Dermatoglyphics as Preliminary Diagnostic tools for Genetic and Non-genetic Diseases 2014 to Date

This research is to generate detailed baseline data on the relationship between dermatoglyphics and disease conditions such as Sickle Cell Anaemia, Asthma, Essential Hypertension, Epilepsy, Cervical Cancer and Breast Cancer.  For the Essential Hypertension Group, the highest fingerprint pattern recorded was loops, followed by whorls  and then arches  in both hypertensive and control groups. For the distribution of the sub-types of fingerprint patterns, ulnar loop dominated, followed by plain concentric whorl, plain arch, double loop whorl, tented arch, radial loop, accidental whorl and central pocket whorl in the hypertensive group.  A similar trend was observed in the control group.  Statistically, there was no significant difference between the two groups. Significant difference was recorded between the essential hypertensive group and control group for the palmar ATD angle for both palms with the control group recording the highest. For the PIC patterns, PIC 300 and 310 dominated in both groups.  Statistically, there was no significant difference between the two groups. This study has provided some baseline data correlating dermatoglyphics and essential hypertension.

Anthropometric Assessment of Ghanaian, Facial Parameters, hand dimensions height, digit length and digit ratios 2012 to date

Our research on Ghanaian facial morphology and hand dimensions has shown that male facial parameters were significantly higher than those of the females.  With the exception of eye fissure width, there were significant variations in all the other facial anthropometric parameters between the males and females.  Also, all the nasal parameters, upper facial heights one and two, midfacial heights one and two, maxillary height, mouth width, eye fissure width and intercanthal width varied significantly between the tribes. The dominant facial (prosopic) index was hyperleptoprosopic (very long face) and the least was euryprosopic (round face).

The best predictors of sex were total facial height, morphological facial height, facial breadth, eye fissure width and anatomical nose width.  Midfacial height two, mandibular height, total facial height, facial and anatomical nose width were the best predictors of sex. Overall accuracy rates for sex prediction were 85.9% and 86.6% for respectively.  Facial dimensions of Ghanaians were significantly different from those of other populations.  The Ghanaian population however, did not differ significantly from the North-eastern Nigerians and Sri Lankans.    

Height correlated with all hand measurements in both sexes.  All hand measurements were sexually dimorphic however, sexually dimorphic digit ratios were right hand 2D:4D, 3D:5D and left hand 3D:5D.  Bilateral asymmetry was observed only in palm breadth and first and second digit lengths.  Regression equations have been developed for sex and height determination based on hand measurements.  The best determinants of height in males were hand length, palm breadth and first and fifth digit lengths.  Right and left hand length were the best determinants of female height.  Digit ratios are not recommended for height determination in both sexes.

The best predictors of sex were palm breadth on the right hand and palm length and breadth on the left hand.  Digit ratios are not useful for sex determination due to considerable overlap in prediction accuracies as well as in height determination due to low coefficients of determination.   Hand dimensions of Ghanaians were significantly different from those of Malaysians, Turks, Saudis and Indians.  The male participants however did not differ significantly from Australian males. 

These studies have provided preliminary baseline data for facial morphology and hand anthropometry for biometric and forensic purposes, facial reconstruction and disaster victim identification procedures. The results affirm population variation in facial anthropometry and hand anthropometry and reinforce the need to establish specific facial anthropometric standards for Ghanaians. 

Skeletal remains, fingerprint patterns, height, finger length, blood group, dental records and facial morphology 2014 to date

My team’s research on Ghanaian skeletal remains shows that there are significant differences between Ghanaian bones and those reported in the literature suggesting that there are inter-population variations and confirms the need for population specific data.  The best indicators were the pelvic acetabulo-pubic index, pubis length and ischial length; femoral maximum length, vertical head diameter, mid-Shaft anterio-posterior diameter and maximum tibial length. Ghanaian male ulnae appeared longer than the comparative populations in the literature. Black South Africans and Ghanaian males were similar in maximum olecranon width but were greatly distinct in minimum width of the olecranon. The greatest dimorphism between the Ghanaian and Northern Indian samples was in radial notch height. In all, regional variation was found between the study and comparative samples with many parameters demonstrating the potential to distinguish between these populations.  Proximal width dimensions showed to be more regionally dimorphic.

I have also been investigating fingerprint patterns and their relationship to blood groups and dental records in Ghanaians in order to establish baseline biometric data. Males and females had loop fingerprints dominating followed by whorls and arches.  Males were significantly taller than females. The relative ratio of finger length (2D:4D) was higher in females than males.  Loop fingerprint pattern predominantly occurred in all Rhesus positive blood groups and in O? blood group. Apart from O?, whorl fingerprint pattern was co-dominant with loops in all the Rhesus negative blood groups.   Arches were the least recorded in all blood groups. Blood groups A?, B? and AB? were the least occurring blood groups in both males and females.  Results of the current study show significant correlations between fingerprint pattern and the ABO, Rhesus blood groups. The study showed that, fingerprint patterns, height, finger length ratio and the ABO, Rhesus blood groups are sexually dimorphic.

Height Estimation using Arm Span as a Proxy among Ghanaians 2018 to Date

In this study, males were significantly taller than females. Arm span measurements were greater in males than in females and were statistically significant. The study showed a strong positive correlation between height and arm span in both males and females. This study has also developed sex specific equations to predict height from arm span measurements among Ghanaians with the pooled equation being the best predictor followed by the male-specific equation and then the female-specific equation. These equations are only applicable within the stated range of the arm span measurements of the Ghanaian population since these equations are population-specific. The study has also provided data for forensic anthropologists and health workers to help in drug administration when patient actual height cannot be easily measured and it is a significant identification parameter which can be used in medico-legal cases.

Morphometric Study of Plantar Arch Index and the Prevalence of Flatfoot among Tribes

The prevalence of flatfoot in the study population was 15.1%. Also, unilateral flatfoot prevalence of the left foot was 6.1% and the right foot was 5.8%.  A bilateral prevalence of 3.2% was recorded. Males recorded flatfoot prevalence of 15.7% whilst females recorded 14.1%. The Akan tribe recorded the same prevalence of 13.7% with the other tribes.  Also, the Ga-Dangbes recorded the highest prevalence of flatfoot of 30.8%.  The Ewes recorded a prevalence of 23.6%.  The Akans, the Ewes, the Ga-Dangbes and other tribes recorded the prevalence of unilateral left flat feet of 5.5%, 5.9%, 15.4% and 6.9% respectively.  The unilateral right flatfoot prevalence recorded among the Akans, Ewes, Ga-Dangbes and other tribes was 5.5%, 11.8%, 7.7%, and 3.4% respectively.  However, the bilateral prevalence recorded among the Ga-Dangbes, Ewes, other tribes and the Akans were 7.7%, 5.9%, 3.4% and 2.7%. The present study has therefore provided knowledge on the prevalence of pes planus in Ghana.

Anthropometry of the Breast 2012- to date

The results of the present study have established the existence of intra-population variation in female breast parameters.  It has also been established that these breast dimensions are significantly different from those established for Chinese, Korean, British and American populations.  In addition, the study has shown that the bilateral asymmetry of the breast changed with age whereas parity had no significant effect on the size of the breast.  Ghanaian female sternal length was significantly greater than that of Indian, Chinese and Nigerian populations.  The results of the study on chest triangles does not support Penn’s equilateral triangle hypothesis; there could be isosceles as well as scalene chest triangles.  The water displacement method for breast volume estimation gives more precise results than Qaio’s formula.   Suprasternal notch to nipple length, weight and BMI are better determinants of breast volume. The above observations reinforce the need for establishing specific breast anthropometric standards for Ghanaian women.  The study has provided preliminary baseline data for plastic surgeons interested in breast reconstruction and correction in Ghanaian women with breast cancer and breast anomalies. 

 Effect of Ethanolic Root Extract of Zingiber Officinale (Ginger) on the Morphology of the Reproductive System of Male Wistar Rats 2014 to date

In this study, administration of ethanolic ginger extract for 30 consecutive days to male albino rats resulted in an increase in body weight, testicular and epididymal weight in a dose dependant manner. Both the control and extract-treated male rats showed normal morphology of the testes. However, in the extract-treated animals, there was a considerable increase in the proportion of interstitial tissues and seminiferous tubules. There was a strong positive correlation between volume fraction of the seminiferous tubules and sperm count. Also, there was a strong positive correlation between sperm count, body weight, epididymal and testicular weight in the extract-treated animals. Ethanolic ginger extract caused a significant increase in sperm count, motility, viability and morphology.  Therefore, ginger extract may be potentially useful in the management of male infertility especially those with low sperm count.

Effect of ethanolic fruit extract of Xylopia aethiopica, garlic, Chinese aphrodisiacs on the morphology and reproductive function of male rats 2007 to date

Our research activities on Xylopia aethiopica has shown that the extract has both spermatogenic and androgenic properties.  It equally exhibits gonadotrophic activity in male rats.   This work has shown that the use of Xylopia aethiopica could positively influence male fertility. Oral administration of the extract significantly augments  total white blood cells and neutrophil in a dose dependent fashion. It however did not affect RBC, Hb and HCT. The extract caused a significant increase in serum total protein, Albumin, Globulin, HDL and total Cholesterol levels as well as indirect and total bilirubin dose dependently while decreasing serum ALT. It did not also have a significant effect on renal function test (urea and creatinine).  These results suggest that the fruit of xylopia aethiopica is a promising immune booster but there is the need for caution on excessive and prolonged consumption especially in persons prone to jaundice.  The results of our research activities have shown that Xylopic acid does not cause any changes in body weight, but significantly decreases testicular and epididymal weight. Sperm motility, variability and epididymal sperm counts were significantly reduced. It also showed various degrees of damage to the seminiferous tubules. Xylopic acid appears to have antiandrogenic and spermatotoxic properties which may have a direct effect on the germ cells in the testes.

A Preliminary Morphometric Study of Ghanaian Foetal Parameters for Size and Age Estimation 2014 to date

Results of our study provide for the first time detailed baseline data on foetal biometry in Ghana. The study confirmed that there is significant disparity between gestational age estimated by the last menstrual period and ultrasound.  Statistically significant differences in foetal biometry exist between the Ghanaian population and the American, British and Chinese populations in the literature. Therefore using standards developed for the present population may improve estimation of the expected date of delivery and prenatal diagnosis of abnormal foetal growth in Ghana than using reference charts that are not representative of the Ghanaian population.

The observed differences in dating using crown-rump length suggest that foetal growth in the first trimester may not be uniform.  In both the second and third trimesters of pregnancy, foetal head circumference was found to be the best single parameter in estimating gestational age in the present population.  The use of multiple foetal parameters in age estimation resulted in an increase in the coefficient of determination and reduction in the standard error of the estimate.  Biparietal diameter was found to be a good predictor of gestational age in the third trimester than previously reported in the literature suggesting normal cephalic indices and proper foetal presentation in the Ghanaian population. 

This study observed significant correlations between foetal parameters and derived formulae for estimating the value of biparietal diameter using femur length or head circumference, in cases of abnormal head shape or breech presentation.

There were significant differences in foetal biometry when measuring techniques used in this study were compared with reference equations which followed different anthropometric techniques.

Morphology of the human umbilical cord and placenta and perinatal outcome  in HIV seronegative and seropositive mothers 2012 to date

This research has generated appropriate local data on perinatal examination of the placenta and umbilical cord for deductive information on the health of the foetus and neonate.  Ghana has high perinatal morbidity and mortality rates and this has been associated with placental and umbilical cord malformations.  It has been reported that in the developed countries, one out of every three to five deliveries will have an umbilical cord finding; one out of 100 deliveries will be at risk of an umbilical cord accident stillbirth.  Different characteristics in placenta and umbilical cord morphology and function may predispose a given foetus to umbilical cord accident under stressful conditions. 

Umbilical cord length is one of the factors associated and documented as a definite risk factor for poor neonatal outcome and associated with umbilical cord accidents.  It has been suggested that there is an association of abnormal cord length with neurological abnormalities and low IQ values, foetal entanglement, true knots, (sometimes multiple) and torsion.  Placental changes are associated with long cords suggesting blood flow disruption or increased resistance.  In addition, absolutely short cords can interfere with the mechanics of labour and delivery while exhibiting changes in foetal heart rate patterns.  The restriction of decent (which is relative to the placental position and insertion) leads to an increase in the incidence of cesarean section, forceps and vacuum extractions.

There are reports in published medical literature suggesting that there are different types of umbilical cord associated deaths and many variables that determine individual types. Accumulated information also suggests that these events are collectively common especially in the developing countries.

The morphology of the umbilical cord suggests that cord length and other associated factors are important risk factors to be considered in preventing foetal morbidity and mortality

In addition discordance in some umbilical cord and placental parameters has been associated with onset of many diseases in middle age therefore there is the need to have reliable data on these structures to aid in clinical diagnosis.  Therefore results of our study are of great relevance in obstetric management and could help explain some birth complications.

In HIV seronegative mothers, our research has shown that there was a higher incidence of short cords and marginal insertions to the placenta. The umbilical cord was commonly positioned centrally or eccentric.  There was a higher occurrence of furcate insertion of umbilical cord vessels into the placenta.  In addition, birthweight correlated significantly with gestational age, maternal age and cord length.  Foetal length correlated significantly with the gestational age.  Foetal head circumference also correlated significantly with cord length and cord diameter. Correlation of cord parameters with perinatal outcome suggests that antenatal detection of umbilical cord abnormalities may be useful in the detection of foetuses at risk of cord related complications.  

For the HIV seropositive mothers, there was a positive correlation between birth weight and placental weight, placental thickness and placental diameter for the HIV exposed babies. The incidence of low birth weight and neonatal death was higher in HIV exposed babies compared to HIV unexposed babies. The duration of antiretroviral treatment correlated negatively with birth weight and length of baby as well as head and abdominal circumference. These findings suggest that Maternal HIV-infection in pregnancy may be associated with adverse pregnancy outcome.  These are baseline data on morphological variations in human umbilical cords and placentae.

Morphometric and histological studies of reproductive system tumours and their association with infertility 2012  to date 

Malignant ovarian tumours occurred in older adults whereas benign tumours were prevalent in women of the 31 – 40 years age bracket.  The prevalence of cervical cancer was higher between 41 to 80 years and the peak incidence was recorded within the 41 to 50 years age bracket. The study also showed that squamous cell carcinomas constituted a vast majority of all cervical cancers (87.5%) while adenocarcinomas accounted for 10.7% of all cases.  The prevalence of squamous cell carcinomas within the study period showed an increasing trend in comparison to adenocarcinomas.

The results also showed that a higher proportion of breast cancer was invasive ductal carcinoma and breast cancer mostly occurred in women than in men within the same age bracket.  The prevalence of malignant breast cancer was highest within age bracket 41- 60 years. The results of the present study show that the highest breast disease recorded was invasive ductal carcinoma followed by fibroadenoma, and then adenoma.  Breast tissues that were negative for malignancy, invasive lobular carcinoma, papillary carcinoma and mucinous carcinoma recorded lower frequencies.  Also, the results of the present study show that the incidence of breast cancer is higher in women within the age group of 40 – 49 years.   Histoprognostic grade of invasive ductal carcinoma studied revealed a high proportion of grade III (59.7%) showing that majority of the patients presented at an advanced stage of the disease.  Furthermore, several benign breast diseases which are precursors for breast cancer such as duct hyperplasia, fibrocystic disease, granuloma tissue, tubular adenoma, phyllodes tumour, chronic abscess, chronic inflammation, duct papillomatosis, duct ectasia and glandular adenoma were identified in women within the age group of 20 – 29 years. Therefore there should be nationwide education and regular screening to help increase the awareness of breast cancer and reduce the increasing incidence of breast cancer.

The results of the study also confirmed that the predominant variant of uterine tubal abnormalities seen at KATH is tubal gestation followed by salpingitis.  Other variants encountered in lesser frequencies were hydrosalpinx, paratubal cyst, tubal abscess, pyosalpinx and haemosalpinx.  A greater proportion of the cases of uterine tubal abnormalities were recorded among women between the ages of 25-34 years.  The least age at diagnosis was found to be 15 years and with tubal gestation.

The most predominant distribution of trophoblastic tissues in the uterine tube was Intraluminal only followed by Intraluminal and Stromal only, Stromal only, Intramuscular only, Intraluminal and Intramuscular only, Intraluminal, Stromal and Intramuscular only and Stromal and Intramuscular only.  These trophoblastic tissue distributions corresponded with their respective volume fractions.  The present study showed that age and volume fraction had a statistically significant negative correlation (p<0.05).  A univariate equation was derived which would be useful in estimating volume fraction. 

This appears to be the first quantitative study on tubal gestation in Ghana.  The study has provided preliminary baseline data on tubal gestation and uterine tubal abnormalities for Obstetricians and Gynaecologists in Ghana.

Morphology and ultrasonography of the endometrium in fertile and infertile Ghanaian women 2007 to date

I have been involved in a number of collaborative projects investigating changes to human endometrium during infertility.  This work uses quantitative light and electron microscopy to investigate the cellular responses that occur during the menstrual cycle.  Many of these events produce relatively subtle changes in cell structure that can be detected only at the ultrastructural level and/or by using morphometric (quantitative microanatomical) procedures.  Often these changes can be correlated with endocrinological and physiological data gathered by clinical staff.  Such correlations have provided insights into the development of infertility and the efficacy of treatment. The work on out-of-phase endometrial development has produced baseline data on luteal phase defect in infertile Ghanaian women.  In addition it suggests that defective luteal phase development of the endometrium, may have made it non-receptive around the peri-implantation period.  Furthermore our research activities on ultrasonography of the thickness of the endometrium throughout the stages of the menstrual cycle has produced a data bank which could be used by clinical staff for the quick evaluation of the endometrium in infertile women.

In Vitro models of human implantation 2007 to date

My major research interest is in the study of the epithelial and stromal compartments of the uterus with a view to understanding further the processes of implantation and fertilisation in humans.  The work involves growing samples of human endometrium on artificial extracellular matrix to produce cells, which are highly polarised, secretory and sensitive to hormonal stimuli.  These cells appear almost identical to those taken at biopsy and we have shown (in collaboration with the Sheffield University) that they respond to certain hormonal supplementations.  Since a basic tenet of Anatomy is that structure is intimately associated with function, these polarised cells are more likely to be representative of the tall columnar cells seen in vivo than traditional flattened, squamous cells grown on plastic.  The polarised cultures appear to be a suitable model for studying human reproductive epithelium under conditions that would be impossible to repeat in the whole individual.  For example, we have used this model to examine the possible secretion of leukaemia inhibitory factor (LIF) and co-culture of the human endometrial epithelial cells with a human trophoblastic choriocarcinoma cell line (BeWo).

The research on BeWo cells has shown that BeWo cell morphology has marked similarities to normal human cytotrophoblast cells making it a useful substitute for human trophoblast. The interactions between BeWo cells and human endometrium as a model of early human implantation has proved to be a very useful model for in vitro study of some of the early aspects of human implantation. 

The results of these research activities have contributed significant new information and improved our understanding of the human identification processes, inter-population variation, placental and umbilical cord morphology that could be useful in obstetric management and could help explain some birth complications.  It has also provided some knowledge on the mechanisms underlying early human implantation. This new knowledge has been shared with the scientific research community through the participation in some international conferences.