Health Sciences Investigations Journal

Welcome message from the Editor-in-chief 2024

Andrew Anthony Adjei — Mon, 30 Dec 2024 00:00:00 +0000

As we come to the end of 2024, I extend my profound appreciation to our numerous Authors and Members of the Clinical and Scientific Communities for their resolute dedication, loyalty and support for the Health Sciences Investigations Journal since 2020.Amidst the challenges and difficulties, we face as a Journal, the Editorial Team, Technical Team and the Secretariat have demonstrated unwavering commitment to improving the quality of manuscripts submitted for publication. Collectively as a Team, we have made tremendous progress attracting manuscripts from several Authors across the globe.It is with much pleasure that I welcome you to volume 6 issue 2 of the Health Sciences Investigations [HSI] Journal.

The HSI Journal remains committed to reaching the global community with open-access publications from basic and clinical health sciences. Reflecting on our journey together since the inception of the Journal, I am elated of what we have
achieved as a Journal. Our dedication, commitment and discipline have enhanced our reputation as one of the leading Journals locally and internationally. In the current issue of the HSI Journal we have featured 22 manuscripts, comprising 20
original articles, a case-control study and a mini-review of 2randomized controlstudies. The substantial increase in the number of articles published in this issue indicates the level of visibility attained and acceptance of the HSI Journal by the
scientific and clinical communities.

In this issue of the HSI Journal, we present an article on the efficacy of herbal medicines in the management of sickle cell disease [SCD]. In Ghana and across countries, plants are crucial to the health of individuals and the community because they have been used in the treatment of several diseases including jaundice, neurogenerativediseases and inflammation. The WHO recommends the integration of ethnomedicines into primary healthcare because about 70 to 95 percent of people especially in developing countries rely on them. SCD is a chronic illness with catastrophic psychological and clinical implications, prompting many affected patients to seek treatment outside of conventional medicine. In this review article, the authors highlighted the potential benefits of using phytomedicines [Niprisan® and Ciklavit®] for the management of SCD and suggested that Niprisan® and Ciklavit® may be used as adjunctive therapies to mitigate the painful episodes that characterize SCD thus improving patients' quality of life. Another interesting article is the use of D-Limonene as a solvent in the softening and removal of gutta-percha during re-endodontic treatment as compared to Eucalyptol and Chloroform in the chemomechanical removal of Root Canal Treatment (RCT). The most commonly used solvents for softening gutta-percha are Chloroform and Eucalyptol.

“Perception” encourages us to challenge our assumptions and biases, and to embrace the complexity of human experiences.

Mon, 30 Dec 2024 00:00:00 +0000

"Perception"
The painting invites viewers to reflect on the subjectivity of perception and the potential for unity and understanding despite apparent differences.

Artist's perspective
At first glance, it appears as if there is one person captured in two halves, with each half holding onto a pillar that separates them. However, upon closer inspection, it becomes evident that there areactually two distinct individuals gripping the same pillar. The title, “Perception,” suggests that the artist is exploring the idea of how our perception of reality can be influenced by our own biases, assumptions, and preconceived notions. The painting challenges the viewer to question their initial interpretation and to consider the possibility of multiple perspectives. The use of a single pillar as a visual element symbolizes a barrier or divide between the two individuals. It represents the concept of separation or differences that
can exist between people. The act of both individuals holding onto the same pillar signifies a shared connection or common ground despite their apparent differences.

The artist’s choice to depict the hands clutching the pillar emphasizes the emotional intensity and the struggle to maintain unity or balance. The hands are a powerful symbol of human touch, connection, and the desire for closeness. The
composition of the painting, with the pillar dividing the canvas into two halves, creates a sense of tension and contrast. The use of color, light, and shadow can further enhance the emotional impact of the artwork.

The ‘cross’ of Oesophageal Stricture in Childern

Mark M Tettey — Mon, 30 Dec 2024 00:00:00 +0000

One of the devastating clinical entities in children, especially in the developing world is oesophageal stricture. Majority of these cases are acquired from accidental ingestion of caustic soda. In this edition, the HIS Journal has shown that over 70% of children who presented with oesophaeal stricture for oesophageal dilation were from caustic soda ingestion. There are articles that have shown increasing incidence in Africa [1]. Other causes of oesophageal stricture in children even though uncommon are congenital and other acquired causes namely post-operative oesophageal procedures, trauma from impacted foreign body, eosinophilic oesophagitis, reflux oesophageal stricture and after radiation radiation therapy. The aetiology varies between countries [2]. Majority of these children diagnosed with caustic oesophageal stricture are under five years. The circumstances leading to accidental ingestion have always been that this toxic substance often used for local soap making is kept in familiar containers. The unsuspecting children are attracted to these containers and mistakenly ingest the content as water.

The immediate complication of this ingestion may lead to burns in the gastrointestinal and the respiratory systems leading to death in some cases. The long-term complications may render these children nutritionally incompetent unless an alternative source of feeding is constituted. In this edition, the HSI Journal has shown successful management of children with oesophageal stricture by dilation. This procedure, especially in children with oesophageal stricture is already known and a welcome procedure for dilatable lesions. Expertise, equipment and the cost of management of these children in a developing world could be a limiting factor. This management procedure however is less of the cost when a major surgery to replace the oesophagus is needed.

The mechanism involved in the dilation of oesophageal strictures is splitting of the stricture and mechanical stretching. These are usually performed to prevent stiffness of the scar when remodelling occurs [3]. Currently there are three types of oesophageal dilators in practice: wire guided Savary-Gilliard dilators, weighted Maloney dilators, and endoscopic balloon dilators (EBD). EBD is increasingly recognized as a better choice [2,4]. In this edition, Savary-Gilliard dilators were used with an impressive success rate. In the absence of fluoroscopy to help with the guide wire placement, gastroscopy through a feeding gastrostomy was used. This is a demonstration of maximizing available equipment to achieve the best.

The use of conscious sedation was a very efficient way of reducing the cost of general anaesthesia and safely accomplishing the desired objective. Many reports have suggested that all endoscopic interventions should be performed under general anaesthesia in paediatric patients [5] but the study in this edition has demonstrated a seamless conscious sedation procedure and an effective and successful endoscopic dilation with minimal complications.

Outpatient appraisal of community reintegration and quality of life for stroke survivors towards rebuilding social lives

Mon, 30 Dec 2024 00:00:00 +0000

Background: Community reintegration and quality of life are important outcomes of rehabilitation on a long term basis, yet it has received little attention from the rehabilitation team post discharge, especially in Ghana.
Objective: This study aimed to appraise the community reintegration (CRI) and quality of life (QoL) of stroke survivors in relation to their age, gender, and comorbidities.
Methods: One hundred and eight stroke survivors attending outpatient physiotherapy units of three hospitals in Accra Metropolis were consecutively enrolled in the study. The Maleka Stroke Community Reintegration Measure and the Stroke specific QoL questionnaire were used as the main outcome measures. Descriptive data were summari s ed with frequency and percentage, while t he association and odd ratios of variables were determined with the Chi squar e and multiple regression tests respectively, at a 95% confidence interval.
Results: Most participants (85.2%) indicated that they did not benefit from community reintegration following their hospital care, whi le 52 (47.9%) reported overall poor QoL. Contrarily, most participants indicated good QoL in language (66.7%), thinking (74.1%) and vision (93.4%) subscales of the QoL questionnaire. Participants ’ gender significantly influenced the levels of CRI (P = 0.043), while QoL was significantly influenced by age only (P = 0.009). Males were four times more likely to have minimal reintegration [OR = 4(1.0 15.3)] relative to having no reintegration as compared to females. Participants within the age range 48 63 years were also found to be four times more likely to have fair QoL [OR = 4(1.4 11.1)] relative to having poor QoL as compared to thos e aged 64 years and above. There was a statistically significant association (P < 0.001) between CRI levels and QoL subscales.
Conclusion:Community reintegration seems to influence the QoL of stroke survivors while gender and age were found to be strong determinants of CRI and QoL, respectively.

SARS-CoV-2 seroepidemiology among tertiary students and health workers at the Korle-Bu community in Accra, Ghana

Mon, 30 Dec 2024 00:00:00 +0000

Background: The COVID 19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) has had an unprecedented impact on nations worldwide. Insight into a population s immunity level is key to implement ing effective control measures. In Ghana, despite mass exposure to the virus, vaccination coverage is still far below expectation, and to date, very few data exist on anti SARS CoV 2 immunity in the Ghanaian population
Objective: This study determined the prevalence of antibodies (IgM and IgG) in both COVID-19 vaccinated and unvaccinated individuals at the Korle Bu Polyclinic and a cross-section of students of the School of Biomedical and Allied Health Sciences in Accra, Ghana..
Methods: A cross sectional study including 207 participants was conducted. Sera were obtained and tested for SARS CoV 2 specific IgG/IgM antibodies, while oropharyngeal swabs from IgM reactive individuals were tested for SARS CoV 2 RNA by RT PCR. Our stud y population comprised 207 individuals o f which 70 were vaccinated and 137 were unvaccinated.
Results: The total seropositivity in the population studied was 67·6% ( n = 140/207). The IgG seroprevalence was 60·9% ( n = 126/207). Evidence of seroconversion was observed in more of the vaccinated individuals (72·9%, n = 51/70) than in individuals who were not vaccinated (54·7%, n = 75/137). Thirteen (18·6%) of the vaccinated individuals were IgM reactive, while 19 (27.1%) w ere IgG unreactive. Seropositivity in healthcare workers was 63·2% ( n = 12/19), which was consistent with that observed for the entire study population. About 20% ( n = 9/46) of the individuals who tested positive for SARS CoV 2 specific IgM had detectable SARS CoV 2 by nucleic acid testing.
Conclusion: The results from this study show evidence of breakthrough infections and suggest a high exposure of the study population to SARS CoV 2, which might underscore a high prevalence of asymptomatic COVID 19 in Ghana despite the low hospitali s ation rate recorded at the time of sampling. This study also reaffirms the need for booster vaccination, reinforcement of COVID 19 control measures, and the need of broader serological studies in Ghana.

Metastatic patterns of breast cancer: a retrospective study in a Teaching Hospital in Ghana

Mon, 30 Dec 2024 00:00:00 +0000

Background: Breast cancer is the most prevalent cancer among Sub-Saharan African women. In Ghana, there is an increasing incidence of breast cancer with a cumulative 5-year survival of 48%. The low survival has been attributed to the late stage of presentation, delays with diagnosis and limited treatment options. Breast cancer-associated morbidity and mortality are generally related to the clinical stage of the disease and are worse in metastatic disease.
Objective: This study determined the time to metastases from the initial diagnosis of breast cancer and the patterns of metastases in a teaching hospital in Ghana.
Methods: This study retrospectively reviewed consecutive cases of breast cancer managed from January 2009 to December 2011 at the Korle Bu Teaching Hospital, Accra, Ghana. Patient case records were reviewed, and data was extracted.
Results: The median age of the patients was 50 years in the non-metastatic group and 51 years in the metastatic group. The median duration from diagnosis to detection of first metastasis was 10.5 months. Fifty-eight percent of participants had metastasis involving 1 site only and the rest had 2-5 sites of metastases. The most common sites of metastases were the lungs and pleura (41%), bones (31%), liver (23%) and
brain (12%). Triple-negative and HER 2 enriched breast cancers were significantly associated with liver metastases. Breast cancer grade was significantly associated with multiple metastatic sites.
Conclusion: The median time to metastases from initial diagnosis was less than 1 year, and two-fifths of patients had more than one site of metastases. It would be useful if clinicians aggressively monitor indications for metastases, especially in the common sites, and for patients at high risk of metastases, both at the initial breast cancer diagnosis and in the early post-treatment period.

Anti-psychotic-like effects of Blighia unijugata: pharmacological validation of traditional uses in mental health management

Mon, 30 Dec 2024 00:00:00 +0000

Background: Blighia unijugata, is a tropical African plant used by traditional healers in Ghana for the management of mental disorders.
Objective: This study sought to explore the neuropharmacological effects of an ethanolic extract from the leaves of this plant to provide corroborating evidence for its use in mental health disorders.
Methods: Mice were subjected to Irwin test to ascertain the general effects of oral Blighia unijugata extract (BUE;100, 300 and 1000 mg/kg, p.o) on the physiology of mice and to determine the onset of neuro-activity. The effects of BUE (100, 300, and 1000 mg/kg, p.o) in novelty- and apomorphine-induced locomotor effects were assessed using the open-field paradigm. Further, apomorphine-induced cage climbing assay was used to assess for any anti-psychotic-like potential of BUE. The potential of BUE to cause extrapyramidal motor effects was also tested.
Results: BUE-treated mice demonstrated excitation at 15 and 30 minutes post-treatment with lower doses at 100 and 300 mg/kg and also showed sedation at 1000 mg/kg at 60,120 and 180 minutes post-BUE administration. There was no significant difference between BUE and the vehicle-treated group regarding the frequency and entry into the centre, corners, or peripheral regions of the open field. BUE, however,
significantly decreased the frequency of cage climbing in the apomorphine-induced cage climbing test. BUE also significantly increased haloperidol-induced cataleptic activity 60 minutes post-administration.
Conclusion: The ethanolic extract of the whole plant of Blighia unijugata possesses antipsychotic-like activity. This finding lends corroborating pharmacological evidence for the traditional use of BUE in the management of mental health disorders.

Exploring the health-seeking behaviour of men with infertility in Southern Ghana

Ezekiel Oti-Boadi, Florence Naab, Josephine M Kyei, Baba Mohammed Mujahid — Mon, 30 Dec 2024 00:00:00 +0000

Background: Despite the rising prevalence of male infertility and the challenges associated with its treatment, there is limited documentation on their health-seeking behaviours worldwide. Health-seeking behaviours are closely linked to a nation’s health status and economic growth, and they are essential as they define disease outcomes and acceptance of health care. In Ghana, little is known about the health-seeking behaviours of men experiencing infertility.
Objective: The aim of this study was to explore the health-seeking behaviours of men experiencing infertility in the Accra Metropolis.
Methods: An exploratory, descriptive design was employed, and snowball and purposive sampling techniques were used to recruit 13 men diagnosed with and who self-reported to have infertility. In-depth face-to-face interviews were conducted using a semi-structured interview guide, each of which lasted between 45 and 60 minutes. The interviews were audio-recorded, transcribed verbatim, and analysed using content analysis.
Results: Two major themes emerged from the data: the attitude of men’s health-seeking behaviour (attitude of men based on health workers’ behaviour, attitude of men about the seriousness of infertility, attributing infertility to female ailment and reaction to diagnosis) and experiences of participants with infertility (personal beliefs about male infertility, beliefs of significant others, family influence and community influence). Participants were hesitant to seek healthcare due to negative healthcare provider attitudes. The negative impact of male infertility included the significant disruption to daily life activities and unproductivity at work. Men often denied infertility diagnoses, attributing them to female health problems.
Conclusion: The findings of this study indicate that men held unfavourable attitudes, as they attributed infertility solely to females. Hence, involving men in infertility discussions and treatments could help to increase awareness and engagement in fertility care. The findings of this study have implications for nursing practice, policy formulation, and infertility research.

Assessment of skeletal age using the cervical vertebrae in Ghanaian orthodontics patients

Mon, 30 Dec 2024 00:00:00 +0000

Background: Skeletal age refers to the general degree of maturation of a part of the skeleton that subjects of a population manifest with growth. Assessing skeletal age involves visually inspecting bones on a radiograph. The hand-wrist and cervical vertebral maturation methods have been used widely to determine skeletal age. Using vertebral development to evaluate skeletal maturity is advantageous because it requires only one radiograph, the lateral cephalogram, which orthodontists routinely use for diagnosis and treatment planning.
Objective: This study aimed to determine the skeletal age according to cervical vertebral maturation (CVM) and its correlation with chronological age.
Methods: Lateral cephalometric radiographs of 70 Ghanaian orthodontic patients aged 9 - 18 years, involving 41 females and 29 males, were taken. Skeletal age was assessed according to Hassel and Farman’s CVM method. The correlation between the chronological and skeletal ages was determined using the Spearman rank-order correlation coefficients.
Results: The mean chronological age of the sample was 12.97 ± 2.74 years; 59% (n = 41) were females and 41% (n = 29) were males. The most prevalent CVM stage was stage 4 (31%, n = 22), and stage 6 (3%, n = 2) was the least prevalent. CVM stages significantly correlated with chronological age (r = 0.759). CVM stages consistently occurred earlier in females than males, indicating that skeletal maturation was more advanced in females than males. The mean pubertal growth spurt (CVM stage 3) occurred for the total sample at 11.98 ± 3.06, 10.46 ±
0.6 years in the females and 16.51 ± 0.00 years for the only male recorded at this stage. Consequently, every child must be treated as an individual based on their level of skeletal maturation.
Conclusion: The lateral cephalograms can be used as initial diagnostic tools for determining the skeletal maturity stage and estimating patients’ age. However, further studies on this topic with a more representative sample to corroborate the findings of this study are required.

Development of a patient-centred toolkit for improving glaucoma medication adherence: a motivational interviewing approach

Mon, 30 Dec 2024 00:00:00 +0000

Background: Non-adherence to medication is reported among patients with glaucoma. The use of cognitive-based behaviour methods such as motivational interviewing (MI) is a promising approach to resolving non-adherence to medication among such patients.
Objective: This study aimed to develop a patient-centred MI manual for improving glaucoma medication adherence.
Methods: This study employed a descriptive methodological design conducted in three phases, namely, content development, validation, and training. Barriers and motivators of non-adherence to glaucoma medication were generated from a qualitative study. Scale level content validity index (SCVI) and intraclass correlation coefficients among the validators were calculated. The extent of collaboration between the
interviewers and the interviewees and the fidelity of the MI process were analysed. P-values less than 0.05 were adjudged statistically significant.
Results: Barriers to glaucoma medication adherence included inadequate knowledge about glaucoma, lack of motivation, cost of medication, forgetfulness, and difficulty with drop administration. The SCVI and the intraclass correlation coefficient were 0.9 and 0.92 (p = 0.0001; 95% CI [0.68, 0.99]) respectively. The correlation coefficient for the extent of the collaboration between the interviewers and the interviewees was 0.931 (p = 0.001). The practitioner’s mean score ± SD was 3.7 ± 0.2.
Conclusion: A patient-centred MI manual developed through a multidisciplinary approach with a good validity index and excellent inter rater reliability can be beneficial in facilitating behavioural change to improve glaucoma medication adherence.

The burden of food allergy among children with asthma; a case-control study.

Mon, 30 Dec 2024 00:00:00 +0000

Background: Children with asthma (CWA) tend to have food allergies due to the common risk factors and underlying pathologies of asthma and food allergies. In their clinical management, the potential comorbidity with food allergies is often ignored. Little is known about the prevalence and clinical symptoms of food allergies among CWA in Ghana.
Objective: This study determined the prevalence and clinical symptoms of food allergies among CWA at the Korle-Bu Teaching Hospital compared with their non-asthmatic controls
Methods: The study design was a matched case-control involving 118 CWA and 118 non-asthmatic controls recruited from the Korle-Bu Teaching Hospital and a public school, respectively. Sampling was consecutive and purposive. The Allergy-Focused Diet History Questionnaire was used to determine the prevalence and presentation of food allergy in both groups. Descriptive statistics was used to analyse data. Statistical significance was set at p ≤ 0.05.
Results: The mean age was 7.5 ± 2.8 years (61% males, 39% females). The prevalence of food allergies among CWA was higher than those without asthma (23.7% vs 2.5%; p < 0.001), with the majority (53.6%) of the former having multiple allergies and 71.4% reporting symptoms in their upper and lower respiratory airway. Conversely, non-asthmatics mostly showed symptoms of food allergy in the skin (66.7%). Peanut allergy was the commonest among children with asthma (24.5%).
Conclusion: The prevalence of food allergy was significantly higher among CWA. Clinical symptoms were mainly upper and lower respiratory symptoms and could potentially trigger asthmatic attacks. Food allergy investigations should be part of routine asthma management and should be effectively managed by the health care team, including registered dietitians. Adrenaline pens may be prescribed
for asthma patients who may be at a higher risk of severe crisis due to greater sensitisation to food allergens to reduce the potential disease
burden.

Prediabetes among individuals with sickle cell disease: a hospital-based cross-sectional study

Evans Aduhene, Seth Agyemang, David Adjei — Mon, 30 Dec 2024 00:00:00 +0000

Background: Studies have shown that comorbidity of sickle cell disease (SCD) and diabetes mellitus (DM) leads to adverse microvascular complications. Recent studies elsewhere have reported co-existence in some populations. The need to determine the relationship between SCD and DM is reasonable due to improved life expectancy among individuals with sickle cell disease and the increasing reports of high DM incidence and prevalence among this population.
Objective: This study aimed to determine whether SCD patients attending the Korle-Bu Teaching Hospital (KBTH) have a lower DM prevalence than non-SCD patients.
Methods: This hospital-based cross-sectional study involving 53 SCD participants and 60 non-SCD randomly selected participants was conducted at KBTH from February to June 2019. About 3 ml of venous blood samples were collected from all consenting patients, and fasting blood glucose (FBG) was estimated using the VITROS Chemistry Analyser. Point of care glucometer (OneTouch® Select™ Plus brand) was used to estimate random blood glucose (RBG) from SCD participants' capillary blood samples taken 2 hours after they ate. RBG levels were not estimated for non-SCD participants. WHO diabetes diagnostic criteria were used to determine the diabetes status of all participants.
Results: While no SCD participant had diabetes, 3.3% (n = 2) of non-SCD participants had diabetes. The mean age and body mass index (BMI) of the non-SCD participants (48 years, 27.0 kg/m2) were higher than that of the SCD participants (36 years, 22.9 kg/m2). Most SCD participants (52.8%, n = 28) had impaired glucose tolerance (prediabetes) (5%, n = 3). Male SCD participants were significantly less likely to have prediabetes than their female counterparts (OR = 0.109, 95% CI: 0.016 – 0.737, p = 0.023).
Conclusion: The prevalence of prediabetes among SCD individuals was high. This might be due to increasing BMI with age among the SCD cohort, suggesting the need for continuous monitoring of DM status among ageing SCD patients.

The effect of combined vaginal misoprostol and tourniquet or tourniquet alone on reducing blood loss during abdominal myomectomy: a randomised controlled trial

Mon, 30 Dec 2024 00:00:00 +0000

Background: Uterine fibroids are common benign tumours in women, with myomectomy being a primary surgical treatment for those desiring to preserve fertility. This procedure is often associated with significant haemorrhage. Both the tourniquet and misoprostol are effective at reducing the associated blood loss, and their combined use may enhance this effect.
Objective: The study aimed to compare blood loss reduction using vaginal misoprostol plus a tourniquet versus a tourniquet alone duringabdominal myomectomy.
Methods: This study was an open-label randomised controlled investigation involving 80 women with symptomatic fibroids, divided into two groups: the treatment group (misoprostol plus tourniquet) and the control group (tourniquet alone). The primary outcome measured was intraoperative blood loss through changes in haemoglobin levels. Secondary outcomes included the need for blood transfusion, postoperative
febrile morbidity, surgery duration, misoprostol’s adverse effects, and length of hospital stay. The treatment group received a single 600µg
dose of vaginal misoprostol one hour before surgery. Data analysis utilised SPSS version 22, employing t-tests for continuous variables and Chi-squared tests for categorical variables, with a significance threshold of p < 0.05.
Results: Results indicated a significant reduction in blood loss (haemoglobin change) when misoprostol plus tourniquet was used for uterine sizes ≥ 18 weeks (1.40 ± 0.50 vs 1.89 ± 0.80 g/dl, p = 0.005). However, there were no significant differences in blood transfusion need (2.5% vs 5.0%, p = 0.55), febrile morbidity (2.5% vs 2.5%, p = 0.99), surgery duration (102.73 ± 36.02 vs 104.08 ± 40.04 min, p = 0.874), or hospital stay length (2.88 ± 0.607 vs 3.05 ± 0.714 days, p = 0.241). Misoprostol adverse effects were minimal (10% in the treatment group).
Conclusion: A 600µg vaginal misoprostol dose plus a tourniquet significantly reduces blood loss during abdominal myomectomy for uterine sizes ≥ 18 weeks compared to a tourniquet alone, with similar transfusion requirements, surgery duration, febrile morbidity, and hospital stay lengths.

Endoscopic dilation of oesophageal strictures in children: an eight-year experience in a tertiary hospital

Taiba J Afaa, Victor K Etwire , John B Ayete-Nyampong , Eric Odjei — Mon, 30 Dec 2024 00:00:00 +0000

Background: Oesophageal strictures in children are either acquired or congenital. The common acquired causes include ingestion of corrosive agents. Oesophageal strictures in children can lead to devastating complications or even death as they pose treatment challenges, especially in developing countries where conservative oesophageal dilation, which may reduce the post-treatment morbidity associated with surgical
intervention, is not readily available.
Objective: This study demonstrates the successful management of oesophageal strictures in a low-resource setting.
Methods: This is a retrospective study of 66 consecutive children with oesophageal strictures who were evaluated and had endoscopy oesophageal dilation from February 2016 to February 2024 at the Paediatric Endoscopy Unit of the Korle Bu Teaching Hospital (KBTH), Accra Ghana.
Results: Four hundred and eighty (480) dilation sessions were done in 57 patients. Most of the children were between 1 and 5 years old, and 57.6% (n = 38) were male. Forty-seven (71.2%) of the strictures were due to ingestion of caustic agents. Fifty-one (89.5%) patients had successful dilatation, and six were lost to follow-up. There were three (0.6%) complications of oesophageal perforations.
Conclusion: Oesophageal stricture is common in children, and accidental ingestion of corrosive substances is the most common cause. Endoscopy dilation of oesophageal strictures can safely be done in most children, with excellent outcomes and low complication rates.

In vitro and animal model estimation of the anti Open Access inflammatory and antinociceptive activities of Abrus precatorius (fabaceae) plant-mediated nanoparticles

Stephenie Chinwe Ama Alaribe, Titilayo E Blessing, Cynthia N. Nnadi — Mon, 30 Dec 2024 00:00:00 +0000

Background: Recent research indicates that biosynthesized metal nanoparticles from natural products such as plants often exhibit higher therapeutic efficacy and reduced toxicity compared to natural products at macro-scale or chemically-synthesized nanoparticles. The potential therapeutic compounds in natural products usually act as capping agents on synthesized nanoparticles, facilitating targeted delivery of those compounds at lower, more effective doses. Given the roles of inflammation, oxidative stress, and nociception in diseases, developing novel drugs with enhanced efficacy and reduced toxicity is crucial.
Objective: This study aimed to investigate the anti-inflammatory, antioxidant, and antinociceptive activities of Abrus precatorius extracts and their mediated nanoparticles using diverse in vitro and in vivo models.
Methods: The anti-inflammatory, antioxidant, and antinociceptive bioactivities of Abrus precatorius (AP) (Rosary pea) extracts were investigated. The extracts, labelled B2 for seeds, A2 for seed coats, and their mediated nanoparticles A1 (silver nanoparticles synthesized from seed coat extracts) and B1 (silver nanoparticles synthesized from seed extracts), were bio-synthesized using the crude extracts. Anti inflammatory activity was assessed using the Carrageenan model and antinociceptive activity was evaluated through acetic acid writhing, hot plate, tail clip tests, and xylene ear oedema in mice, with doses ranging from 10-50 µg/kg. In vitro antioxidant activity was measured with 2,2-Diphenyl-1-picrylhydrazine (DPPH) and Ferric Reducing Antioxidant Power (FRAP) assays at concentrations of 10-50 µg/ml.
Results: The results showed that the aqueous extract of Abrus precatorius significantly reduced oedema volume in rats and increased antinociceptive and antioxidant activities, as did the mediated nanoparticle samples A1 and B1. In the acetic acid writhing test, the samples exhibited inhibition ranging from 5.5% to 83.3% at doses of 0.01-0.05 mg/kg, indicating reduced pain responses induced by acetic acid.
Among the samples, B1 showed the highest inhibition in the acetic acid writhing test. In the DPPH scavenging radical test, sample B2 demonstrated the greatest inhibition of DPPH radicals at 88.64% at a concentration of 0.05 mg/ml, highlighting strong antioxidant activity. Sample A1 exhibited the highest inhibition at 80.42% for the carrageenan test after 6 hours, indicating potent anti-inflammatory effects.
Conclusion: The current research illustrates that the extract of Abrus precatorius, in both its crude and nanoparticle forms, displays notable anti-inflammatory, antioxidant, and antinociceptive properties. The biosynthesized nanoparticles prove to be more effective at lower doses in reducing oedema and scavenging DPPH radicals in rodents compared to the crude extracts.

Funding modalities of Ethics Review Committees: perspectives of representatives of selected ERCs in Ghana

Adolf Kofi Awua, James Akazili, Amos Laar, Kyle Ferguson, Seth Ayettey — Mon, 30 Dec 2024 00:00:00 +0000

Background: Ghana and other African countries contend with issues of funding Ethics Review Committees (ERCs), which limits their effectiveness and benefits to researchers, host institutions and other research ethics stakeholders.
Objective: This study aimed to elucidate the funding challenges of ERCs in Ghana and to seek views on how ERCs could be adequately, ethically, and sustainably funded.
Methods: With a purposive maximum variation sampling approach, five research institutions with well-established ERCs were selected for this study. Views of representatives of their ERCs were sought on the adequacy of funding for their work by interview.
Results: All those interviewed were unanimous in their view that funding was inadequate for ERCs to fulfill their mandate of protecting the research public. This posed ethical dilemmas to the ERCs, especially in adopting a fee-paying policy for the review of protocols that disadvantaged poorly endowed institutions and researchers. To address these challenges, the respondents proposed a multifaceted funding model to include government subsidies, reliance on internally generated funds of the host institutions, and funding supplementation from external agencies and non-governmental organisations. Other recommendations include improvement in the efficiency of the financial administration of the ERCs and the establishment of a legislative instrument for a governing national research ethics committee that will also
advocate adequate funding for ERCs
Conclusion: The multifaceted funding model, which includes government funding as proposed by the respondents, would go a long way to ensure adequate and sustainable funding of ERCs. However, the consideration of fee-charging may pose ethical challenges. To address the funding challenges, the government must, as of utmost importance, recognise the critical roles ERCs play in protecting the research public and establish a national ethics review committee for effective governance to ensure research integrity and adequate budgetary allocation.

Hypopituitarism and associated demographic and clinical factors in patients with pituitary adenoma in Ghana: a hospital-based retrospective study

Josephine Akpalu, John Tetteh, Margaret Reynolds, Yacoba Atiase, Ernest Yorke — Mon, 30 Dec 2024 00:00:00 +0000

Background: Pituitary adenoma is considered one of the main causes of hypopituitarism, which is characterised by a deficiency of one or more pituitary hormones. Clinical features of hypopituitarism may be non-specific, leading to diagnostic delays and an increased risk of morbidity and mortality in affected patients.
Objective: This study aimed to determine the prevalence and associated factors of hypopituitarism among pituitary adenoma patients attending the Korle Bu Teaching Hospital, a tertiary hospital in southern Ghana.
Methods: In this retrospective study, the clinical records of patients diagnosed with pituitary adenoma were reviewed to obtain demographic and clinical data. Pretreatment hypopituitarism, the main outcome measure, was defined as a deficiency of one or more anterior pituitary hormones prior to any therapeutic intervention. Data was analysed using Stata 16.1, and the level of significance was set at p < 0.05.
Results: The prevalence of pretreatment hypopituitarism was 54.51% (95% CI, 47.92 - 60.35) and was associated with older age (Odds Ratio (OR) 2.79; 95% CI 1.41 - 5.50), male sex (OR 2.51; 95%CI 1.47 - 4.28), referral from a primary care facility (OR 4.50; 95% CI 1.39 - 14.47), non-functional pituitary adenoma (OR 4.87; 95% CI 2.78 - 8.56), macroadenoma (OR 9.75; 95%CI 4.15-22.9) and visual field defects (OR 6.35; 95% CI 3.19 - 12.62. Non-functional pituitary adenoma (Adjusted Odds Ratio (aOR) 3.03; 95% CI 1.35 - 6.76) and macroadenomas (aOR 9.62; 95% CI 2.76 - 33.39) were determinants of pretreatment hypopituitarism in patients with pituitary adenoma.
Conclusion: The prevalence of pretreatment hypopituitarism was found to be 54.51% among pituitary adenoma patients attending the Korle Bu Teaching Hospital, a tertiary hospital in southern Ghana, from 1997 to 2019. Non-functional pituitary adenoma and macroadenoma were determinants of pretreatment hypopituitarism. Increasing awareness of the associated factors of hypopituitarism among clinicians couldfacilitate an early diagnosis and appropriate management to avoid the attendant adverse outcomes in patients with pituitary adenoma.

Home-based blood pressure monitoring using the AHOMKA care model: a longitudinal single-group pilot study in Accra

Mon, 30 Dec 2024 00:00:00 +0000

Background: Hypertension is a major risk factor for cardiovascular disease and requires long-term health treatment and ongoing monitoring to the extent that traditional management approaches may be limited in providing. Adopting appropriate digital tools like mobile health technology (mHealth) could be an effective strategy for improving the control and management of this public health burden. This pilot study
evaluated the feasibility of the AHOMKA care model at two tertiary hospitals in Ghana. Outcome measures were changes in systolic (SBP) and diastolic (DBP) blood pressure model acceptance by patients and health care providers.
Objective: This study sought to assess the overall pattern of home blood pressure self-monitoring among participants from two teaching hospitals in southern Ghana, using mHealth.
Methods: Participants attending two (2) cardiology clinics were recruited for this mixed-method pilot study over a period of eight (8) weeks. Following a longitudinal single-group approach, we conducted structured interviews at the baseline and end-line and used exports of the AHOMKA mHealth application, in-depth interviews and focus group discussions with patients and healthcare providers. Repeated measures
analysis of variance was adopted to assess differences in SBP and DBP between baseline and end line.
Results: This pilot study involved 27 participants with a mean of 50.4 ± 11.0 years-approximately 1:1 male-female participation. Mean SBP decreased by 11.6 mm Hg (95% CI = 15.0 to -8.2), from an average of 138.6 mmHg at baseline to 126.2 mmHg at endline. Average DBP was also significantly reduced by 3.0 mmHg (95% CI = -5.5 to -0.5), from an average of 87.0 mmHg at baseline to 83.0 mmHg at endline. Patients and healthcare providers were satisfied and optimistic about the AHOMKA care model.
Conclusion: The encouraging trend in BP outcomes and high response rate from this pilot study provides evidence for further investigation involving the assessment of the effectiveness of the AHOMKA care model while culturally adapting the model to the Ghanaian context. In the spectrum of hypertension interventions, AHOMKA has the potential to ease the burden on the public health system

A comparative study of the softening abilities of three gutta-percha solvents used during endodontic retreatment

Mon, 30 Dec 2024 00:00:00 +0000

Background: The chemomechanical removal of gutta-percha involves the use of solvents, which serve as an adjunct to mechanical instrumentation during Root Canal Treatment (RCT). The most commonly used solvents for softening gutta-percha are Chloroform and Eucalyptol. Due to some unfavourable properties, their usage in the dental setting is debatable. D-limonene is an essential oil which has fewer undesirable properties when utilised as a gutta-percha solvent.
Objective: This study sought to determine whether D-Limonene had comparable gutta-percha softening properties with Eucalyptol and Chloroform.
Methods: This study was a prospective comparative study. Extracted single-rooted teeth were root-treated using the rotary ProTaper system and stored in normal saline for three months. The teeth were randomly assigned to the three solvent groups, and root-filling removal was performed using K-files and solvents. The median initial penetration depth of the K-file into the softened gutta-percha, the median amounts
of additional drops of solvent used, and the median of the total time used to remove all the gutta-percha obturating material from the root canal were statistically evaluated for each of the solvents. The Kruskal-Wallis test was used to compare the medians with the statistical significance set at p < 0.05.
Results: D-Limonene utilised the least number of additional drops of solvent (p < 0.001) during the gutta-percha removal process, while chloroform utilised the greatest number of additional drops of solvent. There was no statistical difference between the three solvents in the initial penetration depth of the K-file into the gutta-percha and the total time it took to completely remove all gutta-percha from the root canals.
Conclusion: Smaller volumes of D-Limonene produced comparable results as Eucalyptol and Chloroform in the softening and removal of gutta-percha during re-endodontic treatment.

Validity and reliability of the KFORCE Sens® electrogoniometer in the evaluation of ankle, knee and hip range of motion

Mon, 30 Dec 2024 00:00:00 +0000

Background: Range of motion (ROM) is essential for diagnosing limitations from musculoskeletal issues, developing treatment plans, and monitoring treatment progress. ROM assessments commonly involve tools like universal goniometers, evaluation scales, inclinometers, and smartphone applications.
Objective: This study aimed to test the validity of the KFORCE Sens® electrogoniometer in evaluating lower extremity ROM by comparing it with the universal goniometer and examining the inter-rater and test-retest reliability.
Methods: Fifty-one healthy volunteers (aged 18 - 25 years) were included in this study. The lower extremity ROM values of each participant were assessed by two assessors separately using a KFORCE Sens® electrogoniometer. The same assessors repeated the KFORCE Sens® electrogoniometer measurements once to examine test-retest reliability. Lower extremity ROM values were also assessed by one assessor
using a universal goniometer.
Results: According to the study findings, both the inter-rater and test-retest reliability of the KFORCE Sens® electrogoniometer device in all ROMs of the lower extremities were excellent (ICC > 0.80). In addition, the ROM values of the KFORCE Sens® electrogoniometer device and the ROM values of the universal goniometer in the same joint were highly correlated (r > 0.80, p < 0.05).
Conclusion: The KFORCE Sens® electrogoniometer is a valid and reliable device for evaluating lower extremity ROM

CYP2B6 and SULT1A1 single nucleotide polymorphism among Ghanaian HIV patients

Mon, 30 Dec 2024 00:00:00 +0000

Background: Nevirapine is used in many developing countries for the management of HIV-1 patients. Despite its usefulness, hypersensitivity reaction is a common complication that accounts for patients defaulting during therapy in Ghana. Genetic variations in drug-metabolising enzymes have been implicated in reported adverse drug reactions observed in patients on nevirapine regimen.
Objective: This study aimed to determine genotypic frequencies of specific CYP2B6 and SULT1A1 variants and their association with nevirapine hypersensitivity among persons living with HIV in the Ghanaian population.
Methods: A prospective study was conducted in Korle-Bu Teaching Hospital, a tertiary health facility in Ghana. Clinical data were recorded from the seventy patients’ folder, and whole blood was collected for genotyping. Genotypes of CYP2B6c.983T > C and SULT1A1c.638G > A were obtained using Restriction Fragment Length Polymorphism method.
Results: The mean age of the participants was 38 ± 9.47 years, with the majority 77% being females. For CYP2B6c.983T > C genotype frequencies, T/T and T/C were 94.3% and 5.7%, respectively, while for SULT1A1c.638G > A genotype frequencies, G/G, G/A, and A/A were 61.4%, 34.3% and 4.3% respectively. The prevalence of CYP2B6c.983T > C and SULT1A1c.638G > A minor allele was 2.9% and 21.4%, respectively among the study participants.
Conclusion: Extensive metaboliser genotypes for CYP2B6c.983T > C and SULT1A1c.638G > A were more than the intermediate and poor metaboliser genotype. However, CYP2B6 983C/C representing poor metabolisers of CYP2B6c.983T>C were not detected among the study population. Genetic polymorphism of CYP2B6c.983T > C and SULT1A1c.638G > A were not associated with nevirapine hypersensitivity.

Evaluating cytokine levels and selected biochemical parameters at two-time points in crossbred cattle infected with Anaplasma marginale

Mon, 30 Dec 2024 00:00:00 +0000

Background: Bovine Anaplasmosis is a destructive disease leading to significant livestock losses. The disease is common in Africa and is caused by Anaplasma marginale. Plasma biochemical profiles, including cytokine levels, can be used as helpful indicators in managing and treating the infection. Additionally, these measurements could provide insight into the physiological responses of the animals in a diseased
state.
Objective: This study aimed to identify A. marginale using PCR and analyse biochemical and cytokine levels related to A. marginale in spontaneously infected Holstein-Friesian and Sanga crossbred cattle.
Methods: Forty (40) apparently healthy cattle were randomly selected from the Amrahia Dairy farm in the Greater Accra region between February and March 2021. Blood samples were taken from these animals via jugular venipuncture at two-time points (four-week intervals). Polymerase chain reaction (PCR) was conducted on DNA isolated from blood samples to detect A. marginale infection in cattle. Serum samples collected were used to measure levels of cytokines- Interleukin-4 (IL-4), Interleukin-10 (IL-10), and Interferon-alpha (IFN-α), along with selected biochemical parameters to assess the liver (Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP), Total Protein, Total Bilirubin, and Direct Bilirubin) and kidney (blood urea nitrogen (BUN), and creatinine(CRE) of the infected animals.
Results: At time point one, 55% of the cattle tested positive, while 70% tested positive for A. marginale at time point two. At time point one, there were no significant differences between infected and non-infected cattle for blood concentrations of IL-10, IL-4, IFN-α, ALT, AST, DB, TB, ALP, TP, BUN, and CRE (p > 0.05 respectively). However, at time point two, IFN-α (p = 0.004), direct bilirubin (p = 0.02), and creatinine (p = 0.004) differed significantly between the two study groups.
Conclusion: The study identified A. marginale by PCR and was diagnostic for Bovine Anaplasmosis. Circulating levels of cytokines and selected biochemical parameters did not alter significantly between infected and non-infected cattle when blood was taken at two-time intervals, suggesting that these cytokines may not directly contribute to the pathogenesis of Bovine Anaplasmosis.

The efficacy of herbal medicines used in the management of sickle cell disease: a systematic review of two randomised control studies

Mon, 30 Dec 2024 00:00:00 +0000

Background: Over 300,000 babies are born with the severe form of sickle cell disease (SCD) worldwide, with most occurring in low- and middle-income countries. Although the pathophysiology of this disease is now better understood, there are still few conventional pharmacological treatments available, with these medicines having adverse effects that affect compliance. Various herbal remedies have been employed since the discovery of SCD to minimise unpleasant sickling events. Additionally, an increasing number of patients have turned to
complementary and alternative medicines (CAM) and naturopathic substances in managing excruciating episodes.
Objective: This mini-systematic review assessed the efficacy of medicinal plants used in the management of SCD.
Method: A web-based literature search was conducted in PubMed, Scopus (Elsevier), Cochrane Library and CINAHL Complete (Ebsco) to obtain randomised controlled studies. Two hundred and five articles were retrieved, of which only two were included in the review.
Results and Concludions: This study found that two phytomedicines, Niprisan® and Ciklavit®, significantly reduced severe pain in patients. The mean frequency of times patients reported severe pains during the 6-month trials was 7.9 for the Niprisan® group and 21.1 for the placebo. After cross-over in the second 6 months, the placebo was 6.9, and Niprisan® was 4.1. Side effects experienced included non-itching macular rashes and headaches. Ciklavit® also reduced painful crises from 207 to 191 with mild side effects, including abdominal distention and tiredness. Niprisan® did not significantly change liver enzyme activity, cause significant differences in jaundice and serum bilirubin, or cause acute liver or renal damage. A significant number of medicinal plants have been documented as folklorically used in managing SCD, its associated pain, and anaemia. These will need in-depth investigations for further advancements. This study highlights the potential benefits of using phytomedicines for the management of SCD.

Hepatoid adenocarcinoma of the colon: a case report of a rare aggressive cancer

Mon, 30 Dec 2024 00:00:00 +0000

Hepatoid adenocarcinoma (HAC) is a rare and aggressive malignancy with histological and immunohistochemical features resembling hepatocellular carcinoma originating from non-hepatic organs. We report a case of HAC in a 34-year-old male, arising from the transverse colon, with metastases to the stomach, liver, lungs, and right femur. He presented with persistent anaemia and sub-acute intestinal obstructive
symptoms. Laparotomy confirmed a transverse colon tumour infiltrating the stomach, accompanied by hepatic and peritoneal lesions. He underwent extended right hemicolectomy and en-bloc resection of the distal stomach, with a histopathological diagnosis of hepatoid adenocarcinoma. Subsequently, he suffered a pathological hip fracture and was treated with open reduction and internal fixation, followed by
radiotherapy and palliative adjuvant chemotherapy. The disease progressed, leading to thoracic spine bone metastasis, necessitating further radiotherapy. He is alive, eight months post-surgery, despite a poor prognosis and disease progression

Intra-arterial chemotherapy for retinoblastoma: a case series report

Mon, 30 Dec 2024 00:00:00 +0000

Intra-arterial chemotherapy (IAC) has recently emerged as one of the most effective treatments for retinoblastoma. This treatment method reduces systemic toxicity by catheterising the ophthalmic artery with extreme precision. Although current data suggests success with the transradial route, it is traditionally performed through the transfemoral access, as is the case with most neurovascular procedures. We report
the first case series in Ghana, as well as our technique, safety, and efficacy of transfemoral intra-arterial chemotherapy. We reviewed our database retrospectively and provided our technique and preliminary results from three consecutive individuals aged 2 to 16 years who underwent seven transfemoral IAC treatments. All of the IACs were completed successfully. Repeat IACs were performed on two patients, and a third session was performed on a third patient, all through the right femoral artery. There were no thromboembolic events or access site complications, such as hematoma. All patients were discharged home the same day of the procedure. In young patients with retinoblastoma, our case series confirms the safety and feasibility of transfemoral IAC. It will become the preferred sight-saving option when more experience is obtained, and the procedure becomes less expensive.