Research

Anna Sarah Erem, Adu Appiah-Kubi, Thomas Okpoti Konney, Kwabena Amo-Antwi, Sarah G. Bell, Timothy R. B. Johnson, Carolyn Johnston, Alexander Tawiah Odoi and Emma R. Lawrence

The leading cause of cancer deaths in Ghanaian women is cervical cancer in part due to late presentation. This, in addition to the chronic late presentation of other gynecologic malignancies, demonstrates a crisis surrounding women’s health in Africa. As a collaboration of US and Ghanaian medical professionals, our paper investigates methods of improving health outcomes for women in Ghana. The gynecologic oncology fellowship program we discuss was developed as part of a longitudinal, multi-decade, partnership between the University of Michigan (MM) and the Ghana College of Physicians and Surgeons.

Erem, A.S., Konney T., Appiah-Kubi, A., Ankomah, K., Amankwa, A.T., Annan, J, K., Tawiah, A., Amoako-Adjei, B., Lartey, K.F., Lawrence, E.R.

In the last 30 years, women’s healthcare in Ghana has undergone an enormous transformation. Initially a collaboration with the University of Michigan, the Carnegie Corporation, and Ghana teaching hospitals set up the first OBGYN residency program. Since that point in 1989, the curriculum has evolved, the Ghana College of Surgeons and Physicians has taken an active role and 246 residents have passed through the program. This improvement in OBGYN training has led to an increased volume in procedures such as Cesarean Sections (CS), a trend seen across low to middle-income countries (LMIC). The management of CS complications, such as Cesarean Scar Ectopic Pregnancy (CSEP), is thus becoming a crucial piece of the education needed to prepare upcoming OBGYN’s, pathologists, and radiologists before they enter the workforce. Although, there is an intimidating amount of data that continues to accumulate in various subspecialties regarding this topic, very little is written about the management of CSEP in LMIC such as Ghana. Our case report investigates the well-accepted risk factors, the appropriate sequence of diagnostic procedures, and its possible optimization in low-resource settings.

Erem, S., Atfi, A., Razzaque, M.S.

Decreased bone mass and an increased risk of bone fractures become more common with age. This condition is often associated with osteoporosis and is caused by an imbalance of bone resorption and new bone formation. Lifestyle factors that affect the risk of osteoporosis include alcohol, diet, hormones, physical activity, and smoking. Calcium and vitamin D are particularly important for the age-related loss of bone density and skeletal muscle mass, but other minerals, such as magnesium, also have an important role. Here, we summarize how optimal magnesium and vitamin D balance improve health outcomes in the elderly, the role of magnesium and vitamin D on bone formation, and the implications of widespread deficiency of these factors in the United States and worldwide, particularly in the elderly population.

Erem, S., Razzaque, M.S.

Phosphate is a common ingredient in many healthy foods but, it is also present in foods containing additives and preservatives. When found in foods, phosphate is absorbed in the intestines and filtered from the blood by the kidneys. Generally, any excess is excreted in the urine. In renal pathologies, however, such as chronic kidney disease, a reduced renal ability to excrete phosphate can result in excess accumulation in the body. This accumulation can be a catalyst for widespread damage to the cellular components, bones, and cardiovascular structures. This in turn can reduce mortality. Because of an incomplete understanding of the mechanism for phosphate homeostasis, and the multiple organ systems that can modulate it, treatment strategies designed to minimize phosphate burden are limited.

Erem S., He, P., Razzaque, M.S.

Chapter 24. The crosstalk between phosphate, FGF23 and klotho in the regulation of tissue homeostasis in health and disease.

Fibroblast Growth Factor 23 describes how FGF23 was initially identified as a bone-derived factor targeting the kidney. As such, sections in this comprehensive book cover exciting research that shows that different FGF23 effects require distinct signaling receptors and mediators that differ among target tissues, cover FGF23 initially identified as a bone-derived factor targeting the kidney, look at FGF23 as a regulator of phosphate metabolism and beyond, and cover research on novel concepts of FGF receptor signaling. Additional sections cover biochemistry, pharmacology and nephrology, making this book an ideal reference source on FGF23.

Erem AS, Razzaque MS, et al.

We all know that too much exposure to UV radiation from the sun can cause skin cancer. It is equally well known that the production of Vitamin D as a result of sunlight exposure has many benefits, not the least of which is its positive impact on bone health and conditions such as rickets, osteoporosis, and osteomalacia, to name a few. What is not well known is the benefits of sunlight exposure beyond Vitamin D production. Our review suggests that sunlight exposure, independent of vitamin D, has positive/moderating effects on colorectal cancer, diabetes, hypertension, immune-mediated inflammatory diseases, multiple sclerosis, and obesity. Covid-19 and its relationship to sunlight exposure and vitamin D are also reviewed.

Erem, AS, Van Treeck, BJ, Hartley, C.

Definition / general
A polyp is an exophytic or sessile lesion distinct from the mucosal surface and may be neoplastic or nonneoplastic
Essential features
> 95% of colorectal adenocarcinoma arises from polyps
Usually asymptomatic

Erem, AS, Hartley, C.

This is the second project that I have worked on where we are providing content for the Pathology Outlines website. Throughout my first 2 years of medical school, I have been a faithful reader of this resource, and this is one of the ways I choose to give back to the community that supports upcoming specialists.

Currently in progress, available in 09/2020

Erem, A.S., Cecchini M. J., Boland, J.M.

This is an exciting project that is supervised by Mayo Clinic, Rochester, and Western University, Ontario.

In this study, we will detail a case of Multiple Primary Lung Cancers in one female patient.
One of the more difficult aspects when evaluating a patient's tumor staging, prognosis, and treatment strategy is whether metastasis has occurred, a diagnosis made all the more difficult when MPLC are suspected.

Erem, A.S., Allamaneni, S.S., Braverman, T.S.

Omental calcifications of the peritoneum are typically small and asymptomatic. However, larger psammomatous bodies that cause symptoms such as abdominal pain and bloating are often associated with tumors such as primary serous papillary carcinoma, mesothelioma, or metastatic ovarian cancer.

Erem, A.S., Krapivina, A., Braverman, T.S., Allamaneni, S.S.

Diabetes mellitus and acute cholecystitis were key factors in the initial infections and abscess. We also suspect this is a rare case of cardiomyopathy induced by a Serratia infection. The source of the Serratia odorifera is less certain, as it postdates placement of a percutaneous drain, raising the potential for a nosocomial infection but not precluding the possibility that both Serratia species were previously present.

Erem, A.S., Ginting, K.E., Braverman, T.S., Allamaneni, S.S.

Please join us at this years CAP20 virtual conference being held from October 10 to 13th or look for our abstract in the CAP20 special edition of Archives of Pathology. Our case documents a rare occurrence of a solitary fibrous tumor (SFT) in the liver and an equally rarer circumstance where this neoplasm tests positive for cytokeratin, bringing the possibility of malignancy into consideration. We will discuss the immunohistochemical signature and cytological description of the tumour, differential diagnosis and recommended treatment / management strategy for the patient

This volume brings together such topics as the history of psychiatry, biomedical ethics in history, military medicine, children, women and changing gender roles in modern medicine, public health history, and a special communication on the history of Canadian hospital workers.
The chapter (p. 171 - 194) on Electroconvulsive Therapy A History of a Shocking Topic