EVALUATION OF MALE SEX HORMONES AND TRACE ELEMENTS IN MALE TYPE 2 DIABETIC PATIENTS ATTENDING NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL DIABETIC CLINICS.

BACKGROUND: There is accumulating evidence that the metabolism of male sex hormones and several trace elements are altered in type 2 diabetic mellitus and may have specific role in the pathogenesis and progression of the disease. AIM: To assess the levels of male sex hormones and trace elements in type 2 diabetic patients and to ascertain an association between male sex hormones and trace elements among diabetic subjects. METHODS: A descriptive cross sectional study was conducted among 125 diabetic and 50 non diabetic subjects. Venous blood samples were collected from all respondents and estimated for fasting blood glucose, male sex hormones and trace elements. The results were subjected to statistical analysis and comparison using Students' test and Pearson correlation analysis. RESULTS: The mean testosterone level was significantly lower in diabetics than in controls (3.9 ± 1.9ng/ml) in comparison with (5.1 ± 1.7ng/ml; P < 0.05). The mean value of Zinc, Manganese, Selenium and Chromium were significantly lower among the diabetics when compared with the controls (Zn;898.7 ± 131.0 µg/l; Mn:0.30 ± 0.06 µg/l;Se:51.3 ± 11.1 µg/l; Cr: 0.04 ± 0.03 µg/I) in comparison with (Zn: 1007.3 ± 85.2 µg/l; Mn: 0.05 ± 0.07µg/l; Se: 62.1 ± 11.1 µg/l; Cr: 0.06 ± 0.01 µg/l; P < 0.05).The mean Fasting Blood Glucose in diabetic subjects was significantly higher when compared with the controls (7.9 ± 3.7 mmol/l) in comparison with (4.6 ± 0.4 mmol/l; P < 0.05).The trace elements showed a positive correlation with testosterone in diabetic subjects (Zn r = 0.359, Ser = 0.443, Mn r = 0.350, P < 0.05). CONCLUSION: This study observed decreased levels of testosterone and trace elements in type 2 diabetics and a positive correlation between low testosterone and low trace elements levels in diabetic subjects. These trace elements are antioxidants and their low levels in diabetic patients may further increase the severity of the disease.

Lipid and Some Other Cardiovascular Risk Factors Assessment in a Rural Community in Eastern Nigeria.

BACKGROUND: Continuous re-evaluation of modifiable cardiovascular risk factors (cardiovascular diseases [CVDs]) in developing nations is imperative as it lays foundation for early preventive/intervention measures at grass root level to improve/prevent CVD morbidity and mortality in those nations where health indices still score below the standard. AIM: The aim was to assess CVD risk factors as a continuous re-evaluation of these may underscore the need for early intervention measures at grass root level. SUBJECTS AND METHODS: A total of 257 apparently healthy inhabitants aged 18-85 years were recruited in a rural community in South Eastern Nigeria by convenient sampling. Blood pressure, waist circumference and blood lipid analysis were done procedurally and data analyzed using SPSS 16.0 statistical software. RESULTS: The males were older (59.41 [5.22]) than the females (53.31 [16.90]). 69.2% (133/192) were low level farmers, retirees and dependents. Total cholesterol (TC), low density lipoprotein (LDL), and risk predictive index were higher in females while triglyceride (TG), high density lipoprotein and very LDL (VLDL) were higher in males. The middle aged and elderly respectively had higher TG and VLDL compared to the young. Aside hypertriglyceridemia, all lipid abnormalities were higher in females than males both singly (high TC: 28.9% [35/121] vs. 16.9% [12/71]; high LDL cholesterol: 52.0% [63/121] vs. 31.0% [22/71]) and in combination hypercholesterolemia with hypertriglyceridemia (42.9% [52/121] vs. 36.6% [26/71]). "Multiple risk factors" also occurred more in females with seeming further increase in older age. CONCLUSION: The chances of a female having CVD after menopause seemed to outweigh that of the male. CVD preventive measures should be focused at the primary/community level as a means to curtailing the increasing morbidity and eventual mortality from CVDs.

Metabolic syndrome in newly diagnosed type 2 diabetes mellitus using NCEP-ATP III, the Nnewi experience.

BACKGROUND AND OBJECTIVES: Type 2 diabetes is becoming epidemic and several studies have shown that diabetes is associated with increased co-morbidities and impaired functional health in the general adult population. Type 2 diabetes is one of the co-morbidities associated with metabolic syndrome that carries with it increased risk of cardiovascular disease and death. The purpose of this study is therefore to determine the prevalence of metabolic syndrome in newly diagnosed type 2 diabetes mellitus subjects seen at Nnewi South East Nigeria. DESIGN AND SETTING: This is a cross-sectional study in newly diagnosed diabetics attending a private hospital-Hope Specialist Hospital, Nnewi. MATERIALS AND METHODS: One hundred and eighteen (118) newly diagnosed diabetic patients were recruited into the study consisting of those who on routine screening were found to have elevated blood glucose or were symptomatic of the disease and presented for treatment. STATISTICAL ANALYSIS: Statistical analysis was carried out using SPSS version 13. Student's t-test was used for continuous variables, and a χ2 test was used for categorical variables. In the analyses a P- value of <0.05 was considered statistically significant. RESULTS: Of the 118 subjects, 25 were removed from the study because their samples were lost as a result of prolonged power outage leaving 93 subjects consisting of 47 males and 46 females. The mean (SD) and the range of age was 55.27 (12.55) years, 24-84 years; SBP 153.52 (29.83) mmHg,100-230 mmHg; DBP 94.23 (15.42) mmHg, 60-140 mmHg; TC 5.17 (1.4) mmol/L, 2.0-11.12 mmol/L; LDL-C 2.06 (1.55) mmol/L, 0.1-9.4 mmol/L; HDL-C 1.28 (0.48) mmol/L, 0.15-2.8 mmol/L; TG 1.75 (0.85) mmol/L, 0.50-5.0 mmol/L; BMI 30.30 (6.23) kg/m 2 , 17.84-49.12 kg/m 2 ; and WC of the general population mean (SD) 96.86 (7.16) cm, range 84-112 cm; for men 101.40 (3.88) cm, range 85-108 cm and for women 92.22 (6.77) cm, 84-112 cm. Metabolic syndrome was found in 62 (66.7%) subjects of which 26 (41.9%) were males and 36 (58.1%) were females (P < 0.019). The prevalence of different components of metabolic syndrome was as follows: hypertension was found in 75 (80.6%): 37 males and 38 females (P = 0.635), dyslipidemia in 31 (60.8%): 19 males and 12 females (P = 0.572). Obesity was found in 23 (45.1%): 8 males and 15 females (P < 0.014). Of the study subjects 33 had hypertension prior to the diagnosis of diabetes mellitus (DM). Seventeen males had hypertriglyceridemia against 11 females (P = 0.357). Equal number of males and females (11 each) had low HDL--C (-C (P = 0.603). CONCLUSION: The study shows that metabolic syndrome is highly prevalent in newly diagnosed type 2 diabetes patients and the most common risk factor is hypertension.

Renal function in patients with hypertension associated congestive cardiac failure seen in a tertiary hospital.

Background. Chronic kidney disease is frequently seen in patients with congestive cardiac failure and is an independent risk factor for morbidity and mortality. The aim of this study was to determine the prevalence of chronic kidney disease in patients with hypertension associated congestive cardiac failure. Method. One hundred and fifty patients with hypertension associated congestive cardiac failure were recruited consecutively from the medical outpatient department and the medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi over a one year period, January to December 2010. Patients' biodata and medical history were obtained, detailed physical examination done and each patient had a chest X-ray, 12 lead ECG, urinalysis, serum urea and creatinine assay done. Ethical clearance was obtained from the Ethical Review Board of our institution and data analysed using SPSS-version 16. Results. There were 86 males and 64 females with mean age 62.7 ± 12.5 years. The mean blood pressures were systolic 152.8 ± 28.5 mmHg and diastolic 94.3 ± 18 mmHg. 84.7% had blood pressure ≥140/90 mmHg on presentation. The mean GFR was 70.1 ± 31.3 mls/min. 76% of subjects had GFR <90 mls/min and no statistical significant difference between males and females, P = 0.344. The mean serum urea was 7.2 ± 51 mmol/L while the mean serum creatinine was 194 ± 416.2 mmol/L. Conclusions. This study has demonstrated that majority of patients presenting with hypertension associated congestive cardiac failure have some degree of chronic kidney disease.

Changes in lipids and lipoprotein indices in relation to the severity of hypertension in newly diagnosed hypertensive nigerians.

Hypertension and dyslipidaemia are important components of metabolic syndrome and both are known to complicate each other. Materials and Methods. A total of 149 subjects consisting of 107 hypertensive patients, grouped into 3 (of 37, 35, and 35 patients categorized based on the grade of hypertension as grade 1, grade 2, and grade 3, resp.) and 42 controls, were recruited for this study. Each subject had a recording of the bio- and anthropometric data comprising of the age, height, weight, body mass index (BMI), and abdominal circumference (AC). The blood pressure was also recorded. Fasting blood was collected and serum was used for the estimation of the lipids: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG), while low density lipoprotein cholesterol (LDL-C) and VLDL were estimated using Friedewald formula. Findings. Patients with hypertension had higher lipid and lipoprotein levels than the controls and the values became more significant with increasing severity of hypertension. The difference was statistically significant for TC, LDL-C, and VLDL-C (P < 0.05). Conclusion. This study showed that lipid and lipoprotein cholesterol abnormalities exist and even worsen with severity of hypertension. It is important that investigations in patients with hypertension should include a lipid profile.

Evaluation of blood pressure and indices of obesity in a typical rural community in eastern Nigeria.

AIM: With increasing urbanization of lifestyle, cardiovascular morbidity and mortality have been on the increase in Africans. Studies on cardiovascular risk factors in rural communities in South East Nigeria are scarce. This study focused on hypertension and obesity in adult Nigerians dwelling in a rural setting in Eastern Nigeria. MATERIALS AND METHODS: A total of 218 participants from the rural community were recruited into the study. A questionnaire was used to assess prior knowledge of their weight and blood pressure status as well as drug history for those found to have hypertension. Each participant's blood pressure was measured and any value ≥140/90 mmHg was regarded as high blood pressure (HBP). Their heights and weights were measured and their body mass indices (BMI) calculated using the standard formula of BMI = Weight in Kg/Height in m 2 ; BMI ≥30 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value ≥102 cm for males and ≥88 cm for females was regarded as abdominal obesity. RESULTS: The general prevalence of HBP in the rural community was 44.5%. The prevalence of HBP increased as age increased and awareness about HBP was low (15.2%). Females were more aware than the males. The prevalence of HBP was higher in males (49.3%) compared with their female counterparts (42.3%), whereas the females had a higher prevalence of all forms of obesity (abdominal: 36.2%, global: 14.8%) compared with the males (abdominal: 14.5%, global: 10.1%). Higher BMI was associated with higher systolic and diastolic BP values. Hypertensive participants had higher BMI and WC than those who had normal BP. CONCLUSION: The prevalence of both hypertension and obesity seems to be increasing in rural communities in Nigeria and thus, the available prevalence documented in previous studies for rural communities may no longer represent the current trend. Awareness of the participants about these major cardiovascular risk factors is still very low. Higher BMI was associated with higher values of both systolic and diastolic BP.

A follow-up comparative study of two modes of learning human anatomy: by dissection and from prosections.

Two groups of medical students (traditional and experimental), who had studied the gross anatomy of the lower limb by different methods (by dissection and from prosections, respectively) 5 years earlier, were re-assessed without warning. The objective was to determine whether or not the learning mode had any implications for the subsequent recall of the material studied. Three tests were administered: a 100-item two-choice theory paper, a practical test consisting of 18 time stations with specimen-based questions, and a standardized oral examination. Both qualitative and quantitative assessments were made in the practical and oral examinations. Although the numerical scores gained by both groups in the practical test were statistically similar, the incidence of random guesswork was significantly less among students on the experimental program. The same group was also adjudged to have performed better in the oral examination by two of the investigators who were blind to the group affiliations of the students. The results suggest that on testing 5 years after a practical learning experience in gross anatomy, the numerical scores gained by students who had studied from prosections were similar to those of their peers who had carried out dissections but that, by some qualitative considerations, the recall ability of the non-dissecting students was superior. Furthermore, the program of study from prosections lasted only 74% of the duration of the dissection course and is thus more efficient. The results recommend the program to institutions faced with unfavorable student-to-cadver ratios. The time it liberates may be dedicated to such other imaginative pedagogical purposes as autonomous student learning, clinical demonstrations, and problem-solving team exercises.

Comparison of medical and non-medical student attitudes to social issues in medicine.

A 63-item questionnaire on attitudes to psychosocial issues in medicine was administered to final-year students in the Faculties of Medicine (n = 104), Pharmacy (n = 57) and Arts and Social Sciences (n = 75) of the University of Benin. The responses given were analysed by the summation and Cornell scalogram techniques for content and intensity. On aggregate, the pharmacy students scored significantly higher than their medical and arts/social science counterparts (P < 0.001). The advantage over medical students was on only one subscale: paramedical cooperation. The scores of the pharmacy and arts/social science groups were significantly lowe than those of medical students on the social factors subscale. On issues that threaten to diminish the traditional role and status of the medical profession (e.g. paramedical cooperation and government intervention), the attitude of medical students was either unenthusiastic or clearly resentful. However, they shared the same orientation as the other groups towards matters which did not challenge the prerogatives of medical doctors (e.g. preventive medicine and doctor-patient relationship). It is suggested that measures be adopted to raise the level of awareness of non-health professionals vis--vis the non-biological antecedents of disease and also to bridge the gap in attitudes among groups in the health care team.