Profile of autoimmune connective tissue disorders in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Autoimmune Connective Tissue Disorders have rarely been reported among African blacks and even in Nigeria, in contrast with African-Americans. Our encounter with these cases shows that the disease may not be rare after all. The objective of this study was to report the prevalence, clinical presentations, laboratory and serological characteristics of patients presenting with autoimmune connective tissue disorders in the University of Port-Harcourt Teaching hospital.Method: This was a retrospective study of patients presenting with autoimmune disorder attending the Rheumatology and Dermatology clinic in University of Port Harcourt Teaching Hospital, Port Harcourt, located in Rivers state, South-South, Nigeria, over a period of one year (2012-2013). A review of the case records of all patients diagnosed and treated for autoimmune connective tissue disorders was utilized using the American College of Rheumatology Criteria for Systemic Lupus Erythematosus, Systemic Sclerosis and Rheumatoid Arthritis.Results: Our study indicates that out of 931 Rheumatology/Dermatology cases seen, 30 were autoimmune connective disorders indicating a frequency of 3.2%. Out of this 3.2%, Systemic lupus erythematosus (SLE) constituted about 91%, rheumatoid arthritis 6% and systemic sclerosis  constituted about 3%. The age range of the subjects was between 14-59years with a mean age of 34years, indicating the universal young age at presentation. Females constituted females 93.3% of the patients with a female to male ratio of 14:1. The duration of disease ranged from (0.1-15 years) with a mean of 5years. The most clinical presentation of systemic lupus was discoid rash constituting about 93%, while that from rheumatoid arthritis was deformities of the proximal interphalangeal and distal interphalangeal joints. The major causes of mortality for the SLE patients were lupus nephritis, congestive cardiac failure and pulmonary hypertension, while death from systemic sclerosis was mostly linked to the renal crises. Rheumatoid factor was positive in 28 (93.3%), while Anti Neutrophilic Antibody was positive in 8 (26.6%) of the tested subjects.Conclusion: Autoimmune disorders may not be uncommon in Port-Harcourt, Nigeria, contrary to previous reports, as both the prevalence and incidence are rising probably due to increasing awareness and better diagnostics. Age, gender and ethnicity may also account for the risk factors. This is the first study to report prevalence of autoimmune connective disorders in Port-Harcourt, Rivers State.Keywords: Profile; Autoimmune connective tissue disorders; Nigeri

Medication Related Cutaneous Disorders in End Stage Renal Disease Patients in Lagos

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Fixed Drug Eruptions (FDE) in an Urban Centre in South-South Nigeria

Background Fixed drug eruptions are adverse cutaneous reactions to ingested drugs, characterized by  the formation of solitary or multiple erythematous patches, plaques, bullae or erosions that reoccur at an identical skin site within hours of re ingestion of the offending drug. The objective of this study was to describe the epidemiology of Fixed drug eruptions with the identification of common causative drugs among patients at the dermatology clinic of an urban tertiary hospital in the South-south region ofNigeria.Methods All consecutive patients with a diagnosis of fixed drug eruptions seen at the dermatology clinic  between January 2005 to January 2013 were included in the study. The diagnosis of fixed drug eruptions was made based on clinical findings of lesion (s) of the same form occurring twice or more at the same  sites as a result of a readministration of a causative drug, and confirmation by a challenge test.Results The diagnosis of fixed drug eruption was made in 99 out of5106 (1.93%) patients, with a slight female dominance. FDE affected all age groups, the youngest presented at 9months of age and the oldest at 86years. Majority of patients (66. 7%) did not know the offending drug. The most implicated drugs  were the sulphonamides (21.2%), followed by antibiotics made up of ampiclox, tetracycline and penicillin ( 4.04%) and Non steroidal anti inflammatory drugs (3.03%). The commonest site of presentation was the face (32%), especially the mucosa of the mouth, followed by generalized presentation (28%).The frequency of Lower limb presentation was (13%),followed by the upper limb (11%) and the trunk(7.1%). Conclusion Fixed drug eruptions are a cause for great concern to the patient. Consistent with some other studies sulphonamides, clotrimoxazole and fansidar were the most implicated drugs.Keywords Fixed drug eruptions; Epidemiology: Out Patient clinic; Nigeria

A case of dengue fever in a health worker in university of Port-Harcourt teaching hospital

Dengue fever is a mosquito borne disease which can easily be missed or misdiagnosed in early stages as a result of poor surveillance, similarity with other febrile illness and unavailability of PCR necessary for its diagnosis. We hereby report a 44year old female nurse living around a bushy and swampy environment, who presented to university of Port-Harcourt teaching hospital (UPTH) with high grade fever of 1week duration, also developed joint pains, passage of coke colored urine, sensor neural deafness, hyperglycemia and petechial hemorrhage while on admission. Patient continued to have persistent fever despite having completed her anti-malaria and antibiotics, viral studies were subsequently done for her and she was found to have dengue virus. Patient was conservatively managed and discharged for follow-up in medical outpatient and Ear nose and throat clinic

Quality of Life of People Living with HIV/AIDS in Port Harcourt, Nigeria

Background: With the advent of free treatment with highly active anti-retroviral therapy across Nigeria, people living with HIV I AIDS (PLWHA) now live longer. However, the burden of the disease still remains high. Aside from quantity of life lived, quality oflife(QOL) as a second key component of the burden of the  disease has therefore come to the fore. There is increasing body of literature on quality of life among  PLWHA from other parts of the country. However, there is still paucity of data in our environment. This study assessed the QOL of PLWHA attending the anti-retroviral clinic in the University of Port Harcourt  Teaching Hospital, Port Harcourt, South - South region of Nigeria.Methods: A descriptive cross-sectional study design was used. Five hundred (500) PLWHA attending the Anti-retroviral Clinic of the University of Port Harcourt Teaching Hospital, were consecutively selected. A questionnaire, administered at interview was used to obtain socio-demographic and medical data. The WHOQOL-HN bref was used to assess the quality of life of each study participant.Results: The mean age ofthe respondents was 37.67 ± 12.1years (range 18-70 years). Two hundred and fifty-six (53%)of the participants were males. 269  (53.8%) were married and 216(80.2%) had spouses who were positive. The QOL mean scores were highest for the environment domain (18.49 ± 2.09) and spirituality I religion I personal beliefs domain (15.52 ± 1.41). Physical health (13.13 ± 1. 70) and psychological domain (13.35 ± 1.31) had QOL mean scores  which were similar. The overall QOL mean scores were lowest in social relationships (12.64 ± 2.17) and level of dependence domains (12.69 + 1.30). A significant  difference in the mean QOL scores was observed among men (12.87 ± 1.04) compared to women (12.48 ± 1.46) in the level of dependence (p=O.OO).Conclusion: The lower mean score in social relationship and level of dependence domain may suggest the fear of stigmatization and discrimination. Any intervention targeted at improving the quality of life among this group must address this fear. Keywords: PLWHA; Quality of life; WHOQOL-HNbref; South-South; Nigeria

Atopic Dermatitis in Adults: Epidemiology, Risk Factors, Pathogenesis, Clinical Features, and Management

Atopic dermatitis (AD) is an itchy chronic relapsing inflammatory skin condition mostly affecting children than adults. Eczematous conditions are common worldwide with increase in the prevalence in both developed and developing countries. AD in adults is of two types – the first type starts as AD in childhood and gradually progresses to adulthood (Persistent AD) and the second type results from AD developing in adulthood (Adult-onset AD). The article reviews and discusses this condition in adults considering the epidemiology, risk factors, pathogenesis, diagnostic criteria, and management of this condition

Body Image Dissatisfaction and Mental Health among Patients with Dermatological Disorders

The self-perception of one's body image could influence mental health outcome. Body image dissatisfaction is a growing research area that is under-diagnosed and under-reported in Nigeria and Africa. The study aimed to assess body image dissatisfaction among patients with dermatological disorders and determine its relationship with perceived stigma and depressive feelings. The study employed a cross-sectional hospital-based design. The study population comprised 94 adult patients attending the dermatology out-patient clinic of the University of Port Harcourt Teaching Hospital (UPTH). Body Image Disturbance Questionnaire (BIDQ), a validated and reliable tool was used to determine body dissatisfaction scores. Scores greater than or equals to 18 were categorized as body image dissatisfaction. Mental health outcomes (perceived stigma and depressive feelings) were assessed from the open-ended responses of the BIDQ. Statistical analyses were performed using IBM Statistical Package for Social Sciences version 25 at p<0.05. The mean (±standard deviation) BIDQ score was 11.0 (±5.6). The differences in the mean scores across the dermatological disorders were not statistically significant (ANOVA=1.507; p=0.111). The prevalence of body image dissatisfaction was 12.8% (n=12). A significantly higher proportion of participants with body image dissatisfaction had depressive feelings (66.7% versus 22.0%; p=0.003) and perceived stigma (41.7% versus 9.8%; p=0.011) in comparison to those that had no body image dissatisfaction. Significantly higher odds of depressive feelings (Odds Ratio=7.1; 95%CI=1.9- 26.3) and perceived stigma (Odds Ratio=6.6; 95%CI=1.7-25.7) were reported among patients with body image dissatisfaction. Body image dissatisfaction is associated with perceived stigma and depressive feelings. Measures to promote mental health are advocated among patients with skin problems

Adult onset still's disease: a rare disorder

Adult onset disease is a variant of systemic onset juvenile idiopatic arthritis characterised by seronegative poly arthritis in association with multi systemic inflammation. it is often seen in young adults. Authors have report a case of a 28 year old male who presented to us with a predominantly systemic symptoms. patient presented with a 6 month history of high grade fever, with associated recurrent joint pains, sore throat, generalized tonic-clonic seizures and skin rashes. Patient remained markedly ill for most of his in-patient stay. Aesilogy is unknown, though it is currently thought that there is interplay between a genetic predisposition, an immune dysregulation and environmental play mainly infectious. Therapeutic decisions should be based on the extent and severity of organ involvement

Hospital prevalence, delay in diagnosis, and sociodemographic features of hidradenitis suppurativa in Nigeria: A multicentre retrospective study

Background: Hidradenitis suppurativa (HS) is rare in Africans and so not commonly documented in this population. Aim: We aimed to document the hospital prevalence, sociodemographic factors, delay in diagnosis, and factors associated with a delay in diagnosis. Materials and Methods: This multicentre retrospective study of 64 HS patients was conducted across seven outpatient dermatology clinics in Nigeria. Data spanning 2017 and 2022 were retrieved following ethical approval. Extracted information included age at onset, age at diagnosis, delay in diagnosis, gender, family history of HS, body mass index, smoking history, socioeconomic status, and Hurley stage. Data were analysed using IBM Statistics version 26. For all statistical tests, P < 0.05 was considered statistically significant. Results: Thirteen thousand six-hundred and two new patients composed of 5850 males and 7752 females attended the clinics and 64 of them had HS giving a hospital prevalence of 0.47% (64/13,602). Most of the HS (70.3%) were female. The median (interquartile range) age of the patients was 30 (24, 36) years and the age range was 12–59 years. Age at diagnosis was 20–39 years in 76.6%. There was a delay in diagnosis in 45.3%, a significant relationship between delay in diagnosis with duration and severity of HS with P < 0.001 and P < 0.005, respectively. Conclusion: HS is uncommon in Nigeria. Diagnosis is frequently delayed and patients present with a severe form of the disease. Furthermore, HS is rare among individuals with a low socioeconomic status. There is a need for more awareness and prompt referral of this debilitating disease at the primary health-care level