A convoluted path to the diagnosis of hepatocellular carcinoma in a resource-limited setting.

Worldwide, chronic hepatitis B virus infection remains the main aetiology of hepatocellular carcinoma, while human immunodeficiency virus may hasten the evolution of hepatocellular carcinoma in those co-infected with hepatitis B virus/human immunodeficiency virus. We describe a 29-year-old female with unmonitored hepatitis B virus infection for over 5 years, human immunodeficiency virus disease on a tenofovir-based antiretroviral regimen for 11 months, who presented with a 2-week history of epistaxis and abnormal vaginal bleeding, associated with unintentional weight loss of 4 months duration. After extensive investigation, a definitive diagnosis of hepatocellular carcinoma was established based on histopathological assessment in the presence of a positive hepatitis B envelope antigen, mildly raised alpha feto-protein, and a non-cirrhotic liver. Periodic surveillance for hepatocellular carcinoma in patients with chronic hepatitis B virus infection is important, particularly in those with evidence of actively replicating hepatitis B virus for early detection and implementation of curative therapies to reduce mortality and morbidity.

Severe iron deficiency anaemia caused by hookworm infestation - a case report - case report

Iron deficiency anaemia is a common clinical problem referred to gastroenterologists for diagnostic evaluation. While hookworm infestation is a known cause of chronic gastrointestinal blood loss, affected patients are usually asymptomatic and only 10% develop anaemia.1,2 Herein we present a case of recurrent profound iron deficiency anaemia caused by hookworm infestation

Exposure to Human Immunodeficiency Disease. What Precautions for the Healtcare Professional?

: The Human Immunodeficiency Virus (HIV) epidemic is more pronounced in sub- Saharan Africa. The ever-increasing prevalence of HIV infection and the continued improvement in clinical management has increased the likelihood of these patients being managed by healthcare workers. The aim of the review was to assess current literature on the risks of transmission of HIV infection and protection of the healthcare worker.Methods: A literature review was performed using MEDLINE articles addressing `human immunodeficiency virus'; `HIV'; `Acquired immunodeficiency syndrome'; `AIDS'; `HIV and Surgery'. We also manually searched relevant surgical journals and completed the bibliographic compilation by collecting cross references from published papers.Results: Transmission is by contamination with body fluids for example needle-stick injury and blood splashes. The risk of HIV transmission from patient to healthcare worker always exists. The risk of transmission is very small and depends on the type of discipline and type of procedure. Hollow needles are more dangerous than suture needles. Sero-conversion is; however; very minimal. Universal precautions are emphasised. In case of needle-stick injury or splash it is important that affected healthcare workers take post-exposure prophylaxis.Conclusion: Occupational HIV transmission is lower than that for other infections. However; protection of all health care personnel should be the prime objective. Universal infection control guidelines must be accepted and strictly enforced. A prompt response to blood contact is crucial and post-exposure prophylaxis is essential