Hormonal Profile of Women Attending Fertility Clinic in Zaria, North-west, Nigeria.

BACKGROUND: Infertility affects approximately 186 million people worldwide and 8-12% of couples of reproductive age worldwide. Female infertility remains the commonest gynaecological case attended to in many fertility centres across Nigeria with a national prevalence of infertility between 10-23.6%. The hypothalamic-pituitary-gonadal (HPG) axis of hormonal interplay and organ sensitivity account for about 19% of the cause of infertility in females in Nigeria and the laboratory assessment of the hormones of this axis have been a significant goal standard in the diagnosis as well as treatment. OBJECTIVES: The study investigated the pattern of the HPG hormones seen in infertile women in a Nigerian fertility treatment centre to identify and classify the causes. METHODS: A descriptive cross-sectional randomized study of 125 participants was selected and stratified into 47 primary and 78 secondary infertility participants respectively, conducted between Oct 2016 and August 2017. The control participants consisted of apparently healthy women, age-matched. Serum levels of four hormones [luteinizing hormones (LH), follicle-stimulating hormones (FSH), prolactin, and oestradiol] were assayed using the ELISA technique. The data were analyzed using SPSS version 20, p-value ≤ 0.05 was considered significant. RESULTS: The mean age of infertile women was 30.4±5.8 years. Serum levels of prolactin (10.6±9.3) and oestradiol (301±157.9) were significantly (p= ≤ 0.05) higher among the participants. However, the levels of LH and FSH were similar among the participants and controls (p = ≤0.77 and ≤0.07 respectively). CONCLUSION: Hyperprolactinaemia and oestradiolaemia are characteristics of secondary female infertility in Nigeria. Laboratory evaluation of the hypothalamic-pituitary-gonadal axis with thyroid hormones cannot be over- emphasized for a proper diagnosis and impact on the treatment of infertility.

CONTEXTE: L'infertilité touche environ 186 millions de personnes dans le monde et 8 à 12 % des couples en âge de procréer. L'infertilité féminine reste le cas gynécologique le plus fréquent dans de nombreux centres de fertilité au Nigeria, avec une prévalence nationale de l'infertilité comprise entre 10 et 23,6 %. L'axe hypothalamohypophyso- gonadique (HPG) de l'interaction hormonale et de la sensibilité des organes représente environ 19 % des causes d'infertilité chez les femmes au Nigeria et l'évaluation en laboratoire des hormones de cet axe a été une norme importante dans le diagnostic et le traitement. OBJECTIFS DE L'ÉTUDE: L'étude a examiné le profil des hormones HPG observées chez les femmes infertiles dans un centre Nigérian de traitement de la fertilité afin d'identifier et de classer les causes. MÉTHODES: Une étude descriptive transversale randomisée de 125 participants a été sélectionnée et stratifiée en 47 participants d'infertilité primaire et 78 participants d'infertilité secondaire respectivement menée entre octobre 2016 et août 2017. Les participants de contrôle étaient des femmes apparemment en bonne santé appariées par l'âge. Les niveaux sériques de quatre hormones (hormones lutéinisantes (LH), hormones folliculo-stimulantes (FSH), prolactine et oestradiol) ont été dosés en utilisant la technique ELISA. Les données ont été analysées à l'aide de SPSS version 20, la valeur p d"0,05 a été considérée comme significative. RÉSULTATS: L'âge moyen des femmes infertiles était de 30,4±5,8. Les niveaux sériques de prolactine (10,6±9,3) et d'oestradiol (301±157,9) étaient significativement (p= ≤ 0.05) plus élevés chez les participantes. Cependant, les niveaux de LH et de FSH étaient similaires chez les participants et les témoins (p = ≤ 0.77 and ≤ 0.07 respectivement). CONCLUSION: L'hyperprolactinémie et l'oestradiolémie sont des caractéristiques de l'infertilité féminine secondaire au Nigeria. L'évaluation en laboratoire de l'axe hypothalamo-hypophysogonadique avec les hormones thyroïdiennes ne peut pas être trop soulignée pour un diagnostic approprié et un impact sur le traitement de l'infertilité. Mots clés: Profil, Hormones de reproduction, Infertilité.

THYROID DYSFUNCTION IN WOMEN OF REPRODUCTIVE AGE: LABORATORY PROTOCOL FOR INFERTILITY EVALUATION.

Background: Infertility in developing counties worldwide is associated with many social, financial, and medical challenges. With a prevalence rate of between 10 - 14 % and biochemical etiology of about 80% of the cases among Nigerian women, laboratory diagnosis has gradually assumed an important role in improved diagnosis. Objective: The aim was to evaluate the prevalence of thyroid dysfunction in infertility and need to evaluate. Methods: This was a descriptive cross-sectional case study of one hundred and twenty-five (125) women selected by stratified random sampling method into two groups of primary and secondary infertility. A total of 125 healthy fertile women served as the control group. Serum freeT3 (fT3), feeT4 (fT4), and TSH were analyzed using commercial ELISA kits. Data were analyzed using SPSS version 20.0 and the p-value of ≤0.05 was considered statistically significant. Results: Twenty participants (16%) were observed to have associated thyroid dysfunction with infertility. The commonest thyroid dysfunction was overt hypothyroidism (9.6%) and subclinical hypothyroidism (4.0%) respectively and this was found to be commoner in secondary infertility (21.8%). Conclusion: Thyroid function evaluation (especially serum TSH) should be included as a routine assessment in infertility protocol, especially in secondary infertility cases.

Relationship between serum level of ionized calcium, magnesium, phosphate, vitamin D and parathyroid hormone with stages of CKD

Background: Chronic kidney disease is defined as either damage or a decreased Glomerular Filtration Rate of less than 60ml/min/1.73m2 for 3 or more months. There is destruction of renal mass with irreversible sclerosis and loss of nephron leading to a progressive decline in GFR.Secondary hyperparathyroidism hyperphosphataemia, hypocalcaemia and vitamin-D deficiency are common complications of CKD. Objective: To determine relationship between serum level of ionised calcium, magnesium, phosphate, vitamin-D and parathyroid hormone with stages of CKD. Method: This study was conducted at ABUTH Zaria. 125 consecutive adult patients in various stages of CKD who presented were enrolled and 125 apparently healthy matched for sex and age controls were also recruited. Results: 9% of patients were in stage-1, 16% in stage-2, 22% in stage-3, 12% in stage-4 and 41% in stage-5. Serum ionised calcium, vitamin-D and eCrCl showed a progressive decline as the stage of CKD advances, while serum phosphate, creatinine and iPTH showed a progressive increase as the stage of CKD advances. Changes in serum magnesium showed a slight change with advancing stages of CKD. The difference in mean serum levels of calcium, phosphorus, vitamin-D, parathyroid hormone, creatinine and eCrCl with different stages of CKD were statistically significant. eCrCl correlated negatively with phosphate and iPTH while serum creatinine correlated negatively with calcium and positively with phosphate and iPTH. Conclusion: Majority of CKD patients were in late stage. Correlation of analytes with stages was more in late stages and biochemical derangements occurred in late, rather than early stages of CKD

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria.

BACKGROUND: Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients. OBJECTIVE: To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke. METHOD: Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). RESULTS: Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772). CONCLUSION: The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

Liver function tests profile in cancer patients on cytotoxic chemotherapy: a preliminary report.

AIMS AND OBJECTIVES: To assess liver function in Nigerian cancer patients undergoing cytotoxic chemotherapy, with a view to contributing to the existing literature and possibly making recommendations for better management of the affected patients in Nigerian hospitals. PATIENTS AND METHODS: Serum levels of total bilirubin (TB), alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), total protein (TP), albumin (ALB) and De Ritis ratio (AST/ALT) were determined in 50 cancer patients both before and after chemotherapy and 50 age- and sex-matched control individuals. The data obtained were analysed using Microsoft Office Excel 2003. Two-tailed student's t- test for matched samples and Pearson's linear correlation statistical methods were employed for the analyses. RESULTS: The levels of serum ALT, AST, ALP and TB, ALB, TP and AST/ALT were significantly higher in cancer patients than in controls both before and after chemotherapy, with more pronounced elevations after chemotherapy. There were positive and significant correlations between cycles of chemotherapy and the serum liver function tests. CONCLUSION: The findings from the present study conclude that there is slight difference when compared to controls in liver function test profile in cancer patients even before commencement of chemotherapy with a worsening of the profile of patients after chemotherapy. This difference in liver function also increases with the cycles of chemotherapy.

Anti-Retroviral Therapy Induced Diabetes in a Nigerian

Background:Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection.This has led to increased life expectancy in HIV infected individuals on one hand; and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipi- daemia; lipodystrophy; insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. Objective: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. Methods: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. Conclusion: Awareness and high index of suspicion is required to identify the metabolic complications of ART

Reference interval of serum heat-stable alkaline phosphatase activity in pregnant women in Zaria.

UNLABELLED: The study was designed to establish a reference interval for serum heat-stable ALP activity in pregnancy, which is not available in this environment. MATERIALS AND METHODS: One hundred (100) apparently healthy pregnant women in their third (3rd) trimester who were attending the antenatal clinic (ANC) of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria were recruited for the study. The serum heat-stable ALP activity was measured using the 4-nitrophenyl phosphate (4-NPP) method introduced in 1946 by Bessey, Lowry and Brock. RESULTS: The reference interval for the serum heat-stable ALP activity was found to be 24-161 IU/L. This was similar to some earlier reports elsewhere. CONCLUSION: The finding will help in the evaluation/diagnosis of patients with placental insufficiency.