Department of Chemical Pathology
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Item Host cytokine genetic polymorphisms in a selected population of persons living with hepatitis B virus infection in the central region of Ghana(BMC Gastroenterology, 2024) Adu, M.; Aniakwaa-Bonsu, E. A.; Ateko, R.O.; et al.Background Hepatitis B virus (HBV) infection is a public health concern in resource limited settings like Ghana. Over the past decades, it is noted that the natural course of HBV in persons infected are taking a worse turn leading to liver cirrhosis and cancer. The outcome of HBV infection is influenced by viral and host factors including genetics. Cytokine variations affect virus survival and progression and may even influence associated complications. Cytokines such as tumor necrosis factor alpha (TNF-α), interleukins (IL-4, IL-6, IL-8, IL-10, IL-18), interferon gamma (IFN)-γ, and tumor growth factor-beta (TGF-β) have key roles in HBV infection and modulation. In this study, polymorphisms occurring in fve cytokines were analyzed to understand how they can influence prognosis of HBV infection. Methods The study is a single centre cross-sectional study involving 227 participants made up of HBV infected participants and HBV-negative controls. Recruitment was from March 2021 to April 2022. Blood samples were taken for full blood count, HBV antigen profile, liver function tests, HBV DNA quantification and cytokine genotyping. FIB score was calculated using available tools. Statistical analysis was undertaken with p<0.05 set as statistically significant. Results The 20–39-year-old group formed majority of the HBV infected participants with 60% of all participants being classified as healthy HBsAg carriers. IL2 rs1479920 GG carriers ((1258.93; 0.00–5011.87) IU/mL had reduced HBV DNA in comparison to IL2 rs1479920 AA ((5011.87; 2113.49–5956.62) /AG (3548.13; 0.00–6309.57) IU/mL carriers. TNF-α rs1800629 AA carriers (1258.93; 0.00–3981.07) IU/mL had a reduction in HBV DNA levels in comparison to TNF-α rs1800629 GG carriers (1584.89; 0.00–5011.87) IU/mL. The results of univariate (OR=0.08, 0.00–0.93; p=0.043) and multivariate (OR=0.02, 0.00–0.67; p=0.029) analysis, showed that carrying TNF-α rs1800629 AA genotype reduce susceptibility to high FIB score compared with GG genotypes. In univariate analysis, subjects aged 20–39 years (OR=5.00, 1.13–6.10; p=0.034) and 40–59 years (OR=41.99, 3.74–47.21; p=0.0002) were more susceptible to high FIB score compared to subjects aged 1–19 years. Being female (OR=2.42, 1.03–5.71; p=0.043) in the univariate models showed higher odds of having high levels of HBV DNA in the multivariate model. There was a reduced likelihood of herbal medicine usage infuencing HBV DNA levels signifcantly (OR=0.29, 0.10–0.86; p=0.025). Conclusion In conclusion, variations in IL2 rs1479920 GG and IL2 rs1479921 AA could ofer protective efects by reduc ing HBV DNA. TNF-α rs179924CT may also cause elevation in HBV DNA levels whiles TNF-α -308A/G, showed a potential protective efect on liver scarring in HBV infected participants. It is therefore important to take a further look at such variations for understanding of HBV modulation in the Ghanaian population.Item Availability and geographic access to breast cancer pathology services in Ghana(PLoS ONE, 2024) Price, M.D.; Mali, M.E.; Abrahams, A.O.D.; et al.Introduction Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana. Methods A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related param eters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access. Results Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%). Conclusion Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.Item Prevalence and risk factors of obesity among undergraduate student population in Ghana: an evaluation study of body composition indices(BMC Public Health, 2024) Obirikorang, C.; Adu, E.A.; Nyarko, E.NY.Background Obesity is a classified risk factor for several of the world’s leading causes of death. In this study, we combined information contained in body mass index (BMI), total percentage body fat (TPBF) and relative fat mass (RFM) to estimate obesity prevalence and examine the risk factors associated with obesity. Methods The study recruited 1027 undergraduate students aged between 16 and 25 years using a cross-sectional study design and two-stage stratified random sampling between January and April 2019 from the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Demographic, lifestyle, and family history of chronic disease data, were collected using a structured questionnaire. Bioelectrical impedance, along with height, weight, age, and gender, were used to estimate BMI and TPBF. The RFM was calculated using a published equation. The TPBF and RFM ranges were evaluated based on standard BMI thresholds and an informative combined obesity prevalence estimated in a Bayesian framework. Multiple logistic regression analysis was used to evaluate potential risk factors of overweight/ obesity. Results Concordance between BMI, TPBF and RFM for obesity classification was 84% among female and 82.9% among male students. The Bayesian analysis revealed a combined prevalence means of obesity of 9.4% (95%CI: 6.9- 12.2%) among female students and 6.7% (95%CI:4.3-9.5%) among male students. The odds of obesity were increased between 1.8 and 2.5 for females depending on the classification index. A significant increasing trend of obesity was observed with university-level. A family history of obesity was associated with a high estimate of general, central, and high TPBF. Conclusion Using multiple adiposity indicators conjointly in a Bayesian framework offers a greater power to examine obesity prevalence. We have applied this and reported high obesity prevalence, especially among female students. University level and family history of obesity were key determinants for obesity among the student population.Item Apolipoprotein E genetic variation, atherogenic index and cardiovascular disease risk assessment in an African population: An analysis of HIV and malaria patients in Ghana(PLOS ONE, 2023) Thomford, N.E.; Anyanful, A.; Ateko, R.O.; et al.Background Apolipoprotein E is involved in lipid transport and clearance of lipoprotein through low-density lipoprotein receptors (LDLR). ApoE variation has been linked to cardiovascular disease (CVD) risk. There are 3 isoforms of ApoE which originate from two non-synonymous single nucleotide polymorphisms denoted as ε2, ε3 and ε4. The ε2 isoform is implicated in higher levels of atherogenic lipoprotein with the ε4 isoform causing LDLR downregulation. This leads to variable effects and differential CVD risk. Malaria and HIV are life-threatening diseases affecting several countries globally especially in sub-Saharan Africa. Parasite and viral activities have been implicated in lipid dysregulation leading to dyslipidaemia. This study examined ApoE variation and CVD risk assessment in malaria and HIV patients. Methods We compared 76 malaria-only, 33 malaria-HIV coinfected, 21-HIV-only and 31 controls from a tertiary health facility in Ghana. Fasting venous blood samples were taken for ApoE genotyping and lipid measurements. Clinical and laboratory data were collected with ApoE genotyping performed using Iplex Gold microarray and PCR-RFLP. Cardiovascular disease risk was calculated using the Framingham BMI and cholesterol risk and Qrisk3 tools. Results The frequency of C/C genotype for rs429358 was 9.32%, whiles T/T genotype for rs7412 was found in 2.48% of all participants. ε3/ε3 was the most distributed ApoE genotype accounting for 51.55% of the total participants whiles ε2/ε2 was found in 2.48% of partici pants, with 1 in malaria-only and 3 in HIV-only patients. There was a significant association between ε4+ and high TG (OR = 0.20, CI; 0.05–0.73; p = 0.015), whiles ε2+ was significantly associated with higher BMI (OR; 0.24, CI; 0.06–0.87; p = 0.030) and higher Castelli Risk Index II in females (OR = 11.26, CI; 1.37–92.30; p = 0.024). A higher proportion of malaria only participants had a moderate to high 10-year CVD risk. Conclusion Overall malaria patients seem to have a higher CVD risk though the means through which this occurs may be poorly understood. ε2/ε2 genotypes was observed in our population at a lower frequency. Further studies are vital to determine CVD risk in malaria and how this occurs.Item Biochemical markers of nephrotic syndrome: An observational, cross-sectional study(Heliyon, 2023) Ofori, E.K.; Clinton, E.B.; Acheampong, O.D.; Asare- Anane, H.; et al.Background: Blood protein leakage, especially albumin, into the urine is the hallmark of nephrotic syndrome (NS), which poses a serious public health problem. The absence of albumin prompts the liver to produce more proteins to make up the difference. The therapeutic significance of these additional proteins in NS is not yet fully understood. Methods: In total, 99 patients with NS and 47 persons without NS (control group) were included in this cross-sectional study. Socio-demographic and clinical information were obtained from recruits utilizing a standard questionnaire and a check of the lab order forms for individuals. Each participant had a 6-mL (6 mL) sample of venous blood taken and levels of calcium, C-reactive protein (CRP), albumin, and other proteins in the serum were assayed. The proteins in serum were separated using the electrophoresis technique, and the various fractions were then measured by a densitometer. Calculations were made for the oncotic pressure. Results: The NS group had significantly greater levels of serum CRP, urea, alpha-2-globulin, gamma globulins, and M component than the control group (p < 0.05 respectively). Transferrin, total proteins, albumin, beta-1-globulins, calcium, and oncotic pressure were significantly higher in persons without NS compared to the NS group (p < 0.05 respectively). In addition, levels of CRP (odds ratio = 1.41, p = 0.005) and gamma globulin (odds ratio = 4.12, p = 0.005) in the blood were observed to be independent predictors in the occurrence of NS. These two factors increased the likelihood of developing NS by approximately 1.5 and 4 times, respectively. Conclusion: Among the proteins assayed, CRP and gamma globulin were found to be predictors of NS. Nonetheless, further studies are required to understand the mechanisms associated with these serum proteins in NS.Item Serum leptin levels in patients with chronic kidney disease and hypertensive heart disease: An observational cross‐sectional study(Health Science Reports, 2023) Ofori, E.K.; Adekena, C.N.; Boima, V.; Asare‐Anane, H.; Yorke, E.; Nyarko, E.N.Y.; Mohammed, B.N.; Quansah, E.; Jayasinghe, S.U.; Amanquah, S.D.Background and Aim: Adipocytes secrete a peptide hormone called leptin, which plays a crucial role in controlling appetite and energy expenditure. Alterations in leptin concentrations are associated with CKD‐related cardiovascular problems such as hypertensive heart disease (HHD). Despite the link, data on the precise function of leptin in people with CKD and HHD is scant. Methods: An observational cross‐sectional study involving a total of 108 participants (72 CKD patients with HHD and 36 healthy controls). Their demographic and anthropometric information was collected using a standardized questionnaire. Certain clinical measures such as blood pressure and body mass index (BMI) were assessed. Fasting blood samples were analyzed for levels of plasma glucose (FPG), lipids, creatinine, and leptin. Data were analyzed with SPSS v23. Results: Leptin, FPG, creatinine and triglyceride levels were all significantly higher in CKD patients with HHD compared to controls (p < 0.01 for all). Furthermore, advanced CKD status (being in stage 5), having a 6‐year diagnosis of HHD, being female, having a higher BMI, and elevation in levels of HDL and FPG contributed significantly to the variance in serum leptin levels in the case group (β = 0.37, 0.22, 0.19, 0.18, 0.27, 0.28; p < 0.05 for all). In the control group, the female gender had the biggest unique effect on circulating leptin levels, followed by BMI and eGFR (β = 0.71, 0.34, −0.22; p < 0.01 for all). Conclusion: Patients with CKD who also had HHD reported considerably higher circulating leptin levels. Significantly higher blood leptin levels were shown to be associated with CKD stage 5 in the case group. These results are consistent with the role of leptin in the metabolic complexity seen in CKD patients. There needs to be more research into treatments that aim to lower leptin levels in CKD patients with HHD.Item Impact of blood perilipin A levels on obesity and metabolic health(. BMC Research Notes, 2022) Ofori, E.K.; Letsu, B.S.; Amponsah, S.K.; Ahenkorah, J.; Crabbe, S.; Kwao‑Zigah, G.; Oppong, S.Y.; Diaba‑Nuhoho, P.; Amanquah, S.D.Objective: Perilipin A is a common protein that coats lipid surfaces preventing them from being exposed to oxida‑ tive damage. Researchers have found little consistency in the relationship between perilipin A levels in the blood and body fat. This study was a cross-sectional observational that looked at circulating perilipin A levels and how they relate to metabolic health. Results: The participants in this study were 86 individuals with a mean age of 45.5±1.2 years. Multiple clinical and metabolic indicators (age, weight, BMI, total body fat mass, triglyceride, and HOMA-IR) were shown to be inversely associated with perilipin A levels (rho=− 0.32, − 0.37, − 0.40, − 0.45, − 0.33 and − 0.29; p<0.05 respectively). Obese persons were almost six times more likely than non-obese individuals to have lower perilipin A levels (odds ratio=6.22, CI=2.35–11.50, p<0.001). Our fndings underscore the important role of perilipin A proteins in metabolic health. KeywordItem Implementing Artificial Intelligence and Digital Health in Resource-Limited Settings? Top 10 Lessons We Learned in Congenital Heart Defects and Cardiology(OMICS A Journal of Integrative Biology, 2020-05-07) Ateko, R.O.; Dzobo, K.; Agamah, F.E.; Bope, C.D.; Thomford, N.E; Chimusa, E.; Mazandu, G.K.; Ntumba, S.B.; Dandara, C.; Wonkam, A.Artificial intelligence (AI) is one of the key drivers of digital health. Digital health and AI applications in medicine and biology are emerging worldwide, not only in resource-rich but also resource-limited regions. AI predates to the mid-20th century, but the current wave of AI builds in part on machine learning (ML), big data, and algorithms that can learn from massive amounts of online user data from patients or healthy persons. There are lessons to be learned from AI applications in different medical specialties and across developed and resourcelimited contexts. A case in point is congenital heart defects (CHDs) that continue to plague sub-Saharan Africa, which calls for innovative approaches to improve risk prediction and performance of the available diagnostics. Beyond CHDs, AI in cardiology is a promising context as well. The current suite of digital health applications in CHD and cardiology include complementary technologies such as neural networks, ML, natural language processing and deep learning, not to mention embedded digital sensors. Algorithms that build on these advances are beginning to complement traditional medical expertise while inviting us to redefine the concepts and definitions of expertise in molecular diagnostics and precision medicine. We examine and share here the lessons learned in current attempts to implement AI and digital health in CHD for precision risk prediction and diagnosis in resource-limited settings. These top 10 lessons on AI and digital health summarized in this expert review are relevant broadly beyond CHD in cardiology and medical innovations. As with AI itself that calls for systems approaches to data capture, analysis, and interpretation, both developed and developing countries can usefully learn from their respective experiences as digital health continues to evolve worldwide.Item Impact of exercise intensity on oxidative stress and selected metabolic markers in young adults in Ghana(BMC Research Notes, 2018-09) Diaba-Nuhoho, P.; Ofori, E.K.; Asare-Anane, H.; Oppong, S.Y.; Boamah, I.; Blackhurst, D.Objective This study aimed to evaluate the effect of different levels of exercise on markers of oxidative stress and selected metabolic parameters in Ghanaian young adults. Results Significant increases in a marker of oxidative stress malondialdehyde and antioxidants such as superoxide dismutase and uric acid were observed in the exercisers compared with the inactive group (p < 0.05). Total cholesterol and high density lipoprotein levels were significantly different (p < 0.05) between the two groups. Positive associations between exercise intensity, antioxidant concentration and malondialdehyde were observed within the exercise group for vigorous exercise with regards to uric acid, superoxide dismutase and malondialdehyde (r = 0.512, p = 0.004; r = 0.810, p = 0.001; r = 0.715, p = 0.001) respectively and moderate exercise vs malondialdehyde (r = 0.841, p = 0.001) compared to the inactive group. Exercise participants performed more vigorous exercise (p < 0.001), moderate exercise (p < 0.001) and more walking (p < 0.001) compared with the inactive group while the inactive group exhibited more sitting (p < 0.001). The study provides a first report on the risk associated with increase in oxidative stress and the importance of walking as a health promotion intervention among young Ghanaian adults.Item Fecal pancreatic elastase-1 in the diagnosis of chronic pancreatitis in patients attending a tertiary referral hospital in Ghana(Gastroenterology International, 2002-03) Nkrumah, K.N.; Rana, S.V.; Amanquah, S.D.Fecal pancreatic elastase-1 assays were performed in 56 patients attending medical and gastroenterology clinics with complaints of chronic or recurrent upper abdominal pains. Some of the patients already had confirmed diagnosis of chronic pancreatitis. The levels showed good correlation with these findings; they also enabled a firm diagnosis of chronic pancreatitis to be made in several cases.