Blood pressure control and kidney damage in hypertension: Results of a three-center cross-sectional study in North Central Nigeria.

BACKGROUND: Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease. METHODS: Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients had their early morning first void urine tested for proteinuria using Combi-10 test strips. eGFR was estimated using the MDRD equation. RESULTS: A total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR. CONCLUSION: A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.

Imatinib (Glivec) and gastrointestinal stromal tumours in Nigerians.

BACKGROUND: To assess the response and the impact on the overall survival (OS) on c-KIT-positive (CD117+) gastrointestinal stromal tumours (GISTs) patients treated with imatinib mesylate. METHODS: Between July 2003 and December 2012, consenting patients with advanced c-kit-positive GISTs were enrolled to receive imatinib mesylate therapy at a dose of 400mg - 800mg daily, supplied gratis by Novartis Pharma (Basel, Switzerland) under its GIPAP initiative. Disease severity was based on tumour site, size and mitotic index at diagnosis. Clinical features together with drug toxicity, haematological and biochemical parameters were monitored. Overall survival (OS) reviewed at 12 months intervals over 5 years was computed using Kaplan-Meier RESULTS: There were 27 patients in all (17 males and 10 females with a median age of 52 years (range 26 - 83). Twenty three patients, 15 males and 8 females that have been followed up for at least 6 months were evaluated, aged 26-83 years (median = 56). There were 17 (73.9%) gastric tumours and 6 extragastric including 3 cases of peritoneum and 1 each of small gut, colon and rectum. At diagnosis, 21 (91.3%) cases were high risk, and 1 each fell into the intermediate and low risks, respectively. Ten patients (43.4%) including 5 with metastases presented with unresectable lesions. Five patients (21.7%) had complete tumour resection, 5 (3 with metastases) had partial resections and 3 others with non-bulky, nonmetastatic diseases underwent no surgery. Imatinib was used as the primary therapy for all patients, except the 5 patients that underwent complete tumour resection. Nine (39.1%) patients were lost to disease progression with a median survival of 16.7 +/- 10.7 (+/- SE) (95% CI = 0-37.6) months. The overall survival at 2 years for all patients was 71.9%, which dropped to 65.9% at 4 years. CONCLUSIONS: Although a small number of GISTs, imatinib induced an extended remission in patients with advanced disease, most of whom would have been dead within a few months of diagnosis.

Gastric precancerous lesions among Nigerians with chronic gastritis.

AIMS AND OBJECTIVES: To investigate the frequency of precancerous lesions in H. pylori gastritis in Nigerians MATERIALS AND METHODS: Previously, the slides of all endoscopic gastroduodenal biopsies seen at the Pathology Department of Obafemi Awolowo University Teaching Hospital, Ile-Ife between 1994 and 2003 were reviewed and published. The current review examined interplay of intestinal metaplasia, glandular atrophy and epithelial dysplasia with H.pylori. The H.pylori, intestinal metaplasia and glandular atrophy were graded based on updated Sydney classification scheme while Vienna classification was used for dysplasia. RESULTS: Out of 1036 biopsies seen during the study period, 135 (13%) had associated precancerous lesions. Intestinal metaplasia was the commonest (9.2%), followed by severe atrophic gastritis (4.3%) and low grade dysplasia (0.7%) occurring either alone or in various combinations. Most of these lesions were seen in patients above 40 years of age and over 80% were H.pylori positive. CONCLUSION: Frequency of precancerous lesions is low among Nigerians with H.pylori gastritis. Intestinal metaplasia was the commonest lesion and was mostly type I with relatively low risk for gastric cancer development. The relatively high prevalence H.pylori infection among these cases could have resulted from repeated infection and most were localised to the corpus relative to the antral region where the precancerous lesions were seen.

Spectrum of colonoscopy findings in Ile-Ife Nigeria.

AIMS AND OBJECTIVES: Lower gastrointestinal (LGI) diseases are the leading causes of morbidity and mortality worldwide. Colonoscopy holds an important place in screening, diagnosing and treatment of these conditions. In Nigeria, as in many other developing countries, the facility for performing colonoscopy is rarely available. This prospective report seeks to evaluate the demographic data of patients presenting for colonoscopy, the pattern and validity of referral diagnosis versus colonoscopy findings in Ile-Ife, Nigeria. SUBJECTS AND METHODS: All patients who had colonoscopy procedure done in the Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex between January 2007 and December 2011 were included in the study. RESULTS: During the study period, colonoscopy was carried out in 320 patients. One hundred and eighty two (56.9%) were males, while 138 (43.1%) were females. The median age was 59.5 years. Their ages ranged from 2-87 years. The most common indications were lower gastrointestinal bleeding and change in bowel habit which together accounted for 79.0%. No abnormality was seen in 93(29.1%) patients. Abnormal endoscopic findings included 66(20.6%) patients who had haemorrhoids, 50(15.6%) cases colorectal cancer, 33 (10.3%) patients had benign polyps and (30 (9.4%) patients had diverticular disease. Other findings were colitis, inflammatory bowel disease, rectovaginal fistula, vascular ectasia and extra luminal compression. Haemorrhoids, diverticulosis and polyps were the most common findings in patients presenting with lower gastrointestinal bleeding. CONCLUSION: This present report showed that colonoscopy is a cheap, safe and effective method of investigating lower gastrointestinal disease in Ile-Ife, Nigeria. When the indication is based on symptoms, the diagnostic yield could be as high as 90%. The common causes of lower gastrointestinal bleeding in Ile-Ife, Nigeria include haemorrhoids, diverticulosis and polyps.

Bowel preparation for colonoscopy: enema versus sodium phosphate.

BACKGROUND: Colonoscopy is considered to be the gold standard investigation for assessing the colonic mucosa. Good bowel preparation is essential in order to achieve optimal visualisation of the mucosa. Traditionally water enema is used for bowel preparation in most centres in Nigeria. This prospective study was performed at the Gastrointestinal Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between July 2008 and June 2009. AIMS AND OBJECTIVES: This study compared patients' tolerability, adverse effects, efficacy and mean duration of colonoscopy of water enema and sodium phosphate (NaP) for bowel preparation toward colonoscopy. PATIENTS AND METHODS: Standard structured questionnaire was completed by 64 patients and the colonoscopist assessing tolerability, adverse effect, efficacy and mean duration of the procedure. RESULTS: There were sixty four patients aged between 22 to 86 years. The mean age was 58.16 ± 15.790. Thirty eight (59.4%) patients were in patients and 26 (40.6%) were out patients. Forty one (64.1%) patients had water enema while 23 (35.9%) patients were included in the NaP group. The median age for patients in both groups was 62.0 years. Patients in NaP group rated their bowel preparation as more tolerable and found the dietary restriction much easier than those in water enema group (p < 0.0001). Better colon cleansing score was found in patient in NaP group as compared with those in water enema group in all region of the colon. The procedure took significantly longer time in patients in water enema group as compared with those in NaP group (p < 0.0001). CONCLUSION: NaP has a better bowel cleansing score for colonoscopy than water. It has better tolerability, side effect profile, efficacy and gives a shorter mean duration for the procedure.

The contribution of alcohol to chronic liver disease in patients from South-west Nigeria.

OBJECTIVE: This study aimed at determining the level and type of alcohol consumed by patients diagnosed with chronic liver disease (CLD) and, hence, the extent to which alcohol may have contributed to the development of the condition. STUDY DESIGN: Patients with diagnosis of CLD were consecutively recruited and a structured questionnaire was administered on each of them. Diagnosis of CLD was made based on liver histology and/or typical clinical and laboratory features. Alcohol consumption was considered significant if a patient took >50 g/day for > 10 years. RESULTS: A total of 145 patients were studied consisting of 102 males and 43 females. Their ages ranged from 20- 80 years with a mean of 46.8 ± 15.7 years. Fifty-one (35.2%) patients, all males, drank significant alcohol while consumption was not significant in 43 (29.6%) patients. Alcohol was not consumed at all by 51 (35.2%) patients made up of 18 males (35.3%) and 33 females (64.7%). Beer was the commonest form of alcohol consumed (70.2%) followed by palm wine (50%) and locally-brewed gin (20.2%). The diagnoses made were liver cirrhosis [LC] (60, 41.38%), chronic hepatitis [CH] (54, 37.20%), hepatocellular carcinoma [HCC] (23, 15.86%), alcoholic liver disease [ALD] (6, 4.14%) and non-alcoholic fatty liver disease [NAFLD] (2, 1.38%). The liver disease spectrum did not differ between the patients who drank significant alcohol and those who did not. However, the proportion of LC/HCC cases increased relative to CH with increasing age and consumption of alcohol. CONCLUSIONS: The proportion of CLD directly attributable to alcohol (i.e. ALD) is low among the patients studied. However, the burden of LC and HCC is directly related to age and the amount of alcohol consumed and the determinants of alcohol abuse are gender and affluence.

Gastroduodenitis and Helicobacter pylori in Nigerians: histopathological assessment of endoscopic biopsies.

OBJECTIVE: Morphologic changes seen in the endoscopic biopsies are dynamic and could be predictive of more important sequelae of chronic H. pylori gastritis such as gastric carcinoma and lymphoma. The objective of the study was to review the biopsy appearances of endoscopic gastroduodenal biopsies using the updated Sydney System of classification in order to throw some light on the biology of gastroduodenitis. METHODS: A retrospective review of all endoscopic gastroduodenal biopsies received in the department of Morbid Anatomy of Obafemi Awolowo University Teaching Hospitals Complex between 1994 and 2003 was undertaken. Grading of the chronicity, activity, atrophy, H. pylori density and metaplasia were done using the updated Sydney System of classification and grading. RESULTS: A total of 1047 gastric and 47 duodenal biopsies from 1047 patients were reviewed. There was evidence of significant chronic gastritis in 98.1% of the gastric biopsies and in 78.0% of these, H. pylori was the main identifiable aetiological agent. Marked atrophic changes and intestinal metaplasia that are known to predispose to gastric malignances were seen in 4.9% and 9.3% of our cases respectively. Chronic duodenitis was seen in 83% of the duodenal biopsies and in 29.6%, H. pylori was seen on a background of gastric metaplasia. CONCLUSION: The prevalence of H. pylori was high and it was the single most important aetiological factor responsible for the biopsy changes associated with chronic gastroduodenitis.

Eosinophilic colitis presenting as a right iliac fossa mass--a case report.

BACKGROUND: Eosinophilic colitis is an inflammatory condition characterized by infiltration of the colonic wall by eosinophils with submucosal oedema. Involvement of caecum, appendix, ascending colon and the omentum by the inflammatory process could mimic a right iliac fossa neoplasm. OBJECTIVE: To highlight the diagnostic challenges posed by eosinophilic colitis and the import of histopathological diagnosis in the treatment of such a patient. METHODS: A47-year old perimenopausal woman presented to hospital with a 6-month history of intermittent lower abdominal pain. Besides clinical evaluation, an abdominal ultrasonography and full blood count were carried out. She subsequently had exploratory laparatomy. RESULTS: The lower abdominal pain was intermittent but not associated with vomiting or diarrhea. There was a tender right iliac mass extending to the suprapubic region. The ultrasound revealed a right-sided tubo-ovarian mass. At surgery, the mass was found to be a complex of caecum, ascending colon, appendix and the omentum. Histological diagnosis of the resected mass was eosinophilic colitis with peritonitis. She was placed on steroid therapy following a course of antihelminthics with sustained clinical improvement six months after surgery. CONCLUSION: Eosinophilic colitis is rare and could mimic a right iliac neoplasm if it is right-sided. Histopathological diagnosis of all specimens removed at surgery particularly in a peripheral district hospital is very important in patient's management.

A histopathological analysis of thyroid diseases in Ile-ife, Nigeria. a review of 274 cases.

OBJECTIVE: To describe the spectrum of histopathological features of thyroid diseases; analyse the occurrence of each of the types and to compare the findings with those from previous studies done in Nigeria and elsewhere. MATERIALS AND METHODS: A retrospective study of thyroid lesions seen at the OAUTHC Histopathology Department during a 10-year period between 1988 and 1997. RESULTS: The 274 surgical thyroid specimens received during the study period came from 235 (85.8%) females and 39 (14.2%) males giving a female: male ratio of 6:1. Colloid goiter accounted for about 75% of cases with an average age of occurrence of 40.7 years. Only 1.8% showed features of toxic goiter and thyroiditis each. The adenomas constituted about 6% while carcinomas constituted about 11% of cases respectively. Adenomas occurred almost a decade earlier than carcinomas. Follicular carcinoma was the commonest thyroid cancer seen in this study. CONCLUSION: This study shows that the commonest thyroid disease in Ile-Ife is colloid goiter, which is a preventable disease. Thus, public health measures such as iodination of salt and health education are called for to reduce the occurrence of this disease.

Severe gastrointestinal haemorrhage due to primary intestinal Kaposi's sarcoma - a case report.

Kaposi's sarcoma (KS) was previously a relatively rare disease. With the advent of HIV/AIDS pandemic however, AIDS-related KS has been on the increase and so has interest in the disease. Ninety per cent of patients with KS present with skin lesions. While the gastrointestinal tract is a fairly common site of metastatic KS, primary gastrointestinal KS is uncommon. The presentation of gastrointestinal KS with severe gastrointestinal bleeding is rarer still. In this report, we present a 56yr old HIV-negative patient who presented with severe gastrointestinal bleeding without any skin lesions. Multiple haemorrhagic polypoidal lesions were found on the walls of the jejunum and ileum as well as the liver at exploratory laparotomy and these were found to be KS on histopathologic examination. We also discuss the diagnostic and therapeutic challenges we had with this rare cause of severe GI bleeding.

Liver cirrhosis: Child-Pugh grading of cases seen in Nigeria.

Child-Pugh grading is an important determinant of treatment options, surgical interventions and prognosis in chronic liver disease. Sixty-four liver cirrhosis patients (49 men, 15 women) seen at Ile-Ife, Nigeria were graded according to the Child-Pugh parameters. Only one (1.6%) was in Class A, while 21 (32.8%) and 42 (65.6%) were in Classes B and C, respectively. Thirty-four either had coagulopathy or were already in encephalopathy at the time of presentation. Hepatitis B virus-associated disease was present in 64% of the patients. Most Nigerian cirrhosis patients present with very advanced disease; they are thus poor-risk candidates for diagnostic procedures and surgery. Efforts should be intensified at making the diagnosis at a much earlier stage and universal immunization with the hepatitis B vaccine should be commenced to reduce the incidence of HBV-related chronic liver disease in Nigeria.

Chronic hepatitis in Nigerian patients: a study of 70 biopsy-proven cases.

BACKGROUND: Liver cirrhosis and hepatocellular carcinoma are known sequelae of chronic hepatitis. Early diagnosis and treatment of chronic hepatitis could delay or even abort progression to terminal liver disease. STUDY DESIGN: Prospective study of 70 consecutive patients with features of early liver disease or discovered with HBsAg (or anti-HCV) during pre-employment and/ or pre-donation screening at Ile-Ife, Nigeria. All the patients had liver biopsy and the histology evaluated with the Knodell Histological Activity Index. RESULT: Fifty-three patients had symptomatic disease (M: F ratio, 1.5:1) while 17 were asymptomatic (M: F ratio, 3:1). The mean ages were 49.04 (SD+/-16.78) and 29.82 (SD+/-6.13) for the symptomatic and the asymptomatic patients respectively (P< 0.005). Major symptoms were right upper abdominal pain (68%), weight loss (51%) and fatigue (41.5%). Alcohol consumption was significantly related to symptomatic chronic hepatitis (P< 0.01). Over 50 % of patients with asymptomatic chronic hepatitis had abnormal liver scan and liver function tests. All the asymptomatic cases and 77.4 % of the symptomatic group had HBsAg while only 1 patient (symptomatic) was anti-HCV positive. On liver histology, all the patients with asymptomatic chronic hepatitis had a Knodell score of< or = 8 and none had fibrosis. Over half of the symptomatic patients had a Knodell score of > or = 9 (56.6%) and stage 2 or 3 fibrosis (51 %). CONCLUSION: Asymptomatic chronic hepatitis patients tend to be younger and of the male sex. Symptomatic chronic hepatitis may signal the onset of significant fibrosis and alcohol abuse may accelerate this process. Serum ALT and liver scan are useful initial screening tests for asymptomatic patients with hepatitis B or C viral markers.

The incidence and characteristics of some paraneoplastic syndromes of hepatocellular carcinoma in Nigerian patients.

OBJECTIVE: To determine whether paraneoplastic syndromes of hepatocellular carcinoma such as erythrocytosis, hypoglycaemia, hypercholesterolaemia and hypercalcaemia are found in Nigerian patients with this tumour, and, if present, to determine their incidence and characteristics. DESIGN: Consecutive patients with a diagnosis of hepatocellular carcinoma seen over a 10-year period at Ile-Ife, Nigeria, underwent haematocrit (100 patients), plasma glucose (65), cholesterol (65) and calcium studies (30). Shortage of laboratory reagents did not allow all the 100 patients to be tested for plasma glucose, cholesterol and calcium. METHODS: Haematocrit was determined by the microhaematocrit method, and the glucose oxidase-peroxidase, Liebermann-Burchard and O-cresolphthalein complexone methods were employed for the estimation of plasma glucose, cholesterol and calcium respectively. RESULTS: The haematocrit values ranged from 19 to 63% with a mean of 34.51% (SD 7.72). Only 1 out of 100 patients (1%) had erythrocytosis (haematocrit 63%). Sixty-five patients had their plasma glucose determined. The range of values for fasting plasma glucose (FPG) was 1-8.4 mmol/l with a mean of 4.3 (SD 1.6). Hypoglycaemia occurred in 18 patients (27.7%)(14 males, 4 females). The mean liver span for patients with FPG > 5.0 mmol/l was 16.87 cm (SD 3.03), while the value for those with FPG < 3.0 mmol/l was 22.0 cm (SD 6.14, P < 0.05). Plasma cholesterol was determined in 65 patients and the range of values was 2.1 -18.1 mmol/l with a mean of 5.65 (SD 2.42). Hypercholesterolaemia occurred in 16 patients (24.6%) (15 males, 1 female). The range of plasma calcium obtained in 30 patients was 1.6-3.15 mmol/l with a mean of 2.36 (SD 0.32). Three patients (10%) (all males) had hypercalcaemia. CONCLUSION: While erythrocytosis has a low incidence, hypoglycaemia and hypercholesterolaemia are important paraneoplastic syndromes of hepatocellular carcinoma in Nigerian patients. The study confirms that the larger the liver mass, the greater the tendency towards hypoglycaemia. Also, the paraneoplastic syndromes studied occurred predominantly in hepatocellular carcinomas with cirrhosis.

Ectopic pregnancy associated with tubal schistosomiasis in a Nigerian woman.

A case of ruptured tubal ectopic pregnancy is presented. On histological examination of the fallopian tube involved, ova of Schistosoma haematobium were found in the submucosal and intramural parts of the tube. The case illustrates a rare preventable cause of ectopic pregnancy in this population.

The surgical pathology of colorectal carcinomas in Nigerians.

This paper presents a 10-year experience on the examination of surgical specimens of colorectal carcinomas in Nigerians. Colorectal carcinomas were found to constitute about 80% of all cases of large bowel malignancy. The Male: Female ratio was 2.28:2. Most of the cases (65.9%) were 50 years or younger and the peak incidence was in the 41-50 year age group. The site distribution in order of frequency was recto-sigmoid area (57.3%), descending colon (23.2%), caecum (12.2%) ascending colon and transverse colon 3.7% each. Seventy-three percent of the tumours were well differentiated adenocarcinomas while 15.9% were poorly differentiated. Mucinous carcinoma and signet ring carcinoma were found in 7.3% and 3.7% respectively. There was colonic metastasis in 54.9% of cases and 20.8% had distant metastases at initial surgery. Associated lesions were villous adenoma, 24.4%, Tubular adenoma-17.1%, amoebiasis 6.1% and schistosomiasis, 3.7%. The above observations together with those of previous authors suggests a difference in the biology of colorectal carcinomas in the tropics. The association with chronic granulomatous diseases, in particular, may be indicative of an entirely different oncogenic mechanism in their development in the tropics.

The surgical pathology of colorectal carcinomas in Nigerians.

This paper presents a 10-year experience on the examination of surgical specimens of colorectal carcinomas in Nigerians. Colorectal carcinomas were found to constitute about 80 per cent of all cases of large bowel malignancy. The male:female ratio was 2.28:1. Most of the cases (65.9%) were below 50 years and the peak incidence was in the 41-50 year age group. The site distribution in order of frequency was recto-sigmoid area (57.3%), descending colon (23.2%), caecum (12.2%), ascending colon and transverse colon 3.7 per cent each. Seventy-three per cent of the tumours were well differentiated adenocarcinoma while 15.9 per cent were poorly differentiated. Mucinous carcinoma and signet ring carcinoma were found in 7.3 per cent and 3.7 per cent respectively. There were colonic metastasis in 54.9 per cent of cases and 20.8 per cent had distant metastasis at initial surgery. Associated lesions were villous adenoma, 24.4 per cent tubular adenoma 17.1 percent, amoebiasis 6.1 per cent and Schistosomiasis 3.7 per cent. The above observations together with those of previous authors suggest a difference in the biology of colorectal carcinomas in the tropics. The association with chronic granulomatous diseases, in particular, may be indicative of entirely different oncogenic mechanisms in their development in the tropics.

Acceptance of hepatitis B vaccine by workers in a Nigerian teaching hospital.

OBJECTIVES: To determine the pattern of vaccine uptake by hospital personnel in a specifically designed pioneer hepatitis B vaccination programme and to highlight major lessons for ensuring success in future programmes. DESIGN: A review of vaccination and employment records for a forty four-month period and comparative analysis on the basis of professional grouping and work units. SETTING: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. SUBJECTS: A total of 2,548 employees of the teaching hospital that have worked for a minimum of one year on a continuous basis between April 1992 and December 1995. INTERVENTIONS: Procurement of recombinant hepatitis B vaccine (Engerix, SmithKline Beecham) by the hospital management and provision of the same to all interested employees of the teaching hospital at no cost under a vaccination programme which was conducted on an on-site basis. MAIN OUTCOME MEASURES: 'Participation' in the vaccination programme was defined as the uptake of at least one dose of hepatitis B vaccine, and 'compliance' defined as the receipt of the three prescribed doses of the hepatitis B vaccine. RESULTS: The level of participation in the vaccination programme was high with 91.9% of the target population of hospital workers receiving at least a dose of the vaccine, while only about half (53.8%) of the group complied with receiving the required three doses of the vaccine. In terms of participation, by professional grouping, laboratory workers and nurses recorded the lowest rates (82.5% and 84% respectively), while 100% participation was recorded in respect of the staff of engineering, medical records, pharmacy and physiotherapy departments. The highest rate of compliance (receipt of three doses) was also found among non-clinical workers (medical record personnel--76.3% and engineering staff--69.5%) while the lowest rate was found among nurses (39.7%) and doctors (40.3%). CONCLUSION: Workers with the highest possibility of knowledge of, and exposure to hepatitis B infection within the hospital setting--doctors, nurses, and laboratory workers--showed the greatest apathy to the vaccination programme. Reasons for this trend demand close examination, and subsequently, identification of specific action that needs to be taken to improve the uptake of the vaccine by the target population, particularly the high-risk groups, in future programmes. Among others, targeting all groups of workers with appropriate education on the infection; active involvement of professional groups in the planning and execution of the vaccination programme; and review of the implementation logistics are some of the key points to note for future programmes.

Hepatitis D virus antigen in HBsAg positive chronic liver disease in Nigeria.

Hepatitis B virus (HBV) is strongly associated with an aggressive type of chronic active liver disease (CALD) and hepatocellular carcinoma, which tend to present in the relatively young, in sub-Saharan Africa. It is known that co-existent infection with HDV tends to aggravate the course of HBV-associated liver disease. This study was carried out to determine the sero-prevalence of hepatitis D virus (HDV) among thirty one consecutive southwestern Nigerians with HBsAg-positive, HCV antibody-negative chronic liver disease. Alongside, we tested for HBsAg and the HDV antigen in fifty randomly selected sera each from blood donors and university freshmen undergoing pre-admission medical tests and who had no clinical evidence of liver disease. The HDV antigen (HDVAg) was found in the sera of two of 31 (6.5%) patients. Among the blood donors and university freshmen, HBsAg prevalence was twelve and eight per cent respectively, while HDVAg was present in none. In addition, liver biopsies of 28 other patients were stained for HDVAg. None of these was positive. These findings show that HDV prevalence is low in our community, and suggest that the virus might play only a minor role in the pathogenesis of HBsAg-associated chronic liver disease among our patients. A review of reports on the epidemiology of HDV in sub-Saharan Africa shows a rather complicated pattern that makes its impact on HBsAg-associated CALD difficult to assess. More studies designed to elucidate this pattern of HDV epidemiology are called for.

Hepatitis B virus markers, hepatitis D virus antigen and hepatitis C virus antibodies in Nigerian patients with chronic liver disease.

Although carrier rates for the HBsAg as well as the prevalence of HBV-associated chronic liver disease (CALD) are known to be high in Nigeria, not much is known about the role of the hepatitis C (HCV) and D (HDV) viruses. We undertook a prospective serological study of a cohort of 50 new patients and attending a Nigerian teaching hospital for various forms of histologically characterised chronic liver disease. Forty-five patients (90%) had antibodies to HBcAg (anti-HBcAb). Thirty one patients (62%) were HBsAg-positive, out of whom 15 were HbeAg-positive. Two (4%) of the HbsAg-positive patients, both suffering from liver cancer, were also hepatitis D antigen positive. Similarly, two (4%) patients were positive for anti-HCV antibodies. There were no cases of co-infection by the HBV and HCV. This study suggests that while the HBV is the major aetiological agent of chronic liver disease in Nigeria, the HDV is not an important aggravating factor save in a small number of patients. The HCV is probably not yet an important cause of chronic liver disease but this situation might change when HBV infection is controlled.

An endometriotic cyst of the left ovary in pregnancy--a case report.

A case of an endometriotic cyst of the left ovary in a pregnant Nigerian woman is presented. Left ovarian cystectomy was performed at the 18th week of gestation. The patient had a spontaneous vaginal delivery of a 3.54kg live male baby.