BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) is one of the commonest gastrointestinal emergencies.Endoscopy done within the first 24 hours of bleeding has been shown to be the most reliable means of establishing the source of upper gastrointestinal haemorrhage. This study was carried out to determine the aetiology and management outcome of patients with UGIB presenting at our facility located in Southwest Nigeria. MATERIALS AND METHOD: 67 patients who presented with UGIB and underwent upper gastrointestinal endoscopy between April 2010 and March 2011 at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Southwest Nigeria were retrospectively studied, relevant data extracted and analysed. RESULTS: The demographic data of the patients showed a mean age of 41.84± 12.81 years, (ages ranged from 17 to 75 years), 40 (59.7%) were males while 27 (40.3%) were females giving a male to female ratio of 1.5:1. Clinical presentations included haematemesis and melena in 26 (38.8%), followed by haematemesis in 22 (32.8%) and melena in 19 (28.4%) of the patients. Antral mucosal erosions were the commonest cause of UGIB (49%), followed by peptic ulcer disease (25.4%), varices (11.9%) and gastric mass (1.5%). No cause for UGIB was found in 8 cases (11.9%). Endoscopy diagnostic accuracy was greater within the first 24 hours of the bleeding onset compared to those who had it done later (p<0.003). Three patients died giving a mortality rate of 4.5%. These deaths were recorded from among the variceal bleeding group giving a mortality rate of 42.9% in this group of patients. CONCLUSION: Antral mucosal erosions were the commonest cause of UGIB in our environment. NSAIDS intake was very high among the populace, especially in mucosal erosion group leading to high morbidity, absent from work and huge financial cost. It is recommended that serious awareness campaigns be mounted to educate the populace of the dangers inherent in indiscriminate use of NSAIDS in our society. As endoscopy diagnostic accuracy was greater within the first 24 hours of the bleeding onset, it is equally recommended that early endoscopy should be performed within 24 h of the onset of bleeding.

Background: Globally, respiratory diseases are common causes of medical admissions. Our objective was to determine the causes and outcome of respiratory diseases in our facility for health planning, policy formulation and allocation of resources.

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Immune Reconstitution Inflammatory Syndromes (IRIS) are exaggerated pathological inflammatory reactions occurring after initiation of highly active antiretroviral therapy (HAART) due to exuberant immune responses to occult or apparent opportunistic infections or cancers. In view of paucity of studies from Nigeria, we report 3 cases of IRIS presenting as disseminated infections in HIV-1 infected patients initiating HAART. The first case was a previously healthy female who developed disseminated tuberculosis after 4 weeks of regular HAART. Her HAART regimen was continued and she improved after commencement of anti-tuberculosis drugs, with evidence of progressive increase in CD4 cell count. The second case was a HAART-experienced female who stopped her drugs for 4months. Two months after recommencement of her previous HAART regimen, she developed features of disseminated herpes zoster infection, despite evidence of decrease in viral load by 95%. HAART was continued and she recovered completely after receiving valaciclovir tablets and antibiotics. The third patient was a female student who was commenced HAART on account of chronic cough and weight loss. Three months after regular HAART, she developed features of disseminated Kaposi's sarcoma involving the skin, oropharynx and lungs, despite evidence of 42% increase in CD4 cell count. Unfortunately, she rapidly deteriorated and died during the course of management. Clinicians should be alert to the possibility of IRIS in HIV-infected patients initiated or re-initiated on HAART. There is need for future prospective studies determining risk factors for IRIS in HIV-infected patients from Nigeria.

Vitiligo is an acquired skin depigmenting disorder resulting from melanocytes loss in the epidermis, associated with an autoimmune aetiopathophysiology. However, there are limited data about the association between vitiligo and Epstein–Barr virus (EBV). Hence, the authors present a case of a 43-year-old male who had progressive symmetrical hypopigmented macules, sometimes coalescing to patches that were generalised but predominantly on the face and torso, with scanty involvement of proximal and distal extremities of the body. The diagnosis of vitiligo was made clinically, and seborrhoeic dermatitis was considered as a differential. Since the patient had been offered treatment for seborrhoeic dermatitis using antifungal with no relief and extensive depigmentation, the authors’ working diagnosis was vitiligo and was confirmed with histology. To establish the likely cause of the condition, viral serology for HIV, Cytomegalovirus, herpes, and EBV were completed, but only EBV serology was abnormal. Therefore, the authors report this case to encourage clinicians to consider EBV infection in the aetiology and predisposition for vitiligo to help explore other pathology that the virus may cause.