Background: Of the estimated 5000 existing mushroom species, only 200 to 300 have been established to be edible and safe, whereas 50 to 100 species are known to be poisonous for human consumption. The toxicity profile of most other species has not been investigated. Consuming mushrooms gathered in the wild is risky, as most of the mushroom poisoning reported are due to accidental ingestion of poisonous mushrooms, which are often misidentified. To study the clinical characteristics of patients who got admitted with mushroom poisoning in North Eastern Indra Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong over the past 5 years. Methods: A retrospective study of case records of patients admitted with mushroom poisoning over 5 years in a tertiary care regional institute of northeastern India (NEIGRIHMS, Shillong) was carried out. Data collection was done using a pre-designed proforma. Results: Fifty-three patients were admitted with mushroom poisoning during the study period of 5 years (2014–2019). Maximum number (16; 30.19%) of the patients belonged to the age group of 11 to 20 years. A two and a half months old baby on breast milk is the youngest patient admitted with mushroom poisoning. Out of 53 patients with mushroom poisoning, 33 (62.26%) reported in six clusters, and 20 (37.74%) were admitted as individual mushroom poisoning patients. The majority, 40 (75.47%), of the patients survived and got discharged. Nine (16.98%) patients died due to complications of poisoning, and four (7.55%) patients left against medical advice. Most of the cases (21, 39.62%) were from Ri-Bhoi district. Most (17, 32.07%) of the mushroom poisoning occurred during the month of May, which coincided with the peak time of mushroom production in the state of Meghalaya. Conclusions: Wild mushroom is a part of routine food consumption in the tribal population of Meghalaya. Nearly 75% of the patients admitted with mushroom poisoning recovered, whereas 16.98% died due to poisoning complications.

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Autoimmune hepatitis is an unrelenting inflammation of the liver of unknown etiology. It is a relatively rare disease that commonly affects women and mostly present as chronic hepatitis. It is basically classified into types 1 and 2. The patient is a 56 year old Northern Nigerian woman with background thyroid disease and rheumatoid arthritis who presented with jaundice and fatigue and elevated liver enzymes with increased serum total protein and low serum albumin. Further evaluation showed non-reactive hepatitis B and C markers, features of chronic liver disease on abdominal ultrasound scanning, elevated anti-nuclear and anti-smooth muscle antibodies and increased serum IgG. Liver histology showed features of chronic hepatitis consistent with AIH. Diagnosis of AIH type 1 was eventually made and patient was started on prednisolone and azathioprine combination therapy with improvement of liver function test few weeks after commencement of therapy. To the best of our knowledge, only 2 cases of AIH has been reported in Nigeria, all from Ibadan, Southern Nigeria. No report of AIH from Northern Nigeria. We therefore report a case of AIH type 1 to increase awareness among clinicians.

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Background: Escherichia albertii is an enteric bacteria associated with infectious gastroenteritis. However, information on this organism remains scant in Nigeria. The work was aimed at determining the prevalence of E. albertii among gastroenteritis patients (GEP) in relation to some risk and demographic factors. Methods: The study was a cross-sectional hospital-based research. A total of 540 stool samples, 450 from GEPs and 90 from apparently healthy individuals, were screened for the pathogen. The isolates were characterized by using both conventional and molecular techniques. Data were obtained using a structured questionnaire and were analyzed for the determination of some risk and demographic factors. Odds ratio and chi-square were used to ascertain the relationship between the factors and the disease. Results: Escherichia albertii was detected with an overall prevalence of 1.1%, which was 1.3% and 0% in the GEPs and apparently healthy individuals, respectively (Odd ratio = 2.6468, 95% CI, 0.1478–47.4042). Diarrhea and abdominal pain were statistically the significant manifestations of the disease. There was an equal prevalence in both males and females (1.3%), however, by chance higher (2.1%) among children aged 0 to 10 years. Additionally, primary school as the highest educational status and open defecation were found to be the risk factors of the infection. Conclusions: Escherichia albertii should be routinely targeted diagnostically in the patients presented with gastroenteritis in the studied area. Neither gender nor age was a risk factor, however open defecation was a significant risk factor of the disease.

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Out of all skin neoplasms, metastasis accounts for only about 2%, and breast cancer is the second commonest malignancy to metastasize to the skin after malignant melanoma. Although triple-negative breast cancer patients tend to have metastatic disease at presentation, cutaneous metastasis is unusual. In this report, we present a 47-year-old asymptomatic woman whose attention was drawn by her hairdresser to a scalp swelling 2 months prior to presentation. Similar swellings were noticed on the back, arms, and thighs. One month later, a left breast lump was noticed during a clinical breast examination by a physician. She was in good physical condition but had generalized cutaneous nodules. Further investigations revealed canon ball metastasis to the lungs, and histopathology with immunohistochemistry confirmed triple-negative invasive ductal carcinoma with cutaneous metastasis. Skin involvement in breast cancer signifies advanced disease. Therefore, high index of suspicion is necessary so as not to overlook early sinister nodules as benign dermatological condition.

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Background: Epidermoid cyst of the oral cavity is very rare, slow-growing, benign neoplasm derived from the remnant of the neural tube. It accounts for less than 0.01% of all cystic lesions of the head and neck. Most of the intraoral cases are reported in the midline and floor of the mouth. Very rare cases are seen involving the tongue, lips, uvula, temporomandibular joint, maxillary, and buccal mucosa. The rare oral lesion is asymptomatic, but large masses present early with difficulty in breathing and swallowing. We report an uncommon case of epidermoid cyst in an infant with failure to thrive due to obstruction and inability to latch breast milk. Case report: A 40-day-old male infant presented with a large oral swelling in the floor of the mouth since birth. It measured 4 × 5 cm in size. Surgical excision with primary closure was successfully performed. The histopathological report confirmed the diagnosis of epidermoid cyst. The child recovered to full general health with no signs of recurrence. Conclusion: Oral epidermoid cyst is a rare neoplasm that may mimic dermoid cyst and teratoid tumors clinically. The treatment of choice is surgical excision; however, there is a recurrence rate of 33% and rarely transforms into malignancy.

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Background: The recent guidelines for HIV treatment initiation in Nigeria do not depend on CD4 cell count or plasma viral load however, assessment of the baseline immunologic and virologic markers could indicate prognosis and transmission index. This study was aimed to estimate CD4 cells and plasma HIV-1 RNA viral load among antiretroviral treatment (ART)-naive populations in three HIV treatment centres in Nigeria. Methods: We conducted a cross-sectional hospital-based study of 50 adult ART-naive patients. Whole blood and plasma samples were estimated for CD4 cells and HIV RNA-1 plasma viral load respectively. Results: The median age of the study participants was 35 years and 64% were female. The median CD4 cell count was 176 cell/μl while the median HIV viral load was 158391 copies/mL. There was a significant moderately strong, negative Spearman correlation between HIV-1 plasma viral load and CD4 cell count (r = −0.5007, P = 0.0002). Female recorded relatively higher CD4 cell count and lower plasma viral load. Six percent (6%) of the ART-naïve patients had undetectable viral load. Conclusion: This study indicates the baseline plasma viral load and CD4 cell count which can affect prognosis, disease progression and transmission. The drug-naïve participants reported with undetectable plasma RNA could be ‘elite’ controllers.

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Background: Adenoidectomy, tonsillectomy, or both are a leading cause of surgical admission, especially in children, in otolaryngological practice in the world. This study aimed to audit the demography, symptoms/signs, indications, types of surgery, postoperative outcome, and histopathological evaluation of adenotonsillectomy in Makurdi, Nigeria. Methods: This was a 3-year retrospective study. Record of total surgical procedures was taken and data of patients who had adenoidectomy, tonsillectomy, or both were retrieved. The data extracted included study population demography, symptoms/signs, indication and surgery carried out, postoperative care, and histopathological reports of specimens. The primary outcomes were symptoms/signs, indication, and type of surgery, whereas postoperative management and histopathological examination findings were secondary consideration. Ethical clearance was obtained. The data were analyzed. Results: Two hundred and twenty different types of surgeries were done within the study period. Seventy-two patients (32.7%) underwent adenoid and tonsil surgeries, comprising 46 males and 26 females; age ranged from 1 to 38 years with mean age of 6.63 ±7.78 years. Majority (68.0%) of the patients were ≤5 years old. Snoring and noisy breathing were common presentations. Obstructive adenotonsillar hypertrophy at 63.9% was the most frequent indication for surgery and adenotonsillectomy constituted the most performed procedure. Postoperatively, all the patients had routine antibiotics, analgesics, and were commenced on graded oral feeds. Nine (12.5%) and six (8.3%) patients had postoperative vomiting and fever, respectively. There were no complications of hemorrhage or fatality. The patients were kept for 2 to 3 days. Histopathology results showed follicular hyperplasia (61.1%) and chronic inflammation (38.9%). Conclusion: Adenoid and tonsillar surgeries still constitute common procedures among children in Makurdi and obstructive adenotonsillar hypertrophy and its surgery is commonly encountered with satisfactory outcome. Routine histopathological examination of nonsuspicious adenoid and tonsil specimens should be discouraged.

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Background: Breast cancer is a major public health problem in most low- to medium-income countries of the world because of its high morbidity and mortality rate. Histopathological features are vital in risk assessment, selection of treatment and prognostication in breast cancer patients. This study aimed to assess the histopathological features of all breast cancer cases seen in a tertiary hospital in the year 2018. Methods: This is a retrospective review of all breast cancer cases histologically diagnosed and confirmed by three Pathologists at the University College Hospital (UCH), Ibadan over a one-year period from 1st January 2018 to 31st December, 2018. Results: A total of 236 breast cancer cases were seen during this period, 234 (99.2%) were females while only 2 (0.8%) were male. 163 (69.7%) patients were between the fourth and sixth decades of life, 65 (27.8%) patients were above sixth decade while 6 (2.5%) patients were below fourth decade. Invasive ductal carcinoma of No Special Type (NST) was the commonest histological subtype 212 (89.8%). Grade 1 cases were 25(10.6%), Grade 2 129 (54.7%) and Grade 3 cases were 40 (16.9%) while 42 (17.8%) were not graded. Lymphovascular invasion observed in 98 (41.5%) of the cases. 54 (22.9%) had immunohistochemistry out of which 23 (43.4%) were triple negative while 8 (3.4%) were triple positive. Conclusion: Histopathological features suggesting aggressive disease was predominantly observed. Efforts should be made towards early diagnosis, adequate evaluation and prompt treatment. Cancer care should be fully incorporated in the National Health Insurance Scheme (NHIS).

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Background Malignant ureteric obstruction is often associated with end-stage cancer arising from the cervix, bladder, prostate and other pelvic organs. We reviewed palliative therapeutic options and outcome of patients with bilateral malignant ureteric obstruction at the Jos University Teaching Hospital (JUTH). Methods This was a retrospective cross-sectional study. Data from patients managed by the Urology division of JUTH for patients with bilateral ureteric obstruction of malignant cause over a period of 10 years were reviewed. Patients’ age, cause of malignant ureteric obstruction and types of interventions carried out were extracted. In addition, mean serum creatinine level at presentation and one-month post intervention were analysed. The overall patient survival over a 6-month period was evaluated. Data were analysed using SPSS version 23. Result 24 patients managed within the period of the study had complete data for analysis. The age range was 43-73years with a median of 49 years. Majority (79.2%) of patients were female. 54.2% of the patients had open nephrostomy. Retrograde ureteric stent insertion (16.6%) and permanent haemodialysis (29.2%) were the other palliative management options. Open nephrostomy offered the most significant improvement in biochemical outcome at one-month post intervention (P = 0.039). 41.6% of patients were alive at 6 months post intervention. None of the treatment options conferred survival advantage over the others. Conclusion Open nephrostomy is the most common palliative management option for patients with bilateral malignant ureteric obstruction at JUTH and achieves the most significant biochemical improvement. No palliative management option conferred superior survival outcome among the patients.

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Background: The burden of HIV has effects on Health-related quality of life (HRQOL). HRQOL assessment is an essential tool in understanding the patient perspective of their quality of life. This study aimed to determine and compare the HRQOL of HIV infected and non-infected adults in Jos North, Plateau State. Method: This was a comparative cross-sectional study conducted in Jos North LGA between January-March 2018. One hundred and seventy-eight of HIV infected and non-infected adults who met the inclusion criteria were selected using a multistage sampling technique. We used a WHOQOL-HIV Bref questionnaire to collect information. We calculated the difference in domain mean score using student t-test and determine factors associated with HRQOL using Chi-square test and logistic regressions at the 5 % level of significance. Statistical analysis was carried out using SPSS version 23.0. Results: The mean ages of HIV infected and non-infected respondents were 38 ± 9 and 35 ± 10 years, respectively. The overall HRQOL mean score for HIV infected was 3.98 ± 0.70 and 4.06 ± 0.60 for non- infected adults, and this was comparative (P = 0.223). In all the domains, the HRQOL mean scores were significantly different between the HIV infected and non-infected except physical domain (P = 0.962). The odds of good HRQOL was higher among those with tertiary education [aOR:8.33; 95%CI: 2.4–29.3] and those employed [aOR:2.34; 95%CI: 1.1–5.2] among HIV infected respondents. Conclusions: This study showed that the overall HRQOL of HIV infected and non-infected adults were similar in Jos North LGA. However, there was a significant difference in all the domains except for physical domain.

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Background: Standard safety precautions are essential in health care deliveryregardless of the presumed infectious state of the patients. Safe handling practices as detailed in the universal safety precaution guidelines are available to health care workers globally. However, there have been documentation of suboptimal adherence to it especially in the developing countries including Nigeria. Hence, this study was conducted to assess the level of safe handling practices and its determinants among resident doctors in Jos University Teaching Hospital, Plateau state, Nigeria. Methods: This was a cross sectional study conducted among 192 resident doctors using quantitative method of data collection in 2018.SPSS version 20 was used for data analysis with chi square test used to identify the determinants of safe handling practices. Crude odds ratio as well as 95% confidence interval were used with a p-value of < 0.05 considered statistically significant. Results: The mean age of the respondents in the study was 33 ± 3 years with 119 (62.0%) of the respondents being males. Good knowledge of infection, prevention and control was reported among 120 (62.5%) while 137 (71.3%) were found to have engaged in safe handling practices. Sex (OR = 4.5; 95% CI = 2.05–9.85) and level of knowledge (OR = 1.97; 95% CI = 1.05–3.72) were found as the determinants of safe handling practice. Conclusion: This study has brought to light the need for improvement in the level of compliance with safe handling practices as it is far from the optimum.

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Background: Appendicitis is most common between the ages of 10 and 20 years, although all ages can be affected. Acute appendicitis is the most common cause of acute surgical abdomen worldwide and its incidence varies with geographical location. The aim of this study was to review all the inflammatory lesions of the surgically removed appendix in University College Hospital, Ibadan, Nigeria and to describe the histopathological patterns of these lesions. Methods: This study was a retrospective review of all appendectomy specimens submitted to the Department of Pathology, University College Hospital, Ibadan, Nigeria from January 2009 to December 2018. Patients’ biodata, clinical parameters, and histological diagnoses were extracted from departmental surgical day books. The data were analyzed using IBM SPSS Statistics (version 23; IBM Corporation, Armonk, New York) and expressed as frequency distribution. Results: A total of 1071 appendectomy specimens were received in our laboratory during the 10-year study period, accounting for 3% of all specimens received. There were 1062 cases of inflammatory lesions, accounting for 99.2% of the cases. There was a male preponderance with male to female ratio of 1.2:1. The age was from 1 to 83 years. The most common histological diagnosis was acute suppurative appendicitis with peritonitis accounting for 47.6% of all the cases. Conclusion: The findings in our study supports the fact that acute suppurative appendicitis is the most common inflammatory disease of the appendix which is consistent with other similar studies that have been done in our environment and in the developed world.

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Background: Gene Xpert mycobacterium tuberculosis (MTB)/Rifampicin (RIF) was introduced for the detection of pulmonary tuberculosis (PTB) at the Federal Medical Centre, Owo, Ondo State, Nigeria in 2015. The study aimed to determine the effect of Gene Xpert MTB/RIF on diagnosis of PTB. Methods: We reviewed Gene Xpert register from January 2015 to January 2017. The agreement of Gene Xpert with acid-fast bacilli was determined using the sensitivity and positive predictive value of the Gene Xpert test. Association was assessed using chi-square test. Binary logistic regression was used to determine the predictors of positive Gene Xpert result. Results: A total of 1246 records were reviewed; the average age was 41 ± 19 years, and nearly half of the patients (48.6%) were female. While 264 (21.2%) were human immuno-deficiency virus (HIV) positive. Smear microscopy was positive in 118 (16.9%); 90 (13.6%) had tuberculosis (TB) detected on Gene Xpert. Those positive for smear microscopy and Gene Xpert were 21 (10.0%). The Gene Xpert detected 90 (8.3%) of the 653 with presumptive TB. The turnaround time for Gene Xpert was 24 hours. When compared to smear microscopy, Gene Xpert showed sensitivity of 45.7% (95% confidence interval [CI]: 31.7–60.1) and specificity of 98.2% (95% CI: 95.1–99.5) in all the cases and sensitivity of 50% (95% CI: 29.8–70.2) and specificity of 100% among HIV positives. Conclusion: Gene Xpert should be preferred to smear microscopy in evaluating HIV positive patients for TB. Nevertheless, clinicians can still rely on results from smear microscopy for clinical decision when Gene Xpert is not available.

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Background: Childhood asthma is the most common chronic lung disease of childhood that requires monitoring including lung function test. This study aimed to evaluate the lung function and the monitoring strategies of children with physician-diagnosed asthma. Methods: Children aged 6 to 18 years attending the respiratory clinic with physician-diagnosed asthma were studied. Clinical status and asthma monitoring strategies were obtained followed by spirometry. The tools used for monitoring asthma included symptom diary, peak expiratory flow meter, exacerbations, and use of rescue bronchodilator in the past 1 year. Results: There were 45 children aged between 6 and 18 years with 29 (64.4%) females and 16 (35.6%) males. There was no seasonal variation in the development of symptoms and most of the parents and siblings had no allergic conditions. Nearly all children did not use monitoring tools; none of them kept a symptom diary and only one (2.2%) and three (6.7%) had an action plan and peak flow meter, respectively. Only one (2.2%) had a history of being admitted to the intensive care unit (ICU). Thirty-three (73.3%) patients had identifiable triggers (single or multiple) with cold being the most common. Eleven (24.4%) patients had the need to use a rescue bronchodilator in the past 12 months. Thirteen (28.9%) patients had an abnormal spirometric pattern and the most common being the obstructive type. Conclusion: The majority of the children had no asthma monitoring tools and a third of them had an abnormal spirometric pattern with the obstructive type being the most common.

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Background: About 15% of blindness in Africa is due to glaucoma. The Nigerian National Blindness and Visual Impairment Survey found that glaucoma accounted for 16.7% of blindness with regional variations. The purpose of the study was to find the regional pattern of presentation and visual outcome to implement preventive measures. Methods: This was a descriptive retrospective study of new patients who presented to the eye clinic of Benue State University Teaching Hospital, Makurdi and were diagnosed of glaucoma. Results: In this study, 795 consecutive new patients who fulfilled the diagnostic criteria for glaucoma were included. Their mean age was 45.5 ± 18.3. There were 450 (56.6%) males. More patients presented in the fourth and fifth decade of life (n = 299, 37.6%). Primary open-angle glaucoma (inclusive of juvenile open-angle glaucoma, n =595, 74.8%, and normal tension glaucoma, n = 8, 1.0%) accounted for a total of 603 (75.8%). There were 145 (18.2%) glaucoma suspects, 23 (2.9%) primary angle-closure glaucoma, 20 (2.5%) secondary glaucoma, and four cases of congenital glaucoma. Vertical cup-to-disc ratio of ≥0.9 was in 634 (39.9%) of eyes; 274 (34.4%) were bilateral, and were all considered to have severe, advanced or end-stage glaucoma. About 203 (25.5%) had discs asymmetry of ≥0.2. About 355 (22.3%) patients’ eyes were blind: 95 (11.9%) bilateral and 165 (20.8%) uniocular. Conclusion: Open-angle glaucoma was most common, and patients presented at a young age with severe eye disease, visual impairment, and blindness.

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Background: In contemporary practice, multiparametric magnetic resonance imaging has become a useful tool to differentiate between prostate cancers of high and low aggressiveness, reduce misdiagnosis, overdiagnosis and therefore overtreatment. This article aims to provide a concise review of the multiparametric magnetic resonance imaging (mpMRI) of the prostate, its interpretation and its role in the current management of prostate cancer. Methods: his was a narrative review of the contemporary role of the mpMRI in the management of prostate cancer. The databases and journals in urology and radiology were searched for relevant and contemporary existing literature on the subject. Results: We reviewed the technical aspects of the mpMRI of the prostate, describing the T-2 weighted imaging, the diffusion weighted imaging and the dynamic contrast enhanced imaging as well as the magnetic resonance spectroscopy of the prostate. We also reviewed the current interpretation and reporting of the mpMRI of the prostate using the PI-RADS; as well as the contemporary role of the mpMRI in prostate cancer management. Conclusion: The mpMRI is technologically robust and fast evolving imaging modality that has become a significant tool in the diagnosis, staging and treatment planning of prostate cancer.

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