Maternal and fetal out comes of jaundice in pregnancyat the University College Hospital, Ibadan

Objective: This study is aimed at determining pregnancy outcome of cases of jaundice in pregnancy over a 10 year period at the University College Hospital, Ibadan. Methodology: All case records of patients with jaundice in pregnancy over a 10-year period from 1 January 1992 through 31 December 2001were retrieved fromthemedical records office of the hospital and analysed. Results: During the ten-year study period, therewere 16,566 registered pregnancies in the hospital, and 52 cases of jaundice in pregnancywere seen, giving an overall incidence of 0.3%or 1 in 318 deliveries.However, 48 case records were retrievable. Viral hepatitis was the commonest cause accounting for 58.3% of cases. It was followed by malaria and sickle-cell anaemia with 20.8% and 16.7% respectively. Other causes include sepsis 14.6%, cholestasis 6.3%, and Pre-eclampsia 2.1%. Pretermdelivery occurred in 39.6%, while intrauterine fetal death (IUFD) occurred in 8.3% of cases, all occurring in the third trimester. Acase of early neonatal death was recorded. There was no maternal death and the mean hospital stay was 18 days (range 4-45 days) during admission. Conclusion: Viral hepatitis, malaria and sickle-cell anaemia are the leading causes of jaundice in pregnancy. These should be promptly diagnosed, investigated and appropriate management instituted as most of the perinatal deaths can be avoided by close fetal monitoring especially in the third trimester and with recourse to early delivery before fetal demise occurs.Keywords: Jaundice in pregnancy, viral hepatitis,pre-term labour, HELLP syndrome, pregnancy outcome

Pitfalls in diagnosis of Hepatitis B Virus infection among adults Nigerians

Objective: Hepatitis B virus infection is common in Nigerians and its diagnosis is necessary for effective treatment and eradication. This study is aimed at highlighting the serological factors jeopardizing the diagnosis and treatment of the infection among Nigerians adults. Patients and Methods: Three studies were carried out. The first study involved 56 Nigerian adults and it compared the assay ofHBsAg byHaemagulationMethod (HMA)with Enzyme linked immunoassay (ELISA). The second study was a comparison of Glaxo Welcome HB rapid test(GWHB) with ELISA in sero-assay of HBsAg and HBeAg among 25 Nigerian subjects while the third study was on the assay of the sera of HBsAg positive patients forHBeAg and anti-HBe in forty twoNigerian patients byELISA. Results: The sero - prevalence rates of HBsAg were 41.8% and 61.8% by HM and ELISA respectively with false HBsAg sero-positives and sero-negatives by HM of 5.4% and 25.5% respectively. Similarly, there was sero-detection of HBsAg in 84% and 80% by ELISA and GWHB respectively in 25 Nigerian adults. In addition, 19% and 64% of the 42 patients with HBsAg sero-positivity were also positive for HBeAg and anti- HBe respectively,while 31%of the patientswere bothHBeAg and anti-HBe sero-negative. Conclusion: Sero-diagnosis of HBsAg and other serological markers of infectivity in patients with HBV should be carried out by ELISArather than HMAamong adult Nigerians. Furthermore, high infectivity of the virus abounds among Nigerians with HBV infection.  Keywords: Pitfalls, diagnosis, HBV, Adults Nigerians, ELISA.

Cutaneous Features Seen in Primary Liver Cell (Hepatocellular) Carcinoma Patients at a University Teaching Hospital in Nigeria

Primary liver cell carcinoma (PLCC), predominantly hepatocellular carcinoma is a killer. In the southwestern region of Nigeria it occupies the second position, behind prostate cancer in males. Females account for about a third of diagnosed cases. Children are not spared. Over 80 % of PLCC cases present to the hospital at an advanced stage in Nigeria and some die within weeks of admission to the wards. A prospective hospital based study was carried out to determine muco-cutaneoeus features associated with the entity as a possible aid to diagnosis cutaneous features being considered a cheap tool that can help diagnosis in a developing country-at an affordable cost. 80 of 84 patients seen during the study period had data that were adequate for analysis. The age range was 18-76 years with a mean of 56.2 years. The male female ratio was 17:3 indicating that males remain the more affected gender. No skin feature was found to be specific to PLCC. Jaundice (63.75 %), pallor 43.75 %), peripheral oedema (32.50 %), palmoplantar macular hyperpigmentation (47.5 %/25.0% - plantar /palmar) however were the common features documented in the study. Moderate to severe pityriasis versicolor was found in 18.75 % of cases. 61.25 % had core temperature less than 36\ub0C. Amongst non-cutaneous features found on examination, right sided upper abdominal pain/discomfort and swelling were common. While none of the features documented in this study are specific to PLCC (and most are likely related to underlying liver cirrhosis) it may be helpful to realize that Jaundice and marked palmoplantar macular pigmentation, the complaint of pain /mass, and the presence of a tender nodular mass in the right hypochondrium should make one to consider the localization of the disease to the liver. Pain/tenderness in the right hypochondrium suggest rapid growth of the liver from increased mitosis in the hepatocytes and a stretching of the liver capsule. Metastasis to the liver accounts for a very small percentage in Nigerians. A nodular liver is thus likely to be from a primary liver pathology

Transfusion Related Hepatitis C Virus (HCV) Infection in Sickle Cell Disease Patients

This study aimed to determine retrospectively, the prevalence of hepatitis C virus infection in relation to a background history of blood transfusion; through anti HCV antibody screening test, amongst adult sickle cell disease patients. Anti HCV antibody was tested for in the serum of 92 consecutively selected adult SCD patients using anti HCV detection test in serum rapid kit by Clinotech diagnostics which has a sensitivity of 99.4%. 13(14.1%) out of the 92 SCD patients were positive by anti HCV screening. All the 13 were HbSS patients and 12(92.3 %) had record of blood transfusion. 8 were males and 5 were females. The mean transfusion requirement amongst SCD patients was 2.1±2.2 units. Out of the total number of 92 SCD patients studied, 65 (70.7% %) had record of blood transfusion of various units of which 60 % of those transfused had at least up to 4 units of blood; while 27 (29.3% ) were never transfused. Conspicuously, HCV positive SCD patients had a background history of blood transfusion. Frequency of transfusion and HCV positivity is higher in HbS than HbSC. Since screening for anti-HCV antibody actually started in the year 1997, the cohorts of patients studied possibly had been transfused blood not screened for anti-HCV antibody.Anti- HCV positive SCD patients require thorough follow up to avert the complications attributable to HCV infection

Cutaneous Features Seen in Primary Liver Cell (Hepatocellular) Carcinoma Patients at a University Teaching Hospital in Nigeria

Primary liver cell carcinoma (PLCC), predominantly hepatocellular carcinoma is a killer. In the southwestern region of Nigeria it occupies the second position, behind prostate cancer in males. Females account for about a third of diagnosed cases. Children are not spared. Over 80 % of PLCC cases present to the hospital at an advanced stage in Nigeria and some die within weeks of admission to the wards. A prospective hospital based study was carried out to determine muco-cutaneoeus features associated with the entity as a possible aid to diagnosis cutaneous features being considered a cheap tool that can help diagnosis in a developing country-at an affordable cost. 80 of 84 patients seen during the study period had data that were adequate for analysis. The age range was 18-76 years with a mean of 56.2 years. The male female ratio was 17:3 indicating that males remain the more affected gender. No skin feature was found to be specific to PLCC. Jaundice (63.75 %), pallor 43.75 %), peripheral oedema (32.50 %), palmoplantar macular hyperpigmentation (47.5 %/25.0% - plantar /palmar) however were the common features documented in the study. Moderate to severe pityriasis versicolor was found in 18.75 % of cases. 61.25 % had core temperature less than 36°C. Amongst non-cutaneous features found on examination, right sided upper abdominal pain/discomfort and swelling were common. While none of the features documented in this study are specific to PLCC (and most are likely related to underlying liver cirrhosis) it may be helpful to realize that Jaundice and marked palmoplantar macular pigmentation, the complaint of pain /mass, and the presence of a tender nodular mass in the right hypochondrium should make one to consider the localization of the disease to the liver. Pain/tenderness in the right hypochondrium suggest rapid growth of the liver from increased mitosis in the hepatocytes and a stretching of the liver capsule. Metastasis to the liver accounts for a very small percentage in Nigerians. A nodular liver is thus likely to be from a primary liver pathology

Safety, Efficacy and Tolerability of Meprasilm in the Treatment of Dyspepsia among Nigerians.

A clinical trial was carried out to establish the tolerability, safety and efficacy of Meprasil brand of omeprazole among Nigerians with acid peptic disease using 20mg daily or 20mg bid of Meprasil. Forty patients were enrolled for the study and were asked to rate their abdominal pains pre-commencement of therapy using a scale of mild, moderate or severe. Serum alanine transaminase (ALT), urinalysis, electrolytes, creatinine and urea were carried out before and after treatment. Patients were then evaluated on days 0, 1, 3, 7, 14, and 28, thereafter monthly for 4 months for relief of symptoms and adverse drugs effect. Only 32 patients completed the study, 17 (Group I) and 15 (Group II).fe, efficacious and well tolerated in amelioration of pain of acid peptic disorder among Nigerian patients

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