Mixed-methods exploration of the knowledge of young adults about blood donation processes; a one-center cross-sectional study in a tertiary institution.

Ghana is a majority youthful population, but is only able to meet 60% of its annual blood donation requirements. Although tertiary students in Ghana may serve as important blood donor resource by virtue of their higher educational attainment, data about their blood donation processes-specific knowledge are scarce. This study therefore explored the perspectives, and experiences of young adults regarding blood donation processes. This exploratory study employed mixed-methods approach (semi-structured questionnaire and focus group discussion, [FGD]). Data collection was sequential; the questionnaire distribution was completed before FGD commenced; themes that emerged from the questionnaire responses guided FGDs. Convenience sampling technique was used to recruit 382 young adults (15-49 years). All statistical analyses were undertaken using the two-tail assumptions; p<0.05 was considered statistically significant. Majority (79.3%) of the participants were in their twenties, with only 1.3% being 40-49 years old. Although two-thirds of participants expressed willingness to donate blood, less than a-third (31.7%; 127/382) had previously donated blood. Overall, less than one-third of participants could correctly identify the minimum weight (26.4%), or the inter-donation interval (14.7%); 37.4% and 58.1% could respectively indicate the required donor age or ≥3 infectious agents screened for prior to blood collection. Among previous donors, 37.2%, 28.1% and 43.0% could identify the required weight, acceptable inter-donation period, and donor age respectively. Two-thirds and a-third of participants preferred voluntary unrelated, and paid donations respectively. Whereas 42.4% of participants indicated intrinsic health benefits of blood donation, 17.0% suggested that blood donation was associated with disease risks. Both previous donors and non-donor groups considered lack of education, fear of post-donation health issues and lack of privacy at blood collection centers as main hindrances to donor recruitment. Targeted intentional blood donation-specific educational campaigns are warranted to address the blood donation processes knowledge gap among the study population.

Metformin Inefficiency to Lower Lipids in Vitamin B12 Deficient HepG2 Cells Is Alleviated via Adiponectin-AMPK Axis.

Background: Prolonged metformin treatment decreases vitamin B12 (B12) levels, whereas low B12 is associated with dyslipidaemia. Some studies have reported that metformin has no effect on intrahepatic triglyceride (TG) levels. Although AMP-activated protein kinase (AMPK) activation via adiponectin lowers hepatic TG content, its role in B12 deficiency and metformin has not been explored. We investigated whether low B12 impairs the beneficial effect of metformin on hepatic lipid metabolism via the AMPK-adiponectin axis. Methods: HepG2 was cultured using custom-made B12-deficient Eagle's Minimal Essential Medium (EMEM) in different B12-medium concentrations, followed by a 24-h metformin/adiponectin treatment. Gene and protein expressions and total intracellular TG were measured, and radiochemical analysis of TG synthesis and seahorse mitochondria stress assay were undertaken. Results: With low B12, total intracellular TG and synthesized radiolabelled TG were increased. Regulators of lipogenesis, cholesterol and genes regulating fatty acids (FAs; TG; and cholesterol biosynthesis were increased. FA oxidation (FAO) and mitochondrial function were decreased, with decreased pAMPKα and pACC levels. Following metformin treatment in hepatocytes with low B12, the gene and protein expression of the above targets were not alleviated. However, in the presence of adiponectin, intrahepatic lipid levels with low B12 decreased via upregulated pAMPKα and pACC levels. Again, combined adiponectin and metformin treatment ameliorated the low B12 effect and resulted in increased pAMPKα and pACC, with a subsequent reduction in lipogenesis, increased FAO and mitochondrion function. Conclusions: Adiponectin co-administration with metformin induced a higher intrahepatic lipid-lowering effect. Overall, we emphasize the potential therapeutic implications for hepatic AMPK activation via adiponectin for a clinical condition associated with B12 deficiency and metformin treatment.

Coagulation Factors and Natural Anticoagulants as Surrogate Markers of Preeclampsia and Its Subtypes: A Case-Control Study in a Ghanaian Population.

Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case-control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p < .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 µg/mL), PS (6.58 µg/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve [AUC] ≥0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE [EO-PE] and late-onset PE [LO-PE]) and should be explored in future studies.

Exploring the perspective of young adults about anaemia prevention; the contributions of knowledge about at-risk groups and consequences of anaemia.

BACKGROUND: Anaemia persistently remains a grave public health challenge in most sub-Saharan African countries. Understanding the perspectives of young adults concerning the multi-factorial nature of anaemia may be an important step towards meeting the 2025 global nutrition target of halving anaemia since these individuals might be in the process of reproductive decisions. AIM: To explore the relationship between students' knowledge about individuals at risk of developing anaemia, and anaemia consequences, and anaemia prevention strategies in a tertiary student cohort. METHODS: This sequential exploratory study adopted a mixed-methods approach to triangulate the data collection. A semi-structured questionnaire was used to gather baseline data regarding students' perspective on anaemia. Themes that emerged from the initial questionnaire data analyses guided a focus group discussion (FGD) to further explore students' perspectives on anaemia. FGD data was thematically analysed to unearth reasons behind questionnaire item selection. Structural equation modeling (SEM) was used to explore the relationship between constructs in the anaemia knowledge questionnaire. RESULTS: Overall, 543 students participated in the initial questionnaire data acquisition compared to 16 in the FGD. Our latent variable structural model showed that knowing the causes of anaemia did not significantly (p > 0.05) associate with either knowledge about anaemia consequences (b = 0.113) or knowledge about anaemia prevention strategies (b = 0.042). However, knowledge about individuals at-risk of anaemia was significantly positively associated with both anaemia prevention strategies (b = 0.306, p < 0.05) and knowledge about consequences of anaemia (b = 0.543, 95%). Moreover, knowing the consequences of anaemia seemed to significantly positively mediate the association between knowledge about at-risk groups and preventive measures that could be adopted (b = 0.410, p < 0.05). CONCLUSIONS: Systems thinking public health educational campaigns that highlight the consequences of anaemia and at-risk groups are more likely to inspire the adoption of preventive strategies among young adults.

Evaluation of an organisational-level monetary incentive to promote the health and wellbeing of workers in small and medium-sized enterprises: A mixed-methods cluster randomised controlled trial.

We conducted an independent evaluation on the effectiveness of an organisational-level monetary incentive to encourage small and medium-sized enterprises (SMEs) to improve employees' health and wellbeing. This was A mixed-methods cluster randomised trial with four arms: high monetary incentive, low monetary incentive, and two no monetary incentive controls (with or without baseline measurements to examine 'reactivity' The consequence of particpant awareness of being studied, and potential impact on participant behavior effects). SMEs with 10-250 staff based in West Midlands, England were eligible. We randomly selected up to 15 employees at baseline and 11 months post-intervention. We elicited employee perceptions of employers' actions to improve health and wellbeing; and employees' self-reported health behaviours and wellbeing. We also interviewed employers and obtained qualitative data. One hundred and fifty-two SMEs were recruited. Baseline assessments were conducted in 85 SMEs in three arms, and endline assessments in 100 SMEs across all four arms. The percentage of employees perceiving "positive action" by their employer increased after intervention (5 percentage points, pp [95% Credible Interval -3, 21] and 3pp [-9, 17], in models for high and low incentive groups). Across six secondary questions about specific issues the results were strongly and consistently positive, especially for the high incentive. This was consistent with qualitative data and quantitative employer interviews. However, there was no evidence of any impact on employee health behaviour or wellbeing outcomes, nor evidence of 'reactivity'. An organisational intervention (a monetary incentive) changed employee perceptions of employer behaviour but did not translate into changes in employees' self-reports of their own health behaviours or wellbeing. Trial registration: AEARCTR-0003420, registration date: 17.10.2018, retrospectively registered (delays in contracts and identfying a suitable trial registry). The authors confirm that there are no ongoing and related trials for this intervention.

HBV Infection Is an Intermediate-Risk Disease, Whereas Anaemia Is a Mild-to-Moderate Public Health Problem in Young Ghanaian Adults: A Four-Year Retrospective Analysis of Students' Medical Records.

Background: In sub-Saharan Africa, malaria, chronic viral diseases, nutritional deficiencies, and haemoglobinopathies are common causes of anaemia. Continual surveillance data is required to situate the anaemia and infectious disease burden within a given population. This study determined the 4-year trends of anaemia, hepatitis B virus (HBV), and HCV infections and factors associated with anaemia in young Ghanaian adults. Methods: This retrospective study analysed the medical records of 21,716 fresh students at the University of Cape Coast. Data was presented as percentages and line graphs to show the yearly trends in anaemia, HBV, and HCV infections. Binary logistic regression was used to determine the increased odds of anaemia in participants. Results: Although the 4-year anaemia prevalence was 14.2% (95% CI: 0.1403-0.1498), anaemia prevalence in women and men were 24.1% (95% CI: 0.2387-0.2562) and 6.6% (95% CI:0.0616-0.0705), respectively. Anaemia prevalence consistently remained mild (males) and moderate (females) public health problem over the four-year period. Adolescents were more represented in the anaemic group (18.7% prevalence), 70.9% of them being females. The prevalence of HBV and HCV infections were 5.4% (95% CI:0.0506-0.0567) and 0.9% (95% CI: 0.0082-0.0108), respectively; only 0.1% of participants had HBV and HCV coinfection. Males were more represented in both HBV (71.2%) and HCV (63.7%) infection groups. Moreover, 15.8% of the participants who were seropositive for HBsAg self-reported having previously been vaccinated, suggesting a breakthrough infection and/or vaccine nonresponse. Furthermore, female (COR: 4.545; p < 0.001), teenagers (COR: 1.697; p < 0.001), 20-29 years (COR: 1.221; p = 0.035), and positive sickling slide test (COR: 1.176; p = 0.003) were statistically significantly associated with increased odds of anaemia. Conclusion: Intentional preventative public health campaigns regarding anaemia, HBV, and HCV infection should, respectively, target females and young adult males to increase chances of making real change in behavioural attitudes in these at-risk groups.

Quality of glycemic control in type 2 diabetes mellitus (T2DM) and its association with markers of coagulation and inhibitors of fibrinolysis: A case-control study in the Upper West Region, Ghana.

Background and Aims: Type 2 diabetes mellitus (T2DM) individuals are at a higher risk of developing diabetes complications, with approximately 80% complication-related mortality. The increased morbidity and mortality among T2DM patients are partly due to dysregulated hemostasis. This study determined the quality of glycemic control in T2DM and its association with markers of coagulation and inhibitors of fibrinolysis. Methods: This case-control study recruited 90 participants involving: 30 T2DM patients with good glycemic control, 30 with poor glycemic control, and 30 nondiabetic subjects as controls at a Municipal Hospital in Ghana. Fasting blood glucose, glycated hemoglobin, activated partial thromboplastin time (APTT), prothrombin time (PT), calculated international normalized ratio (INR), and full blood count (FBC) were determined for each respondent. Plasma levels of plasminogen activator inhibitor-1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI) were determined using the solid-phase sandwich enzyme-linked immunosorbent assay method. Data were analyzed using R language software. Results: Plasma PAI-1 antigen levels were significantly higher in the participants with poor glycemic control as compared to participants with good glycemic control (p < 0.0001). There was no significant difference in plasma TAFI levels between the participants with poor glycemic control as compared to participants with good glycemic control (p = 0.900). T2DM patients had significantly shorter APTT, PT, and INR than controls (p < 0.05). At a cut-off of ≥161.70 pg/µL, PAI was independently associated with increasing odds (adjusted odds ratio = 13.71, 95% confidence interval: 3.67-51.26, p < 0.0001) of poor glycemic control and showed the best diagnostic accuracy for poor glycemic control (area under the curve = 0.85, p < 0.0001). Conclusion: PAI-1 levels were significantly increased in T2DM with poor glycemic control and emerged as the best predictor for poor glycemic control. Good glycemic management to control the plasma levels of PAI-1 is required to prevent hypercoagulability and thrombotic disorders.

Drinking recommended daily water significantly alters haemato-biochemical parameters in prospective blood donors; a one-center quasi-experimental study in a tropical setting.

BACKGROUND: In sub-Saharan Africa, the prevailing high ambient temperatures should warrant increased daily water intake (DWI) to prevent haemo-concentration and its potential to confound patients' laboratory data. AIM: To assess the impact that the recommended DWI has on the haemato-biochemical variables in a tropical setting. MATERIALS AND METHODS: This quasi-experimental study recruited 101 apparently healthy individuals (18-60 years) in the Bawku municipality. DWI, anthropometrics, and haemato-biochemical variables were assessed at baseline. Participants were encouraged to increase their DWI to ≥4 L over a 30-day period; haemato-biochemical variables were re-evaluated. Total body water (TBW) was anthropometrically estimated. RESULTS: The median post-treatment DWI significantly increased; consequently, anaemia cases increased by >20-fold (2.0 % vs 47.5 % post-treatment). RBC count, platelet count, WBC count, and median haemoglobin significantly decreased compared to baseline (p < 0.0001). Biochemically, median plasma osmolality (p < 0.0001), serum sodium (p < 0.0001), serum potassium (p = 0.0012) and random blood sugar (p = 0.0403) significantly decreased. Compared to baseline, significantly higher proportion of participants classified as thrombocytopenic (8.9 % vs 3.0 %), hyponatraemia (10.9 % vs 2.0 %), or normal osmolarity (77.2 % vs 20.8 %). There were differential bivariate correlations between pre- and post-treatment haemato-biochemical variables. CONCLUSION: Sub-optimal DWI is a likely confounder in haemato-biochemical data interpretation in the tropics.

Vitamin B12 Induces Hepatic Fatty Infiltration through Altered Fatty Acid Metabolism.

BACKGROUND/AIMS: Rise in global incidence of obesity impacts metabolic health. Evidence from human and animal models show association of vitamin B12 (B12) deficiency with elevated BMI and lipids. Human adipocytes demonstrated dysregulation of lipogenesis by low B12 via hypomethylation and altered microRNAs. It is known de novo hepatic lipogenesis plays a key role towards dyslipidaemia, however, whether low B12 affects hepatic metabolism of lipids is not explored. METHODS: HepG2 was cultured in B12-deficient EMEM medium and seeded in different B12 media: 500nM(control), 1000pM(1nM), 100pM and 25pM(low) B12. Lipid droplets were examined by Oil Red O (ORO) staining using microscopy and then quantified by elution assay. Gene expression were assessed with real-time quantitative polymerase chain reaction (qRT-PCR) and intracellular triglycerides were quantified using commercial kit (Abcam, UK) and radiochemical assay. Fatty acid composition was measured by gas chromatography and mitochondrial function by seahorse XF24 flux assay. RESULTS: HepG2 cells in low B12 had more lipid droplets that were intensely stained with ORO compared with control. The total intracellular triglyceride and incorporation of radio-labelled-fatty acid in triglyceride synthesis were increased. Expression of genes regulating fatty acid, triglyceride and cholesterol biosynthesis were upregulated. Absolute concentrations of total fatty acids, saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), trans-fatty acids and individual even-chain and odd-chain fatty acids were significantly increased. Also, low B12 impaired fatty acid oxidation and mitochondrial functional integrity in HepG2 compared with control. CONCLUSION: Our data provide novel evidence that low B12 increases fatty acid synthesis and levels of individual fatty acids, and decreases fatty acid oxidation and mitochondrial respiration, thus resulting in dysregulation of lipid metabolism in HepG2. This highlights the potential significance of de novo lipogenesis and warrants possible epigenetic mechanisms of low B12.

Intracellular and Tissue Levels of Vitamin B12 in Hepatocytes Are Modulated by CD320 Receptor and TCN2 Transporter.

The liver mass constitutes hepatocytes expressing receptors for vitamin B12 (B12)-bound transporters in circulation. However, intrahepatic and circulating B12 interrelationship levels remain unclear. We assessed the intracellular B12 levels at various circulating B12 concentrations in human HepG2 cell-line and liver tissue levels of B12 in the C57BL/6 mouse model. In HepG2 cells treated with a range of B12 concentrations, the intracellular and circulatory B12 levels, transcript and protein levels of B12 receptor (CD320) and transporter (TCN2) were determined using immunoassays, qRT-PCR and Western blot, respectively. Similar assessments were done in plasma and liver tissue of C57BL/6 mice, previously fed a diet of either a high or low B12 (30.82 µg B12/kg and 7.49 µg B12/kg, respectively) for 8-10 weeks. The physiological B12 status (0.15-1 nM) resulted in increased levels of intracellular B12 in HepG2 cells compared to supraphysiological levels of B12 (>1 nM). Gene and protein expression of CD320 and TCN2 were also higher at physiological levels of B12. Progressively increasing extracellular B12 to supraphysiological levels led to relative decreased levels of intracellular B12, lower expression of gene and protein levels of CD320 and TCN2. Similar results were observed in liver tissue from mice fed on a low B12 diet verses high B12 diet. These findings suggest that unlike supraphysiological B12, physiological levels of B12 in the extracellular media or circulation accelerates active transport of B12, and expression of CD320 and TCN2, resulting in higher relative uptake of B12 in hepatocytes.

Low Vitamin B12 and Lipid Metabolism: Evidence from Pre-Clinical and Clinical Studies.

Obesity is a worldwide epidemic responsible for 5% of global mortality. The risks of developing other key metabolic disorders like diabetes, hypertension and cardiovascular diseases (CVDs) are increased by obesity, causing a great public health concern. A series of epidemiological studies and animal models have demonstrated a relationship between the importance of vitamin B12 (B12) and various components of metabolic syndrome. High prevalence of low B12 levels has been shown in European (27%) and South Indian (32%) patients with type 2 diabetes (T2D). A longitudinal prospective study in pregnant women has shown that low B12 status could independently predict the development of T2D five years after delivery. Likewise, children born to mothers with low B12 levels may have excess fat accumulation which in turn can result in higher insulin resistance and risk of T2D and/or CVD in adulthood. However, the independent role of B12 on lipid metabolism, a key risk factor for cardiometabolic disorders, has not been explored to a larger extent. In this review, we provide evidence from pre-clinical and clinical studies on the role of low B12 status on lipid metabolism and insights on the possible epigenetic mechanisms including DNA methylation, micro-RNA and histone modifications. Although, there are only a few association studies of B12 on epigenetic mechanisms, novel approaches to understand the functional changes caused by these epigenetic markers are warranted.

Fusobacterium emphysematous pyomyositis with necrotizing fasciitis of the leg presenting as compartment syndrome: a case report.

BACKGROUND: Fusobacterium necrophorum is a common agent of disease in humans, but the occurrence of primary infections outside the head and neck area is extremely rare. While infection with Fusobacterium necrophorum has a rather benign course above the thorax, the organism is capable of producing very severe disease when located in unusual sites, including various forms of septic thrombophlebitis. No infections of the leg have been documented before; thus, antibiotic coverage for Fusobacterium is currently not recommended in this area. CASE PRESENTATION: A 50-year-old homeless African-American man presented complaining of severe pain in his right lower extremity. A clinical workup was consistent with emphysematous pyomyositis and compartment syndrome; he received limb-saving surgical intervention. The offending organism was identified as Fusobacterium necrophorum, and the antibiotic coverage was adjusted accordingly. CONCLUSIONS: Bacteria typically involved in necrotizing infections of the lower extremity include Group A ß-hemolytic Streptococcus, Clostridium perfringens, and common anaerobic bacteria (Bacteroides, Peptococcus, and Peptostreptococcus). This case report presents a case of gas gangrene of the leg caused by Fusobacterium necrophorum, the first such case reported. Fusobacterium should now be included in the differential diagnosis of necrotizing fasciitis of the extremities.

Sampson's Artery Hemorrhage after Inguinal Hernia Repair: Second Case Reported.

Sampson artery is normally obliterated in postembryonic development. In rare cases it can remain patent and complicate a routine outpatient herniorrhaphy when severed. This is the second reported case in the available English literature of hemoperitoneum due to bleeding from a patent Sampson's artery following an open inguinal hernia repair.

A rare case of appendicitis incarcerated in an inguinal hernia.

Amyand's hernia was coined after Claudius Amyand (1660-1740), who was the first to describe the presence of a perforated appendix in a hernial sac and also was the first to perform a successful appendectomy in 1735. It is an exceptionally rare condition in which the hernia itself contains the appendix, which may not necessarily be inflamed. The presence of an inflamed appendix further contributes to the rarity of this case. We report a case of acute appendicitis brought on by its incarceration in the inguinal hernia.

Feasibility of laparoscopic abdominal wall reconstruction in an outpatient community-hospital setting using cPTFE prosthetic mesh: a prospective, multicenter case series.

Objective This study investigated the use of prosthetic condensed polytetrafluoroethylene (cPTFE) for laparoscopic ventral hernia repair (LVHR) in an outpatient community-hospital setting. Methods Patients underwent LVHR with cPTFE at one of three community hospitals. Primary endpoint was hernia recurrence at 1-year postoperatively. Secondary endpoints included pain, surgical site infection, medical/surgical complications, and patient-reported outcomes. Results This study included 65 females and 52 males, aged 46.6 ± 13.2 years (mean ± SD; range 18-84 years). Mean prosthetic size was 413.8 ± 336.11 cm2 (range 165-936 cm2). Mean follow-up was 30 months (range 12-46 months). Hernia recurrence rate was 4.3%. Rate of hospitalization in the first postoperative week was 2.6%. Early and late secondary endpoint complication rates were 24.8% and 27.4%, respectively; pain was the most common complication, followed by seroma (8.5%). Conclusions Outpatient LVHR using cPTFE is feasible in community hospitals. Complication rates were similar to previous reports, and the seroma rate was markedly lower.

Assessment of the impact of malaria on CD4+ T Cells and haemoglobin levels of HIV-malaria co-infected patients.

INTRODUCTION: The human immunodeficiency virus (HIV) and malaria destroy important cells required for proper immunological and haematological functioning of the body. This research therefore aimed to assess the effect of malaria on CD4+ and haemoglobin (Hb) levels of HIV-malaria co-infected patients. METHODOLOGY: The study was performed by sampling 220 adult HIV patients on highly active anti retroviral therapy (HAART) who routinely visited the Tema General Hospital in Ghana. Blood samples were obtained for both blood film microscopy identification of malaria parasites and analysis using rapid diagnostic test kits. A BD Facscount Analyzer was used in the quantification of CD4+ levels. RESULTS: Of the 220 patients sampled, 34 (15.5%) were HIV-malaria co-infected, all of whom (34; 100%) had CD4+ counts below the normal range, while 23 (12.9%) of the HIV mono-infected patients had normal CD4+ counts. Almost all HIV-malaria co-infected patients (33; 97.1%) had low Hb levels, whereas 79 (42.5%) of the HIV mono-infected patients had normal Hb. Malaria infection strongly correlated positively and significantly with both low CD4+ count (χ2 = 0.828, P = 0.003) and Hb (χ2 = 0.817, P = 0.004) levels. CONCLUSION: Malaria co-infection with HIV decreases CD4+ T cells and Hb levels in patients. It is therefore recommended that HIV patients in malaria endemic areas should adhere to malaria preventive measures.