Hepatitis B Vaccination Status and Needle stick Injuries among Medical Students in a Nigerian University

Background: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). Method: Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. Results: Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. Conclusion: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students. Nigerian Journal of Medicine Vol. 17 (3) 2008: pp. 330-33

Relation Between Helicobacter Pylori, Inflammatory (neutrophil) Activity, Chronic Gastritis, Gastric Atrophy And Intestinal Metaplasia

Background: To determine the relation of Helicobacter pylori infection with chronic inflammation, atrophy, activity level and intestinal metaplasia. Patients and Methods: A cross-sectional study of 100 consecutive patients with dyspepsia. These patients were fasted for 12 hours and gastroscopic biopsy specimens were obtained from their gastric mucosae. The specimens were histologically evaluated for H. pylori, inflammatory activity, chronic inflammation, gastric atrophy and intestinal metaplasia. Results: There were 50(50%) females and 50(50%) males. The average ages of women and men were 36.3±11.5 and 42.9±12.8 respectively. Helicobacter pylori was found in 79%. Neutrophil activity was observed in 83%. Inflammation was found in 95%, glandular atrophy in 38%, intestinal metaplasia in 28% of the cases. Incidental (early gastric) cancer was found in 3%, dysplasia in 2% and reactive gastropathy in 7% of the cases. A statistically significant relationship was found between Helicobacter pylori colonization intensity and the degrees of neutrophil activity, chronic inflammation and intestinal metaplasia. Conclusion: We concluded that Helicobacter pylori infection results in neutrophil activation and chronic gastritis, and that it has a role in the development of intestinal metaplasia. The greater the intensity of Helicobacter pylori infection, the greater the degrees of neutrophil activation, chronic gastritis and intestinal metaplasia. Keywords: Helicobacter pylori, Gastritis, atrophy, Intestinal metaplasia, Gastric cancer, Jos Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 270-27

Management of non-ulcer dyspepsia

No Abstract. Journal of Medicine in the Tropics Vol. 7(2) 2005: 1-

Prevalence of helicobacter pylori infection in patients with gasto-duodenal diseases in Jos, Nigeria.

Helicobacter pylori (H. pylori) infection has become topical over the last three decades particularly with regards to its association with gastro duodenal disease. High prevalence rates of this ubiquitous bacterium have been reported in both symptomatic and asymptomatic subjects especially in low socioeconomics communities. Objective: the objectives of this study was to determine the prevalence of H. pylori infection in patients with gastroduodenal disease in Jos Nigeria. Method: a cross sectional study of consecutives patients referred for upper gastrointestinal endoscopy was carried out at the Jos University Teaching Hospital (JUTH) at endoscopy two pairs each of antral and corpus gastric biopsies were taken from each patient and evaluated for the presence H.pylori infection using the rapid urease test . result: the prevalence of h pylori from this study was found to be 90.1% in those with organic disease at endoscopy (organic dyspepsia) and 84% in those with no pathology detected at endoscopy (non-ulcer dyspepsia). There was no statistically significant difference in the prevalence rates of H. pylori in the two groups. (p value 0.0076) the prevalence of the bacterium in patients with organic disease at endoscopy showed the highest prevalence in those with duodenal ulcer 16/17 (94.1%) followed by duodenits 6/7 (85.7%) gastritis 8/9 (88.9%) and gastric ulcer ½ (50%) respectively. Four out of five (80%) of those with reflux oesophagitis and ½ (50%) of those with candida oesophagitis also tested positive to h. pylori. One patients each who had barretts esophagus and hiatus hermia were negative for h. pylori. Conclusion: helicobacter pylori infection in common among patients refereed for upper gastrointestinal endoscopy irrespective of the underlying pathology. this may be a reflection of the generally high prevalence rates of this ubiquitous bacterium in the community. Therefore, the presence of H. pylori infection should be interpreted with caution by clinicians before treatment. Evidence base protocol need to be developed by experts to guide clinicians in optimally caring for dyspeptic based protocols need to be developed by experts to guide clinicians in optimally caring for dyspeptic patients in our communit

Prevalence of irritable bowel syndrome: A community survey in an African population

Background : Irritable bowel syndrome (IBS) has been reported to be common in the West. Community surveys are lacking in the African setting. We determined the prevalence of IBS in a rural community setting in Nigeria. Method : Questionnaires were administered to consenting individuals. Subjects satisfying the Rome II criteria for IBS were invited for physical examination at a health center to identify the presence of "alarm factors." Results : One hundred forty (31.6%) of the 443 evaluated individuals fulfilled the Rome II criteria for IBS, with a male-to-female ratio of 1.37:1 (P= .11). The prevalence of IBS was highest (39.3%) in the third decade, followed by 25% in the fourth decade (P= .009). Ninety-six (67%) IBS individuals had the alternating pattern of diarrhea and constipation, whereas 28 (20%) and 19 (13%) had constipation and diarrhea subtypes, respectively. Conclusion : IBS as diagnosed by the Rome II criteria has a high prevalence in the African rural population, as obtained elsewhere

Anti helicobacter pylori activity of aqueous extracts of vitex doniana

No Abstract

Helicobacer pylori detection using local (in-house) rapid Urease reagent in Jos, Nigeria.

Background: Since the discovery of Helicobacter pylori (H. pylori) by Robin Warren and Barry Marshall in 1982 and its subsequent association with diseases like antral (type B) gastritis, peptic ulcer disease (PUD), gastric cancer and gastric Mucosal Associated Lymphoid Tissue (MALT) lymphoma, various invasive as well as non-invasive methods of detecting the bacterium have been developed. The choice of a particular method usually depends on availability, cost, reliability and convenience of diagnostic facility. Non-availability and high cost of commercially prepared rapid urease test kits have led to the development of locally prepared reagents to serve same purpose. This study compared a locally prepared (“in-house”) rapid urease test solution with standard culture in detecting the presence of H. pylori in gastric biopsies to determine the validity of the former. Materials and Methods: This was a prospective cross sectional study carried out over a 6 months period (April-September 2001) to determine the validity of a locality prepared rapid urease reagent in detecting H. pylori infection among dyspeptic patients at the Jos University Teaching Hospital (JUTH), Jos. Two pairs of antral gastric biopsies were obtained from patients at endoscopy and a pair each was used for rapid urease test using a locally prepared urease reagent and cultures on a horse blood agar. The results of the two methods (cultures being the standard) were analyzed using SPSS (version 11.0) statistical programme and tests of validity carried out. Results: A total of 39 patients made up of 24(61.5%) males and 15(38.5%) females in which rapid urease test were done and culture carried out were studied. The ages of the patients studied ranged from 15 to 70years with mean age of 38.4+12.08 years. 34 (87.2%) and 36 (92.3%) of the patients tested positive to H. pylori using the local rapid urease test and culture respectively. Five (1.3%) and 3 (0.8%) of the patients were negative by rapid urease and cultures respectively. The results of the local rapid urease test were then compared with that of culture. A sensitivity and specificity of 91.7% and 66.7% respectively were obtained for the local rapid urease test. The positive and negative predictive values were 94.1% and 40% respectively. Conclusion: With a sensitivity of 91.7%, the locally prepared rapid urease test is comparable to cultures in detecting H. pylori in gastric biopsy specimens. With this finding and with commercially prepared rapid urease kits either not available or expensive, and cultures cumbersome, the use of locally prepared rapid urease test reagents is appropriate, practicable and sustainable in low resource settings like ours. Sahel Medical Journal Vol. 11 (3) 2008: pp. 93-9

Prevalence of Oesophageal Varices in Newly Diagnosed Chronic Liver Disease Patients at The Jos University Teaching Hospital, Jos

Background: Variceal bleeding is an important complication of portal hypertension and a major cause of death in patients with chronic liver disease (CLD) world wide. This study was carried out to document the occurrence of oesophageal varices and its clinical correlates among 80 Nigerian patients with CLD. Patients and Methods: Eighty patients with CLD were stratified into three groups based on Child- Turcotte- pugh's classification for severity of CLD in a one year study. They had upper gastrointestinal endoscopy to detect and characterize varices. Results: Sixty (75%) of the patients had oesophageal varices at endoscopy with 88.3% having grade 2 or 3 varices while 73.3% had moderate/large varices. Thirty five percent of the varices had “red signs” with “red whale” markings as the predominant red sign. Gastric varices were seen in 12.5%. Variceal size was significantly associated with severity of liver disease (P<0.05) as 90% of the patients with varices presented with Child's class B or C. A multiple logistic regression analysis identified advancing age, ascites, shrunken liver span and low platelet count as independent predictors of oesophageal varices. Conclusion: A large proportion of Nigerian CLD patients have advanced at-risk-for-bleeding oesophageal varices at diagnosis. Early diagnosis of CLD in Nigerians is warranted.Key words: Prevalence, Oesophageal varices, Chronic liver disease, Cirrhosi