Nigerian Patients Research Articles

Medication Adherence and Perceived Family Support Among Elderly Patients with Hypertension Attending a Specialty Clinic in Lagos, Nigeria

Background: Hypertension and medication adherence are global public health challenges, with elderly patients suffering the most because they frequently have multiple co-morbidities. Objective: To evaluate the level of medication adherence and perceived family support among Nigerian elderly patients with hypertension. Methods: A descriptive, cross-sectional study among 293 consecutively consenting elderly hypertensive patients using an interviewer-administered, semi-structured questionnaire. The Modified Morisky Adherence Scale (MMAS-8) and Perceived Social Support-Family Scale (PSS-Fa) tools were used to assess medication adherence and perceived family support, respectively. Results: The mean age of respondents was 69.5±6.4 years. Medication adherence was good, moderate and poor among 14.3%, 68.6%, and 17.1% of the respondents respectively. Difficulty remembering to take medications was the primary reason for non-adherence in 73.7% of cases. Good adherence to medication was significantly associated with male gender (p = 0.046), living with grandchildren (p˂0.001), having other sources of income (p = 0.026) and receiving treatment for comorbid illnesses (p = 0.025). A higher proportion of the respondents (94.9%) had strong perceived family support, which lacked statistical significance regarding good medication adherence. (p = 0.739). Conclusion: This study found medication adherence low, despite most participants' strong family support. Forgetfulness and financial constraints were the primary reasons for poor medication adherence. Although family support is highly recommended and beneficial for medication adherence, other comorbid and social factors should be considered.

Determinants of quality of life in Nigerian female patients with epilepsy on carbamazepine and levetiracetam monotherapy

BackgroundThe study is aimed to identify the predictors of Quality of Life (QOL) in women with epilepsy (WWE) on carbamazepine (CBM) and levetiracetam (LTM) monotherapy. 100 WWE were recruited (50 each on CBM and LTM), after clinical diagnosis of epilepsy supported by Electroencephalography (EEG) features and seizures classification by 2017 International League Against Epilepsy (ILAE) criteria, the Quality of Life Inventory Scale 31(QOLIE-31) and Zung Self-Rating Depression Scale (ZSRDS) were used to assess QOL and depression, respectively.ResultHigher QOLIE-31 scores was seen in the LTM group across all domains except seizure worry (p = 0.051) compared to CBM group. Logistic regression showed that the use of CBM (p = 0.000), fast frequency on EEG (p = 0.005), longer duration of epilepsy (p = 0.017), presence of depression (p = 0.008) and lower level of education (p = 0.003) were predictors of QOL. Progesterone (p = 0.040), oestradiol (p = 0.011) and prolactin (p = 0.002) in follicular phase showed significant association with QOLIE-total score. In the luteal phase, luteinizing hormone–follicle stimulating hormone (LH–FSH) ratio (p = 0.009) and testosterone (p = 0.015), FSH (p = 0.015), prolactin (p = 0.000), showed significant association with QOL. None of the hormones independently predicts QOL.ConclusionLTM group appears to have better QOL than CBM group. Healthcare providers should focus on addressing these identified predictors which include medication effect, depression, Level of education, EEG background and duration of epilepsy with aim of improving QOL.

Human Immunodeficiency Virus, Cardiac abnormalities on Echocardiogram and the use of Highly Active Antiretroviral Therapy in Nigerian Patients

Background: An increasing relationship between HIV/AIDS, highly active anti – retroviral therapy (HAART) and cardiovascular diseases (CVD) have been noted over time. The occurrence of acquired immunodeficiency syndrome (AIDS) – associated heart disease found in post – mortem studies is notably higher than those diagnosed clinically implying that many HIV/AIDS patients may have cardiac abnormalities that are not diagnosed during their lifetime. This misdiagnosis persists even in the presence of dire consequences such as overt heart failure or even death. Aim: This study set to determine what cardiac abnormalities are present in Nigerian HIV positive patients and what differences exist in the manifestations of these cardiac abnormalities between HIV positive patients who have been on HAART and those who are non-treated with HAART. Methods: This was a cross-sectional analytical study with a comparison group in which two groups consisting of 76 HIV positive treatment naïve and 76 HIV positive HAART treated patients who met the inclusion criteria were sampled. The study protocol was reviewed and approved by the Research and Ethics Committee of the University of Benin Teaching Hospital, Benin City. All patients had an echocardiography done and data obtained was entered into and analyzed using the IBM-SPSS version 22.0. A p-value ≤ 0.05 was considered significant for all statistical comparisons done. Results: Total prevalence of ECHO abnormalities was 91.4% in HIV Positive patients. Echocardiographic cardiac abnormalities were more prevalent in HAART treated patients [94.7%] than treatment naïve patients [ECHO = 88.2%]. The cardiac abnormalities found include increased LVMI, left ventricular diastolic dysfunction, increased left ventricular mass, pericardial effusion and abnormalities in left ventricular geometry. Pericardial effusion was more prevalent in treatment naïve patients with treatment naïve patients also noted to have the worst form of left ventricular geometry with over half having abnormal left ventricular geometric patterns compared to about 1/3rd in HAART treated patients. Conclusion: Overall, HAART treated patients had cardiac abnormalities on echocardiogram than treatment naïve patients.

THE IMPLICATION OF GENETIC MEDICINE IN BREAST CANCER THERAPY IN NIGERIA: CLINICAL PRACTICE AND RESEARCH

In the preceding three decades, breast cancer occurrence and mortality rates have proliferated in Nigeria. Despite the considerable health, socioeconomic and developmental burdens breast cancer imposes on Nigeria, researchers have not extensively explored the use of genetic medicine in the management of this disease in Nigerian patients. This review’s objectives were to compare the diagnosis, treatment, and research of breast cancer in Nigeria and other countries. In addition, it also highlighted the setbacks and difficulties in breast cancer management in Nigeria. This journal employs a literature review. Detailed relevant articles were researched in two main electronic databases - Google Scholar and PubMed. The databases were analysed for keywords including: “breast cancer,” “breast cancer therapy,” “breast cancer diagnosis,” “breast cancer in Nigeria,” and “genetic medicine in breast cancer.” Only journals written in the English language between 1998 and 2022 were considered. 34 journals were identified, of which 22 were used for this review. Findings showed that genetics is not often considered for predicting and treating breast cancer. They also show that due to late presentation at the hospital, triple-negative breast cancer, usually at stage III or IV, is the most common breast cancer type in Nigeria. Genetic medicine should be integrated into the therapy and management of breast cancer in Nigeria. It will allow prediction of the disease, and timely diagnosis and ultimately possibly lead to a decline in breast cancer mortality and morbidity, just like in developed countries (high-income countries) such as The United States of America, Canada, and Sweden.

Human Immunodeficiency Virus, Cardiac abnormalities on Echocardiogram and the use of Highly Active Antiretroviral Therapy in Nigerian Patients

Human Immunodeficiency Virus, Cardiac abnormalities on Echocardiogram and the use of Highly Active Antiretroviral Therapy in Nigerian Patients

The development of a machine learning algorithm for early detection of viral hepatitis B infection in Nigerian patients

Access to Hepatitis B Virus (HBV) testing for people in low-resource settings has long been challenging due to the gold standard, enzyme immunoassay, being prohibitively expensive, and requiring specialised skills and facilities that are not readily available, particularly in remote and isolated laboratories. Routine pathology data in tandem with cutting-edge machine learning shows promising diagnostic potential. In this study, recursive partitioning (“trees”) and Support Vector Machines (SVMs) were applied to interrogate patient dataset (n = 916) that comprised results for Hepatitis B Surface Antigen (HBsAg) and routine clinical chemistry and haematology blood tests. These algorithms were used to develop a predictive diagnostic model of HBV infection. Our SVM-based diagnostic model of infection (accuracy = 85.4%, sensitivity = 91%, specificity = 72.6%, precision = 88.2%, F1-score = 0.89, Area Under the Receiver Operating Curve, AUC = 0.90) proved to be highly accurate for discriminating HBsAg positive from negative patients, and thus rivals with immunoassay. Therefore, we propose a predictive model based on routine blood tests as a novel diagnostic for early detection of HBV infection. Early prediction of HBV infection via routine pathology markers and pattern recognition algorithms will offer decision-support to clinicians and enhance early diagnosis, which is critical for optimal clinical management and improved patient outcomes.

Prevalence and determinants of lymphedema in newly diagnosed Nigerian breast cancer patients using bioimpedance estimations.

Breast cancer-related lymphedema (BCRL) is common and has significant impact on quality of life. Very little is known about BCRL in sub-Saharan Africa. Generally, BCRL has been mostly evaluated post treatment, with very limited data on the prevalence of pre-treatment BCRL at baseline. This study presents the prevalence and clinical associations of lymphedema among newly diagnosed, treatment-naive breast cancer patients in a Nigerian cohort using bioimpedance estimations. Consecutively consenting, newly diagnosed, treatment-naive breast cancer patients were assessed for upper limb lymphedema using bioimpedance measurements of the extracellular fluid and the single-frequency bioelectrical impedance analysis value at 5 kHz. Patients were classified as having lymphedema if there was >10% difference in arm measurements or if the ratios of the arm measurements were >3 SD above a normative mean generated from representative controls. Regression analysis was performed to determine clinical variables associated with lymphedema. There were 154 breast cancer patients with a median age of 47 (40.0-56.8) years and a body mass index of 27 (23.5-30.9) kg/m2. The majority (70%) had stage III disease. All measurements were significantly higher in cases than controls. Using various definitions, the prevalence of lymphedema was between 11.7% and 14.3%. Various clinical variables relating to clinical stage were significantly associated with lymphedema. The predominance of locally advanced disease in the Nigerian setting is associated with high pre-treatment lymphedema rates. This may set the stage for higher rates in the post-operative setting. Management of lymphedema should be incorporated into the treatment planning.

Unique microbial biomarkers identified in Nigerian patients with colorectal cancer.

222 Background: The microbiome is an important biomarker associated with the pathogenesis and progression of disease in colorectal cancer (CRC). Genetic, dietary and environmental factors have been implicated in CRC microbial dysbiosis, however geographical distinctions in the microbiome of CRC are largely unknown. In this study, we characterize distinctions in the microbial diversity and microbial enrichment of CRC specimen obtained from a Nigerian and U.S. population. Methods: A validated microbiome bioinformatics pipeline that is generalizable across multiple next generation sequencing platforms was utilized. Microbial profiles for alpha diversity and enrichment were generated for two large, geographically distinct cohorts: (1) U.S. (n=498) and (2) Nigerian (n=65) cohorts. CRC specimen from Nigeria were compared to CRC specimen from the U.S. using the same microbial bioinformatics pipeline and methodology for analysis. Microbial differences stratified based on CRC microsatellite-instability (MSI) status were identified. Results: 9 unique microbial species were significantly enriched in the CRC specimen from the Nigerian cohort when compared to the US cohort. Subset analysis based on MSI status revealed enrichment of Faecalibacterium and Veillonella in the Nigerian cohort for both MSI and microsatellite stable (MSS) CRC (Table). Prevotella was significantly enriched in MSS CRC in the Nigerian cohort (OR=53.35, CI=10.34,275.37, p<0.001). There were no significant differences in alpha diversity between the Nigerian and U.S. cohorts (p>0.05). Conclusions: Several unique species with taxonomic diversity are enriched in Nigerian CRC and can be independently validated based on stratification by MSI status. Given the varied accessibility of diagnostic and therapeutic tools for CRC in these distinct geographical settings, understanding unique microbial biomarkers will provide the landscape to explore key microbial targets for therapy specific to this population.[Table: see text]

Identification of urinary biomarkers of colorectal cancer: Towards the development of a colorectal screening test in limited resource settings.

African colorectal cancer (CRC) rates are rising rapidly. A low-cost CRC screening approach is needed to identify CRC from non-CRC patients who should be sent for colonoscopy (a scarcity in Africa). To identify urinary metabolite biomarkers that, combined with easy-to-measure clinical variables, would identify patients that should be further screened for CRC by colonoscopy. Ideal metabolites would be water-soluble and easily translated into a sensitive, low-cost point-of-care (POC) test. Liquid-chromatography mass spectrometry (LC-MS/MS) was used to quantify 142metabolites in spot urine samples from 514 Nigerian CRC patients and healthy controls. Metabolite concentration data and clinical characteristics were used to determine optimal sets of biomarkers for identifying CRC from non-CRC subjects. Our statistical analysis identified N1, N12-diacetylspermine, hippurate, p-hydroxyhippurate, and glutamate as the best metabolites to discriminate CRC patients via POC screening. Logistic regression modeling using these metabolites plus clinical data achieved an area under the receiver-operator characteristic (AUCs) curves of 89.2% for the discovery set, and 89.7% for a separate validation set. Effective urinary biomarkers for CRC screening do exist. These results could be transferred into a simple, POC urinary test for screening CRC patients in Africa.

Activities of plasma indoleamine-2, 3-dioxygenase (IDO) enzyme in Nigerian patients with lung diseases: basis for tryptophan supplementation or IDO inhibitor use

BackgroundClinical trial of IDO inhibitor or uses of micro-nutrient supplements during management of diseases is commonly done without having adequate basis for the practise. Tryptophan (Trp) is an essential amino acid needed for T-lymphocyte function, and indoleamine-2,3-dioxygenase (IDO) is a potent immunoregulatory molecule that catalyses the rate-limiting step of Trp degradation in the kynurenine (Kyn) pathway.Materials and methodsHuman IDO in the plasma samples was measured using ELISA in patients with non-infectious (asthma) and infectious diseases (pulmonary tuberculosis and COVID-19) compared with corresponding un-infected controls.ResultsMean IDO activity in COVID-19 patients was significantly higher compared with corresponding control (p = 0.001) while mean IDO activity in pulmonary tuberculosis patients was non-significantly higher compared with corresponding control (p = 0.520), and mean IDO activity in asthma patients was non-significantly lower compared with corresponding control (p = 0.102).ConclusionOur data suggest that IDO activity as an innate immune factor is increased in infectious lung diseases (COVID-19 and pulmonary tuberculosis) but reduced in non-infectious disease (asthma) and that use of tryptophan supplementation or IDO inhibitor may not be necessary in all lung diseases.

Transcriptomic profiling and genomic rearrangement landscape of Nigerian prostate cancer.

Men of African ancestry have disproportionately high incidence rates of prostate cancer (PCa) and have high mortality rates. While there is evidence for a higher genetic predisposition for incidence of PCa in men of African ancestry compared to men of European ancestry, there have been few transcriptomic studies on PCa in men of African ancestry in the African continent. We performed transcriptomic profiling and fusion analysis on bulk RNA sequencing (RNA-seq) samples from 24 Nigerian PCa patients to investigate the transcriptomic and genomic rearrangement landscape of PCa in Nigerian men. Bulk RNA-seq was performed on 24 formalin-fixed paraffin-embeded (FFPE) prostatectomy specimens of Nigerian men. Transcriptomic analysis was performed on 11 high-quality samples. Arriba Fusion and STAR Fusion were used for fusion detection. 4/11 (36%) of the samples harbored an erythroblast transformation-specific (ETS)fusion event; 1/11 (9%) had a TMPRSS2-ERG fusion; 2/11 had a TMPRSS2-ETV5 fusion, and 1/11 had a SLC45A3-SKIL fusion. Hierarchical clustering of normalized and mean-centered gene expression showed clustering of fusion positive samples. Furthermore, we developed gene set signatures for Nigerian PCa based on fusion events. By projecting the cancer genome atlas prostate adenocarcinoma(TCGA-PRAD) bulk RNA-seq data set onto the transcriptional space defined by these signatures derived from Nigerian PCa patients, we identified a positive correlation between the Nigerian fusion signature and fusion positive samples in the TCGA-PRAD data set. Less frequent ETS fusion events other than TMPRSS2-ERG such as TMPRSS2-ETV5 and non-ETS fusion events such as SLC45A3-SKIL may be more common in PCa in Nigerian men. This study provides useful working transcriptomic signatures that characterize oncogenic states representative of specific gene fusion events in PCa from Nigerian men.

Surgical site infection in Nigerian patients: A comparative study of two prophylactic antibiotics

Surgical site infection in Nigerian patients: A comparative study of two prophylactic antibiotics

EpCAM expression negatively regulates E-cadherin function in colorectal carcinomas.

This study aimed to characterise epithelial cell adhesion molecule (EpCAM) expression patterns in colorectal carcinomas (CRC) from Nigerian patients, its association with E-cadherin and tumour characteristics, to forecast patient selection for anti-EpCAM therapy among whom no data existed previously. Tissue microarray blocks of formalin-fixed and paraffin-embedded CRC tissues, with their non-cancer margins of resection, were sectioned and stained with EpCAM and E-cadherin primary antibodies. Scoring for antibody staining was done semiquantitatively by combining staining proportion and intensity. The outcome was correlated with patient age, gender and tumour histological parameters with p ≤ 0.05 regarded as statistically significant. Sixty-three carcinoma tissues had staining status for the two markers and were included in this study. Of these, 36 (57.1%) showed positive EpCAM expression (immunoscore ≥3) out of which 83% (30/36 positive cases) were overexpressed (combined immunoscore ≥4) while 12 (19%) tissues were positive for E-cadherin. Non-tumour margins of resection tissues showed less EpCAM positivity in 24% (6/25) of histospots. The difference in staining between tumour and non-tumour margin tissues with EpCAM was significant (p < 0.001). Also, EpCAM overexpression was significantly associated with reduced E-cadherin (p < 0.035) expression in tumour cells. Tumour extent within the gut wall was equal (50% each) for early and late pT stages among EpCAM overexpressing tumours but two-thirds (8/12) of cases expressing E-cadherin had later pT stage paradoxically, while distant metastasis was negligible among tumours bearing both markers. Also, tumours overexpressing EpCAM had significant association with tumour-associated lymphocytes (p < 0.02 each). CRC in this study preferentially overexpress EpCAM over E-cadherin whose strong cell-cell contact inhibitory role is weakened even when expressed, resulting in further local tumour spread. This, and the observed immune response, supports targeted therapy among eligible patients.

Influence of neighborhood environment and social support on physical activity among patients with diabetes mellitus

This study was aimed to determine the relationship of physical activity (PA) with the neighborhood environment and social support for PA among patients with diabetes mellitus (DM).&lt;b&gt; &lt;/b&gt;A total of 193 consenting individuals with DM attending endocrinology clinic in a Nigerian tertiary hospital participated in this cross-sectional study. The&lt;b&gt; &lt;/b&gt;international physical activity questionnaire short form, physical activity neighborhood environment scale (PANES), and physical activity and social support scale (PASSS) were used to assess the PA level (low, moderate, and high), neighborhood environment and social support for PA, respectively. The results of bivariate analyses showed that all elements of built environment and social support were significantly associated with PA. Regression model analyses indicate that PANES score was associated with moderate (adjusted odds ratio [aOR]: 10.76; 95% confidence interval [CI]: 3.82-30.32) to high (aOR: 45.73; 95% CI: 12.14-172.27) PA. In addition, easy access to quality walking facilities (aOR: 46.53; 95% CI: 3.89-557.32; aOR: 46.13; 95% CI: 2.65-802.40) and easy access to recreation infrastructure (aOR: 46.89; 95% CI: 3.95-487.83; aOR: 17.99; 95% CI: 1.28-252.98) were associated with moderate to high PA, respectively, while safety from crime (aOR: 0.21; 95% CI: 0.07-0.64) and easy access to services and shops (aOR: 21.90; 95% CI: 1.83-262.59) were associated with moderate and high PA. Informational social support was associated with moderate PA (aOR: 1.44; 95% CI: 1.04-2.00). In conclusion, the neighborhood environmental and social support factors were associated with the PA activity level among Nigerian patients with DM.

Saving the breasts of Nigerian breast cancer patients: Prospects of breast-conserving therapy in Nigeria

Saving the breasts of Nigerian breast cancer patients: Prospects of breast-conserving therapy in Nigeria

Psychometric adaptation of the hospital anxiety and depression scale as a self-rated suicide risk assessment instrument among Nigerian surgical patients

Psychometric adaptation of the hospital anxiety and depression scale as a self-rated suicide risk assessment instrument among Nigerian surgical patients

A Correlation Study of Liver Biopsy Appearances, Serum HBV DNA and HBsAg Quantification Levels of Nigerian Patients with Chronic Liver Disease

Background: Infection with the hepatitis B virus is highly endemic in much of sub-Saharan Africa where it remains an important cause of chronic ill-health. Quantitative assay of HBV DNA and HBsAg are emerging as useful tools in the management of chronic HBV infection. However, it is not yet clear how well each of these might accurately correlate with the extent of liver damage during the course of the disease. Nevertheless, liver biopsy, albeit an invasive test, affords a superior direct assessment of all stages of the disease. Objective: Thus, we set out to determine how well-correlated serum levels of HBV-DNA and/or HBsAg might be with each other and with the liver biopsy appearances. Methodology: This study was prospective and we enrolled, 83 new treatment-naïve patients, who met the study criteria. Each patient had liver biopsy assessments of the grade of necroinflammation (A) and stage of fibrosis (F), according to the METAVIR Scoring System. In addition, quantitative HBsAg serum levels by immunoassay and HBV DNA by real-time quantitative PCR protocols were made. The Spearman’s and Kruskal-Wallis statistical tests were employed to determine the correlations between these assays separately and with the respective histological grades and stages of liver biopsy. (p=0.05) Results: The greatest number of the patients were within the 21-40 year- age group. Using the Spearman rho’s statistical correlation test, we found a positive but weak correlation between the serum HBsAg and HBVDNA levels (p=0.075, r=0.198). The Kruskal-Wallis analysis revealed statistically significant correlation between HBV-DNA and the grade of necroinflammation but not with the stage of fibrosis. Conclusions: We found that the serum HBV DNA levels had the only statistically significant correlation with the liver histological disease. This relationship needs to be further examined in larger studies in the future.

Optical Coherence Tomography Retinal Nerve Fibre Layer and Ganglion Cell Complex Measurements in Normal Southern Nigerian Eyes.

Introduction Glaucoma is the leading cause of irreversible blindness worldwide. It is more severe in people with African heritage, and intraocular pressure remains the only modifiable risk factor in managing glaucoma. Attempts to improve the diagnosis and monitoring of glaucoma are ongoing. One of those attempts is the development of optical coherence tomography (OCT). However, there is a theoretical possibility of a delayed or wrong diagnosis of glaucoma using the OCT because of racial, age, and sex differences in the RNFL (retina nerve fibre layer), GCL (ganglion cell layer), and GCL+IPL (ganglion cell layer and inner plexiform layer) thickness. Objective This study aims to provide the measurements of RNFL, GCL, and GCL+IPL in normal eyes of southern Nigerian patients and specifically to evaluate the relationship of these measurements to gender, age, intra-eye variability, and the Topcon SD-OCT normative database. Method Three hundred and four eyes of 152 patients who had normal OCT scans using the 6x6 RNFL (four sectors) and Macula scans of the Topcon OCT-1 3D Maestro OCT machine were included for analysis. Parametric tests were used to interrogate the relationship between normally distributed parameters and gender, age, and the Topcon reference database. Non-parametric tests were used for non-normally distributed data. Results The male-to-female ratio was 1:1, and ages ranged between 18 and 71 for both genders. The average RNFL values were 111.49 ± 10.44 (right eye - RE) and 111.96 ± 9.66 (left eye - LE). For the GCL, average values were 66.23 ± 4.4 (RE) and 66.34 ± 4.19 (LE). GCL+IPL values were 104.02 ± 6.71 (RE) and 103.89 ± 6.66 (LE). There was no difference between genders (X2 = 56.467; df = 46; p = 0.160), and RNFL, GCL, and GCL+IPL values showed a significant reduction as the age of the respondents increased. There was a significant difference between RNFL, GCL, and GCL+IPL values and the Topcon reference database, p < 0.001. Conclusion Significant differences exist between the Southern Nigerian eyes' RNFL, GCL, and GCL+ IPL values and the Topcon OCT-1 3D Maestro reference database. While randomised control trials and extensive multi-centre studies have not been conducted to determine the possible effects of these differences between measured values and reference databases of the OCTs, they need to be considered while diagnosing and managing glaucoma with the OCT.

Association between Serum Calcium Concentration and Glycated Haemoglobin in Type II Diabetic Nigerian Patients

Background: Diabetes is a metabolic disease that affects key biochemical parameters in the body. The study was carried out to evaluate the serum calcium concentration and the relationship between serum calcium and glycosylated haemoglobin in type 2 diabetics. Methods: A total of 126 subjects consisting of 63 Diabetic patients and 63 controls participated in this study. Serum calcium and glycosylated haemoglobin concentrations were measured. Fasting blood sugar was also measured. Total calcium was measured using colorimetric determination of plasma total calcium by the o-cresolphthalein o-complexone (CPC) assay principle. Plasma albumin was determined using Bromocresol green (BCG) method, and thus corrected calcium was deduced. Glycosylated haemoglobin (HbA1C) was estimated using an ion-exchange chromatographic method. A semi-structured questionnaire was used for data collection. Results: The mean serum calcium levels of diabetics compared to non-diabetics did not differ statistically even though that of diabetics was in the lower range of normal. There was no statistically significant difference (p=0.099) between the mean serum calcium levels of diabetic patients who had glycosylated haemoglobin values below 6.5 (2.26 mmol/l±0.07) and diabetic patients who had glycosylated haemoglobin values above 6.5 (2.17mmol/l±0.09). Surprisingly, there was a weak positive correlation between glycosylated haemoglobin levels above 6.5 and serum calcium levels (p=0.087) and HbA1C below 6.5 correlated negatively albeit weakly with serum calcium levels though they were both insignificant. Socio-demographic data show that more females were diabetic. Conclusion: Overall, the study reveals that mean serum calcium concentrations in diabetic and non-diabetic patients are not different and this may be due to good blood glucose control in these diabetic patients

Environmental chemical risk factors of breast cancer in Nigeria II: Adolescent hormonal contraceptives use

Globocan’s 2018 cancer statistics show increasing rates of breast cancer in Nigeria. There is sufficient evidence in humans that hormonal contraceptive is a breast cancer risk factor particularly among African American women who begin use before 20 years of age or before first pregnancy. Nigerian breast cancer patients have identical subtypes as African Americans i.e triple negative tumors, early age of onset, clinically aggressive, and poor prognosis. Data from Nigeria show that 37.4% adolescent girls engage in high-risk sexual behaviour. For adolescent girls, dual use of condom and other hormonal contraceptives have been recommended to prevent pregnancy and acquisition of STI/HIV. Adolescents in Nigeria have uncensored access to all the contraceptive mix including hormonal contraceptives. There are also some ethical concerns. There are extremely harmful socio-cultural and socio-economic determinants that promote early sexual debut, Teenage Pregnancy, and Child Marriage. There are also grave health related, social and economic consequences for mother and child, and the community. Both Teenage Pregnancy and Child Marriage undermine nearly every Millennium Development Goal. The notable reason given by some fathers for embracing Child Marriage was to protect daughters from what was perceived as “unwholesome” Western values that permit loss of virginity, pre-marital sex and high adolescent sexual networking, necessitating the use of contraceptives. Hormonal contraceptive is a modifiable risk factor of breast cancer. Appropriate early pre-adolescent and adolescent parental care and nurturing before the crisis stage in godly principles is the gold standard for preventing adolescents’ use of contraceptives. Adolescent pregnancy and Child Marriage are not safe options.