4 research outputs found
The Prevalence of the Metabolic Syndrome in Ghanaian Psychiatric Patients on Antipsychotic (First versus Second Generation) Treatment in the Kumasi Metropolis
Metabolic syndrome (MetS), a predominant public health problem linked to cardiovascular and other morbidities, has acquired a significant precedence in clinical settings and patients with severe mental illnesses who are at higher risk for deviant components of this syndrome due to their illness and its treatment require careful and regular monitoring in this regard. Even though MetS has been established to be more prevalent among psychiatric patients than among any other population group, no data exist on its prevalence in Ghanaian psychiatric patients. This study seeks to find the prevalence of the MetS, in Ghanaian psychiatric patients on antipsychotics (first or second generation) compared to newly diagnosed psychiatric patients. This cross-sectional study of patients attending psychiatric department of the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana between February 2009 and July 2010. A total of 200 psychiatric patients comprising 100 newly diagnosed antipsychotic naïve patients and 100 patients on antipsychotic medication were sampled for the study. Prevalence of MetS diagnosed using the World Health Organization (WHO), International Diabetes Federation (IDF) and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria for defining MetS was employed.The prevalence was significantly higher among psychiatric patients on treatment in comparison with the treatment naïve group using NCEP ATP III (21.0% vs. 2.0%; p < 0.0001) and IDF (29.0% vs. 2.0%; p < 0.0001) criteria but not WHO (13.0% vs. 14.0%; p = 0.8372). Irrespective of the criteria used, the prevalence of MetS was higher among patients on second generation versus first generation antipsychotic medication (i.e. 44.4% vs. 18.7% for NCEP ATP III; 22.2% vs. 12.1% for WHO and 56.6% vs. 27.5% for IDF), however these did not reach a significant levelPrevalence of MetS was not only highly prevalent among Ghanaian patients treated with antipsychotic drugs, it was also higher among patients on second generation versus first generation antipsychotic medication. Keywords: Diabetes, hypertension, dyslipidaemia, mental illness, antipsychotics.
Interplay of adipokines in the pathogenesis of essential hypertension: A comparative cross-sectional in Ghana
Background: The renin-angiotensin-system (RAS), endothelial dysfunction and sympathetic nervous system are mechanistic risk factors of hypertension. The study sought to elucidate the interplay of adipokines in the pathogenesis of essential hypertension.Methodology: This comparative cross-sectional study recruited 200 confirmed hypertensive patients from the KATH and 50 age-matched normotensives. Participants’ blood pressures, anthropometric and socio-demographic information were voluntarily obtained. Serum levels of adiponectin, leptin and resistin of the participants were quantified using the ELISA. Renal function, lipid profile and glycemic status of all subjects were also analyzed.Results: Hypertensive patients showed a significantly higher anthropometric indices of adiposity compared to normotensives, CI (p < 0.0001), BAI (p < 0.0001) and AVI (p = 0.002). Adiponectin levels (p < 0.0001) were significantly lower in the hypertensive relative to the normotensives. Furthermore, significantly higher concentrations of serum leptin (p = 0.016) and the leptin-adiponectin ratio (p = 0.001) were observed among the hypertensive compared to the normotensives. The study further observed a direct association between serum leptin and weight (r = 0.111, p = 0.022), BMI (r = 0.129, p = 0.009) and WHtR (r = 0.098, p = 0.045) but inverse relationship with height (r = -0.134, p = 0.006) among the hypertensive. Serum leptin has a significant negative correlation with HDL-C among the hypertensive (r = -0.174, p = 0.013). The fully aOR for hypertension as predicted by resistin and adiponectin were 1.12 (95% Cl, 1.02–1.25); p = 0.019) and 0.93 (95% Cl, 0.91–0.95); p = 0.0001) respectively.Conclusion: We found that elevations in serum levels of leptin and resistin, and low levels of adiponectin may play a role in the pathogenesis of essential hypertension. Therefore, adipokines may offer themselves as potential indices for early and accurate detection of high blood pressure. At the same time our presentresults also confirm the conclusions with respect to correlation of leptin and obesity. Further longitudinal studies in a larger population are warranted to investigate the physiological and pathological functions of adipokines in hypertension.Keywords: Adipokines, Hypertension, Leptin, Adiponectin, Resisti
Prevalence of anaemia and immunological markers among Ghanaian HAART-naïve HIV-patients and those on HAART
Background: Highly active antiretroviral therapy (HAART) for people
living with HIV/AIDS (PLWHA) has been generally accepted as the gold
standard for the management of HIV patients but conflicting reports
about the ability of HAART to improve upon the quality of life of HIV
patients has cast doubts over the efficacy and the need for therapy.
Objective: This study was conducted to assess the efficacy and ability
of HAART to resolve immunological and haematological abnormalities in
HIV infected patients, existent sex variations in immunological and
haematological parameters and CD4 predictive ability of the study
parameters. Methods: A total of 442 PLWHA consisting of 166 patients on
HAART (28 males and 138 females) and 276 HAART-naïve patients (76
males and 200 females) were recruited for this study. Complete
haemogram, immunological analysis (CD4 & CD3) and weight were
measured for all the patients. Results: HAART patients were older and
heavier than their naïve counterparts. The incidence of anaemia
(Hb less or equal to 10.5 (63%) and PCV < 30% (37.6%)) and
lymphopoenia (16.7%) in HAART-naïve patients was significantly
higher compared to their counterparts on HAART (46%, 15.2% and 5.3%)
respectively. 70% of HAART-naïve females had anaemia in comparison
to 44% in HAART-naïve males (P = 0.0001). The likelihood of
developing microcytic hypochromic anaemia in HAART-naïve patients
was 5 times more compared to those on HAART (P = 0.0002). Total
lymphocyte count, haemoglobin, lymphocyte count and weight were
significant predictors of CD4 counts and TLC values between 1.0 2.0 k
μL-1 was a significant predictor of CD4 <200 cells mm-3.
Conclusion: HAART has the capability of reducing the incidence of
anaemia and lymphopoenia which are associated with disease progression
and death in HIV infected patients. Total lymphocyte count, haemoglobin
and weight could also serve as useful predictive tools in the
management and monitoring of HIV infected patients in resource limited
settings
Renal insufficiency in Ghanaian HIV infected patients: need for dose adjustment
Background: Antiretrovirals (ARVs) could lead to clinically significant
nephrotoxicity and as such will require dose adjustments in the
presence of renal insufficiency. Objective: To explore renal function
estimating equations as alternatives for glomerular filtration rate
(GFR) measurement in a stable cohort of HIV-infected patients.
Methods:In estimating renal insufficiency in Ghanaian HIV-infected
patients, GFR for 276 HAART-naïve patients and 166 patients on
HAART was estimated with the Cockcroft-Gault, 4v-MDRD and CKD-EPI
estimating equations. Results:Females outnumbered males by 3 to 1 in
the HAART-naïve group and 4 to 1 in subjects on HAART. The
prevalence of renal insufficiency calculated with the Cockcroft-Gault,
4v-MDRD and CKD-EPI equations was 8.7%, 9.1% and 8.7% in
HAART-naïve patients; 14.5%, 12.6% and 12.6% in patients on HAART;
7.7%, 11.5% and 11.5% in HAARTnaïve males; 10.8%, 8.1% and 8.1% in
males on HAART; 9.1%, 8.0% and 7.5% in HAART-naïve females and
15.5%, 14.0% and 14.0% in females on HAART. The CKD-EPI equation
yielded lower bias when compared to the Cockcroft-Gault and 4v-MDRD
equations. Conclusion:Renal insufficiency is not uncommon among HIV
infected Ghanaian patients. A significant proportion (10 to 11%) will
require ARV dose adjustment at the time of initiating therapy or
sometime during on-going therapy