Diabetic Foot: Epidemiological, Therapeutic and Evolutionary Aspects in the Department of Medicine and Endocrinology of the Hospital in Mali, Mali

Introduction: The diabetic foot remains a public health problem due to its high frequency, difficult and costly management. The aim of this study was to determine the epidemiological, therapeutic and evolutionary aspects of the diabetic foot in a hospital setting in Bamako. Methodology: This is a retrospective, descriptive, cross-sectional and monocentric study conducted between September 1, 2011 and December 31, 2015 on diabetic patients aged 14 years and older arriving in our department with a foot infection. Results: We identified 94 cases of diabetic foot infection out of a total of 828 hospitalized patients, a prevalence of 11.35%. The age range 41 - 60 years represented 57 cases (60.6%), the extreme ages were 14 and 81 years. Men (38.3%), women (61.7%) with a sex ratio of 0.62%. Housewives 50%, illiterate 51 cases (54.3%), low economic standard of living 40 cases (42.6%), presence of osteitis 40 cases (42.6%), foot at stage D Grade3 28 cases (29.8%). Management was medical in 48 cases (51.1%), treatment with insulin 58 cases (61.7%), Amoxicillin + Metronidazole used 36 cases (38.29%). Amputation was performed in 35 cases (37.2%). Deaths concerned 5 patients (9.6%) with hypoglycemia as the main cause in 4 cases. Conclusion: Diabetic foot is a frequent complication of diabetes. The establishment of a multidisciplinary team should contribute to the improvement of the prognosis of the diabetic foot in a management center.

Diabetic Foot: Epidemiological and Clinical Aspects in the Department of Medicine and Endocrinology of the Hospital of Mali, Mali

Introduction: Diabetes is a heterogeneous group of metabolic diseases characterized by chronic hyperglycemia resulting from a defect in the secretion and/or action of insulin, diagnosed by the observation of high levels of glucose in the blood, responsible in the long term for vascular and nervous complications. The diabetic foot is the set of pathological manifestations affecting the foot in relation to the diabetic disease. Approximately 5% of diabetics present a chronic lesion of the foot. Objective: To describe the epidemiological and clinical aspects of the diabetic foot in the medicine/endocrinology department of the Mali hospital. Methodology: This was a retrospective descriptive study from November 2011 to December 2015. It focused on diabetic patients hospitalized in the department with a foot wound and aged 14 years and over. Results: The study involved 94 patients out of 828 hospitalized, a prevalence of 11.35%. Our series included 36 (38.3%) men and 58 (61.7%) women, i.e. a sex ratio of 0.61%. The mean age was 42.66 years with extremes of 14 and 81 years. Type 2 diabetes was present in 95% of the patients with a duration of evolution of more than 5 years in 60.6% of the cases. The mechanism of occurrence of the wounds was minor trauma in 54 cases (57.4%). Self-medication was the primary treatment in 70 patients (74.5%). More than 50% of the patients wore unsuitable footwear. Clinical and para-clinical examinations revealed isolated neuropathy in 37 cases (39.4%), necrotic wound in 37 cases (39.19%), poor glycemic control: HbA1c > 7% (98.9%), absence of osteitis (57.4%), normal Doppler ultrasound 45 cases (45.7%), stenosing arteriopathy 11 cases (22.3%), non-stenosing 3 cases (20.2%), germs present 56 cases (59.6%) including 21 cases (22.4%) of Staphylococcus aureus. Conclusion: Diabetes and diabetic foot constitute a real public health problem. They are responsible for dreadful and sometimes disabling complications. Its management is multidisciplinary and requires significant financial resources.

Screening of Foot at Risk in Diabetic Patients

Introduction: The term “diabetic foot” refers to all conditions that affect the foot and are directly related to the impact of diabetes. Objective: Screen the foot at risk in diabetic patients at the hospital of Mali. Methods: It was a cross-sectional study from January 1st, 2016 to June 30, 2016, at the Department of Internal Medicine and endocrinology of the Hospital of Mali. It was focused on all hospitalized diabetic patients. Results: Thirty-two (32) patients had a foot at risk among 76 diabetic patients during the study period representing 42.10%. The sex ratio was 0.52. Type 2 diabetes accounted for 82%. A glycemic imbalance (HBA1C > 7%) was observed in 88.15%. Eighteen percent (18%) of patients had a history of ulceration or amputation;33% were walking barefoot;78.9% had tingles in the foot;31.6% had intermittent claudication;64.5% had foot cleanliness;8% claw toes;42% had abolition or reduction of superficial tenderness to monofilament and 21% had mixed foot (neuropathy + arteriopathy). In our study, 58.9% of patients had no risk of podiatry. Conclusion: Screening of foot at risk is essential in the management of diabetes because it determines the podiatric risk enabling to minimize future functional disabilities.

Hemoglobinopathy and Systemic Lupus: A Rare Association

The authors report a case of systemic lupus associated with a composite heterozygosis SC with thalassemic component in a 19-year-old patient hospitalized for anemia and polyarthralgia who has a staturoponderal delay, macular erythematous lesions in butterfly wings on the face and ears, photosensitivity, puffy face, alopecia, pubic and axillary hair loss, scalp dermatophytosis, painful swelling of the interphalangeal joints, wrists and knees. The hemoglobin electrophoresis showed a compound heterozygote SC associated with β thalassemia. Antinuclear antibodies were positive with an anti-Sm positive antibody. Conclusion: The diagnosis of both diseases can be difficult when symptoms are concomitant and look alike.

Tubercular Uveitis in the Event of HIV Infection about a Case

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This disease is the second leading cause of infectious mortality in the world after infection with the human immunodeficiency virus. We report a case of multifocal tuberculosis with neuromuscular and ocular localization in an HIV-1 immunosuppressed patient in clinical and virological failure following therapeutic discontinuation due to non-compliance. This is a 43-year-old immunocompromised HIV1 patient with a history of cerebral toxoplasmosis in 2016 who consulted for right hemiplegia. These symptoms would go back to about 3 days marked by a deficit of progressive installation of the right hemicorps preceded by diffuse headaches, of moderate intensity without triggering factor radiating to the eyes associated with an intermittent fever with periods of spontaneous remissions, night sweats and chills, non-selective anorexia, non-increasing physical asthenia and unquantified weight loss. Management was 8-month antituberculous treatment, combining the first two months isoniazid (INH), rifampicin (RMP), pyrazinamide (PZN) and ethambutol (EMB), then the next 6 months (INH) and rifampicin (RMP). The reintroduction of the same antiretroviral protocol and a reinforcement of the therapeutic education made it possible to observe a decrease of the viral load. Treatment of ocular involvement was instituted with Timosol 1 drop in the eyes morning and evening and Diclocid 1 mg/ml: 1 drop in the eyes in the morning.