Department of Physiology
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Item Maternal Serum Angiopoietin And Vascular Endothelial Growth Factor (Vegf) Levels In Preeclampsia And Pregnancy Outcomes(University Of Ghana, 2021-09) Bayor, F.Introduction: Preeclampsia remains a major obstetric complication globally, accompanied by a significant burden of adverse maternal and perinatal outcomes especially among Sub-Saharan African (SSA) countries including Ghana. The high maternal and perinatal outcomes of preeclampsia may be due to the lack of consensus on the ideal clinical and therapeutic intervention which stems from the insufficient knowledge on the actual etiology and pathophysiological mechanisms that underline the disease progression. Aim: To explore maternal serum levels of angiopoietins (1 and 2), Vascular endothelial growth factor (VEGF), and pregnancy outcomes in preeclampsia. Methods: The study was a comparative cross-sectional study with cases and controls, conducted at the Obstetrics and Gynaecology Department of the Korle-Bu Teaching Hospital (KBTH). A systematic random sampling technique was used to recruit study participants consisting of women diagnosed with preeclampsia (cases), pregnant normotensives (control group 1), and non-pregnant normotensives (control group 2). A structured data extraction form was used to collect data on the demographic and clinical features of the study participants. Results: A total of 263 women including 75 non-pregnant normotensives, 94 pregnant normotensives, and 94 with established diagnosis of preeclampsia (PE) were enrolled. The study revealed that maternal serum VEGF [4.71 (IQR: 3.65, 7.93) pg/ml], Ang-2 levels [1.25 (IQR: 0.90, 2.15) ng/ml] and VEGF/Ang-2 ratio [3.85 (IQR: 1.91, 11.38)] in the PE group were significantly lower than in the normotensives controls. Although elevated maternal serum Ang-1 levels were found, the difference between women with PE and normotensive controls did not reach statistical significance (p>0.05). VEGF levels were significantly lower in early-onset PE [(3.89 (2.87, 4.78)pg/ml;p=0.014] than in late-onset PE [5.23 (3.78, 16.97) pg/ml] while Ang-1/VEGF ratio was found to be higher in early-onset PE [20.62(15.76,Item Baseline Serum and Urine Osmolality and Factors that affect it in Steady State Sickle Cell Disease Patients(University Of Ghana, 2019-07) Kusi-Mensah, Y.A.It is over a century since the discovery of Sickle Cell Disease (SCD) and since then, a lot more is still being discovered about the pathophysiology of the disease. Notable amongst the various factors that affect the disease’s pathophysiology and management is red cell dehydration. Factors that affect cellular dehydration and serum osmolality in SCD patients are not very clearly understood. An objective method among of assessing SCD patient’s hydration status is by measuring the serum and urine osmolality. Limited data exist on factors that affect the hydration status of sickle-cell disease patients especially in Ghana and sub-Saharan Africa. There is therefore the need to collate data about these factors to help in the management of SCD. Aim: The aim of this study was to determine factors that affect serum and urine osmolality in steady-state HbSS and HbSC SCD patients. Methodology: This was a Case-Control study that was conducted at the Department of Haematology (Sickle Cell Clinic), Korle-Bu Teaching Hospital (KBTH) in Accra. 120 cases of SCD (80 HbSS and 40 HbSC genotype) in their steady-state were matched for age to 60 controls. A structured questionnaire was used to obtain the demographic characteristics of recruited subjects, medical history, physical examination findings, a 24-hour dietary recall and frequency of consumption of sodium-rich food. Five millilitres (mls) of venous blood and 5mls of mid-stream urine samples were obtained from each subject. Serum, urine osmolality, full-blood count, blood urea, electrolytes and creatinine (BUE & Cr) were determined. Urine routine examination (Urine R/E) was also done to assess urine pH and specific gravity. Bivariate analysis was used to compare the variables measured, with a p-value < 0.05 deemed as significant. Results: Compared to the mean serum osmolality of the control group (354.50±82.37)mmol/kg, SCD patients (HbSS and HbSC) had a higher mean serum osmolality (440.87±113.14 and 422.90±88.59)mmol/kg respectively (p-value <0.001). The mean urine osmolality of HbSS and HbSC patients (452.28 ± 109.41 and 498.28±87.26)mmol/kg respectively was significantly lower compared to HbAA individuals (681.23±276.82) mmol/kg (p-value <0.001). Comparing HbSS and HbSC patients, there was no significant difference in the mean serum osmolality (p-value =0.382), but a significant increase in the mean urine osmolality of HbSC patients compared to HbSS patients (p-value =0.020). There was a weak negative correlation between serum osmolality and dietary Sodium (r= -0.192), between serum osmolality and average water intake (r= -0.025), between serum osmolality and dietary Protein (r= -0.098) and between serum osmolality and dietary Potassium (r= -0.052) in SCD patients. Analysing data from the Food Frequency Table, majority (> 50%) of study participants (HbSS, HbSC AND HbAA) did not consume most sodium-rich foods (salted meals) very often. The only salt-rich food assessed that was consumed often was stock cubes. Majority (>60%) of study participants (HbSS, HbSC AND HbAA) obtained their food from Food Vendors making it difficult to accurately quantify their food consumption. Conclusion: Sickle Cell Disease patients have a high serum osmolality and a low urine osmolality. The HbSC patients have a higher urine osmolality compared with HbSS patients. In general, study participants did not frequently consume sodium-rich foods. Serum osmolality decreases with increasing consumption of sodium-rich diets, thus the high serum osmolality and low urine osmolality observed in SCD patients is mainly due to the disease pathophysiology.Item Transcutaneous Electrical Nerve Stimulation in the Management of Spasticity in Cerebral Palsy(University of Ghana, 2019-07) Ed-Bansah, D.Background: Spastic Cerebral palsy accounts for 70-80% of all types of Cerebral palsy. Spasticity as a major feature limits and restricts patients’ ability to walk, stand, sit, or roll effectively due to excessive muscle contraction interfering with lengthening of the affected muscles. It poses a challenge even though there are well known interventions. Rehabilitation which includes physiotherapy is one of the widely accepted interventions. Physiotherapists in other countries and in Ghana use stretches, splinting and motor control/ training treatment strategies to reduce spasticity. There is growing interest in the use of Transcutaneous Electrical Nerve Stimulation (TENS) in the management of spasticity in Cerebral palsy. TENS is widely used as a pain management tool in Ghana. However, its use in spasticity management has not been explored and this study seeks to investigate the potential of TENS in the management of spasticity in Cerebral palsy, in Ghana. GENERAL AIM: The aim of this study was to evaluate the effectiveness of TENS in the management of calf muscle spasticity among children with Cerebral palsy. METHODOLOGY: This study was a Quasi-Experimental, One group Pre-test – Post-test design. Fifteen (15) children with spastic cerebral palsy who had spasticity in their calf muscles (gastrocnemius and soleus) were recruited for this study. All participants had two different modes of spasticity assessment electrophysiologically using the H reflex responses of calf muscles and clinically using the Modified Ashworth Scale (MAS). A biomechanical assessment was conducted using the Goniometer to assess Range of Motion (ROM) at the ankle joint in ankle dorsiflexion. All participants then received TENS application to the calf muscles for a duration of thirty (30) minutes after which the H-reflex response, MAS and ROM were assessed again respectively, after the intervention. MAS and ROM carried out before and after the intervention were assessed twice for intrarater reliability. Statistical analysis was done using Mann Whitney U test, Spearman’s rank correlation coefficient and Wilcoxon sign rank test. Predictor analysis was also done to evaluate whether application of TENS could lead to low MAS scores. RESULTS: Results from this study showed that there was no significant difference (p>0.05) between left and right H reflex responses, MAS, and ROM scores at the baseline. There was no correlation (left: p = 0.133, right: p = 0.479) between pre-test left and right H reflex Amplitude (HA) scores and the MAS scores. After application of TENS, there was a reduction in spasticity of the calf muscles as measured by the H reflex, MAS, and ROM. However, only the left sided measures were statistically significant (p = 0.011) for the H reflex Amplitude whilst this asymmetry was not seen in MAS (left: p = 0.009, right: p = 0.004) and ROM (left: p = 0.02, right: p = 0.003). CONCLUSION: TENS may be an effective tool for managing spasticity in spastic Cerebral palsy by reducing neuronal excitability. The asymmetry in response to TENS may have been from asymmetrical pathophysiology in the participants of the study.Item Serum Levels of Angiogenic and Antiangiogenic Factors in Ghanaian Women Diagnosed with Pre-Eclampsia and its Relation to Fetal Outcomes(University of Ghana, 2019-06) Kwawukume, L.A.Background: Pregnancies complicated by pre-eclampsia are associated with a high rate of maternal and fetal morbidity and mortality. The only effective treatment of pre-eclampsia is premature delivery of the baby and the placenta which can result in neonatal complications. Antiangiogenic and angiogenic factors have been implicated in the pathophysiology of pre-eclampsia resulting in of placental ischemia with subsequent maternal endothelial cell dysfunction and fetal complications. General Aim- The aim of the study was to determine the association between the serum levels of antiangiogenic factor, sFLT-1, angiogenic factor, PLGF and the fetal outcome in pre-eclampsia. Methodology- This study was a case control study which included a total of 120 participants, comprised 60 pre-eclamptic women and 60 pregnant women with no complications. A volume of 6mls of blood was drawn from the antecubital fossa using a 10mls syringe from each participant. This was then divided into two 3mls each, one portion was poured into the plain bottle and the other half into an EDTA tube and labelled with indelible ink appropriately. Blood samples were drawn as follows: at presentation, during the active phase of labour and 24 hours after delivery for each participant. The human soluble fms- like tyrosine kinase 1 and placental growth factor ELISA kit were used to measure the antiangiogenic and angiogenic factors respectively. Full blood count blood, urea, electrolytes, creatinine and uric acid, ALT, AST and albumin were measured. Digital weighing scale was used to measure the weight of each baby and the weight of the placenta. The APGAR scores were calculated at 1 and 5 minutes after delivery. Neonatal admission into NICU and neonatal mortality were recorded. Questionnaires on demographics and knowledge of pre-eclampsia were analyzed. Statistical significance was set at a probability of 0.05 Results- The median serum level of sFLT-1 at diagnosis was significantly higher in women diagnosed with pre-eclampsia compared to controls 49622.6pg/ml (IQR:22256.7-122818.6) versus 14842pg/ml (IQR:6289.0-20607.6) p<0.001. Similarly, the median sFLT-1 level during delivery was 50634.6pg/ml(IQR:24171.1-118934.5) and 25046.6pg/ml (IQR:13570.5-40565.4) p=0.002 while the level 24 hours after delivery was 7521.7pg/ml (IQR: 1321.8-41049.5) and 2477.4pg/ml (IQR: 1038.0-7438.2) p= 0.021 in the case and control respectively. The median serum level of PLGF in women diagnosed with pre-eclampsia was significantly lower than controls,78.7pg/ml (IQR: 46.9-188.7) versus 1016.7pg/ml (IQR:280.7-2177.2), p<0.001. Likewise, the median level of PLGF during delivery was 65.1pg/ml(IQR:41.7-105.3) in cases and 202.6pg/ml(IQR:84.8-418.6) in controls, p<0.001. The median level of PLGF 24 hours after delivery was marginally lower in the case 52.9pg/ml (IQR:20.0-114.3) as compared to the control 58.7pg/ml(IQR:30.75-127.1) p= 0.386. The increased serum levels of the anti-angiogenic sFLT-1 and low serum level of angiogenic factor, PLGF was associated with NICU admissions, neonatal death and low birth weight. However, mothers who had still birth had a low sFLT-1 (p=0.403) and PLGF levels (p=0.736). Conclusion- A high serum sFLT-1 and low PLGF levels in women diagnosed with pre-eclampsia is associated with greater NICU admissions, low birth weight and neonatal death. Furthermore, low sFLT-1 levels after high levels in utero regardless of the PLGF level is associated with still birth in women diagnosed with pre-eclampsia. Therefore, neonatal outcomes may improve if there is regular clinical monitoring of sFLT-1 and PLGF levels for women with pre-eclampsia.Item Baseline Serum and Urine Osmolality and Factors that affect it in Steady State Sickle Cell Disease Patients(University Of Ghana, 2019-07) Kusi-Mensah, Y.A.It is over a century since the discovery of Sickle Cell Disease (SCD) and since then, a lot more is still being discovered about the pathophysiology of the disease. Notable amongst the various factors that affect the disease’s pathophysiology and management is red cell dehydration. Factors that affect cellular dehydration and serum osmolality in SCD patients are not very clearly understood. An objective method among of assessing SCD patient’s hydration status is by measuring the serum and urine osmolality. Limited data exist on factors that affect the hydration status of sickle-cell disease patients especially in Ghana and sub-Saharan Africa. There is therefore the need to collate data about these factors to help in the management of SCD. Aim: The aim of this study was to determine factors that affect serum and urine osmolality in steady-state HbSS and HbSC SCD patients. Methodology: This was a Case-Control study that was conducted at the Department of Haematology (Sickle Cell Clinic), Korle-Bu Teaching Hospital (KBTH) in Accra. 120 cases of SCD (80 HbSS and 40 HbSC genotype) in their steady-state were matched for age to 60 controls. A structured questionnaire was used to obtain the demographic characteristics of recruited subjects, medical history, physical examination findings, a 24-hour dietary recall and frequency of consumption of sodium-rich food. Five millilitres (mls) of venous blood and 5mls of mid-stream urine samples were obtained from each subject. Serum, urine osmolality, full-blood count, blood urea, electrolytes and creatinine (BUE & Cr) were determined. Urine routine examination (Urine R/E) was also done to assess urine pH and specific gravity. Bivariate analysis was used to compare the variables measured, with a p-value < 0.05 deemed as significant. Results: Compared to the mean serum osmolality of the control group (354.50±82.37)mmol/kg, SCD patients (HbSS and HbSC) had a higher mean serum osmolality (440.87±113.14 and 422.90±88.59)mmol/kg respectively (p-value <0.001). The mean urine osmolality of HbSS and HbSC patients (452.28 ± 109.41 and 498.28±87.26)mmol/kg respectively was significantly lower compared to HbAA individuals (681.23±276.82) mmol/kg (p-value <0.001). Comparing HbSS and HbSC patients, there was no significant difference in the mean serum osmolality (p-value =0.382), but a significant increase in the mean urine osmolality of HbSC patients compared to HbSS patients (p-value =0.020). There was a weak negative correlation between serum osmolality and dietary Sodium (r= -0.192), between serum osmolality and average water intake (r= -0.025), between serum osmolality and dietary Protein (r= -0.098) and between serum osmolality and dietary Potassium (r= -0.052) in SCD patients. Analysing data from the Food Frequency Table, majority (> 50%) of study participants (HbSS, HbSC AND HbAA) did not consume most sodium-rich foods (salted meals) very often. The only salt-rich food assessed that was consumed often was stock cubes. Majority (>60%) of study participants (HbSS, HbSC AND HbAA) obtained their food from Food Vendors making it difficult to accurately quantify their food consumption. Conclusion: Sickle Cell Disease patients have a high serum osmolality and a low urine osmolality. The HbSC patients have a higher urine osmolality compared with HbSS patients. In general, study participants did not frequently consume sodium-rich foods. Serum osmolality decreases with increasing consumption of sodium-rich diets, thus the high serum osmolality and low urine osmolality observed in SCD patients is mainly due to the disease pathophysiology.Item Transcutaneous Electrical Nerve Stimulation in the Management of Spasticity in Cerebral Palsy(University of Ghana, 2019-07) Ed-Bansah, D.BACKGROUND Spastic Cerebral palsy accounts for 70-80% of all types of Cerebral palsy. Spasticity as a major feature limits and restricts patients’ ability to walk, stand, sit, or roll effectively due to excessive muscle contraction interfering with lengthening of the affected muscles. It poses a challenge even though there are well known interventions. Rehabilitation which includes physiotherapy is one of the widely accepted interventions. Physiotherapists in other countries and in Ghana use stretches, splinting and motor control/ training treatment strategies to reduce spasticity. There is growing interest in the use of Transcutaneous Electrical Nerve Stimulation (TENS) in the management of spasticity in Cerebral palsy. TENS is widely used as a pain management tool in Ghana. However, its use in spasticity management has not been explored and this study seeks to investigate the potential of TENS in the management of spasticity in Cerebral palsy, in Ghana. GENERAL AIM: The aim of this study was to evaluate the effectiveness of TENS in the management of calf muscle spasticity among children with Cerebral palsy. METHODOLOGY: This study was a Quasi-Experimental, One group Pre-test – Post-test design. Fifteen (15) children with spastic cerebral palsy who had spasticity in their calf muscles (gastrocnemius and soleus) were recruited for this study. All participants had two different modes of spasticity assessment electrophysiologically using the H reflex responses of calf muscles and clinically using the Modified Ashworth Scale (MAS). A biomechanical assessment was conducted using the Goniometer to assess Range of Motion (ROM) at the ankle joint in ankle dorsiflexion. All participants then received TENS application to the calf muscles for a duration of thirty (30) minutes after which the H-reflex response, MAS and ROM were assessed again respectively, after the intervention. MAS and ROM carried out before and after the intervention were assessed twice for intrarater reliability. Statistical analysis was done using Mann Whitney U test, Spearman’s rank correlation coefficient and Wilcoxon sign rank test. Predictor analysis was also done to evaluate whether application of TENS could lead to low MAS scores. RESULTS: Results from this study showed that there was no significant difference (p>0.05) between left and right H reflex responses, MAS, and ROM scores at the baseline. There was no correlation (left: p = 0.133, right: p = 0.479) between pre-test left and right H reflex Amplitude (HA) scores and the MAS scores. After application of TENS, there was a reduction in spasticity of the calf muscles as measured by the H reflex, MAS, and ROM. However, only the left sided measures were statistically significant (p = 0.011) for the H reflex Amplitude whilst this asymmetry was not seen in MAS (left: p = 0.009, right: p = 0.004) and ROM (left: p = 0.02, right: p = 0.003). CONCLUSION: TENS may be an effective tool for managing spasticity in spastic Cerebral palsy by reducing neuronal excitability. The asymmetry in response to TENS may have been from asymmetrical pathophysiology in the participants of the study.Item Pulmonary Functional Changes in Ghanaian Patients Undergoing Spinal Anaesthesia(University Of Ghana, 2019-07) Agyei-Fedieley, M.K.BACKGROUND: Although spinal Anaesthesia remains the anaesthetic technique of choice for many surgeries below the umbilicus, it may be associated with increased risk of cardiopulmonary complications such as hypotension, bradycardia and intraoperative cardiopulmonary arrest. Spinal Anaesthesia blocks autonomic, motor and sensory nerves which may affect pulmonary function. In the general population, reduction in the forced expiratory volume in one second (FEV1) is a robust predictor of sudden cardiac death in patients without primary heart or lung disease. It remains unclear how spinal Anaesthesia affects the pulmonary function of healthy individuals and how these changes impact on the incidence and/or severity of spinal Anaesthesia related intraoperative and postoperative complications. GENERAL AIM: To determine pulmonary functional changes and its association with perioperative cardiopulmonary complications in patients undergoing spinal Anaesthesia for elective surgery MATERIALS AND METHODS: An analytical cross-sectional study of 50 patients that meet the American Society of Anesthesiologist physical status class I or II with no history of primary heart or lung disease scheduled for elective surgery under spinal Anaesthesia were recruited for the study. Pulmonary function test (assessed by peripheral capillary oxygen saturation, spirometry and arterial blood gas) was done prior to induction of spinal Anaesthesia, 30min after induction of spinal Anaesthesia and at full recovery from spinal Anaesthesia. The changes in pulmonary function and how they predict the risk of adverse complications (hypotension, bradycardia, dysrhythmia, dyspnoea, nausea and vomiting) in the intraoperative and postoperative period were recorded. Repeated Measures ANOVA was used to determine pulmonary functional changes during spinal Anaesthesia and Logistic regression analysis was used to study the association between baseline pulmonary function and intraoperative and postoperative complication, with adjustments for potential covariates. RESULTS: Spinal Anaesthesia was associated with pulmonary functional changes. There was a significant reduction in FEV1 (best and predicted) and PEFR (best and predicted) during and post recovery from spinal Anaesthesia. There was a significant reduction in PH during Anaesthesia as compared to preoperative (baseline) and post recovery. This was observed with increase in PaCO2 and PaO2 though Arterial blood gas values were within normal physiological limit. There was no significant association between pulmonary function indices (FEV1predicted and PEFR predicted) and spinal Anaesthesia related complications. However, their ODDS ratio determined (preoperative, intraoperative and postoperative) indicated that spinal Anaesthesia related complications were more likely to occur for a unit change in the pulmonary function. CONCLUSION: Spinal Anaesthesia affects pulmonary function. This causes reduction in FEV1 intraoperatively and post operatively. Reduction in FEV1 may be a contributing factor to other mechanisms that result in spinal Anaesthesia related complication. Reduction in FEV1 may be more likely to predict the risk of development of spinal Anaesthesia related complication. RECOMMENDATION: Improved monitoring should be a mandatory safety requirement for all patients as changes in physiological parameters occur during and after spinal Anaesthesia. It is pertinent that all patients be monitored well into the postoperative phase of recovery.Item Exercise Tolerance in Adult Sickle Cell Disease Patients(University of Ghana, 2019-07) Nuako, I.Background Many adults with sickle cell disease (SCD) complain of significant exercise intolerance despite the health benefits in exercise. Most children with SCD also miss out on the important benefits of exercise because of unsubstantiated fears that it might be harmful in their condition. Several factors could contribute to exercise limitation in these patients. The six-minute walk test (6MWT) is a standardized test use to measure a person’s exercise tolerance. It is being increasingly used as a measure of overall functional ability in patients. However little information exists regarding the safety or the limit of exercise SCD patients can tolerate. The purpose of the present study is to examine these issues. General Aim To determine the exercise tolerance limit of SCD patients by using the six-minute walk test. Method A case control study was performed on 36 adult SCD patients (13 males and 23 females) and 36 healthy adult controls (13 males and 23 females) at the Tema General Hospital by the six minute walk test (6MWT). Anthropometric data of all participants comprising of height (cm) and weight (kg) were measured and body mass index (BMI) derived from this data were all recorded. The haemoglobin (Hb) level of all participants were measured. The following parameters were measured and recorded in all the participants prior to the 6MWT, 5 and 10 minutes after the test respectively: blood pressure (SBP and DBP), HR, SpO2, PEFR, chest pain (angina scale), dyspnoea, and leg fatigue (modified Borg scale) The total distance walked was also recorded in metres. The 6MWD was used to estimate the VO2 and the MET. Factors associated with the 6MWD were evaluated using multivariate analysis and used to derive an equation which aimed to estimate the likely 6MWD from the variables. The level of significance was set at p < 0.05. SPSS version 23 software was used for statistical analysis. Results The mean age of the SCD patients was 28.44 ± 6.29years and the healthy controls was 28.44 ± 6.29years. The mean Hb for SCD patients’ males and females were 8.60 ± 1.27g/dl and 9.84 ± 1.75 g/dl respectively: (p = 0.002). The mean Hb for healthy control males and females were 14.11 ± 0.56g/dl and 12.82 ± 0.69g/dl respectively (p < 0.001). There was however no significant difference in the mean height (m) ((1.68 ± 0.08 m) vs. (1.70 ± 0.070 m) (p = 0.137)) and mean BMI ((20.09 ± 3.19kg/m2) vs. (21.4 ± 2.80kg/m2) (p = 0.060)) between cases and controls respectively. There was a significant difference in the mean weight between cases and controls ((56.64 ± 10.67 kg) vs. (62.51± 10.51 kg): (p = 0.021)). There was an increase in the SBP, DBP, HR at the end of the 6MWD and decreased subsequently at 5 minutes and 10minutes after the test for the cases and as well as the controls. The SPO2 however, decreased at the end of the 6MWD and increased at 5 minutes and 10minutes after the test both cases and controls. The PEFR increased at the end of the 6MWD up to 10minutes after the test in both cases and controls. There was also significant difference (p < 0.001) in the mean distance walked in six minutes between SCD patients (551.03± 63.32m) and healthy controls (666.72 ±80.06m). Conclusion This study provides the first preliminary data on exercise tolerance for healthy Ghanaian adults and SCD patients between the ages of 20 years and 45 years. The maximum HR achieved, minimum SPO2, VO2, MET and blood pressures in adult SCD patients and healthy controls were within normal range in this study. Therefore SCD patients may take the 6MWD test safely. There was an improvement in PEFR in both SCD patients and healthy controls after the test. Even though SCD patients achieved lower values than the healthy controls. The maximum distance walked by SCD patients was significantly shorter than that of the healthy controls. Therefore SCD patients have reduced tolerance to exercise than healthy controls.Item Electroencephalography in Seizure Diagnosis and the Prediction of Functional Outcomes of Stroke Patients at Korle Bu Teaching Hospital(University of Ghana, 2018-07) Laryea, R.Y.Background: As compared to developed economies, stroke is a rising epidemic affecting mostly the younger workforce in Sub-Saharan Africa (SSA), exerting a severe toll on the physical, psychoemotional, cognitive and social lives of its victims with a 3-year mortality rate of 84%. The occurrence of seizures lead to poor prognosis and increased mortality in stroke patients. Early screening for seizures and effective prognostication of the functional outcome of stroke may improve the outcomes of patients. General aim: This study aimed to determine the incidence of seizures in 30 stroke patients and how quantitative electroencephalography (QEEG) indices prognosticate their one-month functional outcome. Methodology: Electroencephalography (EEG) is a non-invasive analysis of brain function available at Korle Bu Teaching Hospital. Stroke outcome was measured using the modified National Institute of Health Stroke Scale (mNIHSS), modified Rankin Scale (MRS) and Barthel Index (BI). In this study, routine EEG of thirty (30) consenting acute stroke patients was recorded using the 10/20 standardized format within ten days of stroke onset. The EEG patterns were characterized by a neurologist and then delta/alpha ratio (DAR), relative alpha power (RAP) and the pairwise derived brain symmetry index (pdBSI) were calculated using the EEGLAB software. On the day of recording EEG, the mNIHSS, MRS and Barthel Index scores of the patients were measured and again a month later. Clinical and EEG findings were displayed on bar charts and statistical tables while Spearman’s rank correlation and linear regression was used to determine predictors of one-month outcome using the Statistical Product for Service Solution (SPSS) version 20. Results: The 30 participants of this study consisted 60% aged 60years or below, 66.7% male and 33.3% haemorrhagic stroke. Clinical seizures occurred in 13.3% of study participants, electrographic seizure occurred in 46.7% (with 92.9% being generalized seizures) and cerebral dysfunction was diagnosed in 56.7% of the participants. The MRS, mNIHSS and BI measured at recruitment significantly correlated to their measures at one-month (p < 0.01); the least being between MRS and mNIHSS scores at recruitment (rho = 0.753) and the highest was between MRS and BI scores at recruitment (rho = -0.932). The only correlation for QEEG indices was between RAP and DAR (rho = -0.988, p < 0.001), the highest in the entire analysis. Overall, mNIHSS score at recruitment was the best predictor of all three functional outcome measures at one-month- MRS1 (beta = 0.471, p = 0.001), mNIHSS1 (beta= 0.753, p = 0.001) and BI1 (beta= -0.556, p = 0.001). Conclusion: There was a high incidence of electrographic seizure in stroke patients of Korle Bu Teaching Hospital than what could be clinically diagnosed. The QEEG indices- DAR, RAP and pdBSI did not significantly predict post-stroke functional outcomes measures (MRS, mNIHSS or BI) at one-month across all stroke types. Relative alpha power (RAP) measured at recruitment was the only QEEG index useful in the prediction of neurological deficit (mNIHSS) in ischaemic stroke at one-month post stroke. The mNIHSS measured at recruitment was the most significant predictor of all functional outcome measures (MRS, mNIHSS and BI) assessed at one-month post stroke.Item Arterial Stiffness and Serum Adipokines in Young Ghanaian Adults with Metabolic Syndrome(University Of Ghana, 2016-07) Dodam, K.K.Background: Metabolic syndrome is the clustering of risk factors for cardiovascular diseases (CVDs) such as obesity, insulin resistance, hyperglycemia, hypertension and dyslipidemia in an individual. The relationship between metabolic syndrome and arterial stiffness is unclear and the mechanism linking metabolic syndrome to CVDs is largely uncertain even though adipokines such as leptin and adiponectin have been hypothesized to be implicated. This study assessed the levels of leptin and adiponectin in young Ghanaian adults and the relationship of these adipokines with arterial stiffness and metabolic syndrome. General Aim: The aim of the study was to assess the relationship between metabolic syndrome and arterial stiffness as well as with serum leptin and adiponectin in young adults. Methodology: A cross-sectional study was conducted, 364 young adults aged 20-30 years were recruited randomly from Jamestown in the Accra metropolis. The participants were interviewed using a structured questionnaire for socio-demographic and lifestyle information. Anthropometric indices such as body fat, visceral fat, weight, arm circumference, jugulum-symphysis distance, height, waist and hip circumferences were measured. Haemodyamic indices such as systolic blood pressure, diastolic blood pressure, mean blood pressure and heart rate were measured. Arterial stiffness was assessed as aortic pulse wave velocity (PWVao) as well as aortic systolic blood pressure (SBPao). 10 milliliters (10 mls) of venous blood was obtained and analyzed for fasting plasma glucose, full blood count and plasma lipids. Leptin and adiponectin were assayed in fasting serum samples. Results: The overall prevalence of metabolic syndrome among the participants using the NCEP-ATP III diagnostic criteria was 28.3%, with the female participants showing a higher prevalence of metabolic syndrome as compared to their male counterparts (37.4% vs 19.4%). Compared to the female participants, the male participants had high current alcohol use (33.9% vs 9.5%) as well as high current smoking status (13.2% vs 1.6%). The female participants had high levels of aortic pulse wave velocity (PWVao) as well as increased aortic systolic blood pressure (BP) compared to their male counterparts. The participants with metabolic syndrome had increased PWVao and aortic systolic BP as compared to those without metabolic syndrome. However, there was no difference in the levels of leptin and adiponectin between the genders. The study also observed no association between the adipokines and arterial stiffness as well as with metabolic syndrome even though the participants with metabolic syndrome had elevated serum leptin and lower serum adiponectin as compared to those without metabolic syndrome. Conclusion: The prevalence of metabolic syndrome was 28.3% among the study participants using the NCEP-ATP III criteria with the female participants having high prevalence as compared to the males (37.4% vs 19.4%). Metabolic syndrome was associated with arterial stiffness. The female participants had stiffer arteries as compared to their male counterparts. However, there was no association between the adipokines and metabolic syndrome as well as arterial stiffness. It was recommended that lifestyle modifications such as physical activity and healthy diets among others be pursued to help reduce the burden of metabolic syndrome, arterial stiffness and CVDs.