Occult HBV Infection among a Cohort of Nigerian Adults

Objective: To determine markers of HBV infection and detect the presence of its occult infection in serum of a cohort of adult Nigerians. Methodology: The study involved 28 adult Nigerians with viral hepatitis (Group 1) and 28 apparently healthy adult Nigerians as controls (Group 2). Their sera were assayed for HBsAg; HBeAg; anti-HBe; anti-HBc; anti-HBs; and anti-HCV; while HBV DNA was determined in 15 patients with chronic hepatitis. Significance of differences between the patients and control subjects was assessed using Chi-square test at a 95confidence level. Results: Sero-detection of HBsAg; HBeAg; anti-HBe and anti-HBc was higher among the patients compared to the controls. HBV infection was diagnosed by HBsAg (89) and a duo of HBsAg and anti-HBc (100) among the patients. Similarly; eleven and four types of different patterns of HBV markers were observed among the respective groups. Anti-HBe (9.5); anti-HBc (14.3); and anti-HBs (9.5) were detected among all the subjects who were sero-negative for HBsAg. HBV DNA was also detected in 86.7of the 15 patients with chronic hepatitis; while occult HBV infection was observed in 7.2of the patients and none (0) of the controls; p 0.05. Furthermore; HCV infection occurred among subjects with all the different patterns of HBV markers; except those with occult HBV infection and natural immunity to HBV. Conclusion: This study shows that occult HBV infection is present among Nigerian adults and determination of HBsAg; anti-HBc; anti-HBe; and HBV DNA will assist in its detection

Discriminant analysis of biochemical parameters in liver disease.

Discriminant function analysis has been used to investigate the relative value of six biochemical parameters (plasma ferritin, C-reactive-protein, bilirubin, alkaline phosphatase, glutamic oxaloacetic acid transaminase and albumin) in the diagnosis of liver disease. This was done among four groups totalling 70 subjects including healthy controls and patients with acute viral hepatitis, liver cirrhosis and primary hepatocellular carcinoma. Albumin had most value in distinguishing between groups, followed cumulatively by ferritin, alkaline phosphatase, C-reactive protein, bilirubin and glutamic oxaloacetic acid transaminase. However, if data on albumin, alkaline phosphatase, bilirubin and glutamic oxaloacetic acid transaminase had already been routinely collected, there would be no advantage in collecting data on ferritin and C-reactive protein. Any four of the six parameters would be of about equal value in distinguishing between diagnostic groups. When the data on all six biochemical parameters was combined in an optimum way, about 66% of all individuals could be correctly assigned to one of the four groups using biochemical markers alone. While the control subjects and patients with acute viral hepatitis formed a relatively well defined, tight cluster (apart from two patients with acute viral hepatitis), patients with liver cirrhosis and primary hepatocellular carcinoma were almost indistinguishable, using these biochemical parameters. If the latter two groups were pooled, then about 86% of subjects could be correctly classified.

Complement proteins and soluble immune complex levels in Nigerians having primary liver cell carcinoma

Serum complement(C3); proteins and circulating immune complex levels were estimated in Nigerians having primary liver cell carcinoma and control subjects by immunodiffusion in agar; biuret and polyethylene glycol precipitation methods respectively. There is however no correlation between the complement (C3) concentrations and the serum levels of immune complexes

Factors that may contribute to death from typhoid infection among Nigerians

Nine-five cases of typhoid infection seen at autopsy at the University College Hospital; Ibadan; over a 10-year period were reviewed. The conditions associated to some diseases; the complications and the inappropriate therapy were the main factors that contribute to mortality

Non-ulcer dyspepsia and the dilemma posed to its management.

Dyspepsia is one of the most common ailment that is managed by general practitioners and gastroenterologists worldwide and particularly so in Tropical Africa. Non-ulcer dyspepsia can be defined as the presence of classic ulcer symptoms or any combination of burning, bloating, indigestion or other abdominal symptoms which only sometimes have a relation to food intake with out any radiological or endoscopic evidence of peptic ulceration. Compared to peptic ulcer disease, the literature on Non-ulcer dyspepsia is relatively scanty and studies have been done mostly in populations non-negroid origin. The present study has reviewed Non-ulcer dyspepsia with particular reference to the Africans and has highlighted the intriguing areas of the disorder with the consequent dilemma posed to its management. Further research on this topic is indicated and would be fascinating but a challenging task.

Pattern of metastasis of primary liver cancer at autopsy: an African series.

Out of all the cases seen at autopsy at Ibadan during the study period (1974-1986) ninety-eight patients had primary liver cancer. One of the patients had cholangiocarcinoma. The pattern of metastasis and causes of death of these patients have been studied and discussed in comparison with reports in the literature. The distribution of sites of metastasis in our patients were lungs (37.8%), portal vein (37.8%) and regional lymph nodes (20.4%). We have also shown that the pattern of metastasis of hepatoma arising from cirrhotic liver appears to be different from that of non-cirrhotic liver; the former being more likely to involve the portal vein and regional lymph nodes, while the latter involves more bones. The common causes of death among our patients were bleeding, advanced malignancy and liver failure in 60.2 per cent, 71.4 per cent and 11.2 per cent respectively. Despite recent advances in the management of hepatoma, the above complications remained as major problems.

Malignant metastatic tumours in the liver: an African series.

Ninety-three (40.6%) cases have metastatic tumour deposits in the liver out of all the primary malignant tumours seen at autopsy during the study period (1983-86). An overwhelming preponderance (39.8%) of hepatic metastases was due to tumours of the reticulo-endothelial system. This is notable when compared with the reports in the Caucasians. Many of the patients presented as if they were primary liver tumours with weight loss, hepatomegaly, abdominal discomfort and upper abdominal mass as major clinical features. This study has shown that a cirrhotic liver is particularly immune to invasion by metastases, when compared with the incidence of primary cancer in cirrhotic livers (Z = 9.32; P less than 0.001).

Malignancies of upper gastrointestinal tract in Nigerians: early symptoms and prognosis.

A total of 237 patients with confirmed malignancies of the upper-gastrointestinal tract (UGIT) were studied. Of these, 143 (60.34%) were gastric cancers, 66 (27.85) were oesophageal malignancies and 28 (11.81%) were in the small intestine. Epigastric pain accompanied by vomiting after meals was the commonest first symptom in patients of gastric cancer whereas dysphagia formed the commonest first symptom in oesophageal cancer. However, no definite first symptom could be attributed to those with small intestinal tumors. As many as 134 patients (56.54%) had advanced malignancies at presentation itself. The usefullness of first symptoms in early diagnosis and prognosis is discussed.