Contribution of the Advanced Research Laboratories at the Noguchi Memorial Institute for Medical Research (NMIMR) to SARS-CoV-2 Testing in Ghana

In March 2020, the first cases of SARS-CoV-2 were reported in Accra, Ghana. These initial cases were diagnosed at the Advanced Research Laboratories (ARL) of the Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana. The ARL which hitherto was used for routine clinical research in viral, bacteria and immunological studies has since been the facility of choice for testing for all suspected cases of COVID-19 submitted from across Ghana and beyond. The success of testing at the ARL hinged on the availability of several laboratory spaces furnished with state-of-the-art diagnostic equipment and working aids. During the “peak season” where overwhelming numbers of clinical specimens were received, the ARL processed and got results for close to four thousand samples daily. After general disinfection and re-bagging into smaller numbers, at the entrance of the ARL, the samples are taken to a central receiving laboratory, where they are received and entered in a database with accompanying case investigation forms. All samples that are successfully sorted and matched are sent to general laboratories for nucleic acid extraction and then referred to the Instrumentation laboratory for real time reverse-transcription polymerase chain reaction (RT-PCR). When the RT-PCRs were completed, results were analysed and transmitted via email and/or local network to the data reporting office. The data managers then reported results to the investigators and the Ghana Health Service (GHS). Additionally, the ARL provided a next-generation Genome Sequencing platform in partnership with the West African Centre for Cell Biology of Infectious Pathogens at the University of Ghana, which was essential in reporting the genome data of the circulating variants of SARS-CoV-2 in Ghana. Conclusively, it is worth noting, that the NMIMR fulfilled its mandate of supporting the country with specialized diagnostics through the judicious use of the ARL for SARS-CoV-2 testing, from sample receipt to data reporting. The ARL facility and the research faculty have trained and continue to train budding laboratories on biosafety, biosecurity, best practices and testing protocols. It is obvious that the success story of SARS-CoV-2 testing in Ghana, cannot be complete without the mention of the ARL at NMIMR.

The effects of co-infection with human parvovirus B19 and Plasmodium falciparum on type and degree of anaemia in Ghanaian children

Objective:To determin the extent to which parvovirus B19(B19V)and co-infection of B19V and malaria contribute to risk of anaemia in children.Methods:B19V DNA and malaria parasites were screened for 234 children at the PMI,Children's Hospital in Accra.The role of B19V and coinfection with B19V and malaria in anaemia was evaluated by analysing full blood cell counts,malaria and B19V DNA results from these children.Results:The prevalence of B19V,malaria and co-infection with B19V and malaria was 4.7%,41.9%and 2.6%,respectively.Malaria posed a greater risk in the development of mild anaemia compared to severe anaemia(OR=5.28 vrs3.15)whereas B19V posed a higher risk in the development of severe anaemia compared to mild anaemia(OR=4.07 vrs 1.00)from a non-anaemic child.Persons with co-infection with B19V and malaria had 2.23 times the risk(95%CI=0.40-12.54)of developing severe anaemia should they already have a mild anaemia.The degree of anaemia was about three times affected by coinfection(Pillai's trace=0.551,P=0.001)as was affected by malaria alone(Pillai's trace=0.185,P=0.001).B19V alone did not significantly affect the development of anaemia in a non-anaemic child.Microcytic anaemia was associated with B19V and co-infection with B19V and malaria more than normocytic normochromic anaemia.Conclusions:B19V was associated with malaria in cases of severe anaemia.The association posed a significant risk for exacerbation of anaemia in mild anaemic children.B19V and co-infection with B19V and malaria may be associated with microcytic anaemia rather than normocytic normochromic anaemia as seen in cases of B19V infection among persons with red cell abnormalities.

Marijuana use and repeated attempted suicide among senior high school students in Ghana:Evidence from the WHO Global School-Based Student Health Survey,2012

Background The association between substance use including marijuana use and attempted suicide has been well documented.However,little is known about marijuana use and its association with attempted suicide repetition among young people in low-income and middle-income contexts.Aims This analysis was conducted to assess the factors associated with marijuana use and ascertain marijuana use as a determinant of repeated attempted suicide among senior high school(SHS)students in Ghana.Methods Data from the 2012 Global School-Based Student Health Survey in Ghana was used for this study.Modified Poisson,Logistic and Probit models weighted with Mahalanobis distance matching within propensity calliper were employed separately to determine the hypothetical association between marijuana use and repeated attempted suicide.All analysis was performed using Stata 16 and p<0.05 was deemed statistically significant.Results The prevalence estimates of marijuana use and repeated attempted suicide among SHS students in Ghana were 3.4%(95%Cl:2.3 to 5.1)and 11.5%(95%Cl:9.1 to 14.4),respectively.The prevalence of marijuana use was significantly associated with school grade,smoking exposure,parent smoker,alcohol intake and truancy.Marijuana use was positively associated with repeated attempted suicide among SHS in Ghana correlation=0.23,p<0.001.Repeated attempted suicide among students who use marijuana was approximately threefold and fivefold significant compared with nonmarijuana use students,based on the Poisson(adjusted prevalence ratio:3.02;95%Cl:1.67 to 5.43,p<0.001)and Logistic(adjusted OR:5.06;95%Cl:3.19 to 11.64,p<0.001)estimates respectively.Also,the Probit model showed that marijuana use significantly increased the log count of repeated attempted suicide by 95%(ap:0.95;95%CI:0.49 to 1.41,p<0.001).Conclusion Marijuana use does not only influence the onset of suicidal attempts but also repeated attempted suicide among SHS students in Ghana.Special attention is required for suicide attempters with a history of repeated attempts and current marijuana use among SHS students in Ghana.Early identification of the potential risk and protective factors is recommended to inform school-based interventions.National level structured school-based substance abuse interventions and health promotion programmes would be useful.

Use of Anti-Mullerian Hormone (AMH) for Testing of Ovarian Reserve: A Survey of Fifteen (15) Fertility Centres in Ghana

Anti-Mullerian Hormone (AMH) is a dimeric glycoprotein with a molecular weight of 140 kD, encoded by a gene on the short arm of chromosome and a member of the transforming growth factor-beta (TGF-β) superfamily. The expression of AMH is markedly different in males and females, both in concentration and temporality. In males, Sertoli cells maintain a high concentration of AMH in utero which peaks shortly after birth and then drops precipitously at puberty. In females, granulosa cells produce very low levels of AMH in utero followed by a transient spike in the neonatal period. Concentrations of the hormone then rise steadily through adolescence to a peak in the mid-twenties and subsequently decline until becoming undetectable in menopause. The study aimed to understand how Clinicians and Clinical Embryologists used anti-mullerian hormone (AMH) test to assess ovarian reserve, direct patient selection and treatment regimens and guide in vitro fertilization (IVF) cycle management in all registered fertility hospitals in a West African country, Ghana. A web-based survey (questionnaire) using google forms was performed to solicit responses from all IVF hospitals that are registered with the Fertility Society of Ghana (FERSOG). This questionnaire consisted of fifteen (15) broader questions, ten (10) of which assessed the clinics’ use of AMH. Responses were screened for quality to verify that only one (1) survey was completed by each IVF centre. The study was conducted during May and June 2020 at the In Vitro Fertilization (IVF) Department of the Airport Women’s Hospital (AWH) in Accra, Ghana. Results are reported as the proportion of IVF cycles represented by a particular answer choice. Survey responses were completed from 15 IVF centres, representing 2504 IVF cycles performed annually. A good majority (73.3%) [1835 IVF cycles] of the respondent IVF hospitals reported to use AMH as a first line test and 93.3% reported it as the best test for evaluating ovarian reserve. Another 66.7% reported that AMH results were extremely relevant to clinical practice. However, in contrast, for predicting live birth rate, 60% reported age as the best predictor in their practice. Overall, our results indicate that AMH is considered a first line test for assessing ovarian reserve and is relevant to the clinical practice of majority of Assisted Reproductive Technologies (ART) providers in Ghana.

Update of Aetiological Patterns of Adult Gastric Outlet Obstruction in Accra, Ghana

Background: The aetiology of gastric outlet obstruction globally has evolved from benign to malignant causes, but there seem to be no recent data on the trends in Ghana. The aim was, therefore, to identify the current patterns in the aetiology of gastric outlet obstruction in the adult population in Ghana. Methodology: This was a retrospective review of all confirmed cases of gastric outlet obstruction in the last decade, spanning from June 2004 to May 2014, that were managed at the Korle Bu Teaching Hospital. Results: A total of 107 patients were managed for gastric outlet obstruction with a male to female ratio of 2.15:1 and most of the patients making 71.3% of cases belonged to the age range of 40 to 60 years. The predominant aetiology for gastric outlet obstruction was found to be gastric cancer (55.140%), followed by peptic ulcer disease (27.103%). Conclusion: The aetiology of gastric outlet obstruction in Ghana has evolved from benign to malignant causes, following current global trends. Gastric cancer is now the most important cause of gastric outlet obstruction in Ghana, followed by peptic ulcer disease which predominates as the commonest benign cause.

Marijuana use and suicidal behaviours among school-going adolescents in Africa:assessments of prevalence and risk factors from the Global School-Based Student Health Survey

Background Marijuana use among adolescents,including high school students,has been consistently reported to be associated with a high incidence of suicidal behaviours.Little empirical research has been conducted on the propensity impact of marijuana use on suicidal behaviours in Africa.Aims To assess factors associated with marijuana use and further quantify marijuana use as an associated factor of suicidal behaviours,including repeated attempted suicide,suicidal ideation and suicide planning,among high school students in Africa.Methods A cross-sectional study was conducted among 32802 school-going adolescents using the Global School-Based Student Health Survey data from 10 African countries grouped into West Africa,North Africa,South-East Africa,South Africa and East Africa subregions.Marijuana use and repeated attempted suicide were the main outcome variables.We employed double selection least absolute shrinkage and selection operator poisson regression model to assess risk factors associated with marijuana use and dominance analysis to establish ranked important and common risk factors.Inverse probability weighting poisson regression adjustment was applied to assess impact.Results The prevalence of marijuana use and repeated attempted suicide were 3.7%(95%CI:3.1 to 4.3)and 6.6%(95%CI:5.9 to 7.4),respectively.The most important risk factor for marijuana use generally across the countries and specifically in three subregions was alcohol consumption,which constituted approximately 40%of the impact.The average treatment effect on the treated(ATT)indicated that marijuana use significantly increased the risk of suicidal ideation,suicide planning and repeated attempted suicide by 12%(ATT=0.12(95%CI:0.02 to 0.22)),18%(ATT=0.18(95%CI:0.13 to 0.22))and 31%(ATT=0.31(95%CI:0.20 to 0.41)),respectively.Conclusions Marijuana use was significantly associated with suicidal behaviours(suicidal ideation,planning and repeated attempted suicide)among the students.To achieve Sustainable Development Goal 3.5(to strengthen prevention and treatment of substance abuse),school-based-based psychosocial interventions should be streamlined to adequately assess and manage marijuana use.Targeting the most dominant risk factors in this population could translate into the reduction of suicidal behaviours in countries within Africa.

Urinary Schistosomiasis in Children—Still a Concern in Part of the Ghanaian Capital City

Schistosomiasis is a parasitic disease of the tropics which is estimated to affect up to 300 million people worldwide. While it is being successfully controlled in many countries, it remains a major public health problem, especially in developing countries including Ghana. Extensive work on schistosomiasis has been undertaken along theVoltaRiverbasin, leaving very little data and information on this infection in the urban and peri-urban areas inGhana. This study was aimed at determining the urinary schistosomiasis burden among children of school going age within Zenu, a suburb of the capital city. Urine samples were taken from 274 school children within the Zenu community and examined with urine chemistry dipsticks for detection and confirmation of haematuria, followed by microscopy for detection of Schistosoma haematobium ova. Prevalence of urinary schistosomiasis was 30.7% (95% CI: 25.2-36.2). 44 (52%) of the positive samples were collected from males whiles 40 (48%) were collected from females, but prevalence of the infection was not significantly associated with gender (χ2 = 0.041, DF = 1, P-Value = 0.839). Among the S. haematobium positive children, haematuria was detected by the dipstick in 88.1% (74/84, 95% CI: 81.2- 95.0), but it was not detected in 11.9% (10/84, 95% CI: 5.0-18.8). Meanwhile, the dipstick detected haematuria in 7.3% (20/274, 95% CI: 4.3-7.3) of the total population but microscopy could not detect the presence of Schistosoma ova in those children. An association was found between Schistosoma infection and haematuria detected by dipstick (χ2 = 84.715, DF = 1,

Trifecta Outcomes of Screening Detected and Patients with Lower Urinary Tract Symptoms after Open Radical Prostatectomy for Localized Prostate Cancer

Background: Many studies have reported on trifecta outcomes after radical prostatectomy. There is however paucity of studies that compares the trifecta outcome between screen detected and patients presenting with lower urinary symptoms with localized prostate cancer after radical prostatectomy. This study compares the trifecta outcomes between these two groups after an open retropubic radical prostatectomy. Methodology: This is a retrospective study, on the trifecta outcomes (urinary continence, erectile function, and cancer control) of consecutive patients that had open radical retropubic prostatectomy for localized prostate cancer by a single surgeon. Patients were grouped into screen detected and presentation with lower urinary symptoms or retention of urine. The parameters considered were the age of the patients, the total prostate specific antigen (tPSA) at presentation, the clinical T stage, the Gleason score of prostate biopsies, the risk categories using the D’Amico risk groups and the trifecta outcomes after the procedure. Results: In all, 119 patients met the criteria for inclusion. The median follow up was 63.5 months (range 12 - 156 months). Of these 40.3% of the patients were diagnosed through screening with elevated PSA while 59.7% had presented with symptoms of lower urinary tract obstruction. The mean age for the patients was 60.8 ± 6.5 years, median PSA 12.6 ng/ml (IQR 8.6 - 19.7) and median prostate weight of 50.0 (IQR 40.0 - 60 g). The urinary continence rate after the procedure was 93.3%, erection rate of 81.5%, cancer control rate of 71.4% and trifecta achieved in 57.1%. Comparing the screening and the symptomatic cases, the urinary continence rate was 91.7% vrs 94.3%;erectile function rate was 79.2% vrs 83.1%;cancer control 68.8% vrs 73.2% and trifecta achieved in 58.3% vrs 56.3%. There was no statistically significant difference between the two groups in terms of urinary continence p = 0.564, erection function p = 0.588, cancer control p = 0.595, and achieving trifecta p = 0.829. Conclusion: Patients with localized prostate cancer presenting with lower urinary symptoms compared to screen detected patients have similar outcomes in terms of urinary Continence, erectile function, cancer control and trifecta after open radical retropubic prostatectomy.

Nutraceutical with Anti-Inflammatory Activity for the Management of Airway Remodeling in Bronchial Asthma: <i>Kalanchoe integra</i>Var. Crenata (Andr.) Cuf Leaf Extract

Background: Kalanchoe integra is widely used in folklore medicine as an antiasthmatic agent. Previous studies have shown the ameliorating effect of Kalanchoe integra leaf extract [KILE] on bronchial hyperesponsiveness and inflammation. Further, the stabilizing effect of Kalanchoe sp on mast cell degranulation, suggests that Kalanchoe species are suitable candidates for allergic asthma therapy. This study is designed to investigate the anti-asthmatic potential of KILE and monitor the accompanying histopathological and immunobiochemical changes that occur in an animal model of bronchial asthma using ovalbumin sensitized guinea pigs. Method: Thirty male guinea pigs were divided into five groups of six animals each. Bronchial asthma was simulated in guinea pigs using ovalbumin. Both low dose (300 mg/kg) and high dose extract (900 mg/kg) were administered daily for 42 days. Prednisolone (2.5 mg/kg) was the standard drug used. Results: Guinea pigs in all KILE treated groups maintained the integrity of their airway structures: bronchial folds and walls, alveoli, alveolar ducts and sacs. KILE and prednisolone caused a reduction in immune parameters (p 0.001), extent of bronchoconstriction, bronchial wall thickness and goblet cell accumulation in the sensitized guinea pigs. Conclusion: This study demonstrates the anti-asthmatic potential of KILE during prolonged administration by the oral route.

The Role of Human Herpesvirus Type-6 (HHV-6) in Convulsions Seen in Children at Korle-Bu Teaching Hospital, Accra

Background: Since the isolation of HHV-6 in 1986, extensive investigation has revealed it to be ubiquitous and responsible for the majority of cases of a common febrile rash illness of infants known as roseola. Other clinical associations including seizure disorders, encephalitis and meningitis have also been stated in various publications. Objective: The aim of the study is to find out if there is any association between HHV-6 infection and the convulsions prevailing at the Child Health Department of the Korle-Bu Teaching Hospital, Accra-Ghana. Methods and Results: Children admitted into the Department of Child Health with episode of convulsions were recruited after informed consent had been sought from subjects. Cerebrospinal fluid (CSF) and Plasma were obtained from patients. PCR directed at the detection of the large tegument protein (LTP) gene in the SIE strain of the HHV-6 in Plasma and CSF from patients was done. The mean age of study subjects was 37.44 months with 53 (64.6%) being males. There was a significant relationship between the convulsions and fever (P < 0.05). Based on CSF characteristics gathered, viral infections may be the probable cause of the observed convulsions but not malaria or bacterial infections. None of the samples from the patients had evidence of HHV-6. Conclusion: The study was unable to establish HHV-6 infection in the CSF and Plasma of patients. What role if any HHV-6 has in convulsions seen in children or neurological diseases at large merits further studies. Other neurotropic viruses need to be investigated as possible causes for the convulsions.

Human Immunodeficiency Virus, Syphilis Prevalence and Risk Factors among Migrant Workers in Konongo, Ghana

Migrant workers, particularly gold mining workers, have been identified as a group at risk for HIV and sexually transmitted infections (STI). A cross-sectional study was undertaken on the correlates of human immunodeficiency virus (HIV) and syphilis infections in a sample of migrants (Ghanaian citizens [156] and non-Ghanaian citizens [8]) working in a gold mining centres in Konongo, Ghana. The study was conducted between the months of January 2013 to December 2013. Of a total of 600 eligible migrant workers, only 164 (27.33%;males 114, females 50) of the eligible migrants took part in the study. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimen for testing for the presence of antibodies to HIV and Treponema pallidum, the causative agent of syphilis. These data were analyzed using both univariate and multivariate techniques. The median age of the participants was 29.0 years (range 18 - 62 years). Of the 164 migrant workers tested, HIV and syphilis seroprevalence were 6.7% and 3.7% respectively. On multivariate analysis, the independent determinants for HIV infection were being female [odds ratio (OR) 2.94;95% confidence interval (95% CI 0.86 - 10.0);unmarried (OR 10.13;95% CI 1.2 - 81.09);drug use (OR 3.76;95% CI 0.38 - 36.3);and blood transfusion (OR 2.45;95% CI 0.27 - 22.37). Similarly, on multivariate analysis, the independent determinants for syphilis infection were having concurrent sexual partners (OR 2.16;95% CI 0.38 - 12.12);and blood transfusion (OR 5.07;95% CI 0.51 - 50.37). Consistent with similar studies worldwide, our results suggest high prevalence of HIV and syphilis infections among migrant workers who work in gold mining centres in Ghana.

Insights into Pneumococcal Pathogenesis and Antibiotic Resistance

Since its discovery in 1891, the pneumococcus has been one of the most extensively studied microbes, and was involved in several historical findings such as the discovery of genetic material that was later shown to be DNA. The pneumococcus is part of the normal bacterial flora of the nasopharynx, but can on occasions progress to sterile sites of the body and cause invasive diseases. There are about one million new invasive pneumococcal infections every year, majority of which occur in the developing world where children <5 years are most affected. The burden of pneumococcal disease is further heightened by the increasing prevalence of multidrug resistance of the organism. The pneumococcus remains a pathogen of immense public health significance and understanding its biology, particularly the pathogenesis and antibiotic resistance is crucial to controlling pneumococcal disease.