Cutaneous manifestations of liver cirrhosis in an African (negroid) population

Sixty negroid patients with liver cirrhosis were examined for their cutaneous features at the University College Hospital, Ibadan, Nigeria. When compared with age and sex matched controls, the cirrhotic patients had significantly lower body temperature, onycholysis and hyperpigmented palmo-plantar macular areas (p < 0.05). Until now, these features have not been previously associated with liver cirrhosis. Other cutaneous signs such as sparse silky hair, female public hair pattern, digital clubbing, leuconychia, ankle oedema and corneal jaundice are found more commonly in cirrhotic patients (p < 0.05) and have been previously documented. All these features in a middle-aged man with hepatomegaly may be of added distinctive value particularly in many rural centres in tropical countries where facilities for definitive histological diagnosis are frequently lacking. The relevance of some of these cutaneous features in the light of the pattern described in Caucasians is also discussed

Ascitic lipids and albumin gradient in the differentiation between cirrhotic and malignant ascites in Nigerian Africans

The purpose of this study was to investigate the efficacy of ascitic fluid lipid analysis, and to compare it with albumin gradient and AF total protein in discriminating between cirrhotic ascites and ascites caused by malignancies in Nigerian patients. 40 consecutive ascitic patients, (22 with cirrhotic ascites and 18 with neoplasms metastatic to the peritoneum) were studies prospectively. The roup with liver cirrhosis (LC) consisted of non-alcoholics; 60 percent were hepatitis B surface antigen positive. The patients with malignant ascites comprised four with ovarian carcinoma; three each of lymphoma, gastric and breast carcinoma; two bronchogenic carcinoma; and one each of prostatic, testicular and colon carcinoma. The results show that AF cholesterol provides excellent discrimination between the two types of ascites. Of five diagnostic parameters tested, AF cholesterol gave the best combination of results for the predictive value of a positive test and the predictive value of a negative test. Determination of AF cholesterol and albumin gradient are useful in differentiation ascites caused by malignancies from ascites due to LC. However, AF cholesterol measurement may have considerable advantages in cost effectiveness

Ascites in Ibadan, Nigeria – usefulness of albumin gradient in its etiologic diagnosis

In a 2-year prospective study, ninety adult patients with ascites at the University College Hospital Ibadan were evaluated clinically in addition to a diagnostic work‑up protocol. Of these, 40 (44%) had liver cirrhosis, 21 (23%) had tuberculous peritonitis, 20 (22%) had malignant ascites, 5 (6%) had heart diseases and\ud 4 (5%) had nephrotic syndrome.\ud \ud Albumin gradient was compared with the usual parameters of ascitic fluid analysis in the differential diagnosis of ascites. We showed that the ascitic fluid total protein concentration, the ascitic fluid/serum total protein, the ascitic fluid lactic dehydrogenase, and the ascitic fluid/serum lactic dehydrogenase were lower in the patients with liver cirrhosis than in the patients with tuberculous peritonitis (p<0.0001) or malignant ascites (p<0.0001). In contrast, the albumin gradient (serum albumin minus ascitic fluid albumin) in the patients with liver cirrhosis was significantly higher than in the patients with tuberculous peritonitis (p<0.0001) or malignant ascites (p<0.0001). There was no difference in these biochemical parameters between the patients with tuberculous peritonitis and malignant ascites. Overall, the efficiency of the biochemical parameters in correctly diagnosing patients with ascites caused by liver cirrhosis and those due to tuberculous peritonitis or malignancies was highest for albumin gradient <1.1 g/dL (96%), followed by ascitic fluid lactic dehydrogenase level >180 IU/L (77%), ascitic fluid total protein >3.0 g/dL (73%), ascitic fluid to serum lactic dehydrogenase ratio >0.6 (70%) and ascitic fluid to serum total protein ratio >0.5 (63%)

Dexamethasone suppression tests in liver cirrhosis - abnormalities in patients with primary hepatocellular carcinoma.

[Extract] Primary hepatocellular carcinoma (PHC), an important cause of morbidity and mortality in many African and Asian countries [1-4], has protean manifestations. Aside from its classical clinical and biochemical presentation, PHC is associated with a variety of paraneoplastic phenomena, including increased erythropoietin production, hypoglycaemia, hypercholesterolaemia and hypercalcaemia [5,6]. The terminal patient with PHC in Nigeria may have a variety of fluid and electrolyte abnormalities, particularly resistant ascites and hypokalaemia

High prevalence of hepatitis B virus among female sex workers in Nigeria Alta prevalência de hepatite pelo vírus B entre trabalhadoras do sexo feminino na Nigéria

Hepatitis B virus (HBV) infection is endemic in Nigeria and constitutes a public health menace. The prevalence of HBV infection in many professional groups has been described in Nigeria. However, literature on HBV infection among female sex workers (FSW) in Nigeria is scanty. FSW in Nigeria are not subjected to a preventive control of HBV infection. This study assesses the extent of spread of HBV among FSW in Nigeria. Seven hundred and twenty (n = 720) FSW (mean age = 26.7 years) were tested for hepatitis B surface antigen (HBsAg) by a double antibody sandwich ELISA method. The overall HBV prevalence among the FSW was 17.1%. FSWs between the ages of 31-35 year (20.5%) and those with 'age-at-first-sex' below 10 years of age (28%) were most affected. This high prevalence of a vaccine preventable disease is unacceptable, therefore, vaccination of this high risk HBV reservoir group should be considered worthwhile.<br>A hepatite pelo vírus B (HBV) é infecção endêmica na Nigéria e constitui problema de saúde pública. A prevalência da infecção HBV em muitos grupos profissionais foi descrito na Nigéria. No entanto, a literatura da infecção HBV entre trabalhadoras do sexo feminino (FSW) na Nigéria é escasso. FSW na Nigéria não são submetidas a um controle preventivo de infecção de HBV. Este estudo avalia a extensão da disseminação de HBV entre FSW na Nigéria. Setecentos e vinte (n = 720) FSW (média de idade = 26,7 anos) foram testadas para antígeno de superfície da hepatite B (HBsAg) pelo método ELISA usando sandwich de duplos anticorpos. A prevalência total de HBV entre o FSW foi 17,1%. FSWs entre as idades de 31-35 anos (20,5%) e abaixo de 10 anos de idade (28%) foram mais afetadas. Esta alta prevalência de doença evitável pela vacinação é inaceitável, portanto, vacinação deste grupo de alto risco de HBV deve ser considerada fundamental