Hepatitis B and E viral infections among Nigerian healthcare workers.

BACKGROUND: There is dearth of information on Hepatitis E virus (HEV) infection and its co-infection with HBV among Nigerian healthcare workers (HCWs). Hence, there is the need to determine the rate of HEV infection and its association with HBV among HCWs who are at greater risk of nosocomial infections. METHODOLOGY: Sera from 88 HCWs and 44 non-HCWs healthy adults as controls were tested for the presence of antibody to HEV (anti-HEV). The HCWs were also tested for HBsAg and antibody to Hepatitis B core antigen (anti-HBc) using commercially available ELISA kits. RESULTS: The prevalence of anti-HEV obtained among the HCWs and controls were 43% and 94% respectively (p<0.005) while those of HBsAg and anti-HBc in HCWs were respective 13% and 56%. Overall among HCWs, the prevalence of HBV infection was 65.9%, higher than HEV infection (p<0.005) with only anti-HBc greater among the male participants (p<0.005) while co-infection of HBV with HEV was 27.3%. HEV infection was least among the Paediatricians (18%) and highest among the Surgeons (55%) while HBV infection was similar in all the different occupational groups of HCWs (44-59%) except among the Gynecologists and Obstetricians (80%). CONCLUSION: Infection with HEV is high among Nigerian HCWs but lower than the rate among non-HCWs. It is also co-infected with HBV especially among the different groups of the HCWs and could occur with the diverse clinico-serological patterns of HBV infection.

Tumour markers and hepatitis C virus infection in Nigerian patients with liver diseases.

BACKGROUND: Early diagnosis of hepatocellular carcinoma (HCC) is very important and determination of serum levels of tumour markers in patients with chronic liver diseases could be of immense contribution to their management. METHOD: Forty-two adult Nigerian subjects consisting of 14 healthy subjects (Controls) and 28 patients with primary liver mass (es) and histological diagnoses of liver cirrhosis (LC) +/- chronic active hepatitis (CAH) and hepatocellular carcinoma +/- LC were studied. Their blood samples were assayed for Hepatitis B Surface Antigen (HBsAg), antibodies to HCV (anti-HCV), alkaline phosphatase (AP), Aphafeotoprotein (AFP) and Ferritin. RESULTS: The patients had HCC (10) HCC+LC(4), LC+CAH (2) and LC (12). Serum ferritin> 700ng/ml, AP> 375IU/ml and AFP>200IU/ml were detected in 32%, 11% and 32% of the patients respectively with corresponding specificities of 100%, 86% and 100%. Elevated serum levels of AFP and ferritin were found in patients with HCC +/- LC while raised serum AP occurred in those having PHCC without LC. Only combination of either AFP or ferritin to AP gave significant increase in the diagnostic yield of HCC among the patients than the use of only AR Elevated levels of serum AFP correlated with both HBV and HCV while raised serum levels of ferritin were associated with only with HBV CONCLUSION: Although combination of the tumour markers gave a higher diagnostic yield for HCC among Nigerian patients, serum AFP > 200IU/ml seems the best tumour marker in the diagnosis of PHCC among the patients.

The clinical profile of cyclic vomiting syndrome in a regional hospital, Saudi Arabia.

BACKGROUND: Cyclic-vomiting syndrome is an uncommon disorder in adults. The aim was to determine the frequency and define the clinical characteristics of the syndrome among Saudi patients. METHODS: The subjects were patients with recurrent vomiting who were evaluated and treated in a regional referral centre in Saudi Arabia. RESULTS: Of 4290 patients who had endoscopic examinations during a period of 7 years (1995-2001), 13 patients (11 females and 2 males, mean age = 18.4 years) were diagnosed as cyclic vomiting. Precipitating factors were rarely identified and none of the cases was associated with migraine. Responses to therapy, which comprised reassurance, tricyclic drugs and prokinetic drugs were variable. CONCLUSIONS: The study indicated that the syndrome is relatively rare among Saudi patients with a frequency of 2.6 per 1000. The delay in the referral of these patients to a specialized unit was striking. It is probable that the syndrome is under-diagnosed and under-reported, in general. This report may stimulate more awareness of this disorder among health care givers in Saudi Arabia and may avoid unnecessary and protracted investigations.

Isoniazid acetylation phenotyping in Saudi Arabs.

AIMS: The present study is designed to investigate the acetylator status in Saudi Arabs. METHODS: Isoniazid (INH) acetylation phenotyping was studied in 136 Saudi Arabs in Riyadh, Saudi Arabia, using a single plasma sample taken 3 h post-INH oral dose of 200 mg. Metabolic ratio (MR) of plasma acetyl-INH (Ac-INH) to INH was used to determine the acetylation phenotype. RESULTS: The MR had a bimodal distribution with an antimode of 1.0. The frequency distribution of slow acetylators (MR < 1.0) was 94.9% (n = 129). Using Hardy-Weinberg Law, the gene frequency (q) of the recessive allele determining slow acetylator phenotype was found to be 0.97. CONCLUSION: INH phenotyping suggests a high frequency of slow acetylators among Saudi Arabs. There was no association between the MR of plasma Ac-INH/INH and age or gender.

Hepatitis E virus infection in haemodialysis patients: a case-control study in Saudi Arabia.

To determine the prevalence of antibody to hepatitis E virus (IgM anti-HEV) among haemodialysis patients and evaluate whether there was an increased risk of infection and exposure to HEV in an area of endemic viral hepatitis, serum samples obtained from 83 Saudi patients on chronic haemodialysis (group 1), 400 sex- and age-matched healthy subjects (group 2) and hospital patients (group 3) were tested for the IgM anti-HEV and IgG anti-HEV. The prevalence of anti-HEV among the patients (group 1) and the healthy controls were 4.8% and 0.3%, respectively. The difference (4.5%) was statistically significant, with a calculated odds ratio (OR) of 20.2 (95% CI = 2.1-481.0; P = 0.0002). In contrast, there was no significant difference in the prevalence rates of IgG anti-HEV (7.2% vs 10.8%) in both groups. In nonhaemodialysis patients with various diseases, 1.6% (1 of 64) of outpatients (group 3) and none (0 of 113) of the ward patients (group 4) was positive for IgM anti-HEV. Thus, the prevalence (4 of 83) of IgM anti-HEV in the haemodialysis patients was significantly higher than the rate (1 of 177) in the combined groups of nonhaemodialysis hospital patients. The calculated OR was 8.9 (95% CI = 0.92, 212.8; P = 0.037). IgM antibody to hepatitis A virus (IgM anti-HAV) was not detected in any subjects, and the prevalence rates of IgG anti-HAV were similar in the patients and controls (72.3% and 74.3% in groups 1 and 2, respectively, and 75.7% combined groups 3 and 4). The study indicated a significantly higher risk of acute HEV infection among patients on chronic haemodialysis. It is possible that these were nosocomial infections acquired by person-to-person transmission in the haemodialysis unit. However, it is more probable that the infections were community acquired, a conclusion supported albeit indirectly by the lack of a significant difference between the prevalence in haemodialysis patients (4.8%) and outpatients (1.6%). In areas of endemic HEV, appropriate strategies should be adopted to prevent the risk of HEV among haemodialysis patients.

Barrett's esophagus: a review.

Barrett's esophagus [BE] is usually an acquired, condition in which specialized metaplastic intestinal columnar epithelium with goblet cells replaces the normal stratified squamous epithelium anywhere in the esophagus. It results from chronic irritation of esophageal mucosa by refluxed gastric contents. The importance of BE comes from its potential risk of progression to adenocarcinoma. The development of dysplastic changes in Barrett's metaplasia increases this risk markedly. However, the true incidence and the likelihood of adenocarcinoma developing in such individuals with dysplasia over a lifetime are not well defined. Histopathology of esophageal biopsy is mandatory for the diagnosis, because clinical, radiological and endoscopic findings in such cases can only suspect the disease. The exact prevalence of BE in the general population is difficult to estimate, however worldwide distribution of the disease vary considerably. BE has also been reported to occur in children. It has bimodal age distribution in adults. Despite the considerable attempts to treat BE, complete elimination of this premalignant epithelium is rare. The impact of medical or surgical therapy on the risk of malignancy remains obscure. To date, the optimal form of treatment whether by drugs and/or endoscopic ablation or by surgery remains undetermined.

Ulcerative colitis in Saudi Arabia: a retrospective analysis of 33 cases treated in a regional referral hospital in Gizan.

BACKGROUND: Until recently ulcerative colitis (UC) was considered rare among Arabs. Information on its occurrence among Saudi is scant and limited to a few reports from urban populations. AIM OF STUDY: to assess the frequency and clinico-pathologic pattern of this disease in a rural population in Gizan region, Saudi Arabia. METHODS: thirty three patients found to have UC over a 4-year period in King Fahad Central Hospital were analyzed retrospectively. RESULTS: there were 24 males and nine females patients with UC (ages ranged from 17-70 years, mean age 43.5 years). The commonest presenting symptoms were abdominal pain and diarrhea in 30 and 26 patients respectively. Extra-intestinal manifestations were rare, occurred in only two patients. Total or pancolitis was found in ten (30%) patients and it was severe in nine of them. The disease extended to the splenic flexure in eight (24.2%) of the patients. A total colectomy was required in one patient with severe pan-colitis and a focus of malignancy was present in the resected specimen. No patient died during the follow-up period that ranged from one to six years. CONCLUSION: the study confirmed the occurrence of UC among the rural population studied. The male preponderance, the older age at presentation and relatively milder diseases appeared to be differentiating features from the pattern among western populations.

Spontaneous bacterial peritonitis in Saudi Arabian patients with non-alcoholic liver cirrhosis.

BACKGROUND/AIMS: Spontaneous bacterial peritonitis is a frequent and serious complication of liver cirrhosis. Its prevalence varies from one survey to another. There are only very few reports of its occurrence among Arab patients. METHODOLOGY: We studied 115 Saudi Arabian patients with cirrhotic ascites in the Gizan region, an area of hyperendemic hepatitis B, over a 2-year period. RESULTS: Of these patients 12 (10.4%) had at least 1 episode of culture-positive spontaneous bacterial peritonitis (group A), an additional 34 (29.6%) had culture-negative neutrocytic ascites. The occurrence of spontaneous bacterial peritonitis was more frequent in males but was not influenced by the severity of liver disease or age. The overall mortality was 13.9%, however, only 1 patient died of spontaneous bacterial peritonitis-related cause. The remaining deaths were due to other complications of hepatic failure and portal hypertension. The low clinical threshold for treatment and the use of effective broad-spectrum antibiotics have reduced the mortality due to spontaneous bacterial peritonitis. There were a total of 56 recurrent episodes of infection in the patients. Of these episodes 46 occurred among 29 patients with spontaneous bacterial peritonitis and 10 among 62 patients with no infection during the index admissions. CONCLUSIONS: Prophylactic therapy against spontaneous bacterial peritonitis is a feasible strategy in reducing the frequency of recurrent peritonitis and should be recommended in these patients.

Primary malignant melanoma of the oesophagus: case report and review.

Primary malignant melanoma of the oesophagus [PMME] is a rare tumour. Worldwide, less than 200 cases have been reported to date. We report here a 72 year-old Saudi male who presented with abdominal pain and anorexia. On endoscopy a dark lesion was found in the oesophagus. Its histopathological features were consistent with malignant melanoma. There were no other melanotic lesions elsewhere. PMME occurs most frequently in the 7th and 8th decades of life with a male predominance. It is an aggressive tumour with the majority of patients dying in less than 2 years due to metastases to vital organs. Surgery is the treatment of choice. However, radiation may be useful as adjuvant therapy.

Hepatic granulomas in an arab population: a retrospective study from a teaching hospital in Riyadh.

This is a retrospective analysis of the medical records of 116 patients who presented to the gastroenterology division, department of medicine at King Khalid University Hospital (KKUH) in Riyadh, Kingdom of Saudi Arabia and subsequently had a histopathologic diagnosis of hepatic granulomas. Infections contributed to 56% and were represented mainly by schistosomiasis and to a lesser extent by tuberculosis, brucellosis and hydatid disease. Lymphomas (8%) were the major representative of noninfectious causes. The etiology of 25% of granulomas remained undetermined. Weight loss, fever, anorexia and abdominal pain were the most frequent presenting symptoms in 53, 45, 43 and 42% of patients, respectively. Ten percent of the patients were asymptomatic. Hepatomegaly and splenomegaly were the predominant physical findings in 55% and 43% of patients respectively. Hepatic granulomas in this study are mainly caused by infections. Schistosomiasis, tuberculosis and brucellosis represented the most common etiologic factors.

Barrett's oesophagus and oesophageal cancer in Saudi Arabia.

BACKGROUND/AIMS: Gastrooesophageal reflux disease (GERD) and Barrett's oesophagus (BE) are presumed to be rare among non-western populations. This retrospective survery determined the prevalence of BE and its associated complications of dysplastic lesions (DL) and oesophageal adenocarcinoma (AD) among an Arabian population. METHODOLOGY: From 2572 patients who had endoscopy in King Fahd Central Hospital (KFCH) Gizan, Saudi Arabia, patients (n = 776) were selected for analysis if they had biopsies of the upper gastrointestinal (UGI) tract. The patients (159 of 776) with biopsy-proven oesophageal lesions were categorized and compared. RESULTS: The relative frequencies of BE, DL and AD in 159 patients were 8(5%), 5(3%) and 16 (10%) respectively. These interpreted to prevalence rates of 0.31%, 1.9%, and 0.62% for the respective lesions. The comparison of the mean age +/- SD (in years) of the patients with BE (59.6 +/- 19.8), DL (66 +/- 16.7) and AD (70.6 +/- 12.2) showed to statistically significant difference. Major symptoms in the patients with BE were dyspepsia (4 cases), hematemesis (2 cases) and dysphagia (2 cases). This profile was not different from that observed in 79 patients with GERD. CONCLUSION: The prevalence of 0.31% in our endoscopy population is at the lower range of the 0.3% to 10% reported in the western world. It is likely that the rate was underestimated by this retrospective survey, in which patients were selectively biopsied. Also, it is probable that the majority of individuals in our population with no or minimal symptoms of GERD do not present themselves or are not referred for evaluation. Despite this limitation, our study confirms the occurrence of BE and its complications among a Saudi population. The incidence of BE may increase with the current changes in the life-style and increase in the life-span of the Saudi Arabian population.

Upper gastrointestinal diseases in Saudi Arabian children.

In contrast to the experience in the adults, there are limited data concerning the efficacy and safety of upper gastrointestinal endoscopy (UGIE) in paediatric patients. The information on this procedure is very scanty from non-western countries. We analysed 72 children evaluated in Gizan, Saudi Arabia, an area of high endemic hepatitis B and chronic liver disease. The indications comprised abdominal pain (49%), UGI bleeding (24%) and evaluation of suspected portal hypertension. No abnormality was detected in 33 (46%). Mucosal inflammatory lesions (oesophagitis, gastritis and duodenitis) are the commonest abnormal lesions, occurring in 24 (33%). Duodenal ulcer (4 cases) and gastric ulcer (1 case) were relatively few. No case of malignancy was found. Sclerotherapy for variceal bleeding was effective in 4 patients. Helicobacter pylori was detected in 12 of 23 patients and associated with histologically identified gastritis in the majority of these cases. It is concluded that paediatric UGIE is safe and useful in the diagnosis and therapeutic intervention for UGI diseases in children. Our findings provide additional information on the pattern of diseases among Saudi Arabian children.

Diagnostic yield of upper gastrointestinal endoscopy in relation to age and gender: a study of 10112 Saudi patients.

BACKGROUND/AIMS: The availability of fiberoptic endoscopy has made it relatively easy to evaluate symptoms of upper gastrointestinal disorders with a significant degree of accuracy. MATERIALS AND METHODS: To determine the pattern of upper gastrointestinal lesions in the Saudi population with particular reference to the influence of age and gender, 10,112 patients were studied. RESULTS: No abnormal findings were detected in 26.9%. The frequency of ulcer lesions was 13.7% while non-ulcer, mucosal inflammation was diagnosed with a frequency of 33.7%. In the young (less than 20 years of age), the most common lesion was duodenal ulcer or duodenitis, whereas in the elderly (above 60 years of age), esophagitis, hiatus hernia and esophageal varices were the most frequently diagnosed. The highest mean ages were observed in the group of patients with gastric and esophageal cancers (mean ages of 58.8 and 65.1 years, respectively). There was no gender-related differences with regard to the mean age of patients in all the diagnostic categories. CONCLUSIONS: This study provides baseline data on the age distribution of major upper gastrointestinal diseases among the Saudi population. The peculiarities of upper gastrointestinal endoscopic findings in advanced age are clarified. The influence of demographic changes on the pattern of these diseases in Saudi Arabia can be evaluated against our findings in the future.

The diagnostic utility of serum ferritin estimation in Nigerian patients with primary hepatocellular carcinoma.

Serum hepatitis B surface antigen (HBsAg) status and ferritin levels were measured in three groups of Nigerian subjects: Group A (n = 14) with non-neoplastic disease (CNLD); Group B (n = 14) with primary hepatocellular carcinoma (PHC); and Group C (n = 14) of healthy matched controls. Serum ferritin values were lowest in Group C, intermediate in Group A, and highest in the Group B patients (all p < 0.05). About 79% of the patients with PHC, 43% of those with CNLD, and none (0%) of the healthy controls had hyperferritinemia (serum ferritin > 400 ng/ml). Hyperferritinemia and HBsAg positivity coexisted in 15% and 73% of the patients with CNLD and PHC, respectively. Hyperferritinemia and HBsAg were significantly positively related in the patients with PHC (chi 2 5.09, p < 0.05). The predictive indices of hyperferritinemia in chronic liver disease appeared superior for PHC than for CNLD, and became somewhat enhanced with coexisting HBsAg positivity. These results suggest that serum ferritin could be useful as a tumor marker for PHC in Nigerian patients with established chronic liver disease.

Profile of hepatitis C virus and the possible modes of transmission of the virus in the Gizan area of Saudi Arabia: a community-based study.

The seroprevalence of antibody to hepatitis C virus (anti-HCV) and the possible modes of transmission of HCV were investigated in Gizan, southern Saudi Arabia. The sample size chosen to give an adequate estimate of the seroprevalence, about 1500, was based on the assumption that 5% of the population in Gizan were anti-HCV-positive. Sera from 1482 subjects (705 males, 777 females; aged > or = 10 years) were initially screened for anti-HCV using a commercial, ubiquitin-based enzyme immunoassay. Repeatedly reactive sera were confirmed positive using second-generation immunoassays. Serum samples were also tested by ELISA for hepatitis B surface antigen (HbsAg) and antibodies to this antigen and to the hepatitis B core antigen. Of the subjects tested, 27 (1.8%) were anti-HCV-positive. Exposure to HCV was generally similar in both sexes, age-prevalence curves for anti-HCV peaking in males aged > 49 years (6.2%) and in females aged 40-49 years (5.0%). In the youngest subjects, those aged 10-19 years, the HbsAg carrier rate was significantly higher in males (10.4%) than in females (3.6%). Exposure to the hepatitis B virus was similar in both sexes (31.0% in males v. 28.6% in females). Some 7.4% and 14.8% of the 27 anti-HCV-positive cases had histories of schistosomiasis and blood transfusion, respectively. The corresponding values for the 1455 anti-HCV-negative cases investigated, 1.1% for schistosomiasis and 3.5% for blood transfusion, were much lower. The spouses and other family members of eight anti-HCV-positive index cases were investigated but none was anti-HCV-positive.(ABSTRACT TRUNCATED AT 250 WORDS)

The diagnostic utility of serum ferritin. Estimation in patients with primary hepatocellular carcinoma.

Serum hepatitis B surface antigen (HBsAg) status and ferritin levels were measured in 3 groups of subjects: Group A (n = 14) with chronic non-neoplastic liver disease (CNLD), Group B (n = 14) with primary hepatocellular carcinoma (PHC) and Group C (n = 14) comprising healthy matched controls without liver disease. Serum ferritin values were lowest in Group C, intermediate in Group A and highest in the Group B patients (all p < 0.05). About 79% of the patients with PHC, 43% of those with CNLD and none (0%) of the healthy controls, had hyperferritinaemia (serum ferritin > 400 ng/ml). Hyperferritinaemia and HBsAg positivity coexisted in 15% and 73% of the patients with CNLD and PHC, respectively. Hyperferritinaemia and HBsAg were significantly positively related in the patients with PHC (chi 2 5.09, p < 0.05). The predictive indices of hyperferritinaemia in chronic liver disease appeared superior for PHC than for CNLD, and became somewhat enhanced with coexisting HBsAg positivity. These results suggest that serum ferritin could be useful as a tumour marker for PHC in patients with established chronic liver disease.

Serum alphafoetoprotein, hepatitis B virus infection and primary hepatocellular carcinoma in Nigerians.

Serum alphafoetoprotein and hepatitis B antigen were estimated by radioimmuno-assay and haemagglutination methods respectively in 42 Nigerian adults comprising 14 subjects in each of three groups, viz, controls, liver cirrhosis and primary hepatocellular carcinoma. At an abnormal concentration of serum alphafoetoprotein greater than 200 micrograms/L, a correct diagnosis of primary liver cancer was made in 64.3% of the patients at a specificity of 100%. However, no correlation was found between serum concentrations of alphafoeto-protein and status of hepatitis B surface antigen in the patients with primary liver cancer. It may be concluded that serum alphafoeto-protein is useful in the diagnosis of primary hepatocellular carcinoma in Nigerians and secretion of the onco-foetal protein by neoplastic hepatocytes is unlikely to be influenced by hepatitis B virus infection.