Disseminated vitiligo developing around Kaposi sarcoma nodules in an AIDS patient.

Vitiligo and other autoimmune disorders are increasingly being reported in a background of immunosuppression. Viral-induced immune activation and molecular mimicry are the proposed mechanisms for the development of autoimmune diseases in individuals infected with human immunodeficiency virus (HIV). An association of vitiligo with Kaposi sarcoma (KS) rarely has been reported. The development of vitiligo preferentially around KS lesions in a patient with AIDS is unusual. We report a case of disseminated vitiligo that developed around KS nodules in a patient with AIDS.

Xanthoma disseminatum in a black African woman.

PURPOSE: To report a partial steroid response of xanthoma disseminatum in a black African woman. DESIGN: Case report and literature review. METHODS: Histopathologic study of cutaneous tumour and clinical follow-up. RESULTS: A 32-year-old black African woman with mucocutaneous xanthomatosis and dysphonia, which partially responded to treatment with steroids. CONCLUSIONS: Xanthoma dissseminatum is a rare condition for which there is no medical treatment. We reported the condition in a black African woman whose skin and CNS symptoms regressed remarkably within 22 weeks of steroid therapy.

Prognostic factors in typhoid ileal perforation: a prospective study of 53 cases.

BACKGROUND: Typhoid ileal perforation remains a serious complication of typhoid enteritis with high morbidity and mortality in many tropical countries. AIMS AND OBJECTIVES: To determine the prognostic factors in typhoid perforation in Kano, Nigeria. METHODOLOGY: Fifty-three consecutive patients with typhoid perforation managed surgically were prospectively studied at the general surgical unit of Aminu Kano Teaching Hospital Kano, from March 2004 to February 2006. RESULTS: There were 26 (49.1%) males and 27 (50.9%) females, with age range of 2-55 years and a mean +/- SD of 12.2 +/- 10.2 years. The morbidity was 49.1% and the most common postoperative complications included wound infection, wound dehiscence, burst abdomen, residual intra-abdominal abscesses and enterocutaneous fistula. Mortality was 15.1% and was significantly affected by multiple perforations, severe peritoneal contamination and burst abdomen (p value <0.05, odds ratio >1). The mean duration of hospital stay for survivors was 16.1 days with a range of 8-57 days. CONCLUSION: This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment.

Gun violence in Nigeria: a focus on ethno-religious conflict in Kano.

We investigated small arms and light weapons (SALW) in Africa by reviewing the situation in Nigeria and conducting a small study in one hospital in the country's north. Published reports about SALW in Nigeria suggest that several social, economic, and political factors have caused a marked increase in gun-related violence, including ethno-religious tensions, the response of security forces to criminal activity, and growing economic disparity. In Kano, a northern city that has been the focal point of communal riots between Christians and Muslims, we found that firearm injuries were linked to these riots. We recommend increased outreach to disenfranchised youth, addressing the use of firearms by security forces, and addressing the political and economic disparity between ethnic and religious groups.

Surgical pathology of schistosomiasis.

Schistosomiasis remains an important health problem in many tropical countries and is being seen with increasing frequency in immigrant populations and tourists in developed countries. The pattern of organ involvement and clinical presentation of schistosomiasis in 80 patients (male: female, 9:1) during a five-year period (2001-2005) was examined from archival histopathology records. The urinary bladder was the most common organ affected [50 (62.5%)]. Gastrointestinal, male and female genital schistosomiasis were detected in 12 (15%), eight (10%) and five (6.1%) cases, respectively. Hematuria was the most common presenting symptom [34 (42.5%)], and bladder cancer was the only malignancy found to be associated with the infection. A high clinical index of suspicion usually allows for a preoperative diagnosis where indicated and avoidance of radical surgery. While research for the development of an effective vaccine continues, a plea is made for the expansion of multinational control programs in sub-Saharan Africa.

The triad-iodine deficiency, hyperlipidaemia, high coronary risk- in a 'maternal-neonate' population of rural Africa.

In order to see the pattern of changes in differential serum lipid and lipoprotein fractions as a risk marker of coronary complication in paired 'maternal-neonate' blood samples in an iodine deficient zone, 26 pregnant women and their corresponding new born infants at term delivery from the iodine deficient Bassa region of Plateau state, Nigeria were assessed and the results were compared with those seen in a similar 44 group of women and their newborns assessed in non lodine deficient region of Jos. The serum thyroid function and lipid and lipoprotein profiles were determined by 'ELISA' and 'enzymatic' methods respectively. Urinary iodide excretion level was also measured in 14 pregnant women in Bassa, 23 pregnant women in Jos and 16 non pregnant control from Jos. Results indicate that the pregnant women assessed in Bassa were iodine deficient (P<0.01) and their thyroid status was strikingly reduced as reflected by a drop in serum level of T4/TBG ratio (P<0.01) and a rise in TSH (P<0.005) in comparison to that seen in Jos. There was marked hypertriglyceridaemia and total hypercholesterolaemia (P<0.005), with differential significant rise in LDL cholestotol fraction (P<0.005) in the women assessed in Bassa as compared to Jos. The HDL cholesterol however dropped less significantly in the group (P<0.05) with a concurrent marked rise (P<0.001) in the serum ratio of LDL cholesterol/HDL cholesterol, total cholesterol/HDL cholesterol and triglycerides/HDL cholesterol in the lodine deficient group. A similar pattern of changes were seen in the corresponding neonates in the Bassa group as compared to Jos group. It is concluded that the pregnant women and their newborn offsprings living in a longstanding environmental iodine deficiency run a higher risk of developing coronary complications than those living in non endemic region. It is striking that such newborns surrounded by a continued state of lodine deficient may at a later adult-period of life develop marked risk of coronary complication and other features of hyperlipidaemias associated with varying thyroid insufficiency and accompanied iodine deficiency disorders. Prophylaxis measures as intervention has been highlighted.

AIDS mortality in a tertiary health institution: A four-year review.

Africa contains 70% of adults and 80% of children living with AIDS in the world and has buried 75% of the 21.8 million worldwide who have died of AIDS since the epidemic began. Nigeria, the most populous country in Africa, has 5.8% of her adult population having HIV infection at the end of 2003. We reviewed the causes of death among AIDS patients in Aminu Kano Teaching Hospital Kano, Nigeria over four years. Four-hundred-fifty-five (9.9%) of the 4,574 adult medical admissions were due to HIV/AIDS-related diagnosis. HIV/AIDS admissions increased progressively from 45 cases in 2001 to 174 in 2004. HIV/AIDS caused 176 deaths over the period giving an HIV-related mortality of 38.7%. This also showed a gradual increase from 24 deaths in 2001 to 61 deaths in 2004. The most common causes of death were tuberculosis (33.4%), septicemia (23.8%), advanced HIV disease (9.1%), meningitis (7.4%), other pulmonary infections (5.1%) and Kaposi's sarcoma (4.5%). The present dismal situation of patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed. With the introduction of affordable highly active antiretroviral therapy (HAART) in several centers in Nigeria, it is hoped that infected patients can be made to live longer.

Impact of iodine deficiency on thyroid function in pregnant African women - A possible factor in the genesis of 'small for dates' babies.

The effect of iodine deficiency (ID) on thyroid function in African women during pregnancy and postnatal period was examined, for which very limited information is available. Serum T(4), T(3), TSH, TBG, thyroxine binding capacity (TBK), free thyroxine index (FT(4)I=T(4)/TBK) and T(4)/TBG were determined by ELISA technique in 32 pregnant women (resident of Plateau state, Nigeria- an ID zone) through pregnancy upto term delivery, and in 5 women up to 6 weeks post delivery. Urinary iodide level was measured at delivery to determine the degree of iodine deficiency. Results were matched with a non pregnant control comprising 44 subjects. 5555 birth weights (BW) of term babies in the region were analysed to determine the prevalence of 'small for dates' (SFD) babies in the population. Results show that the level of serum FT(4)I was elevated very significantly at late gestation (P<.001) but the women were not hyperthyroid, suggesting a marked disturbance in binding of T(4) with TBG during pregnancy. Five women with SFD babies were found in 'compensated hypothyroid state' and showed a significant depression (p<.01) in serum T(4)/TBG, T(4), FT(4)I and T(3) levels to a low normal range, with a concurrent significant rise (p.<.001) in TSH level (above normal range) throughout pregnancy. Incidence of SFD babies was higher (p.<.001) in ID zone (Bassa 15.2%) compared to control zone (Jos 9.8%). It is concluded that a state of maternal 'subclinical (compensated) hypothyroidism' during pregnancy possibly plays an important role in the aetiopathogenesis of SFD babies in Africans. A normal reference range for thyroid parameters at various stages of pregnancy in healthy African women is established for the first time.