Nexus between constructs of social cognitive theory model and diabetes self-management among Ghanaian diabetic patients: A mediation modelling approach

The promotion of Diabetes Self-Management (DSM) practices, education, and support is vital to improving the care and wellbeing of diabetic patients. Identifying factors that affect DSM behaviours may be useful to promote healthy living among these patients. The study assessed the determinants of DSM practices among Type 2 diabetes mellitus (T2DM) patients using a model-based social cognitive theory (SCT). This cross-sectional study comprised 420 (T2DM) patients who visited the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana. Data was collected using self-structured questionnaires to obtain socio-demographic characteristics, T2DM-related knowledge, DSM practices, SCT constructs; beliefs in treatment effectiveness, level of self-efficacy, perceived family support, and healthcare provider-patient communication. Path analysis was used to determine direct and indirect effects of T2DM-related knowledge, perceived family support, and healthcare provider service on DSM practices with level of self-efficacy mediating the relationships, and beliefs in treatment effectiveness as moderators. The mean age of the participants was 53.1(SD = 11.4) years and the average disease duration of T2DM was 10 years. Most of the participants (65.5 %) had high ( \u3e 6.1mmol/L) fasting blood glucose (FBG) with an average of 6.93 (SD = 2.41). The path analysis model revealed that age (p = 0.176), gender (p = 0.901), and duration of T2DM (p = 0.119) did not confound the relationships between the SCT constructs and DSM specified in the model. A significant direct positive effect of family and friends’ support (Critical ratio (CR) = 5.279, p \u3c 0.001) on DSM was observed. Self-efficacy was a significant mediator in this relationship (CR = 4.833, p \u3c 0.001). There were significant conditional indirect effects (CIE) for knowledge of T2DM and family and friends’ support at medium and high levels of belief in treatment effectiveness (p \u3c 0.05) via level of self-efficacy on DSM practices. However, no evidence of moderated-mediation was observed for the exogenous variables on DSM. Diabetes-related knowledge of T2DM, family and friends’ support, level of self-efficacy, and belief in treatment effectiveness are crucial in DSM practices among Ghanaian T2DM patients. It is incumbent to consider these factors when designing interventions to improve DSM adherence

Upregulation of cytokeratins in the extravillous trophoblast in the basal plate of healthy and pre-eclamptic placentae

This research has determined which specific keratin molecular species are upregulated when comparing the chorionic villous trophoblast (CVT) to the extravillous trophoblast (EVT) in the basal plate tissues of placentae from healthy and pre-eclamptic mothers at term. Indirect immunofluorescence Confocal Laser Scanning Microscopy (CLSM) revealed that at least 5 keratin proteins are expressed in villous trophoblast and the same 5 in extravillous trophoblast. A further 15 keratin proteins tested were undetectable in these tissues. All the specific keratins identified (K5, 7, 8, 18 and 19) in trophoblast were upregulated by over 20-fold in the EVT “percentage of pixels with high intensity”, a reflection of increased specific immunofluorescence. The statistically significant difference (P < 0.0001) of K5 for example, showed an increase from a median pixel value of 0.14% in CVT to 2.88% in the EVT whereas in the pre-eclamptic there was an increase from 0.06% in the CVT to 2.97% in the EVT. Similar patterns were obtained for K7, 8, 18, and 19. The reduction in the ratio of 4.8:1 of the percentage median pixel intensity from the healthy to pre-eclamptic CVT keratin related immunofluorescence expression was statistically significant in all 5 keratins (p < 0.0001). There were no significant differences in immunofluorescence pixel intensity for the EVTs at the CLSM level. At the electron microscopy level, immunogold labelling technique using anti-K7 and anti-K18 antibodies which were representatives of the two major keratin families TYPE II and TYPE I respectively, were down regulated in the CVT and EVT in pre-eclamptic compared with the healthy. On the basis of the results of these investigations the villous trophoblast in pre-eclamptic placentae may be cytoskeletally weaker through deficiency of these keratin filaments. This could be a reason why, in pre-eclampsia, trophoblast is deported in greater quantity than in healthy placenta

Upregulation of cytokeratins in the extravillous trophoblast in the basal plate of healthy and pre-eclamptic placentae

This research has determined which specific keratin molecular species are upregulated when comparing the chorionic villous trophoblast (CVT) to the extravillous trophoblast (EVT) in the basal plate tissues of placentae from healthy and pre-eclamptic mothers at term. Indirect immunofluorescence Confocal Laser Scanning Microscopy (CLSM) revealed that at least 5 keratin proteins are expressed in villous trophoblast and the same 5 in extravillous trophoblast. A further 15 keratin proteins tested were undetectable in these tissues. All the specific keratins identified (K5, 7, 8, 18 and 19) in trophoblast were upregulated by over 20-fold in the EVT “percentage of pixels with high intensity”, a reflection of increased specific immunofluorescence. The statistically significant difference (P < 0.0001) of K5 for example, showed an increase from a median pixel value of 0.14% in CVT to 2.88% in the EVT whereas in the pre-eclamptic there was an increase from 0.06% in the CVT to 2.97% in the EVT. Similar patterns were obtained for K7, 8, 18, and 19. The reduction in the ratio of 4.8:1 of the percentage median pixel intensity from the healthy to pre-eclamptic CVT keratin related immunofluorescence expression was statistically significant in all 5 keratins (p < 0.0001). There were no significant differences in immunofluorescence pixel intensity for the EVTs at the CLSM level. At the electron microscopy level, immunogold labelling technique using anti-K7 and anti-K18 antibodies which were representatives of the two major keratin families TYPE II and TYPE I respectively, were down regulated in the CVT and EVT in pre-eclamptic compared with the healthy. On the basis of the results of these investigations the villous trophoblast in pre-eclamptic placentae may be cytoskeletally weaker through deficiency of these keratin filaments. This could be a reason why, in pre-eclampsia, trophoblast is deported in greater quantity than in healthy placenta.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Differential expression of cytokeratins 7 and 18 in villous and extravillous trophoblast cells: a confocal laser scanning microscopy study

Differential expression of cytokeratins 7 and 18 in villous and extravillous trophoblast cells: a confocal laser scanning microscopy stud

Correlation Between Soluble Endothelial Adhesion Molecules and Nitric Oxide Metabolites in Sickle Cell Disease.

Nitric Oxide (NO) and soluble adhesion molecules are promising biomarkers, which predict endothelial dysfunction in sickle cell disease (SCD). Several studies have investigated the relationship between NO (as well as its metabolites) and endothelial adhesion molecules in SCD. However, these studies were done mainly in the developed world, and it is difficult to extrapolate the findings to SCD populations in other geographical regions such as Africa due to significant disparities in the results. The aim of the current study was to determine the correlation between levels of nitric oxide metabolites (NOx) and adhesion molecules in SCD patients in a tertiary hospital in Ghana. A case control cross-sectional study involving 100 SCD (made up of HbSS and HbSC patients) and 60 healthy controls was conducted. Concentrations of NOx and soluble endothelial adhesion molecules (ICAM-1, VCAM-1 and E-selectin) were measured in all the study participants (n = 160) by the Griess reagent system and enzyme-linked immunosorbent assay (ELISA). Correlation analysis was performed to determine a possible link between the variables. Levels of soluble adhesion molecules were higher in the HbSS patients. Correlation of NOx with ICAM-1 almost approached significance (r = 0.565, p = 0.058) in the HbSS patients. There were no correlations between NOx and E-selectin in both HbSS and HbSC patients. There were no significant correlations between NOx and VCAM-1 in all the study participants (p &gt; 0.05). Of the soluble adhesion molecules, ICAM-1 showed a significant positive correlation with VCAM-1 in the HbSC patients. There were no significant differences between the adhesion molecules and the age of participants in the various study groups. Whether or not a significant correlation exists between NOx and soluble adhesion molecules may not depend on the sickle cell genotype. The expression of adhesion molecules may not depend on age

Ability of Vital and Fluorescent Staining in the Differentiation of <i>Schistosoma haematobium</i> Live and Dead Eggs

This study reports (for the first time) the staining ability of vital (0.4% trypan blue and 1% neutral red) and fluorescent (Hoechst 33258) dyes to differentiate between live and dead Schistosoma haematobium (S. haematobium) eggs in human urine samples. Since S. haematobium egg is important in disease pathology, diagnosis, transmission, and drug development research, it is essential to be able to easily distinguish live eggs from dead ones. Staining is considered a way of enhancing the identification of live and dead eggs. Urine samples from school children were examined for the presence of S. haematobium eggs. Vital and fluorescent dyes were used to stain the samples that contained S. haematobium eggs, after which they were observed using light and fluorescent microscopes, respectively. The Hoechst 33258 provided a good staining outcome for differentiation between live and dead eggs, followed by 0.4% Trypan blue. Regarding the 1% neutral red stain, even though it provided some evidence of which egg was alive or dead, the distinction was not very clear; therefore, it could be useful when used in combination with other stains for egg viability determination. The benefits of this study will include assessing the effect of drugs on S. haematobium eggs in Schistosomiasis research

Nasopharyngeal Carriage and Antimicrobial Susceptibility Profile of <i>Staphylococcus aureus</i> among Children under Five Years in Accra

This cross-sectional study investigated the Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA) nasopharyngeal carriage epidemiology in Accra approximately five years post-pneumococcal conjugate vaccines introduction in the country. Archived nasopharyngeal swabs collected from 410 children aged under five years old were bacteriologically cultured. The resultant S. aureus isolates were subjected to antimicrobial susceptibility testing and screening for carriage of the mecA and LukF-PV (pvl) genes, following standard procedures. The data obtained were analyzed with Statistical Products and Services Solutions (SPSS) using descriptive statistics and Chi square tests of associations. The isolated bacteria decreased across coagulase-negative Staphylococci (47.3%, n = 194), S. aureus (23.2%, n = 95), Diphtheroids (5.4%, n = 22), Micrococcus species (3.7%, n = 15), Klebsiella pneumoniae (3.2%, n = 13), Moraxella species and Citrobacter species (1.5% each, n = 6), Escherichia coli, Enterobacter species, and Pseudomonas species (0.9% each, n = 2). The MRSA carriage prevalence was 0.49% (n = 2). Individuals aged 37–48 months recorded the highest proportion of S. aureus carriage (32.6%, 31/95). Resistance of S. aureus to the antibiotics tested were penicillin G (97.9%, n = 93), amoxiclav (20%, n = 19), tetracycline (18.9%, n = 18), erythromycin (5.3%, n = 5), ciprofloxacin (2.1%, n = 2), gentamicin (1.1%, n = 1), cotrimoxazole, clindamycin, linezolid, and teicoplanin (0% each). No inducible clindamycin resistance was observed for the erythromycin-resistant isolates. Three (3.2%) of the isolates were multidrug resistant, of which 66.7% (2/3) were MRSA. The pvl gene was associated with 59.14% (55/93) of the methicillin-sensitive S. aureus (MSSA) isolates, but was not detected among any of the MRSA isolates

Persistent Urogenital Schistosomiasis and Its Associated Morbidity in Endemic Communities within Southern Ghana: Suspected Praziquantel Resistance or Reinfection?

Background: schistosomiasis is a neglected tropical disease caused by helminths of the genus Schistosoma. The disease has a worldwide distribution, with more cases occurring in Africa. Urogenital schistosomiasis caused by S. haematobium with its associated morbidity is prevalent in many areas of Ghana. Praziquantel is still the recommended drug of choice for schistosomiasis treatment, although a number of studies have reported sub-therapeutic effects and associated treatment failure. The current study, therefore, assessed whether persistent schistosomiasis, with its associated morbidity among children living in endemic areas within the Greater Accra Region of Ghana, is as a result of reinfection or suspected praziquantel resistance. Methodology: this was a longitudinal study involving a baseline and follow-up sampling after praziquantel treatment. Urine samples were collected from school children (whose parents had also consented) for the detection of S. haematobium ova using a sedimentation technique. The morbidity parameters were examined with urine chemistry strips, as well as microscopy. Viability was assessed using a modified hatchability technique, vital staining (0.4% trypan blue and 1% neutral red) and fluorescent (Hoechst 33258) microscopy. Infected individuals were treated with a single dose of praziquantel (40mg/kg). Resampling to determine reinfection was done sixth months post-treatment, after evidence of total egg clearance. For possible resistance assessment, egg counts and viability testing were conducted on the positive samples at the baseline, as well as weekly post-treatment follow-ups for 12 weeks. Results: out of the 420 school children sampled, 77 were initially positive but, after the sixth month sampling for reinfection assessment, eight out of the initial positives were infected again, giving a reinfection percentage of 10.4%. No suspected praziquantel resistance was recorded in the 21 positives detected out of the 360 sampled for suspected resistance assessment. The egg reduction rate increased weekly in the follow-up samples with a gradual reduction in the egg count. The study also recorded a gradual decrease in the percentage of live eggs after the first week; with all viability testing methods used complimenting each other. The morbidity parameters (proteinuria, haematuria and pyuria) changed between the baseline and post-treatment samples, eventually reducing to zero. Conclusions: the outcome of this study suggests that the persistent schistosomiasis, with its associated morbidity observed in these endemic communities, is not likely to be as a result of praziquantel resistance, but reinfection. Even though there was no suspected resistance observed in the study, there remains the need to continuously intensify the monitoring of praziquantel in other endemic communities

Association between eNOS Gene Polymorphism (T786C and VNTR) and Sickle Cell Disease Patients in Ghana

Endothelial nitric oxide synthase (eNOS) variants have been found to be associated with several vascular disorders as well as the pathogenesis of sickle cell disease (SCD) complications such as vaso-occlusive crises (VOC). Studies on eNOS gene variants among SCD patients are rare in Ghana and several other African countries. The current study aimed to determine a possible association between variants of the eNOS gene (variable number of tandem repeats in intron 4 and T786C) in SCD complications among Ghanaian patients. This was a cross-sectional study involving 89 HbSS patients with complications and 46 HbSS patients without complications. Genomic DNA was extracted from leukocytes in the buffy coat and separated from collected whole blood samples of the study participants. PCR amplification, followed by restriction fragment length polymorphism (RFLP) was used to genotype T786C (rs2070744) variants. Variable number of tandem repeats (VNTR) in intron 4 was genotyped by PCR and direct electrophoresis. There was a significant difference in the genotype frequency of the T786C variant between HbSS patients with complications and those without complications (p = 0.0165). However, there was no significant difference in the VNTR intron 4 variant of the eNOS gene between patients with complications and those without complications (p &gt; 0.05). The study shows an association between the eNOS gene variant (T786C) and complications in SCD