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Atiase Y, Effah K, Mawusi Wormenor C, Tekpor E, Aku Catherine Morkli E, Boafo E, Yorke E, Aryee R, Essel NOM, Danyo S, Kemawor S, Akpalu J. Prevalence of high-risk human papillomavirus infection among women with diabetes mellitus in Accra, Ghana. BMC Womens Health 2024; 24:260. [PMID: 38664791 PMCID: PMC11044360 DOI: 10.1186/s12905-024-03078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There is increasing evidence of a higher risk and poorer prognosis of cervical cancer among women with diabetes mellitus (DM) compared to the general population. These are mediated by higher susceptibility to persistent high-risk human papillomavirus (hr-HPV) infection due to dysfunctional clearance in an immunocompromised state. We aimed to determine the prevalence of hr-HPV infection and cervical lesions in a cohort of women with DM in Ghana. We further disaggregated the prevalence according to DM type and explored factors associated with hr-HPV infection. METHODS This retrospective descriptive cross-sectional study assessed 198 women with DM who underwent cervical screening via concurrent hr-HPV DNA testing and visual inspection with acetic acid in an outpatient department of the National Diabetes Management and Research Centre in Korle-Bu Teaching Hospital, Accra from March to May 2022. Univariate and multivariable binary logistic regression were used to explore factors associated with hr-HPV positivity. RESULTS Among 198 women with DM (mean age, 60.2 ± 12.1 years), the overall hr-HPV prevalence rate was 21.7% (95% CI, 16.1-28.1), disaggregated as 1.5% (95% CI, 0.3-4.4) each for HPV16 and HPV18 and 20.7% (95% CI, 15.3-27.0) for other HPV genotype(s). Respective hr-HPV prevalence rates were 37.5% (95% CI, 15.2-64.6) for type 1 DM, 19.8% (95% CI, 13.9-26.7) for type 2 DM, and 25.0% (95% CI, 8.7-49.1) for unspecified/other DM types. Past use of the combined contraceptive pill independently increased the risk of hr-HPV infection by approximately three times (adjusted odds ratio [aOR] = 2.98; 95% CI, 1.03 - 8.64; p-value = 0.045), whereas each unit increase in FBG level increased the odds of hr-HPV infection by about 15% (aOR = 1.15; 95% CI, 1.02 - 1.30; p-value = 0.021). CONCLUSION Our study points to a high prevalence of hr-HPV among women with DM and highlights a need for glycemic control among them as this could contribute to lowering their odds of hr-HPV infection. The low overall rates of HPV vaccination and prior screening also indicate a need to build capacity and expand the scope of education and services offered to women with DM as regards cervical precancer screening.
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Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box GP 4236, Accra, Ghana.
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana.
| | - Kofi Effah
- Catholic Hospital, Battor, P. O. Box 2, Battor, Ghana
| | | | - Ethel Tekpor
- Catholic Hospital, Battor, P. O. Box 2, Battor, Ghana
| | | | - Eunice Boafo
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box GP 4236, Accra, Ghana
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana
| | - Robert Aryee
- Department of Cardiology, University of Ghana Medical Center, P. O. Box LG 25, Accra, Ghana
| | - Nana Owusu Mensah Essel
- Department of Emergency Medicine, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 730 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Stephen Danyo
- Catholic Hospital, Battor, P. O. Box 2, Battor, Ghana
| | | | - Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box GP 4236, Accra, Ghana
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana
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Yorke E. Co-Morbid Hypothyroidism and Liver Dysfunction: A Review. Clin Med Insights Endocrinol Diabetes 2024; 17:11795514241231533. [PMID: 38348020 PMCID: PMC10860496 DOI: 10.1177/11795514241231533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
The liver and thyroid hormones interact at multiple levels to maintain homoeostasis. The liver requires large adequate amounts of thyroid hormones to execute its metabolic functions optimally, and deficiency of thyroid hormones may lead to liver dysfunction. Hypothyroidism has been associated with abnormal lipid metabolism, non-alcoholic fatty liver disease (NAFLD), hypothyroidism-induced myopathy, hypothyroidism-associated gallstones and occasionally, interferon-induced thyroid dysfunction. NAFLD remain an important association with hypothyroidism and further studies are needed that specifically compare the natural course of NAFLD secondary to hypothyroidism and primary NAFLD. Hepatic dysfunction associated with hypothyroidism is usually reverted by normalizing thyroid status. Large scale studies geared towards finding new and effective therapies, especially for NAFLD are needed. The clinician must be aware that there exists overlapping symptomatology between liver dysfunction and severe hypothyroidism which may make delay the diagnosis and treatment of hypothyroidism; this requires a high index of suspicion.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
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Akpalu J, Ampong C, Adiiboka JG, Nikoi E, Atiase Y, Yorke E. Parathyroid Hormone Resistance: An Uncommon Cause of Hypocalcaemia in an Adult Ghanaian Female. West Afr J Med 2023; 40:1131-1134. [PMID: 37906970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Parathyroid hormone (PTH) resistance, the main biochemical feature of a rare group of disorders known as Pseudohypoparathyroidism (PHP) is an uncommon cause of hypocalcaemia. In addition to the biochemical abnormalities, some individuals with PHP may have features of Albright Hereditary Osteodystrophy (AHO). Being a rare disorder with a significant level of variation and overlap in its clinical presentation, diagnosis of PHP may be challenging in some clinical settings. This case report highlights the diagnosis of this rare disorder. CASE REPORT A 20-year-old Ghanaian female who had been involved in a road traffic accident (RTA) was referred to the endocrine clinic after a computer tomography (CT) scan of her head revealed an incidental finding of multiple basal ganglia calcifications. Investigations revealed hypocalcaemia, hyperphosphatemia, and elevated intact PTH in the presence of normal levels of 25-hydroxyvitamin D and magnesium, and a normal kidney function. She also had phenotypic features of AHO. Findings suggested a diagnosis of PHP, however, the type could not be identified due to the unavailability of further testing. CONCLUSION This report of a Ghanaian female with PTH resistance and features of AHO diagnosed at the age of 20 years, is expected to add to the existing literature and assist in increasing the level of awareness and facilitate the diagnosis of this disorder in our setting.
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Affiliation(s)
- J Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
| | - C Ampong
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Ghana
| | - J G Adiiboka
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Ghana
| | - E Nikoi
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Ghana
| | - Y Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
| | - E Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, Ghana
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Yorke E, Boima V, Ganu V, Tetteh J, Twumasi L, Ekem‐Ferguson G, Kretchy I, Mate‐Kole CC. The mediating role of quality of life on depression and medication adherence among patients with type 2 diabetes mellitus: A cross-sectional study. Health Sci Rep 2023; 6:e1539. [PMID: 37662538 PMCID: PMC10469042 DOI: 10.1002/hsr2.1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Background and Aim Patients living with diabetes mellitus have a high burden of psychological distress such as depression and anxiety as well as impaired quality of life, which may negatively impact their adherence to medications, glucose control, and health-related costs.This study assessed the impact of quality of life and depression on medication adherence among patients with type 2 diabetes (type 2 diabetes mellitus [T2DM]) in a tertiary care setting in Ghana. Methods The study was a cross-sectional study involving 238 patients with diabetes aged 18 years and above. Validated tools were used to assess medication adherence, depressive symptoms, and quality of life. Structural Equation Modeling was adopted to examine the mediation effect of quality of life on the relationship between depression and medication adherence among participants. Results The mean age of the participants was 58.82 ± 13.49, and 169 (71.0%) out of a total of 238 respondents were females. Depression had a significant direct relationship with the quality of life of respondents [aβ (95% confidence interval, CI) = -0.20 (-0.03, -0.00), p < 0.05; -0.21 (-0.41, -0.01) p < 0.05, respectively] and indirect relationship with quality of life [aβ (95% CI) = -0.01 (-0.02, -0.004) p < 0.001]. Educational status and religion both showed a significant indirect relationship with quality of life [aβ (95% CI) = 0.06 (0.07, 0.12), p < 0.05; 0.18 (0.01, 0.35) p < 0.05, respectively]. The mediating effect of quality of life on the relationship between depression and medication adherence was significant (Sobel = -3.19, p < 0.001). Conclusion Depression, medication adherence, and quality of life were higher among older adults with T2DM. Depression was also found to have a strong negative association with both medication adherence and quality of life. Interventions to screen for depression and to improve the quality of life in patients living with diabetes are also recommended and this should go beyond the provision of standard treatments to explore further the mechanisms of this relationships.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health SciencesUniversity of GhanaAccraGhana
| | - Vincent Boima
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health SciencesUniversity of GhanaAccraGhana
| | - Vincent Ganu
- Department of Medicine and Cardiothoracic UnitKorle‐Bu Teaching HospitalAccraGhana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health SciencesUniversity of GhanaAccraGhana
| | | | - George Ekem‐Ferguson
- Department of PsychologyUniversity of GhanaAccraGhana
- National Cardiothoracic CenterKorle Bu Teaching HospitalAccraGhana
- Department of Psychiatry, University of Ghana Medical School, College of Health SciencesUniversity of GhanaAccraGhana
| | - Irene Kretchy
- Department of PsychologyUniversity of GhanaAccraGhana
| | - Christopher C. Mate‐Kole
- Department of PsychologyUniversity of GhanaAccraGhana
- Department of Psychiatry, University of Ghana Medical School, College of Health SciencesUniversity of GhanaAccraGhana
- Center for Ageing Studies, College of HumanitiesUniversity of Ghana
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Atiase Y, Yorke E, Akpalu J, Reynolds M, Annan OA, Aryee R, Hayfron-Benjamin C, Yawson A. Clinical characteristics and severity of diabetic ketoacidosis: A cross-sectional study from a tertiary hospital in Ghana. Trop Med Int Health 2023; 28:790-796. [PMID: 37537727 DOI: 10.1111/tmi.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Diabetic ketoacidosis (DKA) is a common, severe and often fatal complication of diabetes. This study aimed to investigate the clinical characteristics and precipitants of DKA, as well as factors associated with DKA severity in Ghanaian patients. METHODS Cross-sectional study of the medical records of all 70 adult patients >18 years managed for DKA in the adult emergency room of Korle-Bu Teaching Hospital in Ghana from March 2019 to July 2019. DKA diagnosis was based on hyperglycaemia >11.0 mmol/L, ketonuria (more than 2+) plus acidaemia of (pH < 7.3) or bicarbonate (HCO3 - ) <15.0 mmol/L. However, when serum bicarbonate and pH were not available, clinical signs of acidosis, for example, Kussmaul breathing aided in the diagnosis. DKA severity was assessed based on the Joint British Diabetes Societies (JBDS) guidelines of factors suggestive of severe DKA. Multivariable logistic regression was used to determine the factors associated with DKA severity. Odds ratio and 95% confidence interval for factors associated with DKA severity were determined. RESULTS The mean (±standard deviation) age, diabetes duration and blood sugar at admission were 44.06 (±16.23) years, 7.19 (±6.04) years and 26.37 (±6.70) mmol/L, respectively. Females comprised 51.4% of the study population. The most common presenting symptoms were generalised weakness (30.0%) and fever (14.3%). The major precipitants were infection (70.0%) and non-compliance (22.9%). Overall, 71.4% of participants had features suggestive of severe DKA. In a multivariable regression model, Type 2 diabetes was associated with over fourfold decreased odds of severe DKA (OR 0.23, 95% CI [0.07-0.76], p = 0.016). Patient education on prevention of DKA was documented for only 18.6% of patients before being discharged. CONCLUSION In this study, more than 70% of the study participants had features suggestive of severe DKA, with infection being the most common precipitant of DKA. 51.4% of patients had Type 2 diabetes which was associated with a statistically lower risk of severe DKA. Female sex tended to be positively associated with DKA severity. In a setting where the venous/arterial pH and bicarbonate levels may be inaccessible and/or unaffordable, using clinical features as found in the JBDS guidelines may help categorise patients and escalate care when needed. Indeed it may be useful to validate the use of the JBDS criteria for use in such settings.
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Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Margaret Reynolds
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | | | - Robert Aryee
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Cardiology, University of Ghana Medical Center, Accra, Ghana
| | - Charles Hayfron-Benjamin
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Anaesthesia, University of Ghana Medical School, Accra, Ghana
| | - Alfred Yawson
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
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Tetteh J, Yorke E, Boima V, Yawson AE. Prevalence of malaria infection and the impact of mosquito bed net distribution among children aged 6-59 months in Ghana: Evidence from the Ghana demographic health and malarial indicator surveys. Parasite Epidemiol Control 2023; 21:e00302. [PMID: 37200871 PMCID: PMC10185735 DOI: 10.1016/j.parepi.2023.e00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023] Open
Abstract
Objective To assess the prevalence of malaria infection and further quantify the impact of mosquito bed net distribution on malaria infection among children aged 6-59 months in Ghana. Methods A cross-sectional study using Ghana Demographic Health (GDHS) and Malaria Indicator (GMIS) surveys (2014 GDHS, 2016 GMIS, and 2019 GMIS). The exposure and the main outcomes were mosquito bed net use (MBU) and malaria infection (MI). Relative percentage change (Δ) and prevalence ratio (PR) were estimated to assess the changes and the risk of MI by MBU respectively. The Propensity-score matching treatment effect model was employed to estimate the average treatment effect (ATE) of MBU on MI. All analyses were performed using Stata 16.1 and p-value<0.05 was deemed significant. Results The study involved 8781 children aged 6-59 months. MI ranged from 25.8%(22.3-29.7) in 2019 GMIS to 40.6%(37.0-44.2) in 2014 GDHS and the prevalence was significantly high among children who used mosquito bed net. The relative percentage change in MI prevalence showed a significant reduction rate and was high among non-MBU (p-value<0.05). In all, the adjusted PR of MI among children exposed to MBU was 1.21(1.08-1.35), 1.13(1.01-1.28), and 1.50(1.20-1.75) in 2014 GDHS, 2016 GMIS, and 2019 GMIS respectively. The average MI among participants who slept in mosquito bed net significantly increased by 8%(0.04 to 0.12), 4%(0.003 to 0.08), and 7%(0.03 to 0.11) in 2014 GDHS, 2016 GMIS, and 2019 GMIS respectively. Conclusion Even though malaria infection prevalence among children aged 6-59 months is decreasing, the reduction rate seems not to be directly linked with mosquito bed nets distribution and/or use in Ghana. For a continued distribution of mosquito bed nets, and for Ghana to achieve her Malaria Strategic Plan (NMSP) 2021-2025, program managers should ensure effective use of the distributed nets in addition to other preventive measures and nuanced consideration of community behaviours in Ghana. The effective use and care of bed nets should be emphasized as part of the distribution.
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Affiliation(s)
- John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Corresponding author at: Department of Community Health, University of Ghana Medical School, College of Health Sciences, P.O. Box 4236, Accra, Ghana.
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Ofori EK, Adekena CN, Boima V, Asare‐Anane H, Yorke E, Nyarko ENY, Mohammed BN, Quansah E, Jayasinghe SU, Amanquah SD. Serum leptin levels in patients with chronic kidney disease and hypertensive heart disease: An observational cross-sectional study. Health Sci Rep 2023; 6:e1053. [PMID: 36698704 PMCID: PMC9851162 DOI: 10.1002/hsr2.1053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/19/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
Background and Aim Adipocytes secrete a peptide hormone called leptin, which plays a crucial role in controlling appetite and energy expenditure. Alterations in leptin concentrations are associated with CKD-related cardiovascular problems such as hypertensive heart disease (HHD). Despite the link, data on the precise function of leptin in people with CKD and HHD is scant. Methods An observational cross-sectional study involving a total of 108 participants (72 CKD patients with HHD and 36 healthy controls). Their demographic and anthropometric information was collected using a standardized questionnaire. Certain clinical measures such as blood pressure and body mass index (BMI) were assessed. Fasting blood samples were analyzed for levels of plasma glucose (FPG), lipids, creatinine, and leptin. Data were analyzed with SPSS v23. Results Leptin, FPG, creatinine and triglyceride levels were all significantly higher in CKD patients with HHD compared to controls (p < 0.01 for all). Furthermore, advanced CKD status (being in stage 5), having a 6-year diagnosis of HHD, being female, having a higher BMI, and elevation in levels of HDL and FPG contributed significantly to the variance in serum leptin levels in the case group (β = 0.37, 0.22, 0.19, 0.18, 0.27, 0.28; p < 0.05 for all). In the control group, the female gender had the biggest unique effect on circulating leptin levels, followed by BMI and eGFR (β = 0.71, 0.34, -0.22; p < 0.01 for all). Conclusion Patients with CKD who also had HHD reported considerably higher circulating leptin levels. Significantly higher blood leptin levels were shown to be associated with CKD stage 5 in the case group. These results are consistent with the role of leptin in the metabolic complexity seen in CKD patients. There needs to be more research into treatments that aim to lower leptin levels in CKD patients with HHD.
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Affiliation(s)
- Emmanuel K. Ofori
- Department of Chemical PathologyUniversity of Ghana Medical SchoolAccraGhana
| | - Christian N. Adekena
- Department of Chemical PathologyUniversity of Ghana Medical SchoolAccraGhana,University of Ghana Medical CenterAccraGhana
| | - Vincent Boima
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
| | - Henry Asare‐Anane
- Department of Chemical PathologyUniversity of Ghana Medical SchoolAccraGhana
| | - Ernest Yorke
- Department of Medicine and TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
| | - Eric N. Y. Nyarko
- Department of Chemical PathologyUniversity of Ghana Medical SchoolAccraGhana
| | - Bismark N. Mohammed
- Department of Chemical PathologyUniversity of Ghana Medical SchoolAccraGhana
| | | | | | - Seth D. Amanquah
- Department of Chemical PathologyUniversity of Ghana Medical SchoolAccraGhana
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Boima V, Yorke E, Ganu V, Gyaban-Mensah A, Ekem-Ferguson G, Kretchy IA, Mate-Kole CC. Coping strategies and resilience among patients with hypertension in Ghana. Front Psychol 2023; 13:1038346. [PMID: 36687852 PMCID: PMC9845887 DOI: 10.3389/fpsyg.2022.1038346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023] Open
Abstract
Background Hypertension is associated with high morbidity and mortality and this has been linked to poor treatment and control rates. To optimize drug treatment, patient-centered strategies such as coping, resilience, and adherence to medication may improve control rates and decrease the morbidity and mortality associated with hypertension. This study, therefore, assessed coping skills and resilience among patients with hypertension in Ghana. Methods A cross-sectional study was conducted at Korle Bu Teaching Hospital. 224 consented patients with a diagnosis of hypertension were consecutively selected from the outpatient clinic. Questionnaires comprising socio-demographic characteristics, clinical parameters, Adult Resilience Measure, and the Africultural Coping Systems Inventory were administered. Data were analyzed using Stata version 16.1 and significance level was set at p-value of ≤ 0.05. Results The mean age of participants was 62.03 ± 11.40 years and the majority were female (63%). The overall coping strategy mean score was 43.13 ± 13.57. For resilience, median relational and personal resilience (PR) scores were 32 (IQR-7) and 39 (IQR-9), respectively. Increased systolic BP significantly increases the overall coping strategy score. Collective coping strategy and systolic BP significantly increased coping scores (95%CI = 0.05-3.69 vs. 95%CI = 0.58-5.31). Overall coping strategy significantly increased personal and relational resilience (RR) domain scores by 0.004 (95%CI = 0.002-0.01) and 0.005 (95%CI = 0.003-0.006) units, respectively. This study demonstrated that Cognitive and emotional debriefing coping strategy was mostly used by patients with hypertension. Conclusion Coping strategies had a positive and significant correlation with personal and RR, specifically collective and cognitive debriefing had a significant positive association with resilience among study participants. There is a need to actively put in measures that can improve the coping strategies and resilience among patients with hypertension to adjust to the long-term nature of the illness and treatment as this will promote better treatment outcomes.
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Affiliation(s)
- Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Anna Gyaban-Mensah
- Department of Psychology/Center for Ageing Studies, College of Humanities, University of Ghana, Accra, Ghana
| | | | - Irene Akwo Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Charles Christopher Mate-Kole
- Department of Psychology/Center for Ageing Studies, College of Humanities, University of Ghana, Accra, Ghana
- Department of Psychiatry, Korle-Bu Teaching Hospital, Korle-Bu, Ghana
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Yorke E, Amissah-Arthur MB, Boima V, Dey ID, Ganu V, Fiagbe D, Tetteh J, Gyaban-Mensah A, Ekem-Furgurson G, Yawson AE, Mate-Kole CC. A survey of public perception, knowledge and factors influencing COVID-19 vaccine acceptability in five communities in Ghana. Ghana Med J 2023; 57:3-12. [PMID: 37576374 PMCID: PMC10416278 DOI: 10.4314/gmj.v57i1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Objective The present study assessed the public's perception and Knowledge about COVID-19 and factors that could affect vaccine acceptability in Ghana. Design We carried out a cross-sectional population-based study. A structured questionnaire was used to capture data on socio-demographic information, knowledge, and the public's perception of COVID-19 infection, as well as COVID-19 vaccine acceptability from consented participants. Factors affecting vaccine acceptability in Ghana were explored. Robust ordinary least square linear regression analysis was adopted to assess factors associated with vaccine acceptability. Setting Five communities (Labone, Lartebiorkoshie, Old Fadama, Chorkor, and Ashiyie) in Accra in the Greater Accra district were selected. Participants WHO modified cluster-sampling method was applied to select households of 997 participants in the five communities. Results Most respondents were males (57.6%), and the median age of participants was 30 years. The study participants demonstrated a good knowledge of COVID-19 and had high perceptions of the COVID-19 pandemic. The results revealed that the highest educational level, marital status, self-rated Knowledge of COVID-19, Knowledge of COVID-19 definition, Knowledge of COVID-19 symptoms, and perception of the COVID-19 pandemic were significantly associated with vaccine acceptability. Self-reported impact of COVID-19 lockdown/movement restrictions on agriculture and job as a source of livelihood was associated with vaccine acceptability. Conclusion Higher subjective and objective knowledge of COVID-19 increases vaccine acceptability scores significantly thus, education on COVID-19 and the vaccination against SARS-CoV-2 infection must be intensified to improve vaccine acceptability in Ghana, especially among those with lower educational backgrounds. Funding None declared.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Maame-Boatemaa Amissah-Arthur
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Vincent Boima
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Ida D Dey
- Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Vincent Ganu
- Department of Medicine and Cardiothoracic Unit, Korle-Bu Teaching Hospital
| | - Dela Fiagbe
- Department of Psychiatry, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Anna Gyaban-Mensah
- Department of Medicine and Cardiothoracic Unit, Korle-Bu Teaching Hospital
- Department of Psychiatry, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | | | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana
| | - Christopher C Mate-Kole
- Department of Psychiatry, University of Ghana Medical School, College of Health Sciences, University of Ghana
- Department of Psychology, College of Humanities, University of Ghana
- Centre for Ageing Studies, College of Humanities, University of Ghana
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Akpalu J, Ampong C, Atiase Y, Yorke E, Takyi C, Coleman J, Darkwa EO, Adu-Aryee NA. Management of recurrent pheochromocytoma in pregnancy in a young Ghanaian. Ghana Med J 2022; 56:340-344. [PMID: 37575627 PMCID: PMC10416282 DOI: 10.4314/gmj.v56i4.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
The co-existence of pheochromocytoma and pregnancy is rare, with poor maternal and foetal outcomes. This is a case report of a young Ghanaian woman with a pre-existing diagnosis of recurrent pheochromocytoma who became pregnant and experienced elevated blood pressure in the third trimester with proteinuria and abnormal liver function. She was managed as an in-patient and delivered a live baby via caesarean section at 34 weeks after detecting intra-uterine growth restriction. Management of such cases by a multidisciplinary team is recommended for optimal outcomes.
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Affiliation(s)
- Josephine Akpalu
- Endocrinology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School
| | - Charlotte Ampong
- Endocrinology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital
| | - Yacoba Atiase
- Endocrinology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School
| | - Ernest Yorke
- Endocrinology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School
| | - Charles Takyi
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital
| | - Jerry Coleman
- Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital
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Amissah-Arthur MB, Gyaban-Mensah A, Boima V, Yorke E, Dey D, Ganu V, Mate-Kole C. Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study. PLoS One 2022; 17:e0271892. [PMID: 36094929 PMCID: PMC9467363 DOI: 10.1371/journal.pone.0271892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Challenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare. Objectives To examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these. Method A cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for in-depth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis. Results Median duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options. Conclusion We observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.
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Affiliation(s)
- Maame-Boatemaa Amissah-Arthur
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail:
| | | | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Dzifa Dey
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Charles Mate-Kole
- Department of Psychiatry, Korle Bu Teaching Hospital, Accra, Ghana
- Center for Ageing Studies, College of Humanities, University of Ghana, Legon, Ghana
- Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
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12
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Thor M, Yorke E, Moran J, Daly B, Gomez D, Deasy J. PO-1250 Exploring published acute esophagitis models to support improved clinical management in thoracic RT. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Boima V, Yeboah AK, Kretchy IA, Koduah A, Agyabeng K, Yorke E. Health-related quality of life and its demographic, clinical and psychosocial determinants among male patients with hypertension in a Ghanaian tertiary hospital. Ghana Med J 2022; 56:5-14. [PMID: 35919776 PMCID: PMC9334954 DOI: 10.4314/gmj.v56i1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: This study aimed to evaluate Health-related quality of life (HRQoL) among male patients with hyperten-sion and its associated demographic, clinical and psychosocial factors.Design: This was a facility-based cross-sectional studySetting: This study was carried out at the outpatient department in Korle-Bu Teaching HospitalParticipants: Three hundred and fifty-eight hypertensive patients were recruited for this studyData collection: Information on socio-demographic characteristics, clinical features, insomnia, medication adherence, psychological distress, sexual dysfunction and HRQoL were obtained through patient-reported measures using struc-tured questionnaires and standardised instruments. Statistical analysis/Main outcome measure: The study assessed HRQoL among male hypertensive patients. One-way ANOVA was used to compare the average scores of the various domains of HRQL across the independent vari-ables. Multivariate linear regression models with robust standard errors were used to determine factors associated with quality of life.Results: Participants with poor perceived overall HRQoL was 14.0%. Comparatively, HRQoL (mean ± SD) was the least in the physical health domain (56.77±14.33) but the highest in the psychological domain (58.7 ± 16.0). Multi-variate linear regression showed that income level, educational level, insomnia, overall satisfaction, sexual desire and medication adherence were significant predictors of HRQoL. Average scores of HRQoL domains reduced with a higher level of sexual desire dysfunction.Conclusion: HRQoL among male hypertensive patients was negatively affected by insomnia, sexual desire dysfunc-tion, educational level and adherence to antihypertensive medications but positively affected by income level. Clinical practice and policy processes should be directed at these factors to improve HRQoL.
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Affiliation(s)
- Vincent Boima
- University of Ghana Medical School, Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana, Box 4236 Accra, Ghana
| | - Alberta K Yeboah
- School of Pharmacy, Department of Pharmacy Practice and Clinical Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Irene A Kretchy
- School of Pharmacy, Department of Pharmacy Practice and Clinical Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Augustina Koduah
- School of Pharmacy, Department of Pharmacy Practice and Clinical Pharmacy, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Ghana
| | - Kofi Agyabeng
- National Inspectorate Board. Ministry of Education, PMB M18, Accra, Ghana
| | - Ernest Yorke
- University of Ghana Medical School, Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana, Box 4236 Accra, Ghana
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14
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Yorke E. Hyperthyroidism and Liver Dysfunction: A Review of a Common Comorbidity. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221074672. [PMID: 35153522 PMCID: PMC8829710 DOI: 10.1177/11795514221074672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022] Open
Abstract
Deranged liver enzymes due to hyperthyroidism rather than intrinsic liver pathology are not uncommon. The reported prevalence of liver biochemical abnormalities in patients with untreated thyrotoxicosis varies widely ranging from 15% to 76%. The suggested causes of liver dysfunction include direct hepatocyte injury, co-morbid heart failure, associated autoimmune conditions (especially in the setting of Graves' Disease), preexisting liver disease and drugs including antithyroid medications. Although, some patients may have a pattern of mild liver injury, about 1% to 2% can have fulminant hepatitis. Liver enzymes can return to normalcy in as many as 77% to 83% of patients once the initiations of thionamides are started in a timely fashion, which can help forestall complications and prevent or minimize multi-organ dysfunction. Clinicians should maintain a high index of suspicion for underlying hyperthyroidism in patients presenting with unexplained liver dysfunction or unexplained jaundice.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
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15
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Haseltine J, Apte A, Jackson A, Yorke E, Yu A, Wu A, Peleg A, Al-Sadawi M, Iocolano M, Gelblum D, Shaverdian N, Simone, Ii C, Rimner A, Gomez D, Shepherd A. P27.02 Associating Cardiac Plaque Accumulation With Cardiac Toxicity and Overall Survival In Locally Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Yorke E, Boima V, Dey ID, Amissah-Arthur MB, Ganu V, Amaning-Kwarteng E, Tetteh J, Charles Mate-Kole C. Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana. Clin Med Insights Circ Respir Pulm Med 2021; 15:11795484211039830. [PMID: 34566441 PMCID: PMC8458672 DOI: 10.1177/11795484211039830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/26/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion. RESULTS A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, P-value < .05) at 2 months but not at 6 months (87% vs 77%, P-value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively. CONCLUSION A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.
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Affiliation(s)
- Ernest Yorke
- University of Ghana, Accra, Greater Accra, Ghana
| | | | | | | | - Vincent Ganu
- Korle-Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - John Tetteh
- University of Ghana, Accra, Greater Accra, Ghana.,Korle-Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - C Charles Mate-Kole
- University of Ghana, Accra, Greater Accra, Ghana.,Korle-Bu Teaching Hospital, Accra, Greater Accra, Ghana
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17
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T. Asamoah K, Akpalu J, Atiase Y, Yorke E. A case of Cushing Syndrome due to accidental intake of dexamethasone: a call for enforcement of regulatory laws. Ghana Med J 2021. [DOI: 10.4314/gmj.v55i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cushing syndrome could be a complication of long-term steroid use, resulting in a wide range of clinical presentations. Whereas some patients take medically prescribed doses of conventional medicines, including steroids for various ailments, others inadvertently consume unspecified doses by adulterating traditional medicines with these orthodox medications to increase their therapeutic appeal. Furthermore, some individuals with access to conventional medications may sell them in unlabelled packages as traditional medicines (TMs) to unsuspecting customers. This may lead to undesirable side effects and safety concerns. The case report highlights the problem of poorly regulated access to medications and makes suggestions to protect patrons' health of traditional medicines.
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18
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Opoku‐Akyeampong NAAS, Agyei‐Nkansah A, Yorke E. Liver dysfunction associated with hyperthyroidism: Lessons from 2 Case reports. Clin Case Rep 2021; 9:e04067. [PMID: 34136225 PMCID: PMC8190517 DOI: 10.1002/ccr3.4067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Hyperthyroidism may impact liver biochemistry negatively. Clinicians need a high index of suspicion in patients presenting with unexplained deranged liver enzymes or jaundice. Timely initiation of thionamides portends good prognosis.
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Affiliation(s)
| | - Adwoa Agyei‐Nkansah
- Department of Medicine & TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
| | - Ernest Yorke
- Department of Medicine & TherapeuticsUniversity of Ghana Medical SchoolAccraGhana
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19
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Lamptey R, Engmann St ST, Asante B, Yorke E, Mensah YB, Akoriyea SK, Owoo C, Lawson HJ. Atypical presentation of COVID-19 in a patient with type 2 diabetes at an urban primary care facility in Accra, Ghana. Ghana Med J 2021; 54:117-120. [PMID: 33976452 PMCID: PMC8087359 DOI: 10.4314/gmj.v54i4s.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This is a case report of a 55-year-old man with Type 2 Diabetes Mellitus who presented with progressive breathlessness, chest pain and hyperglycaemia. An initial impression of a chest infection was made. Management was initiated with antibiotics, but this was unsuccessful, and he continued to desaturate. A screen for Coronavirus Disease of 2019 (COVID-19) returned positive. There was no prodrome of fever or flu-like illness or known contact with a patient known to have COVID-19. This case is instructive as he didn't fit the typical case definition for suspected COVID-19. There is significant community spread in Ghana, therefore COVID-19 should be a differential diagnosis in patients who present with hyperglycaemia and respiratory symptoms in the absence of a febrile illness. Primary care doctors must have a high index of suspicion in cases of significant hyperglycaemia and inability to maintain oxygen saturation. Patients known to have diabetes and those not known to have diabetes may develop hyperglycaemia subsequent to COVID-19. A high index of suspicion is crucial for early identification, notification for testing, isolation, treatment, contact tracing and possible referral or coordination of care with other specialists. Early identification will protect healthcare workers and patients alike from cross-infection.
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Affiliation(s)
- Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana.,Department of Community Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | | | | | - Ernest Yorke
- Department of Medicine & Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Yaw B Mensah
- Department of Radiology, University of Ghana Medical School University of Ghana, Accra, Ghana
| | | | - Christian Owoo
- Department of Anaesthesia, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Henry J Lawson
- Department of Community Health, University of Ghana Medical School, University of Ghana, Accra, Ghana.,Ghana College of Physicians and Surgeons, Ridge, Accra, Ghana
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20
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Boima V, Amissah-Arthur MB, Yorke E, Dey D, Fiagbe D, Yawson AE, Nonvignon J, Mate-Kole CC. Determinants of willingness to accept kidney transplantation among chronic kidney disease patients in Ghana. BMC Nephrol 2021; 22:129. [PMID: 33849488 PMCID: PMC8045236 DOI: 10.1186/s12882-021-02335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of chronic kidney disease in Africa is three to four times higher compared to high-income countries and the cost of treatment is beyond the reach of most affected persons. The best treatment for end stage renal disease is kidney transplantation which is not available in most African countries. As kidney transplantation surgery is emerging in Ghana, this study assessed factors which could influence the willingness of patients with chronic kidney disease to accept it as a mode of treatment. METHODS This cross-sectional survey was carried out among patients with chronic kidney disease in Korle-Bu Teaching Hospital. A consecutive sampling method was used to recruit consenting patients. A structured questionnaire and standardized research instruments were used to obtain information on demographic, socio-economic characteristics, knowledge about transplantation, perception of transplantation, religiosity and spirituality. Logistic regression model was used to assess the determinants of willingness to accept a kidney transplant. RESULTS 342 CKD patients participated in the study of which 56.7% (n = 194) were male. The mean age of the participants was 50.24 ± 17.08 years. The proportion of participants who were willing to accept a kidney transplant was 67.3% (95%CI: 62.0-72.2%). The factors which influenced participants' willingness to accept this treatment included; willingness to attend a class on kidney transplantation (p < 0.016), willingness to donate a kidney if they had the chance (p < 0.005), perception that a living person could donate a kidney (p < 0.001) and perceived improvement in quality of life after transplantation (p < 0.005). The barriers for accepting kidney transplantation were anticipated complications of transplant surgery and financial constraints. CONCLUSION More than two-thirds of CKD patients were willing to accept a kidney transplant and this is influenced by multiple factors. Government health agencies must consider full or partial coverage of kidney transplantation through the existing national health insurance scheme. Further, efficient educational programmes are required to improve both patients' and physicians' knowledge on the importance of kidney transplantation in the management of end stage renal disease in Ghana.
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Affiliation(s)
- V Boima
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana.
| | - M B Amissah-Arthur
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - E Yorke
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - D Dey
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana
| | - Delali Fiagbe
- Department of Psychiatry, College of Health Sciences and Center for ageing studies, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - A E Yawson
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana.,Departments of Biostatistics, College of Health Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - J Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - C C Mate-Kole
- Department of Medicine and Therapeutics, College of Health Sciences, University of Ghana Medical School, University of Ghana, P. O. Box 4236, Korle-Bu, Accra, Ghana.,Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
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21
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Rimner A, Yorke E, Gelblum D, Shepherd A, Guttmann D, Iqbal A, Daly R, Offin M, Fiore J, Namakydoust A, Li H, Mccune M, Gelb E, Taunk N, Von Reibnitz D, Adusumilli P, Center M, Zauderer M. MA06.08 A Safety Study of Avelumab plus SBRT in Malignant Mesothelioma. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Shepherd A, Yu A, Al-Sadawi M, Peleg A, Iocolano M, Leeman J, Imber B, Wild A, Offin M, Chaft J, Huang J, Rimner A, Wu A, Gelblum D, Shaverdian N, Gomez D, Simone Ii C, Yorke E, Jackson A. FP04.01 Heart Dose is a Dosimetric Predictor of Overall Survival in Patients with NSCLC Undergoing Post-Operative Radiation Therapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Yorke E, Barnes N, Akpalu J, Boafo E, Amoah AB. Predictors of anemia in Type 2 diabetes mellitus without renal disease. Niger J Med 2021. [DOI: 10.4103/njm.njm_131_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Boima V, Agyabeng K, Ganu V, Dey D, Yorke E, Amissah-Arthur MB, Wilson AA, Yawson AE, Mate-Kole CC, Nonvignon J. Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS One 2020; 15:e0244437. [PMID: 33378327 PMCID: PMC7773273 DOI: 10.1371/journal.pone.0244437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. AIM The aim of the study was to assess CKD patients' willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. METHODS A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients' level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. RESULTS The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7-31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 -$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). CONCLUSION The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study's findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.
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Affiliation(s)
- V. Boima
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - K. Agyabeng
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - V. Ganu
- Department of Medicine and therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - D. Dey
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - E. Yorke
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - M. B. Amissah-Arthur
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - A. A. Wilson
- Departemnt of Public Health, Greater Accra regional Hospital, Ghana Health Service, Accra, Ghana
| | - A. E. Yawson
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - C. C. Mate-Kole
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology/Center for ageing studies, College of Humanities, University of Ghana, Legon, Ghana
| | - J. Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Boima V, Tetteh J, Yorke E, Archampong T, Mensah G, Biritwum R, Yawson AE. Older adults with hypertension have increased risk of depression compared to their younger counterparts: Evidence from the World Health Organization study of Global Ageing and Adult Health Wave 2 in Ghana. J Affect Disord 2020; 277:329-336. [PMID: 32858314 DOI: 10.1016/j.jad.2020.08.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression and hypertension interact through a complex interplay of social, behavioral and biological factors. Despite the huge burden of hypertension in the African sub-region, very little information exists on depression among hypertensive patients. This study assessed the prevalence and factors associated with depression among young and older adult hypertensive patients in Ghana. METHOD Data from the World Health Organization Study on Global AGEing and Adult Health wave 2 (2014/2015) for Ghana was used. Depression was estimated among participants with blood pressure 140/90mmHg and above. Weighted descriptive statistics and logistic regression with adjusted predictions were carried out. The analysis was performed using Stata 15. RESULT The overall prevalence of depression was 6.3%. Older hypertensive patients had almost twice the prevalence of depression compared with younger patients (8.4% vs 4.5%). The factors which predicted depression among hypertensive patients were educational level, marital status, religion, region of residence, work status, self-rated health (SRH), and unhealthy lifestyle. Participants with no religion were more than 7 times likely to be depressed compared with Christians [aOR(95%CI)=7.52(2.11-26.8)]. Those in the Volta region were more than 8 times likely to be depressed compared to those in the Greater Accra region [aOR(95%CI)=8.58(2.51-29.3)]. CONCLUSION Older adult hypertensive patients were more likely to experience depressive symptoms. Multiple factors predicted depression in both young and old hypertensive patients; thus a comprehensive care package including psychological support for patients with hypertension is essential for optimum clinical management.
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Affiliation(s)
- Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - John Tetteh
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Timothy Archampong
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - George Mensah
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Richard Biritwum
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, School of Public Health, University of Ghana Medical School, University of Ghana, Accra, Ghana.
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Jackson A, Wang C, Yorke E, Gelblum D, Apte A, Yang J, Rimner A, Wu A. PO-1545: Dose-volume factors predicting esophageal after SBRT for ultra-central lung tumors. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tjong MC, Moraes FY, Yamada Y, Brar S, Cederquist GY, Yorke E, Schmitt AM, Shultz DB. Radiation-induced Lumbosacral Plexopathy after Spine Stereotactic Body Radiotherapy - Should the Lumbosacral Plexi be Contoured? Clin Oncol (R Coll Radiol) 2020; 32:884-886. [PMID: 33082091 DOI: 10.1016/j.clon.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- M C Tjong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - F Y Moraes
- Department of Radiation Oncology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Y Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Brar
- Division of Surgical Oncology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - G Y Cederquist
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A M Schmitt
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - D B Shultz
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Livesey LC, Yorke E, Parra A, Gray Q, Davies C, Weldon D, Schumacher J, Kimura S, Howard C, Sierra‐Rodriguez T, Mora‐Pereira M. Use of a carbonated beverage to disintegrate a phytobezoar obstructing the intrathoracic portion of the oesophagus of a horse. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L. C. Livesey
- Tuskegee University College of Veterinary Medicine Auburn AlabamaUSA
| | - E. Yorke
- Tuskegee University College of Veterinary Medicine Auburn AlabamaUSA
| | - A. Parra
- Tuskegee University College of Veterinary Medicine Auburn AlabamaUSA
| | - Q. Gray
- Tuskegee University College of Veterinary Medicine Auburn AlabamaUSA
| | - C. Davies
- Tuskegee University College of Veterinary Medicine Auburn AlabamaUSA
| | - D. Weldon
- Southeast Equine Veterinary Services Phenix City AlabamaUSA
| | - J. Schumacher
- J.T. Vaughan Large Animal Teaching Hospital Auburn University College of Veterinary Medicine Auburn Alabama USA
| | - S. Kimura
- J.T. Vaughan Large Animal Teaching Hospital Auburn University College of Veterinary Medicine Auburn Alabama USA
| | - C. Howard
- Bluegrass Animal Clinic Grayson Kentucky USA
| | - T. Sierra‐Rodriguez
- J.T. Vaughan Large Animal Teaching Hospital Auburn University College of Veterinary Medicine Auburn Alabama USA
| | - M. Mora‐Pereira
- J.T. Vaughan Large Animal Teaching Hospital Auburn University College of Veterinary Medicine Auburn Alabama USA
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Yorke E, Boima V, Dey ID, Ganu V, Nkornu N, Acquaye KS, Mate-Kole CC. Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia. BMC Psychiatry 2020; 20:143. [PMID: 32245444 PMCID: PMC7119271 DOI: 10.1186/s12888-020-02570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia. METHODS The current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes. Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI). RESULTS The mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants. There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037). CONCLUSION Newly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Legon, Accra Ghana
| | - Vincent Boima
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Legon, Accra Ghana
| | - Ida Dzifa Dey
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Legon, Accra Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Norah Nkornu
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Accra, Ghana
| | - Kelvin Samuel Acquaye
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - C. Charles Mate-Kole
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, Accra, Ghana
- Department of Psychiatry, School of Medicine & Dentistry, College of Health Sciences, Korle-Bu, Accra, Ghana
- Centre for Ageing Studies, College of Humanities, University of Ghana, Accra, Ghana
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Thor M, Deasy J, Iyer A, Bendau E, Fontanella A, Apte A, Yorke E, Rimner A, Jackson A. Toward personalized dose-prescription in locally advanced non-small cell lung cancer: Validation of published normal tissue complication probability models. Radiother Oncol 2019; 138:45-51. [PMID: 31146070 DOI: 10.1016/j.radonc.2019.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE To identify published normal tissue complication probability (NTCP) models suitable for patient-specific dose-prescription in locally advanced non-small cell lung cancer (LA-NSCLC) through in-house validation. MATERIAL AND METHODS From eight previously published candidate NTCP models (≥grade 2 acute esophagitis and radiation pneumonitis; AE2, RP2), patient-specific dose-responses were calculated using model variables and fractionation-corrected doses for 241 LA-NSCLC patients treated with chemo-IMRT to 50-80 Gy@1.8-2.0 Gy between 2004 and 2014 (AE2/RP2 rate: 50%/12%). A model was judged final if it significantly predicted AE2 or RP2 (p ≤ 0.05), was discriminative and well calibrated (AUC > 0.60; Hosmer-Lemeshow test pHL > 0.05), which were assessed as the median over 1000 bootstrap samples. RESULTS Models for AE2 had superior discrimination to RP2 models (AUC = 0.63-0.65 vs. 0.51-0.65). The final AE2 model included mean esophageal dose and concurrent chemotherapy (AUC = 0.65; p < 0.0001). The final RP2 model was a slightly adjusted version of the RP2 model with the best discrimination, and included age, mean lung dose, and pulmonary comorbidity (AUC = 0.73; p < 0.0001). CONCLUSION Of the eight investigated and published NTCP models, one model successfully described AE2 and one slightly adjusted model successfully described RP2 in the independent cohort. Estimates from these two NTCP models will, therefore, be considered internally when prescribing patient-specific doses in LA-NSCLC patients.
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Affiliation(s)
- M Thor
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States.
| | - Jo Deasy
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - A Iyer
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - E Bendau
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - A Fontanella
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - A Apte
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - E Yorke
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
| | - A Rimner
- Dept. of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - A Jackson
- Dept. of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States
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Abstract
OBJECTIVE Pain management is unsatisfactory worldwide, particularly in developing countries where access to opioids is restricted and cost is an issue. It is a major concern in West Africa and we therefore undertook a survey of pain experts to obtain a better understanding of the problems in the region. METHODS Medical practitioners involved in pain management, identified via professional networks, were interviewed to share their experience in treating moderate-to-severe pain in West Africa. The questionnaire was based on an existing version modified to meet African conditions. Additionally, informal focus group meetings with palliative care physicians and pharmacists were conducted. RESULTS A total of 11 questionnaires were returned. All respondents were physicians who reported availability of opioids in their clinics, but access to morphine was challenging and not possible in some rural settings. Obligatory maintenance of detailed records was considered a burden. The main concern raised was the risk of misuse/addiction. Seven of 11 respondents reported that they would use tramadol as an alternative to strong opioids if required and, interestingly, 9 of 11 considered it to be an essential medicine. Based on personal experience, the respondents noted that some properties of tramadol make it a key pain treatment option in West Africa (strong/fast-acting, better tolerated than NSAIDs, less addictive than other opioids and relatively inexpensive). CONCLUSIONS Most stakeholders who completed the survey indicated that tramadol was essential to provide optimal pain management in the absence of access to strong opioids.
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Affiliation(s)
- Ernest Yorke
- a Department of Medicine & Therapeutics School of Medicine & Dentistry , College of Health Sciences, University of Ghana , Accra , Ghana
| | - Folaju O Oyebola
- b Pain and Palliative Medicine Department , Federal Medical Centre , Abeokuta , Nigeria
| | - Samuel Anaja Otene
- c Department of Radiotherapy and Oncology , Ahmadu Bello University Teaching Hospital , Zaria , Nigeria
| | - Axel Klein
- d Global Drug Policy Observatory , University of Swansea , Swansea , UK
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Bioma V, Ganu VJ, Dey DI, Yorke E, Adjei P, Mate-Kole M, Mate-Kole CC. Psychological changes in Africans with kidney disease in Ghana: a comparison of haemodialysis patients and patients with chronic kidney disease not on dialysis. AJN 2019. [DOI: 10.21804/22-1-3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Yorke E, Atiase Y. Impact of structured education on glucose control and hypoglycaemia in Type-2 diabetes: a systematic review of randomized controlled trials. Ghana Med J 2018; 52:41-60. [PMID: 30013260 DOI: 10.4314/gmj.v52i1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evidence for the use of structured education in diabetes management is accumulating and has shown positive influence in the management of Type-2 diabetes. Objective To assess the impact of structured education on glucose control and hypoglycaemia in the management of Type-2 diabetes. Methods A systematic review was done using Medline via Ovid and EMBASE databases of published English literature between 1980 and 2014. Included studies were randomized control trials that assessed the impact of structured education on glucose control and hypoglycaemia. Results Out of the 12,086 full text articles were identified, 36 full text articles were finally considered for this review after applying both inclusion and exclusion criteria, of which 34 were exclusively on the effect of structured diabetes education on glucose control whilst 2 were studies on the effects of structured diabetes education on glucose control and hypoglycaemia. Majority of the studies included a predominant Caucasian population. There was heterogeneity in the included studies such as intervention methods and intensity as well as follow up periods. Group based education was preferred over individual education by most studies. Overall, most of the studies showed a significant positive effect on glycaemic control compared with control groups. One study showed a significant impact of structured education on hypoglycaemia. Conclusion Structured education has positive impact on glucose control and hypoglycaemia in Type-2 diabetes and must be incorporated in routine care. Funding The study was funded by the authors.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yacoba Atiase
- Department of Medicine & Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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Akpalu J, Yorke E, Ainuson-Quampah J, Balogun W, Yeboah K. Depression and glycaemic control among type 2 diabetes patients: a cross-sectional study in a tertiary healthcare facility in Ghana. BMC Psychiatry 2018; 18:357. [PMID: 30400843 PMCID: PMC6219193 DOI: 10.1186/s12888-018-1933-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/19/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes and depression are both chronic debilitating conditions, and their coexistence has been associated with adverse outcomes. In this study, we investigated the association between glycaemic control and depression in type 2 diabetes (T2DM) patients attending a tertiary healthcare facility in Ghana. METHODOLOGY In a cross-sectional study design, Patient Health Questionnare-9 (PHQ-9) was used to assess depression in 400 T2DM, aged 30-65 years. Anthropometric characteristics and blood pressure were measured. Venous blood was collected to measure the levels of glycated haemoglobin (HbA1c). RESULTS The prevalence of depression was 31.3% among T2DM patients. Female gender, being unmarried, frequent intake of alcohol, previous smoking status and insulin use were associated with increased odds of depression, whereas being educated above basic school level was associated with a decreased odds of depression. In a multivariable logistic regression model, being unmarried and poor glycaemic control were associated with an increase in odds of depression after adjusting for age, gender, and social factors. The association between depression and glycaemic control was attenuated when clinical factors were introduced into the model. CONCLUSION In our study population, we found that depression is common among Ghanaians with T2DM, and not associated with poor glycaemic control in a fully multivariable-adjusted model.
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Affiliation(s)
- Josephine Akpalu
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Joana Ainuson-Quampah
- Department of Dietetics, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | | | - Kwame Yeboah
- Department of Physiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
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Wang C, Sidiqi B, Yorke E, Mcknight D, Dick-Godfrey R, Torres D, Gelblum D, Rimner A, Wu A. MA01.10 Toxicity and Local Control in “Ultra-Central” Lung Tumors Treated With SBRT or High-Dose Hypofractionated RT. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Yorke E, Boima V, Dey ID, Atiase Y, Akpalu J, Yawson AE, Ganu V, Forson A, Mate-Kole CC. Examination of Dysglycaemia among Newly Diagnosed Tuberculosis Patients in Ghana: A Cross-Sectional Study. Tuberc Res Treat 2018; 2018:1830372. [PMID: 30345114 PMCID: PMC6174760 DOI: 10.1155/2018/1830372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/05/2018] [Indexed: 01/22/2023] Open
Abstract
The burden of both tuberculosis (TB) and diabetes mellitus in developing countries including Ghana is high; often, the two coexist and impact each other negatively. Objective. The study aimed to determine the prevalence and predictive factors of dysglycaemia among newly diagnosed smear positive tuberculosis patients at a tertiary tuberculosis treatment centre in Ghana. Methods. Dysglycaemia at diagnosis was determined by the use of oral glucose tolerance test (OGTT), while sputum smear microscopy was used to assess the sputum status. Only smear positive patients were included in the study. Information on sociodemographic, anthropometrical, clinical, and medication history was also obtained. Results. In all, 146 participants, aged 18 to 75 years with a mean age of 38.7 years comprising 115 (78.8%) males and 31 (21.2%) females, were involved in the analysis. Upon initial screening, using fasting plasma glucose (FPG), 91.1 % had normal fasting level, 5.5 % had impaired fasting, and 3.4% were diagnosed with diabetes. Using 2-hour postprandial values (2HPP), 59.6% had normal plasma glucose, 28.8 % had impaired glucose tolerance (IGT), and 11.6 % were diagnosed with diabetes. Overall, the prevalence of dysglycaemia (i.e., impaired fasting and diabetes) was 8.9% (95% CI: 5.21-14.82%) with FPG test and 40.4% (95% CI: 32.68-48.65%) with 2HPP test. The analysis revealed that 2HPP was associated with high mean age compared to FPG (36.67 ± 13.97 versus 41.69 ± 13.97, p-value = 0.033). In addition, marital status was significantly associated with FPG status of patients (p = 0.028). Conclusion. The prevalence of dysglycaemia was high among smear positive TB patients in Ghana. Higher mean age and marital status were associated with abnormal glucose tolerance and fasting plasma glucose, respectively. Clinical management of patients with tuberculosis should include screening for diabetes.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Vincent Boima
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Ida Dzifa Dey
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Yacoba Atiase
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Josephine Akpalu
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health, School of Public Health, University of Ghana, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Audrey Forson
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Ghana
| | - C. Charles Mate-Kole
- Department of Psychiatry, School of Medicine & Dentistry, College of Health Sciences, Korle-Bu, Ghana
- Centre for Ageing Studies, College of Humanities, University of Ghana, Ghana
- Department of Psychology, College of Humanities, University of Ghana, Ghana
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Akpalu J, Yawson AE, Osei-Poku F, Atiase Y, Yorke E, Adjei P, Nkromah K, Akpalu A. Stroke Outcome and Determinants among Patients with and without Diabetes in a Tertiary Hospital in Ghana. Stroke Res Treat 2018; 2018:7521351. [PMID: 30298101 PMCID: PMC6157204 DOI: 10.1155/2018/7521351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Diabetes mellitus, a well-established independent risk factor for stroke, has varied association with stroke outcome from previous studies. This study investigated stroke outcome and determinants among patients with and without diabetes in a tertiary hospital in Ghana. METHODS A prospective study conducted among stroke patients with and without diabetes admitted in a Ghanaian tertiary hospital. Baseline clinical and biochemical data were documented. Functional stroke outcome was evaluated at 1, 3, and 6 months after stroke using the modified Rankin Scale. RESULTS Number of participants enrolled were 326 and 105 (32.20%) had diabetes. Higher proportions of diabetes patients had poor functional stroke outcome at 1, 3, and 6 months (79%, 75.23%, 73.33%) compared with those without diabetes (70.13%, 65.16, 61.99) (p>0.05). Stroke patients with diabetes had lower survival compared with those without diabetes (p=0.0745). Mortality at 6 months was more likely among ischaemic stroke patients with diabetes compared with those without diabetes (Odds Ratio 2.037; CI: 1.058-3.923). Determinants of poor functional stroke outcome for diabetes patients were older age (Adjusted Odds Ratio (AOR)-1.07; CI-1.03-1.12), female gender (AOR-3.74; CI-1.26-12.65), and pneumonia (AOR-11.32; CI-1.93-220.05) whereas the determinants for those without diabetes were unemployment (AOR-4.19; CI-1.24-19.50), speech abnormalities (AOR-1.99; CI1.08-3.73), and pneumonia (AOR-4.05; CI-1.83-9.77). High fasting plasma glucose (HR-1.15; CI-1.07-1.23), elevated temperature (HR-1.41; CI-1.11-1.79), and pneumonia (HR-2.25; CI-1.44-3.50) were determinants of low survival among all stroke patients. CONCLUSION Trends towards poorer functional outcome and reduced survival were found among Ghanaian stroke patients with diabetes compared with those without diabetes. Older age, female gender, pneumonia, elevated temperature, and fasting plasma glucose were determinants of adverse outcome in stroke patients with diabetes.
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Affiliation(s)
- Josephine Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Alfred E. Yawson
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana
| | - Foster Osei-Poku
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Yacoba Atiase
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Kodwo Nkromah
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, P.O. Box KB 77, Korle Bu, Accra, Ghana
| | - Albert Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
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Dauer LT, Yorke E, Williamson M, Gao Y, Dauer ZL, Miller DL, Vañó E. Radiotherapeutic implications of the updated ICRP thresholds for tissue reactions related to cataracts and circulatory diseases. Ann ICRP 2018; 47:196-213. [PMID: 29741403 DOI: 10.1177/0146645318759622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation therapy of cancer patients involves a trade-off between a sufficient tumour dose for a high probability of local control and dose to organs at risk that is low enough to lead to a clinically acceptable probability of toxicity. The International Commission on Radiological Protection (ICRP) reviewed epidemiological evidence and provided updated estimates of 'practical' threshold doses for tissue injury, as defined at the level of 1% incidence, in ICRP Publication 118. Particular attention was paid to cataracts and circulatory diseases. ICRP recommended nominal absorbed dose threshold for these outcomes as low as 0.5 Gy. Threshold doses for tissue reactions can be reached in some patients during radiation therapy. Modern treatment planning systems do not account for such low doses accurately, and doses to therapy patients from associated imaging procedures are not generally accounted for. While local control is paramount, the observations of ICRP Publication 118 suggest that radiation therapy plans and processes should be examined with particular care. The research needs are discussed in this paper.
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Affiliation(s)
- L T Dauer
- a Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,b Department of Radiology, Memorial Sloan-Kettering Cancer Center, USA
| | - E Yorke
- a Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M Williamson
- a Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Y Gao
- a Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | - E Vañó
- e Compultense University, Spain
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Thor M, Hotca A, Jackson A, Yorke E, Rimner A, Deasy J. SP-0112: Dose to cardiac substructures predicts survival in non-small cell lung cancer chemo-radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30422-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Atiase Y, Yorke E, Akpalu J, Opoku-Asare B, Adjei P, Amissah-Arthur MB, Akpalu A. Pachydermoperiostosis in a patient with chronic hepatitis B virus infection referred as acromegaly: a case report. J Med Case Rep 2018. [PMID: 29514715 PMCID: PMC5842528 DOI: 10.1186/s13256-018-1578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary hypertrophic osteoarthropathy also known as pachydermoperiostosis is a rare genetic disorder that has often been confused with acromegaly because of similar clinical features. Vascular endothelial growth factors which have been implicated in the clinical features of pachydermoperiostosis, have also been shown to be present in chronic hepatitis and implicated in the malignant transformation of hepatitis B infection to hepatocellular carcinoma. To the best of our knowledge there is one reported case of pachydermoperiostosis with chronic hepatitis B infection. We do not imply a causal relationship between pachydermoperiostosis and hepatitis B infection because pachydermoperiostosis is a genetic disorder; however, the question is raised whether hypertrophic osteoarthropathy is one of the many extrahepatic manifestations of chronic hepatitis B infection. CASE PRESENTATION A 21-year-old African (Ghanaian) man with chronic hepatitis B infection was referred to our Endocrine unit as having acromegaly with changing facial features, enlarging hands and feet, and large knee joint effusions which affected activities of daily living. He was finally diagnosed as having pachydermoperiostosis when acromegaly, rheumatological disorders, as well as cardiopulmonary disorders were ruled out. He improved with arthrocentesis, a tapering regime of steroids, non-steroidal anti-inflammatory drugs, and proton pump inhibitors. CONCLUSIONS The possible role of hepatitis B in hypertrophic osteoarthropathy, that is, secondary hypertrophic osteoarthropathy, needs to be explored; however, with digital clubbing in his father our patient is likely to have pachydermoperiostosis.
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Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Ernest Yorke
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Bismark Opoku-Asare
- Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana
| | - Patrick Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Maame Boatemma Amissah-Arthur
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Albert Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
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Ganu VJ, Boima V, Adjei DN, Yendork JS, Dey ID, Yorke E, Mate-Kole CC, Mate-Kole MO. Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study. Ghana Med J 2018; 52:22-28. [PMID: 30013257 PMCID: PMC6026941 DOI: 10.4314/gmj.v52i1.5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The study examined quality of life and prevalence of depressive symptoms in patients on long term hemodialysis. Further, it explored the impact of socio-demographic characteristics on depression and quality of life. DESIGN Study design was cross-sectional. SETTING Study was conducted in the two renal dialysis units of the Korle-Bu Teaching hospital in Accra, Ghana. PARTICIPANTS AND STUDY TOOLS One hundred and six participants on haemodialysis were recruited for the study. The Patient Health Questionnaire and the World Health Organization Quality of Life instrument were used to assess depression and quality of life. RESULTS Forty five percent of participants screened positive for symptoms of depression. Approximately 19% obtained low scores on overall quality of life. There were significant negative correlations between the following: Depression and overall QoL, Depression and duration of dialysis treatment and Depression and income level. There was positive correlation between overall QoL and duration of dialysis, treatment and income. CONCLUSION Depressive symptoms were common amongst patients on long term hemodialysis. Haemodialysis patients who obtained low scores on quality of life measures were more likely to screen positive for depressive symptoms. Screening for depressive symptoms among these patients is critical as early treatment may improve their general wellbeing. FUNDING Not indicayed.
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Affiliation(s)
- Vincent J Ganu
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra
| | - Vincent Boima
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
| | - David N Adjei
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box 4236, Accra
| | | | - Ida D Dey
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
| | - Ernest Yorke
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
| | - Charles C Mate-Kole
- Department of Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Box 4236, Accra
- Department of Psychology, University of Ghana, Legon
- Centre for Ageing Studies, University of Ghana, Legon
| | - Michael O Mate-Kole
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra
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Dzifa D, Boima V, Yorke E, Yawson A, Ganu V, Mate-Kole C. Predictors and outcome of systemic lupus erythematosus (SLE) admission rates in a large teaching hospital in sub-Saharan Africa. Lupus 2017; 27:336-342. [PMID: 29173007 DOI: 10.1177/0961203317742710] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although it was previously believed that systemic lupus erythematosus was uncommon among Africans, it has become increasingly apparent that the incidence is higher, and socioeconomic challenges such as physician shortages, poor medical facility access, and poor health literacy may worsen prognosis. This retrospective study examines characteristics and outcomes of hospitalized systemic lupus erythematosus patients over a two-year period and serves as a baseline for comparison for future studies to examine the outcomes with the provision of more dedicated care. There were 51 patient admissions over a two-year period, with a mean duration from start of illness to admission of approximately two years. Duration of admission ranged from one to 140 days with a mean period of 26.12 days (SD ± 26.6). There were 22 deaths (43.1% of admissions), which were mainly due to infections and renal complications. Factors associated with risk of death in regression analysis were: infections, fever, disease flare, musculoskeletal involvement, amenorrhea, depression, a clinical finding of hepatomegaly, and chest infection. Understanding the effect and outcome of systemic lupus erythematosus across different countries can elucidate the role of genetic, environmental, and other causative factors in the progression of the disease.
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Affiliation(s)
- D Dzifa
- 1 Department of Medicine and Therapeutics, 63533 University of Ghana School of Medicine and Dentistry , Accra, Ghana
| | - V Boima
- 1 Department of Medicine and Therapeutics, 63533 University of Ghana School of Medicine and Dentistry , Accra, Ghana
| | - E Yorke
- 1 Department of Medicine and Therapeutics, 63533 University of Ghana School of Medicine and Dentistry , Accra, Ghana
| | - A Yawson
- 3 Department of Community Health, 63533 University of Ghana School of Medicine and Dentistry , Accra, Ghana
| | - V Ganu
- 4 Department of Medicine and Therapeutics, Korle bu Teaching Hospital, Accra, Ghana
| | - C Mate-Kole
- 2 Department of Psychiatry, 63533 University of Ghana School of Medicine and Dentistry , Accra, Ghana
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Boima V, Ganu V, Dey D, Yorke E, Yawson A, Otchere Y, Nartey S, Gyaban-Mensah A, Lartey M, Mate-Kole CC. Kidney transplantation in Ghana: Is the public ready? Clin Transplant 2017; 31. [PMID: 28748575 DOI: 10.1111/ctr.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The burden of end stage renal disease (ESRD) is reported to be higher among people of African ancestry. The majority do not have access to kidney transplantation. Africans, in general, are less likely to donate a kidney or receive a transplant. AIMS This study surveyed public perceptions of kidney transplantation in an inner city and suburban communities in Ghana. It examined people's willingness to either accept or donate a kidney to save a life. In addition, it evaluated factors that influenced their opinion on the issue. METHODS A cross-sectional survey was conducted in five purposively selected communities in the Greater Accra region in Ghana. Structured questionnaires and standardized instruments were administered to assess participants' socio-demographic characteristics, religiosity and spirituality, and perception of kidney transplantation. RESULTS Of the 480 participants, 233 (48.5%) were willing to donate a kidney; 71.6% would only do so after death. Religion, loss of body part, and cultural values influenced participants' willingness to donate a kidney. Uncertainty of health status post-transplantation and uneasiness with the concept of transplantation influenced the participants' willingness to accept a kidney transplant. CONCLUSION The study revealed that almost half of the participants hold positive views toward kidney transplantation.
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Affiliation(s)
- Vincent Boima
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching hospital, Accra, Ghana
| | - Dzifa Dey
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Yawson
- Department of Community Health, School of Public Heealth, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yvonne Otchere
- Department of Psychology, Lancaster University, Accra, Ghana
| | - Stella Nartey
- Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
| | - Anna Gyaban-Mensah
- Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
| | - Margaret Lartey
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charles C Mate-Kole
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.,Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
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Akpalu J, Atiase Y, Yorke E, Fiscian H, Kootin-Sanwu C, Akpalu A. Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report. Ghana Med J 2017; 51:39-42. [PMID: 28959072 PMCID: PMC5611947 DOI: 10.4314/gmj.v51i1.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment. FUNDING None declared.
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Affiliation(s)
- Josephine Akpalu
- Endocrinology Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Yacoba Atiase
- Endocrinology Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Ernest Yorke
- Endocrinology Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana
| | - Henrietta Fiscian
- Endocrinology Unit, Korle Bu Teaching Hospital, P.O. Box KB 77, Korle Bu
| | | | - Albert Akpalu
- Neurology Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, PO Box GP 4236, Accra, Ghana
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Sarfo-Kantanka O, Sarfo FS, Ansah EO, Yorke E, Akpalu J, Nkum BC, Eghan B. Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study. BMC Endocr Disord 2017; 17:2. [PMID: 28143459 PMCID: PMC5286684 DOI: 10.1186/s12902-016-0152-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The link between type 1 diabetes and thyroid autoimmunity is well described. The same cannot be said for type 2 diabetes where results have been mixed so far. We investigated the prevalence and determinants of thyroid autoimmunity among Ghanaian type 2 diabetes patients. METHODS This was a case-control study involving 302 type 2 diabetes patients and 310 non - diabetic controls aged 40-80 years. Anthropometric and blood pressure measurements were obtained. Fasting samples were analyzed for glucose, thyroid function, and antibodies to thyroglobulin and thyroid peroxidase. RESULTS The prevalence of thyroid autoimmunity was significantly higher among T2DM subjects (12.2% vs. 3.9%, p = 0.0004). Among T2DM subjects, 44 (14.7%) tested positive for TPOAb, 5 (1.7%) tested positive for TGAb and 15 (5.0%) tested positive for both autoantibodies. Females T2DM subjects showed a 3-fold increased risk of thyroid autoimmunity compared to males (OR:3.16, p =0.004), T2DM subjects with hyperthyroidism had a 41% increased risk of thyroid autoimmunity (OR: 1.41, p < 0.001), sub-clinical hyperthyroidism increased the risk of thyroid autoimmunity by 2 fold, (OR:2.19, p < 0.001), subclinical hypothyroidism increased the risk of autoimmunity by 4-fold, (OR:3.57 95% p < 0.0001), and hypothyroidism was associated with a 61% increased risk of thyroid autoimmunity (OR: 1.61,1.35-2.23). Dyslipidaemia was associated with a 44% increased risk of thyroid autoimmunity (OR: 1.44, p = 0.01) and a percentage increase in HbA1c was associated with 46% increased risk of thyroid autoimmunity (OR:1.46, p < 0.0001). CONCLUSION We observed a high prevalence of thyroid autoimmunity in Ghanaian T2DM subjects compared to the general population. Thyroid autoimmunity in T2DM subjects was significantly associated with female gender, thyroid dysfunction, dyslipidaemia and poor glycemic control.
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Affiliation(s)
- Osei Sarfo-Kantanka
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
| | - Fred Stephen Sarfo
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eunice Oparebea Ansah
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
| | - Ernest Yorke
- Department of Medicine, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Bernard C. Nkum
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Eghan
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Yorke E, Atiase Y, Akpalu J, Sarfo-Kantanka O. Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know. Int J Endocrinol 2017; 2017:1547358. [PMID: 28819359 PMCID: PMC5551520 DOI: 10.1155/2017/1547358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022] Open
Abstract
Cushing's syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing's syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing's syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing's syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines.
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Affiliation(s)
- Ernest Yorke
- Endocrine & Diabetes Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- *Ernest Yorke:
| | - Yacoba Atiase
- Endocrine & Diabetes Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Josephine Akpalu
- Endocrine & Diabetes Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Osei Sarfo-Kantanka
- Directorate of Medicine, Endocrine and Diabetes Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Fong de los Santos L, Dong L, Greener A, Johnson J, Johnson P, Kim G, Mechalakos J, Napolitano B, Parker S, Schofield D, Wells M, Yorke E, Ford E. TU-D-201-02: Medical Physics Practices for Plan and Chart Review: Results of AAPM Task Group 275 Survey. Med Phys 2016. [DOI: 10.1118/1.4957468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fanchon L, Russell J, Dogan S, Carlin S, Pinker-Domenig K, Yorke E, Schmidtlein CR, Fujisawa S, Manova-Todorova K, Zanzonico P, Deasy JO, Humm JL, Solomon S, Kirov AS. SU-F-J-07: Evaluating the Adequacy of Biopsy Specimens for Genetic Signature Assessment by Measuring the Metabolic Activity in Specimens Obtained Under 18F-FDG PET/CT Guidance. Med Phys 2016. [DOI: 10.1118/1.4955915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yorke E. TH-EF-BRC-04: Quality Management Program. Med Phys 2016. [DOI: 10.1118/1.4958239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yang G, Li X, Ma R, Yorke E, Mageras G, Tang X, Xiong W, Chan M, Reyngold M, Gewanter R, Wu A, Deasy J, Hunt M. SU-F-T-253: Volumetric Comparison Between 4D CT Amplitude and Phase Binning Mode. Med Phys 2016. [DOI: 10.1118/1.4956393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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