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Background: Achieving disease control is the goal of asthma management. Serum or sputum eosinophil counts have been known traditional means of assessing eosinophilic airway inflammation in asthma, which is vital in predicting response to corticosteroid therapy which ultimately promotes control of the disease. Evidence suggests that fraction of exhaled nitric oxide (FeNO) may be a more useful non-invasive surrogate biomarker for the assessment of eosinophilic airway inflammation and could help with the timely adjustment of inhaled corticosteroid therapy in the uncontrolled asthma patient. The relationship between FeNO and other markers of airway inflammation has been variable in literature, with limited data in sub-Saharan Africa where FeNO testing is very sparse. We sought to define the relationship between FeNO levels, serum eosinophil counts, spirometry measures and symptom control among asthma patients. Materials and methods: The study was conducted at the Asthma Clinic of a large tertiary hospital. This study included 82 patients with physician-diagnosed asthma being regularly managed at the clinic. All participants were taken through the asthma control test (ACT), had FeNO and spirometry measurements taken according to the American Thoracic Society (ATS) guidelines. Blood samples were obtained from all participants for serum eosinophil counts. Correlation coefficient was used to ascertain the relationship between FeNO levels and serum eosinophil counts, ACT scores, and spirometry measurements. Logistic regression was used to examine the association between high FeNO and abnormal FEV1 percentage predicted (<80%) with adjustments for age, sex, and BMI. Results: A total of 82 patients with asthma were included in the study, with higher prevalence of females (72%). Majority (40.2%) of the patients were found in the 60 and above age category. The median FeNO level and ACT score was 42.00 (26.00-52.50) parts per billion (ppb) and 20.0 (18-23) respectively. The median serum eosinophil counts was 0.25(0.90-0.38) x 109/L. The median FeNO levels were significantly higher in patients with partly and very poorly controlled asthma than in the well-controlled group (p<0.001). A total of 47(57%) of the patients were classified as having well controlled asthma and 35 (42%) uncontrolled. FeNO correlated with serum eosinophil counts (r=0.450, p<0.001), ACT (r = -0.648, p<0.001), and FEV1 percentage predicted (r = -0.353, p=0.001). High FeNO (>50ppb) was associated with an over fivefold increased risk of having an abnormal FEV1 percentage predicted. Conclusion: FeNO levels significantly correlated with the ACT scores, serum eosinophil counts and FEV1% predicted among the asthma patients who were on inhaled corticosteroid therapy. High FeNO was significantly associated with abnormal FEV1 percentage predicted. We suggest that the point of care assessment of FeNO is a reliable marker of eosinophilic inflammation in our cohort of patients and together with 'ACT scores' in our asthma clinics could increase asthma control rates. [ABSTRACT FROM AUTHOR]

Background and Aims: Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold‐Jarisch reflex do not fully explain SA‐related cardiopulmonary complications. Reduction in FEV1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV1 following SA and adverse intraoperative cardiopulmonary complications. Materials and Methods: A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV1% predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV1% < 10% and ∆FEV1% ≥ 10%) based on reductions (∆) in FEV1% predicted following SA. Logistic regression analyses were used to examine associations between ∆FEV1% and intraoperative hypoxia, hypotension, bradycardia, and nausea/vomiting, with adjustments for age, gender, and BMI. Results: The mean FEV1% predicted following SA was lower than the mean FEV1% predicted before SA (83.42 vs. 95.31, p = 0.001). In a fully adjusted model, ∆FEV1% ≥ 10% was associated with an increased risk of hypoxia [AOR 13.55; 95% CI, 1.07–171.24, p = 0.044]. The positive associations between ∆FEV1% ≥ 10% and hypotension [2.02 (0.33–12.46), 0.449], bradycardia [1.10 (0.28–4.25), 0.895] and nausea/vomiting [9.74 (0.52–183.94), 0.129] were not statistically significant. Conclusion: Reduction in FEV1% predicted following SA was associated with adverse intraoperative outcomes. FEV1 may play an important role in the association between SA and cardiopulmonary complications. [ABSTRACT FROM AUTHOR]

Background: The rapidly rising cardiometabolic disease (CMD) burden in urbanizing sub-Saharan African populations and among sub-Saharan African migrants in Europe likely affects serum adiponectin and leptin levels, but this has not yet been quantified. Objectives: To compare the serum levels of adiponectin and leptin among migrant, and non-migrant (urban and rural) populations of Ghanaian descent. Methods: Cross-sectional analysis of serum leptin and adiponectin in the multi-centre Research on Obesity and Diabetes among African Migrants (RODAM) study. Logistic-regression models were used to examine the association between these adipocyte-derived hormones after stratification (sex, geographic area) and adjustments for potential confounders. Results: A total of 2518 Ghanaians were included. Rural participants had the highest serum adiponectin and lowest leptin levels compared to Amsterdam and urban Ghanaians (P <.001). In fully adjusted models, participants living in urban Ghana had significantly higher odds of hyperleptinemia compared to rural participants (women-odds ratio 2.88; 95% CI, 1.12-7.38, P =.028 and men 43.52, 95% CI, 4.84-391.25, P <.001). Urban Ghanaian men also had higher odds of elevated leptin: adiponectin ratio (6.29, 95% CI, 1.43-27.62, P =.015). The odds of hyperleptinemia were only higher in Amsterdam Ghanaian men (10.56; 95% CI, 1.11-100.85, P =.041), but not in women (0.85; 95% CI, 0.30-2.41, P =.759). There was no significant association between hypoadiponectinemia and geographical location in both sexes. Conclusion: Urbanization is associated with serum adiponectin and leptin levels after adjusting for confounding covariates in sub-Saharan Africans. These findings serve as a backdrop for further research on the role adipokines play in CMD epidemiology among Africans. [ABSTRACT FROM AUTHOR]

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 > 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. [ABSTRACT FROM AUTHOR]

Background: Limited longitudinal data exist on chronic kidney disease (CKD) in African populations undergoing epidemiological transitions. We investigated incidence, long-term predictors and progression of CKD among Ghanaians residing in Ghana and Ghanaian migrants in the Netherlands (Amsterdam)., Methods and Findings: We analysed data from 2183 participants in the transcontinental population-based prospective Research on Obesity and Diabetes among African Migrants cohort, followed for approximately 7 years. CKD incidence and its progression to end-stage kidney disease (ESKD) were defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. CKD incidence was calculated using age- and sex standardisation for those without CKD at baseline. Long-term predictors of CKD incidence were identified using one-step robust Poisson regression. CKD progression to ESKD from baseline was also assessed using robust Poisson regressions. Overall age- and sex standardised CKD incidence was 11.0% (95% CI 9.3% to 12.3%) in the population, with Ghanaians residing in Amsterdam at (7.6%; 5.7% to 9.5%) and Ghanaians residing in Ghana at (12.9%; 10.9% to 14.9%). Within Ghana, rural Ghanaians had similar CKD incidence to urban Ghanaians (12.5%; 8.5% to 15.5% vs 12.3%; 8.2% to 15.8%). Residence in Amsterdam was associated with lower CKD incidence compared with Ghana after adjustments (incidence rate ratio=0.32; 0.13-0.77). CKD incidence predictors were advanced age, female sex, alcohol consumption, uric acid levels and hypertension. CKD progression to ESKD was 2.3% among Ghanaians residing in Ghana and 0.0% among Ghanaians residing in Amsterdam., Conclusion: One-tenth of Ghanaians developed CKD over 7 years, with higher incidence in Ghana compared with Europe. Age, female sex, alcohol use, uric acid levels and hypertension were predictive factors. CKD progression to ESKD was minimal. High CKD incidence among Ghanaians, especially those residing in Ghana, calls for in-depth assessment of contributing factors and targeted interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Introduction: Over the past few decades, the prevalence of hypertension in Ghana has increased significantly. Insufficient diagnosis and suboptimal management of diagnosed cases result in increased mortality and morbidity due to poor blood pressure control and attendant complications. This highlights the need for new models of hypertension control in highly burdened, urban poor communities. This study aims to identify patients with hypertension in the coastal communities of the Greater Accra region, link patients newly diagnosed with hypertension to appropriate medical care and monitor treatment outcomes using task-shifting strategies., Methods and Analysis: In this quasi-experimental study, participants with a mean blood pressure of ≥140/90 mm Hg will be recruited from seven coastal communities of Ghana's Greater Accra region. Based on proportion to the size of these communities, we will screen and recruit 10 000 and 3000 participants, respectively, from all study sites. We will link the recruited individuals to designated health facilities and follow them for a year to assess treatment outcomes, blood pressure control, adherence to treatment, anthropometric measurements, funduscopic assessment, urinalysis, blood urea nitrogen and creatinine level, ECG and echocardiograms. In addition, we will use mobile health technology to support community screening, blood pressure checks and remote monitoring of patients diagnosed with hypertension, as well as send messages on medication adherence and lifestyle changes. Furthermore, we will conduct focus group discussions among community members and indepth interviews with persons considered to be newly diagnosed with hypertension, community health workers and religious leaders/representatives to assess the knowledge and perceptions of different study participants regarding hypertension diagnosis, management, control, experiences and treatment., Ethics and Dissemination: The study was approved by the Ghana Health Service Ethics Review Committee (protocol identification number GHS-ERC 028/08/22). We will obtain written informed consent from each participant. In addition to journal publication, dissemination activities will include a report to the Ghana Health Service on the outcome of the project., Trial Registration Number: ISRCTN76503336., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold-Jarisch reflex do not fully explain SA-related cardiopulmonary complications. Reduction in FEV 1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV 1 following SA and adverse intraoperative cardiopulmonary complications., Materials and Methods: A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV 1 % predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV 1 % < 10% and ∆FEV 1 % ≥ 10%) based on reductions (∆) in FEV 1 % predicted following SA. Logistic regression analyses were used to examine associations between ∆FEV 1 % and intraoperative hypoxia, hypotension, bradycardia, and nausea/vomiting, with adjustments for age, gender, and BMI., Results: The mean FEV 1 % predicted following SA was lower than the mean FEV 1 % predicted before SA (83.42 vs. 95.31, p  = 0.001). In a fully adjusted model, ∆FEV 1 % ≥ 10% was associated with an increased risk of hypoxia [AOR 13.55; 95% CI, 1.07-171.24, p  = 0.044]. The positive associations between ∆FEV 1 % ≥ 10% and hypotension [2.02 (0.33-12.46), 0.449], bradycardia [1.10 (0.28-4.25), 0.895] and nausea/vomiting [9.74 (0.52-183.94), 0.129] were not statistically significant., Conclusion: Reduction in FEV 1 % predicted following SA was associated with adverse intraoperative outcomes. FEV 1 may play an important role in the association between SA and cardiopulmonary complications., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)