Correlation of alanine aminotransferase levels and a histological diagnosis of steatohepatitis with ultrasound-diagnosed metabolic-associated fatty liver disease in patients from a centre in Nigeria.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is defined as the occurrence of hepatic fat accumulation in patients with negligible alcohol consumption or any other cause of hepatic steatosis. This study aimed to correlate the ultrasound-based diagnosis of MAFLD with the histological diagnosis of nonalcoholic steatohepatitis (NASH) and alanine aminotransferase (ALT) levels in patients with MAFLD. METHODS: This was a hospital-based cross-sectional study of 71 patients with MAFLD diagnosed by ultrasound. Percutaneous liver biopsy was performed for histological evidence of NASH in all patients, regardless of liver function test (LFT) values, provided that they had no contraindications. Liver histology was graded using the NASH Clinical Research Network MAFLD Activity Score. The data obtained were entered into SPSS version 21 and analysed using descriptive and inferential statistics. The significance level was set at < 0.05. RESULTS: A total of 71 patients (26 males and 45 females) with MAFLD were included. Thirty-nine (76.5%) patients with MAFLD and normal ALT levels had NASH, while 14 (82.4%) had elevated ALT levels. There was no statistically significant difference in the histological grade of NASH between patients with normal and elevated ALT levels. A weak correlation was found between the severity of steatosis on ultrasound scan and NASH incidence (p = 0.026). The sensitivity and specificity of ALT levels for predicting NASH according to the area under the receiver operating characteristics (AUROC 0.590) at an ALT cut-off value of 27.5 IU/L were 55.8% and 64.7%, respectively. CONCLUSION: NASH can occur in patients with MAFLD, irrespective of alanine transaminase (ALT) levels, and ultrasound grading of the severity of steatosis cannot accurately predict NASH. Liver biopsy remains the investigation of choice.

Factors that Influence the Acceptance of Needle Biopsy of the Liver at a Tertiary Hospital in Nigeria.

BACKGROUND: Liver biopsy is a procedure that is carried out for making the diagnosis of abnormal liver conditions. OBJECTIVES: This study assessed the factors that influence patients' acceptance of liver biopsy. METHODS: A hospital based prospective study among patients scheduled for outpatient liver biopsy. They completed an interviewer administered questionnaire that captured their expectations, the degree of pain, areas they think need improvement during the biopsy process and whether they would consent to a second liver biopsy. A qualitative aspect involved an in-depth interview of participants purposively selected for their experience of liver biopsy. Data from the quantitative group were entered into SPSS version 20 and analyzed using simple and inferential statistics while content analysis was done for the qualitative aspect. RESULTS: There were 100 participants in the quantitative group, 61 males and 39 females, and 16 in the qualitative group. Participants in the quantitative group expected a painful procedure (92%) that was likely to restrict their movement (64%). After biopsy, 44%, 40%, 28%, 26%, 18% and 17% of participants were unhappy with the long monitoring hours, biopsy needle pain, number of biopsy passes, lying on the biopsy site, shoulder tip pain and pain of local anaesthetic injection respectively. The qualitative aspect identified five thematic areas and showed that liver biopsy pain was influenced by preoperative anxiety occasioned by ill-advice and was exaggerated among females. CONCLUSION: Consenting for liver biopsy may be influenced by advice from others, while factors relating to the procedure and long monitoring period remain as deterrent factors.

CONTEXTE: La biopsie hépatique est une procédure qui est effectuée pour établir le diagnostic d'affections hépatiques anormales. OBJECTIFS: Cette étude a évalué les facteurs qui influencent l'acceptation de la biopsie hépatique par les patients. MÉTHODES: Une étude prospective en milieu hospitalier parmi les patients devant subir une biopsie hépatique en ambulatoire. Ils ont rempli un questionnaire administré par un intervieweur qui capturait leurs attentes, le degré de douleur, les domaines qu'ils pensaient devoir améliorer au cours du processus de biopsie et s'ils consentiraient à une deuxième biopsie du foie. Un aspect qualitatif impliquait un entretien approfondi avec des participants sélectionnés à dessein pour leur expérience de la biopsie hépatique. Les données du groupe quantitatif ont été saisies dans SPSS version 20 et analysées à l'aide de statistiques simples et inférentielles tandis que l'analyse de contenu a été effectuée pour l'aspect qualitatif. RÉSULTATS: Il y avait 100 participants dans le groupe quantitatif, 61 hommes et 39 femmes, et 16 dans le groupe qualitatif. Les participants du groupe quantitatif s'attendaient à une intervention douloureuse (92 %) susceptible de restreindre leurs mouvements (64 %). Après la biopsie, 44 %, 40 %, 28 %, 26 %, 18 % et 17 % des participants étaient mécontents des longues heures de surveillance, de la douleur à l'aiguille de biopsie, du nombre de passages de biopsie, de la position allongée sur le site de la biopsie, de la douleur et de la pointe de l'épaule d'injection d'anesthésique local respectivement. L'aspect qualitatif a identifié cinq domaines thématiques et a montré que la douleur de la biopsie hépatique était influencée par l'anxiété préopératoire occasionnée par un mauvais conseil et était exagérée chez les femmes. CONCLUSION: Le consentement à une biopsie hépatique peut être influencé par les conseils d'autrui, tandis que les facteurs liés à la procédure et à la longue période de surveillance restent des facteurs dissuasifs. MOTS CLÉS: Facteurs, influence, acceptation, biopsie hépatique. Nigérians.

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.

Diagnostic utility of alpha-fetoprotein and des-gamma-carboxyprothrombin in nigerians with hepatocellular carcinoma.

BACKGROUND: Alpha-fetoprotein (AFP) and Des-gamma-carboxyprothrombin (DCP) have been extensively studied as biomarkers for the diagnosis of and prognostication in hepatocellular carcinoma (HCC). However there are only few reports on the clinical characteristics of hepatocellular carcinoma in relation to the combination of the two tumor markers in hepatitis B virus-related HCC. AIM: The aim of this study was to investigate the clinical characteristics of HBV-related HCC in relation to different sets of AFP and DCP values. METHODS: Sixty-two patients with untreated HCC were studied. The positive value of AFP was set at 20 1U/L while DCP positive value was set at 150 mAU/ml. Patients were divided into three groups: Group 1(n=36) with AFP ≥ 20 IU/L and DCP ≥ 150 mAU/ml. Group 2(n=24) with AFP <20 1U/L and DCP ≥ 150 mAU/ml. Group 3 (n=2) with AFP < 20 1U/L and DCP < 150 mAU/ml. There were no patients in group 4 meant for those with AFP ≥ 20 1U/L and DCP < 150 mAU/ml. Clinical and laboratory variables were compared among the groups. RESULTS: Clinical and laboratory variables were comparable among the groups with the exception of gender and values of serum alanine aminotransferase (ALT). Males were significantly more than females among the groups (p<0.03). ALT values were significantly different among the groups (p<0.006). Paired comparisons between the groups showed the mean values of serum ALT were significantly higher in group 2 than in group 1(p<0.003). The mean serum ALT values were also higher in group 2 than in group 3 (p <0.014). There was no significant difference between group 1 and group 3 (P = 0.124). CONCLUSION: HCC patients who are sero-positive for DCP and sero-negative for AFP have significantly higher levels of serum ALT; serum ALT levels may be of diagnostic importance in AFP-negative, HBV-related HCC patients.

Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria.

BACKGROUND: Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these. OBJECTIVE: To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010. METHODS: This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes. RESULTS: Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001). CONCLUSION: There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade.

Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria

Background. Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these.Objective. To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010.Methods. This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes.Results. Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001).Conclusion. There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade

Fatal haemorrhage from an ultrasound guided fine needle aspiration of the liver in a patient with primary hepatocellular carcinoma: case report.

A case of fatal haemorrhage is reported among 72 ultrasound (US) guided percutaneous fine-needle aspiration liver biopsies (FNAB) performed in the gastro- intestinal unit of Medicine Department in a tertiary hospital. The patient had primary hepatocellular carcinoma (PHCC) with advanced hepatic cirrhosis. Death was due to bleeding from liver nodule resulting in intra-peritoneal haemorrhage. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in the patient. This event is our first experience, but colour flow Doppler ultrasound guidance has been reported to prevent its occurrence. The use of FNAB for the diagnosis of PHCC should therefore be guided with colour flow Doppler ultrasound scan to prevent haemorrhage. In addition, there should be proper selection of patients for FNAB especially in areas where there are no colour flow Doppler ultrasound scans.

Presentation, distribution pattern, and management of diverticular disease in a Nigerian tertiary hospital.

BACKGROUND: Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility. MATERIALS AND METHODS: A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. RESULTS: During the 5-year study period, 40 cases were seen. The patients were aged 41-85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty-four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy. CONCLUSION: Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its complications should increase in the country.

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.

Spectrum of colonoscopy findings in Ile-Ife Nigeria.

AIMS AND OBJECTIVES: Lower gastrointestinal (LGI) diseases are the leading causes of morbidity and mortality worldwide. Colonoscopy holds an important place in screening, diagnosing and treatment of these conditions. In Nigeria, as in many other developing countries, the facility for performing colonoscopy is rarely available. This prospective report seeks to evaluate the demographic data of patients presenting for colonoscopy, the pattern and validity of referral diagnosis versus colonoscopy findings in Ile-Ife, Nigeria. SUBJECTS AND METHODS: All patients who had colonoscopy procedure done in the Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex between January 2007 and December 2011 were included in the study. RESULTS: During the study period, colonoscopy was carried out in 320 patients. One hundred and eighty two (56.9%) were males, while 138 (43.1%) were females. The median age was 59.5 years. Their ages ranged from 2-87 years. The most common indications were lower gastrointestinal bleeding and change in bowel habit which together accounted for 79.0%. No abnormality was seen in 93(29.1%) patients. Abnormal endoscopic findings included 66(20.6%) patients who had haemorrhoids, 50(15.6%) cases colorectal cancer, 33 (10.3%) patients had benign polyps and (30 (9.4%) patients had diverticular disease. Other findings were colitis, inflammatory bowel disease, rectovaginal fistula, vascular ectasia and extra luminal compression. Haemorrhoids, diverticulosis and polyps were the most common findings in patients presenting with lower gastrointestinal bleeding. CONCLUSION: This present report showed that colonoscopy is a cheap, safe and effective method of investigating lower gastrointestinal disease in Ile-Ife, Nigeria. When the indication is based on symptoms, the diagnostic yield could be as high as 90%. The common causes of lower gastrointestinal bleeding in Ile-Ife, Nigeria include haemorrhoids, diverticulosis and polyps.

Bowel preparation for colonoscopy: enema versus sodium phosphate.

BACKGROUND: Colonoscopy is considered to be the gold standard investigation for assessing the colonic mucosa. Good bowel preparation is essential in order to achieve optimal visualisation of the mucosa. Traditionally water enema is used for bowel preparation in most centres in Nigeria. This prospective study was performed at the Gastrointestinal Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between July 2008 and June 2009. AIMS AND OBJECTIVES: This study compared patients' tolerability, adverse effects, efficacy and mean duration of colonoscopy of water enema and sodium phosphate (NaP) for bowel preparation toward colonoscopy. PATIENTS AND METHODS: Standard structured questionnaire was completed by 64 patients and the colonoscopist assessing tolerability, adverse effect, efficacy and mean duration of the procedure. RESULTS: There were sixty four patients aged between 22 to 86 years. The mean age was 58.16 ± 15.790. Thirty eight (59.4%) patients were in patients and 26 (40.6%) were out patients. Forty one (64.1%) patients had water enema while 23 (35.9%) patients were included in the NaP group. The median age for patients in both groups was 62.0 years. Patients in NaP group rated their bowel preparation as more tolerable and found the dietary restriction much easier than those in water enema group (p < 0.0001). Better colon cleansing score was found in patient in NaP group as compared with those in water enema group in all region of the colon. The procedure took significantly longer time in patients in water enema group as compared with those in NaP group (p < 0.0001). CONCLUSION: NaP has a better bowel cleansing score for colonoscopy than water. It has better tolerability, side effect profile, efficacy and gives a shorter mean duration for the procedure.

The contribution of alcohol to chronic liver disease in patients from South-west Nigeria.

OBJECTIVE: This study aimed at determining the level and type of alcohol consumed by patients diagnosed with chronic liver disease (CLD) and, hence, the extent to which alcohol may have contributed to the development of the condition. STUDY DESIGN: Patients with diagnosis of CLD were consecutively recruited and a structured questionnaire was administered on each of them. Diagnosis of CLD was made based on liver histology and/or typical clinical and laboratory features. Alcohol consumption was considered significant if a patient took >50 g/day for > 10 years. RESULTS: A total of 145 patients were studied consisting of 102 males and 43 females. Their ages ranged from 20- 80 years with a mean of 46.8 ± 15.7 years. Fifty-one (35.2%) patients, all males, drank significant alcohol while consumption was not significant in 43 (29.6%) patients. Alcohol was not consumed at all by 51 (35.2%) patients made up of 18 males (35.3%) and 33 females (64.7%). Beer was the commonest form of alcohol consumed (70.2%) followed by palm wine (50%) and locally-brewed gin (20.2%). The diagnoses made were liver cirrhosis [LC] (60, 41.38%), chronic hepatitis [CH] (54, 37.20%), hepatocellular carcinoma [HCC] (23, 15.86%), alcoholic liver disease [ALD] (6, 4.14%) and non-alcoholic fatty liver disease [NAFLD] (2, 1.38%). The liver disease spectrum did not differ between the patients who drank significant alcohol and those who did not. However, the proportion of LC/HCC cases increased relative to CH with increasing age and consumption of alcohol. CONCLUSIONS: The proportion of CLD directly attributable to alcohol (i.e. ALD) is low among the patients studied. However, the burden of LC and HCC is directly related to age and the amount of alcohol consumed and the determinants of alcohol abuse are gender and affluence.

Sexual transmission of the hepatitis B virus among blood donors in a tertiary hospital in Nigeria.

INTRODUCTION: Hepatitis B can be spread by several routes, including sexually. This study aimed to determine the prevalence of sexual transmission of the virus among the Nigerian population. METHODS: This was a prospective cross-sectional study involving 234 blood donors in a Nigerian tertiary hospital. Each prospective donor was screened for hepatitis B surface antigen using an enzyme-linked immunosorbent assay test. A structured questionnaire was used to obtain information regarding the possible routes of hepatitis B acquisition and the number of lifetime heterosexual partners. Respondents were divided into three risk groups. The data obtained was analysed, and the frequencies, percentages, means and standard deviations were obtained. The chi-square test was used to compare categorical variables, and a p-value equal or less than 0.05 was considered statistically significant. RESULTS: A total of 234 respondents aged 18 to 56 years (mean 27.3 years) participated in the study. 223 were male and 11 were female. The overall seroprevalence of hepatitis B was 17.1 percent. The seroprevalence was higher among participants without sexual partners (20.6 percent) and those with multiple sexual partners (20.0 percent), but lower among those with single sexual partners (15.0 percent). A history of needle injuries, jaundice and injections from quacks were statistically significant when these risks were combined with a sexual risk for hepatitis B virus infection (p-value is less than 0.05). CONCLUSION: Sexual transmission of hepatitis B was not found to be an important factor. Preventive strategies should include universal hepatitis B vaccination and discouraging the indiscriminate use of sharp objects and unauthorised medical practices.

HELLP syndrome: the experience at Ile-Ife, Nigeria.

Between 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0-5 and the estimated gestational age from 18-41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.

Correlation between endoscopic suspicion of gastric cancer and histology in Nigerian patients with dyspepsia.

Gastric mucosal biopsies of 77 dyspeptic patients whose endoscopic features were suggestive of cancer and 56 patients with uncomplicated duodenal ulcer (DU) were subjected to histopathological analysis. Gastric cancer was confirmed in 18 (23.4%) of the 77 patients but not in 59 (76.6%). 4 (5.2%) of the 18 patients had early gastric cancer (EGC). Histopathological findings in the stomach biopsy of the 59 patients in whom cancer could not be confirmed were compared with those of the 56 patients with DU. Intestinal metaplasia (IM) was present in 32.2% of the 59 cases with endoscopic suspicion of gastric cancer and in 16.1% of the 56 DU controls (P < 0.05). Mucosa-associated lymphoid tissue (MALT) occurred in 28.8% of the cancer-resembling cases and in 12.5% of the DU patients (P < 0.05). The difference in the prevalence of gastric mucosal atrophy and Helicobacter pylori infection between the two groups (83% vs. 71.4%) did not reach statistical significance (P > 0.10). All 18 patients with gastric cancer were positive for Helicobacter pylori and the prevalence of the infection approached 95% in those with IM and MALT. This study shows that IM and MALT present with endoscopic appearances that resemble that of gastric cancer and that along with the latter, their main aetiological agent is Helicobacter pylori.

Antibiotic resistance of helicobacter pylori from patients in Ile-Ife, South-west, Nigeria

Background: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired; H. pylori persists; usually for life unless eradicated by antimicrobial therapy. Over the past few years; we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife; South-West Nigeria. In one collaborative study; we detected H. pylori in 195 (73) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently; infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. Objectives: More recently; we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. Methods: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. Results: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin; clarithromycin; metronidazole; while 29/31; 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6) of these isolates showed resistance to ciprofloxacin. Conclusions: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly pres-cribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting

Pattern and validity of clinical diagnosis of upper gastrointestinal diseases in south-west Nigeria.

BACKGROUND: Diagnosis of upper gastrointestinal (UGI) diseases is often made on clinical grounds alone in Nigeria due to lack of endoscopic facilities. The validity of using such diagnosis is presently unknown. OBJECTIVE: The study aimed to determine: age and sex distribution of patients presenting for UGI endoscopy; pattern of clinical and endoscopic diagnoses in patients with UGI diseases; and, the validity of clinic-based diagnosis. METHODS: Medical records of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria for UGI endoscopy between September 1999 and August 2003 were reviewed. Data was analysed for sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis using endoscopic diagnosis as "gold" standard. RESULTS: Males constituted 53.4% of subjects and mean age was 45 years (+/- 1.69 SD). Peptic ulcer disease (PUD) constituted 67.6% of referral diagnosis but 33.9% of endoscopic diagnosis. PUD had the highest sensitivity value (0.72) while gastritis had the least (0.04). Specificity ranged from 0.40 for PUD to 1.00 for corrosive oesophagitis. Positive predictive value ranged from 0.29 (oesophageal cancer) to 0.67 (corrosive oesophagitis) and negative predictive value ranged from 0.66 for gastritis to 0.99 for corrosive oesophagitis. CONCLUSION: The validity of clinical diagnosis in UGI conditions varied widely, and in general, there is poor agreement between clinical and endoscopic diagnoses.

Clinical and laboratory indices of cholelithiasis in adult Nigerians with sickle-cell anaemia.

The clinical and laboratory indices of cholelithiasis in adult Nigerians with homozygous sickle-cell disease (SCD) were studied in 100 consecutive patients attending the adult SS clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The study examined the role of clinical (sickle cell (SS) crises, body mass indices [BMIs]), haematological (reticulocyte count, haemoglobin) and biochemical (serum bilirubin, serum alkaline phosphatase and serum amino transaminases) indices in predicting the likelihood of finding cholelithiasis in patients with SS anaemia. A positive correlation was found between the BMI, SS crises, reticulocyte count, serum bilirubin, serum alanine and asparate transferases on one hand and the development of cholelithiasis (at P values of 0.04, 0.03, 0.05, 0.01 and 0.04, respectively) on the other. No such association was found between the other indices studied and cholelithiasis.

Chronic hepatitis in Nigerian patients: a study of 70 biopsy-proven cases.

BACKGROUND: Liver cirrhosis and hepatocellular carcinoma are known sequelae of chronic hepatitis. Early diagnosis and treatment of chronic hepatitis could delay or even abort progression to terminal liver disease. STUDY DESIGN: Prospective study of 70 consecutive patients with features of early liver disease or discovered with HBsAg (or anti-HCV) during pre-employment and/ or pre-donation screening at Ile-Ife, Nigeria. All the patients had liver biopsy and the histology evaluated with the Knodell Histological Activity Index. RESULT: Fifty-three patients had symptomatic disease (M: F ratio, 1.5:1) while 17 were asymptomatic (M: F ratio, 3:1). The mean ages were 49.04 (SD+/-16.78) and 29.82 (SD+/-6.13) for the symptomatic and the asymptomatic patients respectively (P< 0.005). Major symptoms were right upper abdominal pain (68%), weight loss (51%) and fatigue (41.5%). Alcohol consumption was significantly related to symptomatic chronic hepatitis (P< 0.01). Over 50 % of patients with asymptomatic chronic hepatitis had abnormal liver scan and liver function tests. All the asymptomatic cases and 77.4 % of the symptomatic group had HBsAg while only 1 patient (symptomatic) was anti-HCV positive. On liver histology, all the patients with asymptomatic chronic hepatitis had a Knodell score of< or = 8 and none had fibrosis. Over half of the symptomatic patients had a Knodell score of > or = 9 (56.6%) and stage 2 or 3 fibrosis (51 %). CONCLUSION: Asymptomatic chronic hepatitis patients tend to be younger and of the male sex. Symptomatic chronic hepatitis may signal the onset of significant fibrosis and alcohol abuse may accelerate this process. Serum ALT and liver scan are useful initial screening tests for asymptomatic patients with hepatitis B or C viral markers.