Persistent Vomiting as a Manifestation of Coronavirus Disease‑2019

Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2. It often manifest with respiratory symptoms such as cough, fever, and difficulty in breathing. In addition to pulmonary involvement, COVID-19 is also associated with several extrapulmonary manifestations. The extrapulmonary pathology of COVID‑19 could be due to either extrapulmonary  dissemination of the virus and its replication, as has been observed for other zoonotic coronaviruses or widespread immunopathological complications of the disease. We report a case of an 18-year-old female who presented with persistent vomitingas the only presentation of COVID-19. Clinical evaluation including a battery of investigation such as hematological, biochemical,imaging, and endoscopy did not reveal any abnormality. However, her nasopharyngeal and nasal swab samples tested positive forSARS-CoV-2 by polymerase chain reaction (PCR). We placed her on the approved COVID-19 regimen comprising lopinavir/ritonavir,zinc sulfate, hydroxychloroquine and azithromycin with augmentin, vitamin C, metoclopramide and intravenous fluid for one week.The vomiting subsided within 48-h of commencing the medications, and she became asymptomatic after 72-h. Repeat PCR after 12 days returned negative for SARS-CoV-2. This case report highlights the unusual clinical feature of COVID-19. It, therefore, underscores the need to thoroughly investigate symptomatic patients and also to optimize standard precaution as potentially infectious diseases such as COVID-19 may “masquerade” as a vague constitutional symptom(s). Keywords: Coronavirus disease-2019, polymerase chain reaction, severe acute respiratory syndrome coronavirus – 2, vomitin

Ovarian Tuberculosis masquerading as ovarian cancer in HIV infected patient: a plea to avoid unnecessary surgery

Female patients who present with adnexial mass and weight loss should not be presumed to have ovarian carcinoma until after extensive investigation. This is to avoid the mistake of radical surgery with its attendant morbidity and mortality. An important disease to consider in our environment is ovarian TB that respond well to medication. A 35 year old HIV-1 positive house wife presented with fever, persistent vomiting, progressive weight loss, vague abdominal pain and swelling. Patient occasionally ingest unpasteurized milk since childhood but had no sustained contact with adult with chronic cough. She had no menstrual abnormality. Imaging  studies revealed right ovarian mass measuring 11.8cmx10cm. Right ovarian malignancy was highly  suspected, for which she underwent exploratory laporotomy. Histopathology result was consistent with tuberculous granuloma. Chest radiograph was normal. Her CD4 count was 541cells/ul. Patient was  commenced on anti tuberculotic therapy based on the Nigerian National TB control and she responded well. Tuberculosis of the ovary can masquerade as ovarian cancer, especially among HIV patients in regions where TB-HIV co infections is endemic, it should be ruled out before performing extended surgery.Key words: Ovarian TB, ovarian cancer, HIV-TB co infectio

Clinical Characteristics of COVID‑19 in a Tertiary Health Facility in Northeast Nigeria

Aim: The coronavirus disease 2019 (COVID‑19), caused by a newly identified β‑coronavirus (severe acute respiratory syndrome  coronavirus‑2), has a varied clinical manifestation. We evaluated the clinical features of COVID‑19 in symptomatic patients that presented for care at a Federal Medical Centre Nguru, Northeast Nigeria. Methodology: In this retrospective cohort study, we reviewed and analyzed relevant information abstracted from the medical records of symptomatic COVID‑19 patients that were managed from March 14 to October 14, 2020, in the facility. Results: Clinical records of 55 symptomatic COVID‑19 patients were evaluated in this study. Their mean age was 49.1 ± 16.3 (females 51.4 ± 15.6, males 48.5 ± 17.2, P = 0.601) with females constituting 47.2% of the studied patients. Fever (87.3%), cough (67.3%), sore throat (49.1%) and rhinorrhea (41.8%) were the most common clinical feature. Other features included difficulty in breathing (25.5%) and ageusia (14.6%). Gastrointestinal symptoms such as diarrhea, vomiting and abdominal pain were seen in 10.9%, 18.2%, and 9.1%, respectively. Twenty‑one (38.2%) patients had a preexisting health condition. Chronic kidney disease was the most common; it was seen in 34% of patients, other common conditions included hypertensive heart disease (24%), and diabetes mellitus (16%). Conclusion: Respiratory symptoms are the most common presentation of COVID‑19 in our setting. However, some patients also presented with additional extrapulmonary symptoms. A significant proportion, 38.2% of symptomatic COVID‑19 patients, had preexisting health  conditions. Keywords: Clinical characteristics, coronavirus disease 2019, Northeast Nigeri

Risk factors for hepatitis C virus sero-positivity among haemodialysis patients receiving care at Kidney Centre in a tertiary health facility in Maiduguri, Nigeria

Hepatitis C virus (HCV) is an important health care problem in haemodialysis. Hepatitis C virus is both a cause and complication of kidney diseases. Yet there are limited information on antibody against HCV in patients on haemodialysis. The purpose of this study was to determine the prevalence of anti-HCV and the risk factors associated with HCV infection in a cohort of 100 participants on haemodialysis. They were consecutively recruited into the study, anti-HCV testing was made by the 3rd-generation ELISA System (C-100, C-33c, C-22). The prevalence of HCV antibody was 15%, risk factors associated with HCV antibody were history of blood transfusion and duration of session of haemodialysis; the risk increased with increased with the number of blood transfusion and seasons of haemodialysis. The observed high prevalence of HCV antibody among patients on haemodialysis reflect the quality of healthcare services and the standards of infection control practices in our haemodialysis units. Routine screening for HCV should be done before blood transfusion using third generation ELISA assays with high sensitivity and specificity. Safety measures should be taken in our haemodialysis units to prevent cross infection among patients and staffs. These safety measures include; discarding syringes, needles, gloves, bloodlines and dialysers after single use, and the use of sterile dressings on each patient visit

Seroprevalence and associated risk factors of hepatitis E virus infection among pregnant women attending Maiduguri teaching hospital, Nigeria

Background: Hepatitis E Virus (HEV) is a major public health problem in developing countries and often fatal among pregnant women in the third trimester. Objectives: The study investigated the sero-prevalence and risk factors of HEV infection among pregnant women attendee of University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methods: The cross-sectional study was carried out between 4th January 2016 to 30th May, 2016. One hundred and eighty blood samples from pregnant women who consented and enrolled for the study were analyzed for anti – HEV IgM using a quality assured commercial Enzyme Linked Immunosorbent Assay (ELISA) kit. Structured questionnaires were used to collate the sociodemographic characteristics and risk factor of study subjects. Results: Out of the 180 pregnant women sampled, the anti-HEV IgM seroprevalence of 13.3% was recorded.  The seroprevalence was significantly higher in the age range of 31 – 35 years (26.5%) and least in age range ≤ 20 years (4.9%) (p=0.009).  The highest seroprevalence was recorded in the third trimester 14.1% followed by second (p>0.05). After logistic regression, nature of toilet system, and source of water consumption were significant risk factors for active HEV infection (p˂0.05). Conclusion: Based on the 10.8 % pooled national prevalence of HEV infection in Nigeria, this study recorded a significantly high level of anti – HEV IgM seropositivity, an indication of recent and active HEV infection among pregnant women at the study area. Also, these infections are most among the pregnant women in their third trimester. HEV infection was related to personal, water and environmental hygiene

Middle East respiratory syndrome coronavirus (MERS Cov) outbreak so far exempted Sub Saharan Africa; is it good news or call for action?

The reported cases of MERS Cov in Arabian Peninsula and sporadic cases elsewhere except in sub Saharan Africa at present is disquieting considering its initial clinical feature that mimic flu like symptoms caused by other viruses. However MERS Cov is associated with organ dysfunction and high mortality. Although the mode of transmission is still unclear, it is postulated that it spreads through close contact, possibly via respiratory route. High similarities of MERS CoV carried by humans and camels may suggest that the diseases are zoonotic. Furthermore, airborne nosocomial transmission can occur in the room shared by the patients in the hospitals. There is still the confusion of transmission through body fluids or clinical samples, including stools and a cross transmission with medical devices or hands. Currently, all known cases can be directly or indirectly linked to Middle East from where it derives its name. Cases reported outside the Middle East first developed infection in the Middle East and then were exported outside the region. Several hospital-acquired outbreaks that resulted in upsurge of MERS Cov cases in Jeddah revealed lack of systematic implementation of infection prevention and control measures to effectively control emerging infectious diseases. The causative agent is detected and identified using Enzyme Linked Immuunosorbent Assay (ELISA) and real-time polymerase chain reaction (RT-PCR) that is expensive and not readily available in hospitals located in resource poor settings such as sub Saharan Africa. Although, so far no case of MERS Cov has been reported from sub Saharan Africa, the devastating consequences of MERS epidemic will be more catastrophic if it emerges in developing nations especially in sub Saharan Africa where there are no up to date facilities for investigations and management of such cases. Against this backdrop, we review this hazardous and incurable disease believing that it would create the necessary awareness among stakeholders to prepare for ‘alien’diseases like MERS Cov. Pilgrims all over the world visit Saudi Arabia for religious obligation (Hajj). This is a potential way this virus could be transmitted across the globe within a short span especially if an epidemic occurs during or towards the end of the hajj exercise

Evaluation of a rapid dipstick test (Crystal Vc®) for the diagnosis of cholera in Maiduguri, Northeastern Nigeria

Background: Cholera is a preventable diarrheal disease associated with rapidly progressing dehydration. Early detection of the causative agent, Vibrio cholerae (VC) among symptomatic patients is a key step in cholera outbreak management to minimize disease spread and mortality. Materials and Methods: We prospectively evaluated the performance of Crystal VC®, a commercially available test kit for rapid detection of VC serotypes 01 and 0139 directly from stool samples. Patients included in this study were those admitted to the cholera treatment unit from August 14, 2017, to September 20, 2017, during the cholera outbreak in Maiduguri, northeastern Nigeria. Conventional bacterial stool culture is considered the gold standard and was used as the comparator. Results: A total of 156 stool specimens were collected and tested. Compared with stool culture results, the Crystal VC® test had sensitivity (SE) of 95.1% and specificity (SP) of 59.3%. The positive and negative likelihood ratios were 2.33 and 0.08, respectively. The positive predictive value (PPV) was 81.5% while the negative predictive value (NPV) was 86.5%. There was no gender variation with respect to SE, SP, PPV, and NPV. Conclusion: The cholera rapid dispstick test (RDT), Crystal VC®, is a useful tool for diagnosis of diarrheal disease due to VC serotypes 01 and 0139 and may provide an initial alert in an outbreak situation. It may also be used for case surveillance in cholera epidemic prone situations resulting from displacement to camps or overcrowded shelters due to human conflict or natural disasters. Although it is less sensitive than conventional stool culture, it is a convenient and simple test to perform with faster turnaround time

Adenocarcinoma of the Lung with Unusual Widespread Contralateral Lung Metastases in a Young Nonsmoker

Lung cancer is a fairly common malignancy, after breast cancer in women and prostate cancer in males. Most cases of cancer of the lung occur in older patients with a history of tobacco use or other risk factor(s). It rarely occurs in patients under 25 years of age. Female patients with family history appear to develop lung cancer at an earlier age. In patients with extensive disease, intrathoracic metastases often spread to the mediastinum, ipsilateral pleura, body thoracic skeletal, and the ipsilateral lung. However, contralateral lungs metastasis is a very rare finding. This case report involved a 23‑year‑old male, nonsmoker that presented adenocarcinoma of the lung with an unusual widespread contralateral metastasis

Prevalence of Anemia and Immunological Markers in HIV-Infected Patients on Highly Active Antiretroviral Therapy in Northeastern Nigeria

Background There are conflicting reports on the impact of highly active antiretroviral therapy (HAART) in resolving hematological complications. Whereas some studies have reported improvements in hemoglobin and other hematological parameters resulting in reduction in morbidity and mortality of HIV patients, others have reported no improvement in hematocrit values of HAART-treated HIV patients compared with HAART-naïve patients. Objective This current study was designed to assess the impact of HAART in resolving immunological and hematological complications in HIV patients by comparatively analyzing the results (immunological and hematological) of HAART-naive patients and those on HAART in our environment. Methods A total of 500 patients participated, consisting of 315 HAART-naive (119 males and 196 females) patients and 185 HAART-experienced (67 males and 118 females) patients. Hemoglobin (Hb), CD4+ T-cell count, total white blood count (WBC), lymphocyte percentage, plateletes, and plasma HIV RNA were determined. Results HAART-experienced patients were older than their HAART-naive counterparts. In HAART-naive patients, the incidence of anemia (packed cell volume [PCV] <30%) was 57.5%, leukopenia (WBC < 2.5), 6.1%, and thrombocytopenia < 150, 9.6%; it was, significantly higher compared with their counterparts on HAART (24.3%, 1.7%, and 1.2%, respectively). The use of HAART was not associated with severe anemia. Of HAART-naive patients, 57.5% had a CD4 count < 200 cells/μL in comparison with 20.4% of HAART-experienced patients ( P < 0.001). The mean viral load log10 was significantly higher in HAART-naive than in HAART-experienced patients ( P < 0.001). Total lymphocyte count < 1.0 was a significant predictor of <CD4 counts < 200 cells/μL in HAART-naïve patients, but this relationship was not observed in HAART-experienced patients. Conclusion HAART has the capability of reducing the incidence of anemia, other deranged hematological and immunological parameters associated with disease progression, and death in HIV-infected patients. Total lymphocyte count fails to predict CD4 count < 200 cells/μL in our cohort; thus, its use in the management and monitoring of HIV-infected patients in our settings is not reliable

Changes in Lipid Profiles and Other Biochemical Parameters in HIV-1 Infected Patients Newly Commenced on HAART Regimen

Abnormalities of lipid metabolism are common in human immunodeficiency virus (HIV)-infected patients and tend to be accentuated in those receiving antiretroviral therapy, particularly with protease inhibitors (PIs). However, there is a dearth of information on serum lipid profiles and biochemical parameters among treatment-naive HIV-positive patients in our environment. We found that after 24 months of highly active antiretroviral therapy (HAART), there was a significant increase in serum lipids. After 24 months of HAART, renal impairment was associated with a low increase in mean HDL and a high increase in triglycerides (TG). In conclusion, abnormality of serum lipid is common and showed female preponderance among treatment-naive HIV patients in our environment. Patients with HIV infection on HAART should be screened for lipid disorders given their high prevalence as observed in this study, because of its potential for morbidity and mortality in patients on HAART