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.

Pyoderma Gangrenosum in a Young Nigerian Male with Severe Ulcerative Colitis: A Case Report.

Pyoderma gangrenosum manifests as recurrent deep ulceration of the skin and is associated with a variety of disorders. We report a 40-year-old man who developed ulcers on the flexor surface of his right lower limb following a trauma 10 years prior to the current presentation. He was diagnosed with ulcerative colitis 20 years ago, and was previously placed on sulfasalazine and prednisolone. He also developed an enterocutaneous fistula at the right iliac fossa following an appendectomy he had 16 years previously. Mayo score of his ulcerative colitis was severe (11/12), and he received three courses of intravenous infliximab at irregular intervals as it was difficult to access Infliximab in Nigeria. He was stepped down to tablet Mesalazine after the third course due to cost considerations, and skin grafting was done for the extensive leg ulcer to achieve wound healing after failed steroid and sulfasalazine therapy.

Le pyoderma gangrenosum se manifeste par des ulcères profonds récurrents de la peau et est associé à divers troubles. Nous rapportons le cas d'un homme de 40 ans qui a développé des ulcères sur la face antérieure de sa jambe droite suite à un traumatisme survenu 10 ans avant la présentation actuelle. Il a été diagnostiqué d'une rectocolite hémorragique il y a 20 ans et avait précédemment été traité par sulfasalazine et prednisolone. Il a également développé une fistule entérocutanée à la fosse iliaque droite suite à une appendicectomie subie 16 ans auparavant. Le score de Mayo de sa rectocolite hémorragique était sévère (11/12), et il a reçu trois cures d'infliximab par voie intraveineuse à des intervalles irréguliers en raison de la difficulté d'accès à l'infliximab au Nigeria. Il est passé à la mésalazine en comprimés après la troisième cure en raison de considérations budgétaires, et une greffe de peau a été réalisée pour l'ulcère étendu de la jambe afin d'obtenir une cicatrisation après l'échec du traitement par stéroïdes et sulfasalazine. Mots-clés: pyoderma gangrenosum, Rectocolite hémorragique, Infliximab, Africain, Ulcères aphteux.

Sero-prevalence of Hepatitis B virus infection: A cross-sectional study of a large population of health care workers in Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been recognized globally as a major public health challenge necessitating a global call for increased awareness, patients' identification, and development of activities for prevention and control of the disease. Consequently, massive health education campaigns and screening exercises have been mounted globally to mark the World Hepatitis Day (WHD). AIMS: As part of WHD 2016 activities, we undertook a survey and screening of health care workers in order to raise awareness, identify patients and contribute to the Global Health Strategy goal of eliminating HBV infection by the year 2030. METHOD: This was a cross-sectional analytical study done at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Hospital workers voluntarily presented themselves to be screened using a rapid test kit and completing a semi-structured investigator-administered questionnaire. RESULTS: A total of 3123 participants were studied. The mean age of the participants was 39.4 ± 9.6 years. The seroprevalence of HBV infection was 2.3%. Most (97.0%) of the participants had previously heard about HBV infection and over two thirds (68.1%) could correctly identify risk factors and modes of transmission of HBV. Twenty-eight and a half percent of the participants knew their hepatitis B virus status prior to the study. CONCLUSION: The seroprevalence of HBV among healthcare workers in Enugu, Nigeria is relatively low compared to figures from other African countries. The healthcare workers have considerable knowledge of the disease. However, the observed knowledge gaps in awareness and screening need to be addressed.

Hepatitis B surface antigenemia in two rural communities in Enugu, Nigeria.

BACKGROUND: Hepatitis B virus infection is endemic in Nigeria, yet few data exist about the extent of infection in rural communities. OBJECTIVE: To determine seroprevalence of hepatitis B surface antigenemia in two rural communities in Nigeria. METHODS: A 330-person survey for seroprevalence of hepatitis B surface antigen (HBsAg) was carried out in two rural communities in Enugu State, Nigeria, in January, 2017. All study participants were screened for HBsAg using chromatographic immunoassay. Results: The mean age of participants was 57.2 ± 17.4 years, (range = 10-92 years) with 168 (50.9%) aged 60 years and above. The prevalence of HBsAg was found to be 2.1% with the 18-29 years age group having the highest prevalence. CONCLUSION: There is need to increase hepatitis B surveillance in rural communities to reduce transmission and institute early treatment.

Uptake of hepatitis B vaccination and its determinants among health care workers in a tertiary health facility in Enugu, South-East, Nigeria.

BACKGROUND: Hepatitis B vaccination is the most effective method of prevention for hepatitis B virus infection. It is a major public health problem in Nigeria, and health workers are at increased risk. This study determined the uptake of hepatitis B vaccination and assessed its determinants among health care workers (HCWs). METHODS: A hospital-based cross-sectional study was conducted between July and August, 2016 using self-administered structured questionnaires among 3132 HCWs in University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria. Data was analysed using SPSS version 22. Binary logistic regression analysis was used to identify factors that influenced uptake of vaccination. Ethical clearance was obtained from the Research Ethics Committee of the health facility. RESULTS: The uptake of hepatitis B vaccination was 14.2% (n = 445). The number of doses received were: 3 doses (218/3132, 48.9%), 2 doses (71/3132, 16.0%), and one dose (156/3132, 35.1%). The reasons for non-uptake of vaccination included: cost of vaccine 48 (10.8%), 'did not believe they could be infected' 28 (6.6%), long vaccination schedule, and lack of time 150 (35.1%). The Odds for uptake of hepatitis B vaccination were 22% lower among nurses compared to doctors (AOR = 0.78, 95% CI = 0.54-0.98, P = 0.037). It increased with increasing age (AOR = 1.30, 95% CI = 1.08-1.59, P <  0.001), increasing duration of work in the hospital (AOR = 1.19, 95% CI = 1.09-1.32, P = 0.032), and was about twice higher among those that had tertiary education than others that had less education (AOR = 1.96, 95 CI = 0.76-5.07, P = 0.164). CONCLUSIONS: The uptake of hepatitis B vaccination was low among HCWs in Enugu, Nigeria. Age, staff category, and duration of work in the hospital, were independently associated with hepatitis B vaccination. Provision of adequate hepatitis B surface antigen screening facilities and vaccination sites where the cost of vaccination is subsidized for all HCWs is recommended.

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.