Assessment of serum androgen levels in women with acne vulgaris in Southeastern Nigeria: a cross-sectional study.

Introduction: androgens play an important role in the pathogenesis of acne vulgaris. They cause hyperkeratinization of the pilosebaceous follicles and seborrhea. Endocrine diseases characterized by increased levels of androgens often present with acne vulgaris. A correlation between serum androgen levels and acne severity exists, and the assessment of serum androgen levels is therefore essential in women with severe acne vulgaris and treatment resistant acne. Methods: the study was conducted in the Dermatology Clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla. Seventy females with acne vulgaris and seventy females without acne vulgaris were recruited as subjects and controls respectively. Blood samples were taken from subjects and controls to measure levels of serum testosterone, dehydroepiandrosterone sulfate (DHEAS) and androstenedione. Acne severity was measured using global acne grading system (GAGS). Results: the median levels of DHEAS and androstenedione (1.20µg/ml and 1.80ng/ml respectively) were higher in subjects than 1.00µg/ml and 1.70ng/ml in controls respectively, although these findings were not statistically significant. There was also no significant difference between the levels of serum testosterone in both the subjects and the controls. No correlation existed between levels of serum androgens and acne severity. Conclusion: there was no statistically significant difference in the serum androgen levels between the subjects and the control population, and no relationship between androgen levels and severity of acne vulgaris was demonstrated.

Cross-Sectional Review of Prescription Practices of Triple Action Creams Amongst Doctors in South-East.

Background: Topical corticosteroids have had an immense impact in the treatment of skin diseases since their advent and are important in the management of corticosteroid-responsive dermatoses. Triple action creams (TAC) on the other hand are a combination of antibiotics, antifungals and corticosteroids in one cream, in an unspecific bid to target infected dermatoses. The use of TAC has constituted a source of corticosteroid misuse and abuse. This study aims to determine the knowledge, attitude, and prescription practices of TACs among doctors in South-Eastern Nigeria. Methodology: A section of doctors in the five South Eastern states of Nigeria participated in this study. Data was collected using printed or e-copies of pre-tested questionnaires. Information about sociodemographic, steroid classification, the role of TAC, steroid side effects, duration of prescription of TAC, were sought. Statistical analysis was carried out using the statistical package for social sciences version 20. Good knowledge of TAC was set at >65% and poor knowledge <65%. Results: Two hundred and six doctors participated, 59.2% (122) males and 40.8% (84) females. Respondents were distributed as follows: Enugu 28.2% (58), Abia 25.2% (52) Imo 18.4 % (38), Ebonyi 17.5% (36), and Anambra 10.7 % (22). One hundred and seventy-eight (86.4%) work in a tertiary facility while 13.6 % (28) work in primary/secondary facilities. About forty-eight per cent (99) had good knowledge while 51.9 % (107) had poor knowledge. Twenty-five per cent (52) knew that TAC is not useful in managing skin disorders while 66% (136) prescribed TAC as first-line therapy. Conclusion: This study has helped uncover the magnitude of poor knowledge and prescription practice of TAC amongst doctors. To curb topical steroid misuse in a given population, doctors should be re-trained.

Scabies education in secondary schools: A multicenter study.

Background: The aim of this study was to educate secondary school students on etiology, risk factors, clinical features, treatment, and prevention of scabies; to evaluate their knowledge base on scabies before and after an educational intervention; and to reassess this knowledge base and behavioral change, 6 months after, on a second visit. Methods: Questionnaires with standard questions on scabies, graded to a maximum score of 10, were administered to students in junior secondary Classes 1 and 2 across 4 states in Nigeria. Information obtained included subjects' demographics, scabies symptomatology, risks, and preventive behaviors. Students with active scabies were diagnosed and treated. Data were analyzed with STATA. Results: The mean test scores for the pretest and posttest at first visit were 2.82 ± 1.38 and 6.30 ± 1.09, respectively. This difference was statistically significant at t = 3.95, P = 0.004. Six months later, when the same schools were re-visited, the mean test scores for the pretest and posttest were 4.63 ± 0.54 and 5.87 ± 0.25, respectively. This difference was also significant at t = 4.13, P = 0.003. The prevalence of scabies was 3.5% at first visit and 4.34% at second visit; t = 0.24, P = 0.41. Conclusions: Secondary school students lack basic education on scabies and exhibit high-risk behaviors for scabies transmission. Knowledge on scabies needs constant reinforcement.

RésuméContexte: Le but de cette étude était d'éduquer les élèves du secondaire sur l'étiologie, les facteurs de risque, les caractéristiques cliniques, le traitement et la prévention de la gale; évaluer leur base de connaissances sur la gale avant et après une intervention éducative; et de réévaluer cette base de connaissances et ce changement de comportement, six mois après, lors d'une deuxième visite. Méthodes: Des questionnaires contenant des questions standard sur la gale, notés à un score maximum de 10, ont été administrés aux élèves des classes 1 et 2 du premier cycle du secondaire dans 4 États du Nigéria. Les informations obtenues comprenaient la démographie des sujets, la symptomatologie de la gale, les risques et les comportements préventifs. Les étudiants atteints de gale active ont été diagnostiqués et traités. Les données ont été analysées avec STATA. Résultats: Les scores moyens aux tests avant et après le test lors de la première visite étaient respectivement de 2,82 ± 1,38 et 6,30 ± 1,09. Cette différence était statistiquement significative à t = 3,95, p = 0,004. Six mois plus tard, lorsque les mêmes écoles ont été revues, les scores moyens aux tests avant et après test étaient respectivement de 4,63 ± 0,54 et 5,87 ± 0,25. Cette différence était également significative à t = 4,13, p = 0,003. La prévalence de la gale était de 3,5% lors de la première visite et de 4,34% lors de la deuxième visite; t = 0,24, p = 0,41. Conclusions: Les élèves du secondaire manquent d'éducation de base sur la gale et présentent des comportements à haut risque de transmission de la gale. Les connaissances sur la gale nécessitent un renforcement constant.

Lupus Vulgaris and Lichen Scrofulosorum with Disseminated Tuberculosis.

Cutaneous tuberculosis (CTB) represents only 1%-2% of extrapulmonary forms of tuberculosis (TB). CTB can present in the isolation or coexist with pulmonary and disseminated forms of TB. Pathologically confirmed lupus vulgaris (LV) coexisting with lichen scrofulosorum with disseminated TB is presented and discussed. A 12-year-old boy presented with 2 years history of slowly progressive facial plaque and multiple skin colored papules on the neck. Tuberculin skin test was positive with a reading of > 20 mm. Histopathology revealed ulcerated areas with impetiginisation and keratopurulent debris. The entire skin showed pseudoepitheliomatous hyperplasia with numerous granulomas in the superficial dermis consisting of Langhans-type multinucleated macrophages. Lesions responded to anti-tuberculosis therapy (ATT) with residual facial scar. LV and lichen scrofulosurum are two forms of CTB which rarely occurs together. This case is being presented to highlight the occurrence of this rare presentation and the need to institute ATT to prevent scarring.

Chronic HIV infection and health related quality of life in resource poor settings-an assessment from South East Nigeria.

BACKGROUND: Health-related quality of life reflects a patient's general subjective perception of the effect of an illness or intervention on physical, psychological and social aspects of daily life. HIV infection is a major public health problem especially in developing countries where poor health infrastructure and poverty are prevalent. This paper addresses the quality of life in patients with chronic HIV infection in South East Nigeria and addresses issues that may help improve the current situation. METHODS: A cross-sectional survey was carried out at the University of Nigeria Teaching Hospital, Enugu, to assess patients with HIV receiving antiretroviral therapy (ART) using a validated structured questionnaire (WHOQoL-BREF). Ethical clearance for the study was obtained. Study period was from October - December, 2017. Data obtained was analysed. RESULTS: A total of 389 HIV patients consented to the study. Over 70% were aged 18- 45 years and majority were females. Females had a higher quality of life score with respect to the domain of psychological health while males had a higher score with respect to the environmental domain. Older age and presence of co-morbidities were significantly associated with affectation of physical health while younger age was associated with affectation of psychological health domain. CONCLUSION: HIV impairs the quality of life for affected individuals in South East Nigeria especially across the domains of physical and psychological health. No age group is spared. The presence of co-morbidities significantly reduces quality of life in these patients. Younger patients may require mental health services in the management of their disease.

Effectiveness of a Comprehensive 4-Week Course in HIV Medicine for Postgraduate Doctors at University of Nigeria: A Preservice Education Initiative.

There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-limited settings. To strengthen preservice HIV training for postgraduate health care providers, University of Maryland's Institute of Human Virology and Center for Clinical Care and Research Nigeria collaborated with University of Nigeria to plan and implement a comprehensive 4-week course in HIV medicine. The first course was piloted with 30 postgraduate doctors. Mean objective structured clinical examinations (OSCE), pretest, and posttest scores score were 51%, 53%, and 75%, respectively; follow-up examination at 6 months showed mean score of 74%. In multivariate regression analysis, pretest score was positively associated with posttest score (22.03, P < .001) and OSCE (0.29, P = .04), age negatively associated with pretest score (-0.94, P = .001), and female gender positively associated with OSCE score (6.15, P = .05). Six- and 18-month online surveys revealed trainees continued to apply knowledge and skills gained. North-south university collaborations to develop practicum-based preservice curricula offer a sustainable way to strengthen preservice evidence-based HIV medicine training with long-lasting retention of skills and knowledge.

Pattern and determinants of self-reported enacted stigma among rural dwellers living with epilepsy attending a tertiary health facility in Enugu State Nigeria.

PURPOSE: Epilepsy related stigma is a barrier to recovery and has been linked to a broad range of psychosocial consequences and has the potential to influence the provision of care to people with epilepsy. Understanding the determinants of enacted stigma in epilepsy is relevant in the understanding of the burden of epilepsy in Nigeria. METHOD: Using a semi-structured questionnaire, a cross-sectional descriptive study was conducted among rural dwellers receiving treatment for epilepsy in a tertiary referral specialist hospital in Enugu, south east Nigeria. RESULTS: The participants consisted of 108 patients, 63% of whom were males. Most patients 99(91.7%) reported experiencing stigma in the past. The commonest forms of enacted stigma were being regarded as having 'spiritual attack' 88(81.5%) and restraining from interacting with others 49(45.4%). Most individuals who received nonorthodox treatment 55(55.6%) experienced stigma. Severely stigmatized individuals were more likely to be females. Age of onset of epilepsy, use of non-orthodox treatment, seizures occurrence in public places and the presence of physical injuries positively correlated with enacted stigma. CONCLUSIONS: The burden of epilepsy related enacted stigma is high among rural dwellers attending a tertiary medical outpatient clinic in Enugu, southeast Nigeria.

Prevalence of active convulsive epilepsy in an urban slum in Enugu South East Nigeria.

PURPOSE: To determine the prevalence of active convulsive epilepsy and treatment gap in two Urban slums in Enugu South East Nigeria. METHODS: A 3 phase cross-sectional descriptive study was done to survey individuals ≥ 15 years in 2 slums in Enugu, South East Nigeria. RESULTS: The prevalence of epilepsy was 6.0 (95% CI: 5.9-6.0) per 1000 (men 4.4/1000, 95% CI: 2.3-6.4, women 7.8/1000, 95% CI: 4.9-10.4), p=0.06. The peak age of active convulsive epilepsy was 40-44 years (11.2 per 1000) with two smaller peaks at 25-29 and ≥ 50 years. The age and sex adjusted prevalence using WHO standard population and 2006 Nigerian census population were 5.9 per 1000 (95% CI: 4.0-7.9) and 5.4 per 1000 (95% CI: 3.4-7.4). CONCLUSION: The prevalence of epilepsy is high in urban slums in Enugu. Nationwide studies should be done to find out the true prevalence in the country.

Prevalence of primary headaches in an urban slum in Enugu South East Nigeria: a door-to-door survey.

OBJECTIVE/BACKGROUND: This study aims to determine the prevalence of primary headache disorders using the second edition of international classification of headache disorders among urban slum dwellers. Headache is a common neurological disorder and one of the most common reasons for visiting the neurology clinics in Nigeria. Low socioeconomic status has been linked with primary headaches. Factors that may precipitate and sustain headaches are common in Africa especially in urban slums. There are limited population based data on the prevalence of headache from Nigeria and other African countries. METHODS: A 3 phase cross-sectional descriptive study was done to survey at least 40% of the adult population (Igbos) living in an urban slum using the International Classification of Headache Disorders 2nd Edition (ICHD-I) criteria using a validated Igbo language adaptation (translation and back-translation into Igbo language) of a World Health Organization protocol for screening neurological disorders in the community. RESULTS: The lifetime prevalence of headache of any type was 66.7% (95% confidence interval [CI] 64.2-69.2), significantly higher in females (70.2% [95% CI 67.0-73.4]) than in males (62.3% [95% CI 58.5-66.1]; P = .0.002). The prevalence of primary headaches was also significantly lower in males than in females (44.9% [95% CI 45.5-53.3] vs 53.2% (95% CI 49.3-57.1), P = .002). Female (52.1%) drinkers had a statistically higher prevalence of primary headaches than male drinkers (43.6%; P = .004). The prevalence of migraine was 6.4% (95% CI 5.1-7.7); 7.5% (95% CI 5.6-9.4) in females and 5% (95% CI 3.3-6.7) in males (P = .058). Migraine with aura was similar in both males and females. Migraine without aura was significantly higher in females (5.7%) than males (3.1%) (P = .022). Tension-type headache (TTH) had an overall prevalence of 13.8% (95% CI 11.3-16.3), males 12.2% (95% CI 9.7-14.7), and females 15.1% (95% CI 12.6-17.6; P = .118.) The peak decade for all primary headaches was 20-29 years for males (49.8%) and 60-69 years for females (57.5%). CONCLUSION: Headache is a common health problem in an urban slum in Enugu south east Nigeria where 66.7% of participants had experienced headache in their lifetime, and 49.4% had experienced primary headaches. The prevalence of migraine and TTH were 6.4% (5% in males and 7.5% in females) and 13.8% (12.2% in males and 15.1% in females), respectively. The peak ages of migraine and tension-type headache were 30-39 and 60-69 years, respectively. The prevalence of primary headaches was significantly higher among subjects who used alcohol significantly.

Complications of chronic use of skin lightening cosmetics.

Skin lightening (bleaching) cosmetics and toiletries are widely used in most African countries. The active ingredients in these cosmetic products are hydroquinone, mercury and corticosteroids. Several additives (conconctions) are used to enhance the bleaching effect. Since these products are used for long duration, on a large body surface area, and under hot humid conditions, percutaneous absorption is enhanced. The complications of these products are very serious and are sometimes fatal. Some of these complications are exogenous ochronosis, impaired wound healing and wound dehiscence, the fish odor syndrome, nephropathy, steroid addiction syndrome, predisposition to infections, a broad spectrum of cutaneous and endocrinologic complications of corticosteroids, including suppression of hypothalamic-pituitary-adrenal axis. In this era of easy travels and migration, African patients with these complications can present to physicians anywhere in the world. It is therefore critical for every practicing physician to be aware of these complications.