Willingness to enroll and pay for community-based health insurance, decision motives, and associated factors among rural households in Enugu State, Southeast Nigeria.

Background: Over 70% of Nigeria's population is poor and rural, and most lack financial risk protection against ill health. Community-based health insurance (CBHI) may be an essential intervention strategy for ensuring that quality healthcare reaches the informal and rural populations. Aim: This article explores the willingness to enroll (WTE) and willingness to pay (WTP) for CBHI by community members, their decision considerations, and associated factors in Enugu State, Nigeria. Materials and Methods: We adopted a cross-sectional survey design with a multi-stage sampling approach. A validated and pre-tested questionnaire was used to elicit information from the respondents. WTE and WTP for CBHI was determined using the bid contingent valuation method. A test of correlation/association (Chi-square and ordinary least square regression) was conducted to ascertain the relationship between WTP for CBHI and other variables at a 95% confidence interval. The socioeconomic status index was generated using principal component analysis. A test of association was conducted between the demographic characteristics and WTE and WTP variables. Key Findings: A total of 501 household heads or their representatives were included in the study which yielded a return rate of 98.2%. The finding showed that most (92.4%) of the respondents indicated a WTE in CBHI. 86.6% indicated a willingness to pay cash for CBHI, while 84.4% indicated a willingness to pay other household members for CBHI. There was a significant association between gender, marital status, education, location, and willingness to pay. The study shows that 81.6% of the respondent stated that qualified staff availability motivates their WTE/WTP for CBHI, while 78.1% would be willing to enroll and pay for CBHI if services were provided free, and 324 (74.6%) stated that proximity to a health facility would encourage them to enroll and pay for the CBHI. Conclusion: This community demand analysis shows that rural and peri-urban community members are open to using a contributory mechanism for their health care, raising the prospect of establishing CBHI. To achieve universal health coverage, policy measures need to be taken to promote participation, provide financial and non-financial incentives and ensure that the service delivery mechanism is affordable and accessible. Further studies are needed to explore ways to encourage participation and enrollment in CBHI and other contributory schemes among under-served populations and improve access to and utilization of healthcare services.

Burden of COVID-19 Pandemic on Adolescents' Quality of Life: A Cross-Sectional Study among Secondary School Students in North-Central Nigeria.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) has caused millions of mortalities globally. Although the prevalence and fatality rates of COVID-19 among adolescents is low, its impact on their health-related quality of life (HRQoL) is not adequately known. This study was carried out to determine the burden COVID-19 pandemic has on the HRQoL of adolescents. METHODS: A cross-sectional descriptive study was carried out among adolescents in public and private secondary schools in Jos North Local Government Area of Plateau State. A multistage sampling technique was employed to select the schools and recruit the participants in April/May 2021. Data was collected using a self-administered questionnaire containing the participants' socio-demographic characteristics, questions on being burdened by COVID-19 pandemic, and the KIDSCREEN-10 tool for assessing the HRQoL. The data was analyzed using SPSS version 25.0 and a p-value of < 0.05 was regarded as significant. RESULTS: A total of 405 adolescents participated in the study with a mean age of 14.6 ± 2.06 years. Majority (52.8%) of the participants were girls. More than half (53.3%) of the participants reported being burdened by the COVID-19 pandemic. Also, 45.7% of the participants experienced a lower HRQoL. There was a statistically significant association between being burdened by the COVID-19 pandemic and their HRQoL (χ2 = 7.108, p = 0.01). In addition, the participants' HRQoL was significantly associated with their age (χ2= 5.112, p = 0.02). CONCLUSION: This study highlights the significant burden of COVID-19 pandemic on adolescents' wellbeing. Therefore, there is the need to intensify health intervention strategies among adolescents to reduce the physical, emotional, and mental burden imposed by the COVID-19 pandemic in order to optimize their quality of life.

CONTEXTE: La maladie de coronavirus 2019 (COVID-19) a causé des millions de décès dans le monde. Bien que la prévalence et les taux de mortalité du COVID-19 chez les adolescents soient faibles, son impact sur leur qualité de vie liée à la santé (QVLS) n'est pas suffisamment connu. Cette étude a été menée pour déterminer le poids de la pandémie de COVID-19 sur la QVLS des adolescents. MÉTHODES: Une étude descriptive transversale a été menée parmi les adolescents des écoles secondaires publiques et privées de la région de Jos North Local Government Area de l'Etat du Plateau. Une technique d'échantillonnage à plusieurs degrés a été utilisée pour sélectionner les écoles et recruter les participants en avril/mai 2021. Les données ont été collectées à l'aide d'un questionnaire auto-administré contenant les caractéristiques sociodémographiques des participants, des questions sur le fardeau que représente la pandémie de COVID-19, et l'outil KIDSCREEN-10 pour évaluer la qualité de vie. Les données ont été analysées à l'aide de SPSS version 25.0 et une valeur p < 0,05 a été considérée comme significative. RÉSULTATS: Un total de 405 adolescents ont participé à l'étude avec un âge moyen de 14,6 ± 2,06 ans. La majorité (52,8%) des participants étaient des filles. Plus de la moitié (53,3%) des participants ont déclaré être accablés par la pandémie de COVID-19. En outre, 45,7 % des participants ont connu une baisse de leur qualité de vie. Il y avait une association statistiquement significative entre le fait d'être accablé par la pandémie de COVID-19 et leur QVLS (χ2 = 7,108, p = 0,01). De plus, la QVLS des participants était significativement associée à leur âge (χ2 = 5,112, p = 0,02). CONCLUSION: Cette étude met en évidence le poids important de la pandémie de COVID-19 sur le bien-être des adolescents. Il est donc nécessaire d'intensifier les stratégies d'intervention sanitaire auprès des adolescents pour réduire le fardeau physique, émotionnel et mental imposé par la pandémie de COVID-19 afin d'optimiser leur qualité de vie. Mots clés: Adolescents, École secondaire, COV ID-19, Qualité de vie liée à la santé (QVLS), Jos.

Epidemiologic Characteristics, Clinical Features and Outcomes of COVID 19: Patients Admitted at the Asokoro District Hospital Isolation and Treatment Center, Abuja, North Central Nigeria.

BACKGROUND: The COVID -19 pandemic spread rapidly across the globe, making a land-fall on the Nigerian geo-space in early 2020. Key presenting features were; fever, dry cough, fatigue, myalgia, headache, sore-throat, abdominal pain, diarrhea, dyspnoea amongst others, with a clinical spectrum ranging from mild through severe forms. Aside infection control and supportive care, there was no specific therapy until trials with Remdesivir. Studies have described limited epidemiological findings, presentations and outcomes of COVID patients in Nigeria and elsewhere, but not for the Federal Capital Territory, (FCT) specifically Abuja, the Nation's capital city and the second epicenter of the pandemic in Nigeria. The objective of this study therefore, was to describe the Clinical and demographic characteristics of the patients admitted at the Asokoro District Hospital (ADH), Abuja. METHODS: Retrospective study that used records of patients admitted, between April and September 2020. Data include; Socio-demographics, medical history, exposure, residential area, co-morbidities, symptoms, signs, treatment measures, duration of hospital stay and outcomes. RESULTS: 270 patients were enrolled for this study. 170(63%) males and 100(37%) females. Mean age was 40.03+13.5years. Forty-one(15.2%) had travel history while 99(36.7%) had contact with confirmed cases. Majority of the patients were married(63.33%), and had tertiary education(74.82%). Commonest symptoms were cough(43.33%), fever(36.67%), headaches(32.22%) and fatigue(31.48%). The duration of stay at the ADH ranged from 2 hours to 28 days. CONCLUSION: Our patients were young, mainly of the upper class, educated people with mild to severe disease. There was one death, a case with multiple comorbid factors.

CONTEXTE: La pandémie COVID-19 s'est propagée rapidement à travers le globe, faisant une chute sur le géo-espace Nigérian au début 2020. Les principales caractéristiques de présentation étaient les suivantes : fièvre, toux sèche, fatigue, myalgie, maux de tête, maux de gorge, douleurs abdominales, diarrhée, dyspnée, entre autres, avec un spectre clinique allant de doux à travers des formes sévères. En dehors de la lutte contre l'infection soins, il n'y avait pas de traitement spécifique avant les essais avec Remdesivir. Des études ont décrit des résultats épidémiologiques limités, présentations et résultats des patients atteints de COVID au Nigeria et ailleurs, mais pas pour le Territoire de la capitale Fédérale, plus précisément Abuja, la Capitale de la nation et épicentre de la pandémie au Nigeria. L'objectif de cette étude par conséquent, était de décrire le clinique et démographique caractéristiques des patients admis dans le district d'Asokoro Hôpital (ADH), Abuja. MÉTHODES: Étude rétrospective utilisant les dossiers des patients admis, entre avril et septembre 2020. Les données comprennent : Sociodémographie, antécédents médicaux, exposition, quartier résidentiel, comorbidités, symptômes, signes, mesures de traitement, durée de séjour à l'hôpital et des résultats. RÉSULTATS: 270 patients ont été inscrits pour cette étude. 170 (63 %) hommes et 100 (37 %) femmes. L'âge moyen était de 40,03 + 13,5 ans. Quarante et un (15,2 %) avaient des antécédents de voyage, tandis que 99 (36,7 %) avaient des contacts avec cas confirmés. La majorité des patients mariés (63,33 %) et ayant fait des études supérieures (74,82%). Les symptômes les plus fréquents étaient la toux (43,33 %), la fièvre (36,67 %), maux de tête (32,22 %) et fatigue (31,48 %). Durée du séjour à l'ADH variait de 2 heures à 28 jours. CONCLUSION: Nos patients étaient jeunes, principalement de la partie supérieure de la classe, des gens instruits atteints de maladies bénignes à graves. Il y avait un décès, un cas avec de multiples facteurs comorbides. MOTS-CLÉS: Socio-démographie, caractéristiques cliniques, résultats, Patients de la COVID, Abuja-Nigeria.

Significance of the difference in the estimates of glomerular filtration rate obtained using different models.

OBJECTIVE: Chronic kidney disease (CKD) prevalence is rising in Nigeria. Most cases are diagnosed as end stage disease despite availability of formulae to estimate glomerular filtration rate (GFR). Existing formulae, none of which is modelled on Nigerian variables, give different estimates. This study tests the significance of the difference in the estimates obtained using Modified Diet in Renal Disease (MDRD) Study and Chronic Kidney Disease-Epidemiology (CKD-Epi) formulae. METHODOLOGY: This is a cross-sectional study. Data on age, gender, and serum creatinine were used to estimate GFR. Paired sample t test was used to check for difference in means, Pearson correlation test for correlation and Bland and Altman plot for systematic bias. Simple linear regression was used to check for presence and significance of proportional bias. RESULTS: Of the 166 patients studied, 62 were males and 104 were females. Mean age was 49.06 years ± 15.26. Youngest was 18 years and the oldest 81 years. Mean eGFR of 69.4 and 72.77 ml/min/1.73m2 for MDRD and CKD-Epi models respectively differed significantly, P < 0.001. Bland and Altman plot showed lack of agreement of eGFR estimates from the two models with significant bias of -3.37ml/min/1.73m2 despite good correlation, r = 0.984. There was significant proportional bias, P < 0.001. CONCLUSION: MDRD significantly underestimated GFR compared to CKD-Epi in a Nigerian population. This bias was proportional and increased as mean eGFR increased. MDRD and CKD-Epi models do not agree in their measurements of eGFR and should not be used interchangeably. There is urgent need for further studies to develop GFR estimating model on Nigerian variables.

Knowledge and practice of waste management among hospital cleaners.

BACKGROUND: Poor knowledge and practice of waste management among hospital cleaners is a significant occupational and public health risk which could be improved by better training. AIMS: To assess private hospital cleaners' knowledge and practice of hospital waste management and the association with training. METHODS: A cross-sectional study using an interviewer-administered structured questionnaire was undertaken. The questionnaire was designed to record demographics, assess knowledge and assess self-reported practice and training by private hospital cleaners in Etiosa in Nigeria. Results were analysed with SPSS20 using chi-squared tests. RESULTS: Ninety-eight hospital cleaners out of 135 participated (response rate 73%), of whom 81% reported that they had received training. Forty-nine per cent had good knowledge, while 90% self-reported good practice. Statistical analysis showed a significant negative association between training and knowledge (χ2 = 11.1, P < 0.01). There was no significant association between knowledge and practice. CONCLUSIONS: This group of cleaners reported good practice but knowledge was negatively associated with training. This may be related to the nature of training. The study found a knowledge gap, exposing these hospital cleaners to occupational risks which appropriate training has the potential to prevent. Collaboration to produce effective training programmes is recommended.

Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States.

Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once-daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost-effectiveness of EBR/GZR in treatment-naïve and treatment-experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg-IFN/RBV) using a computer-based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000-2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg-INF/RBV were based on wholesale acquisition cost. All costs were from a third-party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver-related complications, liver transplantation, kidney transplantation, end-stage live disease mortality and end-stage renal disease mortality; lifetime quality-adjusted life years (QALY); and incremental cost-utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg-IFN/RBV. EBR/GZR-based regimens resulted in higher average remaining QALYs and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg-INF/RBV (10.2857, $186 701). Peg-IFN/RBV is not cost-effective, and the ICUR of EBR/GZR compared with NoTx was $13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR ($217 000/QALY). Assuming a threshold of $100 000 per QALY gained for cost-effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost-effective in the United States.

Development of solvent exposure index for construction painters.

This article describes methodological approaches for reconstructing long-term occupational exposure to organic solvents among construction painters. A detailed exposure questionnaire was administered to 125 painters to develop a job exposure matrix (JEM). The questionnaire inquired about painting activities with solvent-based paints and use of protection equipment for the previous 25 years in 5-year intervals. Current and historical distributions of solvent air concentrations were assessed for the same time period based on the following information: industrial hygiene measurements, paint composition changes, and VOC emission rate changes from architectural and industrial maintenance coatings. Changes in protection factors of respirators were also assessed. A cumulative solvent exposure index was calculated for each painter through Monte Carlo simulations by combining appropriate input distributions of solvent air concentrations and protection factors of respirators with JEM. Sensitivity simulations revealed that the historical variations in solvent air concentrations had a higher impact on the cumulative solvent exposure index than changes in protection factors for respirators. Fifty-eight percent of painters were classified with a different exposure quartile when the solvent exposure index was used vs. an exposure based only on years using solvent-based paints, suggesting the need for more detailed exposure analysis than just years working when conducting epidemiologic studies for this worker population.

Systemic sclerosis in an Afro-Caribbean population: a review of demographic and clinical features.

OBJECTIVE: To assess the clinical and selected demographic features of patients with systemic sclerosis (SS) seen over a 10-year period at the Rheumatology service of the Queen Elizabeth Hospital, Barbados. To compare these data with what is known to obtain in other ethnic populations. DESIGN AND METHODS: A chart review involving all patients who were found to have SS based on the American College of Rheumatology clinical criteria was conducted between 1996 and 2006. RESULTS: Twenty-seven patients with SS were identified in this predominantly Afro-Caribbean population. The prevalent and incident cases numbered 10 and 17 respectively. Twenty-six of these patients were female and the mean age at diagnosis was 37.3 years. Diffuse cutaneous involvement was seen in 63% of cases and limited cutaneous involvement in 37%. The most common clinical features in descending order of frequency were Raynaud's phenomenon, gastroesophageal reflux, pigmentary skin changes, digital pitting/ulceration, telangiectasia and pulmonary disease. CONCLUSION: In a predominantly Afro-Caribbean population, SS was uncommonly seen, had a marked female preponderance and an earlier age of onset than that seen in Caucasian populations. As expected, diffuse disease was the more common subtype and digital pitting, pigmentary skin changes, and pulmonary disease were amongst the most frequent clinical features. Telangiectasia were found more frequently than the literature suggests is typical for patients of African descent.

Real-world use of elbasvir-grazoprevir in patients with chronic hepatitis C: retrospective analyses from the TRIO network.

BACKGROUND: Elbasvir-grazoprevir is indicated for chronic hepatitis C virus (HCV) genotypes 1 and 4. AIM: To evaluate the utilization and outcomes of chronic HCV patients treated with elbasvir-grazoprevir in the United States. METHODS: We conducted a retrospective cohort study of adults treated with elbasvir-grazoprevir with or without ribavirin for chronic HCV genotypes 1 or 4 infection. Data were collected from healthcare providers and specialty pharmacies through Innervation Platform, a proprietary, cloud-based disease management program from Trio Health. The primary endpoint was per protocol sustained virological response 12 weeks post-treatment (SVR12). RESULTS: Among 470 patients treated in 2016, 95% had HCV genotype 1 infection, 80% (373/468) were HCV treatment naïve and 70% (327/468) had non-cirrhotic disease. Almost 3 quarters (73%) of patients received care in community practices. The majority (89%) of patients received elbasvir-grazoprevir for 12 weeks. Per protocol SVR12 rates were 99% (396/402) for HCV genotype 1 and 95% (21/22) for HCV genotype 4. Among patients with Stage 4 or 5 chronic kidney diseases, 99% (113/114) achieved SVR12. In univariate analyses, variables significantly associated with per protocol SVR12 for the entire sample were therapy duration (P = 0.001), treatment experience (P = 0.016), and cirrhosis status (P = 0.001). However, among HCV genotype 1 patients, no variables were significant. Intent-to-treat SVR12 rates were 89% (396/447) for HCV genotype 1 and 91% (21/23) for HCV genotype 4. CONCLUSION: Elbasvir-grazoprevir is highly effective, and in this 2016 cohort, its use was predominantly in patients with HCV genotype 1 and as a 12-week therapy without ribavirin.

The cost-effectiveness of testing for NS5a resistance-associated polymorphisms at baseline in genotype 1a-infected (treatment-naïve and treatment-experienced) subjects treated with all-oral elbasvir/grazoprevir regimens in the United States.

BACKGROUND: The presence of baseline NS5A resistance-associated variants (RAVs) impacted treatment response in HCV genotype 1a (GT1a)-infected patients treated with elbasvir/grazoprevir (EBR/GZR) for 12 weeks, but not patients treated with EBR/GZR and ribavirin (RBV) for 16 weeks. AIMS: To assess the cost-effectiveness of baseline testing for NS5A RAVs in EBR/GZR-treated patients compared without testing, and with current treatments for GT1a patients. METHODS: We simulated the course of treatment with EBR/GZR, ledipasvir/sofosbuvir (LDV/SOF) and ombitasvir/paritaprevir/ritonavir+dasabuvir (3D) with or without RBV and natural history of disease of GT1a patients. Treatment-related data from clinical trials were used in a state-transition model of the natural history of chronic HCV GT1a infection and liver disease to project lifetime costs (US$2015) and quality-adjusted life years (QALY). Other clinical and economic inputs were estimated from published sources. We conducted base case and sensitivity analyses. RESULTS: RAVs testing-guided treatment with EBR/GZR resulted in more QALYs than EBR/GZR without testing, 3D+RBV, or LDV/SOF8. This strategy was cost-saving relative to 3D+RBV or LDV/SOF8 and was cost-effective compared with EBR/GZR without testing. LDV/SOF12 was not cost-effective compared with the EBR/GZR RAVs testing-based strategy. Treatment with EBR/GZR guided by RAVs testing is the most effective regimen among treatment-experienced patients without cirrhosis and cirrhotic patients. In sensitivity analysis, RAVs testing was cost-effective in 48-55% and 63-85% among noncirrhotic and cirrhotic patients respectively. CONCLUSIONS: RAVs testing before treatment with EBR/GZR is likely to be a cost-effective alternative to the use of EBR/GZR without testing, LDV/SOF, or 3D among GT1a treatment-naïve or treatment-experienced patients.

In vitro properties of ciprofloxacin suppositories formulated with glycerogelatin and theobroma oil bases.

Ciprofloxacin suppositories formulated with glycerogelatin approximately nd theobroma oil bases were evaluated for in vitro bioavailability in 0.01N sodium hydroxide (pH approximately 10) and in phosphate buffer (pE- approximately 7.8). The release of ciprofloxacin from the two bases under conditions which simulated the conditions in the rectum was assessed using isolated pig rectum. The release of ciprofloxacin was faster from theobroma oil base than from glycerogelatin base using 0.01N sodium hydroxide as the dissolution medium. The cumulative amount of ciprofloxacin released was markedly reduced from each of the two bases in the presence of isolated pig's rectum and in phosphate buffer.

Molecular identification of a novel family of human Ig superfamily members that possess immunoreceptor tyrosine-based inhibition motifs and homology to the mouse gp49B1 inhibitory receptor.

The co-cross-linking of gp49B1, a member of the Ig superfamily containing immunoreceptor tyrosine-based inhibition motifs, with the high affinity Fc receptor for IgE on mouse bone marrow culture-derived mast cells inhibits IgE-dependent exocytosis and lipid mediator generation. We now describe the cloning of human cDNAs homologous to the mouse gp49 family. A human monocyte cDNA library was probed with the mouse gp49A cDNA, which is 97% identical with mouse gp49B1, to obtain a homologous partial cDNA that was then used to identify and clone full-length cDNAs from monocyte and human lung cDNA libraries. The 1.6-kbp cDNA, HM18, predicts a 49-kDa type 1 integral membrane protein that, like mouse gp49B1, contains two extracellular C2 type Ig superfamily domains and two consensus immunoreceptor tyrosine-based inhibition motifs in the cytoplasmic domain. ALIGN analysis of the amino acid sequence of the extracellular domains showed that HM18 belongs to a family that includes mouse gp49, the bovine Fc receptor for IgG2, the human myeloid Fc receptor for IgA, and the human NK cell inhibitory receptors. The gene encoding HM18, in common with the genes for the human Fc receptor for IgA and the human NK cell inhibitory receptors, was localized to chromosome 19q13.4. Two other closely related cDNAs, each with four C2 Ig superfamily domains, were characterized. Transcripts for these novel Ig superfamily members were identified in peripheral blood monocytes, the THP-1 monocytic cell line, human lung, human lung mast cells, and NK cells. The data suggest that HM18 is a novel mononuclear cell inhibitory receptor homologous to mouse gp49B1.

Genomic organization of the human leukocyte immunoglobulin-like receptors within the leukocyte receptor complex on chromosome 19q13.4.

The leukocyte immunoglobulin (Ig)-like receptors (LIRs) comprise a family of cell surface receptors that couple to either activating or inhibitory signals depending on the nature of their transmembrane and cytoplasmic domains. We describe the organization and fine localization of the genes for LIR-1 and LIR-5, which are inhibitory receptors, and LIR-6, which is an activating receptor. The genomic organization of all three genes is highly conserved from the signal peptide through the membrane-proximal Ig domain but diverges thereafter depending on the inhibitory or activating nature of the gene product. The 3' untranslated region of the gene for LIR-6 contains a 37-base pair repeat not present in the LIR-1 or LIR-5 genes. 5' rapid amplification of cDNA ends defined the putative transcription initiation site of the LIR-5 gene, which is TATA-less. A nucleotide substitution in the LIR-5 gene led to loss of an intron present in the 5' untranslated region of the LIR-1 and LIR-6 genes. Differences in the genomic structure of these three LIR genes suggests possible mechanisms for their differential expression in cells of hematopoietic lineage. The three genes are in a region of Chromosome 19q13.4 that is immediately centromeric of the killer cell Ig-like receptor genes and are separated from one another by approximately 20 to 30 kb, suggesting that they arose by gene duplication from a common ancestor.

A 14-year-old Nigerian female with idiopathic intracranial hypertension (Pseudotumor cerebri or benign intracranial hypertension).

A 14-year-old secondary school girl presented with acute onset severe generalized headache associated with vomiting and diplopia. These followed an initial fever, which responded to chloroquine. She had been on peflacine for a left knee septic arthritis until onset of her symptoms. The main findings on physical examination were mild obesity, left abducent nerve palsy, bilateral papilledema and evidence of resolving arthritis of her left knee. The results of her investigations, including a brain CT scan were within normal limits. A diagnosis of IIH was made. She responded satisfactorily to oral acetazolamide with complete resolution of her symptoms and signs within 12 days of hospitalization and 2 weeks of follow-up.

Systemic sclerosis in an Afro-Caribbean population: a review of demographic and clinical features / Esclerosis sistémica en la población afrocaribeña: un estudio de las características demográficas y clínicas

OBJECTIVE: To assess the clinical and selected demographic features of patients with systemic sclerosis (SS) seen over a 10-year period at the Rheumatology service of the Queen Elizabeth Hospital, Barbados. To compare these data with what is known to obtain in other ethnic populations. DESIGN AND METHODS: A chart review involving all patients who were found to have SS based on the American College of Rheumatology clinical criteria was conducted between 1996 and 2006. RESULTS: Twenty-seven patients with SS were identified in this predominantly Afro-Caribbean population. The prevalent and incident cases numbered 10 and 17 respectively. Twenty-six of these patients were female and the mean age at diagnosis was 37.3 years. Diffuse cutaneous involvement was seen in 63% of cases and limited cutaneous involvement in 37%. The most common clinical features in descending order of frequency were Raynaud's phenomenon, gastroesophageal reflux, pigmentary skin changes, digital pitting/ulceration, telangiectasia and pulmonary disease. CONCLUSION: In a predominantly Afro-Caribbean population, SS was uncommonly seen, had a marked female preponderance and an earlier age of onset than that seen in Caucasian populations. As expected, diffuse disease was the more common subtype and digital pitting, pigmentary skin changes, and pulmonary disease were amongst the most frequent clinical features. Telangiectasia were found more frequently than the literature suggests is typical for patients of African descent.

OBJETIVO: Evaluar los rasgos clínicos y las características demográficas seleccionadas de pacientes con esclerosis sistémica (ES) atendidos por un periodo de 10 años en el Servicio de Reumatolog?ía del Hospital Queen Elizabeth Hospital, Barbados. Comparar estos datos con lo que se conoce que existe en otras poblaciones étnicas. DISEÑO Y MÉTODOS: Entre 1996 y 2006, se llevó a cabo una revisión de historias clínicas, la cual abarcó a todos los pacientes a quienes se les diagnosticó ES, sobre la base de los criterios clínicos del Colegio Americano de Reumatología. RESULTADOS: Se identificaron veintisiete pacientes con ES en esta población predominantemente afrocaribeña. Los casos prevalentes e incidentes ascendieron a 10 y 17 respectivamente. Veintiséis de estos pacientes fueron hembras y la edad promedio en el momento del diagnóstico fue 37.3 años. En 63% de los casos se observó compromiso cutáneo difuso, en tanto que en el 37% se observó compromiso cutáneo limitado. Los rasgos clínicos más comunes en orden descendente de frecuencia fueron el fenómeno de Raynaud, el reflujo gastroesofágico, cambios de pigmentación de la piel, ulceración digital, telangiectasia y enfermedad pulmonar.