Mortality History of Iceland | Chapter 13 | Current Trends in Medicine and Medical Research Vol. 2

Knowledge of the seasonal variation in births and deaths during normal years is important for analyses of the effects of wars, famines, epidemics or similar privations on these variables. In studies of seasonality, multiple trigonometric regression models are more flexible than the simple sine curve. The seasonal variation in mortality in Iceland, 1856-1990, shows a strong secular decrease, and a connection between this and the epidemiological transition is considered. For equidistant data, the regressor vectors are orthogonal, resulting in parameter estimates that are uncorrelated and independent of the number of trigonometric terms in the models. Comparisons with findings in other European countries are made. The temporal trends in Iceland of the birth components; the twinning rate, the still birth rate and the secondary sex ratio, are presented and compared with the corresponding values in neighbouring countries. No marked differences were emerged. During the first stage of the epidemiological transition the seasonal variation in deaths and births was mainly a result of the living conditions. Therefore, years marked by severe famine or other crises have had strong effects on the seasonal patterns. This can be seen in the data from Iceland during the 19th century. For Icelandic males, one has to include drownings as an important indicator of the harsh living conditions. In the first half of the 19th century, the fishermen had a hard life when they practised their profession and braved the Atlantic storms in the small vessels of that time. Until the 20th century, the sex ratio for the Icelandic population was low relative to the sex ratio for both Norway and Denmark, indicating the greater effect of the fluctuations in mortality on males than on females.

Biography of author(s)

Dr. Fellman Johan
Hanken School of Economics, Finland

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Molecular Biology of Chronic Obstructive Pulmonary Disease: Basic Research and Clinical Application | Chapter 12 | Current Trends in Medicine and Medical Research Vol. 2

Chronic obstructive pulmonary disease (COPD) is a global public health problem. It is projected that by 2020 it will be the third leading cause of dead worldwide, and the fifth leading cause of years of life lost due to disability coupled with years of life lost due to premature dead. The definition provides that, besides being preventable, treatable and characterized by a chronic and persistent airflow limitation (usually progressive), COPD is due to an increased chronic inflammatory response. It has an overwhelming prevalence, yet accepted therapies are ineffective in reducing disease progression. Bronchodilators, the mainstay of COPD treatment, only provide symptomatic relief. Therefore, in order to provide a superior approach, it is important to better understand the rationale behind therapy and the underlying mechanisms by which the inflammatory process, through various pathogenic pathways, leads to deterioration. Cigarette smoke and other pollutants/biomass fuels affect the lungs ability to counterbalance proteases and neutralize different types of stress. Even if the initial noxa is discontinued, inflammation, infection and autoimmunity promote a chronic lung inflammatory response; leading to the development of emphysema and small airway disease. This is due to continuous endogenous production of reactive oxygen species, nitrative and carbonyl stress. The process then continues into a harmful spiral and systemic disease. The objective of this paper is to offer an updated review of COPD, simplifying the integration of basic science research and introducing the concepts and evidence of therapeutic alternatives. This review discusses why some drugs have failed and which alternatives are emerging. Probably there is no unique effective therapy, but several combinations of drugs might be required to impact the different subcellular compartments and obtain a more effective therapy in COPD. High level of ROS initiates the inflammatory process in COPD, with a highly specific cellular and molecular profile. Through protease/anti-protease imbalance and diverse kinds of stress, the pathological phenomena involving the bronchopulmonary, vascular and systemic compartment is generated. Autoimmunity and repeated infections potentially perpetuate and amplify the inflammatory process, even if the initial stimulus is suspended. Failure of current bronchodilator and steroid therapies to attenuate natural evolution of the disease and progressive deterioration indicates the need to develop powerful new drugs with innovative effects. It is likely than drug combinations are required, instead of monotherapy, in order to improve the effectiveness and impact the progressive course and mortality of COPD.

Biography of author(s)

Alcibey Alvarado-González
Internal Medicine and Neumology, Clínica de Diagnóstico Médico, San José, Costa Rica.

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Respiratory Sounds | Chapter 11 | Current Trends in Medicine and Medical Research Vol. 2

Auscultation of the chest is a very old diagnostic method. Originally, it was performed by the examiner directly hearing into the patient’s chest, and this practice dates back to the time of Hippocrates. Recent acoustic research sometimes can’t find the explanation for a term that is supposed to have a pathophysiological basis, but that has been passed down through generations with medical over time.The original description of lung sounds was based on comparing acoustic phenomena that was heard in the chest with gross lesions autopsy. Subsequently, the interpretation of these findings is based on functional rather than anatomical analysis. Auscultation became an invaluable diagnostic method. With the advent of radiological images, increasingly sophisticated, computerized tests of lung function, rapid arterial blood gas analysis, endoscopic studies airway and percutaneous biopsies of pleura and lung; the practice, with method and timing of chest auscultation, has lost presence. In addition, the nomenclature of respiratory sounds is sometimes confusing and the terminology proposed by international committees, little known. One objective of the article is to give a pathophysiological basis of noise based on modern computer-assisted studies which have enabled accurate recording and sound analysis techniques. The other objective is to provide a practical and useful tool to understand and correlate what you hear, with the pathophysiological basis, the underlying condition that generates the phenomena and streamline the diagnostic work. Technology has impacted medical auscultation with computerized equipment that allows to collect, analyze and study sound waves in a realistic way and never before seen. This technological development enables and improvement in auscultation knowledge in order to understand more and better findings. But this development should not pretend to cram sophisticated, expensive and unnecessary medical equipment. Auscultation of the lungs with a simple stethoscope, in day to day work and to the bedside of the sick, is part of the physical assessment. We must remember that it is a tool whose effectiveness depends on the rest of the physical examination and medical history.

Biography of author(s)

Alcibey Alvarado
Internal Medicine and Neumology, Clínica de DiagnósticoMédico, San José, Costa Rica.

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Exercise Rehabilitation in Knee Osteoarthritis | Chapter 10 | Current Trends in Medicine and Medical Research Vol. 2

Introduction: Osteoarthritis (OA) is a joint condition that affects elderly individuals. Therapeutic exercises have several clinical benefits that can be applied by different types, both in the land and in the aquatic environment. OA is characterized by wear of the cartilage that overlaps the articular surfaces, with formation of fibrillation and fissure areas, cysts, subchondral bone sclerosis, and even formation of osteophytes at the joint edges. Among the different types of exercises used in the rehabilitation of knee OA, closed kinetic chain (CKC) exercises are shown to be more functional, in addition to providing a better restoration of muscle strength without damaging the patellofemoral joint.

Objectives: To compare the effectiveness of closed kinetic chain (CKC) exercises performed on the ground and in the swimming pool in women with knee osteoarthritis (KOA).

Study Design: Double-Blind Randomized Clinical Trial.

Place and Duration of the Study: Clinical School of Physiotherapy of Ulbra Torres, from March 2015 to June 2017.

Methodology: Thirty-four women with grade 1 and 2 knee knee OA were allocated into two groups. One group received treatment with CKC exercises on the ground (n = 17) and the other group had the same exercises performed in the swimming pool (n = 17) for a period of two months, three times a week, totaling 24 sessions. Subjects were initially assessed prior to randomization, after 12 sessions, after 24 sessions and 3 months after the end of the protocol. The following variables were evaluated: pain, knee joint mobility, hamstring flexibility, hamstring and quadriceps muscle strength and functionality.

Results: There was an improvement in hamstring flexibility with 12 sessions in the pool group and at the end of the protocol in both groups (P<.05). The range of motion of knee flexion increased in both study groups after the intervention (P<.05). The pool group demonstrated a reduction of this gain in the follow-up. Pain decreased similarly in both groups (P<.05). The pool group showed an initial quadriceps strength and left hamstring strength lower than the ground group. However, at the end of the protocol, both groups improved muscle strength in both knees (P<.05). The Lequesne and WOMAC scores reduced significantly with 12 sessions in both groups (P<.05), remaining likewise in the follow-up.

Conclusion: Therapeutic exercises in different forms and locations present several benefits of pain reduction, improved joint mobility, increased muscle strength and improved function in patients with knee osteosarthritis. There was an increase in quadriceps and left hamstring muscle strength in the CKC Pool group, possibly because this group had predominantly the left knee as the most affected and, therefore, with a significantly higher pre-intervention deficit. Both groups increased quadriceps and right hamstring strength with 24 sessions. Further studies should be performed to confirm these findings.

Biography of author(s)

Marcelo Baptista Dohnert, PT, PHD
Universidade Luterana do Brasil, Torres/RS, Brasil

Rodrigo Boff Daitx, PT, MsC
Universidade Luterana do Brasil, Torres/RS, Brasil

Alex Burin, PT
Universidade Luterana do Brasil, Torres/RS, Brasil

Ricardo Metzelthin Cardoso
Universidade Luterana do Brasil, Torres/RS, Brasil

Pedro Gross, PT
Universidade Luterana do Brasil, Torres/RS, Brasil

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Cardiac Implantable Electronic Device-Related Infection: Updated Review | Chapter 09 | Current Trends in Medicine and Medical Research Vol. 2

In the 1960s, the first pacemaker with transvenous electrodes was implanted. Over the years, there have been advances in technology in this area, with the use of smaller size devices, and with several functions (multifunctional pacemaker). With this expansion of the indications for implantation of these cardiac electronic devices (CED), there was an increase of these procedures and 4.2 million patients underwent implantation of these devices between the years 1993-2008. Besides the association between risk of infection and device replacement, other factors such as male gender, young age, number of procedures, lack of prophylactic antibiotics and multiple comorbidities have also been associated with an increased risk of infection of CED. The risk of infection depends on many factors, including device type and the number of implantation procedures. In addition to significant morbidity, one-year mortality is approximately 20%. Therefore, CED infection is an important health issue. Knowledge of the factors associated with this unfavorable outcome, clinical manifestations, diagnosis and treatment are very important for proper approach. This current review presents all these aspects and strategies for the prevention of infection related to implantable electronic cardiac devices. The main microbial agent is Staphylococcus. Pocket infection is the most common presentation, but endocarditis may occur in up 20% of patients. A high index of suspicion is necessary for diagnosis. Treatment includes antimicrobial therapy and device removal. Prevention and strategies to minimize the risk factors are the key to reducing the rates and severity of infection. With the advent of leadless pacemaker and subcutaneous ICD, this scenario may change.

Biography of author(s)

Rose Mary Ferreira Lisboa da Silva
Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Brazil.

Alessandra de Souza Maciel
Hospital das Clínicas, Federal University of Minas Gerais, Brazil.

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The Role of Cytokines in Vitiligo | Chapter 08 | Current Trends in Medicine and Medical Research Vol. 2

Background: Vitiligo is an acquired disorder of melanin pigmentation that affects approximately 0.5-2% of the population. It is characterized by macular depigmentation of varying sizes or shapes with a tendency to progress.  Depending on the extent of the lesions, vitiligo can be classified into two main categories: generalized and localized. Although several theories have been proposed to explain the loss of melanocytes in vitiligo the pathogenesis of the disease is still unclear. The clinical association with autoimmune disorders and organ specific antibodies indirectly support the idea of an autoimmune pathogenesis of the disease.  Furthermore, many patients with vitiligo have serum auto antibodies and circulating auto reactive T cells directed against melanocytes and there are findings of activated T-cells in the periphery of actively progressing lesions in some vitiligo patients.  Several studies have shown that within the cascade of pathogenesis of vitiligo, cytokines play an important role. An imbalance of several melanogenic cytokines that can affect melanocyte activity and survival has been shown in vitiligo lesional skin and serum of vitiligo patients.

Objectives: Cytokines are the key mediators for cellular communication and networking. Although it is well known that multiple cytokines simultaneous play role in vitiligo, the aim of our study was to evaluate serum concentrations of interleukin- IL-2 (IL-2) and interleukin-2 soluble receptor (IL-2 sR) in patients with vitiligo and healthy subjects and also to asses a possible association between these cytokines and duration of the disease.

Study Design: Case control study.

Place of the Study: The study was carried out in University Clinical Center Sarajevo, Department of Dermatology and Venereology.

Patients and Methods: Twenty one patients (11 female and 10 male; age range 15-53 years) with vitiligo and 20 healthy controls (10 female and 10 male; age range 17-52) were enrolled in the study. c The duration of vitiligo ranged from 2 to 252 months. Ten patients (47.62%) had generalized, and eleven patients (52.38%) had localized vitiligo Serum concentrations of cytokines were measured using enzyme-linked immunoassay techniques.

Results: Both  IL-2 (median 22.600 pg/ml, range 20.900-76.100) and IL-2sR (median 76.100 pg/ml, range 15.700-183.800) in the patient group were significantly higher when compared with that of the normal controls. When the serum cytokine level in vitiligo group were compared to total disease duration (Spearman correlation ρ), serum IL-2 was negatively (ρ= -0.000573, P= 0.9980) and IL-2 sR was positively (ρ=0.241, P= 0.2797) correlated with total disease duration, but it is of borderline significance.

Conclusions: Although the initiating event in vitiligo has not yet been defined, a growing body of evidence indicates that cytokines may help the development and the perpetuation of the chronic inflammatory state. The results presented in our study demonstrate that the median levels of IL-2 and IL-2 sR were significantly elevated in vitiligo patients in comparison with healthy subjects.  Vitiligo is an acquired depigmentary skin inflammatory disorders. Although the initiating event in vitiligo has not yet been defined, a growing body of evidence indicates that cytokines may help the development and the perpetuation of the chronic inflammatory state. An increase in the production of pro-inflammatory cytokines in vitiligo patients, may play an important role in melanocytic cytotoxicity. The imbalance observed in the cytokines examined in the current study suggest their involvement in the pathogenesis of vitiligo. This research could contribute to the interpretation of the role and significance of cytokines in the pathogenesis of vitiligo, and these findings may provide important clues to assist in the development of new therapeutic strategies for patients with vitiligo. The specific blockade of cytokines or their receptors is an alternative approach for the treatment of vitiligo.

Biography of author(s)

Emina Kasumagic-Halilovic
Department of Dermatology and Venerology, University Clinical Center Sarajevo, Sarajevo,Bosnia and Herzegovina.

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Fundamentals of Starvation Therapy for Cancer for the Oncology Practice | Chapter 07 | Current Trends in Medicine and Medical Research Vol. 2

Cancer is a serious disease that has used exhaustive efforts and exerted heavy financial and scientific burdens to develop an understanding into the nature of its’ various types, and to advance therapies and management protocols. It is becoming acceptable that among the major methods that appeared in the literature has been the use of starvation to reduce or even halt the survival of cancer cells at the time when normal cells would be less dramatically affected. 

This work is an attempt to give a comprehensive explanation of the effects of general or selective starvation on cells and highlight the underlying molecular mechanisms of starvation on various cells. The major aims are to understand and to develop suitable and effective therapeutic methods based on nutritional manipulations, for combating malignancies. Starvation modules generally include general starvation, or restricted starvation, where the major modes include glucose deprivation under normal or abnormal oxygenation, amino acid and nucleic acid deprivation, and other selected nutritional precursors. There are also experiments that studied the effects of combined deficiencies. In addition, these artificial nutritional deficiencies have been tested for their potential uses in boosting the effects of chemotherapeutic agents. Thus, presented in this pre-working manual is a comprehensive and a unique account of the literature on the experimental and clinical evidence that support the efficiency of starvation therapy. The molecular mechanisms and cellular alterations that accompany the starvation have been described along. Nevertheless, negative effects of certain nutritional starvation modes have also been described extensively along with much of their underlying cellular mechanisms. Knowledge of these, and of the counter-measures undertaken by malignant cells under starvation, may give leads as to what methods to avoid among the available choices. They also serve as guidelines for research aiming at developing means for antagonizing or neutralizing such unanticipated mechanisms that generate the negative and undesired effects. This study contains vital information that mark differences among various kinds of tumour cells, and differences within one cell type under various growth stages and conditions. Mostly, it represents a trial to collect together information on starvation work in an attempt to draw lines for further work aimed at developing and standardizing methods for treating cancer. Hence a method selected may be unique to a tumour type and stage, with particular considerations for any negative results expected especially with other cancer types. Hence, this work serves as orientation for further organized research and clinical trials which are required to optimize modes of therapy and conditions required per cancer type. This work appears to be a first attempt to compile a vast amount of scattered information into a translatable form that may aid in building up and advancing therapeutic strategies for cancer.

Biography of author(s)

Fawwaz Al-Joudi
Department of Clinical Biochemistry, University of Ontario Institute of Technology, Faculty of Health Sciences, Oshawa, Ontario, Canada

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Possible Thermal Effect on Prevention against Atherosclerosis | Chapter 06 | Current Trends in Medicine and Medical Research Vol. 2

The local thermal stimulation may have various influences on the skeletal muscles widely distributed throughout the body. Fomentation is a method of hyperthermia, and an increase in the local blood flow following local thermal stimulation affects the entire body Fomentation as a nursing technique is used mainly for physical and psychological comfort. Its promoting effects on circulation mainly in the skin and autonomic nervous system, sleep onset, and intestinal peristalsis have been reported. We have reviewed the evaluation methods using physiological parameters in fomentation studied by basic or clinical nurses, and the present status of the studies including the possibility of evaluation based on the metabolic function. Effects of fomentation were assessed based on the vital signs, skin surface temperature, skin blood flow, vascular distension rate, vascular circumference, cerebral blood flow, range of joint motion, autonomic activity etc. However, there is no established method of effective fomentation and no consensus has been reached on the influences of local changes following fomentation.

We have previously demonstrated an increase in the serum adiponectin level and a decrease in soluble urokinase-type plasminogen activator receptor after the application of fomentation to femoral part of lower extremities in healthy people. Furthermore, our transcriptome studies in vitro have indicated that thermal stimulation of human normal skeletal muscle derived cells gave significant changes in gene expression related to atherosclerotic cardiovascular disease. Utilization of thermal stimulation over the skeletal muscle might be prospective tool for prevention against atherosclerosis. Further studies in vivo are required to determine the thermal effect for prevention of atherosclerosis in clinical practice.

Biography of author(s)

Hidesuke Kaji, M.D., Ph.D.
Professor in Kobe Women’s University, Emeritus Professor in University of Hyogo.
Division of Physiology and Metabolism, University of Hyogo, Japan and Division of Pathophysiology, Kobe Women’s University, Japan.

Masayo Nagai, RN, PHN, Ph.D.
Former affiliated institution: Assistant Professor in Division of Physiology and Metabolism, University of Hyogo, Japan and Assistant Professor in Faculty of Nursing, BAIKA Women’s University, Japan.

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Beliefs and Prevalence of Female Genital Circumcision among Pregnant Women Attending Ante-natal Clinic in a Mission Hospital in Uyo, Akwa Ibom State, Nigeria | Chapter 05 | Current Trends in Medicine and Medical Research Vol. 2

Introduction: Every community the world over has specific lifestyle practices that reflect the values and   beliefs held by members of such communities for generations. Female genital cutting (FGC) or circumcision is one of the age-long cultural practices in many African countries including Nigeria. Female genital cutting is harmful to women’s physical and emotional health throughout their lives and has no known health benefits. Common beliefs among adherents in surveys for practicing FGC include social acceptance, religion, hygiene, preservation of virginity, marriageability and enhancement of male sexual pleasures.

Objective: The objective of this study was to assess the beliefs of pregnant women attending the ante-natal clinic of a mission hospital in Uyo, about female genital cutting.

Methods: This was a prospective descriptive cross-sectional study conducted between August and October 2015. Using systematic sampling techniques, 364 newly registered pregnant women who enlisted for care during the study period were recruited. Using strict aseptic technique, vaginal examination was done for each respondent to determine the types of female genital cutting based on World Health Organization (WHO) classification.

Results: The mean age of respondents in this study was 28.3±4.3 years. The prevalence of female genital cutting among respondents in this study was 22.5%. FGC was more prevalent among respondents who were older (p<0.001); Attained higher level of education (p<0.001); and among those in the low income group (p<0.001). Removal of the labia minora (Type 2a) was the dominant type of FGC among respondents accounting for 64.4%; This was followed by type 1a (removal of the clitoral hood or prepuce) 18.3%; Type 1b (removal of the clitoris with the prepuce) was present in 15.9% respondents while type 3a (removal and apposition of the labia minora) was present in 1.2% of the respondents.

Among the respondents, FGC was believed to reduce sexual desire of the victims (p = 0.009; prevents promiscuity (p = .003); While others belief that it improves hygiene (p = 0.018).

Conclusion: Findings from this study have shown that the practice of FGC is complex. The increasing prevalence among those who are older might mean that practice of FGC is reducing among the younger generation. Education and empowerment of women are most needed now along with enforcement of laws aimed at eradicating the practice. The commonly held beliefs for persistence of the practice are tradition, prevention of sexual promiscuity as well as improvement in hygiene of the victims. FGC is a clear violation of the fundamental rights of women. Efforts to eradicate it must be stepped up through health education by the mass media and at ante-natal, post natal and family planning clinics. Such education should include information that clearly stresses the harmful effects of the practice. Misconception, taboos as well as false beliefs associated with FGC must be unequivocally dispelled. Women must be adequately empowered through education and economically as well to defend their rights whenever attempts are made to violate them.

Biography of author(s)

Dr. Alphonsus Idung
Alphonsus Udo Idung is a consultant Family Physician and Lecturer in the Faculty of Clinical Sciences, College of Health Sciences, University of Uyo, Uyo, Nigeria. Born on 24th April, 1963, He was educated at University of Port Harcourt in Nigeria where he obtained a Bachelor of Medical Science degree in Human Physiology (B. Med Sc, Physiol) in 1983 and Bachelor of Medicine, Bachelor of Surgery (MBBS) in 1990. He worked as an interim in St. Luke’s Hospital, Anua in Uyo, and later at the University of Uyo Medical Centre, Uyo, Akwa Ibom State, Nigeria between 1991 and 2004.

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Sweat Potassium Decreases with Increased Sweating in Perimenopausal Women | Chapter 04 | Current Trends in Medicine and Medical Research Vol. 2

Introduction: Perimenopause also known as menopausal transition is the period of a woman’s life preceding the occurrence of menopause. During the menopausal transition stage, increased hot flushes and night sweats are the most frequently reported symptoms. In premenopausal women, cyclic changes in plasma and sweat Na+ concentrations (but not K+) corresponding with hormonal fluctuations during the menstrual cycle have been documented.

Objective: To investigate the relationship between rate of sweat production and sweat potassium concentration in premenopausal (PreM), perimenopausal (PeriM) and postmenopausal (PostM) women after a moderate exercise.

Study Design: This is a cross-sectional study conducted in May 2012 at the Department of Physiology, University of Benin, Nigeria.

Methods: Thirty healthy female volunteers comprising of PreM (aged: 22.5±0.8 yrs, n = 10), PeriM (aged: 46.5±1.1 yrs, n = 10), and PostM (aged: 52.2±0.9 yrs, n = 10) participated in the study. Sweat was obtained with a sweat suction apparatus from a 120 cm2 circular area marked on the skin of the face and neck after a 15 min walk on a calibrated treadmill at a speed of 4.2 km/h at 27°C and a relative humidity of 85-95%, followed by measurement of sweat volume (SV) and [K+]. Sweat rate (SR) was determined by dividing the volume of sweat produced by the duration of exercise. Thirst perception (TP) was self-rated using the Visual Analogue Scale (VAS).

Results: The PeriM women demonstrated higher SR (ml/min) (P = 0.01) and SV (ml) (P = 0.0006) compared to women in the other groups: SR (PeriM = 0.12±0.01; PreM = 0.07±0.02; PostM = 0.06±0.01), and SV (PeriM = 1.7±0.2; PostM = 0.9±0. 1). However, they had lower sweat [K+] (mmol/l) (P = 0.04), compared to their PostM counterparts (PeriM = 19.98±1.5; PostM = 24.90±1.8). Furthermore, sweat [K+] was inversely associated with SR (r = -0.4, P = 0.02); and change in TP (cm) was highest (P = 0.001) in the PeriM women (PeriM = 2.5±0.2; PreM = 2.1±0.3; PostM = 0.99±0.2).

Conclusion: Although excessive sweating can lead to depletion of the body’s potassium concentration, the sweat potassium concentration decreases with increased sweating especially in perimenopausal women. This data indicate that sweat potassium concentration decreases with increased sweating in middle-aged women, and perimenopausal women excrete higher volumes of hypotonic sweat compared to pre – and postmenopausal women. This warrants further investigation, as it could be an adaptive mechanism inhibiting excessive potassium loss.

Biography of author(s)

Dr.  Emmanuel Amabebe
Department of Physiology, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria.

Mrs. Sonia I.  Osayande
Department of Physiology, University of Benin, Benin City, Edo State, Nigeria.

Mrs. Janet O. Nzoputam
Department of Physiology, University of Benin, Benin City, Edo State, Nigeria.

Professor (Sir) Andrew C. Ugwu
Department of Physiology, University of Benin, Benin City, Edo State, Nigeria.

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