Myeloma coexisting with jejunal light chain amyloidosis

Amyloid Light chain (AL) amyloidosis is a rare disease, which is seen in approximately one-tenth of patients with multiple myeloma. We report a 52 years old male, who presented with complaints of anorexia and weight loss. He was diagnosed to have multiple myeloma-international staging score (ISS) Stage 3 and was started on VTD (Bortezomib, Thalidomide, and Dexamethasone) chemotherapy. Within 2 weeks of therapy, he had abdominal symptoms like abdominal pain, loose stools, vomiting and hematochezia. Imaging showed dilated proximal bowel loops with fluid filled contents and prominent vessels in rectum. Emergency surgical exploration revealed thickened proximal jejunum with blood clots in the lumen. Resection of proximal jejunum was done. Histopathological examination of resected specimen was suggestive of AL amyloidosis. Post-surgical resection of jejunum, patient had initial improvement followed by deterioration. He was discharged against medical advice as per relative’s request. Hence an index of clinical suspicion of amyloidosis must been present in all Multiple myeloma patients.

Hand washing practices and techniques among health professionals in a tertiary hospital in Kano

Background: The simple act of hand washing has been proven to reduce the risk of acquiring hospital infection; especially with the current concern of Ebola viral disease. Hospital acquired infections have contributed significantly to overall mortality and morbidity and health care cost. They report that hand washing remains at an unacceptable low level in most medical environments; with large numbers of doctors and nurses routinely forgetting to wash their hands before touching patients. Transmission of health-care-associated infections often occurs via the contaminated hands of health care workers. Materials and Methods: It was a descriptive cross-sectional study carried out among randomly selected doctors and nurses in Aminu Kano Teaching Hospital; Kano. The questionnaires were administered to the respondents during their ward rounds or clinic sessions. Results: One hundred and forty health professionals comprising 98 nurses and 42 doctors were studied. About 64.4% of them were aware of the World Health Organization (WHO) global hand washing day but only 15% stated the date correctly. About 99.3% of them believed that if hand washing is done correctly it can reduce the risk of infection. All (100%) of the health professionals use water and soap or hand rubs as agents of hand washing. About 93.6% were taught hand washing technique and 47% were aware of the five moments in hand washing but only 17% of them could list the five moments in hand washing. Only 25.7% health professionals knew the correct steps of hand washing (?2 = 2.444; df = 2; P = 0.295). Ninety-one percent of the health professionals had seen posters on hand washing. Majority (72.1%) adhered to principles of hand washing (?2 = 0.015; df = 1; P = 0.902) while 82.1% wash their hands before touching patients (?2 = 2.841; df = 1; P = 0.092). However; most of them (95%) washed their hands after touching patients and 97% washed their hands after handling body fluids or secretions from patients. On the other hand; only 39% health professionals washed hands before wearing hand gloves (?2 = 0.321; df = 1; P = 0.571) but 95% washed hands after removing the hand gloves. Ninety-nine percent washed their hands after visiting or using the restroom. Conclusion: This study underscores the need for continuous information and education of health professionals on the importance WHO global hand washing day. As doctors and nurses are important in the health care team; it is important to provide the appropriate knowledge and training regarding preventive practices of infectious diseases. Training and retraining of health professionals on correct steps of hand washing will encourage and remind them on the importance of washing hands before wearing gloves and before touching patients to reduce the risk of infection and cross infection

Recurrent exudative pleural effusion with flare up of chronic hepatitis B virus infection

We describe herein a young male patient who presented with exudative pleural effusion that appeared with flare up of chronic HBV infection and spontaneously recovered with the clinical and biochemical improvement of the hepatitis on two occasions five months apart. Other causes of hepatitis and exudative pleural effusion were excluded with appropriate investigations