Mercury contamination of soil and water media from different illegal artisanal small-scale gold mining operations (galamsey).

Environmental media contamination with mercury, because of illegal artisanal small-scale gold mining (popularly called galamsey), is a major concern in Ghana; yet specific details as to how such contaminations are influenced or distributed across different galamsey operations have been lacking. We monitored mercury levels across nine different galamsey operations (Washing Board, Washing Plant, Anwona, Dig and Wash, Dredging, Underground Abandoned Shaft, Underground Sample Pit, Chamfi and Mill House) in three hotspot assemblies (Tarkwa Nsuaem, Amenfi East and Prestea Huni Valley) of the Western Region of Ghana. Triplicate samples each of background soil, surface water/drainage, slurry/sludge and galamsey waste materials (totaling 160) were obtained and analyzed using Atomic Absorption Spectrophotometer (AAS) to determine total Hg concentrations. From the comparison of mean ranked concentration of mercury, using the Kruskal-Wallis Test, it was realized that the observed differences in ranking was significant for all four environmental media considered. Thus, the poor handling, usage and disposal of mercury from the different galamsey activities did result in elevation of harmful quantities of mercury into the environment. Overall, the highest median value obtained for mercury was recorded at the Mill House galamsey sites and within slurry/sludge medium. This was followed by Chamfi, Washing Board, Washing Plant, Anwona, Dig and Wash and Dredging in descending order, with the Underground Abandoned Shaft and Underground Sample Pit galamsey types recording values below detection limit. In terms of their contribution to mercury contamination to the environment, Mill House, Chamfi, Anwona, Washing Board and Washing Plant galamsey types recorded the highest mean rankings. Overall, key priority information required for influencing reclamation and cleanup policy decisions for mercury, for the many affected wastelands across the country, can be derived from this paper.

Influence of illegal artisanal small-scale gold mining operations (galamsey) on oil and grease (O/G) concentrations in three hotspot assemblies of Western Region, Ghana.

This study determined the contamination levels of oil and grease (O/G) across nine (9) galamsey operations under different environmental media (background soil, surface drainage, slurry/sludge and galamsey wastes) in three galamsey hotspot assemblies (Tarkwa Nsuaem, Amenfi East and Prestea Huni Valley) within the Western region of Ghana. Triplicate samples each of the four environmental media for the nine galamsey types (Washing Board, Washing Plant, Anwona, Dig and Wash, Dredging, Underground Abandoned Shaft, Underground Sample Pit, Chamfi and Mill House) were collected and analysed using n-hexane extractable materials in acidic medium by extraction and gravimetry to determine O/G concentrations. From the comparison of mean ranked concentration of O/G, using Kruskal-Wallis Test, the observed differences in the ranking was significant across all four media. The O/G concentrations for Anwona, Chamfi, Mill House, Washing Board and Washing Plant galamsey recorded exceedances when compared to the Ghana EPA Effluent Guideline Value of 100 mg/L for water and The New Dutch Lists' Target and Intervention Value of 50 mg/kg and 500 mg/kg for solid/semi-solid materials. Consistently and for all environmental media types, the levels of O/G across the galamsey types were in the descending order of: Washing Board, Chamfi, Anwona, Mill House, Washing Plant, Underground Sample Pit, River Dredging, Dig and Wash, Underground Abandoned Shaft and Control Sample (non-galamseyed areas). In general, the surface drainage medium was predominantly found to be the most impacted upon medium from hydrocarbons by seven of the nine galamsey operations (Washing Board, Anwona, Chamfi, Mill House, Dredging, Dig and Wash and Underground Sample Pit). This was followed by slurry/sludge, background soil and waste media in that order. Expectedly, there were no exceedances for the Reference or Control Samples (non-galamseyed areas).

Spatial distribution patterns of illegal artisanal small scale gold mining (Galamsey) operations in Ghana: A focus on the Western Region.

Recently, there have been efforts by stakeholders to monitor illegal mining (galamsey) activities, foster their formalization and reclaim the many abandoned wastelands in Ghana. However, limited information exists on the locations, abundance, scope and scale of galamsey types, which hinders the development of effective policy response. This study attempts to map and analyze the distribution patterns, abundance, activity statuses and the extents of nine (9) galamsey types within eleven (11) Municipal and District Assemblies (MDAs) of Ghana's Western Region. It explores the utility of field-based survey, using the Open Data Kit (ODK) system, ArcGIS and Google Earth Imagery to map and visualize different galamsey types under a hostile working environment. A total of 911 galamsey sightings, of which 547 were found in clusters (corresponding to approximately 7106 individual operational units) and 364 in stand-alone mode. Overall, a total of 7470 individual galamsey operations were encountered in 312 different communities (towns and villages). Operationally, the Alluvial Washing Board, Mill-House and Chamfi were found to be the three most popular and practiced galamsey types. The three main galamsey hotspot districts (out of the 11) are the Tarkwa Nsuaem (294 sightings and 3648 individual galamsey sites), Amenfi East (223 sightings and 1397 individual galamsey sites) and Prestea Huni-Valley Districts (156 sightings and 1130 individual galamsey sites). In terms of their activity statuses, 199 abandoned operations (entailing 1855 individual operations), 664 active (entailing 5055 individuals operations) and 48 semi-active (comprising 560 individuals within clusters) galamsey operations were sighted at the time of the study. While galamsey is generally acknowledged to be widespread in Ghana, the results suggest a scale that probably surpasses any previous estimate or expectation. The findings will adequately inform the prioritization of reclamation efforts.

Prevalence of Risk Factors for Non-Communicable Diseases for New Patients Reporting to Korle-Bu Teaching Hospital.

BACKGROUND: The risk factors of Noncommunicable diseases (NCDs) are not routinely monitored, especially among populace reporting to hospitals to detect and also advise on preventive measures, a key strategy to reducing the impact of NCDs on the Health Care System and population. METHODS: A cross-sectional survey was carried out between the months of May and June, 2010 among a sample representative of the medical and surgical out-patients population to determine the prevalence of certain risk factors of non-communicable diseases (NCDs). Participants (n = 230) were selected by systematic random sampling. Standardised international protocols were used to measure the prevalence of smoking, alcohol consumption, physical inactivity, obesity, raised blood pressure, raised blood glucose and total cholesterol. RESULTS: The obesity level of the study population was 40.4% with 54% being overweight. Tobacco use among the respondents was 4.8%. Alcohol consumption was 64.8%, with 54.3% of the study population being physically inactive. Almost 48%and 70.9% of the participants consumed fruits and vegetables respectively, at least three days in a week. The prevalence of hypertension was 33.6% for men and 35.2% for women. The prevalence of raised glucose and total blood cholesterol level among the study population was 6.5%. Almost 62% of the participants had a combination of three or more risk factors. CONCLUSION: The prevalence of the significant risk factors in this study were physical inactivity (54.3%), alcohol consumption (64.8%), overweight (54%), obesity (40.4%) and raised blood pressure (34.3%). Hospitals should therefore include NCD risk factor monitoring as part of routine services.

Foodborne Illness Among School Children in Ga East, Accra.

BACKGROUND: A food borne illness was reported in Ga-East district of Greater Accra Region among school children in May, 2007 after eating food provided at school. The objective of the investigation was to determine the source, mode of contamination and the causative agent. METHODS: A case-control study was conducted, cases were schoolchildren with abdominal symptoms and controls were children of the same sex and class without any symptom during the same period. The school children were selected by systematic sampling. Food handlers and the children were interviewed by a structured questionnaire. Food handlers were physically examined and their stools and blood examined. The kitchen for food preparation was inspected. Risks of food borne infection from the foods eaten were determined using attack rates. RESULTS: The minimum, peak and maximum incubation periods were 2, 11 and 61 hours respectively. The source was rice and groundnut soup (with the highest attack rate difference). Stool and blood samples of food handlers were not infective. Storage facility for food items was poor. No food samples were available for organism isolation. A protocol to prevent such outbreaks was nonexistent. CONCLUSION: The short incubation period and symptoms presented suggest an infective origin. The storage of the meat may potentially have been the point of contamination. The study showed that the schoolchildren ate contaminated food although the investigation could not determine the causative agent. Protocols to prevent such outbreaks need to be developed for the schools.

Prevalence of Risk Factors for Non-Communicable Diseases for New Patients Reporting to Korle-Bu Teaching Hospital

Background: The risk factors of Noncommunicable diseases (NCDs) are not routinely monitored; especially among populace reporting to hospitals to detect and also advise on preventive measures; a key strategy to reducing the impact of NCDs on the Health Care System and population. Methods: A cross-sectional survey was carried out between the months of May and June; 2010 among a sample representative of the medical and surgical out-patients population to determine the prevalence of certain risk factors of non-communicable diseases (NCDs). Participants (n = 230) were selected by systematic random sampling. Standardized international protocols were used to measure the prevalence of smoking; alcohol consumption; physical inactivity; obesity; raised blood pressure; raised blood glucose and total cholesterol. Results: The obesity level of the study population was 40.4 with 54 being overweight. Tobacco use among the respondents was 4.8. Alcohol consumption was 64.8; with 54.3 of the study population being physically inactive. Almost 48 and 70.9 of the participants consumed fruits and vegetables respectively; at least three days in a week. The prevalence of hypertension was 33.6 for men and 35.2 for women. The prevalence of raised glucose and total blood cholesterol level among the study population was 6.5. Almost 62 of the participants had a combination of three or more risk factors. Conclusion: The prevalence of the significant risk factors in this study were physical inactivity (54.3); alcohol consumption (64.8); overweight (54); obesity (40.4) and raised blood pressure (34.3). Hospitals should therefore include NCD risk factor monitoring as part of routine services

Hospital all-risk emergency preparedness in Ghana.

OBJECTIVE: This paper assessed the emergency preparedness programs of health facilities for all-risks but focused on Road Traffic Accidents, (RTA) resulting in surge demand. It adopted W. H. O checklist covering hospital preparedness, equipment, manpower and surge capacity planning as best practices for the mitigation of public health emergencies. METHOD: This is a cross-sectional study of purposively selected health facilities. The method used consisted of site visit, questionnaire survey, literature and internet review. The W. H. O. standard for emergency preparedness of health facilities was used to evaluate and assess the nation's hospitals surge capacity programs. The study was conducted between March-June, 2010. A total of 22 district and regional health facilities including teaching hospitals participated in the study. All 10 regions of the country were covered. RESULT: These were: (1) many of the nation's hospitals were not prepared for large RTA's resulting in surge demands, and did not possess general emergency preparedness programs. (2) The hospitals' respective abilities to handle large scale RTA's were compromised by the lack of competent medical and allied health personnel and adequate supplies. DISCUSSION: The inadequacies of the hospital system in responding to emergencies raise serious public health concerns. The biggest challenge facing the hospitals in their emergency intervention is the lack of pre-emergency and emergency preparedness plans as well as the coordination of the hospitals response mechanisms. CONCLUSION: The paper ended with recommendations on how the nation's hospitals and their supervisory agencies could improve emergency preparedness.

Cytokine mRNA expression in Mycobacterium ulcerans-infected human skin and correlation with local inflammatory response.

Cytokine mRNA expression in biopsies of Mycobacterium ulcerans-infected human tissue was investigated using real-time PCR, and the findings were correlated with the clinical stages of disease and histopathologies. A broad range of cytokine mRNAs were detected in 16 early nodules and 28 late-stage ulcers, including those for the Th1 cytokines tumor necrosis factor alpha (TNF-alpha) and gamma interferon (IFN-gamma) and the Th2 cytokine interleukin 10 (IL-10). IFN-gamma was strongly expressed in both nodules and ulcers, suggesting that a Th1 response begins early in the disease. There was a significantly higher expression of IL-8 and other proinflammatory cytokines in results from 32 biopsies with neutrophilia than in those from 12 biopsies without acute inflammation. Ten tissue samples containing granulomas showed high mRNA expression for IFN-gamma, IL-1beta, IL-12p35, IL-12p40, IL-15, and TNF-alpha relative to 34 tissue samples without granulomas. These results suggest that the human immune response to M. ulcerans is similar to that seen with some other mycobacteria despite the presence of the toxin mycolactone in the tissues.

Cytokine response to antigen stimulation of whole blood from patients with Mycobacterium ulcerans disease compared to that from patients with tuberculosis.

Mycobacterium ulcerans disease (Buruli ulcer) is a skin-ulcerating infection common in some parts of the tropics. We have investigated cytokine secretion after stimulation of whole blood from Buruli ulcer (BU) patients in a region of endemicity in Ghana with M. ulcerans sonicate or culture filtrate antigens to investigate the development of the response over time and its specificity by comparison with the response to Mycobacterium tuberculosis sonicate in human immunodeficiency virus-negative tuberculosis patients. Significant gamma interferon (IFN-gamma) production in response to whole-blood stimulation with M. ulcerans sonicate was detected in patients with ulcers, which was higher than that in patients with nodules but similar to subjects with healed BU. The mean IFN-gamma response in household contacts of BU patients was not significantly different from that in healthy control subjects from an area of nonendemicity. Results in patients with untreated, smear-positive pulmonary tuberculosis and tuberculosis patients on treatment for more than 2 weeks showed that BU patients responded better to M. ulcerans antigens than tuberculosis patients. In contrast, interleukin-10 results were higher in patients with active M. ulcerans disease than in those with healed lesions, but the pattern of response was similar to that seen in tuberculosis. A similar pattern of cytokine secretion was found using M. tuberculosis sonicate as an antigen. Neither of the two culture filtrate antigens of M. ulcerans appeared to be more specific than M. ulcerans sonicate. In the early stages of M. ulcerans disease there was a mixed Th1 and Th2 cytokine response, but the Th1 response emerged as the dominant type.

Sensitivity of PCR targeting the IS2404 insertion sequence of Mycobacterium ulcerans in an Assay using punch biopsy specimens for diagnosis of Buruli ulcer.

Punch biopsy specimens from Mycobacterium ulcerans disease lesions were used to compare the sensitivities and specificities of direct smear, culture, PCR, and histopathology in making a diagnosis of M. ulcerans disease in a field setting. PCR for the insertion element IS2404 was modified to include uracil-N-glycosylase and deoxyuridine triphosphate instead of deoxythymidine triphosphate to reduce the risk of cross contamination. The "gold standard" for confirmation of clinically diagnosed Buruli ulcer was a definite histological diagnosis, a positive culture for M. ulcerans, or a smear positive for acid-fast bacilli (AFB), together with a possible histological diagnosis. For 70 clinically diagnosed cases of M. ulcerans disease, the modified PCR was 98% sensitive and gave a rapid result. The sensitivities of microscopy, culture, and histology were 42%, 49%, and 82%, respectively. The use of a 4-mm punch biopsy specimen was preferred to a 6-mm punch biopsy specimen since the wound was less likely to bleed and to need stitching. Given adequate technical expertise and the use of controls, the PCR was viable in a teaching hospital setting in Ghana; and in routine practice, we would recommend the use of Ziehl-Neelsen staining of biopsy specimens to detect AFB, followed by PCR, in AFB-negative cases only, in order to minimize costs. Histology and culture remain important as quality control tests, particularly in studies of treatment efficacy.

Neutrophil-platelet interactions and their relevance to bovine respiratory disease.

Respiratory disease is a serious and significant health problem for the bovine industry. Classically, the clinical and research focus has been on the putative causative agents and conditions, and their interactions with host inflammatory cells, particularly alveolar macrophages and blood neutrophils. There is, currently, growing acceptance of the concept that blood platelets play a primary role in the inflammatory process. This review explores the implications of such pro-inflammatory activity, especially in the context of neutrophil-platelet interactions, and the species specificity of cellular responses. The relevance of these issues for the treatment and prevention of bovine respiratory disease is also discussed.

Human platelet thrombin receptors. Roles in platelet activation.

Platelets are essential participants in hemostasis and thrombosis. Platelets normally circulate in blood as discoid resting cells that become critical constituents of hemostatic plugs or arterial thrombi only after specific receptors on platelet membranes interact with their ligands (agonists) to initiate the reactions that lead to platelet activation. The well-characterized events associated with platelet activation include activation of membrane receptors, shape change, granular secretion, cytoskeletal reassembly, platelet cohesion, and aggregation. The plasma protease alpha-thrombin is the most potent physiologic platelet agonist; this enzyme has other key roles in hemostasis, in the genesis of arterial thrombi, and in embryonic development, inflammation, wound healing, and cell proliferation.

Bovine platelet adhesion is enhanced by leukotoxin and sialoglycoprotease isolated from Pasteurella haemolytica A1 cultures.

Platelet and fibrin deposits are among characteristic changes observed in lung alveoli of cattle with pasteurellosis induced by Pasteurella haemolytica (biotype A, serotype 1). To determine whether the platelet function could be directly affected by protein products produced by the bacterium, the effects of leukotoxin and O-sialoglycoprotease, culture supernatant antigen secreted by Pasteurella haemolytica A1, on bovine platelet activation were examined by evaluating the enhancement of platelet adhesion to a negatively charged surface relative to untreated control samples. The glycoprotease, or the leukotoxin, was added to plasma free suspensions of bovine platelets and platelet adhesion assessed by two parameters: (i) the number of 3H-adenine-labeled adherent platelets and (ii) the morphology of unlabeled platelets adhering to the charged surface under scanning electron microscopy (SEM). In the presence of calcium, the glycoprotease produced a dose-dependent increase in adhesion. At a concentration of 4.0 micrograms glycoprotease extract protein per 10(7) platelets, a 2-fold increase in adhesion was observed which was similar to the increase in adhesion induced by 0.10 units of thrombin, a known platelet agonist. Both increased platelet adhesion and platelet aggregation were observed with 0.8 microgram glycoprotease extract protein in the presence of calcium. The response of the bovine platelet suspensions to leukotoxin extract protein was dependent on the dosage of the leukotoxin. Adhesion was enhanced at dosages of 25 micrograms leukotoxin protein per 10(7) platelets and below, while at dosages of 50 micrograms and above adhesion was suppressed. Thus, the two proteins secreted by P. haemolytica may interact directly with bovine platelets to initiate platelet aggregation and fibrin formation in alveolar tissue in pneumonic pasteurellosis.