Faculty of Internal Medicine

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    QUALITY OF LIFE OF PATIENTS WITH PARKINSON’S DISEASE IN THE CENTRAL BELT OF GHANA
    (OBESE VIDA, 2023-01-03) OBESE, VIDA
    Rationale/objectives of the study: The complications of Parkinson’s Disease (PD) have been found to impact on the patients’ Quality of life (QoL). There is a paucity of studies assessing QoL in developing countries such as Ghana. This study principally sought to examine the factors associated with the QoL in patients with idiopathic PD in the neurology clinic of Komfo Anokye Teaching Hospital (KATH) in Ghana. It assessed the associations between QoL and the extent of motor and non-motor complications, stigma, depression, and cognitive impairment among patients with Parkinson’s disease. Materials and methods: A cross-sectional study was conducted with a consecutive sample of 161 PD patients receiving treatment from the neurology clinic at KATH. Structured questionnaires were used for data collection. Parkinson’s disease Questionnaire (PDQ-39) was used, motor and non-motor symptoms assessed using the MDS-UPDRS and Beck depression inventory (BDI) for assessment of depression. Global cognitive performance was assessed using the Montreal Cognitive Assessment Scale (MoCA) and stigma evaluated withthe 24-item stigma scale for chronic illness (SSCI). Ethical clearance was obtained from the Kwame Nkrumah University of Science and Technology Institutional Review Board. The consent of patients was sought, and data gathered was password protected. The data were organized under the research objectives for analysis. ANOVA and independent sampled t-test was used to analyse differences in QoL among patients with different socio-demographic characteristics. Stepwise multiple regression analysis was used to determine the factors that best account for variance in QoL scores. Multivariate linear regression model analysis was used to assess the effects of motor and non-motor variables on the QoL of PD patients. Results: There were 161 participants in this study with an average age of men (n = 114) and women (n = 47) being 65.2 ± 4.96 and 65.5 ± 5.01 respectively. The mean (± SD) non-motor severity score was 41.8 ± 21.6 and that for the motor severity score was 37.1± 20.5 On the Hoehn and Yahr scale, nearly a third (31.7%) of participants were in stage 3. Overall, the mean PDQ-39 Summary Index (PD8-39 SI) was 37.2 ± 17.1 The mean score of the items on the stigma scale was 62.36±14.49. Majority (65.8%) of the study participants had mild cognitive impairment and almost half (44.1%) were moderately depressed. Multivariate linear regression analysis showed that participant’s cognition (β= -0.65, p-value= 0.031), depression(β = 0.52, p-value =0.013) and stigma status (β= 0.51, p-value <0.0001) were independently associated with overall QoL. Conclusions: This study has identified stigma, depression and cognitive performance as independent factors significantly associated with overall health related QoL of individuals living with idiopathic PD in the central belt of Ghana. While non-motor complications were associated with QoL in limited multivariate linear regression models conducted in our study, their associations were lost in the fully adjusted regression models. Screening for depression, stigma and cognitive impairment should be done routinely at neurology clinics and integration of psychosocial support into the care of PD.
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    EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH LIVER CIRRHOSIS AT THE KOMFO ANOKYE TEACHING HOSPITAL, GHANA
    (OPPONG, BRIGHT, 2022-09-01) OPPONG, BRIGHT
    Introduction: Liver cirrhosis remains an important cause of hospitalization, morbidity, and mortality in sub-Saharan Africa. A common complication of liver cirrhosis is acute upper gastrointestinal bleeding. The objective of this study was to assess the prevalence of upper gastrointestinal endoscopic findings and to correlate the presence of these findings with the severity of liver cirrhosis in patients at the Medicine Directorate, Komfo Anokye Teaching Hospital (KATH). Methods: This was a descriptive cross-sectional study of patients accessing care at the KATH. Consecutive sampling was used to recruit patients with cirrhosis of the liver, diagnosed by transabdominal ultrasound scan. A structured questionnaire was administered to assess socio-demographic characteristics and clinical information. Liver chemistry, full blood count, HBsAg, anti-HCV antibodies and INR tests were done for all the patients. An upper gastrointestinal tract endoscopy was performed for all patients and the severity of the cirrhosis was assessed using the Child-Turcotte-Pugh score. Data was collected with the REDcap tool and exported to STATA statistical software for analysis. Descriptive analysis was performed by using frequencies, percentages and means. Chi-square and Fisher exact tests were used to determine the association between severity of cirrhosis and other predictor variables. Logistic regression and partial proportional odds assumption model were used to determine the odds ratio and possible factors that influenced the severity of cirrhosis. Results: The study included 145 participants. The mean age (standard deviation) of participants was 46.5 ± 12.0. the ratio of males to females was 3:1. Seventy percent had oesophageal varices and 46.2% and 47.6% had portal hypertensive gastropathy and gastritis respectively. Other lesions were gastric ulcer (23.5%) and duodenal ulcer (10.3%). Seventy five percent had hepatitis B infection. Majority of the participants (76.5%) had class C disease and Helicobacter. Pylori (H. pylori) was detected in 87.6%. The presence of oesophageal varices and lax Lower Oesophageal Sphincter (LES) correlated positively with severity of the liver cirrhosis. Oesophageal varices was strongly associated with patients who had finger clubbing (p-value, <0.001), leukonychia (p-value, <0.001), silky hair(p-value, <0.001),, ascites(p-value, <0.036),, palmar erythema(p-value, <0.001),, and spider naevi(p-value, <0.003), Conclusion: Hepatitis B infection is the leading cause of liver cirrhosis at KATH. The most prevalent endoscopic finding was oesophageal varices (mostly medium and large varices) but a significant number of participants had non-variceal lesions. H. pylori infection is common in this population. Screening endoscopy is recommended in cirrhosis to detect lesions which can predispose to upper GIT bleeding.
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    NONALCOHOLIC FATTY LIVER DISEASE IN TYPE 2 DIABETES MELLITUS PATIENTS ATTENDING THE DIABETES CLINIC AT THE GREATER ACCRA REGIONAL HOSPITAL
    (BAMPOH SALLY AFUA, 2021-08-26) BAMPOH, SALLY AFUA
    Background: Nonalcoholic fatty liver disease is currently the leading cause of chronic liver disease and the second leading indication for liver transplantation in developed countries. It may be complicated by cirrhosis and hepatocellular carcinoma. The pathogenesis of primary nonalcoholic fatty liver disease involves insulin resistance, which also occurs in type 2 diabetes mellitus. The prevalence of nonalcoholic fatty liver disease is increasing worldwide. However, published data on this condition in Ghana is scarce. General Objective: To determine the prevalence of, and factors associated with nonalcoholic fatty liver disease in type 2 diabetes mellitus patients attending the diabetes clinic at the Greater Accra Regional Hospital in Accra, Ghana. Methodology: This study was a cross-sectional, hospital-based study conducted at the Greater Accra Regional Hospital from May to October 2018. Two hundred and thirty-five type 2 diabetes mellitus patients with insignificant alcohol history and negative screens for hepatitis B and C infection were recruited using systematic random sampling, after giving informed consent. Socio- demographic and clinical data were obtained using a semi-structured questionnaire. Anthropometric measurements, general and abdominal examinations were performed for each participant. Laboratory investigations included full blood count, fasting blood sugar, glycated haemoglobin, lipids and liver biochemistry. Abdominal ultrasonography was performed to assess for liver size and echogenicity and to measure the abdominal subcutaneous fat thickness. Non- invasive scoring systems were used to predict the presence of nonalcoholic steatohepatitis and fibrosis. Captured data was imputed and analysed using SPSS 23.0. Results: The prevalence of nonalcoholic fatty liver disease among this cohort was 38.7% (91/235). Grade 3 disease was the most prevalent (46.1%). Prevalence of nonalcoholic steatohepatitis and fibrosis using non-invasive methods was estimated to be 23.1% and 26.4% respectively, in the population diagnosed with nonalcoholic fatty liver disease. Factors associated with presence of nonalcoholic fatty liver disease included age (p-value = 0.008), shorter duration of diabetes (p- value = 0.004), body mass index (p-value <0.0001), waist circumference (p-value = 0.006), waist/hip ratio (p-value = 0.001), abdominal subcutaneous fat thickness (p-value <0.0001), hepatomegaly (p-value <0.0001), glycated haemoglobin (p-value = 0.003) and hypertriglyceridaemia (p-value = 0.021). Increasing age (OR = 0.949; 95% CI: 0.918 - 0.980), body mass index (OR = 1.108; 95% CI: 1.048- 1.171), hepatomegaly (OR = 4.230; 95% CI: 1.957 - 9.144) and elevated gamma-glutamyltransferase (OR = 3.591; 95% CI: 1.631 - 7.906) were found to be independent predictors of nonalcoholic fatty liver disease among this cohort. Conclusions: Roughly one-third of type 2 diabetes mellitus patients seen in clinics may have nonalcoholic fatty liver disease. Predictors of nonalcoholic fatty liver disease in this study include established non-modifiable risk factors such as age, as well as modifiable risk factors such as increased body mass index. Recommendations: Clinicians should utilize non-invasive markers to aid in the diagnosis of nonalcoholic fatty liver disease, especially in at-risk patients. Aggressive management of type 2 diabetes mellitus is needed to improve the outcome of the disease in Ghana. Further studies on the performance of non-invasive markers compared to liver biopsy are warranted in order to find alternate forms of diagnosis in low resource settings.