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.

Medical Causes of Death in a Teaching Hospital in South-Eastern Nigeria: A 16 Year Review

Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital; Ituku/Ozalla; Enugu; South-East Nigeria from 1995 to 2010. Materials and Methods: Data were collected retrospectively from January 1995 to December 2010. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago; IL; USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables; while Chi-square test was used to test significance of differences between two proportions. Results: The mortality rate was 22.8 (6250/27;514) admissions. The male to female ratio was 1.7:1. Infections (20.2) were the most common cause of death. However; chronic kidney disease was the single most common disease entity causing death (12.3). Other important causes of death in order of prevalence were cerebrovascular accident (10.5); acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3); heart failure (8.8); chronic liver disease (7.0); septicemia (6.5); respiratory failure (5.3); diabetes mellitus (4.6); cardiac arrhythmias (2.9); and primary liver cell carcinoma (2.7). There were few deaths from tetanus; malaria; typhoid fever; and coronary artery disease. Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases

Medical causes of death in a teaching hospital in South-Eastern Nigeria: A 16 year review.

BACKGROUND: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. OBJECTIVE: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South-East Nigeria from 1995 to 2010. MATERIALS AND METHODS: Data were collected retrospectively from January 1995 to December 2010. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables, while Chi-square test was used to test significance of differences between two proportions. RESULTS: The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease. CONCLUSION: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.

Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria.

BACKGROUND: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge. OBJECTIVE: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria. MATERIALS AND METHODS: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010). STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used. RESULTS: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. CONCLUSION: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.

Pattern of liver disease admissions in a Nigerian tertiary hospital.

OBJECTIVE: Liver disease is an important cause of morbidity and mortality globally. Its pattern varies in different geographical locations. This study aimed to determine the pattern and risk factors of liver disease in a Nigerian tertiary hospital. STUDY DESIGN: Retrospective Study Site: University of Nigeria teaching hospital Ituku/Ozalla, Enugu state, Nigeria. MATERIALS AND METHODS: Case notes of patients admitted with a diagnosis of liver disease were reviewed and information relating to demographics, risk factors for liver disease and results of relevant investigations extracted. RESULTS: Liver diseases accounted for 7.9% of medical admissions, with primary liver cancer and liver cirrhosis accounting for 44.3% and 20.4%, respectively. The main risk factors were alcohol consumption (52.1%), hepatitis B virus infection (49.4%), ingestion of herbs and roots (45.5%) and cigarette smoking (30.1%). CONCLUSION: Liver cirrhosis and primary liver cancer account for two thirds of liver disease in hospitalized patients in a Nigerian tertiary hospital. The major putative risk factors are alcohol consumption, hepatitis B virus infection, use of herbs and roots and smoking.

Case fatality among hypertension-related admissions in Enugu, Nigeria.

OBJECTIVE: To determine the case fatality rate and ultimate causes of death among patients with hypertension-related conditions admitted to an urban tertiary hospital, METHOD: A five-year review of hypertension-related admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu, between 1995 and 1999, was undertaken. RESULTS: 7220 patients were admitted into the medical wards during the period under review. Of these, 445 (6.2%) were due to hypertension-related causes. Of the later, 285 (64%) were males while 160 (36%) were females. One hundred and ninety one of the hypertension-related admissions died, giving a case fatality of 42.9%. The mean age at death was 54.8+/-15.8 years (53.5+/-15.9 years for males; 57.2+/-15.4 years for females, t=2.47, df=189, p=0.117). Sixty six percent of these were males while thirty four percent were females. Eighty six (45%) of the deaths occurred during acute hypertensive crises such as cerebrovascular accidents, hypertensive encephalopathy, and acute renal failure. Other important complications leading to death were congestive cardiac failure, accounting for thirty three cases (17.3%); and chronic renal failure 32 (16.8%). In twenty one (11%) hypertension-related admissions, the causes of death were not documented. CONCLUSION: Hypertension, with its related complications, constitute a major cause of morbidity and mortality in our medical wards. The case fatality rate is very high and often mostly avoidable complications were responsible. There is need to further study the determinants of these avoidable causes of death.

Seroprevalence of antibody to HDV in Nigerians with hepatitis B virus-related liver diseases.

OBJECTIVE: Hepatitis D Virus (HDV) infection has been reported to be declining in some geographical areas. In order to ascertain the current status of HDV infection in Nigeria, a study of patients with hepatitis B virus (HBV)-related liver diseases was undertaken to determine the sero-prevalence ofanti-HDV. METHOD: This was a prospective, cross-sectional study in which all consecutive patients with liver disease who tested positive for Hepatitis B surface antigen (HBsAg) were also tested for antibody to HDV. RESULT: Ninety six patients with various forms of HBV-related liver diseases participated in the study (acute hepatitis 8.3%, asymptomatic infection 15.6%, chronic hepatitis 3.1%, liver cirrhosis 21.9% and primary liver cell carcinoma 51.0%). Anti-HDV was demonstrated in 12 patients (12.5%). In patients with acute hepatitis and asymptomatic infection the prevalence was 4.3% while in patients with chronic hepatitis, liver cirrhosis and primary liver cell carcinoma, the prevalence was 15%. CONCLUSION: HDV still contributes to significant morbidity and mortality in HBV-related liver diseases in Nigeria. There is urgent need for larger studies on a national scale to accurately appraise the public health importance of this infection.

Hepatitis C virus infection in Nigerians with diabetes mellitus.

BACKGROUND/AIMS: Studies from mainly Caucasian populations have shown epidemiological evidence of an association between diabetes mellitus and Hepatitis C virus (HCV) infection. The aim of this study was to determine whether any such association exists in a blackAfrican population with diabetes mellitus. METHOD: This was a cross sectional study of consecutive diabetic patients seen at the diabetes clinic of the University of Nigeria Teaching Hospital Enugu, Nigeria between September 1, 2004 and April 30, 2005. Patients who underwent upper gastrointestinal endoscopy during the same period for dyspeptic symptoms were used as controls after matching for age and sex. Structured questionnaire on risk factors for HCV infection was administered to the participants. Blood test for HCV antibodies was carried out on the diabetic patients as well as the control subjects. RESULTS: Out of 191 diabetic patients, 27(14.1%) were HCV antibody positive compared to the control group in which 5 out of 134 (3.7%) subjects had HCV antibodies (p = 0.0046). CONCLUSION: Hepatitis C virus infection is more common in Nigerian patients with diabetes mellitus than in control subjects. The nature of the association between diabetes mellitus and HCV infection remains to be elucidated.

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.