Nonalcoholic Fatty Liver Disease and Associated Risk Factors in Obese Nigerians: A Cross-Sectional Study.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is now adjudged the most common liver disease in the world, contributing to the rising incidence of hepatocellular carcinoma worldwide. However, the true prevalence of nonalcoholic fatty liver disease among obese individuals and its contribution to the burden of liver disease in Nigeria is unknown. AIM: To determine the prevalence of nonalcoholic fatty liver disease and associated risk factors in obese subjects. METHODS: This was a cross-sectional analytical study of 280 obese subjects and 280 nonobese age and sex-matched controls seen at our health facility. Data collection was done using an interviewer-administered questionnaire and anthropometric parameters were obtained. Fasting blood samples were collected for blood glucose, lipid profile, and liver biochemistry. Abdominal ultrasound was used to screen for NAFLD. The results were subjected to relevant statistical analysis using SPSS version 20. RESULTS: A higher prevalence of NAFLD was found in obese subjects, compared with nonobese controls (36.4% versus 0.4% P < 0.001). The degree of obesity, transaminases, total cholesterol, diastolic hypertension, fasting blood glucose, and waist circumference was significantly associated with a higher prevalence of NAFLD. However, using multivariate logistic regression analysis, diabetes mellitus and hypertension were significant associations for NAFLD. Individuals with NAFLD had a significantly higher prevalence of metabolic syndrome 65.9%, compared with 34.1% in obese individuals without NAFLD (P < 0.001). CONCLUSION: The prevalence of NAFLD in obese subjects was significant. NAFLD in obese subjects was associated with degree of obesity, hyperlipidemia, hypertension, and diabetes mellitus.

Knowledge, attitudes and practices towards Covid-19 among Nigerian healthcare workers during the Covid-19 pandemic: A single centre survey.

BACKGROUND: The COVID-19 pandemic has led to hundreds of thousands of deaths worldwide. AIMS: Being a novel viral disease, we sought to evaluate the knowledge and practice of doctors and nurses in a tertiary hospital regarding the disease. SUBJECTS AND METHODS: Using a self-administered questionnaire, respondents were asked questions on the cause, clinical features, and prevention of COVID-19. RESULTS: : We studied 409 respondents (238 doctors and 171 nurses) with a mean age of 34 ± 7 years and a median length of experience of five (IQR 2-9) years. The mean knowledge score was 9.6 ± 1.2 out of a maximum of 12 points with 337 (82.4%) respondents having good knowledge. The majority of respondents (62.8%) had not been trained on infection prevention and control since the outbreak of the pandemic. Only 95 (23.2%) had seen COVID-19 Standard Operating Procedures (SOP) displayed in the hospital. The use of the personal protective equipment (PPE) kit comprising the N-95 mask, face shield, gown, and shoes was seen by 194 (47.4%) respondents in recent times. A total of 397 (97.0%) respondents felt they were at an increased risk of contracting COVID-19 relative to the general populace. Measures taken to prevent COVID-19 included: wearing of face mask (68.7%), hand gloves (78.2%), frequent use of hand sanitizers (84.1%), frequent hand washing (84.8%), the daily wash of uniforms and ward coats (44.5%), daily cleaning of footwear (31.7%), and avoidance of taking home clothing and footwear worn in the hospital (54.2%). CONCLUSION: Despite having good knowledge of transmission and clinical features of SARS-CoV 2, the utilization of protective measures by HCW in this study is unsatisfactory.

Predictors and Prognosis of Stroke in Jos, North-Central Nigeria.

BACKGROUND: Stroke is the second leading cause of death worldwide. Stroke mortality has been shown to be higher in blacks in multiracial studies. It is also a very important cause of disability with its attendant deterioration in the quality of life in survivors. OBJECTIVE: The study sought to determine the risk and prognostic factors associated with stroke in Jos, North Central Nigeria. METHODS: A prospective cohort study of stroke patients that were followed up for 90 days to determine outcomes. The stroke patients were admitted into the neurology unit of Jos University Teaching Hospital between September 2016 and August 2018. RESULTS: We recruited a total of 246 subjects comprising 131 (53.3%) males aged 59.5 ± 13.1 years and 115 (46.6%) females aged 56.7 ± 14.2 years. Obesity, hypertension, dyslipidaemia and alcohol consumption were the commonest risk factors identified. The 90-day case fatality rate of stroke was 22%. Elevated glycated haemoglobin (p = 0.001), loss of consciousness at presentation (p <0.001), atrial fibrillation (p= 0.022), cardiac disease (p < 0.001) and HIV infection (p = 0.001) were significantly associated with poor outcome for stroke. Furthermore, subjects with a high NIHSS had three times the risk of death compared with those with low scores (RR = 2.93; 95% CI = 2.38 - 3.61, p <0.001). CONCLUSION: The prognosis of stroke was poor. The predictors of poor stroke outcome were coma, HIV infection, cardiac disease, high NIHSS and total cholesterol.

HISTORIQUE: L'AVC est la deuxième cause de décès dans le monde. La mortalité par accident vasculaire cérébral s'est avérée plus élevée chez les Noirs dans les études multiraciales. C'est également une cause très importante d'invalidité avec la détérioration de la qualité de vie des survivants. OBJECTIF: L'étude visait à déterminer le risque et les facteurs pronostiques associés à un AVC à Jos, au centre-nord du Nigéria. MÉTHODES: Une étude de cohorte prospective de patients victimes d'un AVC qui a été suivie pendant 90 jours pour déterminer les résultats. Les patients victimes d'unAVC ont été admis dans l'unité de neurologie de l'hôpital universitaire de Jos entre septembre 2016 et août 2018. RÉSULTATS: Nous avons recruté un total de 246 sujets comprenant 131 (53,3%) hommes âgés de 59,5 ± 13,1 ans et 115 (46,6%) femmes âgées de 56,7 ± 14,2 ans. L'obésité, l'hypertension, la dyslipidémie et la consommation d'alcool étaient les facteurs de risque les plus courants identifiés. Le taux de mortalité par accident vasculaire cérébral à 90 jours était de 22%. L'hémoglobine glyquée élevée (p = 0,001), la perte de conscience à la présentation (p <0,001), la fibrillation auriculaire (p = 0,022), les maladies cardiaques (p <0,001) et l'infection à VIH (p = 0,001) étaient significativement associées à de mauvais résultats pour coup. En outre, les sujets avec un NIHSS élevé avaient trois fois le risque de décès par rapport à ceux avec desscores faibles (RR = 2,93; IC à 95% = 2,38 - 3,61, p <0,001). CONCLUSION: Le pronostic de l'AVC était mauvais. Les facteurs prédictifs d'un mauvais pronostic d'AVC étaient le coma, l'infection par le VIH, les maladies cardiaques, un NIHSS élevé et le cholestérol total. MOTS CLÉS: Prédicteurs, pronostic, accident vasculaire cérébral.

Bowel habits of urban and rural populations on the Jos, Plateau, Nigeria.

BACKGROUND: Constipation and diarrhoea are frequent complaints amongst patients attending Gastroenterology Clinics. The normal bowel habits may vary among populations. OBJECTIVE: To characterise and compare the bowel habits of rural and urban dwellers in a Nigerian population. METHODS: Questionnaires were administered to 1236 adults aged 16 years and above recruited from two communities (rural and urban) using a two stage cluster sampling scheme based on existing administrative set up in a cross-sectional study. Information sought included socio-demographics, alcohol consumption, bowel habits and level of physical activity. RESULTS: Adequate data for analysis were available in 1017 subjects giving a response rate of 509(93.1%) and 508(87.7%) for rural and urban populations respectively. The mean weekly bowel frequencies for the rural and urban populations were 10.8 ± 5.1 and 9.7 ± 4.9 (p=0.09) respectively. Four hundred and ninety-four (97%) subjects from the rural community and 493 (97%) from the urban opened their bowels between three times per day to three times per week. Constipation as identified by the passage of three or less motions per week was present in 14 (2.8%) of urban dwellers compared to 4 (0.8%) of the rural (p = 0.01). Bowel motions were more frequent in males than in females. CONCLUSION: Bowel opening appears slightly more frequent among rural plateaus inhabitants than in urban dwellers. Constipation is more common in the urban than in the rural area.

Early virologic response to pegylated interferon in chronic hepatitis B infection.

BACKGROUND: Early virologic response to pegylated interferon in the treatment of chronic hepatitis B infection is not frequently reported. METHOD: The case notes of the patients was retrieved and relevant data extracted, literature review was done using Medline. RESULT: A report of a case of early virologic response in a 62 year old man with chronic hepatitis B infection, receiving pegylated interferon is presented with a review of the relevant literature. He had HBV DNA level assessed by PCR and histology of liver biopsy specimen. CONCLUSION: Clinicians should be on the lookout for early virologic response to pegylated interferon and the eventual outcome of such early response.

Hepatitis B vaccination status and needle stick injuries among medical students in a Nigerian university.

BACKGROUND: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). METHOD: Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. RESULTS: Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. CONCLUSION: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students.

Oesophageal variceal band ligation using a saeed six-shooter multiband ligator; experience at Jos University Teaching Hospital, Nigeria: case report.

BACKGROUND: Oesophageal varices are common sequelae of cirrhosis, which when they bleed can be difficult to control. Oesophageal variceal band ligation, being the best modality for controlling variceal bleeding has not been common practice in West Africa, a region recognized to have a high prevalence of liver diseases. We present a case of band ligation of the varices of a patient that presented to our hospital with variceal haemorrhage, secondary to liver cirrhosis. METHOD: We started by presenting a summary of the presentation of a 31 year old man at the Jos University Teaching Hospital and how we established the diagnosis of grade IV bleeding oesophageal varices. The subject had four bands applied to the oesophageal varices using a saeed six shooter oesophageal Multi-band ligator (North Carolina, USA) using a forward-viewing GIF P30 gastroscope (Tokyo, Japan) with the bands mounted on an Opti-vu barrel-shaped piece. He had a total of three sessions after which he was maintained on propranolol. RESULT: The last recheck endoscopy demonstrated obliterated varices after which he was maintained on propranolol. CONCLUSION: We present a case of successful variceal band ligation of a cirrhotic with extensive oesophageal varices presenting in a resource-constraint medical setting.

Relation between Helicobacter pylori, inflammatory (neutrophil) activity, chronic gastritis, gastric atrophy and intestinal metaplasia.

BACKGROUND: To determine the relation of Helicobacter pylori infection with chronic inflammation, atrophy, activity level and intestinal metaplasia. PATIENTS AND METHODS: A cross-sectional study of 100 consecutive patients with dyspepsia. These patients were fasted for 12 hours and gastroscopic biopsy specimens were obtained from their gastric mucosae. The specimens were histologically evaluated for H. pylori, inflammatory activity, chronic inflammation, gastric atrophy and intestinal metaplasia. RESULTS: There were 50 (50%) females and 50 (50%) males. The average ages of women and men were 36.3 +/- 11.5 and 42.9 +/- 12.8 respectively. Helicobacter pylori was found in 79%. Neutrophil activity was observed in 83%. Inflammation was found in 95%, glandular atrophy in 38%, intestinal metaplasia in 28% of the cases. Incidental (early gastric) cancer was found in 3%, dysplasia in 2% and reactive gastropathy in 7% of the cases. A statistically significant relationship was found between Helicobacter pylori colonization intensity and the degrees ofneutrophil activity, chronic inflammation and intestinal metaplasia. CONCLUSION: We concluded that Helicobacter pylori infection results in neutrophil activation and chronic gastritis, and that it has a role in the development of intestinal metaplasia. The greater the intensity of Helicobacter pylori infection, the greater the degrees of neutrophil activation, chronic gastritis and intestinal metaplasia.

Oral manifestation of HIV/AIDS in Plateau state indigenes, Nigeria.

BACKGROUND: To investigate the prevalence of oral manifestations of HIV/AIDS involving HIV positive Plateau State indigenous adults attending a Special Treatment Clinic serving referred cases and in-patient cases hospitalized in the Medical wards in JUTH, Jos. STUDY DESIGN: A cross-sectional study. RESULTS: A total of 261 patients confirmed for HIV infection were examined. The age range was 17 - 80 years, mean = 35.6 +/- 9.27 (SD). 59.4% were females and 40.6% were males. Oral lesions attributable to HIV/ AIDS infection were found in 109 (41.8%) patients, 38 (34.9%) of these patients had multiple lesions. Oral lesions were diagnosed more frequently in women (59.6%) than in men (p=0.945). Oral candidiasis was the most common presentation (35.7%) with pseudomembraneous candidiasis (23%) and angular cheilitis (10%) being the most common variants. All the cases of erythematous candidiasis (n=7) were exclusively seen in the female population. Oral hairy leukoplakia and xerostomia were present in 4.6% and 3.8% of cases respectively. Kaposi's Sarcoma was in 5 (1.9%) patients. CONCLUSION: The prevalence of HIV-related oral lesions (HIV-ROL) in a hospital based adult population of Plateau State indigenes in Jos is 41.8%. Oral Candidiasis is the most common HIV-ROL detected and this agrees with most reported findings.

Prevalence of HIV--related oral lesions in Nigerian women.

BACKGROUND: Human immunodeficiency virus (HIV) infection affects an increasing number of women throughout the world. Oral lesions are among the earliest clinical manifestations of HIV infection and are associated with its progression. We describe the oral manifestations of HIV/AIDS in Nigerian women and its clinical correlates. METHODS: Nigerian women with HIV/AIDS were examined for the presence of oral lesions attributable to HIV/AIDS. These lesions were diagnosed clinically, according to the criteria established by the European Community Clearinghouse (ECC) on oral problems related to HIV infection. RESULTS: Two hundred and sixty-nine seropositive women were examined with a range of 17-60 years (mean of 32.4 years < 8.09). The age group of 21 30 years was the worst affected (n = 125, 46.5%). Of these patients, 109 (40.5%) were married, 67 (24.9%) were single while 47 (17.5%) had multiple sexual partners. One hundred and eighteen (43.9%) had at least an oral lesion associated with HIV/AIDS. The most common was oral candidiasis, which was present in 98 (36.4%) patients. Pseudomembraneous candidiasis (n = 66, 24.5%) and angular cheilitis (n = 23, 8.6%) were the commonest variants seen. The former was the only lesion significantly associated with the clinical stage of the infection (p = 0.002) while necrotizing gingivitis, linear gingival erythema and angular cheilitis were associated with the age of the patients (p < 0.05). CONCLUSION: Oral manifestations are common features of HIV infection among Nigerian women. Oral candidiasis (OC) was the most notable oral lesion associated with HIV/AIDS. It may be a useful clinical indicator of early immune dysfunction mediated by HIV.

Prevalence of irritable bowel syndrome in a Nigerian student population.

Irritable bowel syndrome (IBS) is a widely recognized disorder accounting for up to 50% of referrals to gastroenterologists in the Western world. Existing literature had suggested that its prevalence is low among native Africans. The objective [corrected] is to document the prevalence of IBS in this environment. A cross-sectional study of clinical students at the Jos University Medical School and the School of Medical Laboratory Technology in Jos University were cohorted. Questionnaires based on the Rome II criteria were administered to 330 students (221 males and 109 females). Irritable bowel syndrome was present in 86 (26.1%) of the subjects, being present in 58 (26.4%) of the males and 28 (25.7%) of the females respectively (OR 0.97, 95% CI 0.57-1.63, p = 0.89). The mean age of subjects with IBS was 26.3 +/- 4.0 years and that of subjects without IBS was 26.5 +/- 3.8 years, p = 0.6. The majority (54.8%) of the subjects did not consider their symptoms as illness and therefore did not seek any form of care. More males sought medical care compared to females (19.6% vs. 3.6% respectively, p = 0.02). Depressive symptoms were present in 21 (24.4%) of subjects with IBS compared to 36 (14.8%) of those without (p = 0.06). Irritable bowel syndrome is a common disorder in the student population of a medical school in Northern Nigeria.

Upper gastrointestinal endoscopic findings in patients with HIV/AIDS at the Jos University Teaching Hospital, Nigeria.

BACKGROUND: Upper gastrointestinal tract involvement in HIV/AIDS is common. No data exist on the pattern of upper gastrointestinal endoscopic findings in HIV/AIDS patients in Nigeria. OBJECTIVE: To describe the pattern of upper gastrointestinal endoscopic findings in HIV/AIDS patients. DESIGN: A hospital based retrospective case-control study involving 52 HIV/AIDS patients and 52 age and sex matched controls. SETTING: Medicine Department of the Jos University Teaching Hospital, Nigeria. METHODS: Medical records of patients with HIV/AIDS and an age and gender matched control who underwent upper gastrointestinal endoscopy over an eight-year period were reviewed. RESULTS: Oesophageal candidiasis was the commonest finding in 18 (34.6%) of subjects with HIV/AIDS followed by normal upper gastrointestinal tract in 17 (32.1%). Normal upper gastrointestinal tract was found in 57.6% of HIV seronegative subjects while oesophageal candidiasis occurred in one (1.9%) of these patients. Duodenal ulcer and gastritis occurred with equal frequencies in HIV/AIDS patients (7.5%) and controls. CONCLUSION: Oesophageal candidiasis was the commonest upper gastrointestinal endoscopic finding in patients with HIV/AIDS.

Aetiological significance of alcohol in liver cirrhosis on the Jos Plateau.

Fifty-one patients with histologically diagnosed cirrhosis were studied prospectively over one year period. There were forty-one males and ten females. The majority of patients (75.59%) took alcohol in significant quantity and it was thought to be the most likely cause of the cirrhosis in them. Eighty percent of them had micronodular cirrhosis and 51.3% of them drank only "burukutu" a local alcoholic brew brewed mostly in iron pots and contains two other hepatotoxic agents--aflatoxin and iron. Eight (5.7%) of the patients and five (9.8%) of controls were positive for hepatitis B surface antigen (HBs.Ag). It is likely that alcohol is very important cause of cirrhosis of the liver seen in Jos.

Anti-CagA antibodies in Helicobacter pylori-positive patients and blood donors from Nigeria.

The prevalence of antibodies to CagA protein was evaluated in 174 Helicobacter pylori-positive. subjects: 110 patients submitted to upper gastrointestinal endoscopy and 64 male blood donors. The patients were from different regions of Nigeria: Jos, North, Benue,West and East and the blood donors were from Jos. Sera were assayed for anti-CagA antibodies using Helicobacter p120, CagA ELISA (Viva Diagnostika, Hürth, Germany). Anti-CagA antibodies were detected in 104 (94.5%) patients and in 61 (95.3%) blood donors (P=1.0). Patients from the Benue region presented a lower frequency of anti-CagA antibodies than patients from the other regions (P=0.0004). When the subjects were stratified by age, a significant increase in IgG concentration was observed among the men (P=0.03) but not among the women (P=0.57) or among the blood donors (P=0.83). In conclusion, similarly toAsian countries, CagA-positive H. pylori infection is highly frequent in Nigeria.

Antibody levels to Salmonella typhi and paratyphi in Nigerians.

OBJECTIVE: To determine the antibody titre levels to typhoid/paratyphoid fever organisms among apparently healthy volunteers. DESIGN: Cross sectional study. SETTING: General community and University Teaching Hospital. PARTICIPANTS: Volunteer sample of 323 apparently healthy individuals with body temperatures < or = 37.8 degrees C. MAIN OUTCOME MEASURES: Questionnaire administration to classify volunteers into three socio-economic status (SES). RESULTS: There were 35.29% of the apparently healthy population in Jos community with antibodies to typhoid/paratyphoid fever organisms. The presence of these antibodies were neither sex nor SES related. Normal antibody titres were up to 1:40 and 1:80 for O and H Salmonella antigens respectively. Contrary to the general belief, typhoid/paratyphoid fevers have not affected virtually everybody in Nigeria. The difference between those without previous history and those with previous history was significant (p < 0.05) with those in the former category having a higher percentage. CONCLUSION: For a single sero-diagnosis to have any diagnostic value in Jos community and its environs, only a four-fold rise to what has been found to be normal should be significant. This means that only titres of 1:160 and 1:320 and above for O and H antigens should be considered significant.

Open clinical trial of roxithromycin in patients of Plateau Hospitals, Jos in upper and lower respiratory tract infections.

An open clinical study to assess the efficacy and tolerance of Roxithromycin 150 mg twice daily was carried out amongst Nigerian patients with upper and lower respiratory tract infections at Plateau Hospital Jos. Twenty-two patients aged between 13 and 86 years comprising of twelve women, seven men and three children completed the study. 18 (81.8%) had bronchopulmonary infections, 3 (13.6%) had tonsillitis and 1 (4.6%) had otitis media. Pathogens isolated included streptococcus Pneumonia (22.7%), Streptococcus pyogenes (13.6%), Bramhella Catarrhalis (9.1%), Haemophilus influenzae (9.1%), Staphylococcus Aureus (4.6%), Klebsiella species (4.6%), Pseudomonas Aeruginosa (4.6%). There was 88.2% bacteriological cure and patients responded fast, with no major adverse reactions. Roxithromycin is therefore concluded to be an effective well tolerated drug for treatment of respiratory tract infections in Nigerians.

Gastroduodenal diseases on the Jos plateau, Nigeria.

Two hundred and forty-three Nigerian patients referred for endoscopy at the Jos University Teaching Hospital in Nigeria were studied. Their overall mean age was 37.7 years (SD 12.7), among those with ulcers it was 38.4 years. The male:female ratio was equal in general, but among those with ulcers it was 2:1. Duodenal and gastric ulcers were found in 42(17.3%) and 12(4.9%) patients respectively, ratio of 3.5:1. There were 3 patients each with oesophageal and gastric carcinoma. Our findings do not support the belief that the savannah region of West Africa is an area of low prevalence of peptic ulcer disease. In the light of the importance of Helicobacter pylori infection in the pathogenesis of gastroduodenal diseases and the apparent discrepancy between its prevalence and that of associated diseases in the developing countries, there is a need to reappraise our traditional beliefs about the epidemiology of these diseases, using similar methods to those used in developed countries.

Chloroquine-resistant malaria in Jos, Nigeria.

A 16-year-old Nigerian boy who had lived all his life in a malaria endemic region presented with continuing fever after what would ordinarily be accepted as adequate treatment for malaria. He went on to develop cerebral malaria, recovering only after administration of quinine.