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BACKGROUND: One key factor proven to increase quality of pregnancy outcome has been antenatal care (ANC) service. The perinatal triad of mother, placenta and fetus becomes functionally complete with a functional umbilical cord. The objective of the study was to establish mathematical models to predict the outcome of umbilical cord morphometric parameters using maternal first antenatal care visit biometric indices. METHOD: This analytical descriptive cross-sectional study was conducted on 240 pregnant women who attended antenatal care for the first time in their first trimester at the Victory Maternity Home and Clinic in the Kumasi Metropolis, between April 2016 and October 2019. Umbilical cord length, diameter, area, volume and weight were measured after delivery. Maternal first antenatal care visit blood pressure was taken and their non-fasting blood samples were collected and lipid profile done. RESULTS: Mean values for umbilical cord measurements were; cord length, 38.10±7.86 cm; diameter, 1.04±0.17 cm; area, 66.10±24.49 cm2 and volume was 34.02±11.16 cm3 respectively while mean cord weight was 65.01±21.35 g. The study found that a unit increase in total cholesterol led to an increase of 2.33 units in umbilical cord length, high-density lipoprotein also resulted in 0.06 units increase in cord diameter while low-density lipoprotein decreases cord length by 3.31 units. Also, a unit increase in maternal booking total cholesterol resulted in 2.33 units increase in umbilical cord length. CONCLUSION: Maternal first antenatal care visit total cholesterol, high-density lipoprotein and low-density lipoprotein could influence the outcome of umbilical cord length, diameter and area. [ABSTRACT FROM AUTHOR]

Objective: We examined BMI as a health risk factor for self-reported diabetes mellitus, angina, strokes and arthritis among older Ghanaians aged 50 years and above. Design: We analysed the individual-level data from the World Health Organization Study on global AGEing and adult health Ghana Wave 2 (2014/2015). The influence of BMI on self-reported chronic conditions including diabetes, angina, stroke and arthritis was examined. Setting: Households from all the administrative regions of Ghana. Participants: Included 3350 adults aged 50 years and older. Results: The prevalence of overweight and obesity among participants was 22·8 % (95 % CI 20·6, 25·2) and 13·2 %, respectively (95 % CI 11·5, 15·1). With respect to individual chronic conditions, arthritis emerged with the highest prevalence rate of 7·3 (95 % CI 5·3, 9·9), while the prevalence rate of diabetes, angina and stroke was 2·8 % (95 % CI 2·0, 3·9), 1·7 % (95 % CI 1·1, 2·6) and 1·3 % (95 % CI 1·0, 1·8), respectively. The risk of diabetes among overweight and obesity was over three and two times, respectively, higher compared with participants with normal weights. Overweight and obesity were significantly more than two and three times likely to experience angina, respectively, compared with participants with normal weight. Obesity significantly influences arthritis with approximately two times increased odds compared with normal weight participants. Conclusion: Prevalence of obesity and overweight in Ghana is high and increasing, which poses a health risk at the individual and population levels. Inter-sectorial and multidisciplinary measures in line with the national non-communicable disease policies aimed at curbing this trend are imperative. [ABSTRACT FROM AUTHOR]

Despite rapidly increasing measles immunization coverage, epidemics of measles occurred from January to March 2000 in some parts of Accra, the capital of Ghana. 44 cases of acute measles were diagnosed at three health facilities during the outbreaks, which we examined clinically and serologically. The peak incidence occurred among 6-12-year-olds, clinical symptoms were milder than the typical symptoms of measles, and fever was significantly less common. None of the cases developed complications and all recovered completely. Thirty-eight (86.4%) were tested serologically; IgM antibodies were detected in 73.7% and IgG antibodies in 84.2% during the acute phase. Milder symptoms in a significant number of cases with measles IgG antibodies suggest that these are vaccine-modified measles, attributable to waning antibodies and low circulation of wild type virus in an area of high vaccine coverage. Serological confirmation will be required for accurate diagnosis, if measles is to be eradicated or kept under control. It also seems likely that multiple dose immunization schedules will be needed in the future to maintain protective antibody levels and to protect children against measles in Ghana. This will eliminate the frequent outbreaks of measles involving immunized children. [ABSTRACT FROM AUTHOR]

Abstract Background Severe malarial anaemia (SMA) is a major life-threatening complication of paediatric malaria. Protracted production of pro-inflammatory cytokines promoting erythrophagocytosis and depressing erythropoiesis is thought to play an important role in SMA, which is characterized by a high TNF/IL-10 ratio. Whether this TNF/IL-10 imbalance results from an intrinsic incapacity of SMA patients to produce IL-10 or from an IL-10 unresponsiveness to infection is unknown. Monocytes and T cells are recognized as the main sources of TNF and IL-10 in vivo, but little is known about the activation status of those cells in SMA patients. Methods The IL-10 and TNF production capacity and the activation phenotype of monocytes and T cells were compared in samples collected from 332 Ghanaian children with non-overlapping SMA (n = 108), cerebral malaria (CM) (n = 144) or uncomplicated malaria (UM) (n = 80) syndromes. Activation status of monocytes and T cells was ascertained by measuring HLA-DR+ and/or CD69+ surface expression by flow cytometry. The TNF and IL-10 production was assessed in a whole-blood assay after or not stimulation with lipopolysaccharide (LPS) or phytohaemaglutinin (PHA) used as surrogate of unspecific monocyte and T cell stimulant. The number of circulating pigmented monocytes was also determined. Results Monocytes and T cells from SMA and CM patients showed similar activation profiles with a comparable decreased HLA-DR expression on monocytes and increased frequency of CD69+ and HLA-DR+ T cells. In contrast, the acute-phase IL-10 production was markedly decreased in SMA compared to CM (P = .003) and UM (P = .004). Although in SMA the IL-10 response to LPS-stimulation was larger in amplitude than in CM (P = .0082), the absolute levels of IL-10 reached were lower (P = .013). Both the amplitude and levels of TNF produced in response to LPS-stimulation were larger in SMA than CM (P = .019). In response to PHA-stimulation, absolute levels of IL-10 produced in SMA were lower than in CM (P = .005) contrasting with TNF levels, which were higher (P = .001). Conclusions These data reveal that SMA patients have the potential to mount efficient IL-10 responses and that the TNF/IL-10 imbalance may reflect a specific monocyte and T cell programming/polarization pattern in response to infection.

Abstract Background Severe anaemia (SA), intravascular haemolysis (IVH) and respiratory distress (RD) are severe forms of Plasmodium falciparum malaria, with RD reported to be of prognostic importance in African children with malarial anaemia. Complement factors have been implicated in the mechanism leading to excess anaemia in acute P. falciparum infection. Methods The direct Coombs test (DCT) and flow cytometry were used to investigate the mean levels of RBC-bound complement fragments (C3d and C3bαβ) and the regulatory proteins [complement receptor 1 (CD35) and decay accelerating factor (CD55)] in children with discrete clinical forms of P. falciparum malaria. The relationship between the findings and clinical parameters including coma, haemoglobin (Hb) levels and RD were investigated. Results Of the 484 samples tested, 131(27%) were positive in DCT, out of which 115/131 (87.8%) were positive for C3d alone while 16/131 (12.2%) were positive for either IgG alone or both. 67.4% of the study population were below 5 years of age and DCT positivity was more common in this age group relative to children who were 5 years or older (Odds ratio, OR = 3.8; 95%CI, 2.2–6.7, p < 0.001). DCT correlated significantly with RD (β = -304, p = 0.006), but multiple regression analysis revealed that, Hb (β = -0.341, p = 0.012) and coma (β = -0.256, p = 0.034) were stronger predictors of RD than DCT (β = 0.228, p = 0.061). DCT was also not associated with IVH, p = 0.19, while spleen size was inversely correlated with Hb (r = -402, p = 0.001). Flow cytometry showed similar mean fluorescent intensity (MFI) values of CD35, CD55 and C3bαβ levels on the surfaces of RBC in patients and asymptomatic controls (AC). However, binding of C3bαβ correlated significantly with CD35 or CD55 (p < 0.001). Conclusion These results suggest that complement activation contributed to anaemia in acute childhood P. falciparum malaria, possibly through induction of erythrophagocytosis and haemolysis. In contrast to other studies, this study did not find association between levels of the complement regulatory proteins, CD35 and CD55 and malarial anaemia. These findings suggest that complement activation could also be involved in the pathogenesis of RD but larger studies are needed to confirm this finding.

Abstract Background The overlap in geographical distribution of Plasmodium falciparum malaria and endemic Burkitt's lymphoma (eBL) – an aggressive Epstein-Barr virus (EBV)-associated B-cell tumour occurring almost exclusively in the tropics – strongly suggests a link between the two diseases. It is suspected that the polyclonal B-cell activation in P. falciparum malaria may precipitate a breakdown in homeostatic T-cell control of EBV-immortalized B-cell proliferation. Previous studies have suggested that a particular T-cell subset, characterized by expression of Vδ1+ γδ T-cell receptors, is important for maintaining B-cell homeostasis, both in P. falciparum- exposed populations and in individuals subject to polyclonal B-cell activation of other aetiology. The objective of the present study was, therefore, to characterize lymphocyte phenotypes and to investigate possible differences in T-cell subset composition and activation status in P. falciparum-exposed Ghanaian children with and without eBL. Methods Venous blood samples in heparin from 21 eBL patients (mean age: 7.0 years; range: 3–11 years), referred to the Burkitt's Tumour Centre at Korle-Bu Teaching Hospital, Accra and 15 healthy, age and sex matched children, were stained with fluorescein isothiocyanate (FITC)-, phycoerythrin (PE)-, R-phycoerythrin (RPE)- and RPE-Cy5-conjugated antibodies (CD3, CD4, CD8, CD25, CD69, CD95, HLA-DR, TCR-γδ, Vδ1, Vδ3, Vγ9 and B-cells) and acquired on a flow cytometer. Results A reduction in the proportion of CD3+ cells in eBL patients, due mainly to perturbations among TCR-γδ+ cells was observed. In contrast, the proportions of CD4+ or CD8+ cells were relatively unaffected, as were the mean numbers of peripheral blood mononuclear cells. Conclusion Selective changes in numbers and activation status of TCR-γδ+ cells occurs in Ghanaian children with eBL, a pattern which is similar to P. falciparum-induced changes. The data supports the hypothesis of a regulatory role for Vδ1+ TcR-γδ T-cells in maintaining B-cell homeostasis and provides insights into the pathogenesis of eBL.

The wettability of subsurface minerals is a critical factor influencing the pore-scale displacement of fluids in underground reservoirs. As such, it plays a key role in hydrocarbon production and greenhouse gas geo-sequestration. We present a comprehensive and critical review of the current state of knowledge on the intermolecular forces governing wettability of rock minerals most relevant to subsurface fluid storage and recovery. In this review we first provide a detailed summary of the available data, both experimental and theoretical, from the perspective of the fundamental intermolecular and surface forces, specifically considering the roles played by the surface chemistry, fluid properties, as well as other significant factors. We subsequently offer an analysis of the effects of chemical additives such as surfactants and nanoparticles that have emerged as viable means for manipulating wettability. In each example, we highlight the practical implications for hydrocarbon production and CO 2 geo-storage as two of the most important current applications. As the physico-chemical mechanisms governing the wetting phenomena are the main focus, special emphasis is placed on nano-scale experimental approaches along with atomic-scale modeling that specifically probe the underlying intermolecular and surface forces. Lastly, we discuss the gaps in the current state of knowledge and outline future research directions to further our fundamental understanding of the interactions and their impact on the wetting characteristics of Earth's minerals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The hand is a versatile structure that performs numerous tasks, ranging from exertion of great force such as grip, pinch and torque to execution of precise fine motor skills. The aim of current study was to undertake a preliminary study on hand dimensions as potential predictors of female populations native to the forest and savanna zones of Ghana. A total of one hundred (100) female students aged between 17 and 24 years were recruited into this study, comprising of 53 native to the forest zone and 47 native to savanna zone of Ghana between 12th June to 27th July, 2023 at the Department of Anatomy, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology. Statistically significant positive correlation was observed between left hand length and right hand length (R = 0.923, p = 0.000). From the binary regression model, it could be speculated that left-hand breadth could predict female populations native to the savanna zone (LHB: β = - 2.37, Expβ = 0.09, p = 0.014). However, right-hand breadth and length and left hand length did not show any potential of prediction (RHB: β = 0.900, Expβ = 2.460, p = 0.410; RHL: β = 0.168, Expβ = 1.683, p = 0.803; LHL: β = - 0.300, Expβ = 0.741, p = 0.656). The study therefore may speculate that left handbreadth could have the potential to differentiate female populations native to savanna zone from females native to forest zone in Ghana., (© 2024. The Author(s).)

Background: Breast cancer incidence rates are rising in Africa and mortality is highest in West Africa. Reasons for poor survival are multifactorial but delays in seeking appropriate health care result in late presentation which contributes significantly to poor outcomes. Total delays of more than 3 months have been associated with advanced stage at presentation and poorer survival., Method: A cross-sectional design was used to assess delays in health-seeking behaviour in consecutive breast cancer patients receiving treatment at Korle Bu Teaching Hospital (KBTH) from January to December 2022 using a structured, interviewer-administered questionnaire. Data were gathered to assess health-seeking behaviour in relation to delays in a presentation to a health care facility, and factors that may have influenced the delays. Statistical analysis was done using descriptive and inferential analyses., Results: The study involved 636 participants with a mean age and SD of 52.6 ± 12 years. Most participants were diagnosed with Stage 3 or 4 breast cancer (56.5%). Ninety percent of participants had visited at least one health facility prior to seeking care at KBTH. Forty-two percent of the participants sought care at a health facility less than a month after noticing symptoms of breast cancer while 34.4% did so greater than 3 months after noticing symptoms. Delays showed a significant association with age, marital status, educational level, average monthly income and cancer stage ( p < 0.05). Common reasons for delays were lack of knowledge of breast cancer signs and/or symptoms (47%), advice from family and friends (15%), financial difficulties (9%), seeking alternate treatments (7%), competing priorities (6%) and indifference (5%)., Conclusion: Lack of knowledge about breast cancer was a major cause of delay in seeking health care in this study. Education should specifically target knowledge about breast cancer and the need for appropriate and timely health seeking., Competing Interests: The authors have no conflict of interest to declare. Kirstyn E Brownson is a representative on the ImpediMed Lymphedema Surgeon Advisory Board., (© the authors; licensee ecancermedicalscience.)

Objective: To assess the clinical presentation and evaluation of acute life-threatening chest pain in Accra, Ghana., Design: This was a cross-sectional study at the emergency departments of two leading tertiary hospitals in Accra., Settings: The study was conducted at the Korle-Bu Teaching Hospital and the 37 Military Hospital in Accra., Participants: The study participants comprised adult patients aged 18 years and above who presented with acute chest pain at the emergency departments between April and June 2018., Main Outcome: Acute coronary syndrome is the leading life-threatening cause of chest pain with poor pre- and in-hospital care., Results: 232 patients with chest pain were enrolled as respondents aged 18 to 94 years. The prevalence of life-threatening conditions causing chest pain was 31.9% of those who presented with acute chest pain. These included acute coronary syndrome (82.4%), pulmonary embolism (14.9%), and acute chest syndrome (2.7%). A few (6.6%) with life-threatening conditions such as acute coronary syndrome were transported by ambulances, and 44.3% reported to the facility within 2 to 9 days after the onset of chest pain. None of the patients with pulmonary embolism and acute chest syndrome had computer tomography pulmonary angiogram (CTPA) and echocardiogram done, respectively., Conclusion: Our study found that life-threatening conditions amongst patients presenting with acute chest pains are common; however, there is a need to improve pre-hospital care and in-hospital assessment of these cases., Funding: The study was partly funded by the Medtronic Foundation., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Hypothesis: Ethoxylated nonionic surfactants are promising candidates for enhanced oil recovery (EOR) from oil-wet carbonate reservoirs due to their ability to reverse the mineral wettability. The wettability-reversal efficiency increases with the number of the ethoxy (EO) groups in the surfactant molecule., Methodology: Contact angle measurements, scanning electron microscopy (SEM) and molecular dynamics (MD) simulations were combined to investigate the wettability reversal of an oil-wet calcite by three ethoxylated nonionic surfactants with 1, 4 and 8 EO groups, respectively, to directly probe the role of the EO groups and to uncover the molecular mechanism responsible for the wettability reversal., Findings: Both experiments and simulations consistently show a clear correlation between the number of EO groups and the wettability reversal efficiency of the surfactants, whereby the higher number of EO groups results in greater degree of wettability reversal. This is due to 1) the more hydrophilic surfactant headgroup weakening the carboxylate interactions with the surface by expanding the surface-adjacent water layer, and 2) the physically larger surfactant molecule attracting the carboxylates more strongly, thus aiding in their removal from the surface., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The aim of this study was to examine the prevalence and factors associated with psychological distress among parents of children with congenital heart disease (PCCHD) receiving treatment at the National Cardiothoracic Centre (NCTC), Accra., Methods: A cross-sectional mixed method study involving 248 parents of children with congenital heart disese receiving treatment at the NCTC was employed. Systematic sampling was used to select participants. The outcome variables were depression, anxiety, and somatization, assessed using the brief symptom inventory. A semistructured interview guide was used to understand the contextual factors that contribute to parents' psychological distress. Poisson regression and inductive thematic analyses were employed for quantitative and qualitative data, respectively., Results: The prevalence of depression, anxiety, and somatization was 42.9% [95%CI = 36.7-49.3], 42.4% [95%CI = 36.3-48.9], and 41.2% [95%CI = 35.1-47.6] respectively. Parents who were divorced [aPR (95%CI) = 1.60(1.02-2.51)], hadonly basic level education [aPR (95%CI) = 2.13(1.34-3.39)], were without a religious affiliation [aPR (95%CI)= 2.24(1.58-3.19)], and in the low asset quintile significantly increased the likelihood of psychological distress. Delay/postponement of scheduled surgery, worsening state of child's condition, feeling a sense of helplessness, societal stigma, and lack of funding or health insurance for the treatment of the condition were contextual factors that contributed to increased psychological distress among parents., Conclusion: The prevalence of psychological distress was quite high among parents of children with congenital heart disease in Ghana and was associated with both parent and patient factors. Psychosocial care should be integrated into the clinical health services of this group of patients and their parents to improve psychological health outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The distribution of nasal types has been reported to be influenced by climatic adaptation as the nose is involved in conditioning inhaled air. Previous studies have reported differential nasal types and dimensions among varying populations which is very beneficial in planning for rhinoplasty and in forensic identification. However, there is inadequate data on nasal types and dimensions of the various ethnic groups in the Ghanaian population. Since it is inappropriate to apply nasal dimensions of one ethnic group to another, the current study sought to assess the nasal types and dimensions of Akans and Ewes in the Ghanaian population. Nasal height, nasal length, nasal tip protrusion, morphological nose width, and anatomical nose width were measured from 202 participants (116 Akans and 86 Ewes) aged 18-27 years belonging to the Akan and Ewe ethnic groups. Nasal index was calculated, and the frequencies of the nasal types among the two ethnic groups were determined. Ewe significantly had greater nasal length and nasal tip protrusion than the Akans. For both ethnic groups, sexual dimorphism was observed in morphological nose width and anatomical nose width, with males having greater values than females. The platyrrhine (broad nose) nasal type was predominant among the Akan and Ewe ethnic groups. The average nasal dimensions of the Akan and Ewe ethnic groups for the Ghanaian population have been reported in the present study, which will be useful in rhinoplasty intended for individuals belonging to these ethnic groups and in identification., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Juliet Robertson et al.)

Background: Smoking is a major risk factor for type 2 diabetes (T2D), but the evidence has mostly relied on self-reports. We aimed to compare the associations of smoking exposure as assessed by self-reports and urine cotinine with T2D., Methods: Using the PREVEND prospective study, smoking status was assessed at baseline by self-reports and urine cotinine in 4708 participants (mean age, 53 years) without a history of diabetes. Participants were classified as never, former, light current and heavy current smokers according to self-reports and analogous cut-offs for urine cotinine. Hazard ratios (HRs) with 95% CIs were estimated for T2D., Results: During a median follow-up of 7.3 years, 259 participants developed T2D. Compared with self-reported never smokers, the multivariable adjusted HRs (95% CI) of T2D for former, light current, and heavy current smokers were 1.02 (0.75-1.4), 1.41 (0.89-2.22), and 1.30 (0.88-1.93), respectively. The corresponding adjusted HRs (95% CI) were 0.84 (0.43-1.67), 1.61 (1.12-2.31), and 1.58 (1.08-2.32), respectively, as assessed by urine cotinine. Urine cotinine-assessed but not self-reported smoking status improved T2D risk prediction beyond established risk factors., Conclusion: Urine cotinine assessed smoking status may be a stronger risk indicator and predictor of T2D compared to self-reported smoking status., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)