Primary liver cancer: Epidemiological and Biomarker Discovery Studies

With previous reports indicating changes in mortality, risk factors and management of primary liver cancer (PLC), evaluation of current trends in the incidence and mortality rates was indicated. Late diagnosis has been implicated to be a major contributor to the high fatality rates of PLC. This work aimed at: • studying trends of PLC by subcategories globally in general, and in England and Wales, in particular; • investigating liver-related morbidities of HIV infected patients in an African setting; and • discovering urinary biomarkers of hepatocellular carcinoma. The World Health Organisation (WHO) and Small Area Health Statistics Unit (SAHSU) databases were interrogated respectively, in order to achieve the first aim. The second aim was achieved through utilisation of databases of an African-based HIV treatment programme- AIDS Prevention Initiative in Nigeria (APIN), located in Jos, Nigeria. The European Union-funded Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) case-control study in three West African countries was the platform through which urinary metabolic profiling was accomplished. Proton nuclear magnetic resonance spectroscopy (NMR) and parallel ultra-performance liquid chromatography mass spectrometry (UPLC-MS) were used for biomarker discovery studies. Mortality rates of intrahepatic bile duct carcinoma (IHBD) increased in all countries that were studied. Misclassification of hilar cholangiocarcinoma accounted for only a small increase in the rate of IHBD in England and Wales. With over 90% screening rate for viral hepatitides, the rates of hepatitis B (HBV), hepatitis C (HCV) and HBV/HCV in HIV-infected patients in the APIN programme were 17.8%, 11.3% and 2.5% respectively. There was attenuated immune response as well as significantly lower survival observed in HBV/HIV co-infection, relative to HIV mono-infected patients (p=0.0097). Whereas single urinary metabolites, including acetylcarnitine, N-acetylglutamate, betaine aldehyde, 3’-sialyllactose, methionine among others possessed high discriminatory power to diagnose HCC, a combination of three metabolites: 3’-sialyllactose, methionine and 9-decenoylcarnitine significantly outperformed serum alpha-fetoprotein (AFP) in the diagnosis of HCC in a cirrhosis population (area under the receiver operating characteristic curve; [urinary panel= 0.96] compared to [AFP = 0.64]). This work informs a critical assessment of current control strategies in the prevention of HCC, and potentially assists in the development of more affordable means of early detection of PLC for most affected regions of the world.Open Acces

Physician use of updated anti-virus software in a tertiary Nigerian hospital

While physicians are becoming increasingly dependent on computers and the internet, highly lethal malware continue to be loaded into cyberspace. We sought to assess the proportion of physicians with updated anti-virus software in Jos University Teaching Hospital Nigeria and to determine perceived barriers to getting updates. We used a pre-tested semi-structured selfadministered questionnaire to conduct a cross-sectional survey among 118 physicians. The mean age (±SD) of subjects was 34(±4) years, with 94 male and 24 female physicians. Forty-two (36.5%) of 115 physicians with anti-virus software used an updated program (95%CI: 27, 45). The top-three antivirus software were: McAfee 40(33.9%), AVG 37(31.4%) and Norton 17(14.4%). Common infections were: Trojan horse 22 (29.7%), Brontok worm 8(10.8%), and Ravmonlog.exe 5(6.8%). Internet browsing with a firewall was an independent determinant for use of updated anti-virus software [OR 4.3, 95%CI, 1.86, 10.02; P< 0.001]. Busy schedule, 40(33.9%) and lack of credit card 39(33.1%) were perceived barriers to updating antivirus software. The use of regularly updated anti-virus software is sub-optimal among physicians implying vulnerability to computer viruses. Physicians should be careful with flash drives and should avoid being victims of the raging arms race between malware producers and anti-virus software developers.Keywords: Anti-virus software; Computer security; Updates; Physicians; Nigeri

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

Metabolic phenotyping for understanding the gut microbiome and host metabolic interplay

There is growing interest in the role of the gut microbiome in human health and disease. This unique complex ecosystem has been implicated in a number of health conditions including intestinal disorders, inflammatory skin diseases and metabolic syndrome. However, there is still much to learn regarding its capacity to affect host health. Many gut microbiome research studies focus on compositional analysis to better understand the causal relationships between microbial communities and disease phenotypes. Yet microbial diversity and complexity is such, that community structure alone does not provide full understanding of microbial function. Metabolic phenotyping is an exciting field in systems biology that provides information on metabolic outputs taking place in the system at a given moment in time. These readouts provide information relating to by-products of endogenous metabolic pathways, exogenous signals arising from diet, drugs and other lifestyle and environmental stimuli, as well as products of microbe-host co-metabolism. Thus, better understanding of the gut microbiome and host metabolic interplay can be gleaned by using such analytical approaches. In this Review, we describe research findings focussed on gut microbiota-host interactions, for functional insight into the impact of microbiome composition on host health. We evaluate different analytical approaches for capturing metabolic activity, and discuss analytical methodological advancements that have made a contribution to the field. This information will aid in developing novel approaches to improve host health in the future, and therapeutic modulation of the microbiome may soon augment conventional clinical strategies

Hepatitis B in Sub-Saharan Africa

No Abstrac

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

Toward elimination of hepatitis A and B in Europe: vaccination successes, challenges, and opportunities

Hepatitis A; Hepatitis B; Vaccination recommendationsHepatitis A; Hepatitis B; Recomendaciones de vacunaciónHepatitis A; Hepatitis B; Recomanacions de vacunacióIntroduction: Hepatitis B and hepatitis A are vaccine-preventable infections of global concern. Hepatitis B virus (HBV) and hepatitis A virus (HAV) vaccines available in Europe are underutilized in some age groups. While most European countries implemented childhood HBV universal routine vaccination (URV), vaccination coverage among adults remains low. Low HAV vaccination coverage among high-risk populations due to variable national vaccination policies, low awareness of vaccination benefits, and other barriers, increases the risk for outbreaks. Areas covered: We discuss the awareness of hepatitis B and hepatitis A burden in different populations in Europe, vaccination recommendations, successes, challenges, and opportunities for their implementation. Expert opinion: Awareness of at-risk populations and HBV/HAV vaccination recommendations should be raised among healthcare providers and the general population to increase access to vaccination. Increasing awareness that HBV vaccination contributes to reduction in the incidence of hepatocellular carcinoma can motivate adults to get vaccinated. Adult HBV URV may be considered in Europe, as in the United States, pending cost-effectiveness assessment at national levels. HAV vaccination recommendations should be updated and expanded to all at-risk persons. National HBV/HAV targets and vaccination strategies should be actively promoted to accelerate the elimination of viral hepatitis in Europe.This manuscript was funded by GSK

Frequency of Cryptococcal Meningitis in HIV-1 Infected Patients in North Central Nigeria

Background: Cryptococcal meningitis (CM) is the most common severe life threatening fungal infection in AIDS patients. It is an important cause of morbidity and mortality. There is paucity of data on the prevalence of CM in Nigeria. We aimed to determine the frequency of CM, the clinical presentation and immunological profile.Methods: A cross sectional study was carried out at the Jos University Teaching Hospital (JUTH), A total of 100 HIV-1 infected patients suspected of having meningitis or meningoencephalitis were subjected to cerebrospinal fluid (CSF) analysis (including Indian ink preparation and fungal culture by conventional methods) and CD4 count was determined using flow cytometry (count bit Y-R 1004 Partec Muster Germany).Results: The freguency of CM was 36% in our cohort. The commonest clinical presentation included headache (100.0%), neck stiffness (77.8%), fever (72.0%), vomiting (55.6%), personality changes (55.6%), photophobia (27.8%) and convulsions (27.8%). The mean duration of symptoms was 24 &plusmn;22 days with a median of 17 days. The mean CD4 count was 89&plusmn;60 cells/mm3 with a median of 82 cells/mm3.Conclusion: The high prevalence of CM and the associated severe immunosuppression underscores the importance of early diagnosis of HIV infection which may reduce the incidence of CM. There is the urgent need for access to Amphotericin B and fluconazole in resource constrained settings in addition to a wide access to HAART.Key words: Cryptococcal meningitis, HIV, North central Nigeri

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.Contexte: Irritable Syndrome (IBS) a \ue9t\ue9 signal\ue9 \ue0 \ueatre commune \ue0 l\u2019Ouest. Enqu\ueates communautaires font d\ue9faut dans le contexte africain. Nous avons d\ue9termin\ue9 la pr\ue9valence de IBS dans un milieu rural. communaut\ue9 d\ue9fi nition dans le Nig\ue9ria. M\ue9thode: Questionnaires ont \ue9t\ue9 administr\ue9 aux personnes consentantes. Sujets de satisfaction de la Rome II crit\ue8res d\u2019IBS ont \ue9t\ue9 invit\ue9s pour l\u2019examen physique dans un centre de sant\ue9 \ue0 identifi er la pr\ue9sence de \u201c alarme les facteurs \u201d. R\ue9sultats: Un cent et quarante (31,6 %) des individus \ue9valu\ue9es 443 rempli le Rome Crit\ue8res II IBS avec un m\ue2le \ue0 ratio f\ue9minin de 1.37:1 (p = 0,11) .la pr\ue9valence IBS \ue9tait plus \ue9lev\ue9 dans la troisi\ue8me d\ue9cennie (39.3 %), suivie de 25 % dans le quatri\ue8me dix ans (p = 0.009). Quatre-vingt-seize (67 %) IBS personnes avaient le mod\ue8le d\u2019alternance de la diarrh\ue9e et constipation, alors que 28 (20 %) et 19 (13 %) avaient constipation et la diarrh\ue9e subtypes respectivement. Conclusion: IBS comme un diagnostic par les crit\ue8res de Rome II a une haute pr\ue9valence dans la population rurale africaine comme obtenu ailleurs

Prevention of Liver Fibrosis and Cancer in Africa: The PROLIFICA project – a collaborative study of hepatitis B-related liver disease in West Africa

Hepatitis B virus (HBV) infection causes a spectrum of acute and chronic liver disease ranging from inactive chronic carrier status to progressive chronic hepatitis, culminating in end-stage cirrhosis and liver cancer. In sub-Saharan Africa, HBV infection is endemic and the HBV-related disease burden is high, making HBV a signficant threat to health in the African continent. The European Union-funded Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) project was established in 2011, with the central directive to reduce the incidence of HBV-related liver cancer in West Africa. In this editorial, we outline some of the achievements and challenges of the PROLIFICA platform in West Africa, highlighting the the importance of collaborative studies in Africa