Alterations in haematological and clotting profile of post-menopausal women in Benin City, Nigeria

Background: The cessation of ovarian functions at menopause and the accompanying decline in the production of ovarian steroid hormones creates a unique set of health concerns for women. Reductions in sex steroid levels, particularly oestrogen, have been associated with various diseases and conditions, including bleeding disorders, coronary heart disease (CHD), osteoporosis, cognitive dysfunction, urinary incontinence, hot flushes, and mood changes, among others. Objective: To determine changes in haemorheological and clotting profile in post-menopausal women. Methods: Two hundred participants comprising one hundred and fifty post-menopausal women and fifty healthy pre-menopausal control subjects were studied. The investigations carried out include whole blood viscosity, plasma viscosity, fibrinogen concentration, Prothrombin time (PT), Activated partial thromboplastin time with kaolin (APTTK) levels and complete blood count using standard methods. Results: The mean age (p=0.01), platelet count (p= 0.013), neutrophil (p= 0.03), neutrophil to lymphocyte ratio (p= 0.045) and platelet to lymphocyte ratio (p=0.044) in postmenopausal women were significantly higher while lymphocyte count (p= 0.004) was significantly lower in postmenopausal compared to premenopausal women. Similarly, plasma oestradiol (p= 0.001), plasma viscosity (p= 0.03), relative blood viscosity (p= 0.03), whole blood viscosity (p= 0.03) and PTTK(p= 0.04) were significantly lower among postmenopausal women compared to premenopausal control subjects. Conclusion: Relative plasma viscosity correlated positively with age. There were significantly lower levels of haemorheological and clotting profile in post-menopausal women. These changes may be due to age or a decline in circulating oestrogen levels.

Association of oxidative stress markers with atherogenic index of plasma in adult sickle cell nephropathy.

This paper evaluates the association of oxidative stress and atherogenic index of plasma in order to assess the cardiovascular risk in Sickle cell nephropathy especially as lipoprotein levels are lower in SCD than non-SCD patients. Antioxidant enzymes, malondialdehyde(MDA), urea, creatinine, and glomerular filtration rate were evaluated in 110 confirmed sickle cell disease patients: 65 males in steady state, aged 21.1 ± 6.0 years, 30 males with macroalbuminuria, aged 24.5 ± 7.0, years and 15 with chronic kidney disease (CKD), aged 31.8 ± 2.0 years. The mean activity levels of glutathione peroxidase (GPx), superoxide dismutase (Cu/ZnSOD), and catalase (CAT) were significantly lower (P < 0.001) in SCD with macroalbuminuria and CKD while MDA was higher (P < 0.001) in SCD with macroalbuminuria and CKD compared with controls. There was negative correlation between GPx (P < 0.001), Cu/ZnSOD (P < 0.02), and Atherogenic index of plasma in SCD with CKD, while MDA shows a positive correlation (P < 0.001) with AIP in SCD with CKD. There was however no correlation between CAT and AIP. Decreased activity levels of antioxidant enzymes and low HDL-cholesterol concentration were confirmed in adult SCD with CKD in Nigerians. The increase oxidative stress and high atherogenic index in CKD may accelerate the process of cardiovascular complications in adult SCD patients. Atherogenic index of plasma was negatively correlated with antioxidant enzymes and positively with MDA.

Proteinuria among adult sickle cell anemia patients in Nigeria.

BACKGROUND/OBJECTIVE: The life expectancy of patients with sickle cell anemia (SCA) has improved with modern medical care, and this has led to frequent observation of various chronic complications of the disease including abnormalities in renal function. Proteinuria is not only a marker of renal disease but is also a predictor of disease progression. This screening study was aimed at evaluating the prevalence of proteinuria among adult SCA patients in Kano, Nigeria, which has not been reported previously. MATERIAL AND METHODS: A total of 200 adult SCA patients were studied. They consisted of 100 men and 100 women. Blood was collected for the assay of serum urea, sodium, potassium, chloride, bicarbonate, and creatinine and estimated glomerular filtration rate (eGFR) was determined using the Cockcroft-Gault formula. Urine dipstick test for the presence of proteinuria and other abnormalities was done, and 24-hour urine protein was measured in those with significant proteinuria. RESULTS: Mean age of the male patients was 25.1 ± 1.0 years, whereas the mean age of the female patients was 22.8 ± 4.2 years. Twenty eight percent (32 males, 24 females) of the subjects were observed to have significant proteinuria. The mean estimated eGFR of the males was 88 ± 19.6 ml/min while that of the females was 92 ± 10.2 ml/min. The male SCA patients with proteinuria had a mean eGFR of 70 ± 6.9 ml/min, whereas the female SCA patients with proteinuria had mean eGFR of 101 ± 2.5 ml/min. Among the male patients with proteinuria, 50% had chronic kidney disease (CKD). CONCLUSION: Proteinuria which is a marker of renal insufficiency is common among adult SCA patients, and routine screening for proteinuria may help detect those at increased risk of renal disease. CKD prevalence is high among SCA patients with significant proteinuria.

Sex dimorphism in serum lecithin: cholesterol acyltransferase and lipoprotein lipase activities in adult sickle cell anaemia patients with proteinuria.

Proteinuria in subjects with sickle cell anaemia (SCA) is an indication of an ongoing renal insufficiency and it's prevalence varies between sexes. We evaluated sex differences in the activities of Lecithin: cholesterol acyltransferase (LCAT), Lipoprotein lipase (LPL) and the levels of lipoproteins in SCA patients with proteinuria. Fifty SCA patients (30 males aged: 26.4 ± 7.3 years and 20 females, aged 25.4 ± 2.6 years) and 50 age and sex matched control SCA patients were recruited for the study. Random urine specimens were collected and tested for the presence of albumin by urine dipstick technique. A 24 h urinary protein was quantitated using sulphosalicylic acid technique. Fasting serum total cholesterol, triglyceride, urea and creatinine were determined using enzymes catalyzed colorimetric methods. HDL cholesterol was determined in the supernatant after precipitation with manganese chloride-phosphotungstic acid solution. LCAT was measured using the Anasolv LCAT assay with proteoliposome as substrate. LPL was determined by incubating the serum in glyceryl trioleate substrate, the glycerol liberated was measured in an aliquot of the incubating mixture. In male SCA controls there was 18.2 and 6.9% increase in the activities of LPL and LCAT respectively when compared with females but in SCA patients with proteinuria there was 8.4 and 5.2% decreases in the male SCA patients compared with females. The concentration of 24 h urine protein in the SCA male subjects with proteinuria was significantly higher (0.25 g/day; P < 0.001) compared with the SCA female patients with proteinuria (0.09 g/day). There are sex differences in the activities of LCAT and LPL in SCA patients with proteinuria. Metabolism of these lipolytic enzymes may be modulated differently in SCA patients with proteinuria.

Sub-clinical hypothyroidism in infertile Nigerian women with hyperprolactinaemia.

Studies on the impact of subclinical hypothyroidism in infertility are scarce and this seeks to determine the proportion of infertile Nigerian women with hyperprolactinaemia that had subclinical hypothyroidism. Serum prolactin and thyroid stimulating hormone were determined using ELECSYS 1010 auto analyzer. Two hundred infertile women were evaluated and 67(33.7%) had hyperprolactinaemia. Subclinical hypothyroidism was observed in 14.9% of women with hyperprolactinaemia, 4.5% and 10.5% of women with primary and secondary infertility, while hyperprolactinaemia was observed in 29.9% and 70.1% in primary and secondary infertility respectively. Mean levels of thyroid stimulating hormone and prolactin were higher in secondary infertility than primary infertility. Subclinical hypothyroidism and hyperprolactinaemia were higher in secondary infertility than primary infertility. The ratio of proportions between hypothyroidism and hyperprolactinaemia was 1:7.

Subclinical hypothyroidism in childhood obesity and its correlation with lipoproteins.

BACKGROUND/OBJECTIVE: There is an ongoing debate regarding the influence of subclinical hypothyroidism on body mass index. The objectives of the study were (i) to determine whether levels of thyroid stimulating hormone (TSH) are elevated in obese children, (ii) to compare the serum levels of triiodothyronine (T3) and thyroxine (T4) in obese with non-obese and (iii) to examine the association of subclinical hypothyroidism with lipoproteins and body mass index. METHODS: Fifty six obese children/adolescent girls aged 10.5 +/- 4.3 years, BMI 31.2 +/- 2.2 kg/m2 and apparently healthy children aged 11.2 +/- 5.2 years, BMI 21.0 +/- 2.1 kg/m2 were evaluated. Serum T3, T4 and TSH were measured using ELECSYS 1010 autoanalyzer while serum triglyceride, total cholesterol, LDL cholesterol, HDL cholesterol and glucose were measured using enzyme catalyzed colorimetric techniques. RESULTS: Subclinical hypothyroidism was observed in 10.7% of obese subjects. Significantly increase levels of T3 (p < 0.02), TSH (p < 0.01) and all lipoprotein fractions (p < 0.001) except HDL cholesterol which was lower (p < 0.001) were observed in obese than control subjects. TSH and triglyceride correlated positively with body mass index. CONCLUSION: Subclinical hypothyroidism was present in 10.7% of obese children. TSH and triglyceride correlated positively with body mass index in childhood/adolescent obesity. There is need for this group ofsubjects to be evaluated for thyroid hormones so that those requiring therapy can be diagnosed and treated.

Correlation of oxidative stress and inflammatory markers with the severity of sickle cell nephropathy.

BACKGROUND: Reactive oxygen species have been shown to mediate inflammatory process and may be involved in lipid peroxidation. METHODS: This study evaluates superoxide dismutase, glutathione peroxidase, catalase, malondialdehyde, C- reactive protein and fibrinogen in the serum of patients with sickle cell disease and their correlation with renal insufficiency. Superoxide dismutase, glutathione peroxides and C - reactive protein were assayed using sandwich ELISA technique while malondialdehyde and fibrinogen were determined using thiobarbituric reactive substance and turbidometric technique, respectively. RESULTS: The study group consisted of 40 patients with sickle cell disease along with macroalbuminuria, 16 with chronic kidney disease and 144 sickle cell disease controls. Superoxide dismutase, glutathione peroxidase and catalase were decreased while malondialdehyde, C-reactive protein and fibrinogen were increased in patients with sickle cell disease along with renal insufficiency. These parameters correlated with the severity of renal disease. CONCLUSION: Oxidative stress and inflammatory parameters correlate with sickle cell disease nephropathy.

Lipid Profile in Sickle Cell Disease Patients with Chronic Kidney Disease

Background: Dyslipidaemia is reported to occur in patients with sickle cell disease as well as patients with chronic kidney disease irrespective of the haemoglobin genotype. This study aimed at evaluating lipid profile in subjects with sickle cell anaemia (HbSS); sickle cell trait (HbAS) and normal haemoglobin genotype (HbAA); and comparing the lipid parameters between sickle cell disease patients with and those without chronic kidney disease. Methods: A total of 66 patients with chronic kidney disease: 26 HbAA; 24 HbAS and 16 HbSS and 60 apparently healthy controls were recruited for the study. Lipoproteins; urea; creatinine; estimated glomerular filtration rate and electrolytes were determined using standard procedures in both patients and controls. Results: The mean total cholesterol; low density lipoproten cholesterol and high density lipoproten cholesterol in stable HbSS subjects were significantly lower (p

Male infertility and endocrinopathies in Kano, Northwestern Nigeria.

BACKGROUND/OBJECTIVE: Endocrinologic disorders and infertility are common all over the world; the prevalence of infertility is high in sub-Saharan Africa. Several authors have suggested that the increased incidence of infertility in Africa is due to high prevalence of sexually transmitted diseases. To evaluate the contributions of endocrine abnormalities to infertility in the male in Kano, Northern Nigeria. METHODS: A total of five hundred males, aged between 28 and 56 years were evaluated over a period of 4 years (2001-2004). The hormones were analyzed using electrochemiluminescene immunoassay technique. RESULTS: Hormonal abnormalities were detected in 22% oligospermic, 40.7% severe oligospermic, and 42.7% azoospermic subjects. CONCLUSION: Endocrine abnormalities are common in the infertile males. The reason for the observed endocrinopathies is not known, appropriate laboratory investigations are essential for effective patients management. Further study to ascertain the cause(s) of hormonal derangements is suggested.

Hormonal abnormalities in azoospermic men in Kano, Northern Nigeria.

BACKGROUND & OBJECTIVES: We undertook this study to observe the pattern of hormonal abnormalities and testicular pathology in azoospermic male Africans in Kano, Northern Nigeria. METHODS: Eighty consecutive azoospermic infertile males attending fertility clinic in Aminu Kano Teaching Hospital, Kano, were selected for the study. Their semen were analyzed three times at eight weeks interval, after which serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and prolactin were assayed in serum samples, and histological examination of testicular biopsies done. RESULTS: Of the 80 subjects studied, 32 (40%) had abnormal hormonal levels, 48 (60%) had normal hormonal values and 36 (45%) had testicular pathology. INTERPRETATION & CONCLUSION: Endocrinopathies are common in azoospermia. Their contribution to male factor infertility cannot be overemphasized. The main reason for the endocrinopathies is not known but environmental factors, endocrine disruptors and genetic polymorphism have been suggested to be contributory.

Human immunodeficiency virus and hepatitis B virus co-infection among patients in Kano Nigeria.

BACKGROUND: Human immunodeficiency virus and hepatitis B virus are widespread in the developing countries and patients with dual infection of HIV and HBV are increasingly being diagnosed among hospital patients. Reports have indicated that hepatitis will contribute significantly to morbidity and mortality in HIV infected patients because of increased use and accessibility of highly active antiretroviral therapy (HAART). The objective of this study is to determine the prevalence of HIV and HBV co-infection in patients in Kano Nigeria and to highlight the reciprocal interactions between the HIVand HBV. METHODS: Three hundred patients consisting of 152 males and 148 females were recruited into the study at the Aminu Kano Teaching Hospital Kano, Nigeria between February 2002 and March 2003. RESULTS: Out of a total of three hundred HIV positive patients, two hundred and eleven (70.3%) were HBV positive. Of the 152 males that are HIV positive, 102 (67.1%) were HBVpositive while out of 148 females that are HIVpositive, 109 (73.6%) were HBV positive. CONCLUSION: A co-infection rate of 70.5% was observed in this study. Since HIV infected patients with HBV co-infection respond less to HAART additional concern and care must be taken in order to minimize the complications associated with the increasing use of HAART The testing of HIV positive patients for HBV will help in the choice of therapy in these patients's.

Acrosin activity in spermatozoa of infertile Nigerian males.

The objective of this study was to evaluate acrosin activity in spermatozoa of infertile Nigerian men and to compare with those of the fertile men. The acrosin activity was evaluated using the Acroscreen reagent kit. The acrosin activity of the fertile men was 40.7±5.2 mIU/10(6) sperm (range 30.1-51.3) and those of the infertile men was 22.4±8.33 mIU/10(6) sperm (range 5.7-39.1). The difference in the mean was statistically significant (P<0.001). There was a subpopulation of the infertile men who had their acrosin activity within normal range of the fertile men, 32.9±1.57 mIU/10(6) sperm. But the difference in the mean was statistically significant (P<0.001). Acrosin activity decreased with increased morphological changes in the spermatozoa. It is concluded that acrosin activity in the infertile Nigerian men is significantly lower than that in the fertile men. Acrosin activity may also be affected by morphological changes in the spermatozoa.

Neonatal chemical hypothyroidism in Nigeria.

To investigate the level of neonatal chemical hypothyroidism (NCH), thyroid function was measured in the cord blood of 271 neonates in an area with a high prevalence of endemic goitre, Bassa (n = 140), and a nonendemic area, Jos (n = 131), in Plateau State, Nigeria. NCH was defined as T4 < 40 nmol/L and TSH > 49 mU/L and borderline compensated NCH as T4 31-50 nmol/L and TSH 41-49 mU/L. NCH was detected in 16.4% of neonates in Bassa and in 3.8% in Jos. Borderline compensated NCH was detected in an additional 18.6% in Bassa and 8.4% in Jos. Contamination of foodstuffs and water by iodine-containing antiseptics and disinfectants during the antenatal period, in addition to factors responsible for endemic goitre, e.g. iodine deficiency and goitrogens, are considered to be responsible for the high prevalence of NCH in the Bassa area. As most infants' thyroid function recovers with time, the former might be a more important factor in the aetiology of NCH.

Early detection of prostate cancer: evaluating the diagnostic performance of prostate specific antigen by comparing with histological technique among africans.

This study was conducted to investigate the diagnostic performance characteristics of prostate specific antigen (PSA) by comparing serum PSA value with histological findings in patients suspevted of having prostate cancer in Aminu Kano Teaching Hospital. Nigeria. Clinical and Laboratory records were examined and collated for serum PSA values, together with histological findings of biopsy specimen, clinical diagnosis, age of patients, and mode of presentation. The serum PSA values were determined by ELECSYS 1010 autoanalysers Roche, Germany based on electrochemiluminescence immunoassay technique. The results show that serum PSA values increase with age in the assymptomatic non-cancer patients who came for medical check up but were within normal limit. In prostatic disease conditions PSA values were raised in benign prostatic hyperplasia 35.957± 4.0315ng/ml, in undifferentiated carcinoma 56.22±4.295ng/ml and adenocarcinoma >100ng/ml as compared to the normal range (0-4ng/ml). These cases were confirmed by histological diagnosis. It is concluded that PSA evaluations is a sensitive marker for prostate cancer but because of various other conditions that affect serum PSA concentration, other methods of investigations such as Digital Rectal examination, Trans Urethral Ultra-Sonography and histological examination should be combined to confirm diagnosis. Prognosis of patients will be better if early diagnosis is made.