Calciphylaxis: case report and literature review.

Tissue calcification is a well-recognized common metabolic disease, but calciphylaxis still remains an enigmatic rarity. The latter may be induced experimentally and acquired naturally in human diseases. Although many chronic azotemic or end stage renal disease patients (ESRD) with hyperparathyroidism (HPT) are at risk of calciphylaxis not all of them do develop the disease, even non-renal, patients may also develop this disease. Out of a total of about 2000 hemodialysis, 15,000 dermatology and 26,000 medical patients seen over a three year period in a busy Saudi Arabian tertiary medical centre, we report a sentinel nephrology patient with sudden excruciatingly painful cutaneous calciphylaxis that necessitated acute dermatology emergency consultation, and present a review of the medical literature. In order to institute appropriate total quality management of this life-threatening, rare disease, it is advisable that a high index of suspicion should be entertained by dermatologists, general physicians, nephrologists, and pulmonologists in an appropriate clinical scenario.

Serum immunoglobulins in Nigerian epileptic patients on phenytoin therapy

This prospective study documents serum immunoglobulins (IgA; IgG and IgM) in 32 Nigerian epileptic patients who had been on phenytoin therapy for a period ranging from 1 to 6 years; 22 epileptic patients that were not on treatment and 20 healthy controls. The patients on phenytoin therapy showed significantly lower mean value of IgA when compared to normals and epileptic controls. There was no significant difference in the values of IgA and IgM between patients on phenytoin therapy and controls. IgA deficiency occurred in one patient on treatment. This result is of clinical significance since IgA deficiency is associated with respiratory tract and gastrointestine infections

Sexually transmitted diseases in clinic patients in Lagos.

In a study of patients attending an STD referral clinic in Lagos, Nigeria, the age distribution was similar to that seen on other parts of the world and the male-to-female ratio was 1.3:1. Non-specific genital infection was diagnosed in about 59% of patients and gonorrhoea in 19%. Most strains of Neisseria gonorrhoeae were sensitive to penicillin (1 unit) and the six relatively penicillin-resistant strains did not produce penicillinase. Candidosis and trichomoniasis were each diagnosed in about 10% of patients and latent syphilis in 1.4% (four cases). Genital warts were also uncommon; venereophobia and other conditions accounted for 1% and 2.2% of cases respectively.

PIP: The study population comprised 276 patients who were either referred to a sexually transmitted diseases clinic or invited to attend through contact-tracing between October 1976 and December 1977. 156 (57%) were men and 120 (43%) women. 43% (119) of the patients were aged between 16 and 29 years. Urethral specimens were collected from all men who presented with urethral discharge using a sterile cotton-wool swab passed into the anterior urethra; the swab was plated directly on to plates of Thayer-Martin (Oxoid) and chocolate agar medium. In women, specimens were obtained with a swab from the cervical os and vaginal vault under direct vision with a Cusco's speculum and processed as above. A wet preparation of the genital discharge was examined for Trichomonas vaginalis, Candida albicans, and parasites, and specimens showing yeast cells were plated on Sabouraud's agar; C albicans was identified by the germ-tube test. Serum from each patient was tested by the Venereal Disease Research Laboratory test and Reiter protein complement fixation test. The most common diagnosis was non-specific genital infection, in 164 (59.4%) of the 276 patients. Gonorrhea was diagnosed in 53 (19.2%) patients and candidosis and trichomoniasis each in 29 (10.5%). Antitreponemal antibodies were detected in 1.4% of patients; all were cases of latent syphilis. Venereophobia, lymphogranuloma venereum, genital warts, and a miscellaneous group of conditions accounted for the remainder of cases. More than one diagnosis was confirmed in 6.5% of patients. Analysis of the source of infection showed that 34.1% of all patients contracted infection through casual partners whom the patients had met only once and could not name or trace; regular partners and prostitutes were the source of infection in 11.6% and 19.2%, respectively. Four strains of N gonorrhea had a minimum inhibitory concentration (MIC) of 0.075-0.3 mcg/ml and two strains an MIC of or= 0.6 mcg/ml. None of the six strains that were relatively resistant to penicillin produced beta-lactamase.

The secular changes of skin and venereal diseases in Nigeria.

A retrospective review of the changing phase of the incidence of dermatological and venereal diseases, as seen in University Teaching Hospital practice in Lagos, Nigeria is presented. About 8,849 new patients were seen over a 5-year-period. An analysis of the dermatological conditions encountered is made, while brief reports of few common skin conditions are also given. The clinical pattern was similar to those of Western countries, but with addition of a great number of dermatoses. This similarity has been modified by epidemiological factors. A national program for improvement of the environmental health including control of industrial and communicable diseases will ameliorate the increasing morbidity of tropical dermatology.