Paradoxical Perforating Folliculitis in a Newly Transplanted Kidney Recipient: Case Study.

We report on a rare case of perforating folliculitis with a paradoxical presentation. An 18-year-old patient with end-stage kidney failure was undergoing continuous ambulatory peritoneal dialysis following 1 year of hemodialysis treatment. While being treated with continuous ambulatory peritoneal dialysis, he developed an itchy papular eruption on an erythematous base over his face and chest, which was diagnosed as chicken pox and treatedwith acyclovir.He also underwent successful deceased donor kidney transplant 1 year later. On day 10 posttransplant, he presented with a papular eruption over the chest, face, and forearms. A skin biopsy revealed a perforating folliculitis lesion. He was treated with prednisone and tacrolimus, as part of the kidney transplant treatment. The skin lesions resolved progressively. His urea, creatinine, and electrolyte levels remained normal and on an ever-improving trend at each visit. By 4 months posttransplant, the skin lesions had resolved almost completely.

Knowledge, self-help and socioeconomic factors in South Asian and Caucasian diabetic patients.

AIMS: We carried out a survey of important nonclinical issues including awareness and self-management of diabetes on a group of South Asian and Caucasian patients attending diabetic clinics within a set period. METHODS: A structured questionnaire examined various issues including demographics, perceived knowledge and awareness of diabetes, perceived self-help/support, and psycho-social factors. A total of 500 patients (268 South Asians and 232 Caucasian) took part. RESULTS: Univariate analysis showed significant differences (P<0.05) with various issues including a lower perceived awareness of diabetes and its complications in South Asians, and of the nutritional content of their diet. Asians also appeared to be less worried in the event of missed clinical appointments and if treatment was not strictly adhered to. CONCLUSIONS: The study provides evidence of the inability of health information systems to convey the importance of diabetic control to the Asian population. In order that this important information reaches the required recipients, more assertive and perhaps more culturally acceptable methods need to be explored.

Impact of age and duration on sight-threatening retinopathy in South Asians and Caucasians attending a diabetic clinic.

AIMS: To examine diabetic retinopathy in Asians and Caucasians attending a hospital diabetic clinic and to evaluate the impact of the significant risk factors on the probability of sight-threatening retinopathy. METHODS: A total of 500 diabetic patients (268 Asians, 232 Caucasians) who attended a diabetic clinic within a defined time period were examined for severity of diabetic retinopathy. The existence of sight-threatening retinopathy (STR) was compared in the two groups. Significant risk factors such as age, duration and hypertension were analysed against the probability of STR in each of the two races. RESULTS: Asians demonstrated significantly higher rates of STR. Univariate analysis showed age, duration, race, gender, and insulin-requiring status to be significantly associated with STR. Multivariate logistic regression showed a significant association of STR with race, age and duration of diabetes, with no significant interaction effects between variables. The logistic regression model predicted STR in Asians to be matched to that in Caucasians by a 12.5-year difference factor; that is, Caucasians were older by 12.5 years or had a 12.5-year longer duration than Asians for the same level of STR. CONCLUSIONS: After adjusting for age and duration of diabetes, the probability of STR in Asian diabetic patients attending the diabetic clinics in Bradford is significantly higher than that in Caucasians (odds ratio=3.184, P<0.05). The impact of age and duration was significantly higher in patients of South Asian origin compared to Caucasians.

Hypoglycemic effect of Hypoxis hemerocallidea corm (African potato) aqueous extract in rats.

Diabetes mellitus has been recognized as a clinical syndrome since ancient times, and remains a crippling global health problem today. It is a group of heterogeneous, autoimmune, hormonal and metabolic disorders, often accompanied by hypertension, hyperlipidemia and obesity. Current estimates suggest that approximately 150 million people worldwide suffer from diabetes mellitus. The present study was undertaken to examine the hypoglycemic effect of aqueous extract of Hypoxis hemerocallidea (family: Hypoxidaceae) corm (locally known as "African Potato") in normal (normoglycemic) and in streptozotocin (STZ)-treated, diabetic rats. Young adult, male Wistar rats weighing 250-300 g were used. Diabetes mellitus was induced in the group of diabetic test rats by intraperitoneal injections of STZ (90 mg/kg). In one set of experiments, graded doses of the aqueous extract of African Potato (100-800 mg/kg p.o.) were administered to 12-h fasted normal and diabetic rats. In another set of experiments, 800 mg/kg of African potato extract, a dose of the plant extract that produced maximal hypoglycemic effects in fasted normal and diabetic rats in our pilot experiments, was used. The hypoglycemic effect of this single dose was compared with those of insulin (5 micro U/kg s.c.) and glibenclamide (5 mg/kg p.o.) in 12-h fasted normal and diabetic rats. Following acute treatment, relatively moderate to high doses of African potato extract (100-800 mg/kg p.o.) produced dose-dependent, significant reductions (p < 0.05-0.001) in the blood glucose concentrations of fasted normal and diabetic rats. Similarly, insulin (5 micro U/kg s. c.) and glibenclamide (5 mg/kg p.o.) produced significant reductions (p < 0.01-0.001) in the blood glucose concentrations of the fasted normal and diabetic rats. At a dose of 800 mg/kg, the plant extract caused 30.20% and 48.54% reductions in the blood glucose concentrations of fasted normal and STZ-treated diabetic rats, respectively. While it is likely that the hypoglycemic effect of the plant extract is largely due to its phytosterols and/or sterolin content, the exact mechanism of its hypoglycemic action is still obscure and will have to await further studies. However, the results of this experimental animal study indicate that African potato possesses hypoglycemic activity; and thus lends credence to the suggested folkloric use of the herb in the control and/or management of adult-onset, type 2 diabetes mellitus in some communities of South Africa.

The clinical characteristics of Asian and Caucasian patients on Bradford's Low Vision Register.

AIM: To analyse the clinical characteristics of patients on the Bradford Low Vision Register with regards to the type (partially sighted or blind), sex, race, causes and age at registration. METHODS: All the data were obtained from the Morley Street Resource Centre, which keeps records of all registrations in the Bradford Metropolitan District. Information including postcode, date of birth, age, gender, ethnic group, degree, date of registration, cause of registration and age at registration were entered into a database. RESULTS: Of all registrations, 64% were blind and 36% were partially sighted. Asians were younger at registration and there were a significantly lower number of females compared to Caucasians. When data were analysed for the different age groups, in the older group of over 65 years, Asians showed significantly more diabetic retinopathy (26.1%) compared to Asians (7.8%), while Caucasians demonstrated significantly more glaucoma (C: 29.3%; A: 17.4%). In the younger age group (<30 years), the leading causes for Asians were retinitis pigmentosa and nystagmus while for Caucasians it was congenital cataracts and optic atrophy. The proportion of Asians registered was significantly lower than expected from the projected population estimates in Bradford. CONCLUSIONS: The study indicates significant differences in the clinical profiles of the two racial groups. The data do not follow the predictions from published population estimates, with Asians, especially females, being under-represented in the register.

Self-reported eye disease in elderly South Asian subjects from an inner city cluster in Bradford: a small-scale study to investigate knowledge and awareness of ocular disease.

PURPOSE: To investigate various issues relating to eye diseases in a sample of 200 South Asian residents living in an inner city regional cluster in Bradford. METHODS: Door to door interviews were carried out by one investigator who spoke English, Punjabi and Urdu. Visual acuity and pinhole acuity were measured using a portable LogMAR acuity chart. A structured questionnaire investigated various issues including self-reported eye disease, knowledge of eye disease, the effectiveness of various sources for eye-related information, the importance of early detection of eye diseases and the need for adequate control of systemic diseases linked to eye diseases such as diabetes. RESULTS: Data revealed poor knowledge of self-reported eye diseases and of the importance of early detection and inadequate knowledge of the link between the control of systemic disease such as diabetes and ocular complications. Language barrier problems and poor utilisation of available ocular health care services were also evident. CONCLUSIONS: These data, although not exhaustive, give an insight into various factors that affect the ocular health of the South Asian community in Bradford.

Familial thrombophilia and retinal vein occlusion.

PURPOSE: To perform a pilot study on the prevalence of familial thrombophilia in all cases of retinal vein occlusion with no known risk factors. METHODS: Over the 1 year study period 71 patients presented with a new diagnosis of retinal vein occlusion (age 28-90 years). Fifty-five (77%) were excluded because of local predisposing factors. The remaining 16 (23%) had a full risk factor history taken and blood investigations of rheological factors and thrombophilia including tests for the factor V Leiden mutation, prothrombin G20210A allele and hyper-homocystinemia. RESULTS: Of those with no local predisposing factors, 3 patients had antiphospholipid antibodies, 3 had raised fibrinogen levels, 4 had hyper-homocystinemia and 1 was heterozygous for the Leiden mutation. Other lifestyle risk factors such as obesity, smoking and a positive family history of venous thrombosis were not uncommon. No patient had the prothrombin G20210A variant. CONCLUSIONS: It seems likely that several risk factors, both genetic and acquired, need to be present for thrombosis to occur. In investigating a new patient with a retinal vein occlusion one should test for hypertension, glaucoma and diabetes mellitus. Estimation of plasma viscosity and a full blood count are cheap investigations which may reveal neoplasia or vasculitis, and lipid levels should be estimated. In a young patient or one with an unexpected vein occlusion and a personal or family history of thrombosis, a hypercoagulable state may rarely be identified. This additional testing should include testing for antiphospholipid antibodies and a full thrombophilia screen including the factor V Leiden mutation, homocysteine and the prothrombin variant as part of a clinical trial. Until the role of these markers in thrombosis is better defined in relation to causation of retinal vein occlusion and treatment has been shown to improve outcome, we can not recommend them for routine testing. If a hereditary defect is found, referral should be made to a hematologist and consideration given to anticoagulation and screening of family members to prevent further thrombotic episodes. Retinal vein occlusions are multifactorial in origin except in rare cases.

Ethnic differences in the clinical and laboratory associations with retinopathy in adult onset diabetes: studies in patients of African, European and Indian origins.

OBJECTIVE: To evaluate the prevalence of diabetic retinopathy (DR) and its associations in adult onset diabetic patients of African, European and Indian origins. DESIGN: The prevalence of retinopathy was determined by 60 degrees retinal photography in 507 consecutive out-patients. Clinical and laboratory associations were evaluated. SETTING: Diabetes clinic in a large community hospital. MAIN OUTCOME MEASURES: The associations between clinical and laboratory measurements with retinopathy. RESULTS: African patients (A) had shorter duration of diabetes (P < 0.001), higher HbA1 levels (P < 0.01) compared to those of Europeans (E) and Indian (I) extraction. A also had lower C-peptide levels (median 0.57 nmol L-1; vs. E. 0.81 nmol L-1 and I, 0.93 nmol L-1) (P < 0.001). The prevalences of retinopathy at diagnosis (21-25%) and overall were similar (A 37%, E 41%, I 37%). Severe DR was more frequent in the Africans (52%, P < 0.0001) and Indians (41%, P = 0.03) compared to the Europeans (26%). In Africans DR was significantly associated only with duration of diabetes (P < 0.0001) and macro-albuminuria (P = 0.01); in I it was also associated with systolic BP (P = 0.03); in E also with lower C-peptide levels (P = 0.0002), worse glycaemic control and greater use of insulin (P < 0.0001). In patients with DR insulin was used less frequently in A (35%) than in E patients (62%) (P = 0.001). CONCLUSIONS: In South Africa, the African population with adult onset diabetes has the highest prevalence of severe retinopathy, probably the result of very poor glycaemic control attributable to more severe insulinopenia and infrequent insulin treatment. Visual loss from diabetic retinopathy is likely to be considerable in Africans.

Screening for diabetic retinopathy in South Africa with 60 degrees retinal colour photography.

OBJECTIVES: Comparison of 60 degrees mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45 degrees fields. DESIGN: Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45 degrees fields (by masking the slides), and at 60 degrees. SETTING: The first 663 patients attending for routine clinic visits and screened for retinopathy. MAIN OUTCOME MEASURES: The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening. RESULTS: Compared to an ophthalmologist's assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60 degrees field, one 45 degrees field missed 31%, and 2 x 45 degrees fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US $37.00. CONCLUSIONS: 60 degrees retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45 degrees field assessments. Both retinae should be screened. This method is cost-effective in our hands.