Chronic kidney disease in type 2 diabetes mellitus patients: Comparison of KDIGO and KDOQI guidelines

Background: Chronic kidney disease (CKD), has become a public health concern as it has been reported to cause adverse outcomes such as kidney failure and premature death. This cross sectional study compared the Kidney Disease: Improving Global Outcomes (KDIGO) and Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines in assessing the prevalence of CKD in Type 2 diabetes Mellitus (T2DM) patients.Methods: We consecutively sampled a cross-section of 202 T2DM patients from the Ho municipality in the Volta region (Ghana). Structured pre-tested questionnaires were administered to obtain information on gender, age, body mass index (BMI), systolic and diastolic blood pressure, medication used, duration on medication, and duration of diabetes. Serum creatinine and urine protein were estimated using standard protocols and CKD was classified according to KDIGO and KDOQI guidelines.Results: The prevalence of CKD was 63.4% and 58.4% using the KDIGO and KDOQI guidelines respectively. The prevalence of mildly decreased renal function or worse (eGFR < 60/ml/min/1.73 m2) was 10.4% for KDIGO guideline and 7.9% for KDOQI guidelines with an excellent agreement between both definitions showing bias = -0.129, 95%CI = (-0.17 to -0.08) on Bland-Altman analysis. Participants older than 70 years were more likely to have CKD when KDIGO criteria was used (P = 0.018). The prevalence of albuminuria was 47.0% with 21.9% presenting with 1+ and 2+ grades.Conclusion: KDIGO guideline estimates higher prevalence of CKD than KDOQI guidelines in the same study population. KDIGO guideline might help in early detection and proper classification of CKD which will illicit stage-specific treatment.Keywords: Type 2 diabetes mellitus, Chronic kidney disease, Estimated glomerular filtration rate, Albuminuri

The role of ALDH1A1 in contributing to breast tumour aggressiveness: A study conducted in an African population

Aldehyde dehydrogenase 1 member A1 (ALDH1A1) is one of the most well studied breast cancer stem cells. Its expression has been associated with poor clinicopathological features and clinical outcomes in several studies. This paper studies the expression of ALDH1A1 and its combination with CD44+/CD24−/low breast cancer stem cell and their association with clinicopathological parameters and molecular subtypes.MethodTissue Microarray was constructed from 222 Formalin Fixed Paraffin Embedded (FFPE) breast cancer tissues. The expression of ALDH1A1, CD44 and CD24 were assessed by Immunohistochemistry (IHC). The association of ALDH1A1 and its association with clinicopathological parameters, molecular subtypes, CD44 and CD24 were studied in an African population. The association between CD44+/CD24−/low/ALDH1+ and the clinicopathological phenotypes were also studied.ResultsA high ALDH1A1 expression of 90% was recorded in this study. No association was found between ALDH1A1 and clinicopathological parameters. ALDH1A1 was positively associated with CD24 (r = 0.228, OR-4.599 95% CI- 1.751–12.076, p = 0.001) and CD44 (r = 0.228, OR-5.538 95%CI- 1.841–16.662, p = 0.001) but not associated with CD44+/CD24−/low (r = 0.134, OR- 2.720 95%CI- 0.959–7.710, p = 0.052). CD44+/CD24−/ALDH1+ however had significant associations with Age (p- 0.020, r = 0.161, OR- 2.771, 95%CI 1.147–6.697), Gender (p = 0.004, OR- 15.333 95%CI 1.339–175.54), Tumour grade (p = 0.005, r = 0.197, OR-3.913 95%CI 1.421–10.776) and clinical prognostic staging (p = 0.014, r = 0.182, OR-3.028 95%CI- 1.217–7.536). There was no association between CD44+/CD24−/ALDH1+ and the molecular subtypes.ConclusionThe high expression of ALDH1A1 in breast cancer makes it an important target for targeted therapy. This study further confirms the increased tumourigenicity of CD44+/CD24−/ALDH1+ combination phenotype and its association with increased tumour grade and clinical prognostic stage. Survival studies of ALDH1A1 and other breast cancer stem cells in African populations are strongly recommended to help further understand their effect on tumour aggressiveness

Assessment of vitamin D levels and adipokines mediated obesity among psychiatric patients on treatment and treatment naïve: A comparative cross‐sectional study

Abstract Background and aims Antipsychotic treatment may contribute to low vitamin D levels and have impact on direct anti‐inflammatory activity such as adiponectin activity and indirect proinflammatory activity such as leptin and resistin activity. However, vitamin D levels and adipokines mediated effect on weight gain and increased adiposity are not well evaluated. This study, therefore, assessed vitamin D and adipokines‐mediated obesity among Ghanaian psychiatric patients. Methods This comparative cross‐sectional study was conducted at psychiatric unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Anthropometric measurements, sociodemographic and previous medical history were taken from 300 antipsychotics treatment naïve and active patients. Obesity was classified using World Health Organization (WHO) body mass index (BMI)‐specific cut‐offs. Blood samples were collected for serum vitamin D and adipokines (adiponectin, leptin, and resistin) analysis using enzyme‐linked immunosorbent assay. Statistical analyses were done using SPSS version 26.0 and GraphPad Prism version 8.0. Results We observed higher prevalence of obesity among treatment active psychiatric patients (40.7%) compared to treatment naïve group (16.8%). Vitamin D insufficiency and deficiency prevalence were significantly higher among the treatment active group (25.3%; 39.5%; p < 0.001) and associated with increased odds of obesity (91.8%; cOR = 91.84, 95% confidence interval [CI]: 24.94–338.13). Moreover, adiponectin (84.2%: cOR = 14.15, 95% CI: 5.52–36.27), leptin (55.6% cOR = 2.20, 95% CI: 1.04–4.67), and resistin (79.4%: cOR = −8.34, 95% CI: 3.39–20.55) were significantly associated with increased odds of obesity among treatment active psychiatric. Furthermore, treatment active psychiatric patients exhibited inverse correlation for adiponectin and leptin with BMI (r = −0.62; −0.24), and WHtR (r = −0.53; −0.24); however, a moderate positive correlation for resistin with BMI (r = 0.80), HC (r = 0.67), and WHtR (r = 0.65). Conclusion Obesity is more prevalent in psychiatric patients on antipsychotics such as Olanzapine and Clozapine. Obesity among treatment active psychiatric patients is associated with vitamin D insufficiency and deficiency, low adiponectin and leptin levels but higher resistin level

Adverse pregnancy outcomes and imbalance in angiogenic growth mediators and oxidative stress biomarkers is associated with advanced maternal age births: A prospective cohort study in Ghana

Background Advanced maternal age (AMA) has been associated with negative pregnancy outcomes. Oxidative stress (OS) and defective placental dysfunction are contributing factors. This study determined the association between AMA and adverse pregnancy outcomes, OS biomarkers and angiogenic growth mediators (AGMs) in normal pregnancies. Methods This prospective cohort study conducted at the Obstetrics and Gynaecology (O&G) Department of the Komfo Anokye Teaching Hospital (KATH) finally included 175 normal pregnant women comprising, 58 AMA (35–45 years), 55 (30–34 years) and 62 optimal childbearing age (20–29 years). Venous blood samples were collected at 28–32 weeks for soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PIGF), 8-epiprostaglandinF2-α (8-epi-PGF2α) and total antioxidant capacity (TAC) assays. Results Pregnancies of AMA had a significantly higher levels of sFlt-1, 8-epi-PGF2α and 8-epi-PGF2α: PIGF ratio but a reduced level of PIGF, TAC and PIGF: sFlt-1 ratio compared to 20–29 years (p\u3c0.0001). A significant negative correlation between AMA and PIGF (r = -0.294; p = 0.038); TAC (r = -0.215; p = 0.001) and PIGF: sFlt-1 ratio (r = -0.457; p\u3c0.0001) and a positive correlation with sFlt-1 (r = 0.269; p = 0.017), 8-epiPGF2α (r = 0.277; p = 0.029) and 8-epi-PGF2: PIGF ratio (r = 0.461; p\u3c0.0001) levels were observed. The adjusted odds ratio (aOR), and 95% confidence interval, and p value for the significant independent adverse outcomes associated with AMA were emergency caesarean section [21.7 (5.9–121.3), p\u3c00001], elective caesarean section [2.7(0.9–5.8), p = 0.0105], stillbirth [12.6 (1.4–82.1), p\u3c0.0001], post-partum haemorrhage [4.3(1.1–18.5), p = 0.0094], preterm delivery [8.2(3.5–28.4), p\u3c0.0001], low birth weight babies [9.7(2.8–29.3), p\u3c0.0001], birth asphyxia [3.8(1.6–12.7), p = 0.0054], Apgar score 7 after 5 min for babies [10.1(4.7–23.2), p\u3c0.0001], placental abruption [3.5(1.3–8.4), p = 0.0117] and intrauterine growth restriction (IUGR) [4.6(2.3–12.9), p = 0.0001]. Conclusion AMA pregnancies correlate with adverse pregnancy outcomes and imbalance in OS biomarkers and AGMs. It is incumbent on health care givers to provide effective antenatal care among AMA mothers as early identification of these imbalance and treatment can prevent adverse pregnancy outcomes. Copyright: © 2018 Odame Anto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Altered Bioavailability of Nitric Oxide and L-Arginine Is a Key Determinant of Endothelial Dysfunction in Preeclampsia

Background. Preeclampsia is a major cause of maternal and neonatal morbidity and mortality in sub-Saharan Africa. Evidence indicates that endothelial dysfunction is central to the pathogenesis of preeclampsia. This study assessed the level of the components of the arginine-nitric oxide pathway to evaluate endothelial dysfunction in normotensive pregnancies and pregnancies complicated with preeclampsia. Methods. This case-control study was conducted among pregnant women who visited Comboni Hospital from January 2017 to May 2018. A total of 180 pregnant women comprising 88 preeclamptic women (PE) and 92 healthy normotensive pregnant women (NP) were recruited. Sociodemographic, clinical, and obstetric data were obtained using validated questionnaires. Blood pressure and anthropometrics were measured, and blood samples were collected for the estimation of nitric oxide (NO∙), L-arginine, asymmetric dimethylarginine (ADMA), and 3-nitrotyrosine using an enzyme-linked immunosorbent assay technique. Results. The mean NO∙ (p=0.010) and L-arginine/ADMA ratio (p<0.0001) was significantly lower in PE compared to NP while mean L-arginine (p=0.034), ADMA (p<0.0001), and 3-nitrotyrosine (p<0.0001) were significantly higher in PE than NP. ADMA showed a significant positive association with systolic blood pressure (β=0.454, p=0.036) in severe PE. Women with PE had significant intrauterine growth restriction (p<0.0001) and low birth weight infants (p<0.0001) when compared to NP. Conclusion. Preeclampsia is associated with reduced NO∙ bioavailability, L-arginine/ADMA ratio, and elevated levels of ADMA and 3-nitrotyrosine. Measurements of the levels of these parameters can help in the early prediction of endothelial dysfunction in preeclampsia. Exogenous therapeutic supplementation with L-arginine during pregnancy to increase the L-arginine/ADMA ratio should be considered to improve endothelial function in preeclampsia and pregnant women at risk of developing preeclampsia

Prevalence and associated factors of fetal macrosomia in a rural community in Ghana

Foetal macrosomia is known to contribute to various perinatal and maternal complications. Additionally, it has been proven to be a primary determinant of the survival of a newborn baby. We sought to determine the prevalence and associated factors of fetal macrosomia in Eikwe, a rural community in the Western part of Ghana. This hospital-based cross-sectional survey conducted from January 2017 to May 2017 engaged 200 women with singleton pregnancies at the maternity/labor unit of the St Martins de pores Hospital. Questionnaires were administered to establish socio-economic and demographic characteristics of respondents while obstetric data were retrieved from participants’ medical records/files. Maternal factors associated with macrosomia were examined using multiple logistic regressions. Of the 200 participants, the prevalence of fetal macrosomia was 6.5% [95% CI: 3.50%–10.86%]. Majority of the participants’ ages ranged between 21–25 (28.5%) and 26–30 (26.30%) years. Most of the participants were multigravida 99 (49.5%) and multipara 76 (38.0%) respectively. Aspiration of the meconium (p < 0.001) and poor Apgar score at the first minute were significantly associated (p = 0.011) with fetal macrosomia. Obesity 7 (53.8%) [11.91 (1.91–63.08), p = 0.019] and history of fetal macrosomia 9 (69.2%) [172.5 (29.37–1088.63), p < 0.001] were significantly associated with macrosomia. The prevalence of fetal macrosomia was 6.5% [95% CI: 3.50%–10.86%]; the previous history of fetal macrosomia and obesity were the main predictors of macrosomia. Moreover, poor Apgar score and aspiration of the meconium were the complications associated with fetal macrosomia

Vitamin D status and its association with insulin resistance among type 2 diabetics: A case -control study in Ghana.

BACKGROUND:Vitamin D plays a major role in physiological processes that modulate mineral metabolism and immune function with probable link to several chronic and infectious conditions. Emerging data suggests a possible influence of vitamin D on glucose homeostasis. This study sought to provide preliminary information on vitamin D status among Ghanaian type 2 diabetics and assessed its association with glucose homeostasis. METHODS:In a case control study, 118 clinically diagnosed Type 2 Diabetes Mellitus (T2DM) patients attending Diabetic Clinic at the Nkawie Government Hospital were enrolled between October and December 2015. Hundred healthy non-diabetics living in Nkawie district were selected as controls. Structured questionnaires were administered to obtain socio-demographic data. Venous blood samples were taken from both cases and controls to estimate their FBG, Lipid profile spectrophotometrically and IPTH, 25OHD by ELISA. Statistical analyses were performed using SPSS v20.0 Statistics. RESULTS:The average age of the study participants was 58.81years for cases and 57.79year for controls. There was vitamin D deficiency of 92.4% among T2DM cases and 60.2% among the non diabetic controls. Vitamin D deficiency did not significantly associate with HOMA-β [T2DM: r2 = 0.0209, p = 0.1338 and Control: r2 = 0.0213, p = 0.2703] and HOMA-IR [T2DM: r2 = 0.0233, p = 0.1132 and Control: r2 = 0.0214, p = 0.2690] in both the controls and the cases. CONCLUSION:Vitamin D deficiency is prevalent in both T2DM and non-diabetics. There is no association between vitamin D deficiency and insulin resistance or beta cell function in our study population. Vitamin D supplementation among type 2 diabetics is recommended

Comparative Assessment of Knowledge, Attitudes, and Practice of Breast Self-Examination among Female Secondary and Tertiary School Students in Ghana

Background. Breast cancer remains a serious public health problem globally. It is particularly increasing among adolescents and premenopausal women. Breast self-examination (BSE) is the most effective and feasible means of detecting breast cancer early in developing countries. This study aimed at evaluating and comparing knowledge of BSE among secondary and tertiary school students and at revealing their attitudes and practices about BSE. Method. This cross-sectional study was conducted among 1036 female secondary and tertiary school students of Kwame Nkrumah University of Science and Technology and Technology Senior High School. Data was obtained using a pretested questionnaire to access sociodemography, knowledge, attitudes, and practice of BSE among the students. Result. Most students were within the age of 15–24 years; 90.9% were aware of BSE. A high level of knowledge on BSE was found in 54.5% of the students. Knowledge was significantly higher in tertiary than secondary school students (p=0.002). 24.1% of the students thought BSE could be performed anytime; however only 8.1% of the students performed BSE monthly as recommended, whilst 41.8% had never practiced. Of these, more secondary students had never practiced BSE as compared to the tertiary students. 22.3% indicated they would wait for a change in a detected breast lump before seeking medical attention. 96.3% of the participants agree BSE is a good practice which must be encouraged. Conclusion. Teaching of BSE should be intensified beginning at the high school level, emphasizing practice and its benefits for early detection of breast cancer

Evaluating Vitamin D Status in Pre- and Postmenopausal Type 2 Diabetics and Its Association with Glucose Homeostasis

Background. Type 2 Diabetes Mellitus (T2DM) and menopause are associated with vitamin D status. Oestrogen decline during menopausal stages promotes hypovitaminosis D. However, the interplay between vitamin D, menopause, lifestyle, and T2DM cannot be overlooked. This study assessed vitamin D status among pre- and postmenopausal T2DM women and determined its association with glycemic control and influence of lifestyle habits on hypovitaminosis D. Methods. This cross-sectional study was conducted at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Structured questionnaires were administered to 192 T2DM women; blood samples were collected for estimation of 25(OH) D and insulin using ELISA. Fasting blood glucose (FBG), lipid profile, glycated haemoglobin (HbA1c), and calcium were measured. Statistical analyses were performed using Graphpad Prism 6. Results. The prevalence of vitamin D inadequacy was 92.2%. Hypovitaminosis D was more prevalent among the postmenopausal T2DM women (63.8% versus 58.2%). Hypovitaminosis D significantly associated with insulin [R2=0.01760, p=0.0008], HbA1c [R2=0.3709, p=<0.0001], and FBG [R2=0.3465, p=0.0001] in only the postmenopausal women. Conclusion. Vitamin D deficiency is prevalent in pre- and postmenopausal T2DM but higher among postmenopausal women. Adequate vitamin D levels in both groups were associated with improved glucose control while hypovitaminosis D in the postmenopausal women was related to poorer glucose control. Vitamin D screening should be incorporated into management plan for T2DM to serve as an early tool for prevention of vitamin D deficiency

Anthropometric and biochemical profile of study participants.

<p>Anthropometric and biochemical profile of study participants.</p