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.

The Pattern of Cervical Cytology in Obstetrics and Gynaecology Clinics in Nnewi; South-Eastern Nigeria

Background: Cervical cytology screening has decreased the incidence of and mortality from invasive cervical cancer in developed and even some developing countries. The story is still different in Nigeria because there is no national screening programme in place.Objectives: The aim of this study was to evaluate the pattern of cervical cytology and relate it to some known risk factors such as age; parity; age at coitarche; number of sexual partners and clinical presentation.Subjects and Methods: A total of 100 women were seen at two Obstetrics and Gynaecology clinics in Nnewi over a three month period (May-July 2005) were screened. Conventional method of staining was used. The first fifty sexually active women that consented to completing the study questionnaire in the two clinics were included.Main Outcome Measures: The work noted the pattern of reports in relation to some known risk factors and adequacy of the sampling.Results: Sampling adequacy was 93; epithelial cell abnormality was reported in only one smear; 58 were reported as normal; 14 showed benign cellular changes (i.e. infective); and 18 reactive changes (i.e. atrophy). Conclusion: Now that infective aetiology has been established in cancer of the cervix; the co-factors may be some of these causes of benign cellular changes of the cervix

Are the symptoms of diabetic peripheral neuropathy in Nigerian patients objective? An evaluation using the United Kingdom Screening Test (UKST) and Bio-Thesiometry.

BACKGROUND: Symptoms suggestive of peripheral neuropathy (PN) in diabetes mellitus (DM) do not always indicate presence ofunderlying PN. OBJECTIVE: A pioneering study among Nigerian diabetic subjects to evaluate the objectivity of their symptoms of PN using two objective diagnostic instruments for PN the United Kingdom Screening Test (UKST) and Bio-Thesiometry. SUBJECTS AND METHODS: One hundred and twenty diabetic participants and a similar number of non-diabetic controls were screened for symptoms of PN using the UKST symptoms score and subsequently separated into two groups those with symptoms ofPN and those without. The "symptomatic" cases and controls were further evaluated with the UKST signs score and Bio-Thesiometry to assess the objectivity of the symptoms. RESULTS: Among 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic cases) while 10 (8.3%) of the 120 non-diabetic controls had neuropathic symptoms (the symptomatic controls). Among the cases, UKST signs score detected PN in 89.2% (74/83) and Bio-Thesiometry 71.1% (59/83), the difference in the ability of the two methods to detect PN in this group being statistically significant (X2 = 8.51, df = 1, p < 0.01). Among the controls, UKST detected PN in 100.0% (10/10) compared to Bio-thesiometry (50.0%; 5/10), the difference in the ability of the two methods to detect PN in this group also being statistically significant (X2 = 4.27, df = 1, p < 0.05, using continuity correction factor). The difference in the ability of both methods to detect PN between the cases and controls was however not statistically significant (X2 = 0.68, df = 1, p > 0.3) CONCLUSION: The symptoms of PN among Nigerian diabetic subjects when evaluated with a gold standard for scoring the symptoms (the UKST symptoms score) are real, objective and truly indicate presence of underlying PN. Diabetic subjects presenting to medical clinics with symptoms of PN should receive serious attention and evaluation using this gold standard to detect early those with genuine PN and are at risk of foot ulceration from PN.

Colonic cancer in adolescents. A report of three cases.

Colorectal cancer is a common malignant neoplasm in adults, with a peak incidence of 60-79 years. About 1 million cases of the disease and half a million deaths associated with it are reported world-wide each year. Colorectal cancer, however, is very uncommon in children and adolescents. This is a presentation of 3 cases of colon cancer in Nigerians aged 17 and 19 years. Two of them were adenocarcinoma and the other leiomyosarcoma. The pathogenesis and aspects of management are discussed.

Is asymptomatic peripheral neuropathy present in Nigerian diabetic patients? An assessment using the United Kingdom screening test (UKST) and bio-thesiometry.

Diabetes mellitus (DM) is commonly complicated by peripheral neuropathy (PN). Symptoms suggestive of peripheral neuropathy (PN) in diabetes mellitus (DM) do not always indicate presence of underlying PN, while absence of symptoms does not rule out presence of underlying PN. To determine the prevalence of asymptomatic PN in diabetic patients using two methods--the United Kingdom Screening Test (UKST) and Bio-Thesiometry. 120 diabetic participants and a similar number of non-diabetic controls were screened for symptoms of PN using the UKST symptoms score and subsequently separated into two groups--those with symptoms of PN and those without. The "asymptomatic" cases and controls were further screened for underlying PN using the UKST signs score and Bio-Thesiometry Among 120 diabetic participants, 37 (30.8%) had no symptoms of PN (the asymptomatic cases) compared to 110 (91.7%) of the 120 non-diabetic controls (the asymptomatic controls). The UKST signs score detected PN more significantly among the cases than the controls (43.2% (16/37) vs 9.1% (10/110); /2 = 22.5, df = I, p < 0.01). Similarly, Bio-thesiometry detected PN more significantly among the cases than the controls (29.7% (11/37) vs 9.1% (10/110); X2 = 9.57, df = 1, p < 0.01) Asymptomatic PN is present among Nigerian diabetic subjects and the absence of "alarm" symptoms of PN does not exclude the presence of genuine PN.

Seroconversion of children following natural measles infection and vaccination.

OBJECTIVE: To evaluate the relationship between measles virus (MV) antibodies (abs) in sera and breast milk of nursing mothers, their contributions in seroconversion of children (0-9 months) post vaccination, prevalence of prevaccination measles abs in sera of children brought for measles vaccination and seroconversion rate in vaccinees from nursing and lactating mothers. Also to determine the potency of vaccines available in Nigeria in relation to seroconversion. METHODS: One hundred and twenty pre- and post-vaccination sera and breast milk samples were collected from each nursing mother while corresponding number of finger prick pre- and post-vaccination sera samples were collected from children on filter papers. These were tested for mv abs using serological techniques. RESULTS: Eighty (20.0%) mothers had measles haemagglutination inhibition (HI) abs in sera and 88 (27.2%) had mv HI abs in breast milk. Eight (2.0%) children who had prevaccination mv abs in sera came from mv ab negative mothers. Forty-four (37.0%) came back for post vaccination sera, sero-converted while 76 (63.3%) gave low sero-conversion rate of 37.0%. Results showed that mv abs in sera or breast milk of mothers did not interfere with mv vaccination in children. The low sero-conversion rate obtained was due to low vaccine potency with titres ranging between (log10-10 - log10-2.5)TCID/per dose, besides non-specific antiviral substances exhibited virus neutralizing activity. CONCLUSION: Poor sero-conversion due to loss of passive immunity arose from undernourishment while low ab titres came with natural infection. This suggested mv vaccination did not immunize following natural mv infection or any other previous immune status.

Axillary fibroadenoma mimicking lymphadenopathy.

Ectopic breast tissues are subject to the similar physiological and pathological alterations seen in breast tissues situated in their normal anatomical positions. We report a 34-year old multiparous woman who presented with a right axillary lump of about 1 year duration, for which clinical impression of axillary lymphadenopathy was made and lumpectomy carried out. Histology of excised lump revealed fibroadenoma. We discussed possible pathogeneses and consequences of this lesion.

Prevalence of dyslipidaemia in apparently healthy professionals in Asaba, South South Nigeria.

BACKGROUND: Hypercholesterolaemia is a major risk factor for coronary heart disease (CHD) especially in industrialized societies. Coronary heart disease is becoming an increasing cause of death even in the developing world. OBJECTIVE: To determine the prevalence of dyslipidaemia in apparently healthy professionals in a developing economy. METHOD: One hundred apparently healthy professionals were recruited from several professions by stratified random sampling. This population was believed to be at higher risk of dyslipidaemia considering their more likely "western diet" lifestyle. Total cholesterol, LDL-cholesterol, HDL-cholesterol and Triglycerides were determined using standard cholesterol LDL precipitating reagents/kits. RESULTS: The mean age of the subjects was 41.59 +/- 8.22 years (range 29 to 58 years) with male to female ratio of 1:1.2. Mean total cholesterol was 180.69 +/- 36.248 mg/dl (4.67 +/- 0.94 mmol/L), LDL cholesterol 122.68 +/- 44.42 mg/dl (3.17 +/- 1.15 mmol/L), HDL-cholesterol 37.47 +/- 9.91 mg/dl (0.96 +/- 0.26 mmol/L) and Triglyceride 83.139 +/- 66.888 mg/dl (0.94 +/- 0.76 mmol/L). Using the Third Report of the NCEP Expert Panel on Detection. Evaluation and Treatment of high blood cholesterol in Adults (ATP III) definition and risk classification, 5% of the study population had hypercholesterolaemia, 23% elevated total serum cholesterol, 51% elevated LDL-cholesterol and 60% low HDL-cholesterol, with females recording better overall lipid profile. CONCLUSION: Dyslipidaemia was highly prevalent in the population studied, with low HDL-cholesterol being the most frequent lipid abnormality. Dyslipidaemia is becoming a serious health problem in the developing world also, even among the apparently healthy, and necessitates periodic lipid profile screening.

Urinary tract pathology in Schistosoma haematobium infected rural Nigerians.

Parasitological investigation assessing the ova of Schistosoma haematobium in the urine of 138 volunteers in Ihieve-Ogben, Edo State, Nigeria revealed 43 positive results (31.2%). Children had a higher prevalence of urinary schistosomiasis 30 (41.1%) than their adult counterparts 13 (20.0%) and this difference was statistically significant (t = 8.89, p > 0.01). More volunteers had light intensity of infection 27 (19.6%) than heavy infection 16 (11.6%) and this difference was statistically significant (chi2 = 22.90, p>0.05). Ultrasonographic investigations carried out on these 43 S. haematobium infected volunteers revealed ten pathological conditions, including abnormal wall thickness 24 (55.8%), abnormal shape 30 (69.8%), irregular bladder wall 12 (27.9%), masses 10 (23.3%), pseudopolyps 2 (4.7%), echogenic particles 30 (69.8%), residual volume 12 (27.9%), calcifications 24 (55.8%), hydroureter 10 (23.3%) and hydronephrosis 8 (18.6%) when compared to control subjects which lacked bladder and kidney abnormalities. These pathological conditions were slightly more common in the volunteers with heavy infection than those with light infection, but this difference was not statistically significant (t = -2.19, p < 0.02). More pathological conditions were found in children than in adults; this finding was statistically significant (t = 3.23, p > 0.03). Hydronephrosis and hydroureter were not found in the volunteers with light intensity of infection.

Resistance Pattern of Urinary Tract Infection Bacterial Isolates to Selected Quinolones

The Quinolones inhibit bacteria by interacting with DNA topoisomerases (gyrases) of which four subunits (two A and B monomers) have been identified thus; inhibiting bacterial DNA gyrase. High level resistance to quinolones can be produced by serial exposure of bacteria to subinhibitory concentration. A Total of 408 suspected UTI and high vagina swab (HVS) samples were examined for bacteria and the isolates obtained tested against the newer quinolones. Prevalence of Bacterial isolates revealed Escherichia coli 10(92) as the most isolated organism from urine; while Staphylococcus aureus 31(32) was the most isolated species from HVS samples. Bacterial species such as coliforms 55(70) and Klebsiella spp 42(84); equally had high prevalence rate in urine samples. Pseudomonas aeroginosa 19(66) was next to Staphylococcus aureus in terms of prevalence of isolated strains from HVS samples. The resistance pattern observed for these isolates; showed that the strains were least resistant to Ciprofloxacin; followed by Ofloxacin and Perfloxacin; while they were most resistant to Nalidixic acid. There was however no statistical significance P0.001) between the use of Ofloxacin and Perfloxacin; however; ANOVA showed a significant difference (P0.05) between the pattern of Klebsiella spp resistance against Perfloxacin when compared to Proteus vulgaris

The reproductive dysfunction effects of gasoline inhalation in albino rats.

Daily exposure to fuel vapour may pose significant health risk to exposed individuals. Fifteen each of male and female albino rats weighing between 110-230g were divided into test (10) and control (5) groups each. The test animals; were exposed to inhalation gasoline for one hour daily for twenty-one consecutive days. All animals were then bled and the serum levels of the reproductive hormones determined. The results showed significant [P < 0.05] reduction in the serum levels of all the hormones of reproduction in both the male and female test animals. The results suggest that inhalation gasoline exposure significantly [P < 0.05] lowers the levels of reproductive hormones in albino rats and may thus interfere with reproduction.