Aetiology of pleural effusions in children living in a high TB endemic setting.

Confirming the aetiology of pleural effusion in children may be difficult in TB-endemic settings. We investigated the role of polymerase chain reaction (PCR) and routine biochemical tests in discriminating pleural effusion caused by bacteria from other aetiologies.This is a cross-sectional post-hoc analysis among children with pleural effusion in a tertiary hospital in South Africa, incorporating new data from PCR testing of stored pleural fluid. Aetiological classification was defined by microbiological confirmation.Ninety-one children were enrolled; the median age 31 months (IQR 12-102). The aetiology of pleural effusion was 40% (36/91) bacteria, 11% (10/91) TB, 3% (3/91) viruses, 11% (10/91) polymicrobial and 35% (32/91) had no pathogen identified. The most common pathogen was Staphylococcus aureus (27/91, 30%) with similar yields on culture and PCR, followed by Streptococcus pneumoniae (12/91, 13%), detected more commonly by PCR. PCR reduced the number of children with unconfirmed aetiologies from 48 to 32. Characteristics of children with no pathogen most resembled those with TB. Pleural fluid lactate dehydrogenase ≥1,716 U/L best discriminated bacterial pleural effusion from other aetiologies (sensitivity of 86%; specificity 95%).PCR improved detection of pathogens and reduced number of children with unconfirmed aetiologies in presumed exudative pleural effusion..

Technoeconomic data and assumptions for long-term energy systems modelling in Indonesia.

Indonesia's emission reduction commitment and clean energy transition target emphasises the importance of energy system modelling for analysing and projecting Indonesia's capacity, resource availability, and future conditions in achieving these objectives. Utilising energy systems modelling based on adequate and reliable data enables policymakers to select the most optimal alternatives in energy planning. Aligned with the U4RIA (Ubuntu, Retrievability, Repeatability, Reconstructability, Interoperability, Auditability) concept, this database may facilitate various related stakeholders in obtaining this comprehensive and detailed energy data, while the data gathering and processing can also be applied to other developing countries. This country-specific dataset covers the historical data of electricity generation, demand, installed capacity, capacity factor, technical lifetime, renewable energy potentials, costs, and its projections up to 2050. The data in this article is ready to be used for energy system and modelling research.

Aetiology and presentation of childhood pleural infections in the post-pneumococcal conjugate vaccine era in South Africa.

Background: Complications of respiratory infections including pleural effusion (PE) are associated with a high morbidity. Differentiating between PE caused by Mycobacterium tuberculosis (Mtb) infection and other bacterial infections in endemic areas is difficult in children, thus, impacting treatment. Objectives: To investigate the aetiology of PE and features distinguishing tuberculosis (TB) from bacterial PE in children. Methods: We conducted a prospective study in children with PE admitted to a tertiary hospital in Cape Town from December 2017 to December 2019. Clinical information and routine laboratory investigations were compared between children with bacterial, Mtb or unclassified PE, categorised according to study definitions. Results: A total of 91 patients were included in the present study and their median age was 31 months (interquartile range (IQR) 11.8 - 102.1). The aetiology was bacterial in 40% (n=37), Mtb in 39% (n=36) and unclassified in 20% (n=18) of patients. Staphylococcus aureus was the most common bacterial isolate, confirmed in 65% (n=24/37) patients, and Streptococcus pneumoniae was confirmed in only 8% of patients. TB was microbiologically confirmed in 33% (n=12/36) of patients. Patients with TB were older (91.6 v. 11.8 months; p<0.001), with more weight loss (28 v. 12 patients; p<0.001), and longer cough duration (10 v. 4 days; p<0.001) than those with other bacterial PE. In contrast, the latter had significantly higher serum C-reactive protein (median 250 v. 122 mg/L; p<0.001), procalcitonin (11 v. 0.5 mg/L; p<0.001), pleural fluid lactate dehydrogenase (7 280 v. 544 U/L; p<0.001), and adenosine deaminase levels (162 v. 48 U/L; p<0.001) and lower glucose levels (1.3 v. 4 mmol/L; p<0.001). Conclusion: Post 13-valent pneumococcal conjugate vaccine, S. aureus is the dominant cause of PE in children using traditional culture methods, while Mtb remains a common cause of PE in our setting. Useful clinical and laboratory differences between Mtb and other bacterial PE were identified, but the cause of PE in 20% of children was underdetermined. Molecular testing of pleural fluid for respiratory pathogens may be useful in such children.

Educating caregivers to recognise the clinical signs of pneumonia in children younger than 6 months

Background. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. Objective. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. Methods. The study involved a cohort of women presenting to the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between 7 July and 8 September 2016. A total of 90 women with children younger than 10 weeks were recruited. Participants were trained on identifying early signs of pneumonia using low-cost equipment. Follow-up training and assessment sessions formed part of the programme.Results. At pre-training assessment, the majority of the participants (n=83/90; 92.2%) recognised lower chest indrawing as a sign of respiratory disease requiring immediate hospital intervention. Participants' performance in determining rhythms of 50 breaths per minute (bpm) and 60 bpm improved significantly across sessions (p=0.011 and p≤0.001, respectively). After training, 87 participants (96.7%) were able to determine rapid breathing accurately compared with 73 participants (81.1%) before training (p=0.001).Conclusion. The results suggest that caregivers can be effectively trained to identify clinical signs of pneumonia in young children, even in low-resource settings. A training initiative as described in this study could be an effective public health intervention to help address the burden of pneumonia in low-resource settings

Agouti-related protein promoter variant associated with leanness and decreased risk for diabetes in West Africans.

OBJECTIVE: The role of the central melanocortin system in the development of obesity has been extensively studied. Single-nucleotide polymorphisms (SNPs) within several candidate genes have been associated with food intake and obesity-related phenotypes; however, few of these associations have been replicated. SNPs in the agouti-related protein (AGRP) gene coding (Ala67Thr, 199G/A) and promoter (-38C/T) have been reported to be associated with body mass index (BMI), fat mass (FM) and percent body fat, in populations of European and African descent. In this study, we evaluated the association between the functional AGRP -38C/T promoter SNP and weight-related traits, namely BMI, FM and fat-free mass (FFM), as well as diabetes status. DESIGN: An association study of the AGRP -38C/T SNP and indices of obesity and diabetes status. SUBJECTS: A well-characterized population of 538 West Africans from Ghana and Nigeria recruited in the AADM (Africa America Diabetes Mellitus) study (mean age 52 years, 41.3% males, 71% diabetic). MEASUREMENTS: Genotyping of the AGRP -38C/T SNP, BMI, FM, FFM and fasting plasma glucose. RESULTS: Women carrying two copies of the variant T allele had significantly lower BMI (OR=0.47; 95% CI, 0.25-0.87). Also, men with at least one copy of the variant T allele were over two times less likely to be diabetic than other men (OR=0.44; 95% CI, 0.22-0.89). CONCLUSION: Our results replicate previous findings and implicate the AGRP -38C/T SNP in the regulation of body weight in West Africans.

A genome-wide scan for quantitative trait loci linked to obesity phenotypes among West Africans.

OBJECTIVE: To identify quantitative trait loci (QTL) for three obesity phenotypes: body mass index (BMI), fat mass (FM) and percent body fat (PBF) in West Africans with type 2 diabetes (T2DM). DESIGN: An affected sibling pair (ASP) design, in which both siblings had T2DM. Obesity was analyzed as a quantitative trait using a variance components approach. SUBJECTS: Sib-pairs affected with T2DM from the Africa America Diabetes Mellitus (AADM) study, comprising 321 sibling pairs and 36 half-sibling pairs. MEASUREMENTS: Weight was measured on an electronic scale to the nearest 0.1 kg, and height was measured with a stadiometer to the nearest 0.1 cm. Body composition was estimated using bioelectric impedance analysis (BIA). Genotyping was carried out at the Center for Inherited Disease Research (CIDR) with a panel of 390 trinucleotide and tetranucleotide repeats. RESULTS: The obesity-related phenotype showing the strongest linkage evidence was PBF on chromosome 2 (LOD 3.30 at 72.6 cM, marker D2S739). Suggestive linkage to FM was found on chromosomes 2 (LOD 2.56 at 80.4 cM) and 5 (LOD 2.25 at 98 cM, marker D5S1725). The highest LOD score for BMI was 1.68 (chromosome 4, 113.8 cM). The areas of linkage for the three phenotypes showed some clustering as all three phenotypes were linked to the same regions of 2p13 and 5q14, and our study replicated linkage evidence for several regions previously reported in other studies. CONCLUSION: We obtained evidence for several QTLs on chromosome 2, 4 and 5 to three obesity phenotypes. This study provides data on the genetics of obesity in populations that are currently under represented in the global effort directed at understanding the pathophysiology of excess adiposity in free living individuals.

Minimal model analyses of beta cell secretion, insulin sensitivity and glucose effectiveness in glucose tolerant, non-diabetic first-degree relatives of Ghanaian patients with type 2 diabetes and healthy control subjects.

OBJECTIVE: We have examined the importance of positive family history of type 2 diabetes on serum glucose, insulin sensitivity, and beta cell secretion in native West Africans (Ghanaians) who reside in their native country. RESEARCH AND METHODS: We evaluated the beta cell secretion, insulin secretion, insulin sensitivity (Si), and glucose effectiveness (Sg) in 42 healthy non-diabetic first-degree relatives of Ghanaian patients with type 2 diabetes (26 females and 16 males) and in 22 healthy control subjects without a family history of type 2 diabetes (12 females and 10 males) living in Accra, Ghana, West Africa. A standard oral glucose tolerance test (OGTT) and a frequently sampled intravenous glucose tolerance (FSIGT) test were performed in each subject. Si and Sg were measured using Bergman's minimal model method. RESULTS: During oral glucose challenge, fasting and postprandial serum glucose levels were not significantly different between the relatives and healthy controls. Mean serum insulin and c-peptide responses after oral glucose tolerance test at t = 60, 90 and 120 minutes (P<.05) were significantly greater in the relatives than in the healthy controls. During the FSIGT, the mean serum glucose responses did not differ. Mean total and acute first and second phases of serum insulin and c-peptide responses were greater in the relatives than in the healthy controls. We found that the Si tended to be lower in the relatives than in the controls, but the mean difference did not vary significantly between the two groups. In addition, the glucose effectiveness at basal insulin level (Sg) was not significantly different in the relatives and healthy controls. CONCLUSIONS: The present study demonstrates that hyperinsulinemia and a tendency to lower insulin sensitivity (insulin resistance), but not altered glucose effectiveness, are found in healthy non-diabetic, first-degree relatives of Ghanaian patients with type 2 diabetes as compared to healthy subjects living in their native country. We conclude that genetic factors could play a significant role in the development of type 2 diabetes in indigenous Ghanaians residing in their native country.

In search of susceptibility genes for type 2 diabetes in West Africa: the design and results of the first phase of the AADM study.

PURPOSE: The purpose of this study is to map type 2 diabetes susceptibility genes in West African ancestral populations of African-Americans, through an international collaboration between West African and US investigators. DESIGN AND METHODS: Affected sib-pairs (ASP) along with unaffected spouse controls are being enrolled and examined in West Africa, with two sites established in Ghana (Accra and Kumasi) and three in Nigeria (Enugu, Ibadan, and Lagos). Eligible participants are invited to study clinics to obtain detailed epidemiologic, family, and medical history information. Blood samples are drawn from each participant to measure glucose, insulin, C-peptide, total cholesterol, LDL, HDL, triglycerides, albumin, creatinine, urea, uric acid, total calcium and to detect autoantibodies to glutamic acid decarboxylase (GAD). DNA is isolated from frozen white blood cells obtained from 20 ml of EDTA whole blood samples. RESULTS: With full informed consent, 162 individuals from 78 families have been enrolled and examined since the Africa America Diabetes Mellitus (AADM) study began in June of 1997. Logistics of field examinations and specimen shipping have been successfully established. At the end of the third year of field activity (September 2000) the AADM study will have enrolled and performed comprehensive examination on 400 ASP with type 2 diabetes, for a minimum of 800 cases and 200 controls from Ghana and Nigeria. At the current participation rate, the goal of 400 sib-pairs and 200 controls will be met before the scheduled closing date. CONCLUSIONS: The AADM study will create a comprehensive epidemiologic and genetic resource that will facilitate a powerful genome-wide search for West African susceptibility genes to type 2 diabetes.

A national diabetes care and education programme: the Ghana model.

An account is given of how a national diabetes care and education programme was developed in Ghana, a developing country, through international collaboration of medical schools, industry and government health care institutions. The approach is by way of trained diabetes teams consisting of physicians, dietitians and nurse educators at two tertiary institutional levels (teaching hospitals) who in turn trained teams consisting of physicians, dietitians or diettherapy nurses, nurse educators and pharmacists at regional and district/sub-regional levels to offer care and education to patients and the community. In three years all regional and about 63% of sub-regional/district health facilities had trained diabetes health care teams, run diabetes services and had diabetes registers at these institutions. Additionally a set of guidelines for diabetes care and education was produced. All programme objectives with the exception of one (deployment of diabetes kits) were met. Distances to be travelled by persons with diabetes to receive diabetes care had been reduced considerably. The success of the project has given an impetus to the collaborators to extend the programme to the primary health care level. The continuing prohibitive prices of diabetes medications and supplies however, could be addressed by removing taxes on such supplies. The Ghana diabetes care model, a 'top-down' approach, initially involving two diabetes centres is recommended to other developing countries, which intend to incorporate diabetes care and education into their health care system.

Facilities and resources for diabetes care at regional health facilities in southern Ghana.

In the fall of 1995, each of the five provincial hospitals in southern Ghana was visited and facilities and resources for diabetes care assessed. In addition, health facilities and standards of care questionnaires were completed. Only Korle Bu Teaching Hospital run a diabetes clinic and had diabetologists. Only two facilities had an eye specialist or trained dietician. None of the five facilities had a trained diabetes educator or chiropodist. Except for sphygmomanometers, basic equipment for clinical care were lacking. Basic biochemistry tests were available at all facilities. Creatinine clearance and 24-h urine protein, glycated haemoglobin, fasting triglyceride, total cholesterol and HDL cholesterol were available at only one centre. None of the facilities measured C-peptide, islet cell antibody and urine microalbumin. None of the facilities had chronic haemodialysis service. Insulin supply was erratic at two institutions. Three regions had active diabetes associations. The facilities and system of diabetes care in southern Ghana revealed in this study are far from satisfactory. Training of health care personnel in diabetes management and education may enhance diabetes care despite the existing constraints. Furthermore, the development of international and regional guidelines for facilities and resources may facilitate implementation of international resolutions and clinical practice guidelines.

Serum lipid and lipoprotein levels in Ghanaians with diabetes mellitus and hypertension.

Both diabetes mellitus and hypertension alter lipid and lipoprotein metabolism and increase the risk of coronary artery disease. We have reported previously on lipid and lipoprotein levels in healthy Ghanaians, and this study deals with the levels of these biochemical parameters in Ghanaians with diabetes mellitus and hypertension. Fasting serum lipoproteins were determined on blood samples drawn from healthy male and female Ghanaians as well as age-matched individuals with either diabetes or hypertension. Cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, and fasting blood glucose were measured. Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were derived. Total serum cholesterol levels were 4.43 +/- 0.22 mmol/L and 4.67 +/- 0.26 mmol/L for diabetic males and females, respectively. High-density lipoprotein was 1.55 +/- 0.09 mmol/L and 1.50 +/- 0.09 mmol/L for male and female diabetics, respectively. Lipid and lipoprotein levels in the hypertensive patients did not differ from the above values. The levels of cholesterol and lipoprotein obtained in Ghanaians with hypertension and diabetes mellitus were similar to those of their age-matched healthy controls. These results suggest a reduced risk of coronary artery disease from the atherogenic effects of cholesterol in Ghanaians with diabetes mellitus and hypertension.

Race and ethnicity determine serum insulin and C-peptide concentrations and hepatic insulin extraction and insulin clearance: comparative studies of three populations of West African ancestry and white Americans.

We examined the importance of ethnicity in terms of beta-cell secretion and hepatic insulin extraction (HIE) and insulin clearance (IC) to peripheral insulin levels before and after stimulation in three populations of West African ancestry, namely African-Americans, Ghanaian immigrants, and native Ghanaians living in diverse environments, and white Americans. Following 10 to 12 hours of overnight fasting, each subject ingested a 75-g oral glucose load. Blood samples for determination of serum glucose, insulin, and C-peptide were obtained at baseline and after the oral glucose load at 30-minute intervals for 240 minutes. Basal HIE and IC were calculated as the molar ratios of C-peptide and insulin concentrations at basal steady state, and postprandial values as molar ratios of the incremental integrated C-peptide and insulin areas. Clinical characteristics of the patients were not significantly different among the four groups. During the fasting and postprandial state, serum glucose levels were not significantly different among the four groups. Surprisingly, the mean fasting insulin concentration was significantly greater in native Ghanaians (21.19 +/- 0.93 microU/mL, P < .05) than in African-Americans (11.90 +/- 1.02,microU/ML), Ghanaian immigrants (8.14 +/- 0.96 microU/mL), and white Americans (7.03 +/- 0.78 microU/mL). Following the oral glucose load, the mean serum peak and incremental integrated areas of insulin were significantly (P < .05) greater in native Ghanaians, African-Americans, and Ghanaian immigrants compared with white Americans. In contrast, there were no significant differences in postprandial serum insulin responses among the three groups of West African ancestry, irrespective of country of origin or residence. Despite the higher insulin concentrations in blacks of West African ancestry compared with whites, the corresponding basal and postprandial serum C-peptide levels were not significantly different among the four groups. Mean basal and postprandial HIE and IC were significantly (P < .05 to .01) reduced (25% to 52%) in the three populations of West African ancestry compared with the white Americans, but these values were not significantly different among the West African descendants. When comparing metabolic responses in obese (body mass index [BMI] > 27 kg/m2) and non-obese (BMI < 27 kg/m2) native Ghanaians, we found no significant differences in fasting insulin, C-peptide, and basal HIE or IC. Also, there were no significant relations between fasting and postprandial serum insulin, obesity indices, and HIE and IC in any of the groups. In summary, our study demonstrates that glucose-tolerant native Ghanaians, Ghanaian immigrants, and African-Americans of West African ancestry manifest hyperinsulinemia and a decreased HIE and IC compared with white Americans. We conclude that race and ethnicity may be the major determinants of the mechanism(s) of beta-cell secretion, insulin action, and peripheral insulin levels and HIE or IC in humans. We speculate that the lower HIE and IC in blacks of West African descent appears to be a highly conserved metabolic trait irrespective of the country of residence.

Serum lipids and lipoprotein in adult Ghanaians.

OBJECTIVES: To date, no measurement of serum lipid levels in healthy adult Ghanaians have been carried out. This study was undertaken with the objective of providing reference values for serum lipid levels in the Ghanaian population. DESIGN/SETTING: Fasting serum lipid levels were measured in 79 adult Ghanaians living in an urban setting. Volunteers were randomly selected from the work force of the University of Ghana in Accra. There were 54 males and 25 females in the study population. RESULTS: The mean serum cholesterol (SC) for Ghanaian males was 4.27 +/- 1.00 mmol L-1. A value of 4.34 +/- 1.12 mmol L-1 was obtained for the females in this study. High-density lipoprotein cholesterol (HDL-C) in Ghanaian males averaged 1.37 +/- 0.44 mmol L-1 and 1.47 +/- 0.50 mmol L-1 in females. There was no statistically significant difference in low-density-lipoprotein cholesterol (LDL-C) and very-low-density-lipoprotein cholesterol (VLDL-C) levels between the females and males in this study. CONCLUSIONS: Compared to other studies, our results show that populations in Europe and North America have higher levels of total cholesterol and LDL cholesterol than Ghanaians. The levels of HDL cholesterol as well as VLDL cholesterol are higher in Ghanaians than in Europeans and Americans. Further work needs to be done to compare lipid levels in urban and rural Ghanaians as well as in those with cardiovascular disorders.

Acute intermittent [corrected] porphyria. An often forgotten diagnosis in acute abdomen.

Three cases of Acute Intermittent Porphyria (AIP) are described. All presented with acute intermittent abdominal pains. One had grand-mal epilepsy as well. Two were diagnosed by chance. In the third case the diagnosis was thought of. It is suggested that AIP should always be considered as one of the differential diagnosis in Acute Abdomen in West Africa.

Impairment of albuterol-induced suppression of food intake in diabetes mellitus.

Albuterol (salbutamol), a beta 2 adrenoreceptor agonist, produced a dose-dependent decrease in food intake in Sprague-Dawley male control rats. This phenomenon appeared to be impaired in streptozotocin (STZ) diabetic rats. The density of beta 2 adrenoreceptors in the ventromedial hypothalamic nucleus was increased as a function of diabetes. In contrast, a decrease in the ventromedial hypothalamic 5-hydroxyindoleacetic acid (5-HIAA) concentration, an indicator of serotonin (5-hydroxytryptamine; 5-HT) release or turnover rate, was observed in this disease state. Neither the beta 2 adrenoreceptor level nor 5-HT turnover rate was altered in the periventricular hypothalamic nucleus of STZ diabetic rats. The concentrations of 5-HT in both hypothalamic nuclei were unchanged in these animals. Neurochemical and behavioral abnormalities featured in the diabetic state were reversed with institution of insulin therapy. These data conclude that diabetes-related impairment in the anorexic action of albuterol may be due to derangements in ventromedial hypothalamic beta 2 adrenoreceptor function.

Acute international [sic] prophyria : An often forgotten diagnosis in acute abdomen

Three cases of acute intermittent prophyria (AIP) are discribed. All presented with acute intermittent abdominal pains. One had grand-mal epilepsy as well. Two were diagnosed by chance. In the third case the diagnosis was thought of. It is suggested that AIP should always be considered as one of the differential diagnosis in acute abdomen in West Africa

Cockroaches (Periplaneta americana) as carriers of agents of bacterial diarrhoea in Accra, Ghana.

Bodies and intestinal contents of 208 cockroaches (Periplaneta americana), collected from kitchens in Accra and some surrounding villages were cultured for enteric bacterial pathogens. Six of them harboured three different serogroups of Salmonella, one had Shigella dysenteriae, 64 had Coliforms, 13 had Proteus species, two had Pseudomonas species and the rest (122) carried none of the bacterial species mentioned above. The presence of Salmonella species Shigella dysenteriae and Coliforms in these insects, which were collected from kitchens where foods are kept, points to the facts that these insects could play an important role in the transmission of these pathogenic organisms, especially in our environment. Permanent solution to these bacterial diarrhoea disease problems could only be solved when food, animals and the environments are free of these microbes.

Effect of hexadecane on piglet epidermal ornithine decarboxylase activity.

Topical application of hexadecane has been shown to induce hyperproliferation and hyperkeratosis in rodent skin. The application of hexadecane to epidermis from the backs of piglets less than 1 week old resulted in a rapid biphasic-rise in the level of ornithine decarboxylase (ODC) activity. The second phase of the elevation of activity was suppressed by cycloheximide indicating that it resulted from de novo protein synthesis. The first, cycloheximide-insensitive phase presumably represents activation of existing enzyme. The activation of this latent ODC by hexadecane was independent of extracellular calcium. A similar degree of activation was observed using the bivalent-cation ionophore A23187 which augmented the hexadecane effect implicating a rise in intracellular calcium concentration as a possible cause for the activation possibly via the receptor-mediated phospholipid hydrolysis. The time-course of the ODC activation also corresponded with a rapid fall in cAMP levels indicating a possible role for cAMP in ODC regulation.