Incidence of hepatotoxicity of highly active antiretroviral therapy in a tertiary health centre in Nigeria.

AIMS AND OBJECTIVES: The aim of this study was to determine the incidence of hepatotoxicity of HAART in HIV infected patients in a tertiary health centre in Nigeria. MATERIALS AND METHODS: This study was carried out on HIV patients on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of University of Benin Teaching Hospital. HAART-naive HIV patients were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardised toxicity grade scale. RESULTS: A total of 84 cases and 42 controls were studied. The mean ages were 35.2± 9.9years and 35.5±9.0 years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.9% and severe hepatotoxicity occurred in 10.7% of the patients. Alcohol use and being underweight were independent risk factors for hepatotoxicity. CONCLUSION: This prospective study clearly shows that there was appreciable hepatotoxicity associated with HAART in the study patients as found in other parts of the world. There is a need for regular monitoring of liver function in these patients because of the risk of hepatotoxicity.

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.

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.

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 34.7had 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

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 34.7had 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

Gastric histopathological findings in mucosal biopsies of symptomatic patients in jos central Nigeria.

BACKGROUND: Dyspepsia is a common disease worldwide. It is a cause of great absenteeism from work with a lot of economic loss. In Jos, it is one of the most common complaints encountered in both general outpatient and specialist clinics. AIM: To evaluate the histopathological changes in gastric mucosa of patients presenting with symptoms of dyspepsia. METHODS: Cross sectional study. Gastric endoscopic biopsy specimens from 100 consecutive patients with symptoms of dyspepsia were histologically evaluated using the criteria of the updated Sydney system. RESULTS: There were 50 males and 50 females. Their overall mean age was 39.6 +/- 12.2 (S.D). The prevalence of Helicobacter pylori colonization was 79%. Males were 53.2% and females 46.8% respectively giving a sex ratio of 1.4:1. Gastritis, neutrophil activity, glandular atrophy and intestinal metaplasia were observed in 95%, 83%, 38% and 28% respectively. Gastric carcinoma was found in 3% ofthe patients. CONCLUSION: From our study, we conclude that the majority of our patients with dyspeptic symptoms have significant histopathological changes in their gastric mucosa with implications for the development of further gastric lesions, and that the most common cause of dyspepsia in our environment is Helicobacter pylori infection.

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.

Helicobacter pylori: pathogen and symbiont.

There are puzzles in defining the exact role of Helicobacter pylori infection in humans. The bacterium, which is associated with human disease of the upper gastrointestinal tract, may otherwise exist as a commensal with probable symbiotic association in some human hosts. Although virulence associated genes have been detected in some strains which explain their pathogenicity, their pathogenic effect and subsequent clinical manifestations seem to vary in different human populations or geographical locations. Some human hosts remain predominantly asymptomatic in spite of the "virulent" H. pylori strain(s) they harbour. There are probable benefits of H. pylori colonisation of the human gastric mucosa. Thus the recommendation of eradication therapy in patients with known peptic ulcer disease may be more advantageous than the "test and treat policy", which suggests treatment of uninvestigated dyspeptic patients, who may not have any lesions.

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.

Antimicrobial susceptibility test of Helicobacter pylori isolated from Jos, Nigeria.

Fifty-five strains of Helicobacter pylori isolated from November 1997 until October 1998 from 33 female and 22 male adults attending for endoscopy at the Evangel Hospital, Jos, Nigeria were assayed for antibiotic susceptibility to amoxycillin, clarithromycin, metronidazole and tetracycline by the E-test strip method. Minimum inhibitory concentration (MIC) within the attainable peak serum concentrations for each drug was used as the parameter to determine the susceptibility of H. pylori. The results showed 100% susceptibility for amoxycillin, 89.0% for tetracycline, 87.3% for clarithromycin and 60% for metronidazole. The MIC50 and MIC90 values were: 0.016 microgram/mL and 0.75 microgram/mL for amoxycillin, 0.016 microgram/mL and 2 micrograms/mL for clarithromycin, 0.094 microgram/mL and 12 micrograms/mL for tetracycline, and 2 micrograms/mL and > 48 micrograms/mL for metronidazole. The MIC90 values for metronidazole (> 48 micrograms/mL) and tetracycline (12 micrograms/mL) were in each case higher than the break-point value (peak serum concentrations) of 8 micrograms/mL for metronidazole and 3 micrograms/mL for tetracycline. This pattern of resistance to metronidazole and tetracycline has to be considered when therapeutic regimens against H. pylori contain either or both drugs.

Blindness in leprosy patients of Kaduna State, Northern Nigeria.

We examined the eyes of 311 leprosy patients to determine the prevalence of blindness and impaired vision, and the causes of blindness in leprosy patients in Northern Nigeria. There was impaired vision or blindness in 74 eyes. Both eyes were affected in 5.1% of patients while 2.9% were totally blind. Leprosy alone was responsible for total blindness in 1.3% of patients, while other ocular diseases contributed to blindness in 1.6%. Exposure keratitis (21.3%), corneal opacities (13.5%) and chronic uveitis (10.1%) were the commonest leprotic cause of blindness. Primary care and early intervention could help prevent blindness in many of these patients. Primary eye care should therefore be given a prominent position in the training of carers of leprosy patients.

Prevalence of gastric and duodenal ulcers at endoscopy in Nigerian and British patients.

We compared endoscopic findings in 243 Nigerian and 1867 British patients undergoing endoscopy for similar indications. The Nigerian patients were much younger, 46.5% of them being less than 35 years old whereas the British patients were older, with only 36.2% being less than 35 years old (P = 0.001). Duodenal ulcers were commoner in the Nigerian patients (P = 0.03) and gastric ulcers were also commoner in the Nigerian patients who were less than 35 years old (P = 0.01). There was no difference in the prevalence of gastric nor oesophageal carcinoma in the two groups.

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.

Chronic duodenitis in Zaria, northern Nigeria.

Thirty-four consecutive patients presenting to the Endoscopy clinic of the Ahmadu Bello University Teaching Hospital, Zaria with symptoms of upper abdominal pain were investigated for chronic duodenitis by endoscopy and histology and for associated diseases. Twenty-two patients had histological evidence of chronic duodenitis. No clinical features separated these from those who had no duodenitis. Endoscopy was a good enough tool for diagnosis. Stool parasites were significantly commoner in those with histological duodenitis. Gastritis was also commoner in those with duodenitis. Ranitidine appeared superior to polycrol in relieving symptoms. Endoscopy is useful in the diagnosis of severe duodenitis. Specific ulcer healing drugs may be tried in treating symptoms associated with duodenitis, though their effectiveness is still open to further research.