Clinical Correlates of Non-alcoholic Steatohepatitis in Nigerian Patients with Metabolic Syndrome.

BACKGROUND: Non-alcoholic steatohepatitis (NASH) is a progressive form of non-alcoholic fatty liver disease (NAFLD). NASH is frequently associated with metabolic syndrome (MetS) and its prevalence is increasing due to rising global epidemics of MetS. This study aimed at determining the prevalence, risk factors and correlates of NASH in patients with MetS in a tertiary hospital in Nigeria. METHODS: We caried out a hospital based cross-sectional study of 81 subjects with MetS. The diagnosis of NASH was made by ultrasound evidence of hepatic steatosis, and exclusion of significant consumption of alcohol as well as histologic evidence of NASH on liver biopsy. Subjects gave informed consent and ethical approval was obtained from the ethics committee of the hospital. Data obtained were entered into SPSS version 20 and analyzed using simple and inferential statistics. A p-value of < 0.05 was considered statistically significant. RESULTS: Total of 81 subjects with MetS were studied, males 36(44.4%), females 45(55.6%), mean age(SD) of 49.77 (12.08) years. Ten (12.3%) subjects were diagnosed with NASH. Subjects with NASH had significant association with obesity, dyslipidaemia, and poor glycemic control. Regression analysis showed that morbid obesity, low HDL and presence of type 2 diabetes mellitus were independent risk factors for the development of NASH. CONCLUSION: NASH is common in Nigerian patients with MetS and its presence is significantly associated with obesity, dyslipidemia, and type 2 diabetes mellitus.

CONTEXTE: La stéatohépatite non alcoolique (NASH) est une forme progressive de stéatose hépatique non alcoolique (NAFLD). La NASH est fréquemment associée au syndrome métabolique (MetS)et sa prévalence augmente en raison de la montée des épidémies mondialesde MetS. Cette étude visait à déterminer la prévalence, le risqué facteurs et corrélats de la NASH chez les patients atteints de MetS dans un tertiaire hôpital au Nigeria. MÉTHODES: Nous avons créé un hôpital transversal étude de 81 sujets atteints de MetS. Le diagnostic de NASH était fait par échographie des signes de stéatose hépatique et d'exclusionde consommation importante d'alcool ainsi que d'histologique signes de NASH sur biopsie du foie. Les sujets ont donné informéle consentement et l'approbation éthique ont été obtenus de l'éthique comité de l'hôpital. Les données obtenues ont été saisies dans SPSSversion 20 et analysée à l'aide de statistiques simples et inférentielles.Une valeur de p de < 0.05 a été considérée comme statistiquement significative. RÉSULTATS: Au total, 81 sujets atteints de MetS ont été étudiés, hommes36(44.4%), femmes 45(55.6%), âge moyen (ET) de 49.39 +11.67années. Dix (12.3%) sujets ont reçu un diagnostic de NASH. Les sujets atteints de NASH avaient une association significative avec l'obésité,dyslipidémie et mauvais contrôle glycémique. Analyse de regression ont montré que l'obésité morbide, un faible taux de HDL et la présence de type 2le diabète sucré était un facteur de risque indépendant pour le développement de la NASH. CONCLUSION: La NASH est fréquente chez les patients nigérians atteints deMetS et sa présence est significativement associée à l'obésité,dyslipidémie et diabète sucré de type 2. Mots-clés: NASH, Syndrome métabolique, Corrélats cliniques, Prévalence.

Cutaneous metastasis from hepatocellular carcinoma: a rare presentation and review of the literature.

A 53-year-old male Nigerian with a rare cutaneous metastasis and a late manifestation of hepatocellular carcinoma is presented. The skin nodules were umbilicated, painless. firm and spread on the chest, abdomen and back. Ultrasonography showed a huge mass in the right lobe of the liver. Fine needle aspiration cytology of the liver revealed hepatocellular carcinoma and the skin nodule, metastatic carcinoma of hepatic origin. The immunological marker HBsAg was positive while Anti-HCV Ab and alpha-feto-protein were negative. Patient died and consent for post-mortem examination was refused.

Diversion procto-colitis: response to treatment with short-chain fatty acids.

BACKGROUND/PURPOSE: Diversion procto-colitis (DPC) results from a deficiency of luminal short-chain fatty acids (SCFAs). Endoscopic and histopathologic features of the disorder are almost universally present in defunctioned bowel, but symptomatic DPC is less common. METHODS: Five children with symptomatic DPC underwent endoscopy and rectosigmoid biopsies. An endoscopic index (EI) was used to quantify disease severity. An SCFA mixture was administered into the defunctioned bowel. RESULTS: A good clinical response and improvement in the endoscopic index occurred in all children. Undiversion or rectal excision was carried out in 4 and was curative in each case. One child is awaiting a redo pull through. CONCLUSIONS: DPC should be considered in children with a defunctioned colon presenting with evidence of colitis. Histopathology provides supportive evidence and SCFAs may provide effective relief of symptoms. Stoma reversal or rectal excision is curative.

Fine needle aspiration cytology diagnosis of liver diseases in the University of Maiduguri Teaching Hospital, Maiduguri.

The study is aimed at classifying liver diseases diagnosed by fine needle aspiration cytology (FNAC) in our environment and to emphasize the importance of the procedure for management of our patients. Forty-two patients were referred by the physicians for fine needle aspiration cytology diagnosis in Histopathology Department, University of Maiduguri Teaching Hospital between January 2001 and December 2003. There were 30 males and 12 females (2.5:1) with mean age of 44.7 years. The peak age is in the 5th decade of life. The commonest hepatic disease is primary hepatic malignancy, which accounted for 78.6% (33 patients); 3 suspicious of malignancy, one case each of metastatic carcinoma, amoebic liver abscess; liver storage disease and large cell dysplasia. The technique has gained popularity in our center because it is cheap, convenient, minimally invasive, quick and has high precision in obtaining samples. We therefore recommend this procedure in centers where liver diseases are common as a means of initial investigation.

Intestinal ulceration, obstruction, and haemorrhage in congenital syphilis.

Intestinal obstruction and bleeding are uncommon complications of congenital syphilis (CS). A VDRL-positive infant developed incomplete intestinal obstruction and rectal bleeding. Despite conservative management, his symptoms continued. At laparotomy, terminal ileal inflammation and stenosis were demonstrated. He underwent ileal resection and primary end-to-end anastomosis with resolution of his symptoms. Histopathological examination demonstrated heavy plasmacytic infiltration of the lamina propria and submucosa with ulceration of the mucosa, consistent with syphilitic ileitis. This report documents for the first time bleeding from ileal ulcers associated with intestinal obstruction in CS and highlights an unusual presentation of the disease.