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

properly cited. 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 2 , independent -test, and ANOVA were done. A 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, Bell's 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/mm 3 . The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders ( = 2.5, = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders ( = 2.8, = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders. Background Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) which affects all body organs either directly or by opportunistic infections, and the eye is not spared. AIDS indicates advanced HIV disease in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive There is a huge dearth of information in Ghana on ocular related findings in HIV patients. Reports from other societies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The purpose of this study was to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods Study Site. The study was carried out at the Antiretroviral Therapy (ART) Specialist Clinic of the Cape Coast Teaching Hospital in Ghana. The Cape Coast Teaching Hospital, one of the five teaching hospitals in Ghana, provides health services to people in the central and western regions and parts of Ashanti and eastern regions. It also has the mandate of training doctors and other medical staff. Study Design and Participants. The study employed a descriptive cross-sectional design. Sample size was determined based on the expression , where is the minimum sample size, is the standard normal deviation, usually set at 1.96 which corresponds to the 95% confidence interval, is the proportion in the target population estimated to have the infection (1.4% for the central region), and is the degree of accuracy desired, usually set at 5%. Consequently, a sample size of 30 was calculated. This was adjusted to 200 participants to account for attrition rate and inefficiencies associated with the sampling method. A systematic sampling method was used to recruit clinically diagnosed HIV patients, who attended the ART Specialist Clinic between January and May 2016. Based on the average daily attendance at the clinic and a determined sampling interval of three (3), the first participant was chosen by randomly selecting a number between one and three. Every third patient from the first participant was then recruited into the study. In all, 320 patients were examined within the period. Out of them, 295 patients had complete medical data and they were included in the analysis. Patients who had comorbidities such as diabetes, hypertension, and sickle cell disease were excluded from the study. Ethical Considerations. The study was conducted in accordance with the Helsinki Declaration on Research Regarding Human Subjects. Ethical clearance (ID number UCCIRB/CHAS/2015/090) was obtained from the Institutional Review Board of the University of Cape Coast. The rationale of the study was comprehensively explained to all participants after which consent forms were issued to them to sign, including local language versions which were read out to illiterate subjects who consented with a thumbprint prior to investigation. For participants below 18 years of age whose assent was sought, their parents/guardians signed the consent forms on their behalf. The participants were assured of confidentiality and safety at all times. They were also reminded of the voluntary nature of the study which granted them the right to withdraw at any point. Data Collection. The method of data collection consisted of semistructured questionnaires, laboratory investigation, medical profiles, and ophthalmic examination. Every consenting patient was assigned a specific study code. A trained investigator interviewed and filled the questionnaires for all the participants. Information obtained from the questionnaires included age, gender, occupation, religion, marital status, level of education, and duration of infection from the time of diagnosis. The patient's HIV related medical information such as the World Health Organization (WHO) clinical stage of the disease, whether the participant was on ART or not, and duration of ART usage was recorded. Blood Sample Collection and Analysis . About 3 mL of venous blood was collected from each participant and HIV biomarkers CD4 counts and viral loads were determined. Two CD4 counts were obtained for this study: nadir CD4 counts (the lowest CD4 count ever recorded) and the current CD4 counts (CD4 counts at the time of the study). It was important to evaluate both the nadir and the current CD4 counts in this study to appreciate the effect of antiretroviral therapy on CD4 and to ascertain the stage at which some HIV related ocular disorders actually occurred. Ophthalmic Examination. Ophthalmic examination was conducted by experienced eye care personnel. Presenting Distance Visual Acuity (PDVA) measurements followed by slit lamp biomicroscopy and dilated funduscopy were performed on all participants. Pinhole acuity was performed to rule out refractive error as the cause of reduced vision. Dilated fundus examination was performed with 2.5% phenylephrine ophthalmic solution. Two drops of the phenylephrine were administered at an interval of 5 minutes followed by one hour of waiting to ensure maximum papillary dilation. Journal of Ophthalmology 3 Ophthalmoscopy was then performed on each participant. Ophthalmic examination forms were correspondingly labeled for each participant. Categories of visual impairment (VI) were determined based on the International Classification of Diseases, where "low vision" is defined as presenting visual acuity < 6/18 in the better eye Statistical Analysis. The data collected were entered into SPSS for Windows, version 21.0.1. The analysis involved the use of frequency distribution tables. Chi-square ( 2 ) test was used to determine the associations between categorical variables. Fisher's exact test was used where counts were less than 5. Independent -test and analysis of variance (ANOVA) were performed to compare the mean values of HIV biomarkers (CD4 counts and viral loads) between participants who had HIV related visual disorders and those who did not. A value ≤ 0.05 was considered statistically significant. Results A total of 320 patients were examined within the period, out of whom 295 had complete medical data and were included in the analysis. They comprised 78 (26.4%) males and 217 (73.6%) females. Their ages ranged from 10 to 83 years with mean age of 45.3 years (SD: ±11.6). According to the WHO criteria on HIV classification, majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three, one, and four that had 68 (23.1%), 62 (21%), and 3 (1%) participants, respectively. Two hundred and five (69.5%) of the participants were on antiretroviral therapy while the remaining 90 (30.5%) were not on therapy. The mean age of participants on ART was 45.9 (SD: ±11.64) years while those not on ART had a mean age of 43.8 (SD: ±11.46) years. There was no statistically significant difference between the mean ages of participants on ART and those without therapy ( = 1.4, = 0.14). The mean current CD4 count of participants on ART was lower (786.5 cells/mm 3 ) than of participants not on ART (863.8 cells/mm 3 ). This difference was, however, not significant ( = 1.3, = 0.20). Similarly, there was no significant difference between the mean viral load counts for participants on ART and those not on ART ( = 1.1, = 0.28). Majority of the participants (150, 50.8%) had normal vision of VA 6/6. One hundred and sixteen (39.3%) had mild visual impairment (VA 6/9-6/18). Twenty-nine (9.8%) of the participants had low vision (VA < 6/18) out of whom 19 (65.5%) were on antiretroviral therapy. Five (17.2%) of the 29 participants were in the first clinical stage of the disease whereas 19 (65.5%) and 5 (17.2%) were in stages two and three, respectively. Low vision occurrence was lower in the ART group (9.8%) than in the non-ART group (11.1%). However, there was no significant association between low vision and ART status ( 2 = 0.24, = 0.62). Out of the 295 participants who took part in the study, 17 (5.8%) had HIV related ocular disorders of whom three were bilateral cases (making 20 eyes in all). Of these 17 participants, 4 (23.5%) were males and the remaining 13 (76.5%) were females. There was no significant association between manifestation of ocular disorders and sociodemographic factors such as gender ( = 1.00), age ( = 0.60), occupation ( = 0.38), and duration of infection from the time of diagnosis ( = 0.81). There was also no significant difference between the mean ages of patients who manifested ocular disorders and those who did not ( = 0.2, = 0.80). The most prevalent HIV related ocular disorder in this study was retinal microvasculopathy (10, 58.8%). The mean CD4 count for participants with this disorder was 142 cells/mm 3 with a mean viral load of 20,308 copies/mL. Herpes zoster ophthalmicus and Toxoplasma retinochoroiditis each accounted for 2 (11.8%) of the ocular disorders found. Participants who had HZO recorded a mean CD4 count of 269 cells/mm 3 and mean viral load of 38,090 copies/mL. Cytomegalovirus retinitis was responsible for only 1 (5.9%) case and it occurred in a participant with a CD4 count of 136 cells/mm 3 and the highest viral load count of 1,474,676 copies/mL. Neuroophthalmic disorders found were Bell's (hemifacial) palsy and optic neuritis, each accounting for (1, 5.9%) of the cases. Participants who had HIV related ocular disorders had significantly lower mean values of nadir CD4 counts (172 cells/mm 3 ) when compared to those who did not have ocular disorders (309 cells/mm 3 ) ( = 0.012). This mean CD4 count (172 cells/mm 3 ) indicates that the patients who manifested HIV related ocular disorders had severe immune suppression (i.e., CD4 < 250 cells/mm 3 ). Also, patients who manifested HIV related ocular disorders recorded significantly higher mean values of viral load copies as compared to their counterparts who did not manifest ocular disorders ( = 0.006). However, no significant association was found between ocular disorders and current CD4 counts ( = 0.10). Non-HIV related ocular conditions such as nonneurological blepharoptosis, pingueculae, pterygia, conjunctivitis, cataract, and glaucoma suspects were also found in the study population. Majority (11, 64.7%) of the participants who had 4 Journal of Ophthalmology HIV related ocular disorders were at stage two of the disease while 4 and 2 were at stages one and three, respectively. There was, however, no association between ocular manifestation and clinical stage of the disease ( 2 = 1.213, = 0.724). Again, no association was found between ART usage and ocular manifestation ( 2 = 0.110, = 1.000). Discussion Previous studies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The current study sought to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. The 5.8% prevalence of HIV related ocular disorders in the present study was lower than in a recently published study from the Ashanti region of Ghana where the authors reported ocular complications in 48% The finding of 9.8% low vision in this study was higher than the 3.1% reported by Abokyi et al. [20] also in the Cape Coast Metropolis in Ghana. HIV retinal microvasculopathy being the most common HIV related ocular manifestation is consistent with the recent report from the Ashanti region, Ghana Herpes zoster ophthalmicus as the second most common ocular disorder was comparable with reported cases from Nigeria and Cameroon The finding on CMV retinitis is consistent with that in Ethiopia Conclusion Consistent with other findings, our study suggests that ocular manifestations in HIV patients are heightened by reduced CD4 counts and corresponding higher viral load copies. Particularly, CMV retinitis was associated with extremely high viral load copies though it was very rare. Ethical Approval Ethical clearance with certificate ID UCCIRB/CHAS/2015/ 090 was obtained from the Institutional Review Board of the University of Cape Coast. Consent Participants and guardians provided informed consent by thumbprinting or signatures after freely agreeing to participate. Competing Interests The authors declare that they have no competing interests. Authors' Contributions Emmanuel Kwasi Abu, Samuel Abokyi, Richard Kobina Dadzie Ephraim, and Daniel Afedo conceived the study idea and participated in its design and data analysis and in the manuscript preparation. Emmanuel Kwasi Abu, Samuel Abokyi, Dorcas Obiri-Yeboah, Daniel Afedo, and Samuel Bert Boadi-Kusi participated in the clinical examination of patients and in the data analysis and were also involved in reviewing the manuscript. Richard Kobina Dadzie Ephraim and Lawrence Duah Agyeman conducted the laboratory analysis of the samples. All authors read and approved the final manuscript

Psychological impact of COVID-19 on diabetes mellitus patients in Cape Coast, Ghana: a cross-sectional study

Introduction: COVID-19 pandemic has had a greater psychological impact on patients with chronic ailments such as diabetes mellitus, tuberculosis, and HIV/AIDS compared to those without chronic conditions. We explored the psychological impacts of COVID-19 among people living with diabetes mellitus in Ghana. Methods: this study employed a hospital-based cross-sectional design involving 157 diabetes mellitus patients aged 20 years and above. We assessed diabetes distress by the seventeen-item diabetes stress (DDS17) scale and COVID-19 worries by 3 specific benchmarks: “worry about overly affected due to diabetes if infected with COVID-19”, “worry about people with diabetes characterized as a risk group” and “worry about not able to manage diabetes if infected with COVID-19”. A close-ended questionnaire was used in data collection. Results: of 157 diabetic patients interviewed, the majority had type 2 diabetes mellitus with known complications and only 42.7% were managing COVID-19 symptoms. The participants showed moderate to high level of COVID-19 specific worry, moderate fear of isolation, and low level of diabetes-associated distress. About 33.8% of the study population expressed a sense of worry towards the pandemic. The logistic regression showed that age, employment status, and presence of other chronic diseases were significantly associated with worries about being overly affected if infected with COVID-19 due to their diabetes status. Age and sex were associated with worries about people with diabetes being characterized as a risk group and age, sex and employment status were associated with participants who were worried about not being able to manage diabetes if infected with COVID-19. Conclusion: the general trend indicates a sense of worry among diabetes patients during the COVID-19 pandemic which is associated with poorer psychological health. Clients' education and counseling on COVID-19 are necessary to address some of their concerns to minimize the level of anxiety and emotional stress in these individuals

Evaluation of Renal Function in Pregnant Women with Malaria: A Case-Control Study in a Mesoendemic Area

Background. Malaria is known to have devastating effects on mortality in tropical and subtropical regions with the effect being magnified in people with weakened immunity such as those in pregnancy. We assessed the effect of malaria on renal function of pregnant women receiving antenatal care in a mesoendemic area of Ghana. Methodology. A case-control study that enrolled a total of 100 pregnant women (50 with confirmed gestational malaria as cases and 50 without malaria as controls). Sociodemographic characteristics, obstetric history (obtained with a questionnaire), urea, creatinine, sodium, and potassium were analyzed using a chemistry automated analyzer. Results. Plasma urea and creatinine were significantly increased (P=0.0003 and P<0.0001, resp.) among cases compared to the controls. Also the levels of urea (P=0.033), creatinine (P=0.032), and parasitaemia (0.016) were significantly increased with increasing gestational age. Conclusion. Malaria has a significant impact on renal function (most importantly, urea and creatinine) and is also significantly associated with increasing gestational age among our study participants

Abnormal coagulation profile in people living with HIV-AIDS on combined Antiretroviral Therapy: findings from a case-control study in the Ho municipality, Ghana

Introduction: Although combined Anti-Retroviral Therapy (cART) has improved the quality of life and survival in people living with HIV-AIDS (PLWHA), there have been reports of increased non-AIDS related co-morbidities such as coagulopathies. The objective of this study was to assess the effect of cART on the coagulation profile of PLWHA. Methods: This case-control study recruited 110 PLWHA (65 patients on cART, and 45 cART naïve patients) from the antiretroviral therapy unit of Volta Regional Hospital, Ho. Blood was collected for prothrombin time (PT), activated partial thromboplastin time (APTT)and platelet count. Results: cART naïve individuals had a high PT (p &lt;0.001; 17.2 vs 13.8) and APTT (p = 0.081; 59.7 vs 55.3) compared to their counterparts on cART. Also, INR was significantly lower in cART-treated PLWHA (p&lt;0.001). Platelet count was high in participants on therapy compared to their naïve counterparts (204.7 vs 193.6, p = 0.402). Patients on zidovudine + nevirapin + efavirenz therapy had a significantly lower PT compared to those on zidovudine + lamivudine + efavirenz therapy {p = 0.02, 13.23 vs 14.66}. Additionally, PLWHA on zidovudine + nevirapin + efavirenz had reduced APTT compared to those on zidovudine + lamivudine + efavirenz therapy, or zidovudine + lamivudine+ nevirapine therapy (p = 0.058; 47.55 vs 56.81 vs 56.85 respectively). Conclusion: HIV infection adversely affects the coagulation profile in PLWHA which improves with cART. Barring the existence of other comorbidities, cART with zidovudine + nevirapin + efavirenz combination could be the treatment of choice as it significantly improves the coagulation profile in PLWHA

Evaluating the Contribution of Nocardia spp. and Mycobacterium tuberculosis to Pulmonary Infections among HIV and Non-HIV Patients at the Komfo Anokye Teaching Hospital, Ghana

Tuberculosis (TB) is a major cause of human mortality particularly in association with the human immunodeficiency virus (HIV). Nocardia spp. has emerged as an opportunistic infection especially in HIV patients. The high prevalence of TB and HIV coupled with the lack of a definitive laboratory diagnosis for Nocardia spp. could lead to misdiagnosed pulmonary TB. This study determined the prevalence of pulmonary infections due to Nocardia spp. and Mycobacterium tuberculosis in sputum of HIV and non-HIV patients with suspected pulmonary tuberculosis at KATH. A total of sixty sputum samples were obtained from HIV and non-HIV patients with suspected pulmonary tuberculosis. Samples were examined by fluorescence based Ziehl–Neelsen staining, culture, and PCR methods. The prevalence of Nocardia spp. and Mycobacterium tuberculosis was 18.3% and 20%, respectively, with the latter having the highest rate among patients aged 21–40 years (P=0.075). The prevalence of Nocardia spp. among HIV patients was 90.9% whilst 16.7% of the patients had HIV/Nocardia spp. coinfection. Detection of Mycobacterium tuberculosis by fluorescence-based Ziehl–Neelsen staining, culture, and PCR yielded 9 (15%), 11 (18.3%), and 12 (20%), respectively. There is a high prevalence of nocardiosis especially in HIV patients. PCR is a better diagnostic method that detects both Nocardia spp. and Mycobacterium tuberculosis and should be incorporated into routine diagnosis for pulmonary infections

An exploratory pharmacogenetic screening of SLC22A6, SLC22A8, ABCC4 and ABCC10 genes in a cohort of Ghanaian HBV patients

Abstract Background Organic anion transporters and efflux transporters are involved in the metabolism of drugs such as tenofovir disoproxil fumarate (TDF). Given the important role of organic anions and efflux transporters in drug disposition, genetic variations lead to interindividual differences in drug response. Variations in the SLC and ABC transporters have been associated with drug-induced renal dysfunction. Looking at the prevalence of HBV infection in our population and the use of drugs such as TDF in managing this condition, this study aimed to undertake an exploratory analysis of genetic variation in renal transporters SLC22A6, SLC22A8, ABCC10 and ABCC4 in a Ghanaian HBV infected cohort. Methods We genotyped 160 HBV infected patients for SNPs in SLC22A6 (rs12293966, rs4149170, rs6591722, rs955434), SLC22A8 (rs11568487), ABCC10 (rs700008, rs831311) and ABCC4 (rs9282570) genes. Clinicodemographic data was taken, and glomerular filtration rate (eGFR) was estimated using the CKD-EPI formula. Genotyping was undertaken using Iplex gold SNP genotyping protocol on the Agena MassARRAY® system. Statistical analysis was undertaken using packages in Stata SE (v17) and GraphPad prism. Hardy–Weinberg equilibrium, haplotype inference, and linkage disequilibrium (LD) were evaluated using web-based tools LDlink and Shesis. Results The average eGFR was 79.78 ± 33.08 mL/min/1.73 m2 with 31% classified as stage 1 with normal or high GFR (eGFR > 90 mL/min/1.73 m2) and 45% with stage 2 CKD (> 60–89.99 mL/min/1.73 m2). All variants were in HWE except rs4149170, rs9282570 and rs700008 where p < 0.05. Strong LD was observed in the variants rs6591722, rs4149170, rs12293966, rs955434 and rs11568487. There was significant association between rs12293966 and eGFR stage under crude dominant inheritance model (OR 0.27, 95% CI 0.08–0.81; p = 0.019). Under crude model (OR 0.21, 95% CI 0.07–0.66; p = 0.008), adjusted model 1 (OR 76, 95% CI 0.39–7.89; p = 0.014) and adjusted model 2 (OR 0.30, 95% CI 0.12–0.78; p = 0.013) there was significant association observed between rs12293966 and eGFR stage in a codominant inheritance. Conclusion The associations observed in this study point to the need for further evaluation with the population of HBV patients on TDF treatment in addition to other factors that would lead to unfavorable outcomes. This exploratory finding may require confirmation in a larger cohort with proper phenotyping to investigate the exact pharmacogenetic mechanisms

Asymptomatic urinary tract infections in pregnant women attending antenatal clinic in Cape Coast, Ghana

Urinary tract infections culminating from poor diagnosis during pregnancy puts pregnant women at high risk of serious complications. This study investigated the incidence of urinary tract infections among pregnant women attending antenatal clinics in the Cape Coast Metropolis of the Central Region of Ghana. Physical, chemical, microscopic, and microbial analysis were performed on urine samples obtained from 200 pregnant women aged 15 -45 years attending the University of Cape Coast Hospital, Cape Coast Metropolitan Hospital and Ewim Urban Health Centre. The prevalence of urinary tract infections in the three trimesters was determined together with sensitivity testing of the bacteria isolates to antimicrobial drugs. Overall prevalence stood at 56.5 %, although comparatively high in pregnant women in the second trimester (50.4 %). Escherichia coli were the most implicated organism (48.7 %). Pregnant women aged between 15 -32 years were the most affected and gentamycin was the most effective antimicrobial against the bacteria isolates. Results indicated that the incidence of urinary tract infections was high among pregnant women in the study area; therefore, urine microbial screening should be included in the routine antenatal checkups for pregnant women to detect the asymptomatic infections to reduce its risk to pregnancies

Impact of Serum Prolactin and Testosterone Levels on the Clinical Parameters of Dry Eye in Pregnant Women

Purpose. To explore the relationship between serum prolactin, testosterone level, and tear film parameters. The potential impact of these hormones on the health of the ocular surface in pregnant women was evaluated. Methods. This was a hospital-based cross-sectional study in which ocular symptoms (Ocular Surface Disease Index (OSDI)), tear function (fluorescein tear breakup time, Schirmer’s test 1), corneal and conjunctival staining, meibomian gland (MG) expressibility, and quality of secretion were measured. Lid margin findings including lid notching, thickness, and lid margin telangiectasia were also recorded. Venous blood was collected and the serum concentrations of prolactin and testosterone were determined using ELISA kits. Correlation and multiple linear regression analyses were used to examine predictors of dry eye symptoms and signs. Results. A total of 160 pregnant women participated in the study and their mean age was 30.1 ± 4.6 years (range 18–42 years). The correlation analysis indicated that testosterone concentration did not significantly correlate with any of the clinical parameters hence it was not included in the linear regression analysis. However, prolactin serum concentration correlated significantly with Schirmer’s test 1. Multiple linear regression was done to predict participants’ Schirmer’s test 1 score based upon their ocular surface staining score (oxford grading scale), meibomian gland expressibility, meibomian secretion quality, and serum concentration of prolactin. Only predictors that significantly correlated with Schirmer’s test 1 in the correlation analysis were included in the linear regression analysis. A significant regression equation was obtained (F (2, 157) = 5.119, p=0.007) with an R square of 0.05. Multiple linear regression analysis revealed that concentration of prolactin (ß coefficient = 0.032, p=0.044) and meibomian gland expressibility scores (ß coefficient = 2.14, p=0.016) were associated with Schirmer’s test 1 scores when adjusted for duration of pregnancy. Conclusion. The study showed that increased serum prolactin levels have a weak but positive impact on Schirmer’s test 1 scores whilst serum testosterone level has no association with the clinical parameters of dry eye in pregnant women

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, Bell’s 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

Profiling immuno-metabolic mediators of vitamin B12 deficiency among metformin-treated type 2 diabetic patients in Ghana.

BackgroundThe association between prolong metformin usage and B12 deficiency has been documented. However, the prevalence estimates of metformin-induced vitamin B12 deficiency showed substantial disparity among studies due to varied study definitions of vitamin B12 deficiency. Metformin blocks the calcium dependent absorption of the vitamin B12-Intrinsic Factor complex at the terminal ileum. Lack of intrinsic factor due to the presence of auto-antibodies to parietal cells (IFA) could lead to vitamin B12 deficiency and subsequently cause peripheral neuropathy. We investigated the prevalence of vitamin B12 deficiency using more sensitive, combined markers of vitamin B12 status (4cB12) and the immuno-biochemical mediators of vitamin B12 deficiency.MethodsIn this observational study, 200 consecutive consenting metformin-treated T2DM patients, aged 35 and above, attending the diabetic clinic at KATH were recruited. Vitamin B12 deficiency was classified based on the Fedosov age-normalized wellness quotient. Anthropometric measurement was taken as well as blood samples for immunological and biochemical mediators. Peripheral neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI). Statistical analysis was performed using the R Language for Statistical Computing.ResultsUsing the combined indicator (4cB12), the prevalence of metformin induced vitamin B12 deficiency was 40.5% whilst the prevalence of MNSI-Q and MNSI-PE diabetic neuropathy was 32.5% and 6.5% respectively. Participants with vitamin B12 deficiency had significantly higher levels of IFA, GPA, TNF-α, TC, LDL and albumin compared to those with normal vitamin B12 levels (p ConclusionVitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF-α and cardiometabolic risk factors (higher LDL and TC and lower HDL). Upon verification of these findings in a prospective case-control study, it may be beneficial to include periodic measurement of Vitamin B12 using the more sensitive combined indicators (4cB 12) in the management of patients with T2DM treated with metformin in Ghana