Prevalence of human papillomavirus genotypes among women with cervical cancer in Ghana.

BACKGROUND: Human Papillomavirus (HPV) infections have been shown to be a necessary risk factor for the development of cervical cancer. However, HPV genotype distribution varies geographically, both in type and relative prevalence. In order to ensure a successful introduction of available vaccines, there is the need to identify pre-vaccination HPV genotype prevalence in Ghana and the extent of single and multiple-infections. METHODS: Paraffin-embedded cervical tissues of 256 confirmed cervical cancer cases diagnosed at the Korle-Bu Teaching Hospital during the period January 2004 to December 2006 were selected after hematoxylin and eosin staining and confirmation. Following a heat-proteinase K-based tissue lysis, HPV was detected and typed by a nested-multiplex PCR assay using an E6/E7 consensus primer and type-specific primers. RESULTS: Of the 256 cases, 230 (89.8 %, 95 % CI 85.7-93.4 %) were positive for HPV DNA. HPV18 (47.4 %), HPV59 (42.2 %), HPV45 (37.4 %) and HPV16 (9.0 %) were the four common HPV genotypes detected. A total of 110 (47.8 %) of the 230 HPV DNA positive tissues, were infected by a single HPV genotype while the other 120 (52.2 %) were infected by multiple HPV genotypes. A significant association was determined between each of the following HPV genotypes and multiple-infection; HPV18 (OR = 6.97; 95 % CI, 3.89-12.50), HPV59 (OR = 9.56; 95 % CI, 5.57-20.02) and HPV45 (OR = 1.94; 95 % CI, 1.12-3.35). CONCLUSION: The prevalence of the following high risk HPV genotypes (HPV18, HPV59, HPV45) were relatively high among the cases of cervical cancers reported at this hospital in Ghana during the study period. Additionally, there was a high frequency of HPV multiple-infections among these cases.

Human papillomavirus genotypes in a subset of head and neck squamous cell carcinoma.

BACKGROUND: Squamous cell carcinoma originating from the oral cavity, lip, larynx and pharynx are grouped under head and neck squamous cell carcinomas (HNSCC). OBJECTIVE: To report on human papillomavirus (HPV) genotypes involved in HNSCC. STUDY DESIGN: A retrospective review of archival HNSCC specimens and patient demographic and clinical data accessioned between January, 2007 and December, 2009 in the Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana. RESULTS: Cases from 58 males and 20 females included 29 from the oral cavity, 33 from the larynx, 11 from the pharynx and 5 from the parotid gland. HPV DNA was found in 15 (19.23%) of the tumors with 12 being HPV-16, 2 HPV-18 and 1 dual infection with HPV-16 and HPV-18, giving HPV-16 prevalence of 86.7%. Higher prevalence of HPV DNA was found in males than females. There was a trend towards subjects younger than 58 years being more likely to have HPV-positive tumors.The 15 HPV-positive cases were distributed in location as 8 of 33 (24.2%) from the larynx, 4 of 29 (13.8%) from the oral cavity, and 2 of 11 (18.2%) from the pharynx and 1 of 5 (20%) from the parotid gland. CONCLUSION: Oncogenic HPV infection was found in 19.23% of HNSCCs, with genotype 16 predominating. HPV-related HNSCC tended to occur at younger age compared to non-HPV-related HNSCC. The commonest site for HPV-associated HNSSC in Ghana is the larynx, rather than the oropharynx as reported in other studies. Host factors may be responsible for the site difference and more work is required to further elucidate this.

Prevalence of hepatitis d infection in patients with hepatitis B virus-related liver diseases in Accra, Ghana.

BACKGROUND: Hepatitis D virus (HDV), a defective RNA virus which depends on hepatitis B virus (HBV) for its replication and expression, appears to be highly pathogenic and modifies the natural history of HBV infection. Two types of infection, co-infection and super-infection are recognised. During infection, anti-delta antibodies appear in serum and can be detected by Enzyme linked Immunosorbent Assay (ELISA). OBJECTIVE: We determined the prevalence of hepatitis D infection amongst HBsAg-positive patients with HBV-related liver diseases in Accra, Ghana using an Enzyme linked Immunosorbent assay (ELISA) method. METHODS: We collected blood samples from 53 patients with hepatitis B-related liver diseases. The sera were analysed using a commercially available kit, the EIA-ANTI-HDV, a third generation ELISA kit (Globe Diagnostics, Italy). RESULTS: There were 39 males (73.6%) and 14 females (26.4%) giving a male:female ratio of about 3:1.The mean age of patients was 38.6 years (range, 15-75). Six patients were reactive for anti-delta antibodies, yielding a HDV sero-prevalence of 11.3%. A higher proportion of males were anti-HDV positive (9.4%) compared to females (1.9%) but the difference was not statistically significant (p=0.350). Anti-HDV was detected in 4(22.2%) patients with chronic hepatitis B, 1(7.6%) with cirrhosis of the liver and 1(5.3%) with hepatocellular carcinoma. CONCLUSION: The prevalence of HDV infection amongst patients with liver disease in Accra with HBV-related liver diseases appears to be high compared to developed countries but similar to several developing countries. No significant difference exists in gender prevalences. A concerted public health effort is required to reduce this high prevalence rate.

Positive tumor margins in wide local excision of breast cancer: a 10-year retrospective study

Background. The safety of wide local excision as a standard surgical option for early stage breast cancer management in Ghana has not been evaluated. The aim of this study was to use retrospective histopathological descriptive study to evaluate the prevalence of positive tumor margins in wide local excision specimens and offer recommendations. Study design. We reviewed 147 breast lumps; following wide local excision; which were received in the Department of Pathology; for positive tumor margins. The data was analyzed using SPSS software (version 16). Results. A total of 2;751 female breast cancers were diagnosed during the study period; of which 147 (5.3%) were from wide local excisions (lumpectomies). Thirty-one (21.0%) had positive tumor margins. The mean age of women with positive margins was 53.4 (SD = 17.1) years. The mean size of primary tumor was 4.0 (SD = 2.1) cm; the majority (53.0%) of which were greater than 2.0?cm; but less than or equal to 5.0?cm (T2). A total of 26 (83.4%) of these tumors were invasive ductal carcinomas (NOS); 24 (92.3%) of the cases had combined Bloom-Richardson grading; and many; 10 (41.7%); were grade 1. Conclusion. Our study shows that 21.0% of all wide local excision biopsies had positive tumor margins; a figure that is comparable to those of other studies. Tumors with positive margins in this study were large; 4.0?cm (T2); and common in relatively young women. Treatment failure is therefore likely to occur in these patients

Perceived and experienced restrictions in participation and autonomy among adult survivors of stroke in Ghana.

BACKGROUND: Many stroke survivors do not participate in everyday life activities. OBJECTIVE: To assess the perceived and experienced restrictions in participation and autonomy among adult stroke survivors in Ghana. METHOD: The "Impact on Participation and Autonomy Questionnaire" (IPAQ) instrument was administered in a survey of 200 adult stroke survivors to assess perceived restrictions in participation and autonomy, followed by in-depth interviews with a sub-sample on the restrictions they experienced in participation. RESULTS: Perceived restrictions in participation were most prevalent in the domains of education and training (3.46±0.79), paid or voluntary work (2.68±0.89), helping and supporting other people (2.20±0.82), and mobility (2.12±0.79). There were significant differences in two domains between survivors who received physiotherapy and those who received traditional rehabilitation. Over half of the survivors also perceived they would encounter severe problems in participation in the domains of paid or voluntary work, mobility, and education and training. The sub-sample of stroke survivors (n=7) mostly experienced restrictions in participation and autonomy in going outside the house, working, and in fulfilling family roles. CONCLUSION: If these perceptions and experiences are not addressed during rehabilitation, they could further inhibit the full participation and social integration of stroke survivors.

Genotoxicity, cytotoxicity and toxicological evaluation of whole plant extracts of the medicinal plant Phyllanthus niruri (Phyllanthaceae).

Phyllanthus niruri is a medicinal plant (commonly known as stone breaker) found in the tropics and other parts of the world. It is known for its capacity to block the formation of calcium oxalate crystals and kidney stone formation in urolithiasis. This plant has been used to treat hyperglycemia, hypertension, pain, and mild cases of malaria. We examined the geno-, cyto- and overall toxicity of P. niruri whole plant ethanolic extract. The extract was administered as a single dose of 30 or 300 mg/kg to laboratory rats by gavage, accompanied by negative (0.9% saline) and positive (10 mg/mL N-ethyl-N-nitrosourea) controls that were injected intramuscularly 48 h after extract administration. The ratio of polychromatic (PCE)/normochromatic erythrocytes (NCE) from femur bone marrow was scored for genotoxicity. Cytotoxicity was determined using descending concentrations (0.2-0.0125 g/mL) of the extract incubated with peripheral blood mononuclear cells. Lactate dehydrogenase release from damaged cells was determined and the CC(50) calculated. Subchronic administration of the extract at 30 or 300 mg/kg was done for 90 days to determine general toxicity. PCE:NCE (%) for the extract and negative control was 63, compared to 168 (positive control). The CC(50) was 26.3 mg/mL and hepato-renal toxicity after subchronic extract administration was nil. We conclude that ethanol extract of P. niruri is not cytotoxic or genotoxic, and is generally non-toxic on subchronic administration.

Survival after short- or long-term ventilation after acute spinal cord injury: a single-centre 25-year retrospective study.

STUDY DESIGN: A retrospective review of acute spinal cord injury patients having assisted ventilation on or after admission between 1981 and 2005. OBJECTIVE: To assess survival after acute ventilatory support. SETTING: Northwest Regional Spinal Injuries Centre, Southport, England. METHODS: Causes of death were ascertained from the Office of National Statistics. Kaplan-Meier analysis of survival was calculated according to ventilator-wean status at discharge. Risk factors were obtained by Cox regression analysis. RESULTS: Over 50% of deaths in weaned and ventilated patients were respiratory in origin. The mean survival of weaned patients in the age group 31-45 was 19.3 compared with 10.5 years for ventilated patients (P=0.047). Those under 30 survived a further 22.1 and 18.4 years (P=0.31), while those over 45 lived for 11.0 and 8.3 years (P=0.50), values for weaned and ventilated patients, respectively. The survival advantage for weaned patients in the middle age group was less evident when the 1-year survivors were compared. The mean survival time of younger patients with diaphragm pacing was 1.8 years longer than those on mechanical ventilation (P=0.142). The variables with significant hazard ratios were any comorbidity (3.07); mechanical ventilation on discharge (2.26); and older age at injury, (3.1). CONCLUSIONS: The survival time for patients with high tetraplegia on long-term ventilation compares with other datasets and older patients have a proportionately greater loss in life expectancy. Self-ventilating patients with tetraplegia remain at considerable risk from respiratory death and consideration needs to be given to more effective preventative measures.

Human papilloma virus genotypes in Ghanaian women with cervical carcinoma.

BACKGROUND: Humanpapilloma viruses (HPVs) have been considered to be the necessary and central agents of cervical cancer among women with nearly 80% of cases found in developing countries. OBJECTIVE: To determine HPV genotypes prevalent in Ghanaian women with cervical cancer. DESIGN: Retrospective study. SETTING: Pathology Department, University of Ghana Medical School, College of Health Sciences, University of Ghana. SUBJECTS: Ghanaian women 23 to 80 years diagnosed with cervical cancer. RESULTS: Of the 50 samples genotyped, 49 (98%) were determined as positive for HPV DNA. Eight out of 18 different HPV genotypes were detected and all were high-risk types. In decreasing order of prevalence, were HPV 18 in 42 (84%) samples, HPV 16 in 12 (24%) samples, HPV 45 in three (6%) samples, HPV 39 in two (4%) samples and HPV 35, 52,56 and 66 in one (2%) sample each. Multiple infections were detected in 13 (26%) of the 50 samples, the most common co-infections being HPV types 16/18 (18%). Triple infections were found in two (4%) samples with HPV types 16,18 and 39. HPV type 18 was more relatively frequent in adenocarcinomas and adenosquamous carcinomas than in squamous cell carcinomas. CONCLUSION: Eight high-risk HPV genotypes: 16,18, 35, 39, 45, 52, 56 and 66 were typed, with HPV type 18 being the most prevalent in Ghanaian women with cervical cancer. This is contrary to the worldwide prevalence where HPV 16 is the most common type associated with invasive cervical carcinoma.

Medical rehabilitation in Ghana.

PURPOSE: To explore the current system of medical rehabilitation services for persons with disabilities in a developing country (Ghana) and to identify future needs, opportunities, and barriers. METHODS: Information was obtained through a literature review and through interviews with healthcare providers, disabled people's organizations, educators, government officials, and consumers. Direct observations were made of Ghana's capital city, Accra, and of a major tertiary medical center there, Korle Bu Teaching Hospital. RESULTS: Ghana has virtually no medical rehabilitation and few laws to protect the disabled. There are no occupational therapists or physiatrists in the entire country, and only a handful of physical therapists, prosthetists, orthotists, and speech therapists. There are many barriers to the establishment of such services, including lack of funding, limited government support, cultural stigma of the disabled and poor utilization of existing resources. CONCLUSIONS: A national model for sustainable medical rehabilitation is needed in Ghana and likely in other similar countries.

Bedside assessment of sympathetic skin response after spinal cord injury: a brief report comparing inspiratory gasp and visual stimulus.

STUDY DESIGN: A case control study in five controls, and 20 tetraplegic and paraplegic patients, complete and incomplete. OBJECTIVE: The aim was to assess the feasibility of a simple test for sympathetic system preservation after spinal cord damage in a pain-free manner and which could be undertaken worldwide without specialist equipment or manpower. SETTINGS: Patients were attending the Southport Regional Spinal Injuries Centre, England, either as outpatients or as in-patients during rehabilitation. METHODS: The sympathetic skin response (SSR) was recorded on a single-channel ECG recorder from the right hand and right foot in turn after inspiratory gasp (IG) or visual stimulation. RESULTS: Unlike the visually evoked SSR, the gasp-evoked SSR was reliable, albeit of variable amplitude, and there was little difference between the hand and foot. Paraplegics had similar SSRs in the hands as the controls. There was minor insignificant habituation of response for the gasp reflex. There was occasional unexpected SSR distally in patients with complete lesions, and in patients with incomplete lesions the responses could not have been predicted from the sensory motor pattern. CONCLUSIONS: Trained IG induces an SSR which is sufficient to elucidate sympathetic loss following spinal cord injury. It is superior to visual stimulation in this respect. Habituation is not a problem with at least 1 min between tests, and high doses of anticholinergics agents may impair the response.

High-level cerebellar expression of cytokines and adhesion molecules in fatal, paediatric, cerebral malaria.

Although the roles played by systemic tumour necrosis factor (TNF) and interleukin 1beta (IL-1beta), and their upregulation of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and E-selectin, in the pathogenesis of human cerebral malaria (CM) are well established, the role of local cytokine release, in the brain, remains unclear. Immunohistochemistry was therefore used to compare the expression of ICAM-1, VCAM-1, E-selectin, IL-1beta, TNF and transforming growth factor beta (TGF-beta) at light-microscope level, in cryostat sections of cerebral, cerebellar and brainstem tissues collected, post-mortem, from Ghanaian children. Among the 21 children investigated were 10 cases of CM, five of severe malarial anemia (SMA), one of purulent bacterial meningitis (PBM), two of non-central-nervous-system infection (NCNSI) and three children who had no infection (NI) when they died. Parasitised erythrocytes were detected in all of the sections from the cases of fatal malaria (CM and SMA), and sequestered leucocytes were present in most of the sections from the CM cases (but none of the sections from the SMA cases). Significantly elevated vascular expression of all three adhesion molecules investigated was detected in the brains of the 15 cases of fatal malaria and one of the cases of NCNSI (a child with Salmonella septicaemia), and in the malaria cases this showed highly significant co-localization with the areas of erythrocyte sequestration. In terms of the levels of expression of ICAM-1, VCAM-1 and E-selectin, there were, however, negligible differences between the CM and SMA cases. Although TGF-beta showed intravascular and perivascular distribution in all the subjects, its expression was most intense in the PBM case and the CM group. Only in the sections from the PBM and CM cases did TNF and IL-1beta show prominent brain parenchymal staining, in addition to the intravascular and perivascular staining seen in all subjects. The highest observed expression of each of the six antigens studied was in the cerebellar sections of the malaria cases. Endothelial activation in the brain therefore appears to be a feature of fatal malaria and Salmonella sepsis, and in cases of fatal malaria is closely associated with leucocyte sequestration. In the present study, IL-1beta and TNF were only up-regulated in the brains of children with neurodegenerative lesions, whereas TGF-beta was present in all cases.

Computed tomographic patterns of intracranial infarcts in Ghanaians.

Computed tomography has given a boost to intracranial imaging in general, and the diagnosis of the subtypes of Cerebrovascular Accident (CVA) in particular. In this study of 1,172 cases of CVA examined by Computed Tomography (CT), 552 (47.10%) showed features of cerebral infarction. There was a male prevalence in the study and the mean age was 59.8 years. As in all infarcts the diagnostic appearance was a wedge shaped hypodensity within the brain parenchyma. This was most often found in the parietal lobe (73.6%) and was always without a mass effect. Even though solitary infarcts were frequent, multiple lesions were reported in 9.3% of cases and these group of respondents presented mostly with seizures. Diabetes mellitus was an important predisposing factor and was found in 163% of cases, while hypertension was found in only 9.1% of cases studied. Other CT findings were cerebral and cerebrellar atrophy. Calcification of the falx and the basal ganglia were also noted.

Spontaneous intracranial haemorrhage: computed tomographic patterns in Accra.

The diagnosis of stroke and the ability to distinguish the subtypes is central in the management of patients. This CT study has confirmed an increased prevalence of stroke (CVA) among Ghanaians. It has also reaffirmed a relatively higher incidence (52.9%) of spontaneous intracranial haemorrhage over cerebral infarcts among the 1,172 stroke patients studied. The study points to a male preponderance and a mean age of 55.7 years. Parenchymal haemorrhage was found to be the commonest variety of these haemorrhages. It occurred in 83.6% of cases while primary subarachnoid haemorrhage was reported in only 8.1% of cases. Ventricular extension of the parenchymal haemorrhage was reported in 22.7% of cases. The latter were mostly unilateral and on the left side especially in the parietal lobe (70.9%), subdural haemorrhage like the parenchymal variety was also reported to be more on the left, mainly unilateral and acute. Haemorrhages in the cerebellum and pons which are normally difficult to diagnose were also outlined with ease in the CT images. Other CT findings in these patients include parilesional oedema and mass effect found in 87.10% and 77.4% respectively.

Eosinophilic enteritis--a diagnostic dilemma.

Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. The diagnosis is often difficult to make and most cases are only diagnosed after laparotomy/ laparoscopy and biopsy. It can be successfully treated with corticosteroids. We report a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone.

Stroke-related mortality at Korle Bu Teaching Hospital, Accra, Ghana.

OBJECTIVES: To determine whether mortality from and the pattern of stroke have changed since the last study in Accra in 1981, the sites of the different types of stroke and the role of hypertension and cerebrovascular disease and to describe the age and sex distribution. DESIGN: Cross-sectional study of fatal stroke cases over a five-year period. SETTING: Korle Bu Teaching Hospital, Accra, Ghana. SUBJECTS: All fatal strokes in persons aged 20 years and above, confirmed at autopsy. RESULTS: Mortality from stroke constituted eleven per cent of autopsies carried out at the Korle Bu Teaching Hospital, Accra, in the five-year period 1994 to 1998. A similar study in 1981 showed the same proportion indicating that the proportion of deaths due to stroke has not changed. The overall male to female ratio was 1.2:1 but the relative risk (RR) of death from stroke was higher for females at 1.23 (95% CI=1.10-1.38). Although haemorrhagic stroke was still more common than cerebral infarction the proportion (61 %) was much less than that of the previous study (89%). Males were more likely (RR 2.07 95% CI=1.75-2.45) to die from haemorrhagic stroke than females (RR 1.32, 95% CI=1.10-1.57). Sixty nine per cent of stroke patients died in less than 24 hours after onset of stroke. The peak age of fatal haemorrhagic stroke was 50-59 years and that of infarction was 60-69 years. Male mortality exceeded female mortality in all age groups up to 60-69 years after which female mortality became preponderant (chi2 with Yates correction = 4.28,0.05>p<0.02). Hypertension was the dominant factor in haemorrhage and an important factor in infarction while cerebral atherosclerosis was the major factor in infarction. Haemorrhage into intraparenchymal sites, mainly the cerebral hemispheres, was more common than into the subarachnoid space. CONCLUSION: The proportion of deaths from stroke in autopsy cases has not changed since the last study in 1981 and stroke still remains an important cause of death in Accra. Cerebral haemorrhage is still a more common cause of fatal stroke than infarction, although the pattern appears to be changing gradually. Females have a slightly greater risk of dying from stroke than males. A community-based study is needed to provide more insight into some aspects of the problem and to provide the basis for appropriate interventions and policy, especially with regard to a control of risk factors.

Osteometric analysis of sexual dimorphism in the sternal end of the rib in a west African population.

This study, and others, are being carried out in order to establish a Forensic Anthropology databank on age estimation and sex determination of skeletonized remains in Ghana. An osteometric study of sexual dimorphism in the sternal end of the right fourth rib on 346 consecutive coroner's autopsy cases (221 males, 125 females) of known age, sex, and race was conducted. The height and width of the sternal end of the rib were measured in each case. The sample was analyzed in three groups: young (< 30 years), old (> or = 30 years), and total sample (total group). Stepwise discriminant function analysis showed that the accuracy of sex determination varied from 80% in the young and 74% in the old groups to 78% for the total group. Statistical analysis of the results obtained when the functions derived from the study were tested using another batch of ribs showed the functions to be effective and reliable in determining sex. When functions derived from a previous study of American Whites were used to determine sex in our study sample, the vast majority of males were misclassified as females. This is the first time, to our knowledge, that a Black African population has been studied osteometrically to evaluate sexual dimorphism in the sternal end of the fourth rib.

Autopsy studies on still births in Korle Bu Teaching Hospital. II: Causes of death in 93 still births.

In this second of three reports dealing with autopsy studies in 93 still births at the Korle Bu Teaching Hospital, Accra, the causes of death are described. Causes of death were grouped using a combination of the modified Aberdeen and Naeye's classification. Asphyxia was the commonest cause of death accounting for 56% of deaths. The single largest contributing factor to fetal hypoxia was antepartum haemorrhage. Foetal infections were responsible for 13% of deaths and maternal pathologic conditions for 10.8%. The commonest maternal condition causing stillbirth was severe pre-eclampsia. Death was due to fatal birth trauma in 5.4% of cases with lethal congenital malformations and placental growth retardation causing 3.2% of deaths each. It is concluded that the vast majority of factors causing or contributing to late foetal deaths are largely preventable and or controllable. It is recommended that antenatal attendance should commence early and be regular and maternal and foetal monitoring be improved so that potential life threatening conditions can be diagnosed early, appropriate management and counselling instituted and therapeutic abortion or delivery planned. Routine examination of placentae at birth and genetic studies in suspicious cases will enable obstetricians counsel parents about the possibility of occurrence of stillbirth or congenital abnormality in future pregnancies. Autopsy examination of stillbirths is encouraged as this may help elucidate deaths in the cases now classified as due to unknown or unexplained causes.

Autopsy studies on still births in Korle Bu Teaching Hospital: pathological findings in still births and their placentae.

Autopsy and histological examinations were carried out on 93 still born fetuses, whose parents gave consent, and their placentae. The commonest pathological finding was asphyxia induced changes which manifested predominantly as haemorrhages in various organs. The associated placental pathological changes were villous oedema, large placental infarcts (more than 20% of placental volume), increased intervillous fibrin deposition and subchorionic haemorrhage in various combinations. Evidence of fetal infection was present in 9 cases (9.7%) but placental inflammation was present in 24.8% of cases. None of the placentae showed the presence of malarial parasites. Lethal congenital malformations were present in 6.2% and maternal floor infarction in 14% of cases. Autopsy and histological examinations of still-born fetuses and their placentae are useful in providing information that may be relevant in the counselling of parents and the extended family (where appropriate) and in auditing antenatal and intrapartum care.

T-lymphocytopaenia, opportunistic infections and pathological findings in Ghanaian AIDS patients and their sexual partners.

Ninety-nine patients at Center for Disease Control (CDC) clinical stage IV were studied. Twelve (12.12%) of these patients turned out to be HIV seronegative. Ten out of the 12 HIV negative patients were immunocompetent whereas the other two had proportional decreases in both CD4+ and CD8+ T-lymphocytes. HIV-1, HIV-2, and dual infection, were detected in 51.5%, 2%, and 22.2% respectively of clinical AIDS patients. The other 12.12% of clinical AIDS patients were indeterminate for HIV antibodies. All HIV positive patients with the exception of two, were immunocompromised with respect to CD4+ and CD8+ T-lymphocyte counts. Two healthy spouses and three children of patients who died from the disease were seronegative for HIV antibodies. Herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV) antibody titres were higher in HIV infected than uninfected blood. Patients with chronic diarrhoea, lymphadenopathy, pneumonia, and tuberculosis, either alone or in combination of two or more of such symptoms, were found to be more likely to be confirmed by serology and immunology as definitive AIDS patients in Ghana. In postmortem studies on 20 patients, pneumonia due to tuberculosis constituted the major cause of death. Toxoplasmosis, cytomegaloviral eosophagitis and enteritis, and cryptococcosis were the major opportunistic infections detected. Programmed cell death (apoptosis) was found by the DNA gel electrophoresis method to be an unlikely major mechanism of accelerated culture induced death of PBMCs from CDC stage IV AIDS patients.

PIP: Since HIV infection was first diagnosed in Ghana in 1986, the incidence of HIV infection has increased steadily in the country over the years. Until 1990, most people infected with HIV in Ghana were infected with HIV-2. However, in 1990, most people tested were found to be dually infected with HIV-1 and HIV-2, and recently, most HIV-infected people in Ghana are only HIV-1 positive. Findings are presented from the study of 99 US Centers for Disease Control and Prevention (CDC) clinical stage IV AIDS patients. Polymerase chain reaction assay identified 12 of these patients as HIV-seronegative. HIV-1, HIV-2, and dual infection were identified in 51.5%, 2%, and 22.2% of clinical AIDS patients, respectively, with the remaining patients being indeterminate for HIV antibodies. All but 2 HIV-positive patients were immunocompromised with regard to CD4+ and CD8+ T-lymphocyte counts. 2 healthy spouses and 3 children of patients who died from AIDS were seronegative for HIV antibodies. Herpes simplex virus type 2 and cytomegalovirus antibody titers were higher in HIV-infected than in uninfected blood. Patients with chronic diarrhea, lymphadenopathy, pneumonia, and tuberculosis (TB), either alone or in combination of 2 or more such symptoms, were more likely to be confirmed by serology and immunology as definitive AIDS patients in this study. Pneumonia due to TB was the major cause of death identified through postmortem studies conducted upon 20 patients. Toxoplasmosis, cytomegaloviral esophagitis and enteritis, and cryptococcosis were the major opportunistic infections detected. Programmed cell death was probably not a major mechanism of accelerated culture-induced death of peripheral blood mononuclear cells.