Sub-chronic toxicity evaluation of top three commercial herbal antimalarial preparations in the Kumasi metropolis, Ghana

Purpose: Safety data on commonly used herbal medicinal (HM) products (HMPs) and marketed in Ghana are scarce. We assessed the sub-chronic toxicity of three most-patronised commercial antimalarial HMPs in Kumasi, Ghana. Method: Top three HMPs (designated as herbal products 'A' (HPA), 'B' (HPB) and 'C' (HPC)) were selected after a mini-survey and sub-chronic toxicity evaluation conducted in accordance with Organisation for Economic Co-operation and Development (OECD) 407 guidelines. Control rats received clean water while test groups received daily adult human dose (DAHD), 5x DAHD or 10x DAHD of either HPA, HPB or HPC for 30 days. Rats were killed on day 31 to obtain biochemical, haematology and histology samples for analysis. Data were analysed by one-way analysis of variance (ANOVA) and post hoc Tukey's test. Results: The three HMPs produced alterations in liver morphology predominantly characterised by prominent foci of fatty change with scattered hepatocytes containing intracytoplasmic fat globules and congested central veins and sinusoids. The lungs showed alveolar with evidence of inflammation and foci of epithelial sloughing. Alveolar spaces were also obscured by debris and inflammatory cells. HPA and HPC produced scattered intensely congested heart vessels while HPB(10) produced haemorrhage and amorphous exudates within the heart. All HMPs produced neither treatment-related deaths nor significant change in haematological and biochemical parameters, except for HPA and HPB which decreased (P Conclusion: Data from the present study suggest the potential of the herbal products (HPs), HPA, HPB and HPC, to cause major organ-system dysfunction or damage. We advise cautious use of these products and recommend further safety evaluation in chronic toxicity models.Peer reviewe

HER-2 Protein Overexpression in Patients with Gastric and Oesophageal Adenocarcinoma at a Tertiary Care Facility in Ghana

The prognosis of gastric and oesophageal adenocarcinoma remains generally poor. However, mounting evidence suggests a positive role of human epidermal growth factor receptor-2 (HER-2) expression in the prognosis of patients with these cancers. In this work, the patterns of HER-2 protein expression were determined in patients with gastric or oesophageal adenocarcinoma. Retrospectively, we reviewed records of gastric and oesophageal biopsies received from 2008 to 2012 and their corresponding archived formalin-fixed paraffin-embedded tissue blocks selected for immunohistochemical analysis. The prevalence of gastric and oesophageal adenocarcinomas and their association with HER-2 protein overexpression were evaluated. Gastric adenocarcinoma made up 18.79% of the gastric biopsies reviewed, and majority of these cancers occurred in males. Regarding the tumour type, HER-2 overexpression was common in the intestinal subtype compared to the diffuse type. Although squamous cell carcinoma was observed to be the commonest (31%) tumour type in the oesophagus compared to adenocarcinoma (8.79%), HER-2 was overexpressed in 42.9% of oesophageal adenocarcinomas, like gastric adenocarcinoma (41.4%). There is a high prevalence of gastric and oesophageal adenocarcinoma, with significant overexpression of HER-2 in these tumours, a window of hope for the management of patients with these cancers

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

Clinicopathologic characteristics of early-onset breast cancer: a comparative analysis of cases from across Ghana

BACKGROUND: Breast cancer is the commonest cancer diagnosed globally and the second leading cause of cancer-related mortality among women younger than 40 years. This study comparatively reviewed the demographic, pathologic and molecular features of Early-Onset Breast Cancer (EOBC) reported in Ghana in relation to Late Onset Breast Cancer (LOBC). METHODS: A descriptive, cross-sectional design was used, with purposive sampling of retrospective histopathology data from 2019 to 2021. Reports of core or incision biopsy, Wide Local Excision or Mastectomy with or without axillary lymph node dissection specimen and matched immunohistochemistry reports were merged into a single file and analysed with SPSS v. 20.0. Descriptive statistics of frequencies and percentages were used to describe categorical variables. Cross-tabulation and chi-square test was done at a 95% confidence interval with significance established at p \u3c 0.05. RESULTS: A total of 2418 cases were included in the study with 20.2% (488 cases) being EOBCs and 79.8% (1930 cases) being LOBCs. The median age at diagnosis was 34.66 (IQR: 5.55) in the EOBC group (\u3c 40 years) and 54.29 (IQR: 16.86) in the LOBC group (≥ 40 years). Invasive carcinoma-No Special Type was the commonest tumour type with grade III tumours being the commonest in both categories of patients. Perineural invasion was the only statistically significant pathologic parameter with age. EOBC was associated with higher DCIS component (24.8% vs 21.6%), lower hormone-receptor-positive status (52.30% vs 55.70%), higher proliferation index (Ki-67 \u3e 20: 82.40% vs 80.30%) and a higher number of involved lymph nodes (13.80% vs 9.00%). Triple-Negative Breast cancer (26.40% vs 24.30%) was the most predominant molecular subtype of EOBC. CONCLUSION: EOBCs in our setting are generally more aggressive with poorer prognostic histopathological and molecular features when compared with LOBCs. A larger study is recommended to identify the association between relevant pathological features and early onset breast cancer in Ghana. Again, further molecular and genetic studies to understand the molecular genetic drivers of the general poorer pathological features of EOBCs and its relation to patient outcome in our setting is needed

Embryonal tumor with multilayered rosettes in a teenager

Background: Embryonal tumor with multilayered rosettes (ETMR), NOS/C19MC- altered, is a rare and recently classified highly aggressive malignant brain tumor in the 2021 World Health Organization (WHO) classification of tumors of the central nervous system 5th edition. They are mostly diagnosed in children before the age of three years. Most of them are located in the supratentorial region. Prior to the reclassification of ETMR as a single entity, three distinct tumors, namely, embryonal tumor with abundant neuropil and true rosettes (ETANTR), ependymoblastoma (EBL) and medulloepithelioma (MEPL) were recognized. Recent studies showed that all the three entities have multilayered rosettes on morphology, sharing a common amplification of the C19MC locus at the chromosome 19q13.42 by fluorescence in situ hybridization, and highly specific immunohistochemical staining for LIN28A rendered their reclassification as a single entity. Report: A 13-year-old girl was rushed to the emergency room unconscious, with no return of spontaneous circulation after cardiopulmonary resuscitation. Autopsy revealed a left cerebellar hemisphere hemorrhagic tumor which histopathological examination revealed a multilayered ependymoblastic rosettes with abundant neuropil. The multilayered rosettes showed reactivity for vimentin but non-reactivity for pan-cytokeratin, the zones with abundant neuropil were reactive for synaptophysin consistent with a diagnosis of embryonal tumor with abundant neuropil and true rosettes now ETMR, NOS (WHO Grade 4) due to the lack of genetic testing for amplification of C19MC. Conclusion: ETMR is a highly aggressive CNS embryonal tumor with extremely poor prognosis. It should be considered in the differential diagnosis of pediatric brain tumors. Multilayered rosettes are a useful clue to histologic diagnosis

A pathological and clinical study of 706 primary tumours of the ovary in the largest tertiary hospital in Ghana

Abstract Background Ovarian tumours are a leading cause of death in Ghana. Even though geographical and racial differences exist in the frequency, types and age distribution of primary ovarian tumours, information about the clinical and pathological characteristics of ovarian tumours in Ghana and its neighboring countries is scanty. We determined the frequency, age distribution, histopathological types and clinical features of primary ovarian tumours diagnosed at the Korle-Bu Teaching Hospital in Ghana to aid in the management of patients. Method All pathology records of ovarian tumours diagnosed from January 2001 to December 2010 were reviewed. Histopathologically, tumours were classified according to the then World Health Organization 1999 classification. Biographical and clinical data of patients were also collected and entered into Epi-info to determine the frequency, age distribution and other clinical features of the types of ovarian tumour. Results Seven hundred and six ovarian tumours were studied. Germ cell tumours were the most common (41.9%), with mean age of occurrence being 30.7 years (SD 12.7), they were dominated by mature teratomas (39.2%). Surface epithelial tumours were second, and commonly occurred in women aged 35–44years, 77 (26.8%). Sex cord stromal tumours followed with mean age of occurrence of 40.2 years (SD 17.9). The most common malignant tumours were surface epithelial (52.1%) dominated by serous carcinomas with mean age 50.1 years. Most patients (47.7%) presented within 1 month of onset of symptoms, feeling a lower abdominal mass (38.5%). Conclusion The most common primary ovarian tumours in this study are Germ cell tumours, dominated by mature teratomas. Adenocarcinomas are mostly serous and occur in younger women compared to findings of other Western studies. The single most common malignant ovarian tumour in children and adolescents is Burkitt lymphoma. Patients who develop ovarian tumours have no specific symptoms or signs at presentation, to aid early diagnosis

Community Causes of Death in the Central Region of Ghana, the Missing Piece in Mortality Data

Objective. Mortality data from hospitals in Ghana suggest a changing mortality trend with noncommunicable diseases (cardiovascular disorders) replacing communicable diseases as the leading cause of death. Our objective was to find out the causes of deaths in the communities of the Central Region of Ghana and raise awareness of these causes of deaths while highlighting the differences that exist between data obtained from the community and that obtained from the hospital. Method. Mortality data from Coroner’s autopsies mostly provide data about the causes of deaths in the community (out of hospital). A retrospective descriptive study of Coroner’s autopsy data at the Cape Coast Teaching Hospital was carried out over a six-year period. The various causes of death were categorized according to broad headings (accidents/injuries/poisoning, cardiovascular, infections, metabolic, neoplasms, and others). Results. A total of 1187 autopsies were reviewed of which 990 (83.4%) were Coroner’s cases. Of these Coroner’s cases, 719 (72.6%) were male and 271 (27.4%) were female. 521 (52.6%) of victims were young adults (18–44 years), and majority of deaths were unnatural (due to accidents, injuries, and poisoning) (64.1%), followed by the general category of others (15.3%). Cardiovascular deaths (6.6%) were fourth after infections (9.8%). In the leading category, most deaths were due to road traffic accidents (50.4%) as occupants of vehicles and motorcycles (28.7%) and as pedestrians (21.7%). Deaths due to road traffic accidents were followed by deaths due to drowning (14.96%). Conclusion. Although noncommunicable diseases are still the leading causes of death outside the hospital, most of the deaths are due to road traffic accidents and drowning. This is at variance with hospital data that suggest that the leading noncommunicable diseases are cardiovascular disorders and cancer. Again, like data derived from hospitals, infections remain a major cause of death in the Central Region of Ghana. Studies combining the causes of death derived from Coroner’s autopsies and communities and from medical certificates of cause of death will present a better picture of the leading causes of death in the Central Region and reveal the true nature of noncommunicable diseases that currently form our largest disease burden

HIV status and knowledge of cervical cancer among women in Ghana

Abstract Background Cervical cancer remains a disease of significant concern to women’s health. The aim of this study was to identify predictors of knowledge of cervical cancer among women living with HIV and those with negative or unknown HIV status at the Cape Coast Teaching Hospital (CCTH). Methods This study was based on a larger hospital-based analytical cross-sectional study conducted at the antiretroviral therapy (ART) and gynaecology clinics of the Cape Coast Teaching Hospital in Ghana. Participants were women living with HIV (WLHIV) and women without HIV or whose status was unknown, aged 25 to 65 years, seeking healthcare. Data were collected with a questionnaire and analysed using frequencies, percentages, Chi-square test, binary logistic regression and multivariate analysis. Results The mean age was 39.5 years (± 9.8) and 47.2 years (± 10.7) for women without or unknown HIV and WLHIV, respectively. HIV-negative/unknown women were mostly nulligravida (76%) and nullipara (69%), while WLHIV mostly had pregnancies (76%) and children (84%) in excess of seven. Knowledge of cervical cancer was statistically significantly associated with HIV status (X2 = 75.65; P-value = 0.001). The odds of having knowledge of cervical cancer for women considered to be negative/unknown for HIV were about three times (AOR = 3.07; 95% CI = 1.47, 6.41) higher than their compatriots with HIV. Women with post-secondary/tertiary (AOR = 4.45; 95% CI = 2.11, 9.35) education had significantly higher odds of having knowledge of cervical cancer than those with no education or those with just primary education. Conclusions To improve knowledge of cervical cancer among women, an intentionally structured health education programme is needed, particularly for WLHIV, those with lower levels of education and the unemployed

Additional file 1 of HIV status and knowledge of cervical cancer among women in Ghana

Supplementary Material

Prevalence of high-risk human papillomavirus infection and cervical lesions among female migrant head porters (kayayei) in Accra, Ghana: a pilot cross-sectional study

Abstract Background Little attention has been given to the risk of high-risk human papillomavirus (hr-HPV) infection and cervical precancerous lesions among female migrant head porters (kayayei) in Ghana, as a vulnerable group, and to promote cervical screening in these women. This pilot study aimed to determine the prevalence of hr-HPV infection and cervical lesions among kayayei in Accra, the capital of the Greater Accra Region of Ghana and to describe our approach to triaging and treating these women. Methods This descriptive cross-sectional cohort study involved the screening of 63 kayayei aged ≥ 18 years at the Tema Station and Agbogbloshie markets in March 2022 and May 2022. Concurrent hr-HPV DNA testing (with the MA-6000 platform) and visual inspection with acetic acid (VIA) was performed. We present prevalence estimates for hr-HPV DNA positivity and VIA ‘positivity’ as rates, together with their 95% confidence intervals (CIs). We performed univariate and multivariable nominal logistic regression to explore factors associated with hr-HPV infection. Results Gross vulvovaginal inspection revealed vulval warts in 3 (5.0%) and vaginal warts in 2 (3.3%) women. Overall, the rate of hr-HPV positivity was 33.3% (95% CI, 21.7–46.7), whereas the VIA ‘positivity’ rate was 8.3% (95% CI, 2.8–18.4). In the univariate logistic regression analysis, none of the sociodemographic and clinical variables assessed, including age, number of prior pregnancies, parity, past contraceptive use, or the presence of abnormal vaginal discharge showed statistically significant association with hr-HPV positivity. After controlling for age and past contraceptive use, only having fewer than two prior pregnancies (compared to having ≥ 2) was independently associated with reduced odds of hr-HPV infection (adjusted odds ratio, 0.11; 95% CI, 0.02–0.69). Conclusion In this relatively young cohort with a high hr-HPV positivity rate of 33.3% and 8.3% of women showing cervical lesions on visual inspection, we posit that kayayei may have an increased risk of developing cervical cancer if their accessibility to cervical precancer screening services is not increased