A rare image of spontaneous enterocutaneous fistula in morbidly obese patient with metabolic syndrome

No Abstract

HIV sero-positive status among clients aged ≥ 50 years that presented for care in a tertiary health facility in northeastern Nigeria.

The introduction of highly active antiretroviral therapy (HAART) has transformed HIV infection from hopeless to manageable health condition comparable to non-infectious diseases such as asthma and diabetes mellitus. This modest achievement has reduced morbidity and mortality and increased longevity and quality of life among HIV infected persons. Although reports from developing countries such as Nigeria, shows that youth within the reproductive are most affected by the scourge of HIV/AIDS. Older patients with features that may be indicative of HIV infection are often overlooked in favour of other differential diagnosis. Objective: To document HIV positive sero-status among client aged 50 years and above that necessitated HIV test as part of their clinical evaluation after voluntary counseling and testing at a tertiary health facility. Method: Record of 1674 adults participants that presented for care between January 2009- December 2013, were retrieved for this study. Results: The HIV-seropositive status among the participants was 370 (22.1%). It showed a female preponderance of 136 (26.0%) than 234 (20.0%) in males. The peak annual prevalence was observed in the year 2010, steady decline was observed thereafter. Overall, older participants between 60-70 years had higher HIV-seropositivity status. This study shows one out four males and five females with index of suspicion either based on clinical presentation or risky sexual behavior are positive for HIV infection. Conclusion: This report underscores the need to explore other risk factors that may be peculiar to older segment of the society and introduce HIV intervention strategies for the older populations. Delivery of HIV intervention measures and services to this segment of the population is expedient. Measures and interventions should take into consideration the peculiarities, specific vulnerabilities and HIV-related challenges faced by this group of clients

A Case Report of a young Lady with Disseminated TB with Rare Skin Manifestation

Tuberculosis (TB) poses an enormous global health challenge with high morbidity and mortality. The deadly synergy of HIV and tuberculosis and emergence of multidrug-resistance M. tuberculosis has transformed the pattern of presentation of tuberculosis from common lung involvement to extrapulmonary site. Dissemination of TB depends on the degree of immunosuppression and host factors. We evaluated 30 year old HIV positive lady that presented with disseminated tuberculosis involving the lungs, abdomen and cervical lymph node with extension to the skin. The skin involvement manifested as an extensive cutaneous ulcer in the left cervical region. Cyto-histopathologcal examination of the wound biopsy shows an ulcerated skin tissue composed of caseous-like necrosis, giant cell like and abundant mixed inflammatory cell infiltrate. Zielhl Neelson stain shows numerous tuberculous bacilli, with no evidence of malignancy. Chest radiograph showed features of consolidation, pleural effusion and milliary shadow evolving both lung fields. Abdominal ultra sound showed features of multiple para aortic lymph node enlargement and moderate ascites, her haemoglobin concentration was 6.0g/dl, CD4+T cell count 327 cells/ul. Hepatitis B surface antigen and hepatitis C virus antibody was negative. Liver and renal function tests were essentially within normal limit. Extensive ulcer in the cervical region could be due scrofuloderma especially in TB endemic region. Disseminated tuberculosis lesion and hypoalbuminaemia is associated with mortality. Facility and expertise required to manage common infectious diseases such as tuberculosis in Sub-Saharan Africa need to be upgraded.Keywords: Cutaneous TB, HIV infection, Histopathology, TB drug induced Hepatiti

Clinical and Histological Characteristics of Mycetoma in a Tertiary Health Institution in Northeastern Nigeria.

Mycetoma are pathological and inflammatory pseudo-tomours often affecting the lower limb and the foot, where it is called "watering can foot," but can rarely affect other parts of the body. It is a bacterial (actinomycetoma) or fungal (eumycetoma) infection of the skin, subcutaneous tissue and dermis, which may extend to underlying bone. The classical clinical feature of both forms of mycetoma is tumescence with formation of abscesses, painless nodules and sinus tract that discharge grains containing aggregate of the etiological agent. The disease is thought to occur after inoculation of soil organisms during penetrating injury. This occur most commonly in rural settings among labourers who work bare foot. As one of the neglected diseases listed by the WHO, determination of the prevalence and characterization of mycetoma in Nigeria is needed to provide a guide to its management in our environment. We retrospectively reviewed documented cases of mycetoma over an eleven year period (2004 -2014) that presented for care at University of Maiduguri Teaching Hospital A total of 35 cases of mycetoma were recorded over the eleven year period, with estimated prevalence of 0. 65 per 100000 hospital visits. Lower limb was the most affected region among males <45 years. Characterization of 17 available cases using special stains indicated that 15 cases (88.2%) were due to actinomycetes and only 2 cases (11.8%) resulted from eumycetoma. Identification and characterization of mycetoma is important, its management requires antimicrobial therapy. In chronic and advanced disease, surgery may be indicated especially in those caused by fungi to avoid deformity, amputation, and death.Keywords: Mycetoma, Histopathological characterization, Special stains

Hepatitis B surface antigenaemia among high risk groups in northeastern Nigeria

Hepatitis B Virus infection is ranked the 10th leading cause of death worldwide. Mortality and morbidity attributable to it in the hyper-endemic sub Saharan African nations such as Nigeria is unarguably high. We postulated that the sero-prevalence of hepatitis B surface antigen (HBsAg) is uneven across sex, age groups and  perceived risks. We determined the HBsAg among six defined groups stratified as low risk (Age < 10 years), average risk (Pregnant antenatal care attendee), moderate risk (parturient women, STD clinic attendee) and high risk (commercial sex workers, CSW and long truck drivers). A total of 838 subjects from birth to age 56 years were screened for HBsAg using an enzyme immunoassay (EIA) technique. The overall prevalence was 16.5%. It was higher in males (25.6%) than females (13.5%) (p <0.001). The seroprevalence rate was highest among children aged < 10 years with 25%. Parturient women and long truck drivers had a similar  seroprevalence of 23.3% and 23.2% respectively. STD clinic attendee had 17.4%, while Antenatal care attendee had 11.3%. CSW had the least seroprevalence rate of 8%. Seroprevalent rate decreased with age (p=0.023), but it increased with parity = 4. Fifteen motherchild pairs (out of the 73 mother-child pairs) had HBsAg positive; mother-child concordance for HBsAg of 20.5%. Hepatitis B virus infection is  common, and it is of hyperendemic magnitude in our environment. Although it commoner among children, it is likely acquired horizontally. This finding underscores the need for early childhood vaccination. Advocacy on discouraging prevalent  harmful traditional practices such as genital mutilation, circumcision, cupping and tribal mark using unsterilized instruments and paraphernalia is expedient in our environment