Incidence of hepatotoxicity of highly active antiretroviral therapy in a tertiary health centre in Nigeria.

AIMS AND OBJECTIVES: The aim of this study was to determine the incidence of hepatotoxicity of HAART in HIV infected patients in a tertiary health centre in Nigeria. MATERIALS AND METHODS: This study was carried out on HIV patients on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of University of Benin Teaching Hospital. HAART-naive HIV patients were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardised toxicity grade scale. RESULTS: A total of 84 cases and 42 controls were studied. The mean ages were 35.2± 9.9years and 35.5±9.0 years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.9% and severe hepatotoxicity occurred in 10.7% of the patients. Alcohol use and being underweight were independent risk factors for hepatotoxicity. CONCLUSION: This prospective study clearly shows that there was appreciable hepatotoxicity associated with HAART in the study patients as found in other parts of the world. There is a need for regular monitoring of liver function in these patients because of the risk of hepatotoxicity.

Indications for oesophagogastroduodenoscopy in Ilorin, Nigeria--a 30 month review.

BACKGROUND: Oesophagogastroduodenoscopy is one of the most commonly performed endoscopic procedures. Properly performed, it provides valuable information in patients with upper gastrointestinal conditions. Oesophagogastroduodenoscopy is a visual examination of the upper intestinal tract using a lighted, flexible fibreoptic endoscope or videoscope. Oesophagogastroduodenoscopy is generally indicated for evaluating upper abdominal symptoms such as dysphagia or odynophagia, oesophageal reflux symptoms, gastroduodenal or oesophageal ulcer, upper tract stricture or obstruction, gastrointestinal bleeding, persistent vomiting of unknown cause etc. This study is therefore to review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. AIM: To review the indications for oesophagogastroduodenoscopy in Ilorin, Nigeria. METHODOLOGY: A review of the indications for oesophagogastroduodenoscopy was undertaken to cover a thirty-month period from June 2006 to November 2008. The endoscopy register of the operating theatre was examined over this period. The biodata of the patients who underwent the procedure over this period was reviewed. RESULTS: A total of 206 patients had oesophagogastroduodenoscopy done on them during the period under review. 124 of the patients were males (60.2%) while 82 were females (39.8%). The indications for oesophagogastroduodenoscopy were dyspepsia, 94 patients (45.6%); upper gastrointestinal tract bleed, 54 patients (26.2%); gastric outlet obstruction, 12 patients (5.8%); gastric cancer, 11 patients (5.3%); dysphagia, 9 patients (4.3%); acute exacerbation of peptic ulcer disease, 8 patients (3.8%); gastro-oesophageal reflux disease, 7 patients (3.4%); recurrent vomiting, 3 patients (1.5%); bloody stool, 2 patients (1.0%); epigastric mass, 2 patients (1.0%); 1 patient (0.5%) each on account of excessive salivation, foreign body ingestion, ingestion of corrosive, and recurrent anaemia. CONCLUSION: The commonest indication for oesophagogastroduodenoscopy in Ilorin is dyspepsia.

Comparative study of stool antigen test and serology for Helicobacter pylori among Nigerian dyspeptic patients--a pilot study.

OBJECTIVE: The purpose of this study was to compare the stool antigen (SAT) and immunoglobulin G (IgG) serology tests for Helicobacter pylori in dyspeptic patients in Nigeria, and determine their usefulness. METHOD: Forty six patients with dyspepsia and age and sex-matched healthy controls had their blood and stool collected and screened for H. pylori infection using the enzyme linked immunosorbent assay (ELISA) IgG serology and SAT respectively. Prevalence of H. pylori was 67.4% and 78.3%, among dyspeptics and controls respectively ((p = 0.48) with the SAT while the corresponding values for IgG serology were 67.4% and 91.3%, p = 0.005). RESULT: Patients aged > or = 50 years(8) were more positive to SAT (80%), compared with controls (13) which recorded more positivity in the age range 30-39 years (92.9%). The male gender had more positive SAT in patients (n = 15, 75%) but the SAT was more positive among the female controls 22 (84.6%). Controls in the age range < 30 years were more positive to H. pylori IgG while the patients were more positive at = 30 yrs 10 (100%). CONCLUSION: It is concluded that SAT and IgG serology for H. pylori are both useful in diagnosis of the infection, and are fairly comparable in their ability to detect infection, even in area of high endemicity.

The relationship between gallstone disease and gall bladder volume.

BACKGROUND: The role of a large gallbladder volume with regards to a predisposition to gallstones is unknown. It is likely that an increase in gallbladder volume could result in impaired gallbladder motility and bile stasis which may encourage gallstone formation. This study is therefore to determine the relationship between the presence of gallstone disease and gall bladder volume. METHODOLOGY: One hundred type 2 diabetic patients and 100 age and sex-matched controls underwent real time ultrasonography to determine the relationship between the presence of gallstone disease and gallbladder volume. Their demographic characteristics were recorded and compared. The ultrasound examinations was done in the morning following an overnight fast (to prevent gall bladder contraction) without sedation. Longitudinal and transverse scans of the right upper quadrant was done in both the supine and left lateral positions The gallbladder volume was measured. RESULT: The mean gallbladder volume in diabetic patients with gallstone disease 28.4 +/- 18.6 ml was higher than in those without gallstone disease 27.4 +/- 14.8 ml p = 0.844. The mean gallbladder volume in the controls with gallstone disease 26.5 +/- 14.7 ml was also higher than in those without gallstone disease 24.1 +/- 12.7 ml p = 0.189. CONCLUSION: The fasting gallbladder volume tended to be larger in patients with gallstones (i.e. both diabetic patients and controls).

Pattern and outcome of medical admission of elderly patients seen at University of Ilorin Teaching Hospital, Ilorin.

The elderly are increasingly been hospitalised into medical wards in Nigeria and little information is currently available on this group of patients. The objective of this study was to describe the demographic, clinical characteristics and outcome of management of elderly patients admitted into medical wards at the University of Ilorin Teaching Hospital Ilorin, Nigeria. A retrospective study in which hospital records of patients admitted between years 2001 to 2004 were reviewed. Information obtained included gender, occupation, diagnosis, investigations, duration of stay and outcome management. A total of 4113 adults were admitted into the medical wards within the period under review. Of these, 456 were aged 60 years and above. The elderly patients accounted for 11.1% of total hospitalisation into the medical wards. The mean age of the patients was 69 +/- 9 years with male:female ratio of 243:105. The 3 most common diagnoses were: hypertensive heart failure (HHF), 19%; cerebrovascular accident (CVA), 12%; and tuberculosis (TB), 11%. The mean duration of hospitalisation was 15.6 +/- 13.8 days. Cases of mortality had significantly higher value of mean serum potassium, urea and creatinine, compared to those with favourable outcome and were eventually discharged home. A total of 192 patients (55.2%) were discharged home, while 109 (31%) died giving in-hospital mortality of 31.7%. Majority of the deaths (75%) occurred within 14 days of hospitalisation. Significantly higher number of patients died within the first seven days compared to those discharged (P<0.01). The mean duration of hospital stay was 15.6 +/- 13.8 days. Patients with favourable outcome spent a mean of 18.5 +/- 14.1 days while cases of mortality had a mean of 10.4 +/- 8.8 days in hospital before death. Geriatric patients constituted more than a tenth of total hospitalisation into UITH medical wards. They accounted for a significant proportion of in-hospital mortality. Since a third of the death occurred within the first few days of admission, improvement in the management of acute medical cases especially in the elderly is urgent needed. This will ensure survival of greater number of patients and thus reduces mortality.

Clinical and laboratory indices of cholelithiasis in adult Nigerians with sickle-cell anaemia.

The clinical and laboratory indices of cholelithiasis in adult Nigerians with homozygous sickle-cell disease (SCD) were studied in 100 consecutive patients attending the adult SS clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The study examined the role of clinical (sickle cell (SS) crises, body mass indices [BMIs]), haematological (reticulocyte count, haemoglobin) and biochemical (serum bilirubin, serum alkaline phosphatase and serum amino transaminases) indices in predicting the likelihood of finding cholelithiasis in patients with SS anaemia. A positive correlation was found between the BMI, SS crises, reticulocyte count, serum bilirubin, serum alanine and asparate transferases on one hand and the development of cholelithiasis (at P values of 0.04, 0.03, 0.05, 0.01 and 0.04, respectively) on the other. No such association was found between the other indices studied and cholelithiasis.

Apparent rarity of cryptosporidiosis in human immunodeficiency virus (HIV)-related diarrhoea in Enugu, South-Eastern, Nigeria.

Cryptosporidium is the most frequently implicated organism in human immunodeficiency virus (HIV)-related diarrhoea worldwide. Because of the increasing incidence and prevalence of HIV infection in Nigeria and the associated increase in the number of patients presenting with chronic diarrhoea, it has become necessary to determine the prevalence of this organism in HIV-infected patients in Enugu, South Eastern Nigeria. One hundred and eighty nine (189) adult patients with chronic diarrhoea admitted to the University of Nigeria Teaching Hospital (UNTH) Enugu from August 1996 to October 1997 were further evaluated by serological testing for HIV infection. Their stool specimens were examined by light microscopy after staining by a modified cold Ziehl-Neelsen (ZN) method. Out of the 189 patients (117 males and 72 females), 161 had HIV infection (85.19%) whereas 28 (14.81%) were HIV-negative. Neither the HIV-infected nor the HIV-negative patients had cryptosporidium oocysts or any other acid-fast organism in stool. Intestinal cryptosporidiosis is not common in HIV-infected patients with chronic diarrhoea in Enugu. More studies are needed to further confirm this trend.

Blood sugar control among fasting Muslims with type 2 diabetes mellitus in Ilorin.

Fasting in the month of Ramadan represents a recurring annual event in the life of a Muslim. It also represents one of the five pillars around which the Islamic faith revolves making it desirable to even diabetic Muslims if only to live a spiritually fulfilling life. We therefore embarked upon the study of 33 patients with Type 2 Diabetes Mellitus who fasted in the month of Ramadan of 1417 Hijra year (1997 Gregorian) with a view to establishing the effect of fasting on their blood sugar control. This is meant to serve as a framework for establishing a scientific basis for advice to Muslim diabetic patients who may wish to fast in subsequent years. Eight point three percent of patients considered for enrollment signified their non-willingness to fast even after health-education. In the month preceding fasting the mean +/- SD for fasting blood sugar (FBS) was 6.71 +/- 2.81 mmol/L, 6.50 +/- 2.34 mmol/L for the month of Ramadan and 6.93 +/- 2.53 mmol/L for the month after. There was no statistically significant difference between the means for the three months. However, larger percentage of patients (76%) had their fasting blood sugar improved upon during fasting than either before or after. In addition, there was no reported case of acute complication from diabetic emergencies all through the period of the study. Based on these findings, it was concluded that most Type 2 diabetic patients actually do as well, like their normal counterparts during fasting and could be encouraged to do so provided they are clinically stable.

The burden of viral hepatitis in Africa.

The burden of viral hepatitis in Africa is difficult to quantify precisely because of inaccurate statistical data and under-reporting. Of the various agents causing viral hepatitis, data on hepatitis B virus have been relatively more available and suggest that 15 to 60 per cent of the normal population in many African countries may be positive for one or more of the serologic markers of hepatitis B virus infection, whilst the corresponding values for patients with PLCC ranged from 49 to 80 per cent. Liver disease was the third most common (12.1%) of all 4,568 deaths on the medical wards of the University College Hospital, Ibadan, Nigeria over a 14-year period. Of all causes of deaths from liver disease, PLCC alone accounted for 42.5% while liver cirrhosis accounted for 21.1% of the deaths and, in both disease, HBV was the commonest cause. PLCC, which accounted for 491 out of 100,000 admissions in that teaching hospital, was the commonest malignancy on the medical wards and was the commonest cause of deaths from cancers in middle-aged and elderly Nigerians. Recent reports suggest that the prevalence of Hepatitis C infection in normal Africans may be as high as 10.9% while the corresponding value for patients with PLCC would be about 18.7 to 38 per cent. There is a need for control of hepatitis particularly hepatitis B virus infection through health education, active immunization of all new-borns and other people at risk in Africa.

PIP: The burden of viral hepatitis in Africa is difficult to quantify precisely because of inaccurate statistical data and underreporting. Of the various agents causing viral hepatitis, data on hepatitis B virus have been relatively more available and suggest that 15-60% of the normal population in many African countries may be positive for one or more of the serologic markers of hepatitis B virus infection, whilst the corresponding values for patients with primary liver cell carcinoma (PLCC) ranged from 49% to 80%. Liver disease was the third most common cause (12.1%) of all 4568 deaths in the medical wards of the University College Hospital, Ibadan, Nigeria, over a 14-year period. Of all causes of death from liver disease, PLCC alone accounted for 42.5% of deaths while liver cirrhosis accounted for 21.1%, and, in both diseases, HBV was the most common cause. PLCC, which accounted for 491 out of 100,000 admissions in that teaching hospital, was the most common malignancy in the medical wards and was the most common cause of death from cancer in middle-aged and elderly Nigerians. Recent reports suggest that the prevalence of hepatitis C infection in normal Africans may be as high as 10.9%, while the corresponding value for patients with PLCC would be about 18.7-38%. There is a need for control of hepatitis, particularly hepatitis B virus infection, through health education and active immunization of all newborns and other people at risk in Africa.

An analysis of tetanus deaths in Lagos.

Between 1974 and 1984, 418 patients with tetanus, aged 10 years and older, represented 64.8% of all admissions to the intensive care unit of the Lagos University Teaching Hospital. Students accounted for the largest single group with tetanus, which mainly occurred during the dry season. There was a male preponderance (1.4 to 1), but no appreciable sex influence on mortality rates (46.1% for men; 44.6% for women). The mean mortality rate was 45.5%, with the highest mortality occurring in the elderly. Other high risk factors identified were neck and head injuries, post abortal or post partum states, hyperpyrexia, and tachycardia.

Plasma HDL cholesterol, triglyceride and total cholesterol levels in non insulin treated Nigerian diabetics.

Total cholesterol, triglyceride and HDL-cholesterol concentrations were measured in 49 non-insulin-treated Nigerian diabetics and 40 healthy controls. Low levels of HDL-cholesterol were observed in the diabetic group (n = 49) and in both male (n = 20) and female (n = 29) diabetics, but these low levels were of significance in female diabetics only (p less than 0.025) and in the diabetic group considered as a whole (p less than 0.05). Significant hypertriglyceridaemia was observed in the diabetic group (p less than 0.005) and in both male (p less than 0.025) and female (p less than 0.05) diabetics. Total cholesterol concentrations were higher in each of the diabetic groups but these differences were not significant. These results suggest that black African diabetic females may represent a high risk group for development of other long term complications of diabetes mellitus and should therefore be monitored.

Pancreatic ascites.

A case of pancreatic ascites in an African is presented. It is a rare condition which is rapidly fatal. The diagnosis can be established if the clinician is aware of this condition; the significant finding is a grossly elevated ascitic fluid amylase.