Comparison of endoscopic based diagnosis with Helicobacter urease test for Helicobacter pylori infection

Background

Helicobacter pylori is an important risk factor for gastritis, peptic ulcers and gastric cancer. The prevalence in developed countries is lower than 40 % but higher than 80 % in some developing countries. It is 75 % in Ghana. The Helicobacter urease test (HUT) is performed at endoscopy and gives an accurate diagnosis. The HUT is not routinely done at our facility and presumption of H. pylori is made based on endoscopic findings and H. pylori eradication prescribed, as the incidence in the general population is presumed high. Is this endoscopic diagnosis sufficient for diagnosing and treating H. pylori? We aimed to assess the feasibility of an endoscopic based H. pylori diagnosis and its accuracy using a HUT as the gold standard in consecutive patients.

Methods

Seventy-six consecutive adult patients with dyspepsia were assessed by upper gastrointestinal endoscopy. A clinical diagnosis of H. pylori or not was made. Biopsy samples were collected for HUT. H. pylori was diagnosed if HUT was positive. The results were then compared.

Results

Median age of patients was 45.0 years. H. pylori prevalence detected by HUT was 51.3 % (95 % CI 40.0–63.0). Sensitivity of endoscopic diagnosis of H. pylori was 71.8 % (95 % CI 55.1–85.0) and specificity was 37.8 % (95 % CI 22.5–55.2). There was no association between clinical findings (73.7 %) and HUT (26.3 %) (OR = 0.80; [95 % CI 0.24–2.64], p = 0.682). There was also no association between endoscopic diagnosis (71.8 %) and HUT (28.2 %), (OR = 1.55; 95 % CI 0.59–4.06, p = 0.373).

Conclusion

Helicobacter pylori infection was not as high as that published in earlier reports. The endoscopic diagnosis alone is not sufficient to make a diagnosis of H. pylori.

Knowledge of Pharmacogenetics among Healthcare Professionals and Faculty Members of Health Training Institutions in Ghana

BACKGROUND

Pharmacogenetics has a potential for optimizing drug response and identifying risk of toxicity for patients. Pharmacogenetics knowledge of healthcare professionals and the unmet need for pharmacogenetics education in health training institutions are some of the challenges of integrating pharmacogenetics into routine medical practice.

AIM

To assess pharmacogenetics knowledge among healthcare professionals and faculty members of health training institutions in Ghana.

METHOD

Semi-structured questionnaires were used to interview healthcare professionals from selected public and private hospitals. Faculty members from health training institutions were also interviewed.

RESULTS

The respondents were Medical doctors 42 (46.7%), Pharmacists 29 (32.2%) and Nurses 19 (21.1%). Healthcare professionals rated their knowledge of Pharmacogenetics as Excellent 5 (5.6%), Very Good 10 (11.2%), Good 53 (60%) and Poor 19 (21.4%). Thirty-two faculty members from health training institutions were also interviewed. Faculty members rated their knowledge of pharmacogenetics as Excellent 2 (6.3%), Very Good 3 (9.4%), Good 9 (28.1%), Fair 12 (37.5%) and Poor 6 (18.8%). Thirty seven percent (12) of these faculty members said pharmacogenetics was not part of their institutions' curriculum, 7 (22%) did not know if pharmacogenetics was part of their curriculum and only 13 (40.6%) said it was part of their curriculum.

CONCLUSION

Few healthcare professionals and faculty members of training institutions are aware of the discipline of pharmacogenetics. There is the need for continuous professional education on pharmacogenetics and development of competency standards for all healthcare professionals in Ghana.

Human papillomavirus genotypes in a subset of head and neck squamous cell carcinoma

BACKGROUND

Squamous cell carcinoma originating from the oral cavity, lip, larynx and pharynx are grouped under head and neck squamous cell carcinomas (HNSCC).

OBJECTIVE

To report on human papillomavirus (HPV) genotypes involved in HNSCC.

STUDY DESIGN

A retrospective review of archival HNSCC specimens and patient demographic and clinical data accessioned between January, 2007 and December, 2009 in the Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana.

RESULTS

Cases from 58 males and 20 females included 29 from the oral cavity, 33 from the larynx, 11 from the pharynx and 5 from the parotid gland. HPV DNA was found in 15 (19.23%) of the tumors with 12 being HPV-16, 2 HPV-18 and 1 dual infection with HPV-16 and HPV-18, giving HPV-16 prevalence of 86.7%. Higher prevalence of HPV DNA was found in males than females. There was a trend towards subjects younger than 58 years being more likely to have HPV-positive tumors.The 15 HPV-positive cases were distributed in location as 8 of 33 (24.2%) from the larynx, 4 of 29 (13.8%) from the oral cavity, and 2 of 11 (18.2%) from the pharynx and 1 of 5 (20%) from the parotid gland.

CONCLUSION

Oncogenic HPV infection was found in 19.23% of HNSCCs, with genotype 16 predominating. HPV-related HNSCC tended to occur at younger age compared to non-HPV-related HNSCC. The commonest site for HPV-associated HNSSC in Ghana is the larynx, rather than the oropharynx as reported in other studies. Host factors may be responsible for the site difference and more work is required to further elucidate this.

Pharmacogenetics in Ghana: reviewing the evidence

Different clinical response of different patients to the same medicine has been recognised and documented since the 1950's. Variability in response of individuals to standard doses of drug therapy is important in clinical practice and can lead to therapeutic failures or adverse drug reactions. Pharmacogenetics seeks to identify individual genetic differences (polymorphisms) in drug absorption, metabolism, distribution and excretion that can affect the activity of a particular drug with the view of improving efficacy and reducing toxicity. Although knowledge of pharmacogenetics is being translated into clinical practice in the developed world, its applicability in the developing countries is low. Several factors account for this including the fact that there is very little pharmacogenetic information available in many indigenous African populations including Ghanaians. A number of genes including Cytochrome P450 (CYP) 2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, MDR1 and TPMT have been genotyped in the Ghanaian population since the completion of the Human genome project. There is however, an urgent need to increase pharmacogenetic research in Ghana to increase availability of data. Introducing Pharmacogenetics into the curriculum of Medical and Pharmacy training institutions will influence translating knowledge of pharmacogenetics into clinical practice. This will also equip health professionals with the skill to integrate genetic information into public health decision making.