Francis Agyemang Yeboah

Blood haemoglobin measurement as a predictive indicator for the progression of HIV/AIDS in resource-limited setting.

BackgroundAnaemia is a frequent complication of infection with the human immunodeficiency virus (HIV) and may have multiple causes. The objective of this study was to find out if blood haemoglobin measurement could be used as an indicator for the progression of HIV/AIDS in resource-limited setting.MethodsTwo hundred and twenty-eight (228) consented People Living with HIV/AIDS (PLWHAs) who were placed in three groups according to their CD4 counts were used in the study. The three groups were those with CD4 counts (1) ≥ 500 mm-3; (2) 200-499 mm-3; and (3) < 200 mm-3. One hundred (100) sex, age-matched and healthy HIV-seronegative individuals were used as control subjects. Blood haemoglobin, blood haematocrit, Red cell indices which included Mean Cell Volume, Mean Cell Haemoglobin Concentration and Mean Cell Haemoglobin and CD4 count were analysed in all subjects.ResultsThe mean blood haemoglobin concentrations in those with CD4 counts < 200 mm-3, 200-499 mm-3 and ≥ 500 mm-3 (8.83 ± 0.22 g/dl, 10.03 ± 0.31 g/dl and 11.3 ± 0.44 g/dl respectively) were significantly lower when compared with the control group (14.29 ± 0.77 g/dl) (p < 0.0001). The mean blood haematocrit levels in those with CD4 counts < 200 mm-3, 200-499 mm-3 and ≥ 500 mm-3 (23.53 ± 0.85%, 28.28 ± 0.77% and 33.54 ± 1.35% respectively) were also significantly lower when compared with the control group (41.15 ± 2.15%) (p < 0.0001). The red cell indices were also lower in the subjects when compared with the control group. Using the Pearsons correlation, there was a significant and positive correlation between the blood haemoglobin level and their CD4 counts ( r2 = 0.1755; p < 0.0001).ConclusionAnaemia in People Living with HIV/AIDS, if persistent, is associated with substantially decreased survival. From our analysis, there was a decrease in the blood haemoglobin, levels as the HIV infection progressed and our findings are consistent with those of other studies of anaemia as a prognostic factor in HIV infection. Haemoglobin levels could be measured easily where resources for more sophisticated laboratory markers such as viral load or even CD4 lymphocyte count are not available given that measurement of the CD4 lymphocyte count requires flow cytometry, an expensive technique unavailable in many developing countries. Regular measurements could help to determine which patients are at greatest risk of disease progression, allowing these patients to be identified for closer monitoring or therapeutic intervention.

Clinical and epidemiological characterisation of Burkitt's lymphoma: an eight-year case study at Komfo Anokye Teaching Hospital, Ghana.

Abstract Endemic Burkitt’s lymphoma (BL) is a juvenile malignant neoplasm of B-lymphocyte origin, markedly affected by climate, vegetation and geographical location. This real country-based, cross-sectional, retrospective study reviews all out-patient clinical records of patients histologically and/or clinically diagnosed with BL from January, 2000 to December, 2007 at the Komfo Anokye Teaching Hospital, Ghana, a country within the malaria and lymphoma belts of the world. The aim of the study is to clinically and epidemiologically characterise all cases of BL over an eight-year period to ascertain the most common form of BL demographically prevalent. A mean age of 6.9±2.7 (range: 1–16) was observed. Males generally dominated in incidence (M:F=1.43:1, P< 0.001) and significantly with facial presentation (P<0.05). Females weakly dominated in abdominal tumour presentation (P>0.05). The age range 4–8 years was the high risk range (P< 0.001) for both sexes. Males were affected early in life (4–7 years) compared to their female counterparts (6–11 years). Of the 551 cases reviewed, 48.3%, 32.7%, 15.8% and 3.3% involved the face, abdomen, combined facial and abdominal and either facial or abdominal with central nervous system (CNS) involvement (usually paraplegia), respectively. An intriguing observation was evident between facial and combined facial and abdominal cases which exhibited reversed trends in incidence. Three regions within the forest zone showed significantly higher (P< 0.001) incidences compared to the seven cohorts from the coastal and savannah agro-ecological zones of Ghana. No region was explicitly associated with any particular clinical presentation. The study has shown that although BL can present with demographic patterns in prevalence within a given geographical location, no clinical characterisation is associated with such patterns.

Prognostic significance of biochemical markers in African Burkitt's lymphoma.

Background and purposeEndemic Burkitt’s lymphoma (eBL) remains the prevalent form of paediatric cancer in tropical Africa with subtle pathological differences. This calls for intensified efforts to validate the global prognostic markers within local settings for improved cancer treatment and survival. This study proposes prognostic markers for enhanced eBL treatment and management.Patients and methodOne hundred and eighty histologically and/or clinically diagnosed BL patients at Komfo Anokye Teaching Hospital, Kumasi, Ghana were eligible for this cross-sectional eight-year retrospective study. Biochemical, clinical and demographic data, before chemotherapy administration, were documented and examined for their progression-free (PFS) and overall survival (OS) significance.ResultsA mean age of 6 (SD=2.7, range: 1–16) years was observed with general male dominance (M:F=1.69:1). Total serum lactate dehydrogenase (HR=2.04; 95% CI, 1.25–3.32; log rank=8.3; p=0.004), serum creatinine (HR=3.59; 95% CI, 1.62–7.98; log rank=15.4; p=0.002) and St. Jude stage (HR=1.74; 95% CI, 1.11–2.73; log rank=8.0; p=0.015) were important independent prognostic biochemical markers for both PFS and OS. Age, serum calcium, uric acid, potassium, sodium and phosphorus were non-prognostic.ConclusionThe better monitoring of these prognostic indices coupled with risk-stratification treatment may improve patients’ survival, especially in resource-limited settings.

Interplay of adipokines in the pathogenesis of essential hypertension: A comparative cross-sectional in Ghana

Abstract Background The renin-angiotensin-system (RAS), endothelial dysfunction and sympathetic nervous system are mechanistic risk factors of hypertension. The study sought to elucidate the interplay of adipokines in the pathogenesis of essential hypertension. Methodology This comparative cross-sectional study recruited 200 confirmed hypertensive patients from the KATH and 50 age-matched normotensives. Participants’ blood pressures, anthropometric and socio-demographic information were voluntarily obtained. Serum levels of adiponectin, leptin and resistin of the participants were quantified using the ELISA. Renal function, lipid profile and glycemic status of all subjects were also analyzed. Results Hypertensive patients showed a significantly higher anthropometric indices of adiposity compared to normotensives, CI (p < 0.0001), BAI (p < 0.0001) and AVI (p = 0.002). Adiponectin levels (p < 0.0001) were significantly lower in the hypertensive relative to the normotensives. Furthermore, significantly higher concentrations of serum leptin (p = 0.016) and the leptin-adiponectin ratio (p = 0.001) were observed among the hypertensive compared to the normotensives. The study further observed a direct association between serum leptin and weight (r = 0.111, p = 0.022), BMI (r = 0.129, p = 0.009) and WHtR (r = 0.098, p = 0.045) but inverse relationship with height (r = −0.134, p = 0.006) among the hypertensive. Serum leptin has a significant negative correlation with HDL-C among the hypertensive (r = −0.174, p = 0.013). The fully aOR for hypertension as predicted by resistin and adiponectin were 1.12 (95% Cl, 1.02–1.25); p = 0.019) and 0.93 (95% Cl, 0.91–0.95); p = 0.0001) respectively. Conclusion We found that elevations in serum levels of leptin and resistin, and low levels of adiponectin may play a role in the pathogenesis of essential hypertension. Therefore, adipokines may offer themselves as potential indices for early and accurate detection of high blood pressure. At the same time our present results also confirm the conclusions with respect to correlation of leptin and obesity. Further longitudinal studies in a larger population are warranted to investigate the physiological and pathological functions of adipokines in hypertension.

Essential and non-essential trace elements among working populations in Ghana

BACKGROUND Lead battery repair workers (LBRW) and electronic repair workers (ERW) may be exposed to inorganic components during work. This study aimed at determining essential and non-essential trace elements in male LBRW, ERW, referents and a group of female petty traders (FPT) in Kumasi (Ghana), taking into account iron status and inflammation. METHODS Altogether 64 LBRW, 64 ERW, 65 referents and 26 FPT were investigated in this cross-sectional study. Urine, whole blood and serum were collected for determination of trace elements. C-reactive protein and ferritin were determined in serum. RESULTS The LBRW had higher blood concentrations of manganese (B-Mn) and lead (B-Pb) and antimony in urine (U-Sb), and lower concentrations of cobalt in blood (B-Co). Being ERW was associated with higher concentrations of blood cadmium (B-Cd), urinary tin (U-Sn) and serum chromium (S-Cr). Concentrations of selenium (B-Se), Co and mercury (B-Hg) in whole blood and iodine in urine (U-I) were relatively high. Marginal iron status appeared to be a determinant for elevated concentrations of Co in particular, but also Mn and Cd in blood. Systemic inflammation was associated with the concentrations of copper and Se. The concentrations of Hg in whole blood were highly associated with Se and arsenic (As) in whole blood, indicating fish consumption as a common source of intake of these elements. However, Hg in whole blood was only slightly associated with Se in serum. CONCLUSIONS The ERW had elevated concentrations of B-Cd, S-Cr, and U-Sn, while B-Mn, B-Pb, and U-Sb concentrations were higher among the LBRW. Iron status and inflammation had substantial impact on some element concentration. This population had high concentrations of B-Se, B-Hg and B-Co and U-I.

Breast Cancer Genetic Testing Among African Patients With Breast Cancer: Deoxyribonucleic Acid Extraction From Tumor Tissue and International Multidisciplinary Partnerships

Breast Cancer Genetic Testing Among African Patients With Breast Cancer: Deoxyribonucleic Acid Extraction From Tumor Tissue and International Multidisciplinary Partnerships Population-based incidence rates of breast cancers that yield negative testing results for estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 biomarkers (triple-negative breast cancer [TNBC]) are 2-fold higher among African American women compared with white American women, and TNBC is a risk factor for breast cancer gene 1 (BRCA1) mutation carrier status that is independent of an individual’s family history. These patterns, coupled with data revealing an increased frequency of TNBC among western, sub-Saharan Africans, suggest that African ancestry is associated with hereditary susceptibility for TNBC. Resources for collecting and analyzing germline DNA from blood and/or saliva specimens to evaluate for BRCA mutations are limited in lowand middle-income countries in Africa, and transporting specimens to laboratories in more affluent countries is challenging. Recent studies suggest that DNA extraction from formalin-fixed, paraffin-embedded tumor specimens is feasible and accurate,1,2 thereby providing a readily available resource for genetic studies. We report the results from a study motivated by the educational and research efforts of an international multidisciplinary breast cancer partnership. Selected BRCA mutations were analyzed among Ghanaian patients with breast cancer, exploring the effectiveness of collaborations between surgeons, oncologists, pathologists, and geneticists in assessing the genetics of breast cancer in lowand middle-income countries in Africa.