Patterns of serologic markers of hepatitis B virus infection and the risk of transmission among pregnant women in southwestern Nigeria

Hepatitis B virus (HBV) infection is a major health concern in developing countries that has a high morbidity and mortality rate. Vertical transmission of HBV from mother to child has been identified as a major factor leading to chronicity with attendant liver conditions, especially in poor socioeconomic settings. This study aims to evaluate the prevalence of serological HBV markers among pregnant women in Ibadan southwestern Nigeria and to determine the implications for perinatal HBV transmission. This study revealed the presence of varied HBV serological patterns of infection or immunity among pregnant women in Ibadan, Nigeria, and thus the risk of mother to child transmission.

Acute Hepatitis E Virus Infection in Two Geographical Regions of Nigeria

Hepatitis E virus (HEV) remains a major public health concern in resource limited regions of the world. Yet data reporting is suboptimal and surveillance system is inadequate. In Nigeria, there is dearth of information on prevalence of acute HEV infection. This study was therefore designed to describe acute HEV infection among antenatal clinic attendees and community dwellers from two geographical regions in Nigeria. Seven hundred and fifty plasma samples were tested for HEV IgM by Enzyme Linked Immunosorbent Assay (ELISA) technique. The tested samples were randomly selected from a pool of 1,115 blood specimens previously collected for viral hepatitis studies among selected populations (pregnant women, 272; Oyo community dwellers, 438; Anambra community dwellers, 405) between September 2012 and August 2013. One (0.4%) pregnant woman in her 3rd trimester had detectable HEV IgM, while community dwellers from the two study locations had zero prevalence rates of HEV IgM. Detection of HEV IgM in a pregnant woman, especially in her 3rd trimester, is of clinical and epidemiological significance. The need therefore exists for establishment of a robust HEV surveillance system in Nigeria and especially amidst the pregnant population in a bid to improve maternal and child health.

Temporal and biological trends in liver cancers at a University hospital in Southwest Nigeria

The changes in incidence, sex distribution and histological profile of cancers of the liver over two decades at the University College Hospital (UCH), Ibadan, Nigeria, were studied. There were 1234 cases of liver cancer, consisting of 876 men and 358 women, a men to women ratio of 2.4:1, and peak age incidence was between 40 and 59 years. Hepatocellular carcinoma (HCC) accounted for 92% of all cases; metastatic carcinoma was 1.78%, cholangiocarcinoma 1.2%, while combined HCC and cholangiocarcinoma was 0.24%.

Cardiorespiratory changes during upper gastrointestinal endoscopy

OBJECTIVES

To determine the changes in oxygen saturation, blood pressure and heart rate during various endoscopic procedures and to find out the risk factors for these changes.

METHODS

Forty patients without cardiorespiratory disorders were recruited. Oxygen saturation, blood pressure and pulse rate were monitored during endoscopy using pulse oximeter and automated blood pressure monitor. These were recorded from baseline until 5 minutes after the procedure. The important variables, which were evaluated in relation to these changes, included age, gender, duration of the procedure and drug/dosages.

RESULTS

Baseline mean oxygen saturation was 96.8 +/- 1.55%. It decreased significantly to 94.53 +/- 3.30%(p= 0.002) during insertion of probe. Mild to moderate hypoxia was found in 19 (47.5%) patients. Severe hypoxia was found in 5 (12.5%) patients. The variables that reached statistical significance for desaturation were age greater than 50 years and duration longer than 27 minutes. Changes in pulse rate were significant post-sedation, during probe insertion, during scoping, at removal of probe and immediately post-procedure (p < 0.02). The mean change in systolic blood pressure was not significant throughout the procedure when compared to baseline, however 14 (35%) patients developed transient hypertension.

CONCLUSIONS

Mild to moderate hypoxia is common during endoscopic procedures and of no serious consequence. However severe hypoxia is less common. We recommend a non-invasive monitoring in patients with age greater than 50 years and procedure longer than 27 minutes.

Co-existing sickle cell anaemia and inflammatory bowel disease: case report and review of the literature

Sickle cell anaemia (SCA) is a chronic haemolytic anaemia associated with vaso-occlusive painful crises which may affect several systems including the gastro-intestinal system, resulting in abdominal pain. The concurrence of inflammatory bowel disease and haemoglobinopathy is rare. No previously reported concurrent cases of both SCA and ulcerative colitis (UC) in sub-Saharan Africa were found in the literature. A 16-year-old girl with concurrent SCA and UC is presented. She was admitted to University College Hospital, Ibadan with a 1-year history of recurrent peri-umbilical pain and bloody stools. These symptoms were mainly attributed to SCA at the referring hospital, and she was managed for chronic tropical diarrhoea without a remarkable clinical response. This case illustrates the concurrent presentation of SCA and ulcerative colitis which led to the missed and delayed diagnosis of ulcerative colitis.

SCHISTOSOMIASIS PRESENTING AS COLONIC POLYPOID MASSES IN A NIGERIAN PATIENT

Intestinal Schistosomiasis is a serious disease and is commonly produced by S. mansoni and japonicum. The presence of viable ova of the organism in the colon elicits inflammation, formation of granuloma, ulcers, haemorrhage and colonic fibrosis with subsequent longterm sequelae. Schistosoma mansoni is endemic in the Middle East, Africa, Central and South America. This is a case of a Nigerian with colonic polypoid masses which turned out to be Schistosomal mansoni infection.

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.

Evaluation of the pattern and prognostic implications of anti-p53 in hepatocellular carcinoma

INTRODUCTION

The p53 antigen is oncoprotective and when damaged, leads to production of anti-p53. It also predisposes to various cancers, including hepatocellular carcinoma (HCC). Serum anti-p53 has been proven to have prognostic and other values in patients with HCC. The objectives of this study were to determine the serum pattern, prevalence, diagnostic and prognostic utility of serum anti-p53 in Nigerians with HCC.

METHODS

41 subjects with HCC and 45 apparently-healthy controls were matched for age and sex. Serum anti-p53 was determined using p53-autoantibody ELISA kit.

RESULTS

The mean age of the patients was 48.9 (+/- 13.8) years, and that of controls was 49.4 (+/- 13.7) years. There was male predominance among the patients, 31 men (75.6 percent) versus ten women (24.4 percent), with a male-to-female ratio of 3.1:1. Similar values among controls were 33 men (73.3 percent) versus 12 women (26.7 percent), with a male-to-female ratio of 2.75:1. Anti-p53 was detectable in the sera of five (12.2 percent) patients and four (8.9 percent) of controls (p-value is greater than 0.05). All the patients with positive sera were males, while one of the controls was a female. Three (60 percent) of the positive patients were in the age range 40-49 years, while in the control group, they were in the age range 50-59 years.

CONCLUSION

There is a low prevalence of serum anti-p53 in our study population, and this is commoner in men. It is also present in the control group and therefore may not be useful as a diagnostic tool in this study population.

Gastrointestinal stromal tumuor- case report and a review of the literature

Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours, comprising 1% of all GI malignancies. This is a report of a middle-aged man diagnosed with GIST of the duodenum. He had gastrojejunostomy and para-aortic lymph node biopsy for histology. He was subsequently commenced on 5-fluorouracil but with little response.

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.

Protein C Deficiency in a Patient with Anomalous Hemiazygous Vein and Portal Vein Thrombosis

Protein C deficiency increases the risk of an individual to develop thromboembolism and its complications. Clinical presentation of the complication of thrombosis in an unusual site may becloud clinical judgment resulting in missed diagnosis. We present an unusual case of protein C deficiency presenting with symptoms referable to the gastrointestinal system. A 34-year-old male with recurrent abdominal discomfort and bloating, managed as a case of gastro-oesophageal reflux disease with poor clinical outcome. Physical examination was unremarkable. Upper gastrointestinal endoscopy showed varices. Abdominal ultrasound scan and CT scan of the abdomen revealed thrombus in the portal vein. Functional assays of protein C and S revealed reduce protein C activity at 65 % (70 - 140%). This case emphasizes the need for extensive investigations in patients with common, sometimes neglected abdominal symptom such as bloating. It has also contributed in expanding the differential diagnosis of bloating and manifestations of protein C deficiency.

Gastrointestinal complications in stroke survivors

The objective of this study was to highlight the gastrointestinal problems that occur in stroke survivors, which may also reduce their quality of life. Stroke patients admitted over an 18-month period were evaluated for common gastrointestinal symptoms as well as type and site of stroke. Symptoms evaluated included vomiting, dysphagia, constipation, masticatory difficulties and sialorrhea among others. Similar symptoms were sought for among controls. There were 54 experimental and 46 control subjects consisting of 25 (46.3%) men and 29 (53.7%) women and 32 (69.6%) men and 14 (30.4%) women respectively. The dominant gastrointestinal symptom was constipation 14 (25.9%), followed by masticatory difficulty 11 (20.4%). Other significant gastrointestinal (GI) symptoms and signs were incomplete bowel evacuation, fecal incontinence, sialorrhea, and dysphagia. There was no significant difference in GI symptoms in either sex, site or type of stroke, except that constipation and incomplete evacuation were commoner in ischaemic stroke. It is advocated that feeding and bowel care should be instituted among stroke patients.

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.

Cecal intubation rate during colonoscopy at a tertiary hospital in South-West Nigeria: How frequent and what affects completion rate?

BACKGROUND

Colonoscopy is useful in the diagnosis, treatment of colorectal diseases, and for colorectal cancer screening program. Complete colonoscopy is therefore crucial for the success of any screening program. One important measure of the quality of colonoscopy is the cecal intubation rate (CIR).

AIM

This was to assess the CIR at our endoscopy unit and evaluate the factors responsible for uncompleted cases.

PATIENTS AND METHODS

This was a prospective study at the endoscopy unit of the University College Hospital, Ibadan. All consenting patients referred for colonoscopy were recruited into the study. Colonoscopy was performed per protocol, and cecal intubation was considered successful when the medial wall of the cecum was intubated.

RESULTS

Total of 305 colonoscopies were performed comprising 168 (55.1%) males and 137 (44.9%) females. Mean age was 57.5 ± 14.0 years (range 15-90 years). The crude CIR was 89.2%, whereas the adjusted CIR was 95.1%. Completion rate was higher in males, in patients who were younger than 58 years and in patients with adequate bowel preparation.

CONCLUSION

CIR in our practice is high and comparable to the recommended rates. Female gender, age older than 58 years, and inadequate bowel preparation had a crude association with lower CIR, but this was not statistically significant.

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.

Electrocardiographic changes during oesophagogastroscopy

BACKGROUND

Oesophagogastroduodenoscopy (EGD) should be very safe, but there are many potential hazards, although the rate of serious complications is small. There are so many complications that can arise during this procedure. Most of these complications involve the respiratory or cardiovascular systems, especially in sick or sedated patients.The aim of this study was to determine the various electrocardiographic changes that can occur at different stages of diagnostic EGD and to determine their severity.

MATERIALS AND METHODS

The study is a descriptive one which was carried out at the endoscopy unit of Ladoke Akintola University of Technology Teaching Hospital, (LAUTECH), Osogbo, Osun State. Consecutive patients who were referred for oesophagogastroduodenoscopy (EGD) over a 3-month period and who consented to take part in the study were recruited. The electrodes of a portable electrocardiographic (ECG) machine (model Cardiovit AT_1ECG Machine) were attached to the patients accordingly and remained fixed till the end of the procedure. ECG recordings were done at baseline, postpremedication, during intubation and 5 minutes postprocedure. The results of the study were analyzed using simple descriptive statistical methods such as range, mean and standard deviation for continuous variables, and numbers and percentages for discreet variables.

RESULTS

Twenty-six (26) patients were studied, comprising 14 (53.8%) males and 12 (46.2%) females. The mean age of the patients was 47.19 ± 14.42 years. Three (11.5%) patients had tachycardia at the beginning of the procedure, while 13 (50%) patients developed tachycardia postpremedication and during the procedure, whereas 17 (65.4%) patients had tachycardia at the end of the procedure. Only one patient had bradycardia. Various ST-T wave abnormalities were observed at each stage of the procedure. Conduction abnormality was observed in 8 (30.8%), 9 (34.6%), 7 (26.9%) and 5 (19.2%) patients at rest, post-premedication, during the procedure and postprocedure respectively. Premature ventricular complexes (PVC) were observed in 4 (15.4%), 5 (19.2%), 4 (15.4%), and 4 (15.4%) patients at rest, post-premedication, during the procedure and post procedure respectively.

CONCLUSION

This study has shown that, although ECG abnormalities do occur during EGD, these abnormalities are not severe enough to warrant specific interventions or discontinuation of the procedure.

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.

Quality of life among primary liver cell carcinoma patients in Ibadan, Nigeria

A descriptive prospective study was conducted to evaluate the quality of life of patients with primary liver cell carcinoma at the University College Hospital, Ibadan, Nigeria. Quality of life (QOL) was evaluated using a modified WHO QOL Field Trial version questionnaire of December 1996. The QOL parameters include body pains, energy and acceptability of bodily appearance among others. Thirty-four patients aged between 23-74 years with a mean age of 49.6 +/- 13.4 were assessed. There were 28 (82.4%) males and 6 (17.6% females) (M/F = 4.6:1). Only about thirty percent of the patients rated their quality of life as being good or very good, with 70% rating their quality of life as very poor, poor or neither poor nor good. Eighty five percent of the patients were dissatisfied with their health, with 44.1% describing their health as very dissatisfying and only less than 10% enjoying satisfactory health. Eighty two percent of the patients responded that physical pain prevented them from doing what they want to do from moderate to extreme extent. All responders believed they require medical treatment to function in their lives with 22 (64%) requiring it very much. Seventeen (50%) of the patients had not enough energy at all for their daily activities, while 21 (61.7%) found their bodily appearance unacceptable to them. Fourteen (41.2%) did not receive adequate information they required about their day-to-day life. We conclude that our patients with PLCC have a low QOL rating and measures such as pain relief, reduction of bodily disfigurement and information to patients need to be put in place in order to improve their QOL.