Matthew N. Tanko

Hepatic histopathological findings in HIV patients at postmortem in Jos university teaching hospital, Nigeria

Multi-organ involvement by opportunistic infections and neoplasms is the major cause of morbidity and mortality in people living with HIV/AIDS. We determined the spectrum/frequency of hepatic histopathological lesions in a prospective study of postmortem liver biopsies from 100 patients (50 females and 50 males, age range 18-55 years) who died from HIV/AIDS in Jos university teaching hospital, Nigeria. The majority of the patients, 65 (65%), had clinical tuberculosis. Granulomatous hepatitis, chronic hepatitis, non-specific reactive hepatitis (NSRH) and steatosis were the commonest hepatic histopathologic lesions occurring in 34, 20,15 and 12% of patients, respectively. Seven (7%) had normal histological features. This study shows that the liver is affected in HIV/AIDS as reported elsewhere in the world. Therefore, liver biopsy in HIV patients may be helpful in the management of these patients.

The bacterium that could cause cancer

For decades clinicians the world over took it for granted that bacteria could not live and grow in the stomach because of the acid pH of its lumen. It was, therefore, a great surprise when Barry Marshall and Robin Warren reported in The Lancet 1 in 1984 that bacteria resembling campylobacter could be found beneath the gastric mucus layer that lines the surface epithelium of the stomach, and that their presence was associated with gastritis, and gastric and duodenal ulcers. In fact, the same authors had already reported their fi nding of “unidentifi ed curved bacilli on gastric epithelium in active chronic gastritis”, which they set out a year earlier in two letters to The Lancet. 2,3 Indeed, similar bacteria had been described repeatedly during the previous century, but had been overlooked partly because they could not be seen with conventional stains. In the 4 years following Marshall and Warren’s report, it was established that Campylobacter pylori infection caused an acute histological gastritis that could become chronic, that it was the causative agent in type-B gastritis, that it was often found in patients with peptic ulcer disease, and that the eradication of the organism was associated with the healing of gastritis and a lower relapse rate in duodenal ulcer disease. 4 The idea that peptic ulcer disease was related to gastric hypersecretion, stress, smoking, or alcohol was abandoned, and the dictum “no acid, no ulcer” was replaced with “no bacterium, no ulcer”. By 1993 (10 years after the fi rst report) it had been shown that half of the world’s population were infected with C pylori, that the mode of transmission was probably fecal–oral, and that its prevalence increased with age and was higher in lower socioeconomic groups. Infection with C pylori could be diagnosed using serology, breath testing, biopsy, and culture. Eff ective therapies had been established, and many double-blind trials had shown that eradicating the bacterium, by then known as Helicobacter pylori, usually cured duodenal ulcer disease. These were signifi cant achievements, but of even greater importance from a biological viewpoint was the link between H pylori and cancer. Before Marshall and Warren’s discovery, no factors had been shown to be causally linked with gastric cancer, although a link between several types of food and drink and gastric cancer had been tentatively suggested. Pivotal work demonstrated that H pylori was related to gastric malignancies, 5 and further studies led the International

Silica exposure and silicosis: action is needed now.

Indeveloping countries, silicosis is largely a hidden epidemicdue to poor or nonexistent surveillance, and available dataare likely to be underestimated. As an example, minerswith severe silicosis can be declared medically unfit forwork or abandon mining work, and thus many studies donot include follow up after employment ceases, when mostcases occur.The burden of silicosis and its long term consequencescan be reduced, even when no therapy is available. First,exposure to and excessive inhalation of silica dust containingquartz particulates can be decreased by incorporating the useof filters and respiratory equipment in mining industries, es-peciallyindevelopingcountries.Insomeresource-poorcoun-tries, mining regulations do not have crystalline silica expo-surelimits.

HIV/TB Co-infection: Liver Biopsy Findings

Abstract Background: Human immunodeficiency virus and tuberculosis (HIV/TB) co-infection in an individual constitutes a serious diagnostic and therapeutic challenge. Objective: To determine liver pathology in patients with HIV and TB co-infection. Methods: Postmortem liver biopsy was done on patients with HIV/TB co-infection. The tissues were subjected to routine histological processing. The sections were stained with haematoxylin and eosin, including special stains. Results: Sixty-seven biopsies from 67 patients (33 men and 34 women) were analysed. Thirty-nine (58.2%) had pulmonary tuberculosis (PTB) while 26 (38.8%) had disseminated tuberculosis (DTB). Two (3%) had tuberculous meningitis (TBM). Fourteen (36%) patients with PTB, 10 (38%) with DTB and one (50%) with TBM had hepatic granuloma with caseation. Histologically granuloma 25 (37.4%), chronic hepatitis 13 (19.4%), nonspecific reactive hepatitis (NSRH) 11(16.4%), steatosis nine (13.4%) and cirrhosis seven (10.4%) were found. Conclusion: This study...