Pattern of paediatric dermatoses at dermatology clinics in Ile-Ife and Ilesha, Nigeria.

BACKGROUND: In developing countries, skin diseases are one of the most common causes of morbidity. AIM: A prospective descriptive study was conducted to determine the pattern of skin diseases in childhood and adolescents presenting to the outpatient dermatology clinics of Obafemi Awolowo University Teaching Hospitals Complex at Ile-Ife and Ilesha, Osun State. METHODS: Patients aged 2 weeks to 19 years attending the clinics between October 2009 and September 2012 were included. RESULTS: A total of 491 dermatoses were recorded in 441 patients. There were 244 (49.6%) males. Dermatophyte infections (17.1%), papular urticaria (6.7%), atopic dermatitis (6.3%), vitiligo (5.3%), acne (4.7%) and viral warts (3.7%) were the most frequent dermatoses. Skin infections and infestations, mostly dermatophyte infections and viral warts, accounted for 57.6% of the skin conditions. Of the non-infectious diseases, papular urticaria and atopic dermatitis were the most common. Dermatophyte infections were the most prevalent in children (25.8%), and acne vulgaris in adolescents (11.8%). CONCLUSION: Skin infections and infestations, mostly dermatophyte infections, were the most prevalent in children, and acne vulgaris in adolescents.

Pattern of dermatoses among inmates of Ilesha Prison, Nigeria.

AIMS AND OBJECTIVES: Dermatoses are common health problems in prisons and environmental conditions influence their prevalence and pattern. Hot and humid environment as obtains in the tropics, stress, and overcrowding are conditions that facilitate development of. The aim of this study was to determine the prevalence and pattern of dermatoses in a prison located in a tropical environment. MATERIALS AND METHODS: The study was done in May-July 2006 in a South-West Nigerian prison. Using a purpose designed questionnaire, information on sex, age, prison status, and number in rooms was obtained and inmates were clinically examined. RESULTS: Inmates studied were 305 (296 males and 9 females). Dermatoses were found in 221 inmates with overall prevalence of 72.5% (221/305). Infectious disorders were seen in 67.9% (150/221) and non-infectious in 32.1% (71/221). The diseases occurred in 72.9% (167/229) of awaiting trial persons and 72.9% (51/70) convicted persons. Overcrowding was more in cells (average sleeping area was 9.5 sq feet). Skin diseases affected 80.3% (61/76) of inmates in cells and 69.9% (160/229) in dormitory rooms.. About 71.2% (94/132) of inmates affected stay in five highly overcrowded dormitory rooms with infectious disorders in 48.5% (64/132). Dermatophyte infections were 34.3% of 332 dermatoses seen, pityriasis versicolor 14.5%, acne vulgaris 12.3%, dandruff 10.5%, 28.4%. A significant relationship was found with overcrowding and place where dermatoses were first noticed. CONCLUSION: Dermatoses are common health problem of prisoners, and prison conditions facilitate these problems.

Evaluation of protein adsorption on atmospheric plasma deposited coatings exhibiting superhydrophilic to superhydrophobic properties.

Protein adsorption is one of the key parameters influencing the biocompatibility of medical device materials. This study investigates serum protein adsorption and bacterial attachment on polymer coatings deposited using an atmospheric pressure plasma jet system. The adsorption of bovine serum albumin and bovine fibrinogen (Fg) onto siloxane and fluorinated siloxane elastomeric coatings that exhibit water contact angles (θ) ranging from superhydrophilic (θ < 5°) to superhydrophobic (θ > 150°) were investigated. Protein interactions were evaluated in situ under dynamic flow conditions by spectroscopic ellipsometry. Superhydrophilic coatings showed lower levels of protein adsorption when compared with hydrophobic siloxane coatings, where preferential adsorption was shown to occur. Reduced levels of protein adsorption were also observed on fluorinated siloxane copolymer coatings exhibiting hydrophobic wetting behaviour. The lower levels of protein adsorption observed on these surfaces indicated that the presence of fluorocarbon groups have the effect of reducing surface affinity for protein attachment. Analysis of superhydrophobic siloxane and fluorosiloxane surfaces showed minimal indication of protein adsorption. This was confirmed by bacterial attachment studies using a Staphylococcus aureus strain known to bind specifically to Fg, which showed almost no attachment to the superhydrophobic coating after protein adsorption experiments. These results showed the superhydrophobic surfaces to exhibit antimicrobial properties and significantly reduce protein adsorption.

Selenium and aspirin in people living with HIV and AIDS in Nigeria.

OBJECTIVES: Aspirin and selenium have been shown in vitro and in vivo to inhibit HIV production through inhibition of the transcription factor, the nuclear factor kappa binding (NF-eB). The aim of this study was to examine the efficacy or otherwise of these drugs in people living with HIV and AIDS (PLWAS) in resource limited countries. PATIENTS AND METHODS: Consenting HAART-naive PLWAS with mean CD4 count of 256.8 +/- 67.6 cells/ul were recruited into the study. Pretherapy blood count, serum biochemistry, chest x-ray, urinary glucose and protein and microscopy and culture of both urine and stool were checked in all cases. Each patient was treated for six months and CD4 counts were repeated at the end of the study. Thirty two patients (23 (72%) females and nine (28%) males), aged 22-52 (median = 36) years were recruited. Twenty-three (72%) were randomised into selenium and aspirin (SAM) and nine (28%) into selenium (SM); multivitamin was added to each arm. RESULTS: Eighteen (56.2%) patients completed the study. Sixteen (88.9%) patients are already on HAART since the termination of the study; one absconded and one died of disease progression. Fourteen (43.8%) of the initial 32 patients dropped out (11 (78.6%) were lost to follow-up, two (14.3%) died and one (7.1%) opted for HAART before completing the study). The post-treatment CD4 count was 293.0 +/-102.2 cells/ml, compared to the pre-therapy mean of 256.8 +/- 67.6 cells/ul, an average rise of 36.2 cells/ul, the difference was not statistically significant (p = 0.059). The post-therapy mean weight was significantly higher than the pretherapy weight, 61.6+/-15.2 kg versus 60.0+/-14.3 kg (p = 0.015). CONCLUSION: The SAM/SM combination regimen improved the quality of life of PLWAS, however, a greater number of patients and a longer period of follow up, are necessary to arrive at a more meaningful conclusion.

African histoplasmosis - masquerading as a malignant bone tumour.

A 23-year-old immunocompetent woman presented with a two-month history of fungating left shoulder and left elbow swellings associated with fever, weight loss and anaemia. X-rays showed lytic destruction of the lateral third of the left clavicle and distal half of the left humerus. Histology of biopsy specimen confirmed African histoplasmosis. The lesion resolved following treatment with ketoconazole.

Multifocal osteonecrosis in HIV/AIDS: a case report.

Many patients with Human Immunodeficiency Virus (HIV) Infection now live long due to the availability of antiretroviral drugs. This has resulted in many hitherto unknown complications being reported. We report a 56-year-old trader who presented with a seven-month history of pain in both shoulders and hips. Laboratory investigations and x-rays confirmed oesteonecrosis of both humeral heads and femoral heads in HIV/AIDS. She is presently on antiretroviral drugs and conservative management of her multiple joint disorders.

The search for a predictor of CD4 cell count continues: total lymphocyte count is not a substitute for CD4 cell count in the management of HIV-infected individuals in a resource-limited setting.

Total lymphocyte count (TLC) has been recommended as a substitute for CD4 cell count for the management of HIV-infected individuals living in resource-limited settings. To confirm this, 151 TLCs and CD4 cell counts were obtained from 109 patients who had not yet started treatment and analyzed. CD4 cell counts of <200 cells/mm3 were found in 42 cases (37.8%) with TLCs of > or =1200 cells/mm3. Thus, 1 in 3 individuals would have been deprived of needed treatment. Therefore, in this setting, TLC is not a reliable predictor of CD4 cell count in HIV-infected individuals.

Attitudes of patients towards voluntary human immunodeficiency virus counselling and testing in two Nigerian tertiary hospitals.

BACKGROUND: Despite new scientific evidence establishing the benefits of counselling and testing as key elements in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) prevention strategy, inappropriate HIV screening without consent and counselling is frequent in Africa. Presumed high rejection rate of HIV test has been adduced to this practice. OBJECTIVE: To determine the acceptability of HIV conselling and testing among Nigerians. METHODS: Consecutive sixty indigenous Nigerians aged 35.10+/-11.31 years with male: female ratio of 2:1, and made of clients with clinically suspected AIDS (20), diseases unrelated to AIDS (15), dermatological problems (10), sexually transmitted diseases (9), and asymptomatic persons (6) were studied. RESULTS: Fifty-three (88.3%) subjects gave informed consent to HIV screening. Of the 53 consenters, 32 (60.4%) were seropositive while 21 (39.6%) were seronegative. Five clients (9.4%) (1seropositive + 4 seronegative consenters) did not turn up for their results, and 2 (3.8%) seronegative consenters did not want to know their serostatus. The reactions to disclosure of seropositive results included grief 9 (28.1 %), indifference 8 (25 %), surprise 5 (15.6%), family concern 5 (15.6%), denial 3 (9.4%) and suicidal ideation 2 (6.3%). Thirteen (40.6%) seropositive clients showed willingness to disclosure of their serostatus to family members including the father (58%), senior brother (23%), wife (11%) and others (8%). Direct cost of screening was N400.00 (U$3.10) per client. An average of 18 minutes per client was spent on counselling. CONCLUSIONS: This study demonstrates the feasibility of VCT in Nigerian hospitals.

Clinical evaluation of Acalypha ointment in the treatment of superficial fungal skin diseases.

In an open non-comparative study to evaluate the efficacy and safety of Acalypha wilkesiana ointment in superficial fungal skin diseases, 32 Nigerian patients with clinical and mycological evidence of superficial mycoses were recruited. Twelve patients defaulted and were lost to follow up, while one patient withdrew because of intolerable excoriation at the site of the lesion. Of the 19 patients that completed the trial, clinical cure was achieved in 73.3% of the patients. The ointment was very efficacious in the treatment of Tinea pedis, Pityriasis versicolor and Candida intetrigo where the cure rate was 100% in each condition. It is recommended that Acalypha ointment can be used for the treatment of these superficial mycoses.

Paediatric HIV/AIDS in Ile-Ife, Nigeria.

OBJECTIVES: To determine the clinical features, modes of transmission and outcome of HIV infection in children. DESIGN: A descriptive study involving prospective HIV antibody screening. SETTING: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, a referral centre. SUBJECTS: Four hundred and one consecutive children aged three days to 17 years presenting with features of immunosuppression from January 1996 to October 2001. MAIN OUTCOME MEASURES: HIV seroprevalence and outcome in infected children. RESULTS: Twenty percent of the children studied were HIV seropositive. More females than males were HIV seropositive (p = 0.004). The probable mode of infection was vertical in 66, blood transfusion in 12 and sexual contacts in four; two children whose mothers were HIV seropositive had previously been transfused with unscreened blood. Of the presenting clinical features, weight loss or failure to thrive, persistent diarrhoea, and skin diseases were highly sensitive and specific with high positive predictive values. Marasmus was the only type of protein energy malnutrition seen in the infected children. Seven patients were discharged against medical advice and 26 were lost to follow up. Thirty seven (46.3%) died within four months of diagnosis mainly from pneumonia and septicaemia. Four patients are still being followed up and only one is receiving antiretroviral drugs. CONCLUSION: HIV infection is a cause of morbidity and mortality in Nigerian children and the main mode of infection is vertical. The presence of any combination of persistent diarrhoea, weight loss/failure to thrive and skin manifestations should arouse suspicion and could be used as a screening test for symptomatic HIV infection in Nigerian children.

A prevalence survey of skin diseases in Nigerian children.

A prevalence survey of 5001 Nigerian children aged 0-12 years seen at the Urban Comprehensive Health Centre, Ile-Ife, Nigeria between July 1995 and June 1996 revealed that 492 children (9.8%) had dermatological conditions. Tinea (17.1%), scabies (16.5%) and impetigo (15.7%) were the most commonly observed childhood skin diseases and were followed by miliaria (9.8%), eczema (7.1%) and diaper dermatitis (7.0%) respectively. The major predisposing factor to acquiring either tinea infection or scabies or impetigo by any of the affected children was the low socioeconomic conditions of their parents. The high prevalence of eczema in the high social classes could be attributed to the early exposure of the children to artificial milk in infancy. It is hoped that aggressive health educational programmes and improvement of the socioeconomic status of the people will bring about a decline in the prevalence of childhood skin diseases in Nigeria.

Prevalence of Mongolian spots in Nigerian children in Ile-Ife, Nigeria.

Three hundred and sixty nine Nigerian neonates and 484 Nigerian children aged 1 month to 14 years were examined for the presence of Mongolian spots. The spots were observed in 381 children (189 boys and 192 girls) with an overall incidence of 44.7% regardless of sex or age. The colour of the Mongolian spots varied from pale blue to grayish blue. The most frequently involved sites were the gluteal, sacrococcygeal and lumbar areas respectively. In our study, Mongolian spots were present in 74.8% of neonates and in 13.6% of pre-school children. There was a rapid disappearance in the incidence of Mongolian spots with advancing age. No case of Mongolian spot was recorded in children aged 6 years and above. Primipara whose children have Mongolian spots should be reassured that the spots are harmless and would usually disappear in early childhood. Physicians should however be alert to marks resulting from child abuse as these could mimic the spots.

Scabies: revisit in a depressed economy.

Scabies is a highly contagious disease of the skin caused by an ectoparasite arthropod called Sarcoptes scabiei var hominis. It has a world-wide distribution and affects all ages with no specific gender predisposition. Scabies is of public health interest because certain environment factors such as overcrowding, poor hygiene, delayed treatment of primary cases and lack of public enlightenment are conducive to its spread. However, prompt and adequate therapy is rewarding and prevents spread.

Chloroquine-induced pruritus in malaria fever: contribution of malaria parasitaemia and the effects of prednisolone, niacin, and their combination, compared with antihistamine.

AIMS: Chloroquine treatment of malaria fever, results in a generalized pruritus of unknown mechanism in up to 60% of adult Africans, by contrast pruritus is unusual in Caucasians following chloroquine use. METHODS: We conducted a double-blind, randomized, parallel group study to examine and compare the antipruritic effects of promethazine, niacin, prednisolone and their combination on pruritus induced by chloroquine, in 28 historical itching patients with parasitologically proven malaria fever. We also evaluated the role of the antecedent malaria parasite density in the severity of chloroquine pruritus intensity. RESULTS: The concurrent administration of chloroquine (2.1 g base total dose) with prednisolone caused a statistically significant reduction in the pruritus AUC (0, 72 h) (P < 0.001 ANOVA) compared with the antihistamine promethazine alone. The areas under the pruritus intensity-time curve were promethazine 105 +/- 28 (units h), niacin 76 +/- 22, prednisolone 28 +/- 24, and prednisolone and niacin 34 +/- 17 (P < 0.001 ANOVA). The 95% confidence interval for the difference in the pruritus AUC between prednisolone and promethazine was 8.4 to 145.6 units h. There was a statistically significant and positive correlation between the pruritus intensity (AUC 0, 72 h) and the malaria parasite load in the itching subjects, not receiving prednisolone (n = 9) (r = 0.73, P = 0.026 ANOVA). CONCLUSION: A single oral dose of prednisolone (10 mg) may be preferable to the antihistamine promethazine (25 mg) as an antipruritic agent for concurrent prescription with chloroquine in individuals predisposed to severe itching. Malaria parasite clearance and clinical amelioration were unaffected by any of the treatments.

Actinic keratosis: a case of sun damage in the tropics.

Sun damaged to the skin in the tropics is not an uncommon event. There is need for a high index of suspicion especially in patients with outdoor occupations. Prompt diagnosis and therapy will prevent progression to a cancerous state. We report a case of cutaneous horns secondary to actinic keratosis, a pre-cancerous condition relatively uncommon in Black skin. The importance of histological support in its diagnosis cannot be over-emphasized.

Seizures associated with filariasis.

A case of epileptic seizures associated with multiple filariasis is presented. The possibility of an aetiological association between epileptic seizures and filariasis is explored in the light of available published literature.

An open non-comparative pilot study of the safety and efficacy of oral fluconazole in the treatment of dermatophyte infections in Nigeria

In an non-comparative study to assess the efficacy and safety of oral fluconazole in superficial fungal diseases of the skin; 82 adult Nigerian patients (58 males and 24 females) with clinical and mycological diagnosis of dermatomycoses were enrolled for the trial. Sixty-five patients completed the trial and each of them received a daily dose of 50mg fluconazole for a period of 4 weeks. An overall 90 per cent cure rate was observed in patients with other forms of dermatomycoses and 80 per cent for patients with pityriasis versicolor. The drug was well tolerated by all the patients and very few side effects were noticed