SEX HORMONES CHANGES ASSOCIATED WITH MENSTRUAL CYCLE IN HIV INFECTED FEMALES AT NAUTH, NNEWI, SOUTHEAST NIGERIA

Background: The association of Human Immune deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and sex hormone changes may grossly affect the reproductive health in affected women. This was a prospective study done at Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria to evaluate the sex hormone changes in HIV infected women of reproductive age group during menstrual cycle. Materials and methods: A total of 90 women (60 HIV positive, 30 Control) were studied. After detailed medical examination, a well-structured questionnaire was self-administered. Blood samples were collected under sterile conditions during the follicular and luteal phases of menstrual cycle after due informed consent had been sought and obtained. The samples were analyzed for sex hormones (Progesterone, estradiol and testosterone) using Enzyme Linked Immunosorbent Assay (ELISA) method. Results: The result showed that the sex hormones (Progesterone, estradiol and testosterone) were significantly lower at both phases of the menstrual cycle in HIV infected women when compared to the Control (P<0.05). Conclusion: The study revealed some degree of hypogonadism in HIV infected women which may have some implication in their reproductive life

SEX HORMONES CHANGES ASSOCIATED WITH MENSTRUAL CYCLE IN HIV INFECTED FEMALES AT NAUTH, NNEWI, SOUTHEAST NIGERIA

Background: The association of Human Immune deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and sex hormone changes may grossly affect the reproductive health in affected women. This was a prospective study done at Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria to evaluate the sex hormone changes in HIV infected women of reproductive age group during menstrual cycle. Materials and methods: A total of 90 women (60 HIV positive, 30 Control) were studied. After detailed medical examination, a well-structured questionnaire was self-administered. Blood samples were collected under sterile conditions during the follicular and luteal phases of menstrual cycle after due informed consent had been sought and obtained. The samples were analyzed for sex hormones (Progesterone, estradiol and testosterone) using Enzyme Linked Immunosorbent Assay (ELISA) method. Results: The result showed that the sex hormones (Progesterone, estradiol and testosterone) were significantly lower at both phases of the menstrual cycle in HIV infected women when compared to the Control (P<0.05). Conclusion: The study revealed some degree of hypogonadism in HIV infected women which may have some implication in their reproductive life

Body Mass Index, Blood Pressure and Serum Cortisol Level as Stress Index in Symptomatic HIV/AIDS Male Subjects on Antiretroviral Therapy Negative to Malaria Parasite in Nnewi, Anambra State, Nigeria

Background: HIV infection is a risk factor for a variety of endocrine problems. Objectives: This study investigated the body mass index (BMI), Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and serum cortisol level as stress factor/index symptomatic HIV/AIDS male subjects on ART who are negative to malaria parasite in Nnewi, Anambra State, Nigeria. Methods: A total of 274 adult male participants aged between 18 and 60 (42 ±13) years were randomly recruited at the Voluntary Counseling and Testing (VCT) Centre in Nnamdi Azikiwe University Teaching Hospital and grouped based on WHO criteria for staging HIV into symptomatic HIV (stage 11) infected male participants on ART (A: n=69), Symptomatic HIV subjects not on ART (B: n= 69), Asymptomatic HIV positive subjects (C: n= 68) and HIV seronegative subjects (D: n= 68). Blood samples were collected from the participants for the determination of HIV status by immunochromatography and HIV confirmation by Western Blot. Enzyme-Linked Immunosorbent Assay (ELISA) was used to assay for cortisol level. Results: The results showed a significantly increased BMI and decreased mean serum cortisol level in HIV/AIDS seropositive participants on ART than in those, not on ART (p<0.05). Also, the BMI and mean serum cortisol level were significantly decreased and increased respectively in  HIV/AIDS seropositive participants not on ART than in Asymptomatic HIV positive subjects and control respectively (p<0.05). However, the mean SBP and DBP did not differ significantly between the groups studied (p>0.05). Conclusion: This study revealed a decreased stress index in HIV/AIDS subjects on ART with hypercortisolism and lower BMI in symptomatic HIV participants, not on ART. Keywords: HIV; AIDS; Malaria uninfected male subjects; Cortisol; Blood pressure; Antiretroviral therapy

Body Mass Index, Blood Pressure and Serum Cortisol Level as Stress Index in Symptomatic HIV/AIDS Male Subjects on Antiretroviral Therapy Negative to Malaria Parasite in Nnewi, Anambra State, Nigeria

Background: HIV infection is a risk factor for a variety of endocrine problems. Objectives: This study investigated the body mass index (BMI), Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and serum cortisol level as stress factor/index symptomatic HIV/AIDS male subjects on ART who are negative to malaria parasite in Nnewi, Anambra State, Nigeria. Methods: A total of 274 adult male participants aged between 18 and 60 (42 ±13) years were randomly recruited at the Voluntary Counseling and Testing (VCT) Centre in Nnamdi Azikiwe University Teaching Hospital and grouped based on WHO criteria for staging HIV into symptomatic HIV (stage 11) infected male participants on ART (A: n=69), Symptomatic HIV subjects not on ART (B: n= 69), Asymptomatic HIV positive subjects (C: n= 68) and HIV seronegative subjects (D: n= 68). Blood samples were collected from the participants for the determination of HIV status by immunochromatography and HIV confirmation by Western Blot. Enzyme-Linked Immunosorbent Assay (ELISA) was used to assay for cortisol level. Results: The results showed a significantly increased BMI and decreased mean serum cortisol level in HIV/AIDS seropositive participants on ART than in those, not on ART (p<0.05). Also, the BMI and mean serum cortisol level were significantly decreased and increased respectively in  HIV/AIDS seropositive participants not on ART than in Asymptomatic HIV positive subjects and control respectively (p<0.05). However, the mean SBP and DBP did not differ significantly between the groups studied (p>0.05). Conclusion: This study revealed a decreased stress index in HIV/AIDS subjects on ART with hypercortisolism and lower BMI in symptomatic HIV participants, not on ART. Keywords: HIV; AIDS; Malaria uninfected male subjects; Cortisol; Blood pressure; Antiretroviral therapy

Estimating the burden of selected non-communicable diseases in Africa: a systematic review of the evidence

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa

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

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\u2032s blood pressure was measured and any value 65140/90 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 6530 Kg/m 2 was referred to as global obesity. Their waist circumferences (WC) were also measured and any value 65102 cm for males and 6588 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

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