Department of Physiology
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Item Effects of mixed hardwoods dust on respiratory function and blood immunoglobulin levels in wood workers(Heliyon, 2024) Ennin, I. E.; Adzaku, F. K.; Dodoo, D.; Maalman, R. S.Background: Occupational exposure to wood dust, generated by various individual wood species, both softwood and hardwood, has been extensively documented as a causative factor for reduced lung function, frequent respiratory symptoms, and increased immunological responses in wood workers. This study explores the impact of wood dust from mixed tropical hardwood species on lung function, respiratory symptoms, and Immunoglobulin (Ig) E and G levels. Methods: A cross-sectional study was conducted among wood workers at the Accra Timber Market and a control group from the University of Ghana. Particulate matter (PM) was sampled using a Minivol Sampler set to a flow rate of 5 l/min. Respiratory symptoms were assessed using ques tions adapted from the British Medical Research Council (MRC) questionnaire (1960). Lung volumes and airflow rates were measured using a spirometer. Total serum IgE and IgG levels were quantified using ELISA. Results: No significant differences were observed between the wood workers and the controls for demographic variables. Wood workers exhibited a significantly higher prevalence of respiratory symptoms, particularly rhinitis, with many reporting the absence of symptoms during holidays. Lung function parameters (VC, FEV1, FEV1%, PEFR, and FEF25-75%) were significantly reduced (p < 0.05) in wood workers. A significant negative correlation was noted between lung function parameters and years of exposure to wood dust. Wood workers showed significantly elevated levels (p < 0.05) of IgG and IgE. Conclusion: The study findings suggest that exposure to mixed tropical hardwood dust induces elevated blood IgE and IgG levels, along with non-allergic respiratory function abnormalities.Item Maternal Serum Angiopoietins Levels In Pre‐Eclampsia And Pregnancy Outcomes(Health Science Reports, 2023) Bayor, F.; Adu‐Bonsaffoh, K.; Antwi‐Boasiako, C.Background and aims: Although the understanding of pre-eclampsia (PE) has improved, there is still insufficient knowledge on the exact etiology and pathophysiological mechanisms. Dysregulation of angiogenic factors has emerged as a significant contributing factor. Among these factors, angiopoietins (Ang1 and Ang2) have gained considerable attention due to their crucial role in regulating vascular development and endothelial function. This study explored the maternal serum levels of angiopoietins and perinatal outcomes in PE. Methods: A case-control study involving women with PE (cases) and normotensive pregnancies (controls) was conducted at the Maternity unit of the Korle‐Bu Teaching Hospital. Descriptive analysis was performed and the Mann-Whitney U test (two sided) was used to compare maternal serum levels of angiopoietins between the cases and controls. Results: We included 188 participants, comprising 94 cases (women with PE) and 94 controls (normotensive pregnancies) with an average maternal age of 29.76 ± 5.56 and 28.43 ± 5.57 years, respectively. Maternal serum levels of Ang2 were significantly lower among the PE cases compared to the normotensive controls (1.25 [0.90, 2.15] vs. 2.14 [1.18, 5.73] ng/mL, p = 0.001) but no significant difference in Ang1 levels (92.61 [80.92, 114.92] vs. 99.26 [81.76, 113.12] ng/mL, p = 0.429) was observed between the groups. The Ang1/Ang2 ratio was significantly elevated among women with PE compared to normotensive controls (74.47 [37.69, 110.59]) vs. 45.98 [16.11, 88.22] ng/mL, p = 0.014). Also, women who delivered vaginally had significantly high maternal serum levels of Ang1 compared to women who had cesarean section delivery (107.98 ± 27.79 vs. 89.02 ± 32.62 ng/mL). Conclusion: Maternal serum levels of Ang2 but not Ang1 were significantly depressed in women with PE compared to the pregnant normotensive controls. No significant associations were observed between Ang‐1, Ang‐2 levels, or the Ang‐1/ Ang‐2 ratio and pregnancy outcomes such as preterm birth, birth weight, and severity of hypertension.Item Serum Adiponectin and Leptin Among Ghanaian Migrants in Amsterdam and Their Compatriots in Rural and Urban Ghana: The RODAM Study(Clinical Medicine Insights: Endocrinology and Diabetes, 2023) Kusi-Mensah, Y.A.; Hayfron-Benjamin, C.; Chetty, S.; et al.Background: The rapidly rising cardiometabolic disease (CMD) burden in urbanizing sub-Saharan African populations and among sub Saharan African migrants in Europe likely affects serum adiponectin and leptin levels, but this has not yet been quantified. Objectives: To compare the serum levels of adiponectin and leptin among migrant, and non-migrant (urban and rural) populations of Ghanaian descent. Methods: Cross-sectional analysis of serum leptin and adiponectin in the multi-centre Research on Obesity and Diabetes among African Migrants (RODAM) study. Logistic-regression models were used to examine the association between these adipocyte-derived hormones after stratification (sex, geographic area) and adjustments for potential confounders. Results: A total of 2518 Ghanaians were included. Rural participants had the highest serum adiponectin and lowest leptin levels com pared to Amsterdam and urban Ghanaians (P < .001). In fully adjusted models, participants living in urban Ghana had significantly higher odds of hyperleptinemia compared to rural participants (women-odds ratio 2.88; 95% CI, 1.12-7.38, P=.028 and men 43.52, 95% CI, 4.84- 391.25, P < .001). Urban Ghanaian men also had higher odds of elevated leptin: adiponectin ratio (6.29, 95% CI, 1.43-27.62, P=.015). The odds of hyperleptinemia were only higher in Amsterdam Ghanaian men (10.56; 95% CI, 1.11-100.85, P=.041), but not in women (0.85; 95% CI, 0.30-2.41, P=.759). There was no significant association between hypoadiponectinemia and geographical location in both sexes. Conclusion: Urbanization is associated with serum adiponectin and leptin levels after adjusting for confounding covariates in sub-Saha ran Africans. These findings serve as a backdrop for further research on the role adipokines play in CMD epidemiology among Africans.Item Associations between spirometric impairments and microvascular complications in type 2 diabetes: a cross sectional study(BMJ Open, 2023) Hayfron-Benjamin, C.F.; Agyemang, C.; Awula, P.; et al.Objective Evidence shows that the conventional cardiometabolic risk factors do not fully explain the burden of microvascular complications in type 2 diabetes (T2D). One potential factor is the impact of pulmonary dysfunction on systemic microvascular injury. We assessed the associations between spirometric impairments and systemic microvascular complications in T2D. Design Cross-sectional study. Setting National Diabetes Management and Research Centre in Ghana. Participants The study included 464 Ghanaians aged ≥35 years with established diagnosis of T2D without primary myocardial disease or previous/current heart failure. Participants were excluded if they had primary lung disease including asthma or chronic obstructive pulmonary disease. Primary and secondary outcome measures The associations of spirometric measures (forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC) and FEV1 / FVC ratio) with microvascular complications (nephropathy (albumin-creatinine ratio ≥30mg/g), neuropathy (vibration perception threshold ≥25 V and/or Diabetic Neuropathy Symptom score >1) and retinopathy (based on retinal photography)) were assessed using multivariable logistic regression models with adjustments for age, sex, diabetes duration, glycated haemoglobin concentration, suboptimal blood pressure control, smoking pack years and body mass index. Results In age and sex-adjusted models, lower Z-score FEV1 was associated with higher odds of nephropathy (OR 1.55, 95% CI 1.19–2.02, p=0.001) and neuropathy (1.27 (1.01–1.65), 0.038) but not retinopathy (1.22 (0.87–1.70), 0.246). Similar observations were made for the associations of lower Z-score FVC with nephropathy (1.54 (1.19–2.01), 0.001), neuropathy (1.25 (1.01–1.54), 0.037) and retinopathy (1.19 (0.85–1.68), 0.318). In the fully adjusted model, the associations remained significant for only lower Z-score FEV1 with nephropathy (1.43 (1.09–1.87), 0.011) and neuropathy (1.34 (1.04–1.73), 0.024) and for lower Z-score FVC with nephropathy (1.45 (1.11–1.91), 0.007) and neuropathy (1.32 (1.03–1.69), 0.029). Lower Z-score FEV1 /FVC ratio was not significantly associated with microvascular complications in age and sex and fully adjusted models. Conclusion Our study shows positive but varying strengths of associations between pulmonary dysfunction and microvascular complications in different circulations. Future studies could explore the mechanisms linking pulmonary dysfunction to microvascular complications in T2D.Item Peripheral sensory neuropathy is associated with circulating angiopoietins in type 2 diabetes patients in Ghana(Journal of Clinical & Translational Endocrinology, 2023) Agyekum, J.A.; Yeboah, K.Objective: Peripheral sensory neuropathy (PSN) is a common complication of type 2 diabetes (T2DM) that can lead to frequent ulcerations, lower extremities, and reduced quality of life. Imbalance in the circulating levels of angiogenic growth factors, notably, angiopoietin (Ang)-1, Ang-2 and vascular endothelial growth factor (VEGF) may be among the underlying mechanisms of PSN in T2DM patients. We studied the association between PSN and angiogenic growth factors, Ang-1, Ang-2 and VEGF in T2DM patients in Ghana. Methods: In a case-control study design, PSN was evaluated in 160 patients with T2DM and 108 nondiabetic controls using vibration perception threshold (VPT) and diabetic neurological examination (DNE). The definition of PSN was abnormal VPT (≥25 mV) or the presence of neuropathic symptoms on examination (DNE score > 3). In addition, fasting venous blood samples were collected to measure circulating levels of Ang-1, Ang-2 and VEGF. Results: Compared to non-diabetic controls, patients with T2DM had a higher prevalence of PSN using abnormal VPT (20.6 % vs 2.8 %, p < 0.001) or neuropathic symptoms (35.6 % vs 3.7 %, p < 0.001). Compared to nondiabetic controls, patients with T2DM had increased levels of Ang-2 [597 (274 – 1005) vs 838 (473 – 1241) ng/ml, p = 0.018] and VEGF [48.4 (17.4 – 110.1) vs 72.2 (28 – 201.8), p = 0.025] and decreased Ang-1 levels [41.1 (30 – 57.3) vs 36.1 (24.7 – 42.1) ng/ml, p = 0.01]. In regression analyses, an increase in Ang-1 levels was associated with decreased odds, while an increase in Ang-2 levels was associated with increased odds, of abnormal VPT and neuropathic symptoms in T2DM patients. Conclusion: In our study population, PSN was associated with reduced plasma levels of Ang-1 and increased plasma levels of Ang-2 in patients with T2DM. Therefore, an imbalance of angiopoietins may be associated with PSN in T2DM.Item Associations between spirometric measures and exercise capacity in type 2 diabetes(Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2023) Antwi-Boasiako, C.; Kollie, M.E.; Kyeremeh, K.A.; et al.Background: Physical exercise aids glycemic control and the prevention of diabetes-related complications. However, exercise beyond an individual’s pulmonary functional capacity may be detrimental. To date, little is known about the relationship between pulmonary function and exercise capacity in people with type 2 diabetes (T2D). We investigated the relationship between pulmonary function and exercise capacity in T2D. Methods: Spirometry and 6-min walk test (6MWT) were conducted for 263 systematically sampled adults with T2D without primary heart/lung disease. The primary measure of exercise capacity was the 6-min walk distance (6MWD); impaired exercise capacity was defined as 6MWD<400 m. Logistic regression analyses were used to assess the associations between spirometric measures and exercise capacity with adjustments for age, sex, height, body mass index, diabetes duration, glycated hemoglobin concentration, smoking, suboptimum blood pressure control, and total cholesterol concentration. Results: Compared with individuals with normal spirometry, those with pulmonary restriction/obstruction had significantly lower 6MWD (404.67 m vs. 451.70),p < 0.001). The proportion of individuals with impaired ex ercise capacity was higher in individuals with impaired pulmonary function compared with those with normal pulmonary function (39.8% vs. 20.7%,p = 0.001). In the unadjusted models, decreasing Z-score FEV1 [odds ratio 1.40, 95% confidence interval (1.07–1.83),p = 0.013] and Z-score FVC [1.37 (1.06–1.76),0.016], but not Z-score FEV1/FVC ratio [1.00 (0.78–1.27),0.972] were significantly associated with impaired exercise capacity. In the fully adjusted model, the strength of association remained statistically significant for Z-score FEV1 [1.60 (1.06–2.41),0.025] but not Z-score FVC [1.48 (0.98–2.23),0.065]. Conclusions: Our study shows inverse associations between FEV1 and impaired exercise capacity in T2D, Future research could characterize optimal exercise levels based on a patient’s FEV1.Item Relationships of blood pressure and control with microvascular dysfunction in type 2 diabetes(Diabetes Epidemiology and Management, 2023) Hayfron-Benjamin, C.F.; Quartey-Papafio, T.R.; Amo-Nyarko, T.; Antwi, E.A.; Vormatu, P.; Agyei-Fedieley, M.K.; Obeng, K.A.Background: In type 2 diabetes mellitus (T2D), cardiovascular risk factors including glycemic control differen tially affect various microcirculatory beds. To date, studies comparing the impact of blood pressure (BP) on various microvascular beds in T2D are limited. We assessed the associations of BP and its control with neural, renal, and retinal microvascular dysfunction. Methods: This was a cross-sectional study among 403 adults with T2D. Microvascular dysfunction was based on nephropathy (albumin-creatinine ratio ≥ 30 mg/g), neuropathy (vibration perception threshold ≥ 25 V and/or Diabetic Neuropathy Symptom score > 1), and retinopathy (based on retinal photography). Logistic regression was used to examine the associations of hypertension, systolic BP, and diastolic BP with microvas cular dysfunction with adjustments for age, sex, diabetes duration, smoking pack years, HbA1c concentration, total cholesterol concentration, and BMI. Results: The mean age (§ SD), proportion of females, and proportion of hypertensives were 56.35 (§ 9.91) years, 75.7%, and 49.1%, respectively. In a fully adjusted model, hypertension was significantly associated with neuropathy [odds ratio 3.44, 95% confidence interval 1.96−6.04, P < 0.001] and nephropathy [2.05 (1.09 −3.85), 0.026] but not for retinopathy [0.98 (0.42−2.31), 0.970]. Increasing Z-score systolic BP was signifi cantly associated with nephropathy [1.43 (1.05−1.97), 0.025] but not for neuropathy [1.28 (0.98−1.67), 0.075] or retinopathy [1.27 (0.84−1.91), 0.261]. Increasing Z-score diastolic BP was significantly associated with nephropathy [1.81 (1.32 − 2.49), < 0.001] but not retinopathy [1.38 (0.92−2.05), 0.120] or neuropathy [0.86 (0.67−1.10), 0.230]. Conclusion: Our study shows varying strengths of associations of hypertension, systolic BP, and diastolic BP with microvascular dysfunction in different microcirculatory beds. Hypertension prevention and/or control may be valuable in the prevention/treatment of microvascular disease, especially nephropathy, and neuropathy.Item Asymptomatic peripheral arterial disease in HIV patients in Ghana: A case-control study(Journal of Vascular Nursing, 2023) Yeboah, K.; Musah, L.; Essel, S.; Agyekum, J.A.; Bedu-Addo, K.Background: Peripheral arterial disease (PAD) is common in HIV patients and can be diagnosed nonin vasively using the ankle-brachial index (ABI). The burden of PAD has not been investigated in Ghanaian HIV patients. We investigated the prevalence and risk factors associated with PAD in HIV patients at a periurban hospital in Ghana. Methods: In a case-control design, ABI was measured in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls with no clinical symptoms of CVDs. PAD was defined as ABI ≤ 0.9. A structured questionnaire was used to collect socio-demographic and clinical data. Fasting venous blood samples were collected to measure plasma levels of glucose, lipid profile, and CD4+ lymphocytes. Results: The prevalence of PAD was 13.9% among cART-treated HIV patients, 21.3% among cART-naïve HIV patients, and 15.4% among non-HIV controls. Patients with PAD had increased odds of having low CD4+ cell counts [OR (95% CI) = 3.68 (1.41–12.85)]. In cART-treated HIV patients, those on TDF-based [5.76 (1.1– 30.01), p = 0.038] and EFV-based [9.28 (1.51–57.12), p = 0.016] regimens had increased odds of having PAD. Conclusion: In our study population, there was no difference in the prevalence of PAD between cART treated HIV patients compared to cART-naïve HIV patients or non-HIV controls. Having a low CD4 cell count and being on TDF- or EFV-based regimens were associated with an increased likelihood of having PAD.Item Comparison of Doppler and Oscillometric Methods of Assessing Ankle-Brachial Index in Non-diabetic Premenopausal Women in Ghana(SAGE Publications Ltd, 2023) Agyekum, J. A.; Oblitey, J.; Yeboah, K.Abstract Introduction: Peripheral arterial disease (PAD) is a common cardiovascular disorder less commonly diagnosed in female patients. Peripheral arterial disease is objectively diagnosed using the ankle-brachial index (ABI), which can be measured using the “gold standard” Doppler method or the oscillometric method. The agreement between these 2 methods is less investigated in the sub-Saharan African population. Therefore, we compared the diagnostic characteristics of the oscillometric method of measuring ABI with the Doppler method in premenopausal female patients in Ghana. Methods: The ABI was measured in non-diabetic premenopausal women suspected of having PAD using the Doppler method with an 8 MHz handheld Doppler (LifeDop 250, Summit Doppler) and an oscillometric device (Vasera 1500N, Fukuda Denshi) in 160 patients (320 legs). Peripheral arterial disease was defined as an ABI <0.90 in at least one leg. Leg symptoms were assessed using the Edinburgh claudication questionnaire. Results: Leg pain on exertion was present in 101 patients screened with similar mean ABIs in the right and left legs. The prevalence of PAD as screened by the Doppler method was 25.7% (18.9%-33.4%) and that of the oscillometric method was 32.2% (24.9%-40.3%). In comparison with the Doppler method, the accuracy of the oscillometric method was 88.2%, and the sensitivity, specificity, positive predictive value, and negative predictive value were 89.7%, 87.6%, 71.4%, and 96.1%, respectively. The overall agreement between the Doppler and oscillometric methods was high, = 0.78 (0.62-0.91), P < .001, with an intraclass correlation of 0.89 (0.87-0.92, P < .001). In receiver-operating characteristic (ROC) curve analysis, the oscillometric method showed an area under the curve of 0.925 compared with the Doppler method in the diagnosis of PAD. Conclusion: In non-diabetic premenopausal women in our study, oscillometric ABI performed acceptably in the diagnosis of PAD when compared with Doppler ABI.Item Comparison of Doppler and Oscillometric Methods of Assessing Ankle-Brachial Index in Non-diabetic Premenopausal Women in Ghana(SAGE Publications Ltd, 2023) Agyekum, J. A.; Oblitey, J.; Yeboah, K.Abstract Introduction: Peripheral arterial disease (PAD) is a common cardiovascular disorder less commonly diagnosed in female patients. Peripheral arterial disease is objectively diagnosed using the ankle-brachial index (ABI), which can be measured using the “gold standard” Doppler method or the oscillometric method. The agreement between these 2 methods is less investigated in the sub-Saharan African population. Therefore, we compared the diagnostic characteristics of the oscillometric method of measuring ABI with the Doppler method in premenopausal female patients in Ghana. Methods: The ABI was measured in non-diabetic premenopausal women suspected of having PAD using the Doppler method with an 8 MHz handheld Doppler (LifeDop 250, Summit Doppler) and an oscillometric device (Vasera 1500N, Fukuda Denshi) in 160 patients (320 legs). Peripheral arterial disease was defined as an ABI <0.90 in at least one leg. Leg symptoms were assessed using the Edinburgh claudication questionnaire. Results: Leg pain on exertion was present in 101 patients screened with similar mean ABIs in the right and left legs. The prevalence of PAD as screened by the Doppler method was 25.7% (18.9%-33.4%) and that of the oscillometric method was 32.2% (24.9%-40.3%). In comparison with the Doppler method, the accuracy of the oscillometric method was 88.2%, and the sensitivity, specificity, positive predictive value, and negative predictive value were 89.7%, 87.6%, 71.4%, and 96.1%, respectively. The overall agreement between the Doppler and oscillometric methods was high, = 0.78 (0.62-0.91), P < .001, with an intraclass correlation of 0.89 (0.87-0.92, P < .001). In receiver-operating characteristic (ROC) curve analysis, the oscillometric method showed an area under the curve of 0.925 compared with the Doppler method in the diagnosis of PAD. Conclusion: In non-diabetic premenopausal women in our study, oscillometric ABI performed acceptably in the diagnosis of PAD when compared with Doppler ABI.