Change in Prevalence and Pattern of Peptic Ulcer Disease in the Northern Savannah of Nigeria: An Endoscopic Study.

Background: Peptic ulcer disease (PUD) is common worldwide. Its incidence and prevalence have been declining in recent years in developed countries, and a similar trend has been observed in many parts of Africa including Nigeria. Aim: This study aimed to provide an endoscopic update on PUD in the Northern Savannah of Nigeria and compare with past reports from the region and recent reports from Nigeria, Africa, and the rest of the world. Methods: Upper gastrointestinal endoscopy records of consecutive patients diagnosed with PUD between January 2014 and September 2022 at an endoscopy unit of a tertiary institution in North-West Nigeria were retrieved and demographic data, types of peptic ulcer, and their characteristics were extracted and analyzed. Results: Over a 9-year period, 171/1958 (8.7%) patients were diagnosed with PUD: mean age 48.8 years (range 14-85), 68.4% male, and 70% >40 years. 59.6% were gastric ulcers (GU), 31.6% duodenal ulcers (DU), and 8.8% were both. The mean age of patients with GU was slightly higher than those with DU (49.9 years vs. 46.6 years, P = 0.29); patients aged <40 years were significantly more likely to be diagnosed with DU than GU (54.7% vs. 33.9%, P = 0.016) while those >40 years significantly more GU than DU (74.6% vs. 54.7%, P = 0.016). There were no significant gender differences between GU and DU. Conclusion: The prevalence and pattern of PUD in Northern Savannah of Nigeria have changed - patients were predominantly male and older, and GU predominated.

Résumé Fond: L'ulcère gastro-duodénal (UIP) est courant dans le monde entier. Son incidence et sa prévalence ont diminué ces dernières années dans les pays développés et une tendance similaire a été observée dans de nombreuses régions d'Afrique, y compris au Nigeria. Avoir pour but: Fournir une mise à jour endoscopique sur l'ulcère peptique dans la savane du nord du Nigéria et comparer avec les rapports antérieurs de la région et les rapports récents du Nigéria, d'Afrique et du reste du monde. Méthodes: Les dossiers d'endoscopie gastro-intestinale supérieure de patients consécutifs diagnostiqués avec PUD entre janvier 2014 et septembre 2022 dans une unité d'endoscopie d'un établissement tertiaire du nord-ouest du Nigeria ont été récupérés et les données démographiques, les types d'ulcère peptique et leurs caractéristiques ont été extraits et analysés. Résultats: Sur une période de neuf ans, 171/1 958 (8,7 %) des patients ont reçu un diagnostic de PUD : âge moyen 48,8 ans (extrêmes 14 ­ 85), 68,4 % hommes, 70 % > 40 ans. 59,6 % étaient des ulcères gastriques (UG), 31,6 % des ulcères duodénaux (UD) et 8,8 % étaient les deux. L'âge moyen des patients avec GU était légèrement plus élevé que ceux avec DU (49,9 ans contre 46,6 ans, P = 0,29) ; les patients âgés de < 40 ans étaient significativement plus susceptibles d'être diagnostiqués avec DU que GU (54,7 % contre 33,9 %, P = 0,016) tandis que ceux de > 40 ans étaient significativement plus GU que DU (74,6 % contre 54,7 %, P = 0,016) . Il n'y avait pas de différences significatives entre les sexes entre GU et DU. Conclusion: La prévalence et le schéma du PUD dans la savane du nord du Nigéria ont changé - les patients étaient principalement des hommes et plus âgés, et les GU prédominaient. Mots-clés: Ulcère peptique, épidémiologie, Kaduna-Nigeria, Ulcère gastrique, Ulcère duodénal.

Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings.

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. Methods: We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. Results: We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10-88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Conclusion: Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.

Résumé L'hémorragie gastro-intestinale haute (UGIB) est une urgence médicale courante et l'endoscopie gastro-intestinale haute (UGIE) rend diagnostic et traitement possibles; la réalisation de cette procédure dans les 24 heures suivant le saignement est considérée comme la norme de soins pour la prise en charge de cette condition. L'accès à l'endoscopie haute améliore le pronostic de la maladie. Méthodes : Nous présentons notre expérience et nos résultats de réalisation UGIE chez les patients référés pour UGIB à une nouvelle unité d'endoscopie dans un centre tertiaire du nord-ouest du Nigeria. Âge, sexe, raisons de l'orientation, l'intervalle entre l'endoscopie et le dernier épisode hémorragique connu et les résultats endoscopiques ont été obtenus à partir des dossiers d'endoscopie. Résultats : Nous réalisé CELU chez 204 patients pour UGIB sur une période de 7 ans : âge moyen 45,5 ans (extrêmes 10­88 ans), 61,8 % hommes, 54,8 % < 50 ans. Suite les patients (81,3 %) ont eu une endoscopie sept jours ou plus après le dernier épisode hémorragique connu et aucun n'a eu d'endoscopie dans les 24 heures. Oesophagien et des varices gastriques ont été trouvées chez près de 30% des patients tandis qu'un ulcère peptique a été trouvé chez 23%. La gastropathie hypertensive portale était trouvé chez 12,7% des patients qui avaient tous aussi des varices oesophagiennes ou gastriques. Érosions de la muqueuse gastrique (7,4 %) et malignité gastrique (6,4 %) étaient d'autres découvertes notables. Aucune anomalie significative n'a été détectée chez 11,8 % des patients. Conclusion : Saignement de l'œsophage/gastrique les varices et les ulcères peptiques étaient les signes les plus fréquents chez nos patients. Il y a eu un retard dans la réalisation de l'endoscopie et l'amélioration L'accès à l'endoscopie et la formation contribueront grandement à relever certains des défis que nous avons identifiés. Mots-clés: Endoscopie, hémorragie non variqueuse, saignement gastro-intestinal supérieur, endoscopie gastro-intestinale supérieure, hémorragie variqueuse.

Tolerance and acceptance for unsedated diagnostic upper gastrointestinal endoscopy in Kaduna, North-West Nigeria.

Background: Upper gastrointestinal endoscopy (UGIE) using pharyngeal anesthesia, with or without sedation to improve tolerance and acceptance, is now standard practice but the unsedated examination is easier to perform, costs less and is associated with fewer complications. It is, therefore, attractive in resource-limited settings like sub-Saharan Africa but studies about tolerance and acceptance of unsedated UGIE there are limited. Objective: The objective of this study was to report the tolerance and acceptance of unsedated UGIE in a tertiary institution in Kaduna, Nigeria. Methods: Consecutive patients referred for diagnostic UGIE were requested to report the overall level of discomfort for the procedure on verbal and visual analogue scales and to indicate whether they would accept the procedure in the future. Their pulse rate, oxygen saturation and blood pressure were monitored. Results: Of 306 patients (mean age: 45.5 years, 39.2% <40 years, 57.5% of females), 51.3% reported no or mild discomfort and only 5.6% reported severe and intolerable discomfort. Overall, 232 (75.8%) tolerated the procedure well and 229 (79.5%) accepted to have the same procedure in the future. Patients <40 years and those with secondary/post-secondary education were significantly less likely to tolerate the procedure well than older patients (81.1% vs. 87.9%, P = 0.006) and those with lower education (72.7% vs. 86.2%, P = 0.032), respectively. 79.5% accepted to have the procedure in the future, with males significantly more so than females (86.9% vs. 74.4%, P = 0.019). Conclusion: Most patients undergoing unsedated diagnostic UGIE in Kaduna, Nigeria, tolerated the procedure well and accepted to have the same procedure in the future.

Psoriasis in Kaduna, North-West Nigeria: A twenty-year experience.

Background: Psoriasis is a chronic inflammatory skin disease which may be associated with joint, cardiovascular, metabolic or psychiatric disease. Countries in North America, Northern Europe and Australia have the highest burden of disease while those in Asia, South America and Africa, the lowest. We report our experience of psoriasis in Kaduna, Nigeria, over 20 years and compare this with previous reports in the same area and in other parts of Nigeria and Africa. Objective: To report the relative incidence, clinical presentation, severity and associations of psoriasis seen over 20 years. Methods: A retrospective review of records of patients with psoriasis seen at two outpatient dermatology clinics in Kaduna, North-West Nigeria, over 20 years. Results: Diagnosis of psoriasis was made in 218 of 39,037 (0.6%) patients with new skin disease: Mean age 35.2 years, range (6 months to 80 years), 60% <40 years, males constituted 64.2%. Mean age of onset was 30.5 years with a quarter developing psoriasis before age 20 and 71.4% before 40 years. Psoriasis presented earlier in females than males (mean age of onset 27.6 vs. 32.2 years, P= 0.052) but was less severe. Psoriasis types were: Plaque 88.1%, guttate 6%, erythrodermic 4.6% and sebopsoriasis 0.9%. Only four patients had joint disease and other associations were infrequent. Overall, 80.3% had mild psoriasis and 13.2% had a family history. Conclusion: Psoriasis remains a rare and mild disease in Kaduna and is infrequently associated with joint and other systemic disease but similar in other respects to the condition elsewhere.

Eruptive neurofibromas in pregnancy.

Neurofibromatosis type 1 is the most common inherited nervous system disorder affecting 1 in 3500 live births. Cutaneous neurofibromas, the most characteristic feature of the disease, begin to appear in adolescence and continue throughout adulthood. Although neurofibromas have been noted to increase in size or number during pregnancy, there have been very few reports of eruption of a large number of lesions during this period. We report a case of a 24-year-old Nigerian woman of 32-week gestation who presented with a history of sudden eruption of neurofibromas during the current pregnancy and the previous one 3 years earlier. We discuss how hormones and growth factors contribute to the increase in numbers of neurofibromas during pregnancy, which is occasionally severe, as in our case, and the complications which may arise in the mother and fetus.

Résumé La neurofibromatose de type 1 est le trouble du système nerveux héréditaire le plus répandu, touchant 1 naissance sur 3 500 naissances vivantes. Les neurofibromes cutanés, la caractéristique la plus caractéristique de la maladie, commencent à apparaître à l'adolescence et se poursuivent à l'âge adulte. Bien que l'on ait noté une augmentation de la taille ou du nombre des neurofibromes au cours de la grossesse, très peu de cas d'éruption d'un grand nombre de lésions ont été rapportés au cours de cette période. Nous rapportons le cas d'une femme nigérienne de 24 semaines de gestation nigérienne présentant des antécédents d'éruption soudaine de neurofibromes au cours de la grossesse en cours et la précédente trois ans plus tôt. Nous discutons de la manière dont les hormones et les facteurs de croissance contribuent à l'augmentation du nombre de neurofibromes pendant la grossesse, parfois sévère, comme dans notre cas, ainsi que des complications pouvant survenir chez la mère et le fœtus.

Sparfloxacin-induced nail pigmentation: A case of fixed drug eruption?

Sparfloxacin, a synthetic, second generation, broad spectrum aminodifluoroquinolone antibiotic, has excellent penetration into respiratory tissues and has good activity against Gram-positive, Gram-negative, and atypical bacteria. Although it is indicated for the treatment of adult community-acquired pneumonia and acute exacerbation of chronic bronchitis, its use has been limited by phototoxicity which is more common with it than with other quinolones. We report a case of a 20-year-old Nigerian woman who developed a diffuse blue-black nail pigmentation of thumb and big toe nails, 2 weeks after completing therapy with sparfloxacin, and a recurrence of the pigmentation in the same nails 1 year after taking the drug again. We think this is likely a case of subungual fixed drug eruption. We briefly discuss the causes and mechanisms of drug-induced nail pigmentation in general.

Knowledge, perception, and practice of patients about pityriasis versicolor in Kaduna, North Central Nigeria.

BACKGROUND: Although pityriasis versicolor (PV) is a common fungal infection of the skin affecting up to 50% of the population in the tropics, little is known about what patients know, believe, or feel about the condition. METHODS: In a cross-sectional questionnaire study of 608 consecutive patients attending the General Outpatient Department and Skin Clinic of a public hospital in Kaduna, Nigeria, self-report of PV, knowledge about its causes, treatments used by patients, and perception and feelings about the condition were assessed. RESULTS: Overall 608 patients were studied (239/594 [40.2%] males, 355/594 [59.8%] females, age 11-49 years, mean ± SD age of 29.3 ± 10.1). Lifetime self-report prevalence of PV was 271/606 (44.7%) (males: 117/239 [50.0%] females: 148/355 [41.7%] P = 0.09). Three hundred and twenty-seven of 608 (53.8%) patients believed PV was transmitted from another person while 204/608 (33.6%) believed the condition was caused by poor personal hygiene. One hundred and thirty of 608 (21.4%) thought PV was caused by fungi living on the skin. Virtually all respondents who had PV had used at least one preparation with more than half visiting a healthcare facility. A total of 305/608 (50.2%), 189/608 (31.1%), and 142/608 (23.4%) respondents reported feeling or likely feeling uncomfortable, embarrassed, or ashamed, respectively, about PV. Being considered a dirty person (45.6%) and being avoided by other people (28%) were common concerns of respondents. CONCLUSION: Most patients did not know what caused PV, and many were uncomfortable, embarrassed, and ashamed, and feared being considered dirty and avoided by others.

Acne vulgaris in Nigerian adolescents--prevalence, severity, beliefs, perceptions, and practices.

BACKGROUND: Community-based studies of acne vulgaris conducted in many parts of the world show that it is very common in adolescents but little is known from Africa. METHODS: In a cross-sectional study, 539 randomly selected students aged 11-19 years in a secondary school in Kaduna, Nigeria were administered a questionnaire to assess self-report of acne, its severity and impact; beliefs and perceptions of causes, and treatments used. 418 students were later examined to detect and grade acne severity. RESULTS: 274 (50.8%) were male while 265 (49.2%) were female. Mean age for respondents was 16 years. 320 students (59.4%) self-reported acne. Of 418 students examined, 379 had acne giving a prevalence of 90.7%. There was no significant gender difference in prevalence at all ages of adolescence. Prevalence of acne increased with age (76.7% at age 10-13 years; 88.2% at age 14-16 years; 97.1% at age 17-19 years). 353 of 379 (93.1%) had mild acne while 26 of 379 (6.9%) had moderate acne. The severity of acne was similar in boys and girls. 47.7% of students reported feeling "very sad/unhappy" about their acne although in more than 70% of those who self-reported, this did not interfere with relationship with family, friends or school work. Diet was the commonest factor believed to cause acne. Cleansing agents were the most commonly used treatments. CONCLUSIONS: Acne vulgaris is very common in Nigerian adolescents, although it is mild acne in most.

Change in pattern of skin disease in Kaduna, north-central Nigeria.

BACKGROUND: We report our experience on the pattern of skin disease in Kaduna, north-central Nigeria over a 6-year period, and compare it with a similar survey conducted in the same area 30 years ago and with surveys from Nigeria and from other parts of Africa. METHODS: The medical records of new patients attending the dermatology outpatient clinics of Barau Dikko Specialist Hospital and Habbat Medical Center from March 2000 to December 2005 were retrieved. Demographic data (age and sex) and the diagnoses of skin disease were extracted and analyzed. RESULTS: A total of 5982 cases was seen. Forty-nine per cent were males and 51% were females. One-third of the patients were aged under 20 years, and three quarters were aged below 40 years. Eczematous dermatitis was the most common skin disorder seen, making up 35% of cases, and had replaced dermatophyte infections and scabies, which were the most dominant skin diseases 30 years previously (now constituting 6% and 1.4% of cases, respectively). Atopic dermatitis had more than doubled in frequency (13.8% vs. 5.2%), and contact dermatitis had tripled in frequency (5.8% vs. 1.8%). Acne vulgaris (6.7%), pigmentary disorders (3.9%), urticaria (3.6%), papular urticaria (3.6%), hair disorders (3.3%), lichen simplex chronicus (3%), viral warts (2.9%), and drug eruptions (2.7%) had also increased. Human immunodeficiency virus-related skin disease constituted 4.3% of cases, with pruritic papular eruption being the most common condition. CONCLUSION: These changes in skin disease can be attributed mainly to an increase in urbanization and improved socio-economic conditions.

Bowen's disease: report of a case in a Nigerian man.

Bowen's disease (cutaneous squamous cell carcinoma in situ), like other cancers of the skin, is rare in black people--to our knowledge, only about 43 cases have been published in the medical literature. We report a 59-year old Nigerian man who presented with a five-year history of a mildly pruritic, slowly enlarging well-circumscribed plaque on the lower part of the anterior region of the chest on the right side. The lesion had an irregular crusted periphery and an atrophic hypopigmented centre. Histological examination confirmed a diagnosis of Bowen's disease. No predisposing factor was found to be relevant in this case--although he might have had brief occupational exposure to arsenic, it is unlikely that this was the cause of his disease. The published literature on Bowen's disease in blacks is briefly reviewed.