Smoke exposure, hemoglobin levels and the prevalence of anemia: a cross-sectional study in urban informal settlement in Southern Ghana.

BACKGROUND: In sub-Saharan African cities, more than half of the population lives in informal settlements. These settlements are close to smoky dumpsites, industrial plants, and polluted roads. Furthermore, polluting fuels remain their primary sources of energy for cooking and heating. Despite evidence linking smoke and its components to anaemia, none of these studies were conducted on populations living in urban informal settlements. This study investigated the risks of anemia/mean Haemoglobin (HB) levels in an informal settlement in Accra, Ghana. Exposure to smoke was examined across various sources, encompassing residences, neighborhoods, and workplaces. METHODS: The study was a facility-based cross-sectional design among residents at Chorkor, an informal settlement in the Greater Accra region of Ghana. A questionnaire was administered at a community hospital during an interview to gather data on sources of smoke exposure in the household, in the neighbourhood, and in the workplace. A phlebotomist collected blood samples from the participants after the interview to assess their anaemia status. RESULTS: The population (n = 320) had a high prevalence of anemia, with 49.1% of people fitting the WHO's definition of anemia, while the average HB level was 12.6 ± 2.1 g/dL. Anemia was associated with the number of different types of waste burnt simultaneously [(1 or 2: prevalence ratio (PR): 95% confidence interval (CI), 1.14, 0.99-1.28: 3+: 1.16, 1.01-1.63, p-for-trend = 0.0082)], fuel stacking [(mixed stacking: 1.27, 1.07-1.20: dirty stacking:1.65, 1.19-2.25, p-for-trend = 0.0062)], and involvement in fish smoking (1.22, 0.99-1.06). However, the lower limit of the CIs for number of different forms of garbage burned simultaneously and engagement in fish smoking included unity. Reduced mean HB levels were associated with the number of different types of waste burnt simultaneously [(1 or 2: regression coefficient (ß): 95% confidence interval (CI), -0.01, -0.97- -0.99: 3+: -0.14, -0.77- -0.05)], current smoker [(yes, almost daily: -1.40, -2.01- -0.79: yes, at least once a month: -1.14, -1.79- -0.48)], Second-Hand-Smoking (SHS) (yes, almost daily: -0.77, -1.30- -0.21), fuel stacking [(mixed stacking-0.93, -1.33-0.21: dirty stacking-1.04, -1.60- -0.48)], any smoke exposure indicator in the neighbourhood (-0.84, -1.43- -0.25), living close to a major road (-0.62, -1.09- -0.49), and fish smoking (-0.41,-0.93- -0.12). CONCLUSION: Although the cross-sectional design precludes causality, smoke exposure was associated with mean HB levels and anaemia among populations living in informal settlements.

A PRELIMINARY ASSESSMENT OF PHYSICAL WORK EXPOSURES AMONG ELECTRONIC WASTE WORKERS AT AGBOGBLOSHIE, ACCRA GHANA.

Occupational exposure associated with unstructured, informal e-waste recycling has received very limited attention. This study aimed to quantify the occupational physical exposures among informal e-waste workers at the largest e-waste site in Africa. A cross-sectional field survey of 163 male e-waste workers was conducted using a self-report occupational physical activity questionnaire, along with direct work observations, and pedometer estimates of walking activity for a subset of workers (n = 42). Results indicated significant differences in self-reported 7-day work exposures among the three main e-waste job categories, namely, collectors (n = 70), dismantlers (n = 73) and burners (n = 20). Prolonged walking, sitting and standing on five or more days in the workweek was frequently reported by collectors (87%), dismantlers (82%) and burners (60%), respectively. Nearly 90% of collectors and burners and 60% of dismantlers reported lifting and carrying on five or more days in the workweek. The exposure combinations identified suggest a risk for musculoskeletal disorders (MSDs). Findings call attention to the need for research examining potential associations between physical exposures and MSDs affecting e-waste workers in Agbogbloshie. The high exposure variability both between and within workers has implications for future exposure assessments conducted in unregulated, informal work settings.

Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana.

BACKGROUND: Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP). METHODS: This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes. RESULTS: Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 µg/m3). Exposure to 1 µg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure. CONCLUSIONS: Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.

Lipid-related genetic polymorphisms significantly modulate the association between lipids and disability progression in multiple sclerosis.

OBJECTIVE: To investigate whether lipid-related or body mass index (BMI)-related common genetic polymorphisms modulate the associations between serum lipid levels, BMI and disability progression in multiple sclerosis (MS). METHODS: The association between disability progression (annualised Expanded Disability Status Scale (EDSS) change over 5 years, ΔEDSS) and lipid-related or BMI-related genetic polymorphisms was evaluated in a longitudinal cohort (n=184), diagnosed with MS. We constructed a cumulative genetic risk score (CGRS) of associated polymorphisms (p<0.05) and examined the interactions between the CGRS and lipid levels (measured at baseline) in predicting ΔEDSS. All analyses were conducted using linear regression. RESULTS: Five lipid polymorphisms (rs2013208, rs9488822, rs17173637, rs10401969 and rs2277862) and one BMI polymorphism (rs2033529) were nominally associated with ΔEDSS. The constructed lipid CGRS showed a significant, dose-dependent association with ΔEDSS (ptrend=1.4×10-6), such that participants having ≥6 risk alleles progressed 0.38 EDSS points per year faster compared with those having ≤3. This CGRS model explained 16% of the variance in ΔEDSS. We also found significant interactions between the CGRS and lipid levels in modulating ΔEDSS, including high-density lipoprotein (HDL; pinteraction=0.005) and total cholesterol:high-density lipoprotein ratio (TC:HDL; pinteraction=0.030). The combined model (combination of CGRS and the lipid parameter) explained 26% of the disability variance for HDL and 27% for TC:HDL. INTERPRETATION: In this prospective cohort study, both lipid levels and lipid-related polymorphisms individually and jointly were associated with significantly increased disability progression in MS. These results indicate that these polymorphisms and tagged genes might be potential points of intervention to moderate disability progression.

An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event.

OBJECTIVE: To investigate the prospective associations between adiposity and lipid-related variables and conversion to multiple sclerosis (MS), time to subsequent relapse and progression in disability. METHODS: A cohort of 279 participants with a first clinical diagnosis of central nervous system demyelination was prospectively followed to 5-year review. Height, weight, waist and hip circumference were measured, and serum samples taken for measurement of lipids and apolipoproteins. Survival analysis was used for conversion to MS and time to relapse, and linear regression for annualised change in disability (Expanded Disability Status Scale). RESULTS: Higher body mass index (BMI; adjusted HR (aHR): 1.22 (1.04 to 1.44) per 5 kg/m2 increase), hip circumference (aHR: 1.32 (1.12 to 1.56) per 10 cm increase) and triglyceride levels (aHR: 1.20 (1.03 to 1.40) per unit increase) were associated with increased risk of subsequent relapse, while adiposity and lipid-related measures were not associated with conversion to MS. In addition, higher BMI (ß: 0.04 (0.01 to 0.07) per 5 kg/m2 increase), hip circumference (ß: 0.04 (0.02 to 0.08) per 10 cm increase), waist circumference (ß: 0.04 (0.02 to 0.07) per 10 cm increase), total cholesterol to high-density lipoprotein ratio (TC/HDL ratio; ß: 0.05 (0.001 to 0.10) and non-HDL; ß: 0.04 (0.001 to 0.08) at study entry) were associated with a higher subsequent annual change in disability. CONCLUSIONS: Higher levels of adiposity, non-HDL and TC/HDL ratio were prospectively associated with a higher rate of disability progression, and higher adiposity and triglycerides were associated with relapse but not with conversion to MS. Improving the lipid profile and losing weight into the healthy range could reduce the accumulation of disability.

Frequency of Comorbidities and Their Association with Clinical Disability and Relapse in Multiple Sclerosis.

BACKGROUND: Multiple sclerosis (MS) patients may be at an increased risk of comorbidities due to the debilitating and chronic nature of the disease. An increased understanding of comorbidities and disease course in MS may provide new insights and enhance MS management. We aimed at investigating the frequency of comorbidities and their associations with clinical disability and relapse in MS. METHODS: A prospective cohort of 198 MS patients was followed during 2002-2005 and queried about specific doctor-diagnosed comorbidities. In Australia, the MS cohort was compared to the 2007 general population with regard to the prevalence of comorbidities. Multilevel mixed-effects linear regression was used to assess the difference in subsequent disability between those who reported comorbidities and those who did not. The association of comorbidities with the hazard of relapse was assessed using survival analysis. RESULTS: The age-standardised prevalence of hypertension, dyslipidaemia, asthma, psoriasis, eczema and anaemia was significantly higher in the MS cohort compared to that in the general Australian population. The level of disability (Multiple Sclerosis Severity Score) in those who reported overweight/obesity (ß: 0.76 (95% CI 0.04-1.48), p = 0.037), or dyslipidaemia (ß: 1.05 (95% CI 0.07-2.02), p = 0.036) was significantly higher compared to those who did not report these comorbidities, even after adjustment for potential confounders. There were no significant associations between comorbidities and change in disability. For relapse analyses, rheumatoid arthritis and anaemia were associated with more than threefold (hazard ratio, HR 3.70 (95% CI 1.80-7.58), p < 0.001) and twofold (HR 2.04 (95% CI 1.11-3.74), p = 0.022) increased risk of subsequent relapse respectively. CONCLUSIONS: The prevalence of some comorbidities was higher in MS patients and associated with greater disability and relapse risk. Treatment of these comorbidities in patients with MS has the potential to improve disease course and help in the understanding of the prognosis and outcomes of MS.

An adverse lipid profile is associated with disability and progression in disability, in people with MS.

BACKGROUND: There is accumulating data suggesting an association between serum lipids, apolipoproteins and disability in multiple sclerosis (MS). OBJECTIVES: To investigate the associations between serum lipids, apolipoproteins and disability in MS. METHODS: A cohort of 178 participants with clinically-definite MS in southern Tasmania, Australia were prospectively followed from 2002 - 2005, and serum samples were obtained at study entry and at each biannual review, to measure lipid profile and apolipoprotein levels. Associations with disability and annual change in disability were evaluated using linear regression and multilevel mixed-effects linear regression. RESULTS: In the unadjusted analyses, nearly all lipid-related variables were positively associated with Expanded Disability Status Scale (EDSS). After adjustment for confounders, total cholesterol (TC) (p = 0.037), apolipoprotein B (ApoB) (p = 0.003), and the apolipoprotein B to apolipoprotein A-I ratio (ApoB/ApoA-I ratio) (p = 0.018) were independently associated with a higher EDSS. Higher body mass index (BMI) was also independently associated with higher EDSS (p = 0.013). With the progression analysis, the total cholesterol to high density lipoprotein (HDL) ratio (TC/HDL ratio) (p = 0.029) was prospectively associated with subsequent change in EDSS. CONCLUSION: In this prospective population-based cohort study, an adverse lipid profile was associated with high levels of MS disability and disease progression. Improving serum lipids may be beneficial for MS patients, to potentially improve clinical outcomes and vascular comorbidities.

Genomic analysis of multidrug-resistant Escherichia coli from Urban Environmental water sources in Accra, Ghana, Provides Insights into public health implications.

Wastewater discharge into the environment in resource-poor countries poses a threat to public health. Studies in this area within these countries are limited, and the use of high-throughput whole-genome sequencing technologies is lacking. Therefore, understanding of environmental impacts is inadequate. The present study investigated the antibiotic resistance profiles and diversity of beta-lactamases in Escherichia coli strains isolated from environmental water sources in Accra, Ghana. Microbiological analyses were conducted on wastewater samples from three hospitals, a sewage and wastewater treatment plant, and water samples from two urban surface water bodies. Confirmed isolates (N = 57) were selected for phenotypic antibiotic resistance profiles. Multi-drug-resistant isolates (n = 25) were genome sequenced using Illumina MiSeq sequencing technology and screened for sequence types, antibiotic resistance, virulence and beta-lactamase genes, and mobile genetic elements. Isolates were frequently resistant to ampicillin (63%), meropenem (47%), azithromycin (46%), and sulfamethoxazole-trimethoprim (42%). Twenty different sequence types (STs) were identified, including clinically relevant ones such as ST167 and ST21. Five isolates were assigned to novel STs: ST14531 (n = 2), ST14536, ST14537, and ST14538. The isolates belonged to phylogroups A (52%), B1 (44%), and B2 (4%) and carried ß-lactamase (TEM-1B, TEM-1C, CTX-M-15, and blaDHA-1) and carbapenemase (OXA-1, OXA-181) resistance genes. Dominant plasmid replicons included Col440I (10.2%) and IncFIB (AP001918) (6.8%). Polluted urban environments in Accra are reservoirs for antibiotic-resistant bacteria, posing a substantial public health risk. The findings underscore the need for targeted public health interventions to mitigate the spread of antibiotic-resistant bacteria and protect public health.

Effect of Particulate Matter Exposure on Respiratory Health of e-Waste Workers at Agbogbloshie, Accra, Ghana.

Background: Direct and continuous exposure to particulate matter (PM), especially in occupational settings is known to impact negatively on respiratory health and lung function. Objective: To determine the association between concentrations of PM (2.5, 2.5-10 and 10 µm) in breathing zone and lung function of informal e-waste workers at Agbogbloshie. Methods: To evaluate lung function responses to PM (2.5, 2.5-10 and 10 µm), we conducted a longitudinal cohort study with three repeated measures among 207 participants comprising 142 healthy e-waste workers from Agbogbloshie scrapyard and 65 control participants from Madina-Zongo in Accra, Ghana from 2017-2018. Lung function parameters (FVC, FEV1, FEV1/FVC, PEF, and FEF 25-75) and PM (2.5, 2.5-10 and 10 µm) concentrations were measured, corresponding to prevailing seasonal variations. Socio-demographic data, respiratory exposures and lifestyle habits were determined using questionnaires. Random effects models were then used to examine the effects of PM (2.5, 2.5-10 and 10 µm) on lung function. Results: The median concentrations of PM (2.5, 2.5-10 and 10 µm) were all consistently above the WHO ambient air standards across the study waves. Small effect estimates per IQR of PM (2.5, 2.5-10 and 10 µm) on lung function parameters were observed even after adjustment for potential confounders. However, a 10 µg increase in PM (2.5, 2.5-10 and 10 µm) was associated with decreases in PEF and FEF 25-75 by 13.3% % [ß = -3.133; 95% CI: -0.243, -0.022) and 26.6% [ß = -0.266; 95% CI: -0.437, 0.094]. E-waste burning and a history of asthma significantly predicted a decrease in PEF by 14.2% [ß = -0.142; 95% CI: -0.278, -0.008) and FEV1 by 35.8% [ß = -0.358; 95% CI: -0.590, 0.125] among e-waste burners. Conclusions: Direct exposure of e-waste workers to PM predisposes to decline in lung function and risk for small airway diseases such as asthma and COPD.

Development of an observation-based tool for ergonomic exposure assessment in informal electronic waste recycling and other unregulated non-repetitive work.

Most existing ergonomic assessment tools are intended for routine work. Time- and cost-efficient observational tools for ergonomic assessment of unregulated work are lacking. This paper presents the development of an observation-based tool designed to investigate ergonomic exposures among informal electronic waste workers that could be applied to other unregulated jobs/tasks. Real time coding of observation is used to estimate the relative duration, intensity, and frequency of exposure to key work postures, forceful exertions, movements, contact stress and vibration. Time spent in manual material handling activities such as carrying, lifting and pushing/pulling of working carts are also estimated. A preliminary study conducted with 6 e-waste workers showed that the tool can easily be used with minimal training and good inter-observer agreement (i.e., 89% to 100%) for most risk factors assessed. This new assessment tool provides effective and flexible options for quantifying ergonomic exposures among workers engaged in unregulated, highly variable work.

Spatiality in Health: The Distribution of Health Conditions Associated with Electronic Waste Processing Activities at Agbogbloshie, Accra.

Background: A walk through the Agbogbloshie e-waste recycling site shows a marked heterogeneity in the spatial distribution of the different e-waste processing activities, which are likely to drive clustering of health conditions associated with the different activity type in each space. Objective of study: To conduct a spatial assessment and analysis of health conditions associated with different e-waste activities at different activity spaces at Agbogbloshie. Methods: A choropleth showing the various activity spaces at the Agbogbloshie e-waste site was produced by mapping boundaries of these spaces using Etrex GPS device and individuals working in each activity spaces were recruited and studied. Upon obtaining consent and agreeing to participate in the study, each subject was physically examined and assessed various health outcomes of interest via direct physical examination while characterizing and enumerating the scars, lacerations, abrasions, skin condition and cuts after which both systolic and diastolic blood pressure values were recorded alongside the administration of open and close ended questionnaires. All individuals working within each activity space and consented to participate were recruited; giving a total of one hundred and twelve (112) subjects in all. Results: A study of the choropleth showed that health conditions associated e-waste processing activities were clustered in a fashion similar to the corresponding distribution of each activity. While a total of 96.2% of all the study subjects had cuts, the dismantlers had higher mix of scars, lacerations and abrasions. Abrasions were observed in 16.3% of the dismantlers. Scars were the most common skin condition and were observed on the skins of 93.6% of the subjects. Prevalence of burns among the study subjects was 23.1%. Developing hypertension was not associated with activity type and while a total of 90.2% of subjects had normal blood pressure and 9.8% of them were hypertensives. Finally, 98.2% of respondents felt the need to have a first aid clinic at the site with 96.4% and 97.3% willing to visit the clinic and pay for services respectively. Conclusion: We conclude that while the observed injuries were random and were due purely to accidents without any role of spatial determinants such as the configuration, slope, topography and other subterranean features of the activity spaces, a strong association between the injuries and activity type was observed.

Determinants of bed net use among older people in Nigeria: results from a nationally representative survey.

INTRODUCTION: the use of bed nets is a well-recognized and cost-effective preventive measure against malaria. However, little is known about factors associated with the use of bed nets among older people in Nigeria. Therefore, this study aimed to examine the determinants of bed net use among older Nigerian adults. METHODS: data from the first wave of the Nigeria General Household Survey-Panel were used, which included 3,439 participants aged 50 years and above. Log-binomial models were used to model the association between participants' sociodemographic characteristics and the use of bed nets. RESULTS: the frequency of bed net use was 26%. The adjusted prevalence ratio (PR) of bed net use was lower in women (PR = 0.83, 95% CI: 0.73-0.96), older age groups (60-69 years: PR=0.85, 95% CI:0.75-0.97; 70 years and above: PR = 0.80, 95% CI: 0.69-0.94), female-headed households (PR = 0.69, 95% CI: 0.53-0.89) and among those in the highest tertiles of per-capita household expenditure (PR=0.77, 95% CI: 0.66-0.90). However, the frequency of bed net use was higher among older adults residing in the rural areas (PR = 1.84, 95% CI: 1.55-2.18) and those who reported never having attended school (PR=1.15, 95% CI: 1.01-1.30). CONCLUSION: the prevalence of bed net use among older adults is lower compared to previously reported data for younger adults, suggesting an increased risk of the older adults of exposure to malaria. Female sex, age ≥ 60 years, level of education, economic status, and rural vs urban residence were important determinants of bed net use among older adults.

Maternal education and child immunization: the mediating roles of maternal literacy and socioeconomic status.

INTRODUCTION: Previous studies in Nigeria have documented significant association between maternal education and child immunization. However, little is known about the pathway through which maternal education improves immunization uptake. This study aims to examine whether maternal literacy and socioeconomic status mediates the relationship between maternal education and complete immunization coverage in children. METHODS: Nationally representative data from the first wave of the Nigeria General Household Survey-Panel were used, which includes 661 children aged one year and below. Regression analyses were used to model the association between maternal education and child's immunization uptake; we then examined whether maternal literacy and household economic status mediates this association. RESULTS: Of the 661 children, 40% had complete immunization. The prevalence ratio (PR) of complete immunization in children whose mothers were educated versus those whose mothers were not educated was 1.44 (95% CI: 1.16-1.77). Maternal literacy substantially reduced the estimated association between maternal education and complete immunization by 90%, whereas household economic status reduced the estimates by 27%. CONCLUSION: These findings suggest that complete immunization was higher in children whose mothers were educated, partly because maternal education leads to acquisition of literacy skills and better health-seeking behavior which then improves immunization uptake for their children. Socioeconomic status is an alternative pathway but with less substantial indirect effect.

Severity of malaria in relation to a complement receptor 1 polymorphism: a case-control study.

BACKGROUND: Studies on the relationship between complement receptor 1 (CR1) polymorphisms in exon 29 encoding the Knops blood group antigens (Swain-Langley (Sl) and McCoy (McC)) and outcome of clinical malaria have produced inconsistent results. METHODS: Blood samples from Ghanaian children (n = 150) aged 1-12 years with complicated and uncomplicated malaria were genotyped for the Sl and McC blood group alleles by polymerase chain reaction and restriction fragment length polymorphism. Effect of Sl and McC genotypes on the clinical outcome of malaria was evaluated using logistic regression. RESULTS: McCa/b genotype was significantly associated with more than two-fold increased susceptibility for severe malaria (OR = 2.31; 95% CI: 1.03-5.20, P = 0.043). However, McCb/b was associated with an 88% reduced risk of severe malaria (OR = 0.12; 95% CI: 0.02-0.64, P = 0.013). In contrast, there was no significant association between severe malaria and Sl1/1, Sl1/2, Sl2/and McCa/a genotypes. There was a trend towards decreased susceptibility to both cerebral malaria (CM) (OR = 0.13; 95% CI: 0.02-1.15, P = 0.07) and severe malarial anaemia (SA) (OR = 0.14; 95% CI: 0.02-1.19, P = 0.07) for McCb/b genotype when compared with the McCa/a genotype. There were no significant associations between Sl1/2 or Sl2/2 genotype and CM or SA when compared with Sl1/1 genotype. CONCLUSIONS: McCa/b was associated with increased susceptibility to severe malaria and McCb/b associated with reduced risk of severe malaria. Further studies with large sample size in other malaria endemic regions in Africa are warranted to confirm these findings.

The co-occurrence of multiple sclerosis and type 1 diabetes: shared aetiologic features and clinical implication for MS aetiology.

We reviewed the evidence for the co-occurrence of type 1 diabetes mellitus (T1D) and multiple sclerosis (MS), and assessed the clinical significance of this association and the shared aetiological features of the two diseases. T1D and MS contribute considerably to the burden of autoimmune diseases in young adults. The co-occurrence of MS and T1D has been reported by a number of studies, suggesting that the two conditions share one or more aetiological components. Both conditions have been associated with distinct human leukocyte antigen (HLA) haplotypes but share a number of similarities in clinical, epidemiological and immunological features, leading to suggestions of possible common mechanisms of development. While underlying genetic factors may be important for the co-occurrence of both conditions, some evidence suggests that environmental factors such as vitamin D deficiency may also modulate an individual's risk for the development of both conditions. Evidence on whether the co-occurrence of the two autoimmune conditions will affect the disease course and severity of MS is merely absent. Further studies need to be conducted to ascertain whether the neuropathology associated with T1D might influence the disease course and contribute to the severity of MS.

Human enteroviruses are not the cause of neurological impairments in children at the Korle-Bu Teaching Hospital.

INTRODUCTION: Convulsions associated with fever and acute onset of unknown aetiology with case fatalities have become a long observed medical condition at the Child Health Department of the Korle-Bu Teaching Hospital. Children admitted to the department with seizures of undetermined origin and fever has been a source of diagnostic confusion. Studies from the Asia Pacific region suggest a link with non-polio enteroviruses. The aim of the study was to investigate the association between non-polio enterovirus and acute encephalopathy causing neurological morbidity in children. METHODS: One hundred and fifty cerebrospinal fluid (CSF), throat swab and serum samples were collected from participants at the Child Health Department of the Korle-Bu Teaching Hospital for virus isolation and characterization. Samples were cultured on cells and positive culture assayed by microneutralisation. Direct PCR as well as multiplex PCR were used to detect other viral agents present. RESULTS: Enterovirus isolation rate was approximately 0.67%. Intratypic differentiation by molecular characterization identified a poliovirus from vaccine origin. Further screening by real-time RT-PCR identified the virus as normal Sabin and not vaccine-derive poliovirus. No arbovirus was however detected. CONCLUSION: Non-polio enteroviruses and chikugunya virus were found not to be the etiologic agent responsible for the convulsion with neurologic morbidity observed in the Ghanaian children. Investigation for other viral agents is recommended.

Vascular comorbidities in the onset and progression of multiple sclerosis.

Vascular comorbidities are common in the general population and are associated with adverse health outcomes. In people with multiple sclerosis (MS), an increasing amount of evidence suggests that vascular comorbidities are also common, but an association with MS risk and disability has not been conclusively established. This review aims to critically examine published data on the relationship between vascular comorbidities (including vascular risk factors) and MS. The evidence suggests an increased risk of MS in people with a high BMI during childhood or adolescence but not adulthood. People with established MS appear to have a slightly increased risk of cardiovascular disease and a greater proportion of people with MS die from cardiovascular disease, which has important implications for clinicians trying to identify risk factors for cardiovascular disease and reviewing treatment options. In relation to whether vascular comorbidities influence MS clinical disability or other aspects of the disease course, the key finding was that having type-2-diabetes, hypertension, dyslipidaemia or peripheral vascular disease at any point in the disease course may be associated with a greater progression in disability. Additionally, a negative effect of high cholesterol and triglycerides and a positive effect of higher HDL (high density lipoprotein) levels on acute inflammatory activity were observed on magnetic resonance imaging. The results of the published clinical trials of statins as an intervention in MS were however conflicting and care needs to be taken when treating people with MS with statins. Taken together, the literature seems to indicate a potential association of vascular comorbidities with MS risk and disability, but the number of prospective studies was sparse, thus precluding ascription of causality. We therefore recommend that future studies of the frequency and effects of vascular comorbidities on MS risk and disability should be prospective and objective where relevant.

Adverse lipid profile is not associated with relapse risk in MS: results from an observational cohort study.

BACKGROUND: There is increasing evidence that serum lipids and apolipoproteins may be associated with multiple sclerosis (MS) clinical course. OBJECTIVE: To investigate the associations between serum lipids, apolipoproteins, body mass index and relapse in MS. METHODS: A prospective cohort of 141 participants with relapsing-remitting MS was followed from 2002 to 2005. Serum lipid and apolipoprotein levels were measured biannually, and body mass index at baseline. The association with hazard of relapse was assessed using survival analysis. RESULTS: Neither body mass index nor any of the lipid-related measures were associated with the hazard of relapse. CONCLUSION: Serum lipid profile and body mass index are not associated with the hazard of relapse in MS.