College of Health Sciences

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The biological validity and feasibility of the community based questionnaire approach in determining the epidemiological status of disease and insect vector nuisance
(1998) Lale, Von Louis
In the present study, the community-based questionnaire approach using an existing disease surveillance network and the school system was compared and validated with standardized biomedical and other techniques for guineaworm infection, schistosomiasis morbidity and blackfly nuisance monitoring. In all, 707 community key informants and 6,020 children were interviewed in 194 communities (70 with schools and 124 without schools) in East Mamprusi District of the Northern Region of Ghana. The communities/schools were randomly allocated to be interviewed during the rainy season or dry season. Children in ninety-nine communities were interviewed in the rainy season and those in the remaining ninety-five communities interviewed in the dry season. All questionnaires were returned within four weeks. Reagent strip tests for haematuria, urine filtration and microscopy were used for validating schistosomiasis, whilst re-interviews by research team for consistency and checks on evidence of infection were used to validate guineaworm and indirect validation for blackfly nuisance was done with checks on the probability of occurrence of the flies at the time of the survey, using Atlas GIS computer software. The sensitivity, specificity, and predictive values of questionnaires in identifying guineaworm were very high. The kappa statistic (K) was very high (0.92), indicating almost complete agreement between questionnaire responses and guineaworm validation. The prevalence of guineaworm of 1.2% from questionnaires is in line with previous epidemiological findings of guineaworm infection in the study area. In this study, the 3+ positives of the investigators’ and interviewers’ reagent strip testing indicated good agreement (K 083 and 0.77 respectively) with microscopy and is therefore a better indicator of positive status of schistosomiasis in the study area. The validity of the questionnaires was less than satisfactory, with very low sensitivity and positive predictive value (4.2%) and very poor agreement with microscopy (K = 0.07). The specificity and negative predictive value were high as generally expected in low prevalence areas. The low prevalence of schistosomiasis in the study area (<1%) complements the key informants’ low ranking for ‘blood in urine’. Questionnaires were fairly sensitive and specific in a high prevalence school (Buipe) but not in the low prevalence schools (New Buipe and Daboya). The use of colour charts for recall of urine colour as opposed to direct questioning, significantly improved the ,c sensitivity, and predictive values in both low and high prevalence schools. Both the school teachers and guineaworm volunteers performed well in respect of questionnaire administration and reagent strip testing. The use of questionnaires cost two times less than reagent strip testing and 25 times less than microscopy in communities with and without schools, whilst the combined use of questionnaires and reagent strips was 12 times and 14 times less in communities with and without schools respectively. About 93% of the children interviewed experienced blackfly bites in the rainy season. The key informant respondents also indicated rainy season as most important for fly nuisance. The 50% or more bites had the highest K for fly nuisance and is thus the best community cut-off for blackfly nuisance monitoring in the study area. There was no significant difference in blackfly nuisance with respect to proximity of communities to potential breeding sites (P>0.05, Mann-Whitney U-test, 95% Cl). The cost of US$ 125 per surveyed community or school under general expenditure represents the logistical expenses for all the diseases and insect vectors included in the questionnaires and this underscores the cost-effectiveness and need to integrate guineaworm surveillance with the monitoring of other health conditions, insect vectors as well as relevant occurrences at the community level.
Health care delivery management in a Ghanaian penal institution: a case study of Kumasi Central Prisons.
(2001) Abban, Herbert (Dr.)
The Ghana Prisons Service is a public sector organization established by an act of parliament (Prisons Act 128) and is charged with the responsibility of ensuring the safe custody, welfare, reformation and where possible rehabilitation of prisoners. Currently, there are fifty-one (51) penal institutions in the country comprising forty-three (43) prisons and eight (8) settlement camps. Each prison has an infirmary with the exception of the Contagious Diseases Prison (CDP) at Ankaful are manned by nursing orderlies of different categories. Indications are that the general environment in these penal institutions is not conducive to the maintenance of good physical, social and mental health of inmates, and that the existing organization and delivery of health care services is less than satisfactory. This study emanating from the above concern attempts to understand the health care delivery system in penal institutions and explores what health care managers could do to address these pertinent issues. The case study was conducted in one of the largest prisons in the northern section of Ghana. Data were collected from two prisons within the Kumasi Metropolis using a combination of in-depth interviews and structured questionnaires to elicit information from respondents as well as physical observance of clinical signs of disease among inmates. The study population consisted of five medical officers, which included specialists from the Ministry of Health, the Kumasi Metropolitan Health Director and three others who see ill prisoners routinely at their facility. Two public hospital accountants, two pharmacists and a laboratory technician and one hundred convicted inmates were interviewed. Seven prison personnel including the deputy director in charge of the Kumasi Central Prisons, the PRO/Administrative officer, chaplain and the two nursing orderlies in charge of the male and female infirmaries were also included in the study. The following are some of the major findings of the study: I. Health Status of prison inmates Prisoners interviewed attributed the causes of morbidity to poor diet, overcrowding, lack of logistic support and poor sanitary conditions in the prison. Health care providers in the prison and government health facilities agreed that most of the diseases that incapacitate prisoners and deaths are preventable. II. Access to health care The prisoners were of the view that even though physical access to the infirmary was unrestricted the standard of care is poor owing to shortages of essential medical logistics. However, access to seek prompt care at government health institutions, notably at CWC and KATH remains difficult. • Exemptions and access to health care Major problems exist with both the policy on exemptions and the way it is implemented. The inclusion of exemptions, partial or total, in the legislative instrument on hospital fees was supposed to provide access to needed care and income protection for the part of the population that is poor and sick. Prisoners belong to this category of vulnerable groups and the study found that the LI 1313 does not cover them by law. The current mechanism instituted by the ARHA does not function well. The study observed that surgical services were not routinely available to prisoners unless under emergency conditions and is a widespread impediment to adequate health care for male offenders. Alternate levels of care, such as skilled nursing care, chronic and rehabilitative care is generally unavailable in prisons. • Exemptions and health care financing Respondents in all government health facilities studied said clients including prisoner pay user fees for services given except where waivers are applicable. The method used by facilities to assist clients who are unable to pay such as prisoners is to offer credit facilities on agreed terms or they are given prescriptions to purchase drugs from sources outside the health facility. The prison authorities settle these bills as and when FEs are made available on quarterly basis. III. Personnel and Administrative issues The infirmary at the Kumasi Central Prisons (KCP) did not have the required staff strength to facilitate efficient and effective service provision. One nursing orderly to nearly a thousand inmates, officers and dependants under existing conditions in the prison is stressful. As a result the nursing orderly is overburdened with tasks beyond her capabilities. lv. Infrastructure, Drugs and supplies The infirmary is old and ill equipped to cater for the immediate health needs of the teeming inmates. The study found that the maintenance of the building and the scant medical equipment has been neglected. Most of the basic drugs listed are available and prescription drugs are purchased for inmates. The only limitation is the ability of the Service to pay for the drugs. The prison infirmary has no essential drug list and a Health committee. Routine drugs are purchased on ad hoc basis without a Purchasing committee. Inadequate drug supply is a serious issue in the prison. Information obtained through interviews with prisoners indicated that respondents were dissatisfied with drugs given them at the infirmary. V. Management practices • Health policy There was the observation that the Ministry of Interior has no clear-cut policy on Penal Health Care. It appears that the burden of health care provision for prison inmates has been delegated to the MOH without any concrete arrangements. In the absence of a national penal health policy health care delivery in the prisons would remain inadequate for a long time. • Health system The penal system is centralized and generally there is lack of information flow vertically. Opinion sought from the nursing orderlies revealed a lower priority given to inmate health care among other activities. The study found that the health care delivery management system in the prison is weak and inadequately funded. The study, on the basis of these findings recommends the following: I. The establishment of a Medical Directorate with a Public Health Division within the Ghana Prisons Service by the Ministry of Interior to be headed by a competent health professional. II. To formulate policies and implement appropriate strategies in collaboration with other stakeholders to work towards the provision of a national framework for a comprehensive system of penal health care administration. Ill. Heads of Penal Institutions should be encouraged to take active part in budget preparation, allocation and utilization of funds and strengthen the management capacity of their institutional health care providers. IV. Management should recognize the right of prison inmates to dignity and present grievances and should show some visible signs of respecting and addressing their health problems.
Biochemical Markers of Oxidative Stress as Indices of HIV/AIDS Progression
(2009-07-12) Obirikorang, Christian
Reactive Oxygen Species (ROS) has been implicated in the pathogenesis and the progression of HIV infection. This study was aimed at investigating the levels of oxidative stress and their probable relationship as markers of HIV disease progression in HIV positive patients in two established HIV/ART centres in Ghana. In all two hundred and twenty eight (228) confirmed People Living with HIV/AIDS (PLWHAs) were included in the study. The subjects were recruited from the Central Regional Hospital (CRH) and Bolgatanga Regional Hospital (BRH). One hundred and forty-three (143; 62.72%) PLWHAs were recruited from CRH and they comprised of eighty one (81; 56.64%) males and sixty two (62; 43.36%) females whilst eighty five (85; 37.28%) PLWHAs were recruited from BRH comprising of forty three (43; 50.59%) males and forty two (42; 49.41%) females. These two hospitals were chosen to give a fair representation of PLWHAs in Ghana. Another 100 sex- and age-matched healthy, HIV-seronegative individuals were studied in parallel as controls. Ethical clearance was obtained from Committee on Human Research, Publications and Ethics (CHRPE), School of Medical Sciences, Kwame Nkrumah University of Science & Technology (KNUST), Kumasi. All subjects gave informed consent to take part in the study after verbal and written explanation of the methods and risks involved had been given. Venous blood samples were taken and assayed for the haematological parameters (haemoglobin (Hb), haematocrit (HCT) and total white blood cell count (WBC), biochemical assays (total Serum Protein, Serum Albumin, Triglycerides, Total Cholesterol, HDL-cholesterol and LDL-cholesterol and markers of oxidative stress (Serum Malondialdehyde (MDA), Ferric Reducing Ability of Plasma (FRAP) and serum Vitamin C and E, Superoxide Dismutase (SOD) Glutathione Peroxidase (GPx). The subjects with the mean age of 36.9±10.9 years which was not significantly different from that of the control group of 39.4+13.4 years. The PLWHAs subjects were grouped per the criteria of the Center for Disease Control (CDC) as: CD4 count (1) ≥ 500 mm-3; (2) 200 – 499 mm-3; and (3) < 200 mm-3. Forty three (43; 18.86%) patients (38.7+10.94 years) had a CD4+ count ≥ 500 mm-3, sixty three (63; 27.63%) patients (37.4+9.54 years) had a CD4+ count between 200 – 499 mm-3 and one hundred and twenty two (122; 53.51%) patients (36.7+10.93 years) had a CD4+ count < 200 mm-3. Markers of oxidative stress revealed significant differences between the patients and control subjects. Malondialdehyde (p<0.001) in the patients was markedly increased as compared to the control group. This suggests increased lipid peroxidation in HIV infected individuals and this increased with the progression of the infection. Ferric reducing ability of Plasma (p<0.0001), Glutathione peroxidase (p<0.0001), Superoxide Dismutase (p<0.0001) were decreased in the patients compared to the control group indicating an increase in free radicals product. Vitamin C (p<0.0001) and E (p<0.0001) were reduced in the patients compared to the control group suggesting a decrease in the antioxidant level as the HIV infection progressed in the patients. Results from the haematological assay revealed a significant decrease in the mean blood haemoglobin levels of the HIV positive patients compared to the control subjects. The significant positive correlation (p<0.0001) between Hb and CD4 count highlights its usefulness in the progression of HIV infection. The haematocrit result pattern showed a consistency with the Hb. There was a significant positive correlation between HCT and CD4 counts (p<0.0001). No significant difference was observed in the total white blood cell count (WBC) of HIV positive patients and the control group (p=0.1830). Apart from serum total Protein (p<0.0001) and Triglycerides (p<0.001), which showed significant increase as compared to the control group, serum albumin (p=0.0106), Total cholesterol (p<0.0001), HDL-cholesterol (p<0.0001) and LDL cholesterol (p<0.0001) showed a significant decrease as compared to the control group. From the correlation analysis, serum Albumin(R=0.41), Total cholesterol (R=0.67), HDL-cholesterol (R=0.27) and LDL cholesterol (R=0.27) showed a positive significant correlation in relation to the CD4 count. However serum total Protein (R=-0.36), Potassium (R=-0.67) and Triglycerides (R=-0.27) did show a negative correlation in relation to the CD4 count. Altogether the findings of this study have revealed that oxidative stress increases as HIV infection progressed. We propose from the study that the interaction of the mechanism underlying oxidative stress and HIV progression and subsequent apoptosis is a receptor-mediated process. During the early phase of HIV infection, generation of ROS has been known to activate HIV replication in vivo through the activation of a factor that binds to a DNA-binding protein, NF-kappa B which is a known activator of HIV replication. This leads to increase in the disturbance in the antioxidant system leading to an increase in ROS production with concomitant biochemical and haematological derangement as observed in the study. Therefore an early intervention with antioxidant supplements in the early phase of HIV infection is likely to reduce HIV progression and improve the immune function.
Anti-inflammatory and ethopharmacological effects of an ethanolic leaf extract of Palisota Hirsuta K. Schum. (Commelinaceae)
(2009-08-09) Boakye-Gyasi, Eric
Leaves of Palisota hirsuta are used in Ghana and other West African states for various painful and inflammatory conditions. This study is aimed at evaluating the anti-inflammatory and ethopharmacological properties as well as toxicity profile of an ethanolic leaf extract of Palisota hirsuta using animal models. Preliminary phytochemical screening showed that the powdered leaves contained tannins, reducing sugars, flavonoids, steroids and terpenoids with traces of alkaloids. Effect of the extract on acute inflammation was assessed in the carrageenan- induced foot edema in 7-day-old chicks with diclofenac and dexamethasone as reference drugs. Pre treatment with the extract (30-300 mg kg-1; p.o.) significantly, inhibited foot edema in the chicks comparable to the NSAID diclofenac with maximal inhibition of 54.71±11.04%. Diclofenac and dexamethasone also dose- dependently inhibited carrageenan-induced foot edema. The anti-arthritic effect of the ethanolic leaf extract was assessed in the Freund’s adjuvant induced-arthritis model in rats. Palisota hirsuta extract (PHE) as well as dexamethasone and methotrexate, used as positive controls, showed significant dose-dependent anti-arthritic properties when administered prophylactically, curatively and also in combination therapy. PHE (30-300 mg kg-1) significantly reduced the arthritic edema in the ipsilateral paw with the highest dose used giving a maximum inhibition of 13.02±8.77%. PHE (300 mg kg-1) also significantly prevented the spread of the edema from the ipsilateral to the contralateral paw indicating inhibition of systemic spread. Dexamethasone (0.3-3 mg kg-1) and methotrexate (0.1-1.0 mg kg-1) significantly and in a dose dependent manner also inhibited polyarthritis edema. PHE in combination with methotrexate did not show significant effect. However there was a significant inhibition of arthritis in both the acute and the polyarthritic phases when PHE was combined with dexamethasone. Dexamethasone in combination with methotrexate caused the greatest inhibition of both phases with an extreme level of significance as expected. Overall, the present results demonstrate that PHE has anti-arthritic effect which could be similar to that exhibited by methotrexate. P. hirsuta (30-300 mg kg-1; p.o.) also dose-dependently decreased baker’s yeast induced fever in rats when Paracetamol (10-100 mg kg-1; p.o.) was used as the reference drug. The in vitro antioxidant properties of the extract were evaluated using the reducing power test; 2, 2-diphenyl-1-picrylhydrazyl hydrate (DPPH) radical scavenging assay and the lipid peroxidation assay. In all tests, n-propyl gallate was used as the reference antioxidant. The extract (0.1-3.0 mg ml -1) showed a reducing power potential (EC ; 133.7±7.59 mg ml-1) but was less than that of the reference antioxidant n-propyl gallate (EC 3.77±0.07 mg ml-1) in the reducing power test. The relative anti-oxidative activity in the DPPH de-colorization assay (defined by the EC ) was in the order: n-propyl gallate (8.02±0.01 × 10-4) > extract (1.77±0.40 × 10-1). The extract (0.1-1.0 mg ml-1) and n-propyl gallate (0.01-0.1 mg ml-1) exhibited a concentration dependent inhibition of lipid peroxidation. The rank order of potency (defined by ED in mg ml-1) was found to be: n-propyl gallate (1.31±3.00 × 10-2) > extract (4.29±0.95 × 10-1). These findings present the extract with potent antioxidant properties which may account in part for its anti-inflammatory and analgesic activities. In the analgesic assay, the leaf extract of P. hirsuta (PHE) (30, 100 and 300 mg kg-1 p.o) as well as morphine and diclofenac (positive controls), caused significant dose- dependent anti-nociceptive activity in all the pain models used. In the tail withdrawal test, PHE (300 mg kg-1) increased withdrawal latencies significantly by 43.83±11.62%. Also, PHE (300 mg kg-1) completely reversed the inflammatory- induced mechanical hyperalgesia with a maximum percentage effect of 154.79±15.84%. PHE significantly reduced the number of acetic acid induced writhing in mice. In the formalin test, PHE (10–300 mg kg-1, p.o.) caused a marked and dose-related inhibition of both phases of formalin-induced nociception. The anti-nociceptive effect exhibited by PHE in the formalin test was reversed by the systemic administration of the non-selective opioid antagonist, naloxone, the NO synthase inhibitor, NG-nitro-arginine methyl ester (L-NAME) and the ATP- sensitive K+ channel inhibitor, glibenclamide. However, theophylline a non- selective adenosine receptor antagonist did not reverse the effect. PHE, unlike morphine, did not induce tolerance to its anti-nociceptive effect in the formalin test after chronic administration and also morphine tolerance did not cross-generalize to PHE. Overall, the present results demonstrate that the central and peripheral anti-nociceptive of PHE may partially or wholly be due to the stimulation of peripheral and/or central opioid receptors through the activation of the nitric oxide-cyclic GMP- ATP-sensitive K+ (NO/cGMP/K+ATP)-channel pathway. As part of the present study, the ethopharmacological properties of the ethanolic leaf extract, in multiple behavioral paradigms of anxiety and depression— the open field test, the light/dark box, the elevated plus maze (EPM), the forced swimming test (FST) and tail suspension test (TST) was evaluated. P. hirsuta treated mice (30-300 mg kg-1) exhibited anxiolytic activity similar to diazepam in all the anxiety models used. PHE significantly increased the percentage number of center entries and the percentage time spent in the center of the open field. It also significantly increased the time spent in the lit area in relation to the time spent in the dark area of the light/dark box as well as significantly increasing open arm activity in the EPM. These effects were completely reversed in the presence of flumazenil (3 mg kg-1), a specific antagonist of the benzodiazepine site in the GABAA benzodiazepine receptor complex. The extract also dose-dependently reduced the duration of immobility in both the FST (ED50: 114.55±72.69 mg kg ) and TST (70.42±0.06 mg kg-1). Pretreatment with •-methyldopa (400 mg kg-1; 3 h; p.o.), to reduce brain NE and DA tissue content or reserpine (1 mg kg-1; 24 h; s.c.) for the disruption of vesicular storage of brain NE, DA and 5-HT tissue content or a combination of the two drugs to deplete both newly synthesized and vesicular components of NE and DA transmission attenuated the anti-immobility effects of both imipramime and the extract but not fluoxetine. Neither the extract nor the standard drugs used modified motor performance on the rota rod test at all doses tested. Collectively, these results suggest that the extract has anxiolytic and antidepressant-like effects in the models employed possibly by GABAergic activation and/or modification of monoamine transport and/or metabolism. In the toxicological study, there were no significant differences found in almost all of the hematological, serum biochemical parameters and organ/body weight ratio. No abnormality of any organ was found during histopathological examination. The results showed that the no-observed adverse- effect level (NOAEL) of P. hirsuta extract (PHE) was >3000 mg kg-1 body weight per day in rats, which can be regarded as virtually non-toxic. In conclusion, PHE had no overt organ specific toxicity and hence has a high safety profile in rats. Putting all together, these novel findings provide some pharmacological evidence and basis for the traditional use of the leaves of P. hirsuta in traditional medicine to manage various painful and inflammatory conditions.
The Chemical Pathology of Leiomyoma
(2009-10-11) Dapilah, Theophilus
Uterine leiomyomas or fibroids are a major public health problem among women, occurring more frequently in women of reproductive age and are associated with diverse symptoms. In spite of the frequency with which fibroids occur, their biology is poorly understood. Studies indicate that oestrogen and progesterone play a role in the regulation of tumour growth, and there is increasing evidence that this response may be mediated via a number of growth factors. The literature regarding predisposing risk factors for development of myomas in Ghanaian women is very limited by the paucity of studies available. This is against the background that Ghana is thought to have a high prevalence of fibroids due to its indigenous black population, since uterine fibroids are more prevalent in black women. Almost all the studies done so far have been on women in the U.S.A or some other developed country where the environmental factors that are thought to influence the development of fibroids are very different from what pertains in the under developed world, particularly, Africa. Against this background, there is the need to investigate the risk factors that are believed to influence the development of fibroids in Ghanaian women. Therefore, the chemical pathology of fibroids was studied to bridge the gap in information on fibroids between the developed and the under developed world. The specific objectives of this study were to: 1) establish the demographic characteristics of women with fibroids in Ghana. 2) assess the association between fibroid development and growth, and the gynaecologic history of patients. 3) assess the relationship between the life styles of patients and the risk of developing fibroids among Ghanaian women. 4) determine the haematological profile of Ghanaian women with fibroids in relation to the tumour growth and development. 5) assess the impact of fibroids on the renal and liver functions of Ghanaian women with fibroids. 6) assess the association of oxidative stress with the development and growth of fibroids among Ghanaian women. A consecutive study of 200 women with fibroids between the ages of 20 to 40 was done in which questionnaires were designed to elicit information on their socioeconomic background and gynaecologic history. Anthropometric features were also taken and their blood samples analyzed for oxidative stress markers, biochemical, and haematological profiles. Women with obvious hormonal imbalances and chronic or malignant diseases were excluded. Control subjects recruited had similar age distribution as the patients and had been examined to exclude fibroids. Significant difference exist between the patients and the controls in terms of socio-economic characteristics most especially education and income earnings. Abortion, nulliparity, early onset of menarche and history of sexually transmitted diseases were observed to be strongly associated positively with the risk of fibroid development. BMI and waist-to-hip ratios of the patients were significantly higher than those of the controls. The results of the liver and renal function tests of patients were not significantly different from those of the controls and generally showed that both patients and controls had normal liver and renal functions. The patients had higher serum malondialdehyde and lower vitamin C levels compared to the controls. It was observed that most red blood cell indices were higher in the patients compared to the controls. However all other haematological parameters of the patients were not significantly different from those of the controls. Though generally, this study’s findings were similar to what has been observed by previous studies, the observation that higher incidence of abortions, PIDs, and STIs in patients may interplay through mediating hormonal and probably growth factors leading to the development of fibroids is quite novel.
Control of pregnancy-associated malaria through community involvement in rural Ghana
(2009-6) Bam, Victoria Bubunyo
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Predictive equations, oxidative and metabolic risk factors among Ghanaian patients presenting with chronic kidney disease
(2010) Ephraim, Richard Kobina Dadzie
Current recommendations emphasize the need to assess kidney function using creatinine-based predictive equations to optimize the care of patients presenting with chronic kidney disease. The most widely used equations are the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI), Cockcroft-Gault (CG) and the simplified Modification of Diet in Renal Disease (MDRD) formulae. However, none of the predictive equations have been validated for the assessment of chronic kidney disease (CKD) cases in Ghana. The metabolic syndrome (MetS) is a common risk factor for cardiovascular and chronic kidney disease (CKD) in Western populations. The relationship between metabolic syndrome and risk of CKD in underdeveloped countries where genetic and environmental backgrounds differ from those in Western countries is not known. Anaemia, a complication of CKD is a potential nontraditional risk factor for cardiovascular disease (CVD). Dyslipidaemia and lipid peroxidation are both known risk factors for cardiovascular disease. This study assessed the lipid profile and oxidative stress/lipid peroxidation in patients presenting with Chronic Kidney Disease (CKD) using the oxidative stress marker; Malondialdehyde (MDA) and antioxidants; Vitamins A and C, Catalase and Uric Acid. Parathyroid hormone (PTH) has been identified as the main regulator of some electrolytes homeostasis, and thus this study set out to evaluate the relationship between PTH and these electrolytes as well as their ratios. The overall aim of this study was to evaluate the use of renal function equations in the assessment of renal function in CKD and to identify specific oxidative and metabolic risk factors in CKD. This is, therefore, the first study to specifically evaluate the predictive performance and accuracy of the seven renal function equations in patients presenting with CKD in our community. Furthermore, this study evaluated whether anaemia poses a cardiovascular risk and whether the risk is modified by the presence of CKD. In addition the present study sought to examine the association between the metabolic syndrome and risk of CKD among Ghanaian patients presenting with CKD. This study also assessed the lipid profile and oxidative stress/lipid peroxidation in patients presenting with CKD using the oxidative stress marker; Malondialdehyde (MDA) and antioxidants; Vitamins A and C, Catalase and Uric Acid. Finally, the relationship between PTH and electrolytes as well as their ratios was evaluated. Anaemia was defined as haemoglobin concentration ≤ 11.0 for both males and females whereas CKD was defined as an estimated GFR of ≥ 60 ml/min per 1.73 m2. The study population included 146 individuals with various diagnosed chronic kidney diseases. Another 80 healthy subjects without any chronic kidney pathology but of similar age and sex distribution were used as controls. iii The results of these predictive equations for 146 patients using stage of CKD were compared with the recommended methods (4v-MDRD and CKD-EPI). The MetS was defined as the presence of three or more of the following risk factors according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria: elevated blood pressure, low high density lipoprotein cholesterol (HDL-C), high triglycerides, elevated plasma glucose and abdominal obesity. Anaemia was defined as haemoglobin concentration ≤ 11.0 for both males and females whereas CKD was defined as an estimated GFR of ≥ 60 ml/min per 1.73 m2. The most accurate results were obtained with the reference equations (4v-MDRD and CKD-EPI) with CKD-EPI having a slight edge over 4v-MDRD equation. The sensitivity and specificity of the 4v-MDRD equation to detect glomerular filtration rate (GFR) values < 60 ml/min/1.73 m2 were 50.0% and 60.0% respectively; that of CKD-EPI was 66.6% and 70.0% respectively. The prevalence of MetS among CKD subjects in this study was 30.1%. The CKD groups had significantly higher waist circumference (WC), were more hypertensive [based on systolic blood pressure (SBP) and diastolic blood pressure (DBP)], had more diabetics based on fasting blood glucose (FBG) and were more hypercholesterolaemic and hypertriglyceridaemic (i.e. TC and TG) as compared to the control. The CKD group are also about 9 times at risk of developing MetS as compared to the control group (OR = 8.8; 95% CI = 3.8-20.5). The female subjects with CKD are 2 times at risk of developing metabolic syndrome as compared to the male counterparts (OR = 1.9; 95% CI = 0.9-4.0). The CKD patients were about 9 fold at risk of developing hypertension (OR = 8.9; 95% CI = 3.1- 25.1) and diabetes (OR = 9.3; 95% CI = 4.7-18.2), about 2 times at risk of developing hypertriglyceridaemia (OR = 2.3; 95% CI = 1.3-4.2) and several folds at risk of developing proteinuria (OR = 409; 95% CI = 24.7-6759). There was a significant graded relationship between the number of MetS components present and risk of CKD. 58.9% of the subjects had CKD with an estimated GFR (eGFR) of < 60 ml/min/1.73 m2, estimated with the Modification of Diet in Renal Disease (MDRD) equation and were more likely to be anaemic and nondiabetic, with higher mean values for serum creatinine (CRT) lower values for haemoglobin (HGB), haematocrit (HCT), and red blood cells (RBC). CKD subjects with anaemia had a higher prevalence of several cardiovascular (CVD) risk factors; age, male sex, diabetes and hypertension and lower haematological parameters and estimated GFR. However they had higher total cholesterol (TC) and higher triglyceride (TG) level. With the exception of HDL-C, which showed no significant difference when CKD patients were compared with controls, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglycerides (TG) increased significantly in the CKD patients. Serum MDA increased significantly in the CKD patients as compared to the controls and increased with the severity of the condition. Vitamin A, Catalase and Uric Acid increased significantly in the CKD subjects as compared to controls, whilst vitamin C decreased significantly among the CKD subjects. For every mmol/l increase in the serum concentration of PO42- (r2 = 0.78, p < 0.0001), K+ (r2 = 0.28, p < 0.0001) iv and Mg2+ (r2 = 0.004, p = 0.0211) there was a corresponding increase in serum concentration of PTH with beta values of 0.005, 0.0007 and 0.001, respectively. However, there was no linear relationship between Na+ and PTH (r2 =0.001, p = 0.6687). The serum concentration of PTH decreased, for every mmol/l increase in the serum concentrations of Ca2+ (r=0.33, p < 0.0001). These results suggest that measurement of GFR with predictive equations might be a prudent strategy for the assessment of renal function among the CKD population and that the metabolic syndrome might be an important factor in the cause and progression of chronic kidney disease among Ghanaian patients presenting with CKD. Furthermore, in persons with CKD, anaemia poses a further cardiovascular risk as it increases some of the traditional cardiovascular risk factors. Dyslipidaemia and increased oxidative stress with abnormal antioxidant levels are common in CKD patients. Therapeutic regimens aimed at strengthening the antioxidant defenses as well as normalizing lipid concentrations would be useful in protecting CKD patients against oxidative stress and any related complications. Excess PTH is linked with derangements in the metabolism of electrolytes like calcium, magnesium, phosphorus and potassium in CKD and contributes to a plethora of complications.
Stabilizing the Ferroelectric Phase of KNO3 Thin Films Using Substrate Electrodes
(2011-07-20) Donkor, Michael Kweku Edem
This research investigated the possibility of stabilizing the ferroelectric phase of KNO3 thin films using substrate electrodes. The substrate electrodes used for this investigation were nickel (Ni), stainless steel (SS) and tantalum (Ta). The dip coating technique was used to deposit the films from the molten form of KNO3. The ferroelectric properties of the films were characterized by means of polarization-voltage measurements, current density-voltage measurements, and dielectric constant temperature dependence measurements. From the results obtained, the e_ect of the di_erent substrate electrodes on the KNO3 thin film ferroelectric phase stability were determined. UV-Visible absorption spectroscopy was used to analyse the optical bandgap of KNO3. An optical bandgap of 3.79 eV was obtained for the film deposited at 480.0 oC. The P-V hysteresis loops exhibited by the KNO3 films deposited on the substrate electrodes and the temperature range over which the hysteresis loops extended revealed the possibility of stabilizing and extending the ferroelectric phase of KNO3 thin films by means of an appropriate choice of substrate electrode. Well-defined hysteresis loops characterized the ferroelectric phase of the films deposited on SS and Ni but the films deposited on Ta exhibited unsaturated hysteresis loops. The Ni and SS substrate electrodes stabilized and extended the ferroelectric phase to 40.0 oC and beyond room temperature respectively. Ta extended the ferroelectric phase to about 50.0 oC. However, it did not stabilize the ferroelectric phase since it severely degraded polarization in the film a condition which led to poorly define hysteresis loops. The characteristic hysteresis loops exhibited by the di_erent samples was attributed to the nature of the current (either displacive or leakage) present in the sample. Displacive current is responsible for hysteresis loop formation while leakage current results in elliptical loop formation. The level of oxygen vacancies at the SS/KNO3 and Ni/KNO3 interface coupled with the electronegativity and d-shell occupancy of SS and Ni caused displacive current to be dominant in the films deposited on them. On the other hand, the films deposited on Ta su_ered large leakage current e_ect due to the electronegativity and d-shell occupancy of Ta as well as the level of oxygen vacancies present at the Ta/KNO3 interface. The dielectric constant behaviour of KNO3 as temperature cooled through the paraelectric-ferroelectric phase revealed anomalies in the vicinity of the Curie point Tc. These dielectric constant temperature dependence curves obeyed the Curie-Weiss law just above Tc in the paraelectric region. The Curie point Tc and Curie temperature To were the same for all samples irrespective of the substrate electrode and this was evidence that the samples underwent a second-order transition. The films deposited on SS exhibited a shift in their inherent Tc from the reported range of between 120.0 oC and 124.0 oC to temperatures above 140.0 oC. The films deposited on Ni and Ta however exhibited no shift. The observed shift in Tc was attributed to strong polarization-strain coupling. The strain is however not due to misfit as a result of thermal stress and lattice misfit but rather due to lattice defects caused by the di_usion of Fe3+ ions into the deposited film layer during the deposition at elevated temperatures. These Fe3+ ions occupied a relatively smaller interstitial sites of KNO3. This condition deformed the lattice of the films prepared on SS causing the development of strain in the film layer. This strain is believed to be the strain that coupled with polarization and caused the shift in Tc. The results obtained form this research have clearly demonstrated and proven the viability of stabilizing the ferroelectric phase of KNO3 thin films by means of an appropriate choice of substrate electrode. With respect to this research, austenitic stainless steel substrate electrode has stabilized and extended the ferroelectric phase of KNO3 thin films beyond room temperature.
Sexual Dysfunction and Metabolic Syndrome Among Diabetic Males Visiting the Tema General Hospital
(2011-09-18) Huseini, Alidu
Diabetes mellitus is a chronic disease that can result in various medical, psychological, metabolic and sexual dysfunctions (SD) if not properly managed...
Chemical constituents, anti-inflammatory, anti-oxidant and antimicrobial activities of the stem bark and leaves of Ficus Exasperata (VAHL)
(2012) Amponsah, Isaac Kingsley
The work presented in this thesis involves the scientific investigation of the traditional uses of the leaves and stem bark of Ficus exasperata Vahl (Moraceae) as an anti-inflammatory, analgesic and wound healing agent. It also describes the isolation and characterization of the active principles from the Ficus exasperata. The petroleum ether, chloroform, ethyl acetate and 70% ethanolic extracts of the leaves and stem bark were assessed for anti-inflammatory, antioxidant and anti-microbial activities. The anti-inflammatory activities of the extracts and isolates were investigated using the carrageenan – induced foot pad eodema model in seven – day old chicks. The extracts were given orally to the chicks at 30, 100 and 300 mg/kg body weight, 1 hour after induction of oedema with carrageenan. Diclofenac and dexamethasone were used as reference drugs and the foot volume measured by water displacement plethysmography for five hours. All extracts exhibited anti – inflammatory effect with the stem bark showing the highest activity (ED50 = 50.65± 0.012). Antioxidant properties of the extracts were investigated using five assays; total antioxidant capacity, total phenolic content, DPPH scavenging activity, reducing power and lipid peroxidation activity. The most active antioxidant extract was the stem bark with IC50 values of 42.27±0.012, 20.09±0.001 and 61.80±0.001 µg/ml for the lipid peroxidation, DPPH scavenging and reducing power assays. The respective values for the standard antioxidant compound n-propyl gallate were 73.54±0.014, 10.8±0.002 and 66.88±0.002 µg/ml. Antimicrobial evaluation of extracts at concentrations of 10 mg/ ml was done using the agar well diffusion and micro-dilution assays. Seven organisms; P. aeruginosa, S. typhi, K. pneumoniae, E. coli, B. subtlilis, S. aureus and C. albicans were used. The chloroform extract of the stem bark was the most active with MIC of 1000 µg/ml against P. aeruginosa and S. aureus. Bergapten, oxypeucedanin hydrate and sitosterol-3-O-β-D-glucopyranoside were isolated from the bioactive chloroform extract of the stem bark whereas β-sitosterol and sitosterol-3-O-β-D-glucopyranoside were isolated from the pet-ether and ethyl acetate extracts of the leaves. To the best of our knowledge, this is the first report of the isolation of these compounds in Ficus exasperata. They exhibited dose-dependent anti-inflammatory activities with ED50 values of 101.6 ± 0.003, 126.4 ± 0.011, 275.9 ± 0.012 and 123.4 ± 0.033 mg/kg body weight for bergapten, oxypeucedanin hydrate, sitosterol-3-O-β-D-glucopyranoside and β-sitosterol respectively. They also showed significant DPPH scavenging effect with IC50 values of 63.38 ± 0.010, 46.63 ± 0.011, 220.3 ± 0.031 and >1000 µg/ml for the respective compounds. In the antimicrobial assay, β-sitosterol and its glucoside were inactive against all the organisms. Bergapten and oxypeucedanin hydrate gave MIC’s >1000 µg/ml against all susceptible organisms. They were the most active anti-inflammatory, anti-oxidant and antimicrobial compounds. The results of these studies have demonstrated that extracts of the leaves and stem bark of F. exasperata possess anti-inflammatory activity and also display antioxidant and antimicrobial activities. These findings provide scientific justification for the use of the stem bark and leaves of F. exasperata Vahl, in various traditional medicines, for the treatment of inflammatory and infectious conditions.
Reproductive and Developmental Toxicity of the Aqueous Root Extract of the Antimalarial Herbal Cryptolepis Sanguinolenta (Lindl.) Schltr (Periplocaceae) in Experimental Animals.
(2012) Mensah, Kwesi Boadu
Cryptolepis sanguinolenta, the West African antimalarial plant, is a known cytotoxic to mammalian cells in vitro, a DNA intercalator and topoisomerase II inhibitor. Malaria is endemic in Africa. The high cost of conventional antimalarial agents would suggest that pregnant women particularly in rural West Africa could be exposed to cryptolepis. Recently, cryptolepis containing products have appeared in Ghanaian pharmacies and herbal shops as male sexual enhancers. Paternal exposure to xenobiotics has an equal chance of having an adverse effect on the health of the conceptus as that of the mother. Using animal models, the effects of cryptolepis on reproduction, foetal development and in vivo mutagenesis is extensively studied in this project. Cryptolepis extract (62.5- 1000 mg/kg) reduced female fertility from 100 % in the control group to 0 % at the highest dose of 1000 mg/kg when given during mating and gestation. However, in females unlike males, pretreatment before mating did not have adverse outcomes on reproduction. Further studies showed that inhibition of ovulation is one the mechanisms of cryptolepis reproductive toxicity. In developmental studies, cryptolepis did not induce malformations (monstrosity) or structural abnormalities. However, early treatment of pregnant mice with cryptolepis resulted in terminations of pregnancy which was as high as 66 % when cryptolepis (100 mg/kg) was introduced on the day of mating till the end of gestation. Intrauterine growth inhibition was significant (p < 0.01) for cryptolepis treatment at 100 - 500 mg/kg. The developmental toxicity observed was largely influenced by the time of treatment with cryptolepis and the developmental stage of the conceptus. In functional toxicity studies, prenatal treatment with cryptolepis delayed the development of sensori-motor systems, caused hyperactivity, anxiety, reduced same sex pair interactions and affected object recognition in first generation animals. It however had minimal effect on spatial and reference memory. In the mounting behavioural test to study the aphrodisiac potential of cryptolepis in mice, acute dosing had insignificant effect on all mounting parameters except penile licking which was very significant (p < 0.001) at all doses tested. All aphrodisiac properties were reversed below control vi values with subacute treatments. Histological studies showed that it affected the histoarchitecture of the testes. Cryptolepis also reduced serum testosterone in male mice significantly at all doses of treatment thus consistent with the lack of aphrodisiac property observed with subacute treatments. Cryptolepis exhibited potent anti-androgenic effects by the chick comb method. It was approximately 31.05 times less potent than the cyproterone acetate used as the standard drug. Furthermore it inhibited exogenous testosterone induced comb growth in the white leghorn chick, Gallus domesticus. Cryptolepis (100 – 1000 mg/kg p.o) also induced significant renal damage. In the dominant male lethal assay for genotoxicity and mutagenicity, cryptolepis (62.5-1000 mg/kg) did not induce significant increase in post implantation losses. Overall, the study shows that the aqueous extract of Cryptolepis sanguinolenta (Periplocaceae) affects reproduction and foetal development in experimental animals. Though results from this study cannot be directly extrapolated to man, caution should be exercised in the use of aqueous extract of Cryptolepis sanguinolenta in pregnancy for the treatment of malaria.
Anti-Nociceptive Properties of the Ethanolic Extract Of Fruits of Xylopia Aethiopica (Dunal) A. Rich (Annonaceae) and its Major Constituent, Xylopic Acid
(2012) Ameyaw, Elvis Ofori
The fruits of Xylopia aethiopica are traditionally used to treat malaria, fibroid (uterine), fungal infection, rheumatism, arthritis, amenorrhea, boil, haemorrhoids and flatulence whilst the crushed seeds are applied topically on the forehead in the treatment of headache and neuralgia. TLC and HPLC analyses of the extract revealed the presence of several compounds. The isolated xylopic acid produced a single spot in a number of solvent systems including petroleum ether: ethyl acetate (1:9) and hexane: ethyl acetate (1:9) and a single peak in HPLC analysis certifying the level of purity of the compound The extract and xylopic acid exhibited antinociception in all the pain models used. In the acetic acid-induced writhing test, the extract (30 – 300 mg kg-1) (F3,28=14.37, P<0.0001) and xylopic acid (10 – 100 mg kg-1) (F3,28=20.56, P<0.0001) significantly reduced abdominal writhes induced with acetic acid in mice with the highest dose of the extract inhibiting visceral nociception by 98.8 ± 0.8%. The highest dose of xylopic acid also inhibited visceral nociception by 93.8 ± 1.4%. Morphine (1 – 10 mg kg-1) (F3,28=9.77, P=0.00016) and diclofenac (1 - 10 mg kg-1) (F3,28=4.04, P=0.0165) used as controls in this model similarly exhibited significant antinociceptive activities in this test. The extract (30 – 300 mg kg-1) (F3,28=6.93, P=0.0012) significantly attenuated mechanical hyperalgesia in the Randall-Selitto test with maximum possible effect of 110 ± 16.17% at the highest dose used. Similarly xylopic acid (10 – 100 mg kg-1) significantly (F3,28=4.86, P=0.0076) attenuated mechanical hyperalgesia with a maximum possible effect of 94.58 ± 21.6% at the highest dose in the same test. The extract and xylopic acid were both relatively more effective in the Hargreaves thermal paw withdrawal test, (extract: F3,64= 8.10, P=0.0338, xylopic acid: F3,64= 7.11, P=0.03) compared to the tail flick test (extract: F3,64= 6.47, P=0.045, xylopic acid: F3,64= 19.5, P<0.0001). For the acute and chronic musculoskeletal pain tests morphine was most efficacious. The extract was also more efficacious than xylopic acid. Xylopic acid was however more potent in reducing both the chronic muscle and knee pain whereas the extract was more efficacious in the chronic skeletal pain model. The extract, xylopic acid and pregabalin ameliorated vincristine-induced neuropathic pain. Common symptoms experienced by patients with neuropathic pain such as mechanical hyperalgesia, tactile and cold allodynia were measured using Von Frey filaments and cold water. The extract (F3,28=5.12, P=0.006), xylopic acid (F3,28=3.72, P=0.0229) and pregabalin (F3,28=5.92, P=0.0029) produced tactile anti-allodynia. Similar effects were observed in the Von Frey intermediate and mechanical hyperalgesia as well as cold allodynia tests. In the formalin test the extract and xylopic acid inhibited both neurogenic and inflammatory phases of pain. The antinociception of the extract, xylopic acid and morphine involved the inhibition of opioid, NO-cGMP, 5-HT3, adenosine and muscarinic pathways Further determination of the mechanism of antinociception of xylopic acid carried using binding assay revealed the binding of xylopic acid to μ-opioid receptors with an enhancement of endogenous opioid binding. Capsaicin-sensitive C-fibres-glutamatergic-nociceptive pathway was found to participate in the antinociception of extract and xylopic acid. Tolerance to morphine antinociception on the opioid receptors developed after chronic treatment for eight days but failed to develop to the extract and xylopic acid. Also morphine tolerance did not cross-generalize to the extract and xylopic acid. In order to elucidate the drug—drug interaction between xylopic acid/morphine and xylopic acid/diclofenac in combination administrations, isobolographic analysis was performed. The experimental ED50’s (Zmix) of xylopic/morphine combination were smaller than their corresponding theoretical ED50’s (Zadd) in both phases of the formalin test indicating synergism. Isobolographic analysis of xylopic acid/diclofenac combination carried out also indicated potentiation of the combination as the experimental ED50 lay below the line of additivity. The degree of potentiation calculated as interaction index indicated that the combination synergized to produce antinociception. In summary these findings provide scientific data for the use of the fruit of X. aethiopica in the treatment of painful conditions and co- administration of xylopic acid/morphine and xylopic acid/diclofenac may be said to be beneficial as their various side effects may be reduced due to lower doses used with potentiation of their therapeutic effects.
Safety Evaluation and Hepatoprotective Activity of the Aqueous Stem Bark Extract of Spathodea Campanulata
(2012) Dadzeasah, Phyllis Elsie Abaiduwa
Spathodea campanulata, a widely used traditional African medicinal plant for skin diseases and stomach aches has not been scientifically assessed for toxicity and hepatoprotection. The aqueous extract of the stem bark of the plant Spathodea campanulata (SCE) was therefore evaluated for safety and potential hepatoprotective activity in rodents. The extract (1250, 2500, 5000 mg/kg, p.o) administered to rats and mice over a 24-hour period did not show any signs of toxicity or mortality, suggesting that the oral LD50 of the aqueous extract (in rats and mice) was beyond 5000 mg/kg. Daily administration (1250, 2500, 5000 mg/kg; p.o) of extract for 14 days did not cause any changes in behavior or alterations in haematological parameters of the animals. Serum biochemical analysis in rats showed a rise in alkaline phosphatase (ALP) (339.50±90.50 in the control to 582.5±28.50 U/L in the highest dose of 5000 mg/kg) and a decrease in Na+ concentration (147.3±1.856 mmol/L in the control to 135.0±1.00 in the 5000mg/kg dose), but no change in other parameters. These observations did not reflect in the histopathology of the liver and kidneys of treated animals. However, the diuretic test on the extract was positive. Urine output, Na+ and K+ concentration in urine were increased significantly by the administration of extract for seven days. In hepatoprotective studies, rats were pre-treated with 625 mg/kg , 1250 mg/kg, 2500 mg/kg p.o for 4 days before intoxication with carbon tetrachloride (CCl4) (1 ml/kg, 20 % in liquid paraffin, p.o) or mice and rats with 100 mg/kg, 300 mg/kg, 625 mg/kg for 4 days before intoxication with paracetamol or aflatoxin B1 (AFB1) respectively. Generally, the administration of these hepatotoxic agents caused an increase in liver weights which were prevented or restored by pre-treatment with extract in both rats and mice. The aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transpeptidase (GGT), bilirubin-induced by these hepatotoxic agents (CCl4, parcetamol and AFB1) were significantly reduced with SCE treatment. Additionally, administration of CCl4 daily for 5 days, followed by treatment with 100, 300, and 625 mg/kg p.o daily for 3days (curative) decreased profoundly the AST, ALT and GGT levels induced by CCl4. These results correlated well with the histopathological studies observed in the photomicrographs of liver for treated and control groups. Treatment with the extract decreased the extent of fatty liver and necrosis caused by the hepatotoxic agents. Lipid peroxidation measured as TBARS was elevated by CCl4 but this was reversed by treatment with the extract at all dose levels. Again, pretreatment with SCE (625 mg/kg) before hepatotoxicity by CCl4 or paracetamol restored the decrease in super oxide dismutase (SOD) and glutathione peroxidase (GPx) activity caused by the hepatotoxin. This decrease was more profound after paracetamol intoxication than it was after CCl4 intoxication. The extract (625 mg/kg) also showed strong enzyme inhibition when it reduced the total cytochrome P450 in both mice and rats when given for seven consecutive days. This decrease was also reflected in the presence of CCl4 and paracetamol. The preliminary phytochemistry which showed the presence of tannins, sterols and reducing sugars as well as the in vitro testing which gave positive results for reducing power and total phenolic content also support the activity of the plant extract in interference with hepatotoxicity. Collectively, the results indicate that the aqueous extract of Spathodea campanulata is fairly nontoxic and may exhibit hepatoprotective activity at lower doses by enhancing antioxidant protection in the cell and inhibiting total cytochrome P450 hence interfering with bioactivation of hepatotoxic agents.
A comparative study of oxidative stress and type 2 diabetes mellitus in rural and urban communities in the Ashanti Region, Ghana
(2012) Quartey, Perez
BACKGROUND/AIM: A growing area of research is the relationship between oxidative stress and diabetes. Accumulating evidence indicates that oxidative stress, a condition of excessive reactive oxygen species, may play a role in the aetiology of type 2 diabetes mellitus by inducing insulin resistance in the peripheral tissues and impairing insulin secretion from pancreatic beta-cells. However, the link between oxidative stress and the development and progression of diabetes and its complications is still not fully understood. The fast progressive westernization of the Ghanaian society is predisposing increasing numbers of the population to higher rates of oxidative stress and may be the results of the increase in the prevalence of type 2 diabetes and other dysmetabolic conditions. The development of a simple screening tool may help to identify individuals at high risk of development of such dysmetabolic states in the society. METHODOLOGY: 210 adults were recruited from urban Kumasi and 180 adults were recruited from 3 rural villages in the Ashanti region. Sociodemographic data was collected from the subjects. Anthropometric measurements including blood pressure, weight, and height and waist circumference were determined by qualified nurses. Blood samples were collected after 12 hours of overnight fast for the analysis of glucose, lipids, oxidative stress indices and other biochemical parameters. RESULTS: In this study, the prevalence of type 2 diabetes mellitus and IFG were considerably higher among the urban subjects (10.5% and 28.0% respectively for urban subjects and 3.8% and 22.1% respectively for rural subjects). Dyslipidaemia and hypertension were also found to be more prevalent in the urban subjects than the rural population. Plasma antioxidant levels were also higher in the rural population than the urban population whiles malondialdehyde levels were found to be higher in the urban population as compared to the rural population. CONCLUSION: Type 2 diabetes and other dysmetabolic conditions are on the increase in the urban population of the Ashanti. In conclusion, the study hypothesizes that the fast progressive westernization of the Ghanaian culture predisposes individuals to higher rates of systemic oxidative stress as a result of increased exposure to reactive oxidants and this is accelerating the ageing process in the society as evident in the increasing incidence of type 2 diabetes mellitus and other dysmetabolic conditions. Additionally, a simple risk tool like the Ghana Diabetes Risk Score can be used to identify individuals at high risk of development of these dysmetabolic conditions.
Safety Evaluation of a Polyherbal Antihypertensive Mixture Used in Ghana in Mice
(2012) Koffuor, George Asumeng
Herbal medicine in being used extensively globally with the notion that they are natural and therefore relatively safe compared to other forms of medicine. This study therefore assessed the safety of an FDB approved polyherbal anti-hypertensive used extensively in Ghana. Using ICR mice, the effect of 32 - 550 mg/kg/day of the product on; general health, locomotory activity, muscular coordination and strength, vestibular function, organ functions, hematological, lipid, and histopathological profiles, urine content, pentobarbitone-induced sleeping time, cytochrome P450 activity and reproductive toxicity was assessed. One hour post-treatment observation in acute toxicity studies showed sedation and lethargy and a significant dose-dependent reduction (P ≤ 0.05-0.001) in locomotion, rearing, centering, grip strength, muscle coordination, and righting response. These observations were however not significant 24 h post-treatment. Acute toxicity studies also showed no significant differences in hematological profile (except in WBC), liver function, kidney function (in plasma urea), and urine content up to 10 days post-treatment. A 45-day sub-chronic toxicity study showed no physical deterioration, and observable clinical and autonomic toxic symptoms. Among other vital organs, only the liver showed significant decrease (P ≤ 0.01-0.001) in organ weight to body weight ratio with treatment. WBC increased significantly (P ≤ 0.05 – 0.001) while RBC, MCV, and RBC distribution width were not affected. HGB decreased significantly (P ≤ 0.001) after 23 days but normalized. HCT, PCT and PDW increased significantly (P ≤ 0.001) and MCH and MCHC were significantly reduced (P ≤ 0.01-0.001). Plasma albumin decreased (P ≤ 0.01 – 0.001) initially but later increased significantly (P ≤ 0.001) globulin levels increased significantly (P ≤ 0.001) hence a significant increase (P ≤ 0.001) in total protein. ALT, AST, ALP increased significantly (P ≤ 0.01) after 23 days post-treatment but decreased very significantly (P ≤ 0.001) below the control after 45 days. Direct, indirect, and total bilirubin increased significantly (P ≤ 0.001) with duration of treatment. Plasma urea decreased significantly (P ≤ 0.001) but creatinine increased significantly (P ≤ 0.001) with higher dosing and longer treatment time. Total cholesterol and HDL reduced very significantly (P ≤ 0.001) initially but returned to normal while TAG, VLDL, and LDL were significantly very high (P ≤ 0.001) initially but reduced by day 45. Urine analysis showed no significant changes. The liver, kidney and spleen showed histopathological changes. Pentobarbitone-induced sleeping time was prolonged. Liver cytochrome P450 level decreased very significantly (P ≤ 0.001). Observations made suggested that the product is not lethal but had CNS depressant, anxiolytic, and probably muscle relaxant activity which affected activity and neurological behavior. It did not have abnormal proliferative effect on blood forming cells but caused microcytic-anisocytic anaemia. Liver synthetic and excretory functions colud be affected with its use. Concomitant administration with other drugs could result in some drug interaction as the product inhibits CYP 450. Within limits of the doses administered in this study, it did not cause reproductive toxicity.
The Hypoglycaemic and Antioxidant Constituents of the Stem of Adenia Lobata Engl (Passifloraceae) and the Stem Bark of Morinda Lucida Benth (Rubiaceae)
(2012-06-15) Sarkodie, Joseph Adusei
The hypoglycaemic and antioxidant activities of two Ghanaian medicinal plants namely Adenia lobata Engl (Passifloraceae) and Morinda lucida Benth (Rubiaceae), used to treat diabetes mellitus in traditional medicine, have been investigated. The dried stem powder of A. lobata was successively extracted by Soxhlet with petroleum ether and 70% ethanol to obtain the crude petroleum ether (PEAL: yield =1.1w/w %) and ethanol (EEAL: yield = 5.4 w/w %) extracts. The dried stem bark powder of M. lucida was similarly extracted with petroleum ether, ethylacetate and 70% ethanol to obtain the crude petroleum ether (PEML: yield = 0.9%), ethylacetate (EAEML: yield = 4.0%) and ethanol (EEML: yield = 4.6%) extracts. The extracts were initially assessed for their hypoglycaemic and antioxidant activities and later subjected to chromatographic separation to isolate their chemical constituents. The isolated compounds were identified using NMR spectroscopic methods with reference to literature, and also assessed for their hypoglycaemic activities. The hypoglycaemic activity of PEAL and EEAL were determined in streptozotocin-induced diabetic rats (80 mg/kg body weight). Five groups of diabetic rats were given 150, 300 and 600 mg/kg body weight of PEAL and EEAL orally once daily for 20 days. Glibenclamide (5 mg/kg body weight) was used as positive control while distilled water (5 ml) acted as the normal diabetic control. The blood glucose levels were monitored initially for 6 hours and subsequently over 20 days. Both extracts exhibited statistically significant (p< 0.001) hypoglycaemic activity throughout the study period, with EEAL showing the greatest activity. EEAL at 600 mg/kg body weight after 6 hours produced 50.3% reduction whereas glibenclamide gave 52.7% reduction over the initial blood glucose levels of the diabetic rats. Again, both EEAL at 600 mg/kg body weight and glibenclamide caused the blood glucose levels of the diabetic rats to fall by 81.0% and 82.1% respectively after the full 20 days. The same protocol was followed to establish the hypoglycaemic activity of PEML, EAEML and EEML in the diabetic rats using doses of 100 mg/kg, 200 mg/kg and 400 mg/kg. The most significant reduction (51.2%) by the extracts after six hours was caused by EEML at a dose of 400 mg/kg body weight and glibenclamide caused 53.0% reduction in blood glucose levels of the diabetic control rats. However, after day 20, at 400 mg/kg body weight, PEML exhibited the most significant reduction (77.7%) of the blood glucose levels compared to EEML (60.7%). The antioxidant properties of the petroleum ether and ethanol extracts of A. lobata (PEAL, EEAL) and M. lucida (PEML, EEML) were evaluated using five assays; total phenolic content, total antioxidant capacity, reducing power, DPPH scavenging effect and lipid peroxidation activity. In all these assays, the antioxidant properties increased with increasing concentration of the extracts. The IC50 values for DPPH scavenging effect for PEAL and EEAL were 2.106 ± 0.008 and 0.5210 ± 0.006 respectively while that of N-propyl gallate was 0.2917 ± 0.005. The IC50 values for lipid peroxidation activity for PEAL and EEAL were 8.593 ± 0.090, 0.5985 ± 0.008 respectively and that of N-propyl gallate was 0.4217 ± 0.006. The IC50 values for DPPH scavenging activity for PEML and EEML were 7.426 ± 0.007 and 0.4403 ± 0.005 respectively whereas that of lipid peroxidation activity gave 3.554 ± 0.009 for PEML and 1.928 ± 0.007 for EEML. Thus, for both A. lobata and M. lucida, the ethanolic extracts showed better antioxidant potential than the petroleum ether extracts. The 70% ethanol extract of A. lobata (EEAL) and the petroleum ether extract of M. lucida (PEML) which showed the most significant hypoglycaemic activity were subjected to series of column chromatographic separation using silica gel as stationary phase and eluting with petroleum ether, ethylacetate, ethanol, and their mixtures in gradient elution. Two compounds, palmitic acid and -hydroxy--valerolactone were isolated from A. lobata extract and stigmasterol was isolated from M. lucida extract. These were characterized using 1H, 13C NMR, COSY, HSQC and HMBC Spectroscopy with comparison to literature. All the compounds were also evaluated for hypoglycaemic activity over 6 hours. The compounds at various doses were administered orally to diabetic rats and the most significant hypoglycaemic effects were caused by the highest doses of the compounds used in the experiments. The palmitic acid (180 mg/kg body weight), -hydroxy--valerolactone (180 mg/kg body weight) and stigmasterol (100 mg/kg body weight) caused 30.4%, 50.9% and 40.5% reduction respectively over the initial blood glucose levels in the diabetic rats. The results of these studies have shown that the extracts of stems of A. lobata and stem bark of M. lucida possess hypoglycaemic activity in diabetic animal model and also display antioxidant properties. The compounds, palmitic acid, -hydroxy--valerolactone and stigmasterol also possess hypoglycaemic activity. These findings may justify the traditional use of these medicinal plants in the management of diabetes mellitus.
District inequities in household child survival practices in the Upper West Region of Ghana
(2012-06-19) Otupiri, E.
Worldwide, too many children under-five die needlessly but the greatest burden is in sub-Saharan Africa where in 2008, one-in-seven children died before the fifth birthday. Evidence shows that a set of 23 effective interventions could reduce child mortality by 66% if delivered at universal coverage (99%). Four of these interventions are capable of reducing the burden remarkably at universal coverage; three of these interventions do not require contact with the formal health sector. The children who are in greatest need of these life-saving practices do not get them. In Ghana, the worst place to live as a child under-five for the last two decades has been the Upper west Region; the 2008 GDHS reported a burden of 191 per 1000 live births for the region. Even though data on coverage of household practices for child survival growth and development are available at the regional level, the same cannot be said for data at the district and sub-district levels. Data at lower levels are poor, inconsistent and unreliable. National and regional data mask significant inequities within regions. We sought to determine whether the then eight districts in the Upper West Region differ in terms of the uptake of the four core household practices evidenced to be capable of reducing the under-five mortality burden by up to 41% even in resource-constrained settings such as the Upper West Region; the region is one of the poorest in Ghana. Additionally, we were interested in differences across the districts with reference to specific cofactors. We collected data from 2400 households (300 per district) using the methodology described by UNICEF in the 2005 Multiple-indicator Cluster Survey manual. The outcome variables were the four core household practices – exclusive breastfeeding, appropriate complementary feeding, insecticide bed net use and oral rehydration salt for diarrhoea management – which together at universal coverage could considerably reduce under-five deaths. The cofactors we studied included: child characteristics (age, sex); maternal characteristics (age, level of education, ability to read and write English); husband characteristics (age, level of education, ability to read and write English) and household wealth. In the Upper West Region, the overall prevalence of the four-core household practices was: exclusive breastfeeding (23%), appropriate complementary feeding (22%), insecticide bed net use (68%) and oral rehydration salt (47%). Even after multivariate adjustment, statistically significant district differentials were observed for all outcome variables (p≤0.05). With reference to the cofactors studied the following relationships were observed even after multivariate adjustment: wealthy mothers were significantly less likely to have initiated breastfeeding within an hour of delivery (AOR=0.85, p-value≤0.001, 95%CI: 0.77-0.93); a mother’s ability to read and write English and her husband’s age were significantly associated with appropriate complementary feeding (AOR=2.22, p-value ≤0.01, 95%CI: 1.35-3.56 and AOR=1.31, p-value≤0.01, 95%CI:1.09-1.57 respectively); children under-five from wealthy homes were less likely to have slept under an insecticide-treated bed net the night preceding the survey (AOR=0.78, p-value ≤0.001, 95%CI: 0.72-0.85) and a mother’s age, her husband’s age and ability to read and write English, and household wealth were significant predictors of a mother’s ability to correctly prepare ORS. The study indicates important district inequities across the Upper West Region. Interventions should be evidence-based emphasizing district level differentials and recognizing the paradoxical effect of wealth. Further research could emphasize the cofactors studied, cultural practices, access to and utilization of health care facilities and family planning.
Anticonvulsant, Antidepressant and Anxiolytic Effects of Mallotus Oppositifolius (Geiseler) Müll. Arg. (Euphorbiaceae)
(2012-08-20) Kukuia, Kennedy Kwami Edem
Mallotus oppositifolius is used in Ghana for CNS disorders but very little scientific evidence exists to support its use. Thus central effects of 70% v/v hydroalcoholic extract of the leaves of Mallotus oppositifolius (MOE) was assessed. Anticonvulsant effects of the extract in acute and chronic seizure models were evaluated. The study also investigated the effect of the extract on animal models of depression and anxiety. In a preliminary screening of the central effects of the extract, oral dose of MOE induced sedation (1000 – 3000 mg kg-1); caused neuromuscular deficits in the rotarod test (300 – 3000 mg kg-1); reduced spontaneous locomotor activity in the activity cage; exhibited anticonvulsant effect (30 – 3000 mg kg-1) and central analgesic effect in the tail immersion test (100 – 3000 mg kg-1). The LD50 was approximately 6000 mg kg-1 in mice. M. oppositifolius (10 - 100 mg kg-1, p.o.) exhibited anticonvulsant effect in the picrotoxin and strychnine induced seizure tests. The extract significantly delayed onset of myoclonic jerks and clonic convulsions; decreased the frequency and duration of clonic convulsions in these models. In the MES test, the extract caused a significant and dose dependent decrease in the duration of tonic limb extensions. In the pilocarpine induced status epilepticus, MOE delayed the onset of clonic convulsions and decreased the duration of these seizures. Furthermore, the extract protected mice against mortality induced by 4-aminopyridine and delayed the onset of both clonic and tonic convulsions. Flumazenil, a GABAA/benzodiazepine antagonist, reversed the anticonvulsant effect of the extract in the PTZ-induced seizure test suggesting enhancement of GABAA neurotransmission is involved in the anticonvulsant effect of the extract. Isobolographic analysis of the combination of diazepam and extract showed a synergistic effect but the mode of action of this effect may not be dependent on enhancement of GABAA neurotransmission since flumazenil failed to reverse their anticonvulsant effect. Oral doses of MOE (10 - 100 mg kg-1), fluoxetine (3 - 30 mg kg-1) and imipramine (3 - 30 mg kg-1) decreased the frequency of immobility and immobility periods of mice in both the FST and TST when compared to control group, indicating significant antidepressant activity. In the open space swim test, a chronic depression model, MOE demonstrated antidepressant-like effect on the first day of treatment and sustained it throughout the period of drug treatment. MOE decreased immobility time while increasing the distanced travelled by the mice. The depression induced in this model induced significant impairment in spatial learning and memory in the Morris water maze—this was reversed by the extract and fluoxetine but not imipramine. Extract, fluoxetine and imipramine treatments did not have significant effects on weight variation. A day after the 14th day of drug treatment, the antidepressant effect was still significant. A 3-day subcutaneous pretreatment with 200 mg kg-1 para-chlorophenylalanine (pCPA), reversed the antidepressant effect of MOE and fluoxetine but not imipramine, suggesting that serotoninergic enhancement may be involved in the behavioural effect of the extract. This was confirmed by the ability of the extract to potentiate the head twitch responses induced by 5-hydroxytryptophan in mice, a model sensitive to 5-HT2A receptor activation. Pretreatment with α-methyldopa (400 mg kg-1) however, failed to reverse the behavioural effect of the extract and fluoxetine treatments in the forced swim test. The same result as above was observed for extract and fluoxetine treatments when mice were pretreated with reserpine (1 mg kg-1) or a combination of α-methyldopa (200 mg kg-1) and reserpine (1 mg kg-1). This suggests that the antidepressant effect of the extract may not be dependent on central noradrenergic mechanisms. Administration of D-serine (600 mg kg-1), a full agonist on the glycine site of the NMDA receptors, reversed the antidepressant effect of the extract, fluoxetine and desipramine in both the TST and FST. D-cycloserine (2.5 mg kg-1), a partial agonist potentiated this behavioural effect in both extract and fluoxetine treated mice but not desipramine in both the TST and FST. This suggests possible involvement of glycine/NMDA receptor or pathway antagonism in the antidepressant effect of the extract. MOE slightly increased curling score in the tail suspension test and this was significantly potentiated by D-cycloserine, suggestive of possible opioidergic activity. MOE (10 - 100 mg kg-1, p.o.) showed anxiolytic effect in the three anxiety models used namely; elevated plus maze, light-dark box and open field tests. M. oppositifolius treatment significantly increased the percentage of centre entries and the percentage time spent in the centre of the open field. M. oppositifolius also increased the time spent in the lit area and the latency to leave the lit area in light/dark box. In the EPM, it significantly increased open arm activities by increasing percentage open arm entries and duration. MOE also decreased risk assessment behaviours such as the head dips, stretch-attend postures and rearing. Acute and subacute toxicity in rats did show deaths after 14 day treatment with the extract (30 – 3000 mg kg-1). Extract treatment did not affect weight of rats or the relative organ weights. Haematological or serum biochemical parameters were not affected except increases in serum bilirubin (300 and 3000 mg kg-1), urea and creatinine (30 and 100 mg kg-1). Histopathological examination did not reveal toxic effect on the stomach, heart, liver and spleen. There were however some morphological changes of the kidney at 30 mg kg-1. These results suggest that the extract has anticonvulsant effect possibly through enhancement of GABAergic, glycinergic and potassium channel activation or increased potassium conductance. Possible inhibition of muscarinic and glutamatergic transmission may also be involved. The antidepressant-like effects of the extract may be due to the interplay of serotoninergic, glycine/NMDA and opioidergic pathways. The extract also demonstrated anxiolytic-like effects possibly by the involvement of GABAergic and serotoninergic mechanisms.
Analgesic and antispasmodic constituents, and standardization of the root bark of Cassia Sieberiana D. C. [Caesalpiniaceae]
(2013) Sam, George Henry
Medicinal plants have been used by man for the treatment of various diseases however many of the products from these have not been scientifically standardized. Cassisa sieberiana D.C. (Caesalpiniaceae) is a tree whose root bark is traditionally used as an analgesic, especially for schistosomiasis in Ghana. This work was carried out to validate its analgesic and antispasmodic action, identify the isolates by guided fractionation and standardize the power root bark which is used in therapy...
Anti-inflammatory and anti-anaphylactic effects of trichilia monadelpha (thonn.) j. j. de wilde. ex oliv.pp (meliaceae) extracts in Rodents
(2013-08-04) Okon, Inemesit Ben
Trichilia monadelpha (Meliaceae) in Ghana and other parts of Africa, is used locally to manage various inflammatory and pain conditions.Three extracts(petroleum ather extrct,PEE, etthyll acetate extract, EthE, and ethernal extarct, EAE) obtained from this plant and evaluated pharmacologically................

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