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   Table of Contents - Current issue
Coverpage
January-June 2022
Volume 14 | Issue 1
Page Nos. 1-46

Online since Thursday, July 21, 2022

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EDITORIAL  

From the editor’s desk p. 1
Fatimah Abdulkareem
DOI:10.4103/njgh.njgh_13_22  
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REVIEW ARTICLES Top

Prevalence, diagnosis and treatment of Helicobacter pylori infection in Nigeria Highly accessed article p. 2
Stella I Smith, Abraham Ajayi, Tolulope F Jolaiya, Utibeima Essiet
DOI:10.4103/njgh.njgh_10_22  
Helicobacter pylori infection remains a major health concern around the world as untreated infection can lead to gastric cancer. The burden of H. pylori infection in Nigeria is high (87.7%) with the northern part of the country having a higher prevalence compared to other regions of the country. Methods comprising invasive and non-invasive approach are widely used around the country for the diagnosis of H. pylori infection. However, data on use of culture which gives the advantage of antimicrobial susceptibility testing is limited. Treatment and management of H. pylori in Nigeria is becoming difficult as the rate of resistance to antibiotics is on the rise. This review highlights key findings on the incidence, diagnosis and treatment of H. pylori infection in Nigeria.
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Colonoscopy practice and polyp detection in Nigeria: A systematic review p. 11
Emeka Ray-Offor, Rex Friday Ogoronte A Ijah, Stella-Maris C Egboh
DOI:10.4103/njgh.njgh_8_22  
Evaluation of colorectal pathologies by colonoscopy is increasingly reported from different centers across Nigeria. However, a comprehensive review of current colonoscopy practice across the country is yet to be documented. To report on colonoscopy practice, the detection rate, site(s), and geographic distribution of colorectal polyps in Nigeria, a systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search databases comprised MEDLINE, African Journal Online, and Google Scholar. The eligibility criteria included publications on flexible lower gastrointestinal endoscopies (LGIEs) performed on Nigerian population over a 20-year period from January 2002 to 2022. Relevant data on study characteristics, demographics of study patients, indication(s), complications of polypectomy, quality metrics for colonoscopy, polyp morphology size, location, and histopathology were extracted and analyzed. Twenty-one observational studies were included comprising 5821 patients who underwent LGIE with an age range of 2–101 years and an M: F of 1.8:1. The polyp detection rate (PDR) was 8.5% in North-West Nigeria, and the mean value ranged from 11.3% [95% confidence interval (CI) 7.0–15.6] in South-West Nigeria to 38.0% (95% CI 165.3–241.3) in South-South Nigeria. The rectosigmoid segment had the highest frequency of polyps [43% (358/828)], and adenomatous, inflammatory, hyperplastic, and malignant polyps were the frequent histology reported: 221 (26.7%), 174 (21.0%), 38 (4.6%), and 13(1.6%), respectively. Summarily, a large disparity exists in PDR among endoscopists in Nigeria. The training of Nigerian endoscopists on techniques to enhance caecal intubation rate, polyp detection, and comprehensive documentation of quality metrics in colonoscopy studies are recommended.
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ORIGINAL ARTICLES Top

The efficacy of the EncephalApp in diagnosing minimal hepatic encephalopathy (MHE) among patients with liver cirrhosis in Jos Nigeria p. 24
Nyam Paul David, Mary John Duguru, Pantong Mark Davwar, Patience One Omaiye, Edith Nonyelum Okeke, Ameh Ojonugwa Alufiya, Crystal Chikor Umejiaku, Shedrack Felangu Kenis, Jireh Dan Makpu, Nenman Bitrus Sekat
DOI:10.4103/njgh.njgh_9_22  
Background and Objectives: Minimal hepatic encephalopathy is a condition in which patients with liver cirrhosis with normal mental and neurological status on clinical examination show cognitive dysfunction detectable on psychometric or neurophysiologic tests. Routine detection of this condition is not commonly carried out despite the high prevalence among patients with liver cirrhosis and a high risk of progression to overt hepatic encephalopathy. We compared the smartphone based EncephalApp with the standard psychometric hepatic encephalopathy score (PHES) in diagnosing MHE in patients with liver cirrhosis in Jos University Teaching Hospital. Materials and Methods: Fifty healthy subjects and 42 patients with liver cirrhosis who did not have overt hepatic encephalopathy and who fulfilled other study criteria were recruited in this cross-sectional analytical study. Both healthy subjects and patients were tested with the EncephalApp, and with the paper-pencil PHES test. Data analysis was done using Statistical Package for the Social Sciences (SPSS) 23.0. A value of P < 0.05 was considered statistically significant. Results: The mean age of the control group was 35.9 ± 8.7 years, whereas that of the patient group was 38.9 ± 8.7, P = 0.099. The mean number of years in school for the control group was 16.5 ± 3.4 years, whereas that of the patients was 16.1 ± 3.1, P = 0.471. The prevalence of MHE by PHES was 40.5%. The prevalence of MHE by EncephalApp was 51.4% based on the cutoff of 241.8 s, sensitivity = 54.1% and specificity = 90.0%, AUROC = 0.77. Conclusion: The prevalence of MHE in patients with liver cirrhosis in Jos, Nigeria, is about the same with values documented in other parts of the world. The EncephalApp was shown to be a reliable screening tool with good sensitivity, specificity and AUROC in our patients with liver cirrhosis.
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HBsAg Loss among a Cohort of Nigerians with chronic hepatitis B virus infection p. 29
Olusegun Adekanle, Oluwasegun Ijarotimi, Ikenna Kenechi Umenze, Dennis A Ndububa
DOI:10.4103/njgh.njgh_7_22  
Background: Chronic hepatitis B (CHB) virus is an infection that has lasted for 6 months or more without a complete resolution. Nigeria has a hyper-endemic CHB infection rate. There are few or no reports of HBsAg loss among Nigerians on treatment for CHB. We therefore report seven cases of CHB that cleared HBsAg with treatment from the Obafemi Awolowo University Teaching hospital Ile-Ife, Nigeria. Materials and Methods: Case records of patients that cleared HBsAg during follow-up treatment in the gastrointestinal clinic were reviewed and information on biodata, prescribed medication, duration of treatment, and hepatitis B viral quantity among others were extracted and presented in a table and as percentages. Results: Seven patients had lost HBsAg among our treated cases; they were five males and two females. Duration of treatment ranged from 6 months to about 4 years. All were HBeAg negative. Serum HBV-DNA ranged from 22 to 3.2 x 106 IU/mL at the start and was not detectable at the end of treatment. Anti-HBs were detectable in three cases. Serum alanine aminotransferase (ALT) reduced significantly in five cases. Tenofovir disoproxil fumarate (TDF) was prescribed in four cases, one had PEGylated interferon (PegIFN), and two other cases switched between TDF and PegIFN. Conclusion: Antivirals for CHB are effective and HBsAg loss may follow undetectable viral suppression. Antivirals are therefore beneficial among Nigerians who are infected with CHB.
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CASE REPORTS Top

Gall bladder perforation with contained bilioma: A rare complication of Calculous cholecystitis p. 33
Krishnanand Anand, Sakshi Goyal, Amit Tiwari, Pranav Kumar Dave
DOI:10.4103/njgh.njgh_25_20  
Gall bladder perforation (GBP) is a rare and potentially life-threatening complication of acute cholecystitis. The main cause of GBP is cholecystitis with or without cholelithiasis and is often associated with high morbidity and mortality. It is subdivided into three categories, whereas the development of biloma is extremely rare. We report an interesting case of GBP after acute calculous cholecystitis causing subhepatic bilioma formation who presented in emergency with pain in the right upper abdomen and fever.
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Gangrenous Cholecystitis: A case report p. 36
Adedire Timilehin Adenuga
DOI:10.4103/njgh.njgh_1_21  
Gangrenous cholecystitis (GC) depicts gallbladder (GB) wall necrosis which occurs following prolonged acute cholecystitis that ultimately causes impairment in blood supply. GC is more common in the elderly and in patients with comorbidities. These patients may present with vague symptoms which may be confused with other conditions. Blood work may show elevated white cell count, and computed tomography may show lack of enhancement of the GB wall, air within the lumen or wall, and pericholecystic abscess. These patients would require proper resuscitation and an emergent cholecystectomy. This is the case report of a 75-year-old diabetic woman who presented acutely with a history of right upper abdominal pain and imaging finding of GC. She had an emergency subtotal cholecystectomy performed with good outcome.
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Primary Hepatic Neuroendocrine Tumour: A case report p. 40
Renuka Venkata Inuganti, Chaitra Boregowda, Tejeswini Vaddati, Ramya Potti
DOI:10.4103/njgh.njgh_4_22  
Primary hepatic neuroendocrine tumors (PHNETs) are infrequent and rarely cause carcinoid syndrome unlike metastatic deposits in the liver from primary neuroendocrine tumors (NETs) in other parts of the gastrointestinal system. There are only about 61 cases of PHNET reported in the literature. We present a case of a 30-year-old woman with a PHNET in the left lobe of the liver for which a lobectomy was successfully done. This case was subjected to a thorough workup to exclude an occult extra hepatic NET.
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Intestinal tuberculosis complicated by pulmonary embolism and deep vein thrombosis p. 44
Mansoor C Abdulla
DOI:10.4103/njgh.njgh_5_22  
Venous thromboembolism (VTE) secondary to tuberculosis (TB) is a rare complication that can occur either at the time of presentation or later in the course of the disease. A 24-year-old woman was admitted with low-grade fever, abdominal pain, abdominal distension, and loose stools for one and half months. She was evaluated and diagnosed with abdominal TB. On the second day of admission, she had a sudden onset of the right lower limb edema with pain followed by breathlessness. Contrast-enhanced computed tomography of the thorax showed a thrombus in the left pulmonary artery. She was treated with low-molecular-weight heparin and started on anti-TB drugs. She was continued on oral anticoagulation with warfarin. We describe a patient who developed pulmonary embolism and lower limb deep vein thrombosis secondary to abdominal TB without paraaortic lymphadenopathy and a negative procoagulant workup, which was not reported previously. The mechanisms of VTE in TB are complex and may need further studies in the future, which may help the clinicians develop appropriate strategies for treatment.
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