School of Medicine and Dentistry
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Item Streptococcus Mutans and Lactobacillus Species Infection in Obese and Non Obese School Children in Accra, Ghana(Journal of Obesity and Overweight, 2015) Ndanu, T.A.; Aryeetey, R.; Sackeyfio, J.; et al.Background: Streptococcus mutans and Lactobacillus species are major bacteria associated with dental caries. In the presence of fermentable sugars and poor oral hygiene, these bacteria increase the risk of caries. Some studies have associated obesity with dental caries while others did not. High-sugar snacks are risks for both obesity and dental caries. Citation: Ndanu TA, Aryeetey R, Sackeyfio J, Otoo G, Lartey A, et al. (2015) Streptococcus mutans and Lactobacillus Species Infection in Obese and Non-Obese School Children in Accra, Ghana. J Obes Overweig 1(1): 101. doi: 10.15744/2455-7633.1.101 Objectives: This study aimed at determining Streptococcus mutans and Lactobacillus species infection and its relationship with dental caries among obese and non-obese children. Methods: Oral plaque was taken from 75 obese and non-obese children from private schools in Accra, Ghana. The plaque was pre-enriched in thioglycollate broth for 48 hours at 37 °C. Streptococcus mutans and Lactobacillus species were recovered after sub-culturing the broths onto Mitis Salivarius Bacitracin (MSB) and Man Rogosa Sharpe (MRS) selective plates, respectively, and incubation at 37 °C under anaerobic conditions. Bacteria isolates on the selective plates were identified using Gram morphology and catalase activity. Results: Streptococcus mutans was isolated in 51 (33.6%) of all 150 children. The prevalence of Streptococcus mutans was significantly higher in the obese children 31 (41.3%) than the non-obese 20 (26.0%), p=0.033. Recovery of Lactobacillus species was low 2 (1.3%). Caries prevalence was similar in the obese 14.9% and non-obese 15.1%. There was no significant association between Streptococcus mutans infection and the dental caries. Overall Silness and LÖe Plaque Index of 1.1 ± 0.5 indicate good oral hygiene status for the children. Conclusion: Obese school children had higher oral Streptococcus mutans infections than non-obese children but this was not significantly associated with dental caries prevalence.Item Streptococcus Mutans and Lactobacillus Species Infection in Obese and Non Obese School Children in Accra, Ghana(Journal of Obesity and Overweight, 2015) Ndanu, T.A.; Aryeetey, R.; Sackeyfio, J.; et al.Background: Streptococcus mutans and Lactobacillus species are major bacteria associated with dental caries. In the presence of fermentable sugars and poor oral hygiene, these bacteria increase the risk of caries. Some studies have associated obesity with dental caries while others did not. High-sugar snacks are risks for both obesity and dental caries. Citation: Ndanu TA, Aryeetey R, Sackeyfio J, Otoo G, Lartey A, et al. (2015) Streptococcus mutans and Lactobacillus Species Infection in Obese and Non-Obese School Children in Accra, Ghana. J Obes Overweig 1(1): 101 Objectives: This study aimed at determining Streptococcus mutans and Lactobacillus species infection and its relationship with dental caries among obese and non-obese children. Methods: Oral plaque was taken from 75 obese and non-obese children from private schools in Accra, Ghana. The plaque was pre-enriched in thioglycollate broth for 48 hours at 37 °C. Streptococcus mutants and Lactobacillus species were recovered after sub-culturing the broths onto Mitis Salivarius Bacitracin (MSB) and Man Rogosa Sharpe (MRS) selective plates, respectively, and incubation at 37 °C under anaerobic conditional morphology and catalase activity identified bacteriuria isolates on the selective privity. Results: Streptococcus mutans was isolated in 51 (33.6%) of all 150 children. The prevalence of Streptococcus mutans was significantly higher in the obese children 31 (41.3%) than the non-obese 20 (26.0%), p=0.033. Recovery of Lactobacillus species was low 2 (1.3%). Caries prevalence was similar in the obese 14.9% and non-obese 15.1%. There was no significant association between Streptococcus mutans infection and the dental caries. Overall Silness and LÖe Plaque Index of 1.1 ± 0.5 indicate good oral hygiene status for the children. Conclusion: Obese school children had higher oral Streptococcus mutans infections than non-obese children but this was not significantly associated with dental caries prevalence.Item Oral Hygiene Practices and Caries Prevalence among 9-15 Years Old Ghanaian School Children(Journal of Nutrition and Health Sciences, 2015) Ndanu, T.A.; Aryeetey, R.; Sackeyfio, J.; et al.Introduction: Good oral hygiene protects against oral diseases such as caries and gum infections. Twice daily tooth brushing with fluoride pastes and flossing is recommended to keep the mouth clean and reduce plaque bacterial growth. Poor access to oral cleaning material and dental care services exposes children from poor backgrounds to oral diseases. Objectives: The study assessed oral hygiene practices and caries prevalence among school children. Dental caries and gum disease are the most common oral diseases in children [1] and may be associated with severe pain [2-4]. The pain may interfere with food intake and affect the normal growth of the child [1,5]. Globally prevalence of dental caries is declining but the factors that predispose children to caries persist [6]. These factors include high snacking habits and bad oral hygiene practices [7]. Studies have indicated that socio-economic factors are associated with caries prevalence in both adults and children [4,8,9]. Dental caries was shown to be most prevalent in school children from poorer families. These Children also had a greater number of untreated oral lesions [10,11]. Dental Caries is an infectious disease caused by the acid produced by the fermentation of simple sugars by oral bacteria, the chief of which are streptococcus mutans and lactobacillus species [12,13]. Although sugars are provided by the type of diet consumed especially in our snacks, its effect on caries shows only when it is accompanied by poor oral hygiene practices and resultant poor oral hygiene status [14,15]. Oral cleanliness is therefore a basic factor for good oral health, especially in children. Poor oral hygiene leads to dental plaque formation [16,17]. Dental plaque, the soft adherent materials deposited on the tooth surface may consist of bacteria, desquamated epithelial cells, and migrated polymorphonuclear leukocytes [18]. A study in suburban school children in Accra reported plaque accumulation of 90% in 5-6 year-olds but 54% in 9-year-olds. [19]. Poor oral hygiene therefore allows the bacteria in the plaque to thrive and then ferment sugars in foods to produce acid that leads to dental caries. Methods: A cross-section of 9-15-year-old school children (n=1,040) were randomly selected from private and public schools in Accra, Ghana. Oral hygiene and snacking habits were assessed by interview using a structured questionnaire. Oral cleanliness and dental caries were assessed by oral examination by two calibrated dental surgeons. Silness and LÖe Plaque Index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were used to determine oral hygiene and caries status respectively. Results: The mean age of the sample was 12.01±1.52 years. Overall caries prevalence was 17.4% but (19.9%) in the public and (15.1%) in the private schools. It was higher in the females (19.3%) than the males (15.1%) in both private and public schools. Almost all (96.6%) brushed once a day. About 60.0% had plaque and 64.4% had supra gingival calculus. The overall mean DMFT score was 1.138±0.476. Types of snacks taken in a day and weekly frequency of snacks were significantly higher in the private schools than in the public school children. Overall, oral hygiene status was acceptable in the children. Lack of good oral hygiene therefore becomes the single most important factor in determining the risk of caries, especially in children. Frequent snacking on sugar foods such as soft drinks, candies, fruit drinks, and high-sugar fruits may increase the risk of caries in children [20,21]. Simple mouth cleaning practices can easily clear this sugar substrate remove oral plaque, and reduce the incidence of dental caries. Caries will occur when plaque pH levels drop below 5.5 due to increased acid production in the dental plaque from the fermentation of sugars in the foods consumed [22]. Conclusion: Oral hygiene practices and status were comparable in the private and public schools. Snacking frequency was high in both groups but did not account for the differences in caries prevalence observed.Item Evolution of Modern Medicine in Ghana: 1880-1960(University of Ghana, 1995-09) Addae, S.An attempt has been made in this work to narrate the evolution of modern medicine in Ghana between 1880 and 1960. The work deals with public health services only, government being the overwhelming provider of medical services. First, the Colonial Office's medical policies which guided the local colonial government in public health matters are described. This is followed by a description of the evolution and growth of public health infrastructure, curative and preventive health services, sanitation and health education. The special means by which public health services reached the rural community are described as are the development and growth of the professional and the supporting medical staff, tropical medical research, the major diseases of the time and how they were handled by the Medical Department. It ends with a description of medical education of the indigenous Africans, the early failed attempt by the colonial government, and the eventual success of the first African government, to establish a medical school in the country. Starting from scratch in the 1880s, the colonial governments built up a public health service, which, by 1930, could boast a quite modern complexion. From the 1920s, Africans increasingly embraced modern medicine and they, from then, became the chief users of the services. Sanitary reforms, though started from very primitive beginnings, had by 1950 become a regular feature of public health. By 1950, the major epidemic and certain hyperendemic diseases had been eliminated or tamed. The growth of the professional medical and subordinate staff was exceedingly slow and was never able to cope with the grow1ng African population and the ever-lengthening queues of African patients. The colonial government bequeathed the first African government, from 1951, a health service which was largely curative-oriented; this was the greatest shortcoming of the colonial public medical serV1ce. By 1960, under the first African government, health facilities had been greatly expanded, particularly in the rural areas; medical personnel had also been greatly augmented. The first African government's greatest failure was its inability to shift its focus from curative medicine to preventive health; it passed on, in turn, to future African governments, the heavy burden of continued concentration on curative service with which governments increasingly found themselves unable to cope.Item Phenotypic and Molecular Characterization of Extended-Spectrum Βeta-Lactamases in Klebsiella Pneumoniae and Escherichia Coli Isolates in Accra, Ghana(University of Ghana, 2015-06) Hackman, H. K.; Twum-Danso, K.; Brown, C. A.; University of Ghana, College of Health Sciences, School of Medicine and Dentistry Department of Biomaterial SciencesExtended-spectrum beta-lactamases (ESBLs) are plasmid-mediated enzymes capable of hydrolysing beta-lactams except carbapenems and cephamycins but are inhibited by beta-lactamase inhibitors. Most of these ESBL plasmids also carry genes conferring resistance to several non-beta-lactam antimicrobials. Hence, ESBL-producing isolates limit therapeutic options, contribute to treatment failure, increase morbidity and mortality, prolong hospitalization and increase cost of healthcare. There is no published work on the genetic characterization of ESBL producing strains, the characteristic antimicrobial resistance profile of CTX-M and TEM ESBL producers and the occurrence of AmpC beta-lactamases among ESBL and non-ESBL phenotypes in Accra. This work determined the phenotypic and molecular characterization of ESBLs in K. pneumoniae and E. coli isolates and their antimicrobial resistance profile in Accra. Four hundred (400) K. pneumoniae and E. coli non-duplicate isolates were collected at Korle Bu Teaching Hospital and Advent Clinical Laboratories. The species identification, ESBL detection, MIC and antimicrobial susceptibility testing were concurrently determined using Vitek 2 Compact System. The Combined Disc Synergy Method (CDM) was used to confirm ESBL-producing strains. The isolates were screened for AmpC beta-lactamase phenotypes using disc synergy testing. The genotypes of the ESBL-coding genes were determined by PCR using already published primers. The results showed that 202 (50.5%) of the bacterial isolates were ESBL-producers with high co-resistance to beta-lactams, beta-lactam/beta-lactamase inhibitors and non-beta-lactams. The sensitivity (98.5%), specificity (98.9%), positive predictive value (99%) and negative predictive value (98.5%) of Vitek 2 Compact system confirmed it as a rapid and reliable system for accurate detection of ESBL strains in Accra. The findings of this current study showed a low rate of AmpC beta-lactamase phenotypes which might not to interfere with the detection of ESBL producers. There were significant differences (p<0.05) between the resistance of ESBL producers and non-ESBL producers to beta-lactams, beta-lactam/beta-lactamase inhibitors and non-beta-lactams. Of a 100 randomly selected ESBL producers based on the MIC of cefotaxime, CTX-M (90%) and CTX-M-1group (78%) were the dominant ESBL genes, 2% were positive for CTX-M-9 group ESBL genes and 25% had TEM genes. None of the ESBL producers possessed SHV genes. CTX-M-type ESBLs are more efficient in hydrolysing cefotaxime with typical cefotaxime MIC of ≥64μg/ml. TEM-type ESBL producers appeared to be more efficient in hydrolysing ceftazidime than CTX-M-types ESBL producers and hydrolysed both ceftazidime and cefotaxime. The CTX-M-type and TEM-type ESBLs showed co-resistances to beta-lactams, beta-lactam/beta-lactamase inhibitors and non-beta-lactams and hydrolysed cefepime with less efficiency. Imipenem and amikacin were the drugs of choice for managing CTX-M and TEM-type ESBL producers. It is vital to routinely detect ESBL-phenotypes and implement appropriate antimicrobial stewardship programs in health facilities. Further studies into the sequencing of ESBL genes is recommended to determine specific ESBL gene present in a strain. Department of PsychiatryCollection Department of RadiologyCollection Department of Restorative DentistryCollection Department of Restorative DentistryCollection