Hepatitis C virus infection in Ghana: time for action is now

Chronic hepatitis C virus (HCV) infection is a blood borne infection just like hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) with a significant global health impact. Since the discovery of the HCV, several developments including a better understanding of the clinical epidemiology, availability of diagnostics and approval of newer therapies over the last decade have occurred and changed the frontiers of HCV management. Many nations now place HCV infection as a priority public health issue. In Ghana however, awareness, advocacy and treatment of HCV still plays a second fiddle to HBV and HIV. This must change and the time to act is now

Delayed diagnosis of polycythaemia vera in an adult female with non-cirrhotic portal hypertension

Polycythaemia vera (PV) is a rare myeloproliferative neoplasm characterized primarily by erythrocytosis and an in-creased risk of thrombosis. We report a case of PV in a 60-year-old female with diabetes mellitus (DM) and a past history of recurrent abdominal pain and documented oesophageal varices who was followed up for 2 years as a case of non-cirrhotic portal hypertension of unknown cause. PV was only diagnosed after persistent complaints of vaso-motor symptoms and better scrutiny of full blood count results

Non-invasive markers as predictors of oesophageal varices in cirrhotic patient in a teaching hospital in Ghana

Introduction: Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis. Upper GI endoscopy is recommended for screening for varices in cirrhotics for early detection and treatment, however, this is invasive. The purpose of this study was to assess the predictive values of the noninvasivetests in detecting the presence of OV.Methods: A cross-sectional hospital-based study involving 149 patients with liver cirrhosis was carried out at the Korle-Bu Teaching Hospital from 1st November 2015 to 25th November 2016. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Full blood count and liver function tests, abdominal ultrasoundand gastroscopy were done for all the participants. Receiver operating characteristic curve was generated to determine the cut-off values for the best sensitivity, specificity, negative and positive predictive values of the variables (serum albumin, platelet count (PC), aspartate aminotransferase (AST)/alanine aminotransferase (ALT), PC/Spleen diameter(SD)) with regard to the presence of OV.Results: On gastroscopy, 135 (90.60%) had OV and 14 patients (9.40%) had no OV. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. The overall mean of serum albumin, PC and PC/SD were not significant predictors of the presence of OV. However, the overall mean of AST/ALT significantly predicted the presence of OV. A PC/SD cut off value of ≤833.3 had 72.62% diagnostic accuracy for diagnosing all OV.Conclusion: PC/SD cut-off could be used to screen cirrhotics for OV and treatment initiated in geographical areas lacking endoscopy facilitiesKeywords: oesophageal varices, non-invasive, predictors, platelet/spleenFunding: None declare

Khat-related liver disease in sub-Saharan Africa: neglected, yet important reply

The question of khat's liver toxicity is complex. It contains numerous compounds, including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins, and minerals.5 Research into the deleterious effects of khat has largely concentrated on the pharmacological effects of cathinone and cathine on the cardiovascular system and CNS, and studies on possible liver toxicity in humans are restricted to Ethiopia and Somaliland and to reports from western Europe almost exclusively involving Somali men. Additional research is necessary to establish the prevalence of liver toxicity in people who chew khat in Ethiopia versus Djibouti (where liver toxicity is apparently not observed)6 and Yemen (which has the highest proportion of users worldwide),7 and in Kenya, Uganda, and Madagascar, where studies have not been done. Also necessary is investigating the mechanisms and progression of liver damage induced by khat, the effects of gender (khat toxicity is observed much more frequently in males)8 and genetics (genetic variants in CYP2D6 might play a role in liver toxicity),9 and the contribution of other compounds found in khat and of contaminating herbicides and pesticides to liver disease.10 Current evidence shows that hepatitis viruses and alcohol are the main contributors to the incidence of liver cirrhosis throughout sub-Saharan Africa1 and efforts should continue to curb their effects. We declare no competing interests

Gastroenterology practice in the COVID-19 era: Ghana Association for the Study of Liver and Digestive Diseases (GASLIDD) position statement

The COVID-19 pandemic has impacted healthcare negatively across the globe. The practice of gastroenterology has been affected especially gastrointestinal (GI) endoscopy which is considered high risk for transmission of the virus. As a community of practitioners there is the need to share information and make evidence-based statements to guide GI practice in Ghana. This GASLIDD position statement based on the growing and rapidly evolving body of knowledge is to provide up to date information on the COVID-19 disease and guidance for the practice of gastroenterology in Ghana and beyond. It is to help the GI community of practice to maintain the highest level of health delivery and safety for our patients, staff, community and GI practitioners

Clinical characteristics of COVID-19 patients admitted at the Korle-Bu Teaching Hospital, Accra, Ghana

Design: Study design was a retrospective single-center review of hospital data.Setting: The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana.Participants and study tools: A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form.Results: The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50).Conclusion: In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Introduction: Hepatocellular carcinoma (HCC) is a cancer of global public health concern because of its high incidence and mortality. The impact is greatest in areas with high prevalence of its major risk factors including chronic hepatitis B virus (HBV). HBV is endemic in Ghana but a comprehensive data on HCC is lacking. The aim of this study was to describe the clinical, laboratory and radiological features of HCC at the Korle Bu Teaching Hospital in Ghana. Methods: the medical records of 194 HCC cases attended to at the Gastrointestinal Clinic of the Korle Bu Teaching Hospital between January 2015 and December 2018 were retrospectively analyzed for demographic, clinical, laboratory and radiological data. Results: the male: female ratio was 2:1 and mean age was 45.2 years. Weight loss and abdominal pain were the major presenting symptoms. No patients were identified through surveillance. HBsAg was positive in 109/145 (75.2%) of cases tested. Sixty-five (59.6%) of 109 HBsAg positives were aware of their HBsAg status but only 3 were receiving medical follow ups prior to the diagnosis of HCC. Raised alpha-fetoprotein level >165.2 IU/ML was found in 53.9%. One hundred and forty-four patients were eligible for only analgesia. Conclusion: HBV infection is the leading aetiologial risk factor associated with HCC. Majority of HBV carriers are aware of their status but do not receive care prior to HCC diagnosis. Majority present late and are eligible for only palliative treatment. Improvement in the health seeking behavior of HBV carriers can aid early detection of HCC

Oesophageal varices in patients with liver cirrhosis attending a major tertiary hospital in Ghana

Introduction: oesophageal variceal bleeding is a potentially fatal consequence of portal hypertension in cirrhotic patients. In Ghana, bleeding oesophageal varices (OV) are a significant cause of acute upper gastrointestinal bleeding with comparatively high mortality. This study was to determine the prevalence of OV and its clinical correlate in cirrhotic patients. Methods: this was a cross sectional hospital based study of 149 subjects with liver cirrhosis from 5th November, 2015 to 4th November, 2016. Demographic and other clinical data were collected using standardized questionnaire. Liver function, full blood count, HBsAg and anti-HCV Ab tests were done for all patients. All patients underwent an abdominal ultrasound to assess liver and document ascites. Upper GI endoscopy (UGIE) was done to screen for and grade varices. Results: a total of 149 patients with a mean age of 45 ± 12.28 years were evaluated. Men were 77.85% and 22.15% were women, with male to female ratio of 3.5:1. By Child-Pugh Classification, 12 (8.16%) patients were in class A, 64 (43.54%) in class B and 71 (48.3%) in class C at presentation. On UGIE, 135 (90.60%) had varices and 14 patients (9.40%) had no varices. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. Conclusion: majority of cirrhotic patients present late with advance disease to this referral centre. Most have large varices on their first screening endoscopy. Prophylactic treatment should be considered for all cirrhotics especially patients with decompensated liver cirrhosis when UGIE cannot be done immediately

Khat-related liver disease in sub-Saharan Africa: neglected, yet important reply

The question of khat's liver toxicity is complex. It contains numerous compounds, including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins, and minerals.5 Research into the deleterious effects of khat has largely concentrated on the pharmacological effects of cathinone and cathine on the cardiovascular system and CNS, and studies on possible liver toxicity in humans are restricted to Ethiopia and Somaliland and to reports from western Europe almost exclusively involving Somali men. Additional research is necessary to establish the prevalence of liver toxicity in people who chew khat in Ethiopia versus Djibouti (where liver toxicity is apparently not observed)6 and Yemen (which has the highest proportion of users worldwide),7 and in Kenya, Uganda, and Madagascar, where studies have not been done. Also necessary is investigating the mechanisms and progression of liver damage induced by khat, the effects of gender (khat toxicity is observed much more frequently in males)8 and genetics (genetic variants in CYP2D6 might play a role in liver toxicity),9 and the contribution of other compounds found in khat and of contaminating herbicides and pesticides to liver disease.10 Current evidence shows that hepatitis viruses and alcohol are the main contributors to the incidence of liver cirrhosis throughout sub-Saharan Africa1 and efforts should continue to curb their effects. We declare no competing interests

Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved

Acute liver failure affects previously healthy and often young people and has a very high mortality due to rapid multi-organ failure. The diagnosis is based on the presence of coagulopathy (International normalized ratio >2 or prothrombin rate <50%) and hepatic encephalopathy within 8 weeks of onset of jaundice in patients with no previous liver disease (1). In resource-constrained developing countries, hepatitis A, B, and E infections, traditional medicines (2), drugs, herbal supplements (3), and halothane (4) are the main causes. Even though liver transplantation is the treatment of choice nowadays, the survival rate without liver transplantation in adults is as high as 40% in high-income countries (5, 6). Unfortunately, it is much lower in developing countries (7) where cases are diagnosed too late or considered untreatable in the absence of a transplant center. We propose a practical approach that can be used in Intensive Care Unit-equipped hospitals in resource-constrained countries to try and reduce the high mortality rate where liver transplantation is not available