Meta-Analysis of Circulating Tumor Cell PD-L1 Expression and the Association with Clinical Outcomes in Non-Small Cell Lung Cancer.

BACKGROUND: Programmed death ligand-1 (PD-L1) expression on circulating tumor cells (CTCs) has been suggested to provide prognostic information in non-small cell lung cancer (NSCLC), but consensus relative to treatment outcomes is lacking. We conducted the first comprehensive meta-analysis exploring its potential as a prognostic and predictive marker, and assessed the concordance between PD-L1 + CTCs and paired tumor tissue in NSCLC patients. METHOD: A comprehensive search was applied to PubMed and EMBASE to identify 26 studies that evaluated PD-L1 + CTCs and their association with survival outcomes in 1236 NSCLC patients. RESULTS: The meta-analysis estimated a mean PD-L1 + CTCs detection rate of 61% (95% CI, 49-72). Subgroup analysis based on treatment showed that PD-L1 + CTCs was not significantly associated with better overall survival (OS) in NSCLC patients treated with immune checkpoint inhibitors (ICIs) (Hazard Ratio (HR) = 0.96, 95% CI, 0.35-2.65, P = 0.944), but was predictive of worse OS in those treated with other therapies (HR = 2.11, 95% CI, 1.32-3.36, P = 0.002). Similarly, PD-L1 + CTCs was not significantly associated with superior progressing free survival (PFS) in NSCLCs treated with ICIs (HR = 0.67, 95% CI, 0.41-1.09, P = 0.121), but was significantly associated with shorter PFS in patients treated with other therapies (HR = 1.91, 95% CI, 1.24-2.94, P = 0.001). The overall estimate for the concordance between PD-L1 expression on CTCs and tumor cells was 63% (95% CI, 44-80). CONCLUSION: The average detection rate of PD-L1 + CTCs was comparable to the rate of PD-L1 expression in NSCLC tumors. There was a trend towards better PFS in ICI-treated NSCLC patients with PD-L1 + CTCs. Larger longitudinal studies on the association of PD-L1 + CTCs with clinical outcomes in NSCLC patients treated with ICIs are warranted.

Health seeking behaviour and knowledge on neonatal danger signs among neonatal caregivers in Upper Denkyira East Municipality, Ghana.

BACKGROUND: The purpose of the project was to assess the health seeking behaviour and knowledge on neonatal danger signs among neonatal caregivers in Upper Denkyira East Municipality. METHODS: The study used a cross-sectional design and simple random sampling technique was employed to sample mothers' neonates visiting the postnatal clinic in the selected health facilities. The target population was mothers with neonates and above 18 years visiting the health facilities and were willing to be part of the study. Total population for the study was 387 however, 381 responded to the questionnaire. Structured questionnaire was the main data collection tool for the study. Data were analysed with SPSS version 23.0. Logistic regression with Pearson Chi square, p-value and odd ratio were the main statistical methods for the data analysis. RESULTS: The results showed that 138 (36.2%) of the respondents stated that diarrhoea and vomiting constituted the major danger signs that sent their neonates to the hospital. Also the health seeking behaviour of the mothers showed positive results as most of the mothers (77.2%) attended hospital upon seeing neonatal danger sign. Finally, the association between mothers' socio-demographic characteristics and recognition of neonatal danger signs showed that mothers educational level and occupation were statistically significant (p-value = 0.000). CONCLUSION: The study concluded that mothers' knowledge level on neonatal danger signs was high and also caregivers had good health seeking behaviour. It is recommended that community health nurses and midwives should embark on home visits to encourage mothers to practice the knowledge and skills acquired during counselling at the hospital. Mothers should be empowered to make decisions concerning their children's health care.

A Rapid, Shallow Whole Genome Sequencing Workflow Applicable to Limiting Amounts of Cell-Free DNA.

BACKGROUND: Somatic copy number alterations (sCNAs) acquired during the evolution of breast cancer provide valuable prognostic and therapeutic information. Here we present a workflow for screening sCNAs using picogram amounts of cell-free DNA (cfDNA) and single circulating tumor cells (CTCs). METHODS: We repurposed the Ion ReproSeq PGS™ preimplantation genetic testing kit to perform shallow whole genome sequencing on 178 cfDNA samples (300 pg) and individual CTCs from 10 MBC patients with metastatic breast cancer (MBC) recovered by CellSearch®/DEPArray™. Results were analyzed using a tailored ichorCNA workflow. RESULTS: sCNAs were detected in cfDNA of 41/105 (39%) patients with MBC and 3/23 (13%) primary breast cancers on follow-up (PBC FU), all of whom subsequently relapsed. In 8 of 10 MBCs, individual CTCs had a higher copy number count than matched cfDNA. The median tumor fraction detected by ichorCNA was 0.34 (range 0.17-0.58) for MBC and 0.36 (range 0.31-0.37) for PBC FU. Patients with detectable tumor fraction (≥ 0.1) and TFx and OncomineTM variants had significantly lower overall survival rates (P values P = 0.002 and P < 0.0001 for the log-rank test, respectively). CONCLUSIONS: The ReproSeq PGS assay is rapid, at approximately $120 per sample, providing both a sCNA profile and estimation of the tumor DNA fraction from limiting cfDNA template (300pg) and individual CTCs. The approach could be used to examine the copy number landscape over time to guide treatment decisions, support future trial designs, and be applied to low volume blood spot samples enabling remote monitoring.

NTCP gene polymorphisms and hepatitis B virus infection status in a Ghanaian population.

BACKGROUND: SLC10A1 gene codes NTCP, a receptor through which the hepatitis B virus (HBV) gets access into hepatocytes - a stage of the viral cycle necessary for replication. Polymorphism variants of SLC10A1 play roles in HBV infection, viral clearance, treatment outcome, and complications, in diverse ethnic groups and countries. However, no such study has been conducted in the Ghanaian population, a country with HBV endemicity. Therefore, an exploratory study was conducted to investigate the presence of three (3) single nucleotide polymorphisms (SNPs) in the SLC10A1 gene (rs2296651, rs61745930, and rs4646287) and assessed the risk of HBV infection among the Ghanaian population. METHOD: Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine the presence of the SNPs among 292 participants comprising 146 HBV infected persons as case-subjects and 146 HBV non-infected persons as control-subjects. RESULTS: The minor allele frequency (T) of rs2296651 was present in a significantly high proportion of cases compared with the control group (11.6% vs. 3.1%, p < 0.0001). The homozygote recessive variant of rs61745930 was present in 2.7% of the control group and 5.5% of the case group. Moreover, the minor allele frequencies of rs4646287 were 9.3 and 8.2% among the control and the case group, respectively (p = 0.767). Under the dominant (CC) genetic model of inheritance, rs2296651 was found to be protective of HBV infection [OR = 0.18 (0.07-0.44)], whereas under the co-dominant and additive model, rs2296651 was a potential risk factor for HBV infection [OR = 5.2 (95%CI: 2.1-12.8); 3.5 (95%CI: 1.6-7.6], respectively. Variants of rs61745930 and rs4646287 were not associated with HBV infection (p > 0.05). Polymorphisms in SLC10A1, however, did not show any significant association with HBV infectivity (p > 0.05). CONCLUSION: The study highlights some polymorphism proof that variants rs2296651, rs61745930, and rs4646287 exist in HBV-infected individuals in Ghana. Although variant rs2296651 was found to be associated with HBV infection, this association warrants more studies. Polymorphisms in SLC10A1 were not associated with HBV infectivity among the Ghanaian population. Further investigation is warranted to assess the offensive role of the relationship between rs2296651 and HBV infectivity.

Weight management among school-aged children and adolescents: a quantitative assessment in a Ghanaian municipality.

BACKGROUND: Childhood and adolescent overweight, obesity and underweight have become an issue of grave concern to both the developed and developing countries in context of global burden of non-communicable diseases. Unhealthy weight status is a significant public health issue for developing countries, of which Ghana is not excluded. This study evaluated the prevalence of overweight, obesity and underweight and its related factors among school-aged children and adolescents. METHODS: A total of 1004 participants were randomly selected from six schools. A structured questionnaire on demography and socioeconomic status of students' parents/guardians was completed by the selected students. Anthropometric parameters were measured, and body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. BMI-for-age z-scores were used to categorize anthropometric data of the children as underweight, normal, overweight or obese. A cut-off value of > 0.50 was used to define obesity by WHtR. RESULTS: Overweight prevalence of 13.8% and 12.6 was observed among basic school and high school students respectively based on BMI classification. Obesity prevalence of 8.8% was found in basic school students and 8.9% among high school students. Underweight was observed in 114 (11.3%) basic school students and 86 (8.6%) high school students. There was a difference in sex prevalence in unhealthy weight-behaviours; with more girls being overweight (19.4% vs 7.6%, p < 0.001) and obese (10.2% vs. 7.3%, p = 0.177) compared to boys. High WHtR found in 10.5% of basic students and 5.0% of high school students, with a statistical difference. Overweight/obesity was significantly associated with taking snacks before bed among basic school students [aOR = 10.45(5.95-18)] and high school students [aOR = 10.23(5.95-18.37)] respectively. Watching TV [aOR = 0.39(0.22-0.70)], sleeping during leisure periods [aOR = 0.43(0.23-0.81)] and bicycling as a means of transport [aOR = 0.37(0.19-0.72)] to school was protective of obesity among basic school students. CONCLUSION: High prevalence of unhealthy weight-related behaviours was observed among school-aged children in the Bekwai Municipality. Snacking before bed was a major factor promoting obesity among school-aged children while leisure behaviours such as TV watching, and sleeping were protective of obesity. Therefore, it is recommended to promote and support healthy eating habits among school-aged children which are likely beneficial in reducing the risk of childhood unhealthy weight-related behaviours.

Evaluation of Dyslipidaemia Using an Algorithm of Lipid Profile Measures among Newly Diagnosed Type II Diabetes Mellitus Patients: A Cross-Sectional Study at Dormaa Presbyterian Hospital, Ghana.

Background and Objectives: Dyslipidaemia and its associated complications have been reported to increase mortality among type 2 diabetes mellitus (T2DM) patients. However, there is a dearth of data on the incidence of dyslipidemia among Ghanaian patients with T2DM. This study evaluated dyslipidemia among newly diagnosed T2DM patients at Dormaa Presbyterian Hospital, Ghana. Materials and Methods: This cross-sectional study recruited a total of 215 participants at the Presbyterian Hospital, Dormaa-Ghana. A well-structured questionnaire was administered to collect demographic data. Predisposing factors of dyslipidemia such as BMI, hypertension, and family history of diabetes were also obtained. Lipid profile was performed on the serum obtained from each respondent. Dyslipidaemia was defined as total cholesterol (TC) >200 mg/dL, triglyceride (TG) >150 mg/dL, low density lipoprotein cholesterol (LDL-c) >100 mg/dL, and high-density lipoprotein cholesterol (HDL-c) <40 in males and <50 mg/dL in females. Combinations of the individual parameters of dyslipidaemia were further evaluated. Results: Of the total (215) participants, 86 (40%) were males and 129 (60%) were females, representing a ratio of 1:1.5. High total cholesterol was more prevalent in females (69.0%) than males (53.5%). Generally, dyslipidaemia was predominant among those aged >40 years, with the exception of increased LDL-c (25.1%), which was higher among the 20-40 years age group. The male participants exhibited significantly (p < 0.001) higher percentages of all combined measures of dyslipidaemia-such as high TG and reduced HDL-c (77.9%), high TG and elevated LDL-c (75.6%) and high LDL and low HDL (65.1%). BMI was significantly associated with HDL levels (p = 0.02), whereas family history of diabetes was associated with TC (p = 0.004) and TG levels (p = 0.019). Conclusion: Combined dyslipidaemia is relatively high among newly diagnosed T2DM patients in Ghana, and in those >40 years. Gender is significantly associated with combined dyslipidaemia in T2DM, and males may be at a higher risk than females. BMI and family history of diabetes are potential risk factors of dyslipidaemia in T2DM.

Predominant Complications of Type 2 Diabetes in Kumasi: A 4-Year Retrospective Cross-Sectional Study at a Teaching Hospital in Ghana.

Background and objectives: Diabetes mellitus type 2 (T2DM) has been associated with several microvascular and macrovascular complications. However, studies regarding the predominant complications of T2DM in Ghana have not been conducted. This study evaluated the prevalence and predominant complications of T2DM and assessed the sociodemographic factors associated with the development of diabetes-related complications in Kumasi, Ghana. Materials and Methods: This was a retrospective cross-sectional study conducted at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. A total of 1600 Ghanaian T2DM adults were included in this study. Patients' clinical data from 2012 to 2016 were retrieved from the hospital's archive. Results: The prevalence of macrovascular and microvascular complications of T2DM was 31.8% and 35.3% respectively. The prevalence of neuropathy, nephropathy, retinopathy, sexual dysfunction, diabetic keto-acidosis (DKA), and hypoglycemia were 20.8%, 12.5%, 6.5%, 3.8%, 2.0%, and 0.8% respectively. Sexual dysfunction was significantly associated with the male gender compared to females. Being employed: Informal (aOR = 0.479, p < 0.0001), and Formal (aOR = 0.475, p = 0.0008) was associated with lower age- and sex-adjusted odds of developing T2DM-related complications while having T2DM for 5-10 years (aOR = 1.550, p = 0.0009) and more than 10 years (aOR = 2.755, p < 0.0001) was associated with increased odds of developing complications. Conclusions: Microvascular complication is the most predominant among T2DM in Kumasi, Ghana. The most prevalent T2DM-related microvascular complication in Kumasi, Ghana is neuropathy. Sexual dysfunction is associated with male compared to female T2DM patients. Being employed reduces the chance of developing T2DM-related complications while increasing DM duration increases the risk of complications.

Knowledge of complications of diabetes mellitus among patients visiting the diabetes clinic at Sampa Government Hospital, Ghana: a descriptive study.

BACKGROUND: Diabetes mellitus (DM) appears to be a global epidemic and an increasingly major non-communicable disease threatening both affluent and non-affluent society. The study aimed to determine the knowledge of diabetic complications among diabetes mellitus clients visiting the Diabetic Clinical at Sampa Government Hospital, Ghana. METHOD: This questionnaire-based descriptive study recruited a total 630 patients visiting the Diabetes Clinic at the Sampa Government Hospital. Structured questionnaire was used to obtain information such as socio-demographic and knowledge on complications of diabetes. RESULTS: Out of a total of 630 participants, 325 (51.5 %) knew diabetic foot as the most common complication followed by hypertension 223(35.4 %), neuropathy 184 (29.2 %), hypoactive sexual arousal 160(25.4 %), arousal disorder 135(21.5 %), eye diseases 112(17.7 %), heart disease 58(9.2 %), and renal disease 34(5.4 %). Comprehensive assessment of level of knowledge on the complications showed that majority 378(60.0 %) of T2D patients did not have knowledge on diabetes complications, 169(26.9 %) had inadequate knowledge on diabetics complication while 82(13.1 %) had adequate knowledge. The risk factors associated with the level of knowledge of diabetic complications were female gender adjusted odd ratio (AOR) =2.31 (1.56-3.41) married participants AOR = 3.37 (1.44-7.93), widowed AOR = 2.98 (1.10-8.08), basic level of education AOR =0.18 (0.082-0.50), Junior High School (JHS) and above of education level AOR = 0.035(0.017-0.75), 5-9 years of T2D duration AOR = 0.31(0.018-0.57), ≥10 years T2D duration AOR = 0.042 (0.02-0.10) and urban dwellers AOR = 0.36 (0.22-0.68) respectively. CONCLUSION: Participants knew the individual complication of diabetic mellitus but lack an in-depth knowledge on the complications. Further expansion of diabetic educative programs like using mass media and involving national curriculum of education can improve self-regulatory awareness of diabetic complications which may reduce the morbidity and mortality of diabetic patients.

Developments in emergency nursing education in Ghana.

Providing effective emergency nursing is challenging in low- to middle-income countries because of limited resources and an inadequate infrastructure. The role of the emergency nurse is growing throughout sub-Saharan Africa and this will help decrease the burden of acute illness and trauma on both the people and the economies in the area. However, there is a gap in education for emergency nurses in this part of the world which needs to be addressed. This article describes an emergency nursing degree programme in Ghana which was developed in collaboration with a university in the United States and one in Ghana. It also outlines the development and content of the programme and discusses its success and challenges.

Low-temperature Slow-release Permanganate Gel for Groundwater Remediation: Dynamics in Saturated Porous Media.

Due to its adverse health and environmental impacts, groundwater contamination by toxic organic compounds such as chlorinated solvents is a global concern. The slow-release permanganate gel (SRP-G) is a mixture of potassium permanganate (KMnO4) and colloidal silica solution. The SRP-G is designed to radially spread after injection via wells, gelate in situ to form gel barriers containing permanganate (MnO4-), and slowly release MnO4- to treat plumes of chlorinated solvents in groundwater. This study aimed to characterize the effects of temperature on the dynamics of SRP-G in saturated porous media. In gelation batch tests, the viscosity of ambient-temperature (24 oC) SRP-G with 30 g/L-KMnO4 was 21 cP at 70 min, 134 cP at 176 min, and peaked at 946 cP to solidification at 229 min. The viscosity of low-temperature (4 oC) SRP-G with 30 g/L-KMnO4 was 71 cP at 273 min, 402 cP at 392 min, and peaked at 818 cP to solidification at 485 min. A similar pattern, e.g., increased gelation lag time with low-temperature SRP-G, was observed for SRP-Gs with 40 g/L, 50 g/L, and 60 g/L KMnO4. In flow-through tests using a glass column filled with saturated sands, injection rates, spreading rates, and release durations were 0.6 mL/min, 46 mm/min, and 33 hr for KMnO4(aq), 0.2 mL/min, 2 mm/min, and 38 hr for ambient-temperature SRP-G, and 0.4 mL/min, 16 mm/min, and 115 hr for low-temperature SRP-G, respectively. These results indicated that the injectability, injection rate, and gelation lag time of SRP-G and the size, release rate, and release duration of MnO4- gel barriers can be increased at low temperatures. The low-temperature SRP-G scheme can be useful for treating large or dilute dissolved plumes of chlorinated solvents or other pollutants in groundwater.

Ecotoxicological and health risks associated with sediment-bound polycyclic aromatic hydrocarbons in peri-urban closed and open coastal lagoons.

Coastal urbanisation has ramifications for the sustainable development of developing nations. There are often unquantified ecological and health risks associated with urbanisation. Sixteen polycyclic aromatic hydrocarbons (PAHs) were analysed in surface sediment from three peri-urban coastal lagoons in southern Ghana. We found significant spatial variations of sediment PAHs. These variations were attributed to physiography of the lagoons and diverse anthropogenic activities surrounding them. Total PAHs ranged from 20.81 to 24,801.38 µg/kg (dry weight), underscoring a low to very high pollution level. Diagnostic ratios revealed both pyrogenic and petrogenic origins. Over 50 % of individual PAHs were of moderate ecological risk to benthic organisms, and cancer risk to humans was above the World Health Organisation's recommended safety limit (1 × 10-6). These ecological and health risks should be wake-up call for a more integrated urban planning approach to coastal urbanisation as coastal communities largely depend on natural ecosystems for food and livelihood opportunities.

Comparative analysis of breast cancer characteristics in young premenopausal and postmenopausal women in Ghana.

Breast cancer is increasingly common among young women in Ghana. BCa is heterogeneous with unique traits that impact causes, prognostic, and predictive outcomes of patients before and after menopause. However, limited evidence exists on differences between young premenopausal (YPM) and postmenopausal cases in Ghana. This study compared breast tumour characteristics between YPM women (under 35 years) and postmenopausal women. We conducted a prospective cross-sectional study involving 140 BCa-diagnosed women at the Breast Care Clinic of Komfo Anokye Teaching Hospital (KATH), Kumasi from November 2019 to June 2021. Thirty-one (22.1%) of participants were YPM and 109 (77.9%) were postmenopausal. The median ages for YPM and postmenopausal were 32.0 (range: 25.0-35.0) and 57.0 (48.0-86.0) respectively. Invasive carcinoma was the most common histological type (97.1%). Left tumour location was the most frequent in both groups (51.6% for YPM and 51.8% for postmenopausal). Lumps detected were frequently in the outer upper quadrant in both groups (61.3% and 56.0%). The majority of the YPM women (80.7%) and postmenopausal women (87.0%) had stage III and IV diseases. Most YPM (64.5%) and postmenopausal women (64.4%) exhibited triple-negative breast cancer (TNBC). Both YPM 13 (56.6%) and postmenopausal participants 40 (56.3%) exhibited a predominantly partial response to neo-adjuvant chemotherapy but YPM women (21.7%) experienced disease progression than the postmenopausal women (12.7%). The study highlights consistent tumour characteristics and advanced clinical stages at diagnosis in both groups with a higher prevalence of TNBC. TNBC and HER2+ subtypes respond better to Anthracycline-based neoadjuvant chemotherapy. Establishing Breast Care Clinics in district and regional hospitals for early detection is crucial and further studies are warranted to understand the higher TNBC prevalence in black Africans and re-evaluate breast education programs to address the persistently late presentations.

Noncentrosymmetric Triangular Magnet CaMnTeO6: Strong Quantum Fluctuations and Role of s0 versus s2 Electronic States in Competing Exchange Interactions.

Noncentrosymmetric triangular magnets offer a unique platform for realizing strong quantum fluctuations. However, designing these quantum materials remains an open challenge attributable to a knowledge gap in the tunability of competing exchange interactions at the atomic level. Here, a new noncentrosymmetric triangular S = 3/2 magnet CaMnTeO6 is created based on careful chemical and physical considerations. The model material displays competing magnetic interactions and features nonlinear optical responses with the capability of generating coherent photons. The incommensurate magnetic ground state of CaMnTeO6 with an unusually large spin rotation angle of 127°(1) indicates that the anisotropic interlayer exchange is strong and competing with the isotropic interlayer Heisenberg interaction. The moment of 1.39(1) µB, extracted from low-temperature heat capacity and neutron diffraction measurements, is only 46% of the expected value of the static moment 3 µB. This reduction indicates the presence of strong quantum fluctuations in the half-integer spin S = 3/2 CaMnTeO6 magnet, which is rare. By comparing the spin-polarized band structure, chemical bonding, and physical properties of AMnTeO6 (A = Ca, Sr, Pb), how quantum-chemical interpretation can illuminate insights into the fundamentals of magnetic exchange interactions, providing a powerful tool for modulating spin dynamics with atomically precise control is demonstrated.

Angiogenic growth factors, oxidative stress and haematobiochemical measures as predictors of preeclampsia with and without foetal growth restriction: A case-control study in a Ghanaian population.

INTRODUCTION: This study compares the angiogenic growth mediators (AGMs), oxidative stress (OS) and haematobiochemical profile as well as foeto-maternal outcomes of preeclampsia (PE) with and without foetal growth restriction (FGR) and the discriminative potential of these markers for identifying these conditions. METHODS: This hospital-based case-control study recruited a total of 209 women including 109 PE women without FGR and 48 PE women with FGR as cases whereas 52 normotensive pregnant women were recruited as controls. OS and AGMs and haematobiochemical markers were measured for all participants. RESULTS: The rates of foetal complications including intrauterine foetal death and foetal distress were more common in PE with FGR than PE without FGR (p < 0.05) but maternal complications were comparable across these groups (p > 0.05). Of the haematobiochemical markers, placental growth factors (PIGF), PIGF/8-Isoprostane, sFlt-1/PIGF (AUC = 0.87, p < 0.001), soluble FMS-tyrosine kinase receptor-1 (sFlt-1) (AUC = 0.85, p < 0.001), total antioxidant capacity, 8-isoprostane (AUC = 0.83, p < 0.001) and lactate dehydrogenase (AUC = 0.70, p < 0.001) were more associated and showed at least an acceptable discrimination for PE with FGR against PE only. DISCUSSION: The occurrence of FGR in PE patients does not necessarily indicate a severe maternal presentation of the condition but a tendency for adverse foetal outcomes. Cumulative assessment of OS and AGMs may provide diagnostic usefulness for distinguishing PE with and without FGR.

Serial Postoperative Circulating Tumor DNA Assessment Has Strong Prognostic Value During Long-Term Follow-Up in Patients With Breast Cancer.

PURPOSE: Here, we report the sensitivity of a personalized, tumor-informed circulating tumor DNA (ctDNA) assay (Signatera) for detection of molecular relapse during long-term follow-up of patients with breast cancer. METHODS: A total of 156 patients with primary breast cancer were monitored clinically for up to 12 years after surgery and adjuvant chemotherapy. Semiannual blood samples were prospectively collected, and analyzed retrospectively to detect residual disease by ultradeep sequencing using ctDNA assays, developed from primary tumor whole-exome sequencing data. RESULTS: Personalized Signatera assays detected ctDNA ahead of clinical or radiologic relapse in 30 of the 34 patients who relapsed (patient-level sensitivity of 88.2%). Relapse was predicted with a lead interval of up to 38 months (median, 10.5 months; range, 0-38 months), and ctDNA positivity was associated with shorter relapse-free survival (P < .0001) and overall survival (P < .0001). All relapsing triple-negative patients (n = 7/23) had a ctDNA-positive test within a median of 8 months (range, 0-19 months), while the 16 nonrelapsed patients with triple-negative breast cancer remained ctDNA-negative during a median follow-up of 58 months (range, 8-99 months). The four patients who had negative tests before relapse all had hormone receptor-positive (HR+) disease and conversely, five of the 122 nonrelapsed patients (all HR+) had an occasional positive test. CONCLUSION: Serial postoperative ctDNA assessment has strong prognostic value, provides a potential window for earlier therapeutic intervention, and may enable more effective monitoring than current clinical tests such as cancer antigen 15-3. Our study provides evidence that those with serially negative ctDNA tests have superior clinical outcomes, providing reassurance to patients with breast cancer. For select cases with HR+ disease, decisions about treatment management might require serial monitoring despite the ctDNA-positive result.

Performance evaluation of developed macrophyte-assisted vermifiltration system designed with varied macrophytes and earthworm species for domestic wastewater treatment.

Development of sustainable technology to treat domestic wastewater with added advantages of cost reduction and improved handling efficiency is crucial in developing countries. This is because, domestic wastewater from households are stored in septic tanks and are poorly treated prior discharge. This study developed a macrophyte-assisted vermifiltration (MAV) system to treat domestic wastewater. The MAV system is an integrated approach of macrophytes and earthworms in a vermifiltration and complex physicochemical mechanism processes. The use of different macrophyte and earthworm species was hypothesized by the study to affect and vary the treatment performance of the developed MAV. The study therefore aimed to evaluate the treatment performance of the developed MAV when three varied macrophyte species (Eichhornia crassopes, Pistia stratiotes and Spirodela sp.) and two varied earthworm species (Eisenia fetida and Eudrilus eugeniae) were used to design the treatment system. Treated effluents were collected every 48hours within two weeks for physico-chemical, pathogen and helminth analysis. The contaminants (Ntot, NH3, NO3-N and Ptot) in the wastewater were high (>50 mgL-1, >5 mgL-1, >1 mgL-1 and >20 mgL-1 respectively). Results revealed that the developed MAV systems were effective in the removal of solids (>60%), nutrients (>60%) and pathogens (>90%). In most cases, there were no significant differences between the selected varied macrophytes and earthworms in the treatment performances. Results therefore demonstrated that the selected macrophytes combined with the earthworm species were suitable when used in the development of the MAV system. Developing the MAV with the selected varied macrophyte and earthworm species did not only contribute to the treatment of the wastewater, but also improved the vermiculture. Eudrilus eugeniae however demonstrated higher biomass gain (5-10% more) compared to Eisenia fetida.

The relevance of knowledge, perception, and factors that influence contraceptive use among married women living in Uaddara Barracks, Ghana.

Background: Contraceptive use has many advantages for personal growth and societal advancement, but there is still the problem of unmet needs for women, which highlights the gap between women's reproductive intentions and contraceptive use. This study investigated knowledge, perceptions, and factors that influence contraceptive use among married women living in a military base in Ghana. Methods: This cross-sectional study involved 350 married women between the ages of 20 and 58 years at the Uaddara Barracks, Kumasi. A structured questionnaire was used to collect information on the background, knowledge, perceptions on contraceptive use, and contraceptive methods used by participants. Data was entered into an Excel sheet and analysed using R version 4.2.1. Results: Most of the participants were between the age range of 36 and 40 years (25.5%). Almost all study participants (97.4%), had heard about contraceptives with 80.6% showing a high level of knowledge on contraceptives. The majority of the women (84.6%) had previously used some form of contraceptives and 53.1% presently do. More than half of the participants (69.4%) had a positive perception of contraceptive use; 80.6% responded it was their own decision to use contraceptives, and 80.3% had the support of their husbands. Husbands' support of contraception resulted in a 5 times higher usage of contraceptives among women (aOR = 5.35; p < 0.001) while women who were married to military men were 45% (aOR = 0.45; p = 0.007) less likely to use contraceptive when compared to civilian wives. Demographic characteristics like being above 40 years (aOR = 0.25; p = 0.014), being a housewife (aOR = 0.42; p = 0.043) and working in the private sector (aOR = 0.33; p = 0.015) were significantly linked with less contraceptive use. Conclusion: The study showed that women used contraceptives at a rate that was much higher than the national norm at the Uaddara Barracks, demonstrating the beneficial influence men had on women's contraceptive use. This thereby underscores the need for interventional policies that prioritized the male as much as women, while emphasizing the benefits of contraceptive use to the family and not just as an awareness program only.

Assessment of the performance of haematological and non-invasive fibrotic indices for the monitoring of chronic HBV infection: a pilot study in a Ghanaian population.

OBJECTIVE: Haematological and liver fibrotic markers could be appreciably utilized for effective monitoring of Chronic Hepatitis B viral (HBV) infection, thereby increasing patient's treatment outcome. The objective of this study was to assess the applicability of complete blood count (CBC) and non-invasive liver-fibrotic indices as markers of prognostic outcome and monitoring in HBV infections. RESULTS: Significant differences in levels of white cell and differentials counts, red blood cell count, hemoglobin indices, and platelet indices were observed between HBV-infected patients (cases) and uninfected persons (controls). Levels of haemoglobin (Hb), total white blood cells (tWBC), neutrophils, monocytes, platelets, and Platelet Distribution width (PDW) were significantly lower (p < 0.05) in the cases compared to the controls. Total and indirect bilirubin; De-Ritis ratio, Aspartate transaminase to platelet ratio index (APRI) and RDW-to-platelet ratio (RPR) were elevated in cases compared with controls (p-value < 0.05). In a multivariate adjusted model to test the significance of markers, Hemoglobin Index (beta coefficient = - 0.876, p-value < 0.001), NLR (beta coefficient = - 0.839, p-value < 0.001), MPV_10000 (beta coefficient = - 0.333, p-value < 0.001) and Albumin (beta coefficient = - 0.059, p-value = 0.014), were associated with HBV infection status. Receiver operative characteristics curve analysis showed Hemoglobin Index (AUC = 0.744) and MPV_10000 (AUC = 0.730) as better prognostic markers for HBV-infection.

Genetic analysis of heterogeneous subsets of circulating tumour cells from high grade serous ovarian carcinoma patients.

Circulating tumour cells (CTCs) are heterogenous and contain genetic information from the tumour of origin. They bear specific intra- and extra-cellular protein markers aiding in their detection. However, since these markers may be shared with other rare cells in the blood, only genetic testing can confirm their malignancy. Herein, we analyse different CTC subsets using single cell whole genome DNA sequencing to validate their malignant origin. We randomly selected putative CTCs identified by immunostaining that were isolated from 4 patients with high grade serous ovarian cancer (HGSOC) and one with benign cystadenoma. We specifically targeted CTCs positive for epithelial (CK/EpCAMpos), mesenchymal (vimentinpos), and pseudoendothelial (CK/EpCAMpos plus CD31pos) markers. We isolated these cells and performed whole genome amplification (WGA) and low-pass whole-genome sequencing (LP-WGS) for analysis of copy number alterations (CNA). Of the CK/EpCAMpos cells analysed from the HGSOC patients, 2 of 3 cells showed diverse chromosomal CNAs. However, the 4 pseudoendothelial cells (CK/EpCAMpos plus CD31pos) observed in the HGSOC cases did not carry any CNA. Lastly, two of the clusters of vimentin positive cells sequenced from those found in the benign cystadenoma case had CNA. Despite the low number of cells analysed, our results underscore the importance of genetic analysis of putative CTCs to confirm their neoplastic origin. In particular, it highlights the presence of a population of CK/EpCAMpos cells that are not tumour cells in patients with HGSOC, which otherwise would be counted as CTCs.

Powering single-cell genomics to unravel circulating tumour cell subpopulations in non-small cell lung cancer patients.

BACKGROUND: Circulating tumour cells (CTCs) are attractive "liquid biopsy" candidates that could provide insights into the different phenotypes of tumours present within a patient. The epithelial-to-mesenchymal transition (EMT) of CTCs is considered a critical step in tumour metastasis; however, it may confound traditional epithelial feature-based CTC isolation and detection. We applied single-cell copy number alteration (CNA) analysis for the identification of genomic alterations to confirm the neoplastic nature of circulating cells with only mesenchymal phenotypes. METHODS: We isolated CTCs from blood samples collected from 46 NSCLC patients using the Parsortix system. Enriched cells were subjected to immunofluorescent staining for CTC identification using a multi-marker panel comprising both epithelial and mesenchymal markers. A subset of isolated CTCs was subjected to whole genome amplification (WGA) and low-pass whole-genome sequencing (LP-WGS) for the analysis of copy number alterations (CNAs). RESULTS: CTCs were detected in 16/46 (34.8%) patients, inclusive of CK+/EpCAM+ CTCs (3/46, 6.5%) and Vim+ CTCs (13/46, 28.3%). Clusters of Vim+ cells were detected in 8 samples, which constitutes 50% of the total number of NSCLC patients with CTCs. No patients had detectable hybrid CK+/EpCAM+/Vim+ cells. All of the tested CK+/EpCAM+ CTCs and 7/8 Vim+ CTCs or CTC clusters carried CNAs confirming their neoplastic nature. Notably, the Vim+ cluster with no CNAs was characterised by spindle morphology and, therefore, defined as normal mesenchymal circulating cells. CONCLUSION: Our results revealed that CK-negative, vimentin-expressing cells represent a large proportion of CTCs detected in NSCLC patients, which are likely missed by standard epithelial-marker-dependent CTC categorisation.