Diabetes Complications and Associated Factors in Type 2 Diabetic Patients in Cotonou

Long-term complications are the main sources of morbidity and mortality in diabetic patients. Aims: The aims of the study were to determine the rate of long-term complications in type 2 diabetic patients and to identify factors associated to these complications. Patients and method: Successive type 2 diabetic patients attending the diabetic center were submitted to a questionnaire and to clinical examination. Data were completed by consulting their medical reports. Chi square test was used for statistical analysis. Results: In 150 diabetic patients included in the study, the global rate of complications was 78.0%. Specific rate for itch complication investigated was 57.7% for peripheral neuropathy, 75.0% for erectile dysfunction, 20.0% for nephropathy, 36.6% for retinopathy, 40% for macroangiopathy and 8.0% for foot ulcer. Factors significantly associated with high rate of complications were age above or equal to 50 years (p = 0.001), the male gender (p = 0.000), high blood pressure (p = 0.0001), the absence of familial history of diabetes (p = 0.02), the duration of the disease above 5 years (p = 0.001) and high HbA1c level (p = 0.001). Conclusion: This study revealed that type 2 diabetic patients followed up in the diabetic center in Cotonou showed a high rate of chronic complications which often occurred in a younger age than in developed countries. Numerous socio-demographic and biological factors were significantly associated with the high rate of complications.

鼻部巨大鳞状细胞癌并发颅内扩散(法语)

Introduction. Cutaneous squamous cell carcinoma is an invasive and destructive tumor, and may cause death by local extension or because of metastasis. We repo rt the case of a patient with a giant squamous cell carcinoma of the nose and ex tension to the brain and discuss the main risk factors from this extension. Obse rvation. Resection of a giant squamous cell carcinoma was performed of the nose in a 45 year-old man after debulking radiotherapy. Histological examination dis closed a well-differentiated tumor and perineural involvement, with at least a 6 mm margin. A first relapse occurred on the orbital edge of the initial resecti on, the lesion was removed revealing an involvement of the infra-orbital nerve. Whilst the patient was receiving chemotherapy, a second relapse occurred respon sible for ophthalmoplegia and loss of vision, with involvement of the left orbit al apex, cavernous sinus and temporal lobe. The patient died from grand mal seiz ures. Discussion. Brain extension of cutaneous squamous cell carcinoma of the he ad is rare. It develops along the anatomic pathways, especially perineural sprea d. Main risk factors for such a poor course are discussed, including the size of tumor, the anatomic site, the depth and perineural invasion.

动脉源性和血液因素导致的脑梗死:洛桑经验和文献回顾(法国)

Introduction. Hematological diseases are seldom found as the etiology of isch emic strokes, but are frequently investigated by expensive laboratory tests afte r a first cerebral vascular event. Methods. In the Lausanne Stroke Registry, we retrospectively reviewed the cases of patients hospitalized between 1979 and 2001 for a first is chemic arterial stroke which was attributed to a hematological etiology. Of 4697 patients, 22 (0.47 per cent) had a stroke due to one of the following hematolog ical pathology: polycythemia vera (4), secondary polycythemia (4), essential thr ombocytemia (2), secondary thrombocytosis (4), multiple myeloma (1), CIVD (1), p rotein S deficiency (1), antiphospholipid antibody syndrome (4), moderate homocy steinemia (1). A literature review was undertaken for each hemopathy. Conclusion . In light of the results of these data, we concluded that a complete blood coun t provides sufficient hematological screening for the majority of patients hospi talized for an arterial stroke. The antiphospholipid antibody syndrome is a rare cause of cerebral infarction, which needs to be investigated in young patients, in cases of multiple or recurring stroke or in the presence of a typical histor y. Inherited thrombophilias are not a significant risk factor for arterial cereb ral infarction and their investigation is only warranted for a sub-group of yo ung patients with a cryptogenic stroke, in which group the prevalence is slightl y increased. Moderate homocysteinemia must be considered as a cerebrovascular ri sk factor of minor importance, but potentially treatable by a substitution of vi tamin B 12, B 6 and folates. The efficacy of this substitution in the prevention of cardiovascular events needs vet to be demonstrated.

与经颈静脉肝内门体分流术相关的复发性肠球菌菌血症(法)

Transjugular intrahepatic portosystemic shunts (TIPS) are an accepted techniq ue for controlling the complications of portal hypertension. Although the incide nce of TIPS- associated bacteremia appears to be low (2% ), this complication has a high mortality. We report one case of recurrent enterococcal bacteremia as sociated with TIPS and regression of TIPS thrombus after antibiotherapy. The ant ibiotic regimen is similar to that given in bacterial endocardites.

Capacity gaps in health facilities for case management of intestinal schistosomiasis and soil-transmitted helminthiasis in Burundi

Background:Schistosomiasis and soil-transmitted helminthiasis(STH)are endemic diseases in Burundi.STH control is integrated into health facilities(HF)across the country,but schistosomiasis control is not.The present study aimed to assess the capacity of HF for integrating intestinal schistosomiasis case management into their routine activities.In addition,the current capacity for HF-based STH case management was evaluated.Methods:A random cluster survey was carried out in July 2014,in 65 HF located in Schistosoma mansoni and STH endemic areas.Data were collected by semi-quantitative questionnaires.Staff with different functions at the HF were interviewed(managers,care providers,heads of laboratory and pharmacy and data clerks).Data pertaining to knowledge of intestinal schistosomiasis and STH symptoms,human and material resources and availability and costs of diagnostic tests and treatment were collected.Findings:Less than half of the 65 care providers mentioned one or more major symptoms of intestinal schistosomiasis(abdominal pain 43.1%,bloody diarrhoea 13.9%and bloody stool 7.7%).Few staff members(15.7%)received higher education,and less than 10%were trained in-job on intestinal schistosomiasis case management.Clinical guidelines and laboratory protocols for intestinal schistosomiasis diagnosis and treatment were available in one third of the HF.Diagnosis was performed by direct smear only.Praziquantel was not available in any of the HF.The results for STH were similar,except that major symptoms were more known and cited(abdominal pain 69.2%and diarrhoea 60%).Clinical guidelines were available in 61.5%of HF,and albendazole or mebendazole was available in all HF.Conclusions:The current capacity of HF for intestinal schistosomiasis and STH detection and management is inadequate.Treatment was not available for schistosomiasis.These issues need to be addressed to create an enabling environment for successful integration of intestinal schistosomiasis and STH case management into HF routine activities in Burundi for better control of these diseases.