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Background: We compared the diagnostic validity of three non-invasive tests of fibrosis: age to platelet index, aspartate transaminase to platelet ratio index and aspartate transaminase to alanine transaminase ratio to histology fibrosis stage among Africans chronically infected with the hepatitis B virus. Methods: Ninety treatment-naive chronic hepatitis B patients were subjected to liver biopsy. Excluded from the study were patients with HCV and HIV co-infection, and significant alcohol consumption. Staging was performed using the Metavir system, whereas AST, ALT, and platelet count were determined using manual methods, within 4 weeks of liver biopsy. Results of fibrosis score and markers of fibrosis were compared using EPI Info 2005 version 3.3.2. Results: The mean age of the study population was 31.8 ± 8.9 years. Fibrosis stages and AAR, API and APRI scores were positively correlated, respective correlation coefficients being 0.48, 0.48 and 0.22 ( p %lt; 0.0001). Their positive predictive values were 52% (AAR), 63% (API) and 54% (APRI), with sensitivities of 60, 11 and 96%, respectively. The diagnostic accuracy of AAR for cirrhosis was 100%. Conclusions: Non-invasive fibrosis markers are not as sensitive for diagnosing significant fibrosis in chronic hepatitis B compared to hepatitis C patients and might have a limited utility for use in hepatitis B endemic populations.

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Hungarian Medical Journal
Solomon O. Ugoya
Mayowa O. Owolabi
Tokunbo A. Ugoya
Fabian H. Puepet
Godwins O. Echejoh
, and
Adesola Ogunniyi

Background: Over three hundred million people worldwide were estimated to be become diabetic by year 2025. The rates of both obesity and malnutrition are on the increase worlwide. The goal of this study was to describe the relationship of body mass index (BMI) and diabetic peripheral neuropathy (DPN) in persons with diabetes mellitus. Research design and methods: A cross-sectional analysis of BMI and peripheral neuropathy was conducted among one hundred and twenty diabetic subjects, who were grouped based on presence or absence of DPN. Ninety of the diabetic persons had peripheral neuropathy, while thirty of the diabetic persons had no neuropathy. DPN was determined only by clinical assessment using an aspect of the Michigan Neuropathy Screening Instrument (MNSI). Result: The two groups were not different in BMI, total cholesterol and high density lipoproteins (HDL). The group without peripheral neuropathy had better glycaemic control; HB A1C = 5.9 ± 2.5 (%), shorter mean duration of diabetes = 5.3 ± 3.6 years and younger age. More of those with peripheral neuropathy were underweight (six compared to none ‘0’ of those without neuropathy). Similar result was obtained for morbid obesity ‘class 3’, although BMI had no significant effect on DPN after controlling for age, duration of DM and glycaemic control. Discussion and conclusion: Obesity is an index of insulin resistance which may account for poor glycaemic control and predispose to peripheral neuropathy and other complications. Weight loss depicts severity of type 1 DM which may account for complications. This pattern also depicts the trend in a sub-Saharan African city like ours with uneven distribution of wealth and resources hence the poor result in both the underweight and obese class 3.

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