School of Medicine and Dentistry
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Item Blood Pressure Variability Indices and Self-Reported Quality of Sleep Among Adolescents Living with HIV(University of Ghana, 2023) Kofi,A.Background: Children and adolescents living with HIV (ALHIV) are highly prone to develop cardiovascular diseases (CVDs) in the future. Blood pressure is a predictor for future development of cardiovascular diseases. Ambulatory Blood pressure indices predicts changes in blood pressure better than Office blood pressure. However, most healthcare facilities in Ghana use Office BP and Ambulatory blood pressure has not been used a lot. Most research evaluating the relation between HIV and blood pressure (BP) measurements have mainly focused on the conventional sphygmomanometric method, which carries a significant risk of human error and inaccuracy and does not accurately reflect the blood pressure characteristics of HIV positive patients BP variability Ambulatory blood pressure monitoring (ABPM), is a key instrument for evaluating blood pressure variability (BPV) which is a predictor of hypertensive end-organ damage. This study is a novel study and there is scanty literature on evaluating Blood pressure variability among ALHIV. This study may provide data and literature on blood pressure variability indices and self-reported sleep to help in the management of cardiovascular risk among ALHIV. Cardiovascular disorders among children and adolescents may also be contributed by poor sleep quality. Blood pressure changes over a 24-hour period might occur in HIV positive patients who have sleep disturbances. Lack of sleep may cause sympathetic activity to rise, which could raise blood pressure. General aim of study: The study aims to investigate the relationship between 24-hour ambulatory blood pressure variability indices and self-reported sleep quality among adolescents living with HIV. Methods: A cross-sectional study design was employed for this study. A cluster-randomized sampling technique was used to recruit health facilities and 122 adolescents living with HIV (ALHIV). A 24-hour ABPM was performed using a validated portable ABPM 50 device with the BP readings set at 15 minutes intervals, from 7 am to 10 pm for daytime, and 20 minutes intervals during the night, from 10 pm to 6 am. The Pittsburg Sleep Quality Index (PSQI) Questionnaire was used to assess the quality of sleep. Anthropometric measurement of participants was also conducted. Body weight (in kilograms) and height (in meters) were taken for the calculation of Body mass index (BMI). Variables such as Self-reported sleep quality, BMI, and ART regimen was held as independent variables while Beat-to-beat BPV variables and circadian variability variables were held as dependent variables Results: Ages of participants were from 6 years to 19 years; with a mean age of 13.6 ± 3.2 years. The males were (N=56(45.9%)) and the females were (N=66 (54.1%)). Most of the females (N=32(48.5%)) were aged 14 years and above. Females (N=21(31.8%)) had a healthier BMI compared to males (N=18(32.1%)). There was no significant relationship between gender and BMI of participants, p value= 0.25. Relationship between gender and antiretroviral therapy (ART) regimen was not significant, p-value=0.304. For sleep quality comparison among genders, most females reported poor sleep quality, (N=18(27.3%)). Most females had good sleep quality (N=48(72.7%)). Hypertension was reported among (N=13 (10.6)) of which (N=2 (1.64%) reported Hypertension stage 1 (>=pct90 and (pct99+5 mmHg/ 0.05. The p-value for the association between self-reported sleep and circadian variability (Nocturnal dip, p value=0.984, BP surge, p-value = 0.695). Findings from this study showed a significant association between cardiovascular outcomes and blood pressure variability. Cardiovascular outcomes of ALHIV was determined by ambulatory systolic blood pressure and office systolic blood pressure levels. For Ambulatory BP levels, study showed Blood pressure variability; Awake SD BPV increases with increasing ambulatory and office blood pressure, at an R-Squared value = 0.038 and p-value =0.03. Conclusion: Blood pressure variability may have a relationship with cardiovascular outcomes among ALHIV. Findings from this study shows that, as blood pressure variability increases, there is a tendency for blood pressure to also rise. Self-reported sleep quality did not have any significant association with short term blood pressure variability and circadian variability. ART and BMI showed some association with blood pressure variability. The study showed that most ALHIV have elevated blood pressure.Item Metabolic Syndrome And Generalized Anxiety Disorder Among Young Adult Ghanaians(University of Ghana, 2020-11) Baah, R.A.Background: Mental health has been associated with cardiovascular diseases (CVDs) in several studies. Negative affective disorders like generalized anxiety disorders (GAD) and depression are common in patients with CVDs. Depression and GAD can be screen in epidemiological studies using simple standardized questionnaires, GAD-7 and patient health quaestionnaire (PHQ)-9. Metabolic syndrome is the clustering of risk factors for CVDs such as obesity, insulin resistance, hyperglycaemia, hypertension and dyslipidaemia in an individual. The presence MetS is a strong predictor of future development of CVDs. The relationship between MetS and GAD has not been reported in the Ghanaian population. This study investigates MetS in young Ghanaian adults and its relationship with GAD and depression. General Aim: The aim of this study is to investigate the association between MetS and GAD as well as depression in young adults. Methodology: The study was a cross-sectional design involving 364 young adults, aged 20- 30 years, and recruited from Jamestown in the Accra Metropolis. The gender composition of the study participants were 174 (47.8%) males and 190 (52.2%) females. The study participants were interviewed using a structured questionnaire for socio-demographic and lifestyle information. GAD-7 and PHQ-9 instruments were used to screen GAD and depression, respectively. Anthropometric indices such as body fat, visceral fat, weight, height, waist and hip circumferences were measured. Blood pressure was measured using semiautomated blood pressure monitor. 10 millilitres of venous blood was collected and analysed for fasting plasma glucose, lipids and triglyceride. MetS was defined using the harmonized joint interim statement criteria. Results: The overall prevalence of MetS among the participants was 27.96%, with the female participants showing a higher prevalence of metabolic syndrome as compared to their male counterparts (37.4% vs 18.4%, p<0.001). Compared to the female participants, the male participants had high current alcohol use (33.9% vs 9.5%, p<0.001) as well as high current smoking status (13.2% vs 1.6%, p<0.001). The female participants had higher levels of systolic (119 }13 vs 113 }11, p< 0.001), diastolic (76 }10 vs 74 }8 p=0.002), pulse (76 }10 vs 74 }8, p=0.002) and mean (91 }10 vs 87 }8 p<0.001) as compared to their male counterparts. The prevalence of GAD was 39.6 % in all study participants, with females having more representation in mild anxiety category and males being presented more in moderate anxiety category. MetS was independently associated with mild [odd ratio (OR)=3.16 (1.04 – 9.59), p=0.042] and moderate [OR=1.57 (1.08 – 2.68), p=0.034] in multinominal logistic regression models. No association between depression and MetS was found. Conclusion: There is high prevalence of MetS in our study participants, with more females having MetS compared to males. GAD was also common among young adults and it is independently associated with MetS in the study population.Item Electronic Health Reacord (EHR) Benefit Realization: Assessing the Perception and Expectation among Electronic Health Record Users at the Volta River Authority (VRA) Clinic.(University of Ghana, 2018-07) Quaye, E.Electronic Health Records (EHR) are being flaunted as the “perfect” replacement for paper-based patient records yet many researches show that adoption and success rate of this Information Technology is less than satisfactory. Involvement of users in system specification and evaluation of performance of EHR has been suggested in literature as one key factor towards successful realization of EHR benefits. The study compares EHR users’ level of benefit realization expectations and their subsequent perception level of benefit realization after a few years (one-five years) of using the EHR system. Questionnaires were distributed to participants drawn from a sample of convenience. Non-parametric t-test statistics was used to determine if there were significant differences and relationships between pre-usage levels of expectations and subsequent levels of perceptions. The results showed that users maintained a high level of benefit realization expectations at the end of data collection period. However, participants also expressed some level of dissatisfaction with the current level of performance of the EHR.Item Metallo-Beta-Lactamase-Producing Acinetobacter Spp. From Clinical Isolates at a Tertiary Care Hospital in Accra, Ghana.(University of Ghana, 2017-07) Adetokunbo, M.O.T.Background: One of the most pertinent issues in health-care institutions is the emergence and global spread of metallo-β-lactamase (MBL) producing bacteria of blaVIM-, blaIMP- and blaNDM types. Metallo-β-lactamase producing-Acinetobacter has become a public health concern due to therapeutic treatment challenges associated with nosocomial infections. In Ghana, limited information is available on clinical isolates of MBL-producing-Acinetobacter. Aim: The aim of the study was to determine the prevalence of MBL-producing-Acinetobacter spp. of routinely collected clinical isolates from the Korle-Bu Teaching Hospital, Accra. Methodology: A total of 87 clinical isolates of Acinetobacter were routinely collected from cultures of aspirates, urine, ear, eye and wound swabs between August 2014 to July 2015. Susceptibility pattern was done by Kirby-Bauer disk diffusion method. Meropenem-resistant Acinetobacter isolates were screened for enzymes using Modified Hodge test (MHT) and carbapenem-EDTA combined disc test (CDT). Additionally, multiplex PCR was used to determined MBL genes (blaVIM, blaIMP and blaNDM) in MBL screen positive Acinetobacter isolates. Results: The 87 Acinetobacter isolates showed high levels of antibiotic resistance to cefotaxime (90.8%), ceftadizime (75.9%), co-trimoxazole (70.1%), ciprofloxacin (64.4%), gentamicin (72.4%), levofloxacin (67.8%) and meropenem (59.8%). A total of 54 (62.1%) of Acinetobacter isolates were multidrug-resistant. Out of 52 (59.8%) meropenem-resistant Acinetobacter, 3 (5.8%) were carbapenemase producers by MHT whilst, 23 (44.2%) were MBL screen positive by CDT. There was no significant difference between the resistance pattern of amikacin, ceftazidime, co-trimoxazole, ciprofloxacin and meropenem amongst MBL screen positive and MBL screen negative isolates (p-value >0.05). A total of 7 of 87 (8.1%) MBL screen positive Acinetobcter isolates harboured blaNDM. Of these, 4 (57.1%) were from wound swabs, urine 2 (28.6%) and ear swab 1 (14.3%). However, no blaVIM or blaIMP was detected. Conclusion: PCR analysis for blaVIM, blaIMP and blaNDM showed that less than 9% of 87 Acinetobacter spp. harboured NDM encoding genes. MBL-producing-Acinetobacter isolates showed high levels of resistance to multiple antibiotics. The detection of blaNDM amongst MBL producing-Acinetobacter is a cause for concern, therefore, strict antibiotics usage and infection control measures should be instituted to prevent the spread of these resistance genes. UniversityItem Pneumococcal Carriage Among HIVAIDS Patients in Accra, Ghana.(2017-07) Baffuor-Asare, M.Background: Streptococcus pneumoniae is part of the normal flora of the upper respiratory tract (nasopharynx) and carriage is a prerequisite for invasive pneumococcal diseases and dissemination of the pathogen from-person-to-person. HIV/AIDS patients are 30-100times more vulnerable to pneumococcal infections compared to HIV negative individuals. General Aim: The aim of the study was to investigate the epidemiology of pneumococcal carriage among HIV/AIDS patients at the Korle Bu Teaching Hospital and Princess Marie Louise Hospital, in Accra, Ghana. Methodology: The research was a prospective cross-sectional study. A total of 245 nasopharyngeal swabs were collected from consenting HIV/AIDS positive patients visiting the Korle Bu Teaching Hospital and the Princess Marie Louise Hospital in Accra, Ghana from November 2016 to March 2017. The samples were transported in Skim milk-tryptone soya broth glucose-glycerol(STGG) media on ice to the Microbiology Laboratory of the University of Ghana School of Biomedical and Allied Health and Sciences, Korle-Bu for processing. Identification and characterization of S. pneumoniae were done based on standard bacteriological methods described by the World Health Organization and the Clinical and Laboratory Standards Institute. Epidemiological data pertaining to demography, household characteristics and medical history were obtained from the study participants using a structured questionnaire. Results: Overall, pneumococcal carriage amongst the study population was determined to be 11.0%; carriage prevalence among the HIV/AIDS positive children and adults were 25.0% and 7.3% respectively. Pneumococcal antibiotic resistance prevalence was, Levofloxacin (0.0%), Erythromycin (7.4%), Tetracycline (66.7%), Cotrimoxazole (92.6%) and Penicillin non susceptibility defined as partial or complete resistance to penicillin was determined to be 25.9%. The prevalence of multidrug resistance defined as non-susceptibility to penicillin and two or more of the other classes of antibiotics used for this study was 18.5%. History of pneumococcal disease in the past 1year prior to sampling, Gender, School attendance and presence of respiratory symptoms were found to have significant associations with pneumococcal carriage with p-values <0.05 each. Conclusion: Overall, about one-tenth of the study participants carried pneumococcus and carriage in the children was 3-folds higher than in adults. Tetracycline and Cotrimoxazole may therefore be unsuitable for treating pneumococcal disease in HIV positive people. Several demographic and clinical features were found to have significant associations with pneumococcal carriage.Item Phenotypic and Genotypic Analysis of Onchocerca Volvulus Response To Ivermectin Treatment(University of Ghana, 2017-07) Yabani, J.E.Ivermectin remains the only potent drug for the control and mass treatment of onchocerciasis. Nonetheless, recent studies indicate sub-optimal responses and genetic changes in some populations of the adult Onchocerca volvulus. Hence, more studies are required to determine whether resistance is developing. This requires analysis of phenotypic and genotypic responses of O. volvulus to ivermectin treatment to determine the association between worm phenotype and genotype after treatment. Forty archived O. volvulus female worms were obtained from patients hailing from three Ghanaian endemic communities: Asubende, Kyingakrom and Agborlekame. These communities were known to harbour both good and poor ivermectin response groups. The female worms were retrieved from nodules removed from patients who previously had undergone 16-17 rounds of (150 µg/kg) ivermectin treatment with one year interval between treatments. The samples were obtained 3 months after the last round of treatment. Genetic analysis of the beta-tubulin gene of the adult worms and their pooled microfilariae (MF) on a 538 bp DNA fragment of the beta-tubulin gene as well as restriction was done to determine mutations in the beta-tubulin gene. It was detected that 70% (28/40) of the worms harboured greater than 70% of normal stretched MF in their genital tracts; these were considered as poor responders to ivermectin treatment. On the other hand, 30% (12/40) of the worms that harboured less than 10% of the stretched MF in their genital tracts were considered as good responders to ivermectin treatment. Molecular analysis indicated single nucleotide polymorphism (SNP) for both adult worm and their corresponding MF with the heterozygote mutant adult worms showing strong association with the MF. In conclusion, it is found in this study that some of the worms have responded poorly or sub-optimally to ivermectin treatment. This development stems from mutations in the beta-tubulin gene of the adult female worms that have been passed on to their progeniesItem Prevalence and Risk Factors of Symptomatic Gallbladder Stone Disease Using Ultrasonography(University of Ghana, 2014-07) Boateng, E. S; Hewlett, V.K; Arthur, L; Opoku, S.Y; University of Ghana, College of Health Sciences, School of Medicine and Dentistry, Department of RadiologyBackground: Diseases of the gallbladder are common and its management is costly. The best epidemiological screening method to accurately determine point prevalence of gallstones disease is ultrasonography. Symptomatic gallstones present with characteristic right upper quadrant discomfort or pain (biliary colic).Many risk factors for cholesterol gallstones formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for cholesterol gallstones are obesity, rapid weight loss and a sedentary lifestyle. The rising epidemic of obesity and the metabolic syndrome predicts an escalation of cholesterol gallstones frequency. Worldwide risk factors for biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease have been identified worldwide as risk for black pigment stones. The risk factors associated with gallstones in the Ghanaian context is however yet to be determined. Aim: The aim of this research study was to determine the prevalence and risk factors of symptomatic gallstones among Ghanaian patients in three hospitals in Accra. Methods: Using a quantitative cross sectional method, 100 patients aged more than 20 years were enrolled by convenient sampling method in April 2014 .They answered questionnaire pertaining to symptoms of gallstones, diet and environmental factors. Subsequently ultrasonography was performed in all the 100 participants with right upper quadrant abdominal pains using Toshiba Aplio 300 ultrasound scanner with a curvilinear transducer of frequency 5.0 MHz, 2005 make. The data was analyzed using SPSS version 13. Results: Ultrasonography revealed a 42% prevalence of gallstones at the selected hospitals. Chi-square test revealed a significantly increased risk of gallstones in females aged between 20-30years, 60-70years with multiparity status and a clinical history of right upper quadrant abdominal pains. An increased risk was revealed in diabetic males who drank unpurified water. Conclusion: A strong association was discovered between high cholesterol diet intake and gallstones disease. The study further revealed high prevalence of gallstones in females (47.2%) than males (28.6%).This finding is agreeable with most published literature which indicated female: male ratio of almost 2:1.Item Factors Influencing the Uptake of Intermittent Preventive Treatment of Malaria among Pregnant Women in the Gushegu District, Northern Region, Ghana(University of Ghana, 2014-06) Atasige, S.A.; Wurapa, F; University of Ghana College of Health Sciences , School of Medicine and Dentistry, Department of Oral Pathology and MedicineBackground: Despite reducing from 451 in 2007 to 350 in 2010 per 100,000 live births, Ghana has a high maternal mortality rate. NMCP target for IPTp2 is 80%, Ghana‟s coverage was 64.4% in 2011.This contrasts with 84.7% ANC attendance coverage for at least 4 visits. Northern Regional IPTp2 coverage is lower than the national average at 51.2%. In Gushegu 44% registered pregnant women received IPTp2 in 2013. Low IPTP coverage is a threat to reducing malaria incidence and maternal mortality. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp. Methods: A cross sectional study was conducted among ANC clients and staffs of the Gushegu RCH. Questionnaires were administered to 330 conveniently sampled nursing mothers and filled by ANC staff. A checklist was used for health facility observations. Univariate analyses of variables were expressed as frequencies and proportions. Bivariate analysis was used to show associations between the various independent and the dependent variables, Results: A total of 8.5% and 91.5% of respondents took inadequate (≤1dose) and adequate (≥2doses) IPTp-SP respectively. 85.4% respondents made early first ANC attendance, 92% are unemployed and 80% multiple gravidae. Mean ANC visits is 5. Mean gestational age at first attendance for inadequate and adequate dosage is 6 and 4 respectively. 25% and 15.5% reported side effects and malaria infection after SP use respectively. The odds ratios at 95%CI of Unemployment, single gravidae and late first ANC visit to predicting inadequate SP uptake were OR4.9 (1.88-13.14.), OR3.38 (1.52-7.55) and OR6.8 (2.96-15.40) respectively. DOT practice, good staff attitude and health talks at the facility was observed and confirmed by 96.7%, 94% and 87.2% of clients. ITNs coverage is 23% and usage72%. Conclusion: Adequate uptake of SP among respondents was high. Majority were unemployed, have had multiple pregnancies and made early first ANC visits. The mean number of ANC visits meets WHO standards. Unemployment, single parity and late first ANC visits are significantly associated with taking inadequate SP dose.ANC staff attitude and practices are satisfactory. The coverage of ITNs is low but its use is high among the respondents.Item An Immunohistochemical Study of Cytokine and Adhesion Molecule Expression In Human Brain in Fatal Cerebral Malaria.(University of Ghana, 2003-07) Armah, H.; Wiredu, E. K.; Adjei, A. A.; Tettey, Y.; University of Ghana, College of Health Sciences, School of Medicine and Dentistry, Department of Oral Pathology and MedicineIntroduction: Although the role of systemic proinflammatory cytokines, IL-ip and TNF-a, and their up-regulation of adhesion molecules, ICAM-1, VCAM-1 and E-Selectin, in the pathogenesis of cerebral malaria (CM) is well established, the role of local cytokine release remain unclear. Methods: Immunohistochemistry (IHC) was used to compare the expression of ICAM-1, VCAM-1, E-Selectin, IL-ip, TNF-a and TGF- P at light microscopic level in cerebral, cerebellar and brainstem postmortem cryostat sections from 10 CM, 5 severe malarial anaemia (SMA), 1 purulent bacterial meningitis (PBM), 2 non-central nervous system infections (NCNSI) and 3 non-infections (NI) deaths in Ghanaian children. Results: Fatal malaria and Salmonella sepsis showed significantly higher vascular expression of all 3 adhesion molecules, though their expression in the sepsis case was not as intense as that in the fatal malaria sections. There was highly significant co-localization of receptor expression with sequestration in the malaria cases, though there was negligible difference in their expression between the CM and SMA sections. TGF-P showed intravascular and perivascular distribution in all cases, but expression was most intense in the PBM case and CM group. TNF-a and IL-ip showed prominent brain parenchymal staining, in addition to intravascular and perivascular staining, in only the PBM case and CM group. The increased expression of the adhesion molecules was associated with increased local proinflammatory cytokine release in the CM sections, but not in the SMA group. The maximal expression of all 6 antigens studied was in the cerebellar sections of the malaria cases. Conclusions: Endothelial activation is a feature of fatal malaria and Salmonella sepsis, with adhesion molecule expression being highly co-localized with sequestration in fatal malaria. IL-ip and TNF-a are expressed in only cases with neurodegenerative lesions, whilst TGF-P is present in all cases. Both cytokines and adhesion molecules were maximally expressed in the cerebellar sections of the malaria cases.Item Maternally transferred antibody levels and IgG3 hinge region length polymorphisms in the risk of clinical malaria in infants in a birth cohort at Kintampo, Ghana.(University of Ghana, 2014-07) Opoku-Mensah, J.; Dodoo, D.; Asante, P. K.Introduction: Plasmodium falciparum malaria remains a global public health threat especially for children under five years. Fetuses receive maternal immunoglobulins in utero by passive transfer and this is believed to protect infants at least for the first six months after delivery. IgG3 among the IgG subclasses is known to be more protective because of the long hinge region making the molecule flexible and easier to link antigens and Fc receptors for antigen elimination. However, there are hinge region polymorphisms among the IgG3 molecules that may have an impact on their protective potential. Aim: This study investigated the relationship between maternally transferred total IgG (IgG) levels and their subclasses against GLURP R0 and MSP1-19. Also to investigate the role of infants’ IgG3 hinge region length polymorphisms in the risk of clinical malaria in a birth cohort at Kintampo, Ghana. Methodology: Serum and blood blots samples with the clinical data of participants were taken from a previous birth cohort study conducted in Kintampo. Serum samples were taken from cord blood at birth (month 0), month 3 and month 6 from 202 infants for immunoglobulins level measurement against GLURP R0 and MSP1-19 using indirect ELISA. IgG with its subclasses were measured at month 0 and IgG3 levels measured at months 3 and 6. One hundred and forty blood blots were selected to determine infants’ IgG3 hinge region length polymorphisms using polymerase chain reaction (PCR). Results: Among 202 infants, 112 (55.45%) were not protected from clinical malaria (presence of parasites and fever), 68 (33.66%) had asymptomatic parasitaemia (protected) and 22 (10.89%) had no parasites and no fever (indeterminate group). There weresignificant differences in anti-GLURP R0 and anti-MSP1-19 total IgG levels at birth (p < 0.05) between protected and non-protected infants but not so for the subclasses. There was a sharp decrease in IgG3 levels against both antigens from month 0 to month 3. Among the 138 infants whose IgG3 hinge region length polymorphisms (IgG3HRLPs) were genotyped, 93.33% had clinical malaria in first year of life. Four IgG3HRLP genotypes were found. The homozygote medium (MM) polymorphism had the highest frequency of 53.33%, followed by the homozygote long (LL) polymorphism with a frequency of 42.22%. The homozygote short (SS) and heterozygote long-medium (LM) polymorphisms were very few among these infants. Conclusion: Maternally transferred anti-GLURP R0 and anti-MSP1-19 IgG levels at birth were associated with protection against clinical malaria in infants but the subclasses were not. Infants’ IgG3HRLPs was not associated with protection from clinical malaria after one year.
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