Emmanuel Kwasi Abu

Investigation of amplitude of accommodation among Ghanaian school children

Background:  Deficient amplitude of accommodation is the most frequently used criteria in an optometric practice in diagnosing whether a patient has accommodative insufficiency. This deficiency is determined based on an age‐related expected finding calculated using Hofstetters equation derived from Donders and Duanes data. The aim of the present study was to investigate the amplitude of accommodation among Ghanaian school children and to compare the findings with age‐expected norms predicted by Hofstetters equation.

Infection risk factors associated with seropositivity for Toxoplasma gondii in a population-based study in the Central Region, Ghana.

About 20-90% of the worlds population has had contact with Toxoplasma gondii parasites. The aim of this study was to determine the seroprevalence and risk factors associated with T. gondii infection in the Central Region, Ghana. A community-based cross-sectional study was conducted in three selected communities. Serum samples were tested for the presence of anti-T. gondii IgG and IgM antibodies by ELISA. A serological criterion for seropositivity was a positive test result for any of the two anti-Toxoplasma IgG or IgM antibodies or a combination of both. In all, 390 participants of mean age 47.0 years consisting of 118 (30.%) males and 272 (69.7%) females were tested. The overall seroprevalence of T. gondii was 85% (333/390) where fishermen, farmers and fishmongers, respectively, had the highest seropositivity. IgG and IgM antibodies were detected in 329 (84%) and 25 (6%), respectively, while both IgG and IgM antibodies were detected in 21 (5%) of the participants. Respectively, 1% (4/390) and 79% (308/390) of participants tested positive for IgM-only and IgG-only antibodies. There was a significant relationship between Toxoplasma seropositivity and contact with soil, presence of a cat in the surrounding area, age, sources of drinking water, level of formal education, and socioeconomic status. The results suggest that the seashore may serve as a good ground for sporulation and survival of Toxoplasma oocysts.

Visual Outcome in Ocular Toxoplasmosis: A Case Series of 30 Patients from Ghana

Purpose: To determine visual outcome (low vision and blindness) in patients with inactive ocular toxoplasmosis. Methods: This study employed a cross sectional design involving a series of 30 patients with inactive toxoplasmic ocular lesions. Ophthalmic assessment including best corrected visual acuity (BCVA) measurement, slit lamp biomicroscopy, and dilated fundus examination by indirect ophthalmoscopy was performed on all participants. Ocular toxoplasmosis was diagnosed based on characteristic retinal lesions in addition to a positive serologic testing using commercial ELISA kits. Visual impairment (VI) was determined based on the International Classification of Diseases. Results: Their ages ranged from 16-59 years (mean age of 34.2 ± 14.19), with 19 (63.3%) males and 11 (36.7%) females. There were 33 infected eyes in all (3 patients had bilateral cases). The most common complaint (77%) was blurred vision in the infected eyes. 11 (33%) eyes had mild or no visual impairment (VI category 1), 22 (67%) eyes had low vision (VA<6/18), and 11 (33%) eyes were blind (VA<3/60). Posterior pole (p<0.001) and larger retinal lesions (p=0.04) were the major causes of visual impairment. However, there was no association between visual impairment and the number of lesions occurring in the infected eyes (χ2=3.52, p=0.11). Older patient age was significantly associated with: posterior pole lesions (0.003), larger retinal lesion sizes (p=0.001) and multiple lesions (p=0.001). Only three cases each of strabismus and bilateral involvement suggest that acquired infection is more common in this Ghanaian population. Conclusion: Low vision and blindness were common in Toxoplasma eye infection in our Ghanaian population and that posterior pole and larger retinal lesions rather than multiple lesions were the major causes of reduced vision.

Anti-Cataract Potential of Heliotropium indicum Linn on Galactose-Induced Cataract in Sprague-Dawley Rats

ABSTRACT Objective: To evaluate the anti-cataract potential of an aqueous whole plant extract of Heliotropium indicum (HIE) on galactose-induced cataract in Sprague-Dawley rats. Materials and methods: Cataract scores were recorded in 3-week-old Sprague-Dawley rats in which cataract was being induced by an oral administration of 1500 mgkg−1 galactose twice daily for 4 weeks, and concurrently being treated with 30, 100, or 300 mgkg−1 HIE daily over the induction period. Fasting blood glucose was monitored at weekly intervals. Changes in body weight as well as total lens protein, lens glutathione, and superoxide dismutase (SOD) were determined initially, and at the end of the experimental period. Crystalline lens weight-to-body-weight ratio was also determined for the various treatment groups at the end of the experimental period. Preliminary phytochemical screening, total antioxidant capacity, and reducing power assays were conducted on HIE. Results: The 30 and 100 mgkg−1 HIE-treated rats recorded significantly lower (p ≤ 0.05–0.001) cataract scores (indicating very significant delays in cataractogenesis by the 3rd and 4th weeks of treatment) and blood glucose levels. Rats with delayed cataractogenesis also exhibited significant (p ≤ 0.05–0.001) weight gain, and reduction in lens weight. Total lens proteins glutathione and SOD levels in the crystalline lens were also significantly preserved (p ≤ 0.01–0.001). HIE showed substantial antioxidant capacity and reducing power. Conclusion: The aqueous whole plant extract of Heliotropium indicum delays cataractogenesis at an optimum dose of 30 mgkg−1 in Sprague-Dawley rats.

Epidemiology of Ocular Toxoplasmosis in Three Community Surveys in the Central Region of Ghana, West Africa

ABSTRACT Purpose: To conduct the first ever population-based survey on ocular toxoplasmosis in the Central Region of Ghana. Methods: A cross-sectional population-based study was conducted in three randomly selected communities in the Central Region, Ghana. Visual acuity (VA) measurement, dilated fundus examination by indirect ophthalmoscopy and serology testing were performed on all participants. Ocular toxoplasmosis was diagnosed based on characteristic retinal lesions and supported by positive serologic testing using commercial enzyme-linked immunosorbent assay (ELISA) kits. Results: A total of 390 subjects aged 10–100 years (mean age 47 years) were examined; 118 (30.3%) were male and 272 (69.7%) female. Ten subjects (6 females and 4 males) had toxoplasmic ocular lesions (prevalence 2.6%). Of these, two had bilateral lesions and eight had unilateral lesions. Subjects with toxoplasmic ocular lesions were older than those without lesions (p = 0.028). The development of ocular toxoplasmosis was not associated with rural dwelling, sex, keeping cats, or consumption of meat. Conclusion: The prevalence of ocular toxoplasmosis in our Ghanaian study population was lower than findings from Southern Brazil, where there is a similar prevalence of infection in the general population.

Visual impairment attributable to uncorrected refractive error and other causes in the Ghanaian youth: The University of Cape Coast Survey

Purpose To determine the prevalence of visual impairment attributable to refractive error and other causes in a youthful Ghanaian population. Methods A prospective survey of all consecutive visits by first-year tertiary students to the Optometry clinic between August, 2013 and April, 2014. Of the 4378 first-year students aged 16–39 years enumerated, 3437 (78.5%) underwent the eye examination. The examination protocol included presenting visual acuity (PVA), ocular motility, and slit-lamp examination of the external eye, anterior segment and media, and non-dilated fundus examination. Pinhole acuity and fundus examination were performed when the PVA ≤ 6/12 in one or both eyes to determine the principal cause of the vision loss. Results The mean age of participants was 21.86 years (95% CI: 21.72–21.99). The prevalence of bilateral visual impairment (BVI; PVA in the better eye ≤6/12) and unilateral visual impairment UVI; PVA in the worse eye ≤6/12) were 3.08% (95% CI: 2.56–3.72) and 0.79% (95% CI: 0.54–1.14), respectively. Among 106 participants with BVI, refractive error (96.2%) and corneal opacity (3.8%) were the causes. Of the 27 participants with UVI, refractive error (44.4%), maculopathy (18.5%) and retinal disease (14.8%) were the major causes. There was unequal distribution of BVI in the different age groups, with those above 20 years having a lesser burden. Conclusion Eye screening and provision of affordable spectacle correction to the youth could be timely to eliminate visual impairment.

Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana

Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including χ2, independent t-test, and ANOVA were done. A p value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bells palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm3. The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders (t = 2.5, p = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders (t = 2.8, p = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders.

Comparing different methods of measuring accommodative amplitude with Hofstetter’s normative values in a Ghanaian population

ABSTRACT Aim: Amplitude of accommodation (AoA) can be determined clinically using different methods. Some methods are known to be more reliable than others for measuring AoA in different age categories. The purpose of this study was to compare Hofstetter’s age-expected norms with five recommended methods of measuring AoA in order to determine age-appropriate techniques for a Ghanaian population. Materials and methods: AoA was measured using four subjective methods (push-up, push-down, minus lens, and modified push-up) and one objective method, the modified dynamic retinoscopy. The amplitudes obtained by each technique were compared to each other and also compared to the age-expected amplitudes as predicted by Hofstetter’s equations. Results: 352 non-presbyopes aged 10–39 years were included in this study. All five methods except the push-up (p = 0.089) and modified push-up (p = 0.081) differed significantly from Hofstetter’s data, while the modified dynamic retinoscopy recorded the strongest agreement with Hofstetter’s average (ICC = 0.78, p ˂ 0.001). With reference to Hofstetter’s expected AoA, the minus lens, push-down, modified dynamic retinoscopy, and modified push-up methods underestimated AoA by −4.18D, −1.99D, −0.48D, and −0.43D, respectively. As age increased, underestimated AoA values by the minus lens (10–19 years: −5.57D, 20–29 years: −3.50D, 30–39 years: −2.39D), modified push-up (10–19 years: −1.51D, 20–29 years: +0.40D, 30–39 years: +0.56D), and push-down (10–19 years: −2.90D, 20–29 years: −1.07D, 30–39 years: −1.46D) methods decreased but the modified push-up in relation to Hofstetter’s expected was most accurate for the older age. The push-up, on the other hand, overestimated accommodation in all age categories by +0.42D (10–19 years: +0.01D, 20–29 years: +0.82D, 30–39 years: 0.67D). Thus, the push-up method became more accurate as age decreased. Conclusion: This study suggested that Hofstetter’s formulae could be used to predict the amplitudes of Ghanaian non-presbyopes aged 10–39 years using the push-up and modified push-up. With regard to Hofstetter’s data, the push-up method was more accurate for the younger age-group 10–19 years while the modified push-up was more accurate for the older age-group 20–39.

Associations between Polymorphisms within Interferon Gamma and Tumor Necrosis Factor Genes and Toxoplasma Retinochoroiditis in Ghanaian Patients

ABSTRACT Purpose: To evaluate associations between IFN-γ +874T/A and TNF-α-308G/A polymorphism with the development of Toxoplasma retinochoroiditis. Methods: By ARMS–PCR, a cross-sectional genetic study involving 30 patients with Toxoplasma retinochoroiditis and 87 controls was carried out. Results: IFN-γ +874: by comparing with the AA genotype, individuals with the TT genotype had a 3.4 odds ratio (OR); AT had a 1.6 OR; and the T allele had a higher OR (1.6), indicating a likely susceptibility of IFN-γ +874T to the infection, though the overall distribution was not significant (p = 0.259). For TNF-α-308G/A, individuals with both GA and AA genotypes had lower ORs when compared with the GG genotype, implying the A allele could confer protection against Toxoplasma ocular lesions. Conclusions: IFN-γ +874T allele may increase the risk of ocular lesions in Toxoplasma infection. The principle of natural selection seems to also play a role. The less common TNF-308A allelic form could be protective against the development of Toxoplasma ocular infection.

Caesarean section in a primary health facility in Ghana: Clinical indications and feto-maternal outcomes

There is great concern about the increasing rise in the rate of caesarean section in both developed and developing countries. This study was to ascertain the prevalence and compare outcomes of elective and emergency caesarean sections among women who deliver at the University of Cape Coast Hospital, Ghana. This retrospective study reviewed records of 645 women who delivered through caesarean sections during the period of January 2014 and December 2015. The prevalence of caesarean section was 26.9%. There was a significantly higher rate of adverse fetal outcomes (P=0.016) among babies born through emergency caesarean section. There were 12 (1.9%) women who had caesarean section done based on maternal request. The caesarean section rate found in this study was high. The lack of availability of technology for diagnosing fetal distress found in this study could possibly lead to over diagnosis of fetal distress. Thus availability of such diagnostic technology could reduce the high caesarean section rate. The high numbers of women requesting caesarean section without medical indication should be investigated and the motivation factors identified so as to curb the practice.