A Rare Case of Acute Myeloid Leukemia Initially Presenting With Fever of Unknown Origin and Rapidly Progressing Pericardial Effusion.

This case report highlights a patient who had persistent fevers for weeks and rapidly progressing pericardial effusion following a positive test for coronavirus disease 2019 (COVID-19) two weeks before presentation to the hospital. The initial thought was that her fever was of infectious etiology, but relevant investigations led to the diagnosis of acute myeloid leukemia (AML). AML, which is characterized by clonal expansion of immature "blast cells" in the peripheral blood and bone marrow resulting in ineffective erythropoiesis and bone marrow failure, is the most prevalent form of leukemia. It is the most aggressive form of leukemia, which has varying prognoses determined by the subtypes. This report explores the association between AML, fever of unknown origin, and pericardial effusion, shedding light on a notable clinical aspect. Fever in AML may be attributed to underlying inflammatory processes, cytokine dysregulation, or bone marrow failure. Recognition of fever as a potential indicator of AML contributes to enhanced clinical vigilance. Pericardial effusions and cardiac tamponade, although rare, can be a presenting feature of AML, and can present side by side with fever of unknown origin as seen in this case report.

A Rare Case of Extra-Medullary Portacaval Plasmacytoma in a Patient With Relapsed Multiple Myeloma.

Multiple myeloma (Kahler disease) is a monoclonal plasma cell immunoproliferative neoplasm originating within the bone marrow that involves the production of monoclonal immunoglobulins, mostly IgG and IgA. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms that can develop in patients at the time of diagnosis with multiple myeloma, or relapse of the disease. Symptoms related to plasmacytomas depend on the primary location. Here in, we present a rare case of extramedullary plasmacytoma involving the portacaval space in an 83-year-old African American female with relapsed multiple myeloma. She was treated successfully with radiation therapy with complete resolution of the mass. In this case report, we aim to discuss the clinical features along with diagnostic methods and treatment for extramedullary plasmacytomas with emphasis on utilizing a multidisciplinary approach in managing these rare cases.

Antimicrobial Usage in Smallholder Poultry Production in Nigeria.

The indiscriminate use of antimicrobials in livestock production is of increasing concern due to the threat of antimicrobial resistance in both humans and animals. Much emphasis has been placed on intensively managed poultry production systems, which routinely use antimicrobials as against smallholder poultry production systems (SPPS). Therefore, this study investigated the use of antimicrobials among smallholder poultry farmers in Nigeria, and compared the prevalence of antimicrobial drug use against the practice of ethnoveterinary medicine (EVM). A cross-sectional study was conducted in five states (agroecologies) of Nigeria using structured questionnaires administered on a total of 350 farmers. The practice of EVM was prevalent among most of the farmers (39%). The western method (pharmaceuticals) was practiced by a large proportion of farmers (60%), either solely (25%) or in combination with EVM (35%). Antimicrobials were used primarily for treatment and prevention of diseases (78%). Semi-scavenging system of production had the highest proportion (49%) of farmers using antimicrobials, compared to semi-intensive (37%) and scavenging (14%) systems. Gender (χ 2 = 9.30, p = 0.01), and location (χ 2 = 216.86, p ≤ 0.001), influenced farmers' choice of methods for bird treatment. Education (odds ratio [OR] odds ratio [OR] 3.06, 95% CI 2.10-4.44), income (OR 1.99, 95% CI 1.10-3.59) and management system (OR 1.97, CI% 1.1-3.45) were most associated with antimicrobial use. Critically important antibiotics, with lower to higher risk of antimicrobial resistance, were used by farmers (40%). These findings showed the indiscriminate use of antimicrobials by farmers and the potential risk of antimicrobial resistance within the SPPS in Nigeria.

Extra-Medullary Hematopoiesis in Sickle Cell Disease Presenting as a Right Adrenal Mass.

Extramedullary hematopoiesis can occur during normal fetal development or as a compensatory mechanism in chronic anemia when the primary sites of hematopoiesis fail. When it occurs, it is mostly seen in sites such as the liver, spleen, and lymph nodes. Extramedullary hematopoiesis is seen in patients with abnormal morphology of red blood cells like thalassemia and abnormal red blood cell shape like hereditary spherocytosis. The incidence of extramedullary hematopoiesis in sickle cell disease is very rare. We report a case of focal adrenal extramedullary hematopoiesis in a 21-year-old patient with sickle cell disease who presented with pain in the right thorax. A retroperitoneal mass was seen in the MRI of the abdomen of the patient suggestive of extramedullary hematopoiesis. Our case highlights the importance of physician awareness of this rare pathology for proper diagnosis and management.

Acute Myeloid Leukemia in a Patient With Human Immunodeficiency Virus-Related High-Risk Myelodysplastic Syndrome.

The human immunodeficiency virus (HIV) is a retrovirus that infects a subset of T lymphocytes referred to as CD4 T-helper cells. This insult to the quantity and quality of T lymphocytes leads to a significant compromise of the immune system and the development of an environment of abnormal immune activation. This aberrancy in the immune system increases the susceptibility to developing various malignancies. Hematological abnormalities like cytopenias are among the most common complications of HIV and acquired immunodeficiency syndrome (AIDS)-related lymphoid malignancies. Myelodysplastic syndrome (MDS), a disease of ineffective hematopoiesis causing dysplastic cells and hypercellular bone marrow, manifesting as pancytopenia, has been described in patients with HIV but is poorly documented in the medical literature. We present the case of a middle-aged male with longstanding HIV who developed severe pancytopenia secondary to high-risk MDS and eventually progressed to and died from acute myeloid leukemia (AML), a phenomenon infrequently reported as associated with HIV/AIDS. Patients with HIV/AIDS and cytopenias should get a detailed hematological evaluation so as not to miss or delay the AML diagnosis.

Dilemma of Anticoagulation Therapy in Mild or Asymptomatic COVID-19 Cases.

Severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) infection can be a life-threatening disease, which has emerged as a public health hazard. Thrombotic events have been reported in hospitalized patients with severe disease however scarce data is available regarding the screening of thromboembolic disease and pulmonary embolism in those with mild or asymptomatic infection. Herein, we describe the development of pulmonary embolism in two asymptomatic patients with COVID-19 and suggest the need for close monitoring and anticoagulation to prevent this life-threatening complication.

Production performance and survivability of six dual-purpose breeds of chicken under smallholder farmers' management practices in Nigeria.

Chickens kept under free-range, backyard or semi-intensive systems in the developing countries have more diverse use and benefits to rural households. Their use varies from region to region and from community to community within a region. The study investigated growth, laying performance and survivability of six improved dual-purpose breeds in five agroecologies of Nigeria represented by the following states: Kebbi (Sudan savanna/northern Guinea savanna); Kwara (northern Guinea savanna/southern Guinea savanna); Nasarawa (southern Guinea savanna/derived savanna); Imo (lowland rainforest/swamp); and Rivers (freshwater swamp/mangrove swamp). On-farm data were obtained from 2100 smallholder poultry farmers that received an average of 30 birds (mixed sexes) of any one of the following dual-purpose breeds (Fulani, FUNAAB Alpha, Kuroiler, Noiler, Sasso and Shika-Brown) randomly allocated to them. The farmers used the backyard, scavenging system of management. Body weight and mortality records for cocks were taken for 18 weeks, while body weight, mortality, egg production and egg weight data were collected for hens up to 72 weeks. Compared with the local cocks (680 g), Kuroiler (1391 g), Sasso (1398 g) and Noiler (1461 g) had over 200 % body weight at 18 weeks. Hen day egg production (HDEP) was higher in Shika-Brown (45.9 %), FUNAAB Alpha (45.8 %) and Kuroiler (45.7 %) compared with the other breeds. Fulani, FUNAAB Alpha and Shika-Brown had higher survivabilities ( p < 0.05 ) than Noiler, Sasso and Kuroiler. Ranking of the breeds for growth, laying performance and survivability was as follows: Shika-Brown/Sasso  >  FUNAAB Alpha/Noiler  >  Kuroiler  >  Fulani. The performance of the breeds was significantly ( p < 0.05 ) influenced by the agroecologies. The cock body weights for Fulani (1121.1 g), FUNAAB Alpha (1502.4 g) and Noiler (1459.2 g) were highest in Kebbi, while for Kuroiler (1561.0 g), Sasso (1695.9 g) and Shika-Brown (1131.6 g) cock body weights were highest in Imo. Across the states, Imo had the highest HDEP (62.8 %). Overall, the lowland rainforest/ freshwater swamp agroecologies supported the highest production performance of the breeds.