Usefulness of Serum Pepsinogen I as a Biomarker in Early Diagnosis of Aetiology of Dyspepsia.

BACKGROUND: Dyspepsia, according to Rome III criteria, is defined as pain or discomfort centred in the upper abdomen in addition to symptoms like early satiety, postprandial fullness, bloating and nausea. Pepsinogens which are secreted by chief cells of the stomach play an important role in its physiology. They could determine the functional state of the mucosa in health and in diseased conditions. Serum levels of pepsinogen have aided the diagnosis of gastric pathologies such as atrophic gastritis, peptic ulcer disease and gastric cancer. Pepsinogen assay, being a simple, non-invasive procedure, can aid in determining the aetiology of dyspepsia especially in a resource poor setting. OBJECTIVE: This was to evaluate the diagnostic significance of serum pepsinogen I in patients with dyspepsia. METHODS: The study involved 112 adult patients with dyspepsia and an equal number of controls. A questionnaire was used to obtain biodata, clinical features and other relevant information. The patients had abdominal ultrasound scan, urea breath test and upper gastrointestinal endoscopy (UGIE), while the controls had only abdominal ultrasound scan. Sera prepared from 10ml of venous blood from each participant were stored at -20ºC and later analysed for pepsinogen I (PG I). RESULTS: Females predominated in both groups (F:M = 1.4:1). The mean age of cases was 51±15.9 years and was similar to that of controls 51.4±16.5. The most frequent symptom was epigastric pain in 101 (90.2%) patients. Median pepsinogen I level in patients (28.5ng/ml) was significantly lower than in controls (68.8ng/ml) (p<0.001). The most frequent endoscopic finding was gastritis. Serum PG I level at a cut-off point of 79.5ng/ml had a specificity of 88.8% and sensitivity of 40% in identifying dysplasia. CONCLUSION: Serum PG I level was lower in patients with dyspepsia than controls. It showed high specificity in identifying dysplasia and could be a biomarker for early gastric cancer.

CONTEXTE: La dyspepsie, selon les critères de Rome III, est définie comme une douleur ou une gêne centrée sur la partie supérieure de l'abdomen, en plus de symptômes tels qu'une satiété précoce, une plénitude postprandiale, des ballonnements et des nausées. Les pepsinogènes, sécrétés par les cellules principales de l'estomac, jouent un rôle important dans sa physiologie. Ils peuvent déterminer l'état fonctionnel de la muqueuse, qu'elle soit saine ou malade. Les taux sériques de pepsinogène ont facilité le diagnostic de pathologies gastriques telles que la gastrite atrophique, l'ulcère gastroduodénal et le cancer gastrique. Le dosage du pepsinogène, qui est une procédure simple et non invasive, peut aider à déterminer l'étiologie de la dyspepsie, en particulier dans un contexte de ressources limitées. OBJECTIF: Évaluer l'importance diagnostique du pepsinogène I sérique chez les patients souffrant de dyspepsie. MÉTHODES: L'étude a porté sur 112 patients adultes souffrant de dyspepsie : L'étude a porté sur 112 patients adultes souffrant de dyspepsie et un nombre égal de témoins. Un questionnaire a été utilisé pour obtenir les données biologiques, les caractéristiques cliniques et d'autres informations pertinentes. Les patients ont subi une échographie abdominale, un test respiratoire à l'urée et une endoscopie gastro-intestinale supérieure, tandis que les témoins n'ont subi qu'une échographie abdominale. Les sérums préparés à partir de 10 ml de sang veineux de chaque participant ont été conservés à -20ºC et analysés ultérieurement pour le pepsinogène I (PG I). RÉSULTATS: Les femmes prédominaient dans les deux groupes (F:M = 1,4:1). L'âge moyen des cas était de 51±15.9 ans et était similaire à celui des témoins 51.4±16.5. Le symptôme le plus fréquent était la douleur épigastrique chez 101 (90,2 %) patients. Le taux médian de pepsinogène I chez les patients (28,5 ng/ml) était significativement plus bas que chez les témoins (68,8 ng/ml) (p<0,001). Le résultat endoscopique le plus fréquent était la gastrite. Le taux sérique de PG I à un seuil de 79,5 ng/ml avait une spécificité de 88,8 % et une sensibilité de 40 % dans l'identification de la dysplasie. CONCLUSION: Le taux de PG I sérique était plus faible chez les patients souffrant de dyspepsie que chez les témoins. Il a montré une spécificité élevée dans l'identification de la dysplasie et pourrait être un biomarqueur pour le cancer gastrique précoce. Mots-clés: Dyspepsie, Pepsinogène I sérique, Helicobacter pylori, Biomarqueur.

Adherence to Medication among Patients with Chronic Hepatitis B Infection Attending a Tertiary Hospital in South Western Nigeria.

INTRODUCTION: Chronic hepatitis B (CHB) is an international public health problem. Treatment reduces its morbidity, mortality and infectivity. The aim of this study was to determine adherence among CHB infected patients on Tenofovir and the reasons for non-adherence. METHODOLOGY: It was a cross-sectional study of patients on tenofovir for at least 6 months. Information was obtained on bio- data, adherence to tenofovir, duration and reasons for nonadherence using an interviewer administered questionnaire. Non- adherence was defined as patient reporting missing medication at all. Chi square or Fisher exact test and Student's t-test were used to determine associations. P value less than 0.05 was considered significant. RESULTS: A total of 150 participants comprising of 76 (50.7%) females and 74 (49.3%) males with mean age of 39.2 ± 11.4 years, participated in the study. Non adherence rate was 65%. There was no significant association between non-adherence and tribe (p=0.7), level of education (p=0.8), religion (p=0.2), sex (p=0.9), clinical state (p=0.8), treatment experience (p=0.8) and months on Tenofovir (0.1) while a significant association existed with age (0.01), the presence of comorbidity (p=0.02) and taking another medication apart from tenfovir (0.00). The reasons for non-adherence included out of station 22 (14.7%), financial constraint 19(12.5%), unavailability of the drug 19 (12.5%), forgetfulness 15 (10%), perceived side effects 12 (8%), undetectable serum DNA quantification 11 (7.3%), ignorance of continuous use of Tenofovir 10 (6.7%), and pregnancy 9 (6%) among others. CONCLUSION: Adherence to Tenofovir is poor among CHB patients attending University College Hospital, Ibadan.

INTRODUCTION: L'hépatite B chronique (HCB) est un problème de santé publique international. Le traitement réduit sa morbidité, sa mortalité et son infectiosité. Le but de cette étude était de déterminer l'adhésion chez les patients infectés par CHB sur Tenofovir et les raisons de la non-adhésion. MÉTHODOLOGIE: Il s'agissait d'une étude transversale de patients sous ténofovir depuis au moins 6 mois. Des informations ont été obtenues sur les données biologiques, l'adhésion au ténofovir, la durée et les raisons de la nonadhésion à l'aide d'un questionnaire administré par un intervieweur. La non-observance a été définie comme un patient déclarant qu'il n'y avait aucun médicament manquant. Le test du chi carré ou exact de Fisher et le test t de Student ont été utilisés pour déterminer les associations. Une valeur p inférieure à 0,05 a été considérée comme significative. RÉSULTATS: Un total de 150 participants comprenant 76 (50,7%) femmes et 74 (49,3%) hommes avec un âge moyen de 39,2 ± 11,4 ans, ont participé à l'étude. Le taux de non-adhésion était de 65 %. Il n'y avait pas d'association significative entre la non-adhésion et la tribu (p = 0,7), le niveau d'éducation (p = 0,8), la religion (p = 0,2), le sexe (p = 0,9), l'état clinique (p = 0,8), l'expérience du traitement (p=0,8) et des mois sous Ténofovir (0,1) alors qu'il existait une association significative avec l'âge (0,01), la présence de comorbidité (p=0,02) et la prise d'un autre médicament en dehors du tenfovir (0,00). Les motifs de non-observance inclus hors station 22 (14,7%), contrainte financière 19 (12,5%), indisponibilité du médicament 19 (12,5%), oubli 15 (10%), effets secondaires perçus 12 (8%), quantification de l'ADN sérique indétectable 11 (7,3 %), méconnaissance de l'utilisation continue du ténofovir 10 (6,7%) et grossesse 9 (6 %) entre autres. CONCLUSION: L'adhésion au ténofovir est faible chez les patients infectés par CHB fréquentant l'University College Hospital d'Ibadan. MOTS-CLÉS: Infection chronique par l'hépatite B, ténofovir, observance, Nigéria.

Accuracy of non-endoscopic predictors of oesophageal varices in liver cirrhosis using platelet count, splenic size and portal vein diameter.

BACKGROUND: Endoscopy has been recommended for all patients with liver cirrhosis to detect varices, but it is expensive, invasive and uncomfortable. There is therefore, need to find non-endoscopic means to predict oesophageal varices. AIM: To determine the sensitivity and specificity of platelet count, splenic size and portal vein diameter to predict oesophageal varices in patients with liver cirrhosis. METHODOLOGY: Subjects were patients with liver cirrhosis and controls without liver disease aged 18 years and above. Platelet count was determined using Mindray BC-3000plus auto-analyzer. Portal vein diameter was measured at a point where it crosses the hepatic artery. Splenic length was measured through the hilum, as the distance between the dome and the tip. All the patients had upper gastrointestinal endoscopy. Varices were graded into I,II, III based on the Japanese classification of oesophageal vatices. RESULTS: The patients comprised 59 (81%). males and 14 (19%) females, while controls comprised 29 (73%) males and 11 (27%) females. The mean±(S.D.) age of the patients and controls was 44±12.6 and 40± 13 years respectively. There was statistically significant difference in the means of platelet count and platelet count/splenic size between patients with large oesophageal varices and those with small or no varices (p=0.00), while no such difference in the means of splenic size, portal vein diameter and the presence/size or absence of varices. (p=0.06). CONCLUSION: Platelet count has the best sensitivity and specificity among the three values in predicting both small and large varices in patients with liver cirrhosis.

Circulating CD56dim natural killer cells and CD56+ T cells that produce interferon-γ or interleukin-10 are expanded in asymptomatic, E antigen-negative patients with persistent hepatitis B virus infection.

Infection with hepatitis B virus (HBV) can result in spontaneous resolution or chronic infection, which can remain asymptomatic or can progress to cirrhosis and/or hepatocellular carcinoma. The host immune response is thought to be a major determinant of the outcome of HBV infection and virus-specific cytotoxic T lymphocytes (CTL) can mediate immunity against the virus and cause liver pathology. Antigen-nonspecific innate lymphocytes may also contribute to HBV infection and liver disease, therefore, we examined the frequencies, phenotypes, cytolytic activities and cytokine profiles of circulating natural killer (NK) cells, CD1d-restricted invariant natural killer T (iNKT) cells and CD56(+) T cells in 102 asymptomatic HBV-infected patients and compared them with those in 66 uninfected control subjects. NK cells expressing low levels of CD56 (CD56(dim)) and CD56(+) T cells were significantly expanded in the circulation of HBV-infected patients compared with control subjects. CD1d expression and iNKT cell frequencies were similar in both groups. Despite these expansions, we did not detect augmented natural or cytokine-induced cytotoxicity in the HBV-infected subjects. All lymphocyte populations studied produced interferon-γ (IFN-γ) significantly more frequently when taken from HBV-infected patients compared with when taken from healthy controls. Additionally, NK cells from the patients more frequently produced interleukin-10. As our HBV-infected cohort consisted of asymptomatic patients with low viral loads, we propose that CD56(dim) NK cells and CD56(+) T cells control HBV infection by noncytolytic mechanisms.

CLINICAL CHARACTERISTICS AND OUTCOME OF PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING AT THE EMERGENCY DEPARTMENT OF A TERTIARY HOSPITAL IN NIGERIA.

BACKGROUND: Upper gastrointestinal bleeding is a potentially life threatening condition with multiple causes. There is scarcity of health data depicting the clinical characteristics of the condition in African countries. This study was designed to describe the demographic, clinical characteristics and outcome of the patients who presented to our Emergency Department. METHOD: The records of cohort of all patients admitted with upper gastrointestinal tract bleeding from 1 January 2011 to 31 December 2012 were retrospectively reviewed from admission to discharge or death. RESULTS: There were 169 patients with median age of 44.0 years (range 13-89); 25 (15.0%) of them were known peptic ulcer disease patients. Most (69.2%) of the patients were males. The most common presenting symptom was haematemesis (34.9%) followed by melaena (16.6%). There was a history of NSAIDs use in 16.8% and alcohol ingestion in 12%. Upper Gastrointestinal Endoscopy was performed in 6.8% cases. Twenty-three (13.6%) patients died. There was association between mortality and diastolic blood pressure; more deaths (1/7; 14.3%) occurred in those with diastolic blood pressure > 90mmHg compared with ≤90mmHg (5/70; 7.1%) (P = 0.002). There were more deaths among patients who did not receive blood transfusion (4/40; 10.0%) compared with those who had blood transfusion (2/37; 5.4%) (P=0.008). CONCLUSION: The common presentations were haematemesis and melaena, mainly in middle aged men with mortality in one out of seven patients. The high mortality may be due to co-morbidities and poor support services.

Characteristics of inflammatory bowel disease in three tertiary health centers in southern Nigeria.

BACKGROUND: Inflammatory bowel disease (IBD) refers to two chronic inflammatory disorders of the gastrointestinal tract which is generally believed to be rare in most African countries. The objectives of the current study were to present the experience of three tertiary gastroenterology centers in southern part of Nigeria on IBD, highlighting the age distribution of the patients seen, management and the impact on the quality of their life in university-based community-type practices in Nigeria. METHODS: This was a retrospective review of charts of inflammatory bowel disease seen between January 2007 and June 2010 at three teaching hospitals in Southern Nigeria. Diagnosis of IBD was made from clinical manifestations, colonoscopic and histopathological findings. RESULTS: During the study period, 12 patients presented with clinical features consistent with inflammatory bowel disease. There were 8 (66.7%) males and 4 (33.3%) females and had ages ranged from 18 years to 80 years with a median of 26.5 years. Eight (66.7%) patients had ulcerative colitis while 4(33.3%) had Crohn's disease. Ten (83.3%) patients had severe disease with main clinical features being recurrent diarrhoea and passage of mucoid bloody stools. All the patients had treatments with sulphasalazine or mesalazine, steroids and antibiotics with good responses. One patient died following the occurrence of toxic megacolon. CONCLUSION: Although IBD is uncommon in Nigeria, high index of suspicion is necessary by attending physicians managing patients with recurrent passage of mucoid bloody stools. Prompt gastroenterological referral and judicious use of colonoscopy and biopsy will assist in making the diagnosis.

Livolin ameliorates elevations in alanine transaminase in HIV infected patients commencing highly active antiretroviral therapy.

BACKGROUND: HAART associated hepatoxicity is an important cause of poor adherence to therapy in HIV infected persons. An initial manifestation is elevation in the level ofAlanine Transaminase (ALT) in blood. We sought to evaluate the protective effects of Livolin, a phosphatidylcholine containing preparation, against elevations in this enzyme in persons just commencing HAART. METHODOLOGY: All consenting patients deemed eligible for HAART and who were sero-negative for Hepatitis B and C were recruited into the study. Subjects were divided into a test group which received a thrice daily dose of Livolin capsules for 3 months in addition to HAART and a control group that received only HAART. Blood samples were collected at baseline and after 3 months and analysed for ALT, Aspartate aminotransferase, alkaline phosphatase and creatinine. The specific HAART combination, age and gender were also noted. RESULTS: Seventy nine (79) persons comprised of 43 test and 36 control subjects completed the study. Sixty six percent (79%) of all subjects were on Nevirapine containing combinations. In total, 8.9% and 11.7% of our patients had elevations at baseline and after 3 months respectively. These were mostly grade I, with grade II toxicity being observed in 3.3% of patients after 3 months of HAART. There was no instance of severe toxicity. For individuals with an elevation in ALT values at baseline, the mean drop at 3 months was significantly more in the test group compared with the control group (34.67 iu/L vs. 14.90 iu/L, p=0.005). Among subjects with on Nevirapine, the mean increment in ALT in the control group was 7.73 iu/L compared with 1.73 iu/L for the test group. CONCLUSION: The findings in this study mirror findings in both animal experiments and human studies of a potential benefit of phosphatidylcholine preparations, like Livolin, in protecting against drug induced hepatotoxicity.

HBV infectivity among Nigerians.

The study involved 60 (non-immunized), 14 (immunized against HBV), healthy Nigerian adults and 28 Nigerian patients with hepatitis. Their sera were tested for HBsAg, HBeAg, anti-HBe, anti-HBc, anti-HBs and anti-HCV while only 15 subjects with chronic hepatitis had HBV DNA assay by PCR. The subjects aged 21 to 72 years and comprised 75 male and 27 female adults. The prevalence of HBV infection by HBsAg and/or anti-HBc sero-positivity was 55.9%. Only HBsAg and anti-HBs were detectable in 21% each among immunized while HBsAg, HBeAg, anti-HBe, anti-HBc, anti-HBs were present in 58%, 20%, 6%, 32%, and 42% respectively in the non-immunized subjects. HBV DNA was positive in 86.7% of the 15 subjects. About fifty five percent of all subjects were infectious of HBV with 13.7%, 3.9%. 32.3% and 4.9% accounting for high, medium, low and very low infectivity respectively while 44.1% and 1% of the subjects were susceptible and naturally immuned to HBV respectively. Coinfection with HCV tends to favour HBV infectivity. In conclusion, the infectivity of HBV among Nigeria is varied but high and a great proportion of the population is susceptible.

Are patients with primary hepatocellular carcinoma infectious of hepatitis B, C and D viruses?

Primary HepatoCellular Carcinoma (PHCC) has been strongly associated with HBV and HCV infections among other aetiological factors. However; do the patients still spread the viruses? This study involved forty one Nigerian adult patients with PHCC and 45 controls who were tested for HBsAg, HBeAg, Anti-HBe, Anti-HBs, anti-HCV IgM and IgG, anti-HDV and HDV antigen using ELISA. Statistical analysis was carried out with the student - t - test and Mc Nemar test at p < 0.05. The subjects consisted of male:female ratio of 3:1 for both the PHCC patients and controls. Evidence of exposure to hepatitis B, C and D viruses was detected in 95.1%, 44% and 0% of the patients respectively while the respective values of 24%, 11.1% and 0% were obtained for the controls. Indication for high (HBeAg) and low (anti HBe) HBV viral replication, and acute HBV infection were detected in 12.5%, 92.7% and 2.2% respectively among the patients while only 35.6% of the controls had low HBV viral replication. Acute and chronic infections of HCV were also found in 26.8% and 24.4% of the patients respectively compared to the respective values of 2.2% and 11.1% of the controls. Occult HBV infection occurred in equal proportions (11%) of both the patients (31.7%) and controls (35.6%). In conclusion, infectious HBV and HCV particles are present among Nigerian patients with PHCC while HDV infection is uncommon. Hence, safe medical care should be practised for all patients with PHCC while relatives should be screened for these viruses.

Correlation of cag-A serological status with histological parameters of chronic gastritis among dyspeptic patients in south western Nigeria.

BACKGROUND: The aim of this study was to determine the sero-prevalence of Cag-A strains of Helicobacter pylori in both dyspeptic and non-dyspeptic individuals and also correlate the serological status of Gag-A strain of H. pylori with the various graded histological variables of chronic gastritis in the dyspeptic patients. METHODS: Using helicobacter p120 Cag-A enzyme linked immunosorbent assay, Cag-A serology test was carried out on 65 dyspeptic patients and 65 age and sex matched non-dyspeptic controls. The gastric biopsies of the patients were also histologically examined to ascertain the presence, nature and degree of the following histological variables of gastritis: colonisation by H. pylori; inflammation, intestinal metaplasia and mucosal atrophy. The CagA serological status was then correlated with the graded variables. RESULTS: A prevalence of 46.2% and 58.8% seropositivity for Cag-A strain of H. pylori was found among dyspeptic patients and control individuals respectively. Cag-A seropositive patients accounted for nine(81.8%) of the 11 cases with moderate to severe activity and 75% of both cases with mucosal atrophy and cases with intestinal metaplasia. CONCLUSION: Infection with Cag-A positive Helicobacter pylori was equally prevalent among both dyspeptic patients and control subjects studied. CagA seropositivity, however, appeared to be associated with higher inflammatory activity in the mucosa of patients with chronic gastritis and may be associated with intestinal metaplasia and mucosal atrophy in H. pylori-induced chronic gastritis.

Correlation of Serum Anti-Helicobacter pylori Immunoglobulin A (IGA) with Histological Parameters of Chronic Gastritis in Ibadan; Nigeria

Background: The seroprevalence of anti-H. pylori IgA antibodies has been reported to vary among populations and in relation to strains of Helicobacter pylori bacterium. However; there has been conflicting reports on the association between IgA serological status and the histological variables of chronic gastritis. This study was therefore conducted to clarify this relationship. Method : Using an ELISA based commercial kit; anti-H. pylori IgA antibody tests were performed on 65 dyspeptic patients and 65 age- and ex-matched controls. The gastric biopsies of these patients were also examined histologically for the degrees of inflammation; activity; intestinal metaplasia and atrophy. The CagA status of the patients had been determined previously. Results: There was an anti-H. pylori IgA antibody prevalence of 67.7in dyspeptics and 56.9in non-dyspeptic individuals. No correlations were observed between serum H. pylori IgA antibody and the graded parameters of chronic gastritis in dyspeptic patients; although twice more patients with mild gastric inflammation were found among IgA positive than among IgA negative patients. However; a statistically significant relationship was established between serum IgA positivity and the CagA status of the patients (p = 0.028). Conclusion: The seroprevalence of anti-H. pylori IgA antibody is high in our environment. Serum IgA status may be associated with milder degrees of gastritis in our patients but a larger cohort of patients is needed to confirm this. There seems to be a good agreement between serum IgA and CagA statuses among dyspeptic patients

Detection of a new subgenotype of hepatitis B virus genotype A in Cameroon but not in neighbouring Nigeria.

To further investigate the genetic diversity of hepatitis B virus (HBV) genotype A in Africa, we analysed 263 HBV strains from Nigeria (n=163) and Cameroon (n=100). Phylogenetic analysis of S fragment sequences attributed 175 strains (66.5%) to genotype E and 88 (33.5%) to genotype A. In Cameroon, genotype A strains were the most prevalent (79/100, 79.0%), whereas, in Nigeria, genotype E was highly dominant (154/163, 94.5%). The genotype A strains grouped with reference strains of subgenotype A3 (n=8), the provisional subgenotype A5 (n=43), a recently reported new variant from Rwanda (n=35), or as outliers (n=2). Ten complete genome sequences obtained from strains that clustered with the new variant from Rwanda formed a separate group supported by a bootstrap value of 96. The between-group distance to other potential or recognized subgenotypes of genotype A was at least 3.81%. Thus, the new group of strains could be considered as a new subgenotype of HBV genotype A, tentatively named 'A7'. Interestingly, the 'A7' strains from Rwanda and Cameroon showed an interspersed clustering, but essentially no other (sub)genotypes were shared between the two countries, suggesting that 'A7' may have evolved in a yet unknown place and may have only relatively recently spread to Rwanda and Western Cameroon. Strains attributed to provisional subgenotype A5 were found for the first time in Cameroon (n=36) and Central Nigeria (n=2), indicating that A5 is more widespread than previously thought.

Accuracy of clinical diagnosis of liver diseases at Ibadan.

BACKGROUND: Liver diseases are a major cause of morbidity and mortality in Africa and rest of the world. The contribution of specific liver disease to overall mortality has not been well documented in Nigeria. OBJECTIVE: To study aimed at determining the relative frequency of liver diseases seen at autopsy and the accuracy of ante-mortem clinical diagnosis of liver diseases relative to post-mortem findings at the University College Hospital (UCH), Ibadan. METHOD: A retrospective study of autopsies performed at the Pathology Department of the UCH, Ibadan between January 1991 and December 2000. Information obtained from the autopsy records included age, sex, ante-mortem clinical diagnosis, and post-mortem diagnosis. The data were analysed for frequencies, means, proportions and sensitivity. RESULTS: A total of 4,604 post-mortem examinations were performed over the 10-year-period with an annual average of 460.4. Of this, 3,408 (74.02%) were coroner's while 1,196 (25.98%) were routine. There were 75 autopsy diagnosis of liver disease accounting for 6.27% of the total routine autopsies and a frequency of 7.5 per annum. The liver cases at autopsy were made up of 53 (70.7%) males and 22 (29.3%) females with those in the age range 40 - 49 years accounting for about one quarter of all. There was positive correlation of the Clinical diagnoses with post-mortem diagnoses in 33 (44%) but discordance in 42 (56%) of cases. CONCLUSION: The concordance between ante-mortem clinical diagnosis and post-mortem diagnosis of liver disease is rather low. There is a need to provide facilities for efficient diagnosis of liver diseases.

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.

Autoimmune liver disease in a Nigerian woman.

Autoimmune liver diseases are chronic liver disease with similar clinical features to viral and non-autoimmune liver disorders but with distinct sero-autoimmunologic features. In developed countries, it accounts for about 20% of all liver transplantations in the USA. Most studies on liver disease in Nigeria centred on viral or alcohol aetiology with complete absence of data on autoimmune liver disease.We here report a case of a young woman with autoimmune hepatitis for the first time in Nigeria. The patient presented with features of chronic liver disease of neither viral nor alcoholic aetiology. The diagnosis was based on the presence of hypergammaglobulinaemia and auto-antibodies in the serum.We concluded that physicians should always bear in mind the possibility of autoimmune hepatitis in patients with features of chronic liver disease, especially when the viral markers are negative and there is no history of significant alcohol consumption.

Maternal and fetal outcomes of jaundice in pregnancy at the University College Hospital, Ibadan.

OBJECTIVE: This study is aimed at determining pregnancy outcome of cases of jaundice in pregnancy over a 10 year period at the University College Hospital, Ibadan. METHODOLOGY: All case records of patients with jaundice in pregnancy over a 10-year period from 1st January 1992 through 31st December 2001 were retrieved from the medical records office of the hospital and analysed. RESULTS: During the ten-year study period, there were 16,566 registered pregnancies in the hospital, and 52 cases of jaundice in pregnancy were seen, giving an overall incidence of 0.3% or 1 in 318 deliveries. However, 48 case records were retrievable. Viral hepatitis was the commonest cause accounting for 58.3% of cases. It was followed by malaria and sickle-cell anaemia with 20.8% and 16.7% respectively. Other causes include sepsis 14.6%, cholestasis 6.3%, and Pre-eclampsia 2.1%. Preterm delivery occurred in 39.6%, while intrauterine fetal death (IUFD) occurred in 8.3% of cases, all occurring in the third trimester. A case of early neonatal death was recorded. There was no maternal death and the mean hospital stay was 18 days (range 4-45 days) during admission. CONCLUSION: Viral hepatitis, malaria and sickle-cell anaemia are the leading causes of jaundice in pregnancy. These should be promptly diagnosed, investigated and appropriate management instituted as most of the perinatal deaths can be avoided by close fetal monitoring especially in the third trimester and with recourse to early delivery before fetal demise occurs.

Pitfalls in diagnosis of hepatitis B virus infection among adults Nigerians.

OBJECTIVE: Hepatitis B virus infection is common in Nigerians and its diagnosis is necessary for effective treatment and eradication. This study is aimed at highlighting the serological factors jeopardizing the diagnosis and treatment of the infection among Nigerians adults. PATIENTS AND METHODS: Three studies were carried out. The first study involved 56 Nigerian adults and it compared the assay of HBsAg by Haemagulation Method (HMA) with Enzyme linked immunoassay (ELISA). The second study was a comparison of Glaxo Welcome HB rapid test(GWHB) with ELISA in sero-assay of HBsAg and HBeAg among 25 Nigerian subjects while the third study was on the assay of the sera of HBsAg positive patients for HBeAg and anti-HBe in forty two Nigerian patients by ELISA. RESULTS: The sero - prevalence rates of HBsAg were 41.8% and 61.8% by HM and ELISA respectively with false HBsAg sero-positives and sero-negatives by HM of 5.4% and 25.5% respectively. Similarly, there was sero-detection of HBsAg in 84% and 80% by ELISA and GWHB respectively in 25 Nigerian adults. In addition, 19% and 64% of the 42 patients with HBsAg sero-positivity were also positive for HBeAg and anti-HBe respectively, while 31% of the patients were both HBeAg and anti-HBe sero-negative. CONCLUSION: Sero-diagnosis of HBsAg and other serological markers of infectivity in patients with HBV should be carried out by ELISA rather than HMA among adult Nigerians. Furthermore, high infectivity of the virus abounds among Nigerian with HBV infection.

Occult HBV Infection among a Cohort of Nigerian Adults

Objective: To determine markers of HBV infection and detect the presence of its occult infection in serum of a cohort of adult Nigerians. Methodology: The study involved 28 adult Nigerians with viral hepatitis (Group 1) and 28 apparently healthy adult Nigerians as controls (Group 2). Their sera were assayed for HBsAg; HBeAg; anti-HBe; anti-HBc; anti-HBs; and anti-HCV; while HBV DNA was determined in 15 patients with chronic hepatitis. Significance of differences between the patients and control subjects was assessed using Chi-square test at a 95confidence level. Results: Sero-detection of HBsAg; HBeAg; anti-HBe and anti-HBc was higher among the patients compared to the controls. HBV infection was diagnosed by HBsAg (89) and a duo of HBsAg and anti-HBc (100) among the patients. Similarly; eleven and four types of different patterns of HBV markers were observed among the respective groups. Anti-HBe (9.5); anti-HBc (14.3); and anti-HBs (9.5) were detected among all the subjects who were sero-negative for HBsAg. HBV DNA was also detected in 86.7of the 15 patients with chronic hepatitis; while occult HBV infection was observed in 7.2of the patients and none (0) of the controls; p 0.05. Furthermore; HCV infection occurred among subjects with all the different patterns of HBV markers; except those with occult HBV infection and natural immunity to HBV. Conclusion: This study shows that occult HBV infection is present among Nigerian adults and determination of HBsAg; anti-HBc; anti-HBe; and HBV DNA will assist in its detection