Correlation of alanine aminotransferase levels and a histological diagnosis of steatohepatitis with ultrasound-diagnosed metabolic-associated fatty liver disease in patients from a centre in Nigeria.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is defined as the occurrence of hepatic fat accumulation in patients with negligible alcohol consumption or any other cause of hepatic steatosis. This study aimed to correlate the ultrasound-based diagnosis of MAFLD with the histological diagnosis of nonalcoholic steatohepatitis (NASH) and alanine aminotransferase (ALT) levels in patients with MAFLD. METHODS: This was a hospital-based cross-sectional study of 71 patients with MAFLD diagnosed by ultrasound. Percutaneous liver biopsy was performed for histological evidence of NASH in all patients, regardless of liver function test (LFT) values, provided that they had no contraindications. Liver histology was graded using the NASH Clinical Research Network MAFLD Activity Score. The data obtained were entered into SPSS version 21 and analysed using descriptive and inferential statistics. The significance level was set at < 0.05. RESULTS: A total of 71 patients (26 males and 45 females) with MAFLD were included. Thirty-nine (76.5%) patients with MAFLD and normal ALT levels had NASH, while 14 (82.4%) had elevated ALT levels. There was no statistically significant difference in the histological grade of NASH between patients with normal and elevated ALT levels. A weak correlation was found between the severity of steatosis on ultrasound scan and NASH incidence (p = 0.026). The sensitivity and specificity of ALT levels for predicting NASH according to the area under the receiver operating characteristics (AUROC 0.590) at an ALT cut-off value of 27.5 IU/L were 55.8% and 64.7%, respectively. CONCLUSION: NASH can occur in patients with MAFLD, irrespective of alanine transaminase (ALT) levels, and ultrasound grading of the severity of steatosis cannot accurately predict NASH. Liver biopsy remains the investigation of choice.

Factors that Influence the Acceptance of Needle Biopsy of the Liver at a Tertiary Hospital in Nigeria.

BACKGROUND: Liver biopsy is a procedure that is carried out for making the diagnosis of abnormal liver conditions. OBJECTIVES: This study assessed the factors that influence patients' acceptance of liver biopsy. METHODS: A hospital based prospective study among patients scheduled for outpatient liver biopsy. They completed an interviewer administered questionnaire that captured their expectations, the degree of pain, areas they think need improvement during the biopsy process and whether they would consent to a second liver biopsy. A qualitative aspect involved an in-depth interview of participants purposively selected for their experience of liver biopsy. Data from the quantitative group were entered into SPSS version 20 and analyzed using simple and inferential statistics while content analysis was done for the qualitative aspect. RESULTS: There were 100 participants in the quantitative group, 61 males and 39 females, and 16 in the qualitative group. Participants in the quantitative group expected a painful procedure (92%) that was likely to restrict their movement (64%). After biopsy, 44%, 40%, 28%, 26%, 18% and 17% of participants were unhappy with the long monitoring hours, biopsy needle pain, number of biopsy passes, lying on the biopsy site, shoulder tip pain and pain of local anaesthetic injection respectively. The qualitative aspect identified five thematic areas and showed that liver biopsy pain was influenced by preoperative anxiety occasioned by ill-advice and was exaggerated among females. CONCLUSION: Consenting for liver biopsy may be influenced by advice from others, while factors relating to the procedure and long monitoring period remain as deterrent factors.

CONTEXTE: La biopsie hépatique est une procédure qui est effectuée pour établir le diagnostic d'affections hépatiques anormales. OBJECTIFS: Cette étude a évalué les facteurs qui influencent l'acceptation de la biopsie hépatique par les patients. MÉTHODES: Une étude prospective en milieu hospitalier parmi les patients devant subir une biopsie hépatique en ambulatoire. Ils ont rempli un questionnaire administré par un intervieweur qui capturait leurs attentes, le degré de douleur, les domaines qu'ils pensaient devoir améliorer au cours du processus de biopsie et s'ils consentiraient à une deuxième biopsie du foie. Un aspect qualitatif impliquait un entretien approfondi avec des participants sélectionnés à dessein pour leur expérience de la biopsie hépatique. Les données du groupe quantitatif ont été saisies dans SPSS version 20 et analysées à l'aide de statistiques simples et inférentielles tandis que l'analyse de contenu a été effectuée pour l'aspect qualitatif. RÉSULTATS: Il y avait 100 participants dans le groupe quantitatif, 61 hommes et 39 femmes, et 16 dans le groupe qualitatif. Les participants du groupe quantitatif s'attendaient à une intervention douloureuse (92 %) susceptible de restreindre leurs mouvements (64 %). Après la biopsie, 44 %, 40 %, 28 %, 26 %, 18 % et 17 % des participants étaient mécontents des longues heures de surveillance, de la douleur à l'aiguille de biopsie, du nombre de passages de biopsie, de la position allongée sur le site de la biopsie, de la douleur et de la pointe de l'épaule d'injection d'anesthésique local respectivement. L'aspect qualitatif a identifié cinq domaines thématiques et a montré que la douleur de la biopsie hépatique était influencée par l'anxiété préopératoire occasionnée par un mauvais conseil et était exagérée chez les femmes. CONCLUSION: Le consentement à une biopsie hépatique peut être influencé par les conseils d'autrui, tandis que les facteurs liés à la procédure et à la longue période de surveillance restent des facteurs dissuasifs. MOTS CLÉS: Facteurs, influence, acceptation, biopsie hépatique. Nigérians.

Nigerian resident doctors' work schedule: A national study.

Background and Aim: The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety. Subjects and Methods: A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05. Results: The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48-72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%). Conclusion: The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.

Fatal haemorrhage from an ultrasound guided fine needle aspiration of the liver in a patient with primary hepatocellular carcinoma: case report.

A case of fatal haemorrhage is reported among 72 ultrasound (US) guided percutaneous fine-needle aspiration liver biopsies (FNAB) performed in the gastro- intestinal unit of Medicine Department in a tertiary hospital. The patient had primary hepatocellular carcinoma (PHCC) with advanced hepatic cirrhosis. Death was due to bleeding from liver nodule resulting in intra-peritoneal haemorrhage. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in the patient. This event is our first experience, but colour flow Doppler ultrasound guidance has been reported to prevent its occurrence. The use of FNAB for the diagnosis of PHCC should therefore be guided with colour flow Doppler ultrasound scan to prevent haemorrhage. In addition, there should be proper selection of patients for FNAB especially in areas where there are no colour flow Doppler ultrasound scans.

Comparison of short versus long term antibiotic prophylaxis in elective caesarean section at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

AIMS AND OBJECTIVES: This study was to determine any significant difference between the incidence of infectious morbidity with the use of a 24 hour antibiotics regimen compared to a 7-day course of antibiotics following elective caesarean section using a cheap and easily available combination of Ampicillin/Cloxacillin and Metronidazole. PATIENTS AND METHODS: Two hundred patients planned to have elective caesarean section for various indications and who satisfied the inclusion criteria were enrolled in the study in two groups of 100 patients each between the period of January to June 2010. Patients were randomized to receive either Ampiclox as 4 intravenous doses of 1g stat and 500 mg each 6 hourly and Metronidazole as 3 intravenous doses of 500 mg each 8 hourly both for 24 hours or same combination intravenously for 48 hours and subsequent oral use for 5 days. RESULTS: The mean maternal age, parity, gestational age and indication for caesarean section were similar in the two groups of participants. There was no statistical difference in the incidence of febrile morbidity (17%/18%, p=0.852), urinary tract infection (6%/4%, p=0.196), wound infection (4%/3%, p=0.056) and endometritis (3%/2%, p=0.367). The mean cost of antibiotics per patient (N730/$4.65) in the short term prophylaxis group was half that of the long term prophylaxis group (N1, 540/$9.81). CONCLUSION: There was no difference in the incidence of infection related morbidity when short term prophylactic antibiotics was used at elective caesarean section compared to long term prophylactic antibiotics.

Nutritional status and intelligence quotient of primary schoolchildren in Akure community of Ondo State, Nigeria.

A cross-sectional survey was conducted among 402 children (10-15 years) randomly selected from twelve public and private primary schools in Akure community of Ondo State, Nigeria. Self-administered questionnaire was used to collect information on children's demographic features and parent's socio-economic characteristics. The subject's weight, height, height-for-age and weight-for-height z-score were measured and determined respectively. Raven Standard Progressive Matrices consisted of 60 questions was administered in a quiet classroom within 60 minutes to assess intelligence quotient (IQ) of the children. The means of measured parameters were: age, 11.5 +/- 0.08 years; weight, 33.3 +/- 0.35 kg; height, 1.4 +/- 0.0 m; height-for-age z-score, -0.003 +/- 0.04; weight-for-height z-score -7.2E-7 +/- 0.1 and IQ, 20.9 +/- 0.56 (34.8%). The occupations of the children's parents were civil service (43.3%), petty business (21.9%), farming (15.8%), vocational jobs (16.0%) and none (3.2%). The majority of the parents (31.8%) had secondary school education. Parents with no formal education, primary education, tertiary education and higher degrees accounted for 7.2%, 30.6%, 22.9% and 7.4%, respectively. Monthly incomes ranged between $38.5 and 230.8. Weight-for-height z-score of the children showed that 49.8% were normal, 40% mildly wasted, 9.7% moderately wasted and 0.5% severely wasted. Height-for-age z-score was 50% normal, 35.1% mildly stunted, 13.4% moderately stunted and 1.5% severely stunted. IQ scores were 5% superior 11.2% above average, 11.4% average, 8.2% below average and 64.2% intellectual deficit. The interrelationship between height-for-age, IQ and socio-demographic characteristics showed that there were insignificant differences between the age groups, gender and socio-economic status of the pupils. Conclusively, this study showed that the proportion of malnourished and intellectual deficit among the studied population were high. However, it is not clear whether the findings are specific to the studied population alone or applicable to other parts of Nigeria. Further studies are therefore needed to confirm these findings.

Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria.

BACKGROUND: Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these. OBJECTIVE: To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010. METHODS: This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes. RESULTS: Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001). CONCLUSION: There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade.

Nutrient composition of selected medicinal leafy vegetables in Western Nigeria.

The objectives of this study were to evaluate the nutritional composition and consumption patterns of selected local leafy vegetables among families in Akure Township, Western Nigeria. The data collection involved administration of interviewer-structured questionnaires to the mothers. The questionnaire was designed to collect information on the medicinal and consumption pattern of vegetables. The chemical compositions of the vegetables were analyzed using standard methods. The nutrient composition of the vegetables showed that the protein content of Jathropha tanjorenses (40.94%) was significantly higher than the remaining leafy vegetable samples, whereas Curcubita pepo (8.25%) contained the least protein content. The fiber content of Solanum americanum (13.79%) was significantly higher when compared with other leafy vegetable samples. Also, the energy value of Baselia allia (401.68 kcal) was the highest, whereas that of C. pepo (285.10 kcal) was the lowest. Regarding mineral composition, J. tanjorenses had the highest contents of zinc, iron, and Na/K ratio, whereas Vernononia amygdalina and Solanum macrocarpon had the least and highest Na/K and Ca/P ratios, respectively. The consumption patterns of the respondents showed that one-quarter of the respondents consumed the vegetables regularly, whereas the remaining consumed occasionally or never consumed the vegetables. In conclusion, this study established that the leafy vegetables contained appreciable amounts of nutrients that could be of health and nutritional benefits to the consumers.

Determination of amino Acid content and protein quality of complementary food produced from locally available food materials in ondo state, Nigeria.

Protein-energy malnutrition is increasing among children in developing countries due to low nutrient density of traditional complementary diets. Therefore, this study aimed at determining the protein quality of a complementary food produced from cooking banana fruits and bambara groundnut seeds. The cooking banana and bambara groundnut seeds are locally available in both urban and villages markets in Nigeria. The cooking bananas (CB) and bambara groundnut (BG) seeds were processed into flours using standard procedure. The flours were mixed in a ratio of 70:30 (CBR1) and 60:40 (CBR2) of CB and BG respectively. A commercial weaning food (Nutrend) and traditional weaning food, ogi(corn gruel), were used as control food samples. The amino acid content and protein quality of the food samples were determined using standard procedures. Glutamic acid (CBR1 = 4.353 g/100g, CBR2 = 5.804 g/100g) was the highest while cysteine (CBR1= 0.252 g/100g; CBR2 = 0.336 g/100g) was the lowest of the amino acids in the food samples. The amino acids composition increased as the percentage supplementation of bambara ground nut increased in the mixtures. The formulated food sample showed that CBR1 and CBR2 met 31.8% and 42.4% respectively of the recommended dietary allowance (RDA) fulfilment of essential amino acids. The biological value (BV) of CBR2 (90.5%) was significantly high when compared with CBR1 (75.9%) and ogi (52.4%). There was no significant difference between the BV of CBR2with the BV of Nutrend (93.8%). Also, the net protein utilisation (NPU), total digestibility (TD), protein efficiency ratio (PER), feed efficiency ratio (FER) and nitrogen retention (NR) of CBR2 were within a similar range as those for Nutrend. As for the haematological variables, there were no significant differences between those fed the formulated diets and the control samples. The rate of weight gain for the animals fed with CBR2 food sample was higher than those fed with CBR1 and ogi but were lower than those for animals fed with Nutrend and casein. The study established that the CBR2 samples contained.

Nutritional knowledge, nutrients intake and nutritional status of hypertensive patients in Ondo State, Nigeria.

This study aimed at assessing the anthropometry, dietary intake and micronutrient status of hypertensive patients attending specialist hospitals in Ondo State, Nigeria. A descriptive case control study was conducted among subjects attending two specialist hospitals located in Akure and Ondo towns. A total of 452 subjects (44.9% males and 55.1% females), was purposely selected from the study centres. A structured questionnaire was designed to collect information on demographic characteristics, socio-economic parameters, nutrition knowledge and dietary intakes of the subjects. The quantities of subjects' dietary intakes were measured using household measurements. Weight, height, systolic (SBP) and diastolic (DBP) blood pressures were measured using electronic bathroom scale, standiometer and sphygmomanometer, respectively. The subject's urine was collected; and vitamin C, sodium, potassium, calcium, zinc and magnesium were determined using standard procedures. The results showed the following means: age 52.4 +/- 2.38 years, weight 66.4 +/- 1.63kg, height 1.64 +/- 0.01m, body mass index (BMI) 24.13 +/- 0.69kg/m2, SBP 124.86 +/- 2.3mmHg and DBP 76.22 +/- 1.86 mmHg. Blood pressure (BP) of the subjects showed that 46.9% had optimal BP, 14.2% normal BP, 11.5% high normal BP, 12.8% mild hypertension, 9.7% moderate hypertension and 4.9% severe hypertension. For BMI, 8.8% were underweight, 47.1% normal, 30.3% overweight, 6.0% obesity class I, 6.0% obesity class II and 1.8% obesity class III. The proportion of hypertensive subjects that were obese was significantly (P = 0.0001) higher than control subjects. Three-fifth of the control subjects had good nutrition knowledge compared to one-fifth of hypertensive subjects. The estimated mean energy intake was 8.46 MJ, protein 93.1g, carbohydrate 314.5g, fat 42.9g, fibres 5.6g and appreciable amount of vitamin C, calcium, zinc, magnesium, sodium and potassium. The subjects' urinary vitamin C concentration was 32.49 +/- 2.53mg; calcium 0.41 +/- 0.06mg, zinc 0.04 +/- 0.01mg; magnesium 4.57 +/- 0.37mg, sodium 8.33 +/- 0.37mg) and potassium 7.45 +/- 0.21mg. Statistically, there were significant differences (P < 0.05) between urinary vitamin C, sodium and potassium concentration (except zinc) of hypertensive patients and the control subjects. Weak correlations were observed between the subjects' systolic (P < 0.05) and diastolic (P < 0.01) BP and age, BMI and magnesium; with inverse correlations between vitamin C, sodium and potassium. The study concluded that hypertension was significantly influenced by BMI of the subjects, which may be an indication of high intake of calories. Therefore, calorie intake should be controlled among the hypertensives.