Pattern of Breast Diseases in Accra: Review of Mammography Reports

Objectives: To document the mammographic patterns in females seeking medical attention in Accra.Design: An analytic retrospective study was conducted using data extracted from mammography request forms and corresponding radiological reports of 180 females. Setting: The radiology departments of Korle-Bu Teaching Hospital, the Trust Hospital and Medical Imaging Ghana, all located in Accra.Results: One hundred and eighty radiologic request forms for mammographic evaluations and their corresponding reports from the study period were reviewed. The mean age of the study population was 48.7 years (SD=10.0), and the median age group was the 41–50 group. There were more screening mammography evaluations (115 examinations) than diagnostic mammography evaluations (65 examinations). Most of the cases diagnosed as breast cancer were in the age group 41–50 years. Benign lesions were commoner than cancer (55 and 16 cases respectively). The commonest presenting complaint was of pain.Conclusion: The larger number of screening mammographic evaluations conducted for asymptomatic females during the study period, as compared to diagnostic mammographic evaluations for symptomatic females, suggests that educational programs on early breast cancer detection are having a positive impact on the target population. The observation that 22.8% of lesions had features suggestive of breast cancer in the study is significantly high to also warrant intensification of the existing awareness programs. As non-specific masses were the most common radiographically observed lesions, hospitals equipped with sonography and biopsy facilities that compliment their mammography are better suited for thorough breast disease evaluation.Keywords: Mammography, sonography, screening study, diagnostic study, ductal carcinoma in situ, invasive ductal carcinoma

Molecular epidemiology of group A human rotaviruses in North West region, Cameroon

Background: Rotavirus (RV) is the most common cause of severe diarrhea in children <5 years of age worldwide accounting for 527,000 deathsannually. Over 80% of these deaths occur in South Asia and sub-Saharan Africa. RV vaccines have significantly reduced RV-associated morbidityand mortalities in several countries like the United States and Mexico while vaccine trials have proved efficacious in Ghana and other developingcountries. However, there is paucity of data on RV infection in Cameroon where diarrhea is a major childhood disease. Methods: A total of 534 stool specimens collected between January 2003 and December 2004 from children with acute gastroenteritis in five health districts in the NWR of Cameroon were screened for group A human rotavirus antigen by ELISA and their electropherotypes determined by Polyacrylamide gel electrophoresis.Results: RV was detected in 153 (28.7%) diarrheic specimens with infection occurring throughout the year, being more commonin children under two years of age (P < 0.01) with the highest incidence in the 7-9 months age group (P <0.05). Sub clinical infections (9%)occurred mostly in children aged 0 - 6 months old (P<0.01). Source of drinking water was not associated with RV infection. Elevenelectropherotype patterns were detected with predominance of long electropherotypes (92.8%) and mixed electropherotypes were seen only inhospitalized children. Some isolates showed overlapping or merged genome segments 7 and 8 or 9 and presenting with 10 segments of the RV genome. Conclusion: RV is a significant cause of pediatric diarrhea in the NWR affecting mostly children under 2 years of age. Continuous RVsurveillance and nationwide surveys are recommended to improve the health of young children in Cameroon. More research is needed to fullycharacterize the isolated RV strains.Key words: Rotavirus, diarrhea, molecular epidemiology, electropherotype

The African Vaccine-Preventable Diseases Network: a vaccine advocacy initiative

Achieving high and equitable childhood immunisation coverage in Africa will not only protect children from disability and premature death, it will also boost productivity, reduce poverty and support the economic growth of the continent. Thus, Africa needs innovative and sustainable vaccine advocacy initiatives. One such initiative is the African Vaccine-Preventable Diseases Network, formed in 2009. This association of immunisation practitioners, vaccinologists, paediatricians, and infectious disease experts provides a platform to advocate for the introduction of newly available vaccines (e.g. 10-valent and 13-valent pneumococcal conjugate and rotavirus vaccines) into the Expanded Programme on Immunisation (EPI) as well as increased and equitable coverage for established EPI vaccines.Key words: Vaccine preventable diseases, vaccine, network, Africa, awareness, child healt

Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics

<p>Abstract</p> <p>Background</p> <p>Acute diarrhoea is a major cause of childhood morbidity and mortality in sub-Saharan Africa. Its microbiological causes and clinico-epidemiological aspects were examined during the dry season 2005/6 in Tamale, urban northern Ghana.</p> <p>Methods</p> <p>Stool specimens of 243 children with acute diarrhoea and of 124 control children were collected. Patients were clinically examined, and malaria and anaemia were assessed. Rota-, astro-, noro- and adenoviruses were identified by (RT-) PCR assays. Intestinal parasites were diagnosed by microscopy, stool antigen assays and PCR, and bacteria by culturing methods.</p> <p>Results</p> <p>Watery stools, fever, weakness, and sunken eyes were the most common symptoms in patients (mean age, 10 months). Malaria occurred in 15% and anaemia in 91%; underweight (22%) and wasting (19%) were frequent. Intestinal micro-organisms were isolated from 77% of patients and 53% of controls (<it>P </it>< 0.0001). The most common pathogens in patients were rotavirus (55%), adenovirus (28%) and norovirus (10%); intestinal parasites (5%) and bacteria (5%) were rare. Rotavirus was the only pathogen found significantly more frequently in patients than in controls (odds ratio 7.7; 95%CI, 4.2–14.2), and was associated with young age, fever and watery stools. Patients without an identified cause of diarrhoea more frequently had symptomatic malaria (25%) than those with diagnosed intestinal pathogens (12%, <it>P </it>= 0.02).</p> <p>Conclusion</p> <p>Rotavirus-infection is the predominant cause of acute childhood diarrhoea in urban northern Ghana. The abundance of putative enteropathogens among controls may indicate prolonged excretion or limited pathogenicity. In this population with a high burden of diarrhoeal and other diseases, sanitation, health education, and rotavirus-vaccination can be expected to have substantial impact on childhood morbidity.</p

Prevalence of enteropathogenic viruses and molecular characterization of group A rotavirus among children with diarrhea in Dar es Salaam Tanzania

Different groups of viruses have been shown to be responsible for acute diarrhea among children during their first few years of life. Epidemiological knowledge of viral agents is critical for the development of effective preventive measures, including vaccines. In this study we determined the prevalence of the four major enteropathogenic viruses - rotavirus, norovirus, adenovirus and astrovirus - was determined in 270 stool samples collected from children aged 0 - 60 months who were admitted with diarrhea in four hospitals in Dar es Salaam, Tanzania, using commercially available ELISA kits. In addition, the molecular epidemiology of group A rotavirus was investigated using reverse transcriptase multiplex polymerase chain reaction (RT-PCR). At least one viral agent was detected in 87/270 (32.2%) of the children. The prevalence of rotavirus, norovirus, adenovirus and astrovirus was 18.1%, 13.7%, 2.6% and 0.4%, respectively. In most cases (62.1%) of viruses were detected in children aged 7-12 months. The G and P types (VP7 and VP4 genotypes respectively) were further investigated in 49 rotavirus ELISA positive samples. G9 was the predominant G type (81.6%), followed by G1 (10.2%) and G3 (0.2%). P[8] was the predominant P type (83.7%), followed by P[6] (0.4%) and P[4] (0.2%). The following G and P types were not detected in this study population; G2, G4, G8 G10, P[9], P[10] and P[11]. The dominating G/P combination was G9P[8], accounting for 39 (90.7%) of the 43 fully characterized strains. Three (6.1%) of the 49 rotavirus strains could not be typed. Nearly one third of children with diarrhea admitted to hospitals in Dar es Salaam had one of the four viral agents. The predominance of rotavirus serotype G9 may have implication for rotavirus vaccination in Tanzania

IP-10-Mediated T Cell Homing Promotes Cerebral Inflammation over Splenic Immunity to Malaria Infection

Plasmodium falciparum malaria causes 660 million clinical cases with over 2 million deaths each year. Acquired host immunity limits the clinical impact of malaria infection and provides protection against parasite replication. Experimental evidence indicates that cell-mediated immune responses also result in detrimental inflammation and contribute to severe disease induction. In both humans and mice, the spleen is a crucial organ involved in blood stage malaria clearance, while organ-specific disease appears to be associated with sequestration of parasitized erythrocytes in vascular beds and subsequent recruitment of inflammatory leukocytes. Using a rodent model of cerebral malaria, we have previously found that the majority of T lymphocytes in intravascular infiltrates of cerebral malaria-affected mice express the chemokine receptor CXCR3. Here we investigated the effect of IP-10 blockade in the development of experimental cerebral malaria and the induction of splenic anti-parasite immunity. We found that specific neutralization of IP-10 over the course of infection and genetic deletion of this chemokine in knockout mice reduces cerebral intravascular inflammation and is sufficient to protect P. berghei ANKA-infected mice from fatality. Furthermore, our results demonstrate that lack of IP-10 during infection significantly reduces peripheral parasitemia. The increased resistance to infection observed in the absence of IP-10-mediated cell trafficking was associated with retention and subsequent expansion of parasite-specific T cells in spleens of infected animals, which appears to be advantageous for the control of parasite burden. Thus, our results demonstrate that modulating homing of cellular immune responses to malaria is critical for reaching a balance between protective immunity and immunopathogenesis

High toxicity and specificity of the saponin 3-GlcA-28-AraRhaxyl-medicagenate, from Medicago truncatula seeds, for Sitophilus oryzae

<p>Abstract</p> <p>Background</p> <p>Because of the increasingly concern of consumers and public policy about problems for environment and for public health due to chemical pesticides, the search for molecules more safe is currently of great importance. Particularly, plants are able to fight the pathogens as insects, bacteria or fungi; so that plants could represent a valuable source of new molecules.</p> <p>Results</p> <p>It was observed that <it>Medicago truncatul</it>a seed flour displayed a strong toxic activity towards the adults of the rice weevil <it>Sitophilus oryzae</it> (Coleoptera), a major pest of stored cereals. The molecule responsible for toxicity was purified, by solvent extraction and HPLC, and identified as a saponin, namely 3-GlcA-28-AraRhaxyl-medicagenate. Saponins are detergents, and the CMC of this molecule was found to be 0.65 mg per mL. Neither the worm <it>Caenorhabditis elegans</it> nor the bacteria <it>E. coli</it> were found to be sensitive to this saponin, but growth of the yeast <it>Saccharomyces cerevisiae</it> was inhibited at concentrations higher than 100 μg per mL. The purified molecule is toxic for the adults of the rice weevils at concentrations down to 100 μg per g of food, but this does not apply to the others insects tested, including the coleopteran <it>Tribolium castaneum</it> and the Sf9 insect cultured cells.</p> <p>Conclusions</p> <p>This specificity for the weevil led us to investigate this saponin potential for pest control and to propose the hypothesis that this saponin has a specific mode of action, rather than acting <it>via</it> its non-specific detergent properties.</p

Glatiramer acetate reduces the risk for experimental cerebral malaria: a pilot study

<p>Abstract</p> <p>Background</p> <p>Cerebral malaria (CM) is associated with high mortality and morbidity caused by a high rate of transient or persistent neurological sequelae. Studies on immunomodulatory and neuroprotective drugs as ancillary treatment in murine CM indicate promising potential. The current study was conducted to evaluate the efficacy of glatiramer acetate (GA), an immunomodulatory drug approved for the treatment of relapsing remitting multiple sclerosis, in preventing the death of C57Bl/6J mice infected with <it>Plasmodium berghei </it>ANKA.</p> <p>Methods and Results</p> <p>GA treatment led to a statistically significant lower risk for developing CM (57.7% versus 84.6%) in treated animals. The drug had no effect on the course of parasitaemia. The mechanism of action seems to be an immunomodulatory effect since lower IFN-gamma levels were observed in treated animals in the early course of the disease (day 4 post-infection) which also led to a lower number of brain sequestered leukocytes in treated animals. No direct neuro-protective effect such as an inhibition of apoptosis or reduction of micro-bleedings in the brain was found.</p> <p>Conclusion</p> <p>These findings support the important role of the host immune response in the pathophysiology of murine CM and might lead to the development of new adjunctive treatment strategies.</p

Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis

A time series analysis by Manish Patel and colleagues shows that the introduction of rotavirus vaccination in Brazil is associated with reduced diarrhea-related deaths and hospital admissions in children under 5 years of age