Does prolonged stress enhance coping? Nigerian healthcare providers and COVID-19-related stress management

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Clinical and aetiologic profile of patients with chronic urticaria at the outpatient clinic of a tertiary hospital in Lagos, Nigeria: a cross-sectional observational study

Chronic urticaria is a condition characterized by recurrent wheals associated with itching lasting longer than six weeks. The condition tends to run a chronic course with significant morbidity. Several factors have been explored in the cause, yet the aetiology is still uncertain. We documented the clinical profile and assessed the possible aetiologic factors in patients with chronic urticaria. Clinical profile of sixty consecutive patients with chronic spontaneous urticaria was assessed with possible precipitants identified using a structured questionnaire. The complete blood count with erythrocyte sedimentation rate, antithyroid peroxidase (antiTPO), hepatitis B surface antigen (HBsAg), antihepatitis C virus screening (AntiHCV), stool for ova and parasites and helicobacter pylori were carried out. Controls without a history of urticaria were recruited in a 1:1 ratio for stool for parasites and H. pylori because of the high prevalence rates reported in this environment. Data analysis was carried out with Statistical Packages for Social Sciences (SPSS) version 22. Sixty patients with chronic urticaria and sixty age and sex matched controls were enrolled in the study. Females presented more often with urticaria with a M:F ratio of 1:2.5. The mean age of onset of urticaria was in the third decade of life. Precipitants were identified in close to a third of patients. The investigated antigenic aetiology was not found to play a role. The presentation and clinical profile of patients in this environment is similar to previously documented studies. History still remains the cornerstone of management as precipitants and triggers may be identified. Management of patients should therefore be individualized

Clinical, epidemiological characteristics and associated factors of hair greying in Lagos, Nigeria

Objective: To document the epidemiological, clinical characteristics, believed triggers and associated behaviour in hair greying.Design: A community based cross-sectional descriptive study was conducted in February 2020 following ethical ap-proval and written informed consent from participants. All participants were clinically evaluated for hair greying, its pattern and location on the scalp. Socio-demographic data were documented. Data was entered and analyzed using the IBM statistics software version 22. Numerical and categorical variables are presented.Setting: The study was conducted at an urban market in Lagos, Nigeria.Participants: The study participants comprised 307 adult traders.Results: The mean age of the 307 participants studied was 42.7±12.8 years. The prevalence of hair greying was 47.6% (51% in males and 45.9% in females). The median (IQR) age of those with grey hair was 52 (44, 59) years. The prevalence of hair greying was 14.8% in those aged 30-34 years and 97.2% in those aged 60 years and above. The prevalence of premature greying was 17.7% and greying before friends and family members was reported at 19.9% and 13%, respectively. Grey hair was diffuse in 81.5%; localized to the frontal area of the scalp in 55.5%. Use of hair dye was noted in 15.8%.Conclusion: Hair greying is common in the study population. The age at onset is 30 years. Premature hair greying is uncommon in Nigeria. More epidemiological studies of hair greying especially of premature hair greying are needed

Predictors and outcomes of COVID-19 patients with hypoxemia in Lagos, Nigeria

Objectives: The coronavirus disease 2019 (COVID-19) pandemic is the current public health concern. Hypoxemia has been identified as an independent risk factor for mortality in COVID-19 patients regardless of age or sex. This study therefore aimed to assess the profile of COVID-19 patients with hypoxemia in Lagos, Nigeria and identify their associated socio-demographic and clinical risk factors, predictors, and outcomes.Materials and Methods: This was a retrospective cohort study in which data were extracted from medical records of real-time polymerase chain reaction confirmed COVID-19 positive patients admitted between April and October 2020. Data extracted included age, sex, comorbidities, disease category/classification, symptoms, lowest oxygen saturation (SPO2), and outcomes. Bivariate analysis was done to test associations between hypoxemia and other variables. Multivariate analysis was done to determine significant predictors of hypoxemia.Results: A total of 266 patients were included in the study; mean (SD) 49.80 (± 16.68) years. Hypoxemia (lowest SPO2 ≤ 90 in adults and < 92% in children) was found in 102 (38.3 %) of the cases. SPO2 of hypoxemic patients ranged from 33% to 90%, Mean ±SD of 77±13%. About half of the hypoxemic cases, 53 (52%) were ≥ 60 years and mostly male 70 (68.6%). Difficulty breathing was present in 56 (55%), while the common comorbidities were hypertension 86 (32.3%) and diabetes mellitus 47 (17.7%). Age ≥ 60, difficulty breathing, and fever were independent predictors of hypoxemia. Hypoxemia was significantly associated with death (X2-42.13; P < 0.001); odds ratio 14.5 (95% CI: 5.4–38.8).Conclusion: Hypoxemia occurred in 1 out of every 3 COVID-19 patients with poor prognosis. SPO2 monitoring and early presentation in hospital for those 60 years and above or with dyspnea may be essential for early identification and treatment of hypoxemia to reduce mortality

Management challenges of epidermodysplasia verruciformis in a resource-limited setting: A retrospective review

Background: Epidermodysplasia verruciformis (EV) is a rare genodermatosis with autosomal recessive inheritance linked to human papilloma virus 5 and 8. It presents with flesh-colored or hypopigmented macules and plaques on the face, neck, hands, and body. They are asymptomatic but cause great cosmetic concern to affected individuals. An immune deficient state renders patients more susceptible to it; although some have no demonstrable ill health. Diagnosis is mostly clinical; nevertheless, skin biopsy for histopathology may be performed in doubtful cases. Treatment is aimed at cosmetic removal with retinoids, Imiquimod, and keratolytics among others. The aim of this report is to document the clinical profile of patients with EV, and highlight the challenges faced in managing patients. Materials and Methods: The clinical records from January 2006 to December 2013 were reviewed. Demographic data, HIV status, and biopsy results were extracted and entered onto Microsoft Excel spreadsheet. The results were analyzed with SPSS version 18. Results: A total of 33, 326 patients were seen during the review period; 96 (0.3%) had a clinical diagnosis of EV with 45 (46.9%) males and 51 (53.1%) females. The mean age was 20.8 ± 13.4, with a range of 2–52 years. A quarter of the patients were tested for HIV and 12 (13%) were positive. Conclusions: This study documents the frequency of EV in our environment and provides a baseline for more studies. The results concur with its rare occurrence worldwide and fail to show the exact relationship between HIV infection and EV. The challenges to managing these patients are mostly due to financial constraints; hence, basic investigations and optimal treatment could not be done in many of the patients

Chronic Urticaria in Blacks: Is Autoimmunity An Important Etiological Factor?

Background: The etiology and pathophysiology of chronic urticaria is poorly understood with several implicated factors. The role of autoimmunity has been explored by several studies with such studies on chronic urticaria lacking in the black population despite the significant morbidity caused by chronic urticaria. Aim: We assessed the possible contribution of autoimmunity in the etiology of chronic urticaria using autologous serum skin testing (ASST). Materials and Methods: Sixty consecutive patients with chronic spontaneous urticaria (CSU) with age‑ and sex‑matched controls in a ratio of 2:1 had ASST done for comparison. Student’s t‑test and Chi‑square were used to compare means and percentages, respectively. Results: The male:female ratio of CSU was 1:2.5 with females presenting more often. The ASST was noted to be significantly positive in patients compared to controls with a positivity rate of 68.3% in the former compared to 16.7% in the latter (P = 0.0001). A higher incidence of angioedema was also documented in patients with a positive ASST in association with urticaria (23/28, P = 0.04). Conclusion: Overall, we conclude from our study that autoimmunity may be a possible cause of chronic urticaria in Nigerians which may also be extrapolated to other black population. Patients with positive ASST may have more severe disease which may be important when educating and counselling the patients about the course of the disease. This study is the first to assess the possible role of autoimmunity in a predominantly black population and will serve as a baseline for future studies