Faculty of Clinical Sciences

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    Open Access
    Cardiopulmonary and Quality of Life Responses of Individuals with Type 2 Diabetes to Therapeutic Excercises
    (2011-04) Osho, O.A
    BACKGROUND: Cardiopulmonary complications of diabetes mellitus contribute greatly to the morbidity, mortality, and reduced quality of life in people with type 2 diabetes (T2DM). These complications require multifactorial treatment which includes targeting hyperglycaemia, obesity, hypertension and reduced lung functions among other factors which had been shown to pose challenge to people with T2DM. The inclusion of an appropriate exercise program is thus critical for optimal health in individuals with diabetes. OBJECTIVE: This study was designed to investigate the cardiopulmonary, biochemical, anthropometric and QoL of individuals with T2DM in response to therapeutic exercises. It was also aimed at determining the time frame when therapeutic effects of exercise interventions occur. METHODOLOGY: Sixty individuals with T2DM, both male and female within the age range of 20-75years participated in this study. They were consecutively recruited and randomly allocated into two exercise groups and a control group. Therapeutic exercise interventions for groups I and II were existing exercise protocols which were aerobic exercises on treadmill and bicycle ergometer respectively at progressive moderate intensity of 60%, 70% and 80% of heart rate reserve combined with resistance exercises at moderate intensity of 50%, 60% and 70% of one repetition maximum. The outcome measures were obtained at baseline, 4th week, 8th week and 12th week of the intervention period. These included cardiovascular parameters [resting arterial systolic (RASBP) and diastolic blood pressure (RADBP) and resting rate pressure product (RRPP)], pulmonary parameters [oxygen uptake (VO2max), forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1)], anthropometric parameters (body mass index (BMI), waist hip ratio (WHR), and waist circumference (WC)) and QoL variables. The QoL was assessed using Diabetes Quality of Life Clinical Trial Questionnaire-Revised. The biochemical parameter [glycosylated haemoglobin (HbA1C)] of the subjects was assessed at baseline and at the end of the 12th week. Descriptive and inferential statistics were utilized for data analysis. Level of significance was set at p<0.05. RESULTS: Groups I and II recorded significant reduction in cardiovascular, biochemical and some anthropometric variables while pulmonary and QoL variables were significantly increased post intervention (<0.05). RASBP, RADBP, RRPP, HbA1c were significantly reduced while VO2max, FEV1, and QoL were significantly improved in the two exercise groups when compared with the control group (P<0.05). However, FVC and WC were only significant in group I (p=0.00 and 0.03). Furthermore, Group I recorded better improvement in pulmonary function (FEV1 and FVC) when compared to group II. Therapeutic effect of moderate intensity combined aerobic and resistance exercise on some cardiopulmonary variables occurred as early as four week post exercise intervention (RRPP, VO2max and FEV1), the trend of this effect continue to the eighth and twelfth week post intervention. CONCLUSION: Weight bearing and non-weight bearing aerobic exercises when combined with resistance exercise both gave significant therapeutic benefits on the cardiopulmonary and QoL of people with T2DM. However, the choice of either should ultimately depend on the superior judgment of the clinicians; it should also depend on the outcome measures which the clinicians are aiming at improving on. In the absence of significant reduction of pulmonary variables, non-weight bearing exercises combined with resistance exercises will be suggested especially if there are contradicting foot pathologies which may be aggravated by weight bearing aerobic exercises combined with resistance exercises (WBARE). Otherwise, WBARE will be more beneficial in the absence of foot pathologies. In addition, assessment of RRPP, VO2max and FEV1 in people with T2DM should commence after four weeks post intervention.
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    Open Access
    The contribution of adrenoceptors and calcium to the control of ventilation during carotid body stimulation in Cats
    (School of Postgraduate Studies of the University of Lagos, Akoka, 1991) Jaja, S.I
    The contribution of alpha-adrenoceptors, beta-adrenoceptors and calcium to ventilation during carotis body simulation remains controversial. In the present study, this has been investigated. The experiments were performed in cats anesthetized with a mixture of urethane and chlralose.
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    Open Access
    Early Tuberculosis Immunodetection using Genomic Antigens and Inducement of T-Cells in HIV+TB Subjects in Lagos, Nigeria
    (2015) Adeiga, A.A
    The probability of developing tuberculosis (TB) disease is higher in immune compromised subjects such as HIV/AIDS patients. Conventional methods of diagnosing TB which include sputum smear microscopy, culture and chest X-ray have drawbacks and established limitations. The limitations are pronounced in immuno-compromised subjects. The consequence of poor diagnosis of TB especially in resources limited environment like Nigeria contributes to the rising incidence of TB. Introducing immuno detection method using genomic antigens is priming for early detection of TB. This study was designed to evaluate the available genomic TB antigens for T-cell stimulation and to explore possibility of improving diagnostic performance in immuno-compromised patient by inducing T-cells. The study population includes subjects with active TB only, HIV+TB, HIV only, subjects with TB contacts and apparently healthy controls. Smear microscopy and culture were performed on sputum samples obtained. Whole blood cells from suspected TB infected subjects and TB contacts were incubated with RPMI 1640 and glutamine to provide enriched medium of protein and vitamins for the T-cells in the blood and fetal calf serum (FCS) to induce T-cells during incubation so as to make the T-cells respond better when stimulated during incubation. Low dosage of 2.5 µg/ml of TB antigens (ESAT-6,CFP-10 and ELLI the new TB antigen) obtained from LIONEX Inc. Germany was used to stimulate the T-cells in the whole blood during the 72 hour incubation. Sera obtained after stimulation were used for Interferon Gamma Release Assay (IGRA) to assess the IFN-γ released during T-cell stimulation. The result of smear microscopy and culture revealed that even though a high percentage of positivity was obtained from the result of smear microscopy and culture, some of the positives (20.83%) smear microscopy were negative for culture. These were part of the drawbacks of high sensitivity and low specificity observed. Result of using TB antigens for T-cell stimulation showed that ELLI the new antigen was the most immunogenic of the antigens used when compared with existing ESAT-6 and CFP-10. T-cells performed optimally when induced with 1% FCS and stimulated with low dose antigen of ELLI and the combined ESAT-6+CFP-10. The inducement of T-cells improved the diagnosis of TB in HIV subjects that were asymptomatic of TB and individuals at risk especially the previous TB contacts. Sensitivity and specificity of IGRA increased above 80% with the inducement of T-cells. In conclusion, the study attempts to improve TB diagnosis using genomic antigens relative to the conventional non genomic antigens methods. This approach has the potential to improve detection of TB subjects using immunodetection technique.
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    Open Access
    Early Tuberculosis Immunodetection using Genomic Antigens and Inducement of T-Cells in HIV+TB Subjects in Lagos, Nigeria
    (School of Postgraduate Studies University of Lagos, 2015-03) Adeiga, A.A.
    The probability of developing tuberculosis (TB) disease is higher in immune compromised subjects such as HIV/AIDS patients. Conventional methods of diagnosing TB which include sputum smear microscopy, culture and chest X-ray have drawbacks and established limitations. The limitations are pronounced in immuno-compromised subjects. The consequence of poor diagnosis of TB especially in resources limited environment like Nigeria contributes to the rising incidence of TB. Introducing immuno detection method using genomic antigens is priming for early detection of TB. This study was designed to evaluate the available genomic TB antigens for T-cell stimulation and to explore possibility of improving diagnostic performance in immuno-compromised patient by inducing T-cells. The study population includes subjects with active TB only, HIV+TB, HIV only, subjects with TB contacts and apparently healthy controls. Smear microscopy and culture were performed on sputum samples obtained. Whole blood cells from suspected TB infected subjects and TB contacts were incubated with RPMI 1640 and glutamine to provide enriched medium of protein and vitamins for the T-cells in the blood and fetal calf serum (FCS) to induce T-cells during incubation so as to make the T-cells respond better when stimulated during incubation. Low dosage of 2.5 µg/ml of TB antigens (ESAT-6,CFP-10 and ELLI the new TB antigen) obtained from LIONEX Inc. Germany was used to stimulate the T-cells in the whole blood during the 72 hour incubation. Sera obtained after stimulation were used for Interferon Gamma Release Assay (IGRA) to assess the IFN-γ released during T-cell stimulation. The result of smear microscopy and culture revealed that even though a high percentage of positivity was obtained from the result of smear microscopy and culture, some of the positives (20.83%) smear microscopy were negative for culture. These were part of the drawbacks of high sensitivity and low specificity observed. Result of using TB antigens for T-cell stimulation showed that ELLI the new antigen was the most immunogenic of the antigens used when compared with existing ESAT-6 and CFP-10. T-cells performed optimally when induced with 1% FCS and stimulated with low dose antigen of ELLI and the combined ESAT-6+CFP-10. The inducement of T-cells improved the diagnosis of TB in HIV subjects that were asymptomatic of TB and individuals at risk especially the previous TB contacts. Sensitivity and specificity of IGRA increased above 80% with the inducement of T-cells. In conclusion, the study attempts to improve TB diagnosis using genomic antigens relative to the conventional non genomic antigens methods. This approach has the potential to improve detection of TB subjects using immunodetection technique.
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    Open Access
    Effects of Stabilization Exercise on Pain, Cross-Sectional Area and Muscle Thickness of Lumbar Multifidus in Patients with Chronic Low Back Pain.
    (2014) Akodu, A.K
    Low Back Pain (LBP) is a highly prevalent problem and one of the main causes of disability in the society. About 80-90% of people suffer LBP during their lifetime and it is the second most frequent reason for visits to the physician. Although the aetiology is diverse, many causes have been related to weakness or injury of the soft tissue in the lumbar area. Different treatment modalities have been used in the treatment of LBP, but with temporary relieve of symptoms and lack of improvement of the atrophy of lumbar multifidus muscle which improves the stability of the lumbar spine. This study investigated the effect of stabilization exercise on chronic pain, cross-sectional area and muscle thickness of Lumbar Multifidus (LM) muscle in patients with chronic low back pain. A total of 122 patients (44 males, 78 females) with non-specific chronic low back pain (NCLBP) were recruited from Orthopaedic Clinic of Lagos University Teaching Hospital (LUTH), Idi- Araba, Lagos and National Orthopaedic Hospital Igbobi, Lagos. They were randomly assigned to four different groups (1, 2, 3 & 4) using computer generated numbers. The participants went through stabilization exercise only (Group 1) for 30 minutes twice weekly one day interval for 8 consecutive weeks, stabilization exercise for 30 minutes combined with Transcutaneous Electrical Nerve Stimulation (TENS) for 10 minutes (Group 2) twice weekly one day interval for 8 consecutive weeks, stabilization exercise for 30 minutes combined with TENS for 10 minutes and massage for 5 minutes (Group 3). Group 4 is the control that was placed on drug therapy. A randomized control study was adopted in this study. Measurement of Cross-Sectional Area (CSA) and muscle thickness of LM muscle, self perceived pain intensity, functional disability and fear were assessed using Ultrasound machine (Mindray 2200), modified visual analogue scale, Oswestry disability questionnaire and fear avoidance belief questionnaire respectively at baseline, end of 4th week and end of 8th week. Data were analysed using statistical package for social science version17 and presented using descriptive statistics of mean and standard deviation. Kruskal Wallis test was used to analyse each of the outcome measure parameters and analysis of variance (ANOVA) was used to analyse the cross-sectional area (CSA) and thickness pre and post treatment intervention across the groups. Patients in groups 1, 2 and 3 recorded significant reduction in pain severity, increased functional ability and decreased fear avoidance belief following intervention (P<0.05). Post hoc analysis revealed that the significance lies between group 1&4, group 2&4, groups 3&4 post intervention assessment. This reveals that the intervention used in the course of this study was effective in the management of patients with chronic low back pain. There was predominant increase in the CSA at 4th and 5th lumbar vertebrae only with more increment in group 1 with a mean and standard deviation of 11.85± 1.99 at 4th lumbar vertebrae and 12.10 ± 2.19 at 5th lumbar vertebrae. There was increase in the LM muscle thickness at L4-L5 post-intervention assessment with more increment in group 1 with a mean and standard deviation of 3.19 ± 0.69, within the three groups these shows that stabilization exercise alone and in combination with TENS and massage are effective in increasing the CSA and thickness of lumbar multifidus muscle in patients with non-specific chronic low back pain. The study established that stabilization exercise only and in combination with TENS and massage is effective in managing patients with non-specific chronic low back pain (NCLBP). It was also established that assessment of CSA and muscle thickness of LM can be used as a measure of treatment improvement or progression in patients with NCLBP.
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    Open Access
    Medication Counselling Practice in Community Pharmacies in Lagos State, Nigeria.
    (2014) Ajiboye, W.T
    Community pharmacies are major sources of medicines in most communities in Nigeria. Clients visit community pharmacies to seek help in medication therapy from community pharmacist,who has a professional responsibility to protect the public from the dangers of self medication through provision of adequate medication counselling. It is however not known to what extent community pharmacists fulfil this roles. The aim of this study was to examine the nature, extent and adequacy of medication counselling practice in community pharmacies and the factors influencing counselling practice. A cross sectional survey of community pharmacies using simulated clients visit (Observational study) and cross sectional survey of community pharmacists using self administered questionnaire were carried out. Documents containing policy statements, laws and regulations were also reviewed. Educational intervention involving training of pharmacists in a workshop and on-site practical demonstration was carried out. A total of 185 community pharmacies had complete data for inclusion in the analysis, representing 89.9% response rate. Pharmacist in 65 % of the pharmacies provided counselling. None of the pharmacist asked more than two questions, Information on dosage and frequency were the most (48%) frequently mentioned medication information items and information on adherence to medication least mentioned (3.6%). Only 10% pharmacies provided adequate medication counselling. Workload in the pharmacy (number of clients seen daily), and time of the day in which the pharmacy was accessed were found to be predictors of the amount of counselling offered by pharmacy staff (R= -0.268 & -0.329 ; p= 0.01 & 0.002 respectively). Weak regulatory framework on counselling practice, inadequate knowledge of medication counselling among many (72.3%) community pharmacists and lack of medication counselling guide/aids were also identified as potential factors influencing counselling practice. Medication counselling practice in community pharmacies in Lagos State is grossly inadequate. Workload in the pharmacy, inadequate knowledge of pharmacists and weak regulatory framework should be targeted as intervention by various pharmacy and public health stakeholders in order to improve the practice.
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    Open Access
    Pharmaceutical care and syndromic management of sexually transmitted infections (STIs) by Community Pharmacists in Lagos State
    (School of Postgraduate Studies of the University of Lagos, Akoka, 2011-09) Joda, A.E.
    Sexually Transmitted Infections (STIs) are infections passed from one person to another during sexual contact though some are also passed from mother to child during pregnancy, birth or while breast feeding. STIs constitute an important public health problem. The early detection and treatment of STIs are important aspects of a comprehensive approach to reducing the spread of HIV. Although public-sector services are available even in the most resource-poor countries, they are not acceptable to many clients because they do not have appropriate health personnel or the necessary medicines. Private providers are often preferred because they are perceived to offer better access and confidentiality, and often have the reputation of being less stigmatizing than public sector facilities. However, many of these patients are not managed rationally as their management does not conform to stated guidelines. The main aim of this work was to determine the knowledge and practice of the community pharmacists on pharmaceutical care and syndromic management of STIs and assess the impact of training. The work also investigated the patronage of STI patients in health facilities, knowledge and practice of the general public as well as the quality of ciprofloxacin tablets in pharmacies in the State.
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    Open Access
    Return to Driving After Musculoskeletal Disorders: Developing a Nigerian Musculoskeletal Disability Index.
    (2014) Okafor, U.A.C
    BACKGROUND / OBJECTIVE: Returning to driving is a major concern to individuals who stopped driving due to health problems or other reasons as many see the ability to drive again as a crucial index of recovery. Not much is known about the extent to which individuals who present with musculoskeletal disorders, injury or surgery return to driving and the evaluation they receive prior to return as studies are sparse on the subject matter. This study aimed to determine the factors predicting return to driving after musculoskeletal disorders, and to develop a Driving Musculoskeletal Disability Index (DMDI) to determine suitability of return to driving after musculoskeletal disorders, injury or surgery. METHODOLOGY: Three independent surveys involving patients (n=320), healthcare practitioners (n=355) and road traffic safety regulators (n=300) were polled. Patients who drove before their musculoskeletal disorders, injury or surgery were recruited from the three Nigerian National Orthopaedic Hospitals. The healthcare practitioners comprised Orthopaedic Surgeons / Senior Registrars, Physiotherapists and Occupational Therapists across Nigeria’s six geo-political zones while the road traffic regulators comprised Senior Field Operations and Research Officers of the Federal Road Safety Commission across Nigeria with a minimum of two years field experience in the corps. RESULT: Knowledge scores on return to driving after musculoskeletal disorders showed that healthcare practitioners had a fair knowledge (125, 41.8%), the practitioners and regulators had a positive attitude whereas a good practice score was shown by the practitioners (259, 86.6%). The patients exhibited poor knowledge (122, 60.7%), negative attitude (126, 62.4%) and poor practice (160, 79.6%) towards return to driving regulation in Nigeria (p= 0.0001. Logistic regression analysis showed that gender and severity of injury were predictors of return to driving following musculoskeletal disorders, injury or surgery. A DMDI was developed with predictive validity of 86% (sensitivity) and 80% (specificity) as a clinical tool to determine suitability of returning to driving after musculoskeletal disorders, injury or surgery in Nigeria. CONCLUSION: Healthcare practitioners had a fair knowledge and good practice; the regulators had a positive attitude whereas the patients had poor knowledge, negative attitude and poor practice towards return to driving policy and regulation in Nigeria. The study further showed that gender and severity of injury are predictors of return to driving after musculoskeletal disorders, injury or surgery. A Driving Musculoskeletal Disability Index (DMDI) was developed as an outcome measure with psychometric property to determine suitability of returning to driving after musculoskeletal disorders, injury or surgery in Nigeria.
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    Open Access
    Role of the Peripheral Arterial Chemoreceptors in the Integrated Cardiovascular Response to Systematic Hypoxia
    (University of Lagos, 1987) Egbengu, E.P.
    Experiments were performed on healthy male and female mongrel dogs, anaesthetized with a sodium pentobarbitone. The animals were either allowed to breathe spontaneously or were artificially ventilated using a mechanical respirator. Systematic hypoxia was induced by allowing animals to breathe a hypoxia gas mixture containing 7% 02 in 93% nitrogen. Vascularly isolated carotid chemoreceptor areas were perfused at constant perfusion pressure through an extracorporeal circuit assembly with hypoxic blood or arterial blood obtained from an artificial membrane lung. The role of carotid chemoreceptor was assessed by perfusing the carotid bifurcation areas with arterial or normoxic blood, while the animal still breathe the hypoxic gas mixture. The role of aortic chemoreceptor was assessed by comparing cardiovascular responses to systemic hypoxia before and after bilateral mid-cervical vagotomy, since afferents from aortic and carotid chemoreceptor during systemic hypoxia was assessed by perfusing the carotid chemoreceptor with arterial blood in animals that were vagotomised. Cardiovascular variables measured included blood pressure (BP) hear rate (HR), left ventricular pressure (LVP), MAXIMUM RATE OF RISE of left ventricular pressure (LVdp/dt max) and femoral artery perfusion pressure (FAPP). The control values of these variables were determined and compared with the values during systemic hypoxia; systemic hypoxia with carotid withdrawal; systemic hypoxia with aortic withdrawal by vagotomy; and with systemic hypoxia with both carotid and aortic withdrawal.
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    Open Access
    Studies on the Pathogenicity of Campylobacter Jejuni
    (University of Lagos, 1990-11-16) Epoke, J
    Rats experimentally, infected with about 106 CFU or more of Campylobacter jejuni were promptly colonized. Campylobacter jejuni was recovered from faecal cultures of infected rats for up to 17 weeks post infection. The infected rats did not succumb to diarrhoea throughout the experiment. Haemagglutination assay was used to detect adhesins of Campylobacter jejuni isolated locally. Five out of 15 (33 percent) of the strains tested agglutinated erythrocytes of human blood group A + and guinea pig but not sheep RBC"s. The haemagglutination observed was inhibited by mannose and galactose but not glucose. The presence of dhesins and the ability of Campylobacter jejuni to colonize the intestinal tract both enhance the establishment of infection. Two out of five (40 percent) culture filtrates of Campylobacter jejuni showed both cytotonic and cytotoxic activities on Vero, Hela and Hep2 cells. Two out of 18 (11 percent) of the filtrates also caused fluid accumulation in ligated rat ileal loop. The cytotonic toxin may be responsible for diarrhoea induction while the cytotoxc toxins may account for the sydenteric symptoms observed with Campylobacter jejuni infections. Purified endotoxin extracted from Campylobacter jejuni was used for Schwartzman reaction in rats. Localized Schwartzman reaction was observed in rats eight hours after second injection of Campylobacter jejuni purified endotoxin extract. The localized lesion was mainly an erythematous swelling. Animals subjected to generalized reactions manifested wide spread deposition of fibrin thrombi. The thrombi observed resulted from disseminated intravascular coagulation. The lungs, heart, kidneys, liver and spleen were all affected in the generalized reaction. Two out of five Campylobacter jejuni strains were recovered from blood of animals following oral experimental infection. The organisms were also recovered from the liver, spleen and kidney after oral infection. The translocation of the organisms from the gastrointestinal organs denotes invasiveness of the strains studied. Kerato conjunctivitis was examined in this work. This negative sereny test implies that the guinea-pig conjunctival cells may be resistant to invasion by Campylobacter jejuni. Oral infection of rats with Campylobacter jejuni gave rise to distinct histological lesions. The gastrointestinal tract showed focal hyperplasia of lymphoid follicles with prominent germinal centres. There were also focal necrosis of superficial epithelia and focal oedema of villi tips. The necrosis gave rise to "gully ulcers" in the mucosa. The lesions were concentrated at the upper ileum. The liver of infected rats should focal perivascular haemorrhage with prominent diffuse hydropic degeneration of hepatocytes. Rats are very useful in the study of histopathology from experimental Campylobacter jejuni infection despite their resistance to diarrhoea. This is because the lesions observed in experimentally infected rats in this work were comparable to lesions observed in human Campylobacteriosis.
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    Open Access
    Studies on the Relationship between Some Trace-Elements and Steroid Hormones in Prostatic Disorders amongst Nigerians
    (University of Lagos, 1986) Ogunlewe, O.J.
    Benign hyperplasia and carninome of prostate are prostatic disorders commonly found in aging males. These diorders are reported to be less common amongst Nigerians, though there has been no concrete pathophysiological evidence to support this observation.The exact aetiology of these disorders has not been resolved, but some factors have been identified as being contributory to their development. Amongst these factors are androgenic hormonal control and the influence of some trace-elements on the metabolic activities of the gland.We investigated the interrelationship between these factors in Nigerians with a view to elucidating any physiological differences that may exist between Nigerians and other peoples. Our results showed that the extracellular hormonal millieu of the prostate gland in Nigerians is not significantly different from those of Caucasians in Europe and North America. Plasma testosterone levels in healthy Nigerians, aged between 50 and 90 years (15.5 + 0.4)nmol/1 SE) is comparable to the levels reported for caucasians of a similar age group in Germany and England. This level is also significantly higher than the levels in age-matched cancer patients (10.9 + 0.7) nmol/1) (P<0.001), but not significantly different from the levels in age-matched BPH patients (14.9 + 0.4 nmol/1 SE: P>0.10). Levels of other androgens were not different between the three groups. Plasma levels of zinc were higher in BPH subjects and lower in cancer patients compared wih healthy controls, while plasma cadmium was higher in cancer patients. Intraprostatic DHT was elevated in hyperplastic tissues (4.9 + 0.2 ng/g) relative to normal tissues (1.7 + 0.18 mg.g) ad malignant tissues (1.7 + 0.2 ng/g). In contrast, testosterone and A-Dione were found in greater concentration in malignant tissues (7.9 + 0.6 ng/g and 4.6 + 0.3 ng/g respectively) than in BPH (0.5 + 0.3 ng/g; 0.2 + 0.01 ng/g and normal tissues 0.3 + 0.05 ng/g; 0.2 + 0.03 ng/g). Zinz was significantly concenrtrated in hyperplastic tissues (17.9 + 0.6 umol/g or 1170 + 39.2 ug/g) and Normal tissues (12.1 + 0.8 umol/g; 791 + 55.5 ug/g) than in malignant tissues 2.9 + 0.4 umol/g; 189.6 + 26.1 ug/g). A greater proportion of zinc and DHT were located in the nuclear fraction of hyperplastic tissues. In contrast, the cytoplasmic concentration of zinc was inversely proportional to DHT concentration in these tissues. Cadmium accumulated more in malignant tissues (28.9 + 0.37 nmol/g) compared with normal 3.8 + 0.63 nmol/g) and hyperplastic tissuess (14.6 + 1.1 nmol/g). The results suggest an interrelationship between the concentration of zinc and accumulation of DHT, especially in the nucleus of hyperplastic tissues. Results of in vitro experimental studies involving additions of varying concentrations of exogenous zinc and cadmium aptly supported the above findings. Additions of low concentration (10-5 to 10-12M) of exogenous zinc enhanced the activities of 5 & reductase and 3 & hydroxy-steroid dehydrogenase (Reductase) in the conversion of testosterone to DHT and DHT 3 & diol in hyperplastic tissues, whereas concentrations higher than 10-5M inhibited the reaction. Similar results but to a lesser degree were obtained with carcinomatous tissues. Experiments with cadium also showed similar efefcts on the transformation of testosterone to DHT. This study shows the intracellular and extracellular hormonal environments of the prostate gland in Nigerians are not different from that of Europeans. However, the interrelationship between plasma and tissue concentrations of zinc and androgens appears to affect the levels of androgens available to the prostate, which in turn could promote or prevent the processes culminating in prostatic disorders.
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    Open Access
    Therapeutic Exercises for Female Breast Cancer Survivors: Assessment of Cardiopulmonary, Anthropometric and Quality of life outcomes.
    (2014) Aweto, H.A
    Breast cancer (BC) is a prevalent disease whose incidence continues to rise especially in economically developing countries. Reduction in cardiopulmonary capacity of BC Survivors, which is positively associated with reduction in quality of life (QoL) and premature death, is a major problem associated with the disease. Therapeutic approaches that will improve cardiopulmonary capacity, QoL and survival rate of BC survivors are pressing concern. This study therefore investigated the effects of therapeutic exercises on selected cardiopulmonary, anthropometric and QoL parameters in premenopausal and postmenopausal BC survivors. Ninety-six (96) female BC survivors with stage I, II and III BC, recruited through referrals by physicians from the Radiotherapy and Oncology Department of Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State completed the study. They were randomly assigned to 4 groups (A, B, C and D) and each group was further subdivided into 2 subgroups (1 and 2) based on their menopausal status. Group A underwent moderate intensity aerobic exercise using treadmill with educational and counseling sessions, Group B, stretching exercises with educational and counseling sessions and Group C, combined moderate intensity aerobic exercise using treadmill and stretching exercise with educational and counseling sessions. Group D was the control group which had no therapeutic exercise intervention but had only group educational and counseling sessions. Topics discussed during the group educational and counseling sessions included problems BC survivors are faced with as a result of the disease and its treatments as well as the means to deal with them. The duration of therapeutic exercises started at 15 minutes for weeks 1 – 3 and systematically increased by 5 minutes after every 3 weeks. Therapeutic exercise frequency was 3 times a week for 12 weeks. The moderate intensity for aerobic exercise was calculated as the equivalence of the subjects’ target heart rates. Statistical Package for Social Sciences (SPSS) version 20.0 was used to analyse the data. Data was analysed using descriptive statistics of mean and standard deviation. Analysis of variance (ANOVA) was used to compare the physical characteristic variables of subjects across groups. Repetitive ANOVA was used to compare the cardiovascular, pulmonary and anthropometric variables across the baseline, end of 3rd, 6th, 9th and 12th weeks within the groups. Paired t test was used to compare the pre and post treatment mean values of the same outcome variables within groups. Paired t test was used to compare the changes in the selected variables of premenopausal BC survivors with those of postmenopausal BC survivors at the end of 12th week. Paired t test was also used to compare the changes in the various exercise groups with those of the control group. Friedman test was used to analyse QoL values within groups and Kruskal-Wallis H test across groups. Level of significance was set at p<0.05. Subjects in the three therapeutic exercise groups had significant improvements in the cardiopulmonary and QoL variables although in various degrees. Those in Group C recorded the highest improvements followed by those in Group A and then those in Group B. Improvements in the cardiovascular variables of Groups B and C were more in the postmenopausal BC survivors than those of the premenopausal BC survivors while the reverse was the case for Group A. No significant improvement was observed in the anthropometric variables of any of the groups. Combined aerobic exercise using treadmill and stretching exercise brought about the most significant therapeutic effects on selected cardiovascular and pulmonary parameters in BC survivors. This was followed by aerobic exercise using treadmill alone and then stretching exercise alone. All the therapeutic exercises brought about significant improvements in the QoL of the BC survivors. The combined exercise therapy and stretching exercise alone brought about more prominent therapeutic improvements in the cardiovascular parameters of postmenopausal BC survivors than those of premenopausal BC survivors. None of the therapeutic exercises brought about significant improvements in the anthropometric variables of the BC survivors. Therefore, an ideal dosage of therapeutic exercise intervention that improves cardiopulmonary functions and QoL of BC survivors is combined moderate intensity aerobic exercise using treadmill and stretching exercise performed for 30 minutes, 3 times a week for at least 12 weeks.