Correlation of Serum Anti-Helicobacter pylori Immunoglobulin A (IGA) with Histological Parameters of Chronic Gastritis in Ibadan; Nigeria

Background: The seroprevalence of anti-H. pylori IgA antibodies has been reported to vary among populations and in relation to strains of Helicobacter pylori bacterium. However; there has been conflicting reports on the association between IgA serological status and the histological variables of chronic gastritis. This study was therefore conducted to clarify this relationship. Method : Using an ELISA based commercial kit; anti-H. pylori IgA antibody tests were performed on 65 dyspeptic patients and 65 age- and ex-matched controls. The gastric biopsies of these patients were also examined histologically for the degrees of inflammation; activity; intestinal metaplasia and atrophy. The CagA status of the patients had been determined previously. Results: There was an anti-H. pylori IgA antibody prevalence of 67.7in dyspeptics and 56.9in non-dyspeptic individuals. No correlations were observed between serum H. pylori IgA antibody and the graded parameters of chronic gastritis in dyspeptic patients; although twice more patients with mild gastric inflammation were found among IgA positive than among IgA negative patients. However; a statistically significant relationship was established between serum IgA positivity and the CagA status of the patients (p = 0.028). Conclusion: The seroprevalence of anti-H. pylori IgA antibody is high in our environment. Serum IgA status may be associated with milder degrees of gastritis in our patients but a larger cohort of patients is needed to confirm this. There seems to be a good agreement between serum IgA and CagA statuses among dyspeptic patients

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

Nigerian butchers and hepatitis B virus infection.

Various target groups have been identified in Nigeria for studying the prevalence of hepatitis B virus infection; however there is no information on its prevalence among workers in slaughter houses. This study determined the seroprevalence of hepatitis B virus infection in Nigerian butchers at Ibadan, and comprised 360 healthy Nigerian adult subjects (180 butchers, 180 traders as controls) selected by multistage stratified sampling. A questionnaire was used to collect relevant information and included points about risk behaviour. ELISA was used to detect the hepatitis B surface antigen in the serum; the seroprevalence rate in butchers and controls was 9.4% and 3.3%, respectively (p<0.05). Risk behaviour was seen more commonly in butchers than in controls. The presence of hepatitis B surface antigen in the serum was not related to the duration of occupational exposure or the number of partners. In summary, butchers comprise a high-risk occupational group for exposure to hepatitis B virus infection. We conclude that routine screening for parenterally acquired infections in this group is thus necessary in order to identify those who will require treatment and immunisation, especially against hepatitis B virus infection.

Enteric fever with suspected intestinal perforation and incidental renal cell carcinoma--a case report.

Enteric fever presents with protean manifestations, at times eluding the treating physician. We report the case of a 19-year-old woman whose clinical presentation suggested enteric fever, however, autopsy revealed occult renal cell carcinoma. We emphasise here, the need to investigate non-infective causes of pyrexia.

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.

Prevalence of hepatitis B surface and e antigens, risk factors for viral acquisition and serum transaminase among blood donors in Ibadan, Nigeria.

The objective of this study was to determine the prevalence of hepatitis B e antigen (HBeAg) in blood donors with hepatitis B surface antigen (HBsAg), and alaninine transaminases (ALT) levels and possible risk factors for the transmission of hepatitis B virus (HBV). Over a 6-month period, consecutive blood donors were screened for HBsAg, HBeAg, ALT and risk factors for HBV transmission. One hundred seventy-five adults (158 males, 17 females) were screened. Thirty-seven (21.3%) were HBsAg positive, 4 (2.3%) were HBeAg Positive and 17 (9.7%) had a raised ALT level, which ranged between 42-126 IU/L. All the HBeAg-positive subjects had raised ALT levels. The main risk factors among others, were scarification and indiscriminate injections. Twenty of the 37 HBsAg-positive subjects (54%) had no identifiable risk factor. The present study revealed that, HBeAg positivity among HBsAg positive blood donors was infrequent and whenever present was associated with active liver disease indicated by raised ALT value.

Retrospective analysis of typhoid fever in a tropical tertiary health facility.

A retrospective analysis of cases diagnosed as typhoid fever over a ten-year period at the University College Hospital, Ibadan, Nigeria was carried out to assess the presentation pattern, laboratory investigation, mortality and mode of therapy. Incidence was of typhoid fever was highest in the dry months of the year. The mean age of survivors and the dead are 25.7 and 21.9 years respectively. Most of the patients presented with fever, abdominal pains and other gastrointestinal symptoms such as vomiting, constipation and diarrhoea. There was no specific temperature pattern but pulse rate > or = 120/minute was significantly associated with mortality. The commonest complication was intestinal perforation followed by haemorrhage with septic shock playing a prominent role in mortality. Mortality rate of 22.2% was recorded which is not significantly different from the 24% recorded at the same centre over three decades ago and most of them died within nine days of admission with 50% dying within 3 days. Most patients were scantily investigated with poor yield on blood, stool and urine cultures. Widal's test was not a favoured investigation and was not helpful in diagnosis. Chloramphenicol was the drug of choice as monotherapy, while metronidazole and gentamicin were used in cases of gut perforation. It is concluded that typhoid fever is still a major health concern in the tropics and efforts need to be geared up to combat this preventable scourge by improvement in basic necessities of life such as potable water, hygienic food in addition to health education.