Viral Hepatitis B and C: Epidemiological, Clinical and Paraclinical Aspects in the Internal Medicine Department of KARA University Hospital in Togo

Introduction: Viral hepatitis B and C constitute real public health problems worldwide. The objective of this work was to describe the epidemiological, clinical and paraclinical aspects of viral hepatitis B and c in the internal medicine department of Kara University Hospital. Method: this was a retrospective descriptive study carried out in the Internal Medicine department of Kara University Hospital, over a period of 3 years from March 2020 to April 2023. It included all patients seen in consultation or hospitalized for hepatitis viral B and/or C. Results: A total of 57 patients were included in our study. The average age was 44.30 years ± 16.75 and the M/F sex ratio was 1.38. Married people were in the majority 63.2%. The circumstances of the discovery of viral hepatitis B and C were dominated by abdominal pain in 35.1% of cases and hepatomegaly in 29.8% of cases and in 33.3% of cases, it was during screening voluntary. Patients with viral hepatitis B only accounted for 64.9% of cases;those with only viral hepatitis C represented 31.6% of cases and 3.5% of cases had HVB/HCV co-infection. We recorded 36.8% complications including 52.4% liver cirrhosis and 47.6% hepatocellular carcinomas. During the evolution, there were 03 deaths. Conclusion: the prevalence of hepatitis B and C virus carriage in patients followed in internal medicine at Kara University Hospital is high. It is therefore essential to put in place treatment and prevention strategies against these viruses.

Clinical and Epidemiological Aspects of Hepatocellular Carcinoma at the Internal Medicine Department of Point “G” Teaching Hospital in Mali

Liver cancer is the malignant transformation of liver cells. It develops in 90% of cases of cirrhosis, more rarely on chronic non-cirrhotic liver disease, and exceptionally in a healthy liver. This study aimed to investigate the clinical aspects of Hepatocellular Carcinoma (HCC). It was a retrospective descriptive study covering 10 years, focusing on HCC cases seen in outpatient and inpatient settings at the Internal Medicine Department. We recorded 153 cases out of 7021 patient records, resulting in a hospital frequency of 2.17%. The male-to-female ratio was 3.5. The mean age was 52.37 ± 14.34 years. The most common presenting complaint was pain in 16.3% of cases. A history of jaundice was found in 25.5% of cases. Alcohol consumption was observed in 15.38% of cases. The main physical sign found was hepatomegaly in 76% of cases. HBsAg was positive in 33.3% of cases. Alpha-fetoprotein levels were above 400 IU/ml in 50.81% of cases. Patients classified as CHILD PUGH A represented 39.72% of cases. Abdominal ultrasound revealed portal thrombosis associated with heterogeneous multinodular hepatomegaly in 11% of cases. Cytology confirmed HCC in four out of six patients who underwent the examination. We recorded 63 deaths out of 111 hospitalized patients. Complications included encephalopathy, hematemesis, and ascites in 48 patients. Hepatocellular carcinoma remains a significant public health issue. Its predominance in men and its occurrence in adults with factors such as viral infections and ethylism mean that prevention of this pathology could greatly reduce its incidence.

Stroke (Cerebrovascular Accident): Epidemiological, Clinical and Evolving Aspects in the Internal Medicine Department of the Public Health Establishment 1 (EPS1) of Tivaouane

Introduction: The frequency, severity, cost of treatment, morbidity and mortality of stroke make it a real public health problem. In industrialized countries, strokes are the leading cause of physical disability in adults, the second leading cause of dementia (after Alzheimer’s disease), and the third leading cause of death (after cancer and cardiovascular disease). It’s also a major cause of depression. The objective of our study was to describe the epidemiological, clinical and evolutionary aspects of stroke in the internal medicine department of Tivaouane Hospital. Material and Method: This is a retrospective study carried out from January 1, 2015 to December 31, 2018 on the files of patients hospitalized for stroke in the medical department of the EPS1 in Tivaouane. We took into account all the patients who had a brain CT (computed tomography) scan. We collected data related to socio-demographic characteristics, history, risk factors, reasons for admission, clinical signs, paraclinical examinations, as well as evolution. Results: Out of 1999 patients, 206 files of patients with stroke were collected, i.e. a proportion of 10.3%. Our study population had a mean age of 65.53 years [16 - 97 years]. We noted a clear predominance of women (50.5%). The majority of the population came from the outskirts of Tivaouane (56.7%). Risk factors for stroke were dominated by hypertension (90.3%), dyslipidemia (19.4%), previous stroke (18.9%), and diabetes (16%). The clinical signs were dominated by a motor deficit (94.1%), speech disorders (67.4%) and consciousness disorders (47%). Ischemic strokes were predominant (65%) over hemorrhagic strokes (34.5%). The outcome was generally unfavorable with 14.6% total recovery, 58.7% recovery with sequelae and a case fatality of 26.7%. Conclusion: It emerges from this study that strokes still remain a real public health problem. Knowledge of populations of risk factors as well as their proper management is fundamental in primary prevention strategies, the only guarantee for a reduction in the still very high morbidity and mortality of this disease.

Biermer Disease: Initial Presentation and Follow-Up of 66 Patients in Internal Medicine Department in Senegal

Pernicious anemia in black people, is little known. Through this study we assess its diagnostic and evolutive aspects, and compare vitamin therapy B12 intramuscular and oral. Sixty six Biermer disease patients followed (January 2000-June 2014) at Internal Medicine Department of Aristide Le Dantec University Teaching Hospital (Senegal) are included. They were 26 men and 46 women (gender ratio: 0.65), who had a mean age of 47.84 years ± 15.25 years. Patients consulted for anemia (65 cases), acquired melanodermia (36 cases), gastrointestinal symptoms (30 cases), peripheral neuropathy (27 cases), venous thrombosis (2 cases), acute depression (1 case). Macrocytosis was observed in 52 cases. The mean hemoglobin in the vitamin B12 intramuscular group (52 patients) or oral group (14 patients) was the inclusion: 6.55 g/dl ± 3.12 g/dl vs 6.52 g/dl ± 2.18 g/dl (p = 0.04);and at day 8 treatment: 8.69 g/dl ± 2.49 g/dl vs 8.85 g/dl ± 1.9 g/dl (p = 0.43). Neurological and vascular presentations are unusual in contrast to macrocytic anemia. Oral administration of vitamin B12, simple and effective should be recommended in country with limited resources.

Profile of Urinary Tract Infections in the Elderly in the Internal Medicine Department of the University Hospital Center of Point G, Bamako, Mali

Introduction: Urinary tract infections (UTI) are frequent and of polymorphous clinical symptomatology in elderly subjects both in and out of hospital. In Mali, to our knowledge, no study concerning UTIs in the elderly has been conducted, hence the interest in this innovative work. Objectives: To determine the prevalence and clinical and paraclinical aspects of urinary tract infections in the elderly. Materials and Methods: This was a prospective descriptive and cross-sectional study from September 1, 2013 to August 31, 2014, i.e. duration of 12 months. All patients aged 65 years and over, hospitalized or ambulatory in the internal medicine department with a documented urinary tract infection were included. Results: We collected and examined 194 patients. The cytobacteriological study of urine (CBSU) was positive in 28 patients, i.e. a prevalence of 14.43%. The male sex represented 59.8% of the cases, the sex ratio was equal to 1.46. The age groups between 65 - 69 and 70 - 74 years were the most affected, respectively 28.57% and 39.28%. The main clinical signs were: asthenia, anorexia, dependence, fever, urinary burning, dysuria. Hospitalization was associated with urinary tract infection with P = 0.01. The group of enterobacteria were incriminated in 75% of cases. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa represented 39.28%, 14.28% and 10.71% of cases. Urinary tract infections were represented by pyelonephritis, acute prostatitis, orchi-epididymitis and simple cystitis. Conclusion: Urinary tract infection is frequent in the elderly, its clinical presentation is polymorphic and enterobacteria are the most incriminated group of bacteria.

Metabolic Syndrome: Epidemiological, Clinical and Biological Profiles in the Cardiology and Internal Medicine Departments of the Mother-Child CHU “Luxembourg”

Introduction: The metabolic syndrome is a clinical entity defined by the association in the same subject of four of the following five factors: abdominal obesity (or android), type 2 diabetes, hypertension, hypo HDL cholesterolemia, hypertriglyceridemia. The aim of the work was to study the epidemiological, clinical-biological profiles and complications of patients in the cardiology and internal medicine department of the Mother-Child CHU “Luxembourg”. Materials and Methods: We carried out a cross-sectional study, from September 2019 to June 2020 in the cardiology and internal department of the mother-child CHU “Luxembourg”. All patients with metabolic syndrome admitted to the two departments who agreed to participate during the study period were included in the study. These patients meet the 2009 harmonization attempt criteria (IDF 2009). The variables studied were: socio-demographic characteristics (sex, age, profession), pathological history, clinical signs (functional signs, BMI, waist size), paraclinical signs (ECG, cardiac ultrasound, laboratory assessment) and complications. Results: A total of 104 patients were included. The female sex represented 58.65% of cases. The 60 to 69 age group was the majority with 40.78%, housewives occupied 41.34% of cases. Diabetes, arterial hypertension and dyslipidemia were the most represented cardiovascular risk factors with respectively: 80.77%, 79.81% and 53.85%. Visual blurring was the most common functional sign with 23.08% of cases. Moderate obesity was observed in 34% of patients. Waist circumference was high in 39.53% of male patients and 37.70% of female patients. Cardiac ultrasound found a severely collapsed ejection fraction in 25% of patients. HDL-c levels were low in 64.52% of male patients and 75% of female patients. The most observed complications were: dyslipidemia (53.85%), stroke and renal failure with 23% respectively. Conclusion: The metabolic syndrome remains a real public health problem, constantly increasing in our populations and constitutes a danger by its constituent elements.

The COVID-19 Pandemic in Senegal: Experience of an Internal Medicine Department as an Epidemic Treatment Center

Introduction: The COVID-19 pandemic has turned the global health system upside down. Senegal recorded its first case on 2 March 2020. As part of its control strategy, the internal medicine department was set up as an epidemic treatment center (ETC). We report on our experience in the management of patients hospitalized in the said center. Material and Methods: Retrospective and descriptive study with analytical aim carried out at the ETC of the CHU Le Dantec of Dakar during the period from 29 April to 30 October 2020 (1st wave) then from 30 December 2020 to 30 April 2021 (2nd wave). All hospitalized patients who tested positive for RT-PCR were included. Epidemiological, clinical, paraclinical and evolutionary data were collected from a pre-established survey form and analysed using the software. Results: Five hundred and seventy files were collected: 379 patients (66%) in the 1st wave and 191 patients (34%) in the 2nd wave. There were 312 men and 258 women, i.e. a sex ratio of 1.22. The median age was 56 years [1.5 - 100 years]. Two thirds of the patients (66%) were over 50 years of age and 223 patients (39.1%) were over 65 years of age. Community transmission was reported in 72% of cases. The average length of hospital stay was 10 days [1 - 32]. Clinically, the mild form predominated (50.9%);the severe and critical forms were 32.6%. Comorbidity was noted in 68% of patients. The different comorbidities were: hypertension (36.1%), diabetes (28.2%), advanced CKD (9.8%). The case fatality rate was 17.2% with a mean age of 70 years. Conclusion: COVID-19 is responsible for respiratory but also systemic manifestations. This 3rd pandemic particularly affects vulnerable people with a significant morbidity and mortality, thus requiring the implementation of standardized CTE with multidisciplinary teams in the control strategies.

Epidemiology of Anemia at the Internal Medicine Department in Borgou Departmental Hospital Center(DHC)in Parakou(Benin)

Objective: To describe clinical and biological characteristics of anemia in the Internal Medicine department of Borgou Departmental Hospital Center (DHC). Methods: This was a transversal and descriptive study for an analytic purpose. All patients hospitalized in the Internal Medicine department of Borgou DHC who had a hemogram for their care were included in the study. Anemia was defined as a hemoglobin level lower than 12 g/dL for men and lower than 11.5 g/dL for women. Results: Frequency of anemia was 61.8% (76 of 123 patients). Anemia was moderate in 47.4% of the cases and severe in 27.6% of the cases. Basing on the mean corpuscular volume, microcytic anemia accounted for 36.8%, anemia was normocytic in 46.1% and macrocytic in 17.1% of cases. According to the mean corpuscular hemoglobin concentration, normochromic anemia accounted for 81.6% of the series and hypochromic in 18.4%. The most common pathologies found in anemic patients came from digestive origin (17%), the renal causes were also found in 17% of the cases. Cardiac pathologies were responsible for anemia in 13% of cases. Malaria and pulmonary pathologies were responsible for anemia in respectively 12% and 9%. The main factors associated with anemia were young age (young adult) and neurological pathologies. Conclusion: Anemia hospital prevalence is very high in the Internal Medicine Department of Borgou DHC. Awareness of populations and practitioners for the early management of various pathologies which provide anemia could improve this presentation.

Epidemiological, Clinical, Bacteriological Profile of Urinary Tract Infection in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.

Etiological and Evolutionary Profile of Anemia in Patients Hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Anemia is one of the most common public health problems in the world and affects all ages. Objective: To describe the etiological and evolutionary profile of anemia in patients hospitalized in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all anemic patients hospitalized during the study period. Results: We identified 91 cases of anemia out of 200 patients admitted to the Unit that is a hospital prevalence of 45.5%. The age group of 26 to 35 years was the most represented, that is to say 29 cases (31.87%) with an average age of 43.55 years ± 17.48 years, the female sex predominated, 51 cases (56.04%) with a sex ratio of 0.78. Housewives represented 41 cases (45.05%). The majority of patients resided in rural areas 48 cases (52.75%). The main manifestations were: asthenia 75 cases (78.02%), vertigo 68 cases (74.72%), dyspnea 62 cases (68.13%), headaches 59 cases (64.83%), palpitations 55 cases (60.44%), conjunctival pallor 53 cases (58.24%), tachycardia 43 cases (47.25%), systolic murmur 18 cases (19.78%) and IMO 11 cases (12.09%). The associated pathologies were: infected diabetic wounds 25.27%, followed by bacterial pleuro-pneumopathy 18.68%. Biologically, microcytic anemia was the most frequent 49 cases (53.84%), followed by normocytic anemia 35 cases (38.46%) and macrocytic anemia 7 cases (7.7%). Anemia was hypochromic, 53 cases (58.24%) were more encountered compared to normochromic anemia 38 cases (41.76%). The anemia was: severe in 43 cases (47.25%), moderate 29 cases (31.87%) and mild 19 cases (20.88%). Inflammatory anemia is the most common etiological diagnosis in 60% of cases, followed by vitamin B12 deficiency anemia observed in 21% of patients and then blood diseases in 7.33% of cases. The main causes of death were HIV (50%) and kidney failure (33.33%). Conclusion: Anemia is a frequent symptom in internal medicine. It constitutes a real diagnostic challenge for the internist and this sometimes in an emergency context. The use of specialized examinations and labile blood products is essential in our hospital.

Liposarcoma Retro-Peritoneal in the General Surgery Department of the Hospital of the District of the Commune IV

Retroperitoneal soft tissue sarcomas in the retroperitoneal/intra-abdominal regions represent 10% - 15% of all cases of soft tissue sarcoma. Liposarcomas, which are the most common histological type, account for 20% - 45% of retroperitoneal/intra-abdominal sarcoma cases, and 20% of liposarcomas cases are primary retroperitoneal liposarcomas. Surgical resection in case of malignancy remains the treatment of choice for liposarcomas, according to the guidelines of most major international companies. Our goal was to improve the management of retroperitoneal liposarcoma. This was a 65-year-old patient, with no medical or surgical history, who was referred to us for abdominal swelling, in whom clinical and paraclinical examination found retroperitoneal liposarcoma stage IV, and the surgical treatment consisted in making a tumor reduction. Conclusion: Retro-peritoneal liposarcoma is an undervalued malignant tumor, and the diagnosis is often late.

Cancer and Covid-19 in the Department of Internal Medicine and Medical Oncology at the National Teaching Hospital Hubert Koutoukou Maga of Cotonou, about 4 Cases: A Review of the Literature

Coronavirus Disease-19 (COVID-19) manifests itself by a respiratory attack that can go from mild to severe forms. The factors favoring the severe forms are age, arterial hypertension, diabetes mellitus, and cancer. We report 4 cases of COVID-19 on cancer, followed in the Department of Internal Medicine and Medical Oncology of National Teaching Hospital Center Hubert Kougougou Maga (NTHC-HKM). Case 1: A hypertensive 65-year-old female patient with a severe form of COVID-19 on an FIGO (International Federation of Gynecology and Obstetrics) IVB endometrioid adenocarcinoma with pulmonary metastasis: unfavorable evolution under treatment with death. Case 2: A 56-year-old hypertensive patient with severe COVID-19 with pulmonary metastatic recurrence of SBRIII, HER2 positive invasive ductal carcinoma of the left breast: favorable evolution with cure of COVID-19, subsequent death related to active tumor. Case 3: A 37-year-old patient with a moderate form of COVID-19 with hepatocellular carcinoma complicating post alcoholic cirrhosis, CHILD C: favorable evolution with cure of COVID-19, patient lost to follow-up. Case 4: A 56-year-old patient, hypertensive, type II diabetic, presenting a severe form of COVID-19 on a field of ovarian serous adenocarcinoma of high grade FIGO IV A with pleuropulmonary metastasis: favorable evolution with cure of COVID-19, subsequent stroke, patient followed in palliative home hospitalization. The diagnosis of COVID-19 in cancer with pulmonary metastases is difficult. The pulmonary location of tumors seems to be a factor favoring severe forms.

Healthcare-Associated Bacteremia and Urinary Tract Infections in Wards A and B of Medicine Department, CNHU-HKM of Cotonou: Characteristics and Risk Factors

Introduction: Healthcare-associated infections are involved in hospital long-stay and in the increase in inherent costs to patients care. Objectives: Objective was to describe the characteristics of healthcare-associated bacteremia and urinary tract infections in medical wards of CNHU-HKM of Cotonou, describe the distribution of germs identified according to admission wards and identify factors associated with onset of healthcare-associated infections. Materials and Methods: It was a cohort study conducted from 4th April to 16th September 2016. The study population included patients admitted in wards A and B of CNHU-HKM Medicine department for at least the past 48 hours, or readmitted in one of the medical wards less than 14 days after their discharge from hospital. Results: The study included 825 patients in total. Prevalence of healthcare-associated infections was 9.8%. Bacteremia was the most represented group (65.4%). The most often identified germs regardless of the site were respectively: K. pneumonia (38.5%), S. aureus (23.1%) and E. coli (20.0%). HIV+ status, internal medicine department, nephrology and endocrinology, duration of admission and the use of urinary catheter represent factors statistically associated with the onset of healthcare-associated infections. Conclusion: Healthcare-associated infections are a real public health issue in CNHU-HKM Medicine Department. There is pressing need to conduct a study on clinical hygiene so as to assess healthcare staff in practice.

Reasons for the Use of Health Care in Elderly Persons Undergoing Consultation in the University Clinic of Internal Medicine and Medical Oncology of the Hubert Koutoukou Maga National Hospital and University Center (CNHU-HKM) of Cotonou

Introduction: The progressive ageing of the population from southern Sahara is leading to an increase in health needs among the elderly. The purpose of this study was to output an overview about the reasons why the elderly come for consultation in the internal medicine department of the HKM-NHUC in Cotonou. Methodology: This was a retrospective, descriptive, and analytical study, which included all patients aged 65 years and over, who came for the first time for consultation in the Internal Medicine Department of the CNHU-HKM between January 1st and December 31st, 2017. Results: Among the 680 new patients received in internal Medicine consultations during the study period, 118 people were aged 65 and over, representing a hospital frequency of 17.35%. The sex ratio was 0.9 with a mean age of 73 ± 7 years. Hypertension was the main comorbidity of the patients (69%). Cough (11.3%) and low back pain (8.2%) dominated the reasons for consultation. The three main nosological groups of pathologies were, in descending order, diseases of the osteo-articular system (17.5%), diseases of the respiratory system (16.5%) and diseases of the circulatory system (12.4%). Pneumonia (11.3%) and lumbosacral spondylarthrosis (10.3%) were the most frequent pathologies in patients whose health needs remain quite varied. Conclusion: The elderly become gradually an important part of the population in southern Sahara. A better understanding of the health needs of this category of the population is necessary to deal effectively with the health challenges that will accompany this phenomenon.

Epidemiological, Clinical, Paraclinical and Evolutionary Aspects of Urinary Tract Infection in Diabetics Hospitalized at the Department of Medicine of Abass Ndao Hospital from January 01, 2018, to December 31, 2018

Introduction: Urinary tract infection (UTI) is a major public health problem because of its morbidity and mortality. It occurs with increased frequency during diabetes. The objective of this work was to study the frequency and etiologies of urinary tract infections in diabetics hospitalized at the department of medicine of Abass Ndao Hospital. Patients and Methods: This work was a cross-sectional, descriptive, and analytical study conducted from January 01, 2018, to December 31, 2018. It focused on hospitalized diabetic patients with urinary tract infection. Epidemiological, clinical, and evolutionary data of UTI were evaluated. Results: One hundred and twenty-eight (128) diabetic patients had a cytobacteriological urine exam (CUE). 44 of who had a positive CUE (34.4%). The age group [60 - 69] years was the most represented (31.8%). Women predominated (61.4%) with a sex ratio (m/f) of 0.63. Abdominal pain was the most frequent reason for consultation, followed by polydipsia. Fever was recorded in 21 patients (47.7%). Type 2 diabetes was found in most patients (70.5%). Glycemia above 2g/l was found in 34 patients (89.5%). Anemia accounted for more than half of the patients with 29 cases (65.9%). Leukocytosis was noted in 28 patients (63.6%) and a positive CRP in 33 patients (75%). An increase in urea-creatinine was noted in 23 cases (52.3%). The results of the CUE revealed Escherichia coli as predominant (43.2%, n = 19), followed by Candida with 22.7% (n = 10). Antibiotic therapy was given to all patients. The mostly used antibiotic in the treatment of UTI was Cefotaxime 27.3% (n = 12). Older age and female gender were associated with the presence of E. coli. Four (4) deaths were recorded (9%). They were all male over the age of 65. Conclusion: UTI in diabetes is an important cause of morbidity and mortality. The development and implementation of a prevention and management program are essential.

Pulmonary Embolism: Epidemiological, Clinical, Therapeutic and Evolution Aspects in the Medicine Department of Hospital of Mali Bamako

Background: Pulmonary embolism (PE) is a severe form of venous thromboembolic disease. In Africa, prevalence of PE in hospitalized medical patients varies among studies. Objective: Aim of this work was to study the epidemiological, clinical, therapeutic and evolution aspects of PE in the medicine department of Mali’s Hospital Bamako-Mali. Methodology: This was a retrospective cross-sectional study carried out from January 01, 2017 to December 31, 2020 in the medicine department of Mali’s hospital Bamako, including all inpatients admitted for PE during the study period. Results: Of 1814 hospitalized patients, 54 patients had pulmonary embolism. Hospital frequency of pulmonary embolism was 2.97%. Predominance was female and sex-ratio M/F was 0.38. Mean age in our series was 54.24 ±1.19 years. Predisposing factors to pulmonary embolism were dominated by obesity 37%, high blood pressure 35.2% and history of cardiovascular disease 20.4%. Dominant signs were dyspnoea and chest pain in 83.3% and 70.4% of cases respectively. Probability of pulmonary embolism was high in 40.7% according to Wells score. Patients with right heart failure were 22.2%. EKG showed sinus tachycardia70.4% and S1Q3 aspect 7.4%. Heart right chambers were dilated at transthoracic echography 42.6%. Obstruction was bilateral at chest angio CT for 51.9% and proximal for 42.6%. Deep venous thrombosis was associated at EP in 16.6%. Treatment was low weight molecular heparin followed by vitamin K antagonist or direct oral anticoagulant. One patient was successfully treated by thrombolysis. Hospital mortality was 16.7%. Conclusion: PE is a serious disease probably underdiagnosed. It is responsible of important mortality.

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.

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.

The Prevalence of Heterozygous Familial Hypercholesterolemia among Adult Filipino Patients with Dyslipidemia at Universidad de Santa Isabel Health Services Department: An Observational Descriptive Prospective Study

Objectives: It is to determine the prevalence of familial hypercholesterolemia (FH) among adult Filipino patients with dyslipidemia at Universidad de Santa Isabel Health Services Department in one year. Methods: An observational descriptive prospective study involves Filipino patients, aged 19 years and older, with dyslipidemia. The Dutch Lipid Network (DLN) Criteria was used to diagnose FH. Prevalence data and categorical variables were expressed as percentages, while continuous variables were reported as mean and standard deviations. Results: 529 patients were included in the study. 302 were females, and 227 were males. 180 (34%) scored Unlikely, 100 (19%) scored Probable, 185 (35%) scored Possible, and 64 (12%) were classified under Definite Familial Hypercholesterolemia. Most of the patients diagnosed with definite FH did not have diabetes, cerebrovascular disease (CVD), and coronary artery disease (CAD). The diagnosis was not affected by gender, BMI, smoking, and alcohol consumption. Hypertension was significantly correlated to the diagnosis of FH, as most of them were already hypertensive at diagnosis. It was noted that hypertension, diabetes, CVD, and CAD were seen at an earlier age among patients with definite FH. Conclusion: The prevalence of heterozygous FH at 12% among dyslipidemia patients and 1.3% among the general population was described for the first time in our region. This result should raise the awareness of our healthcare providers that FH, which is a major risk factor for premature CAD and CVD, exists, and early detection and management are important.

Prevalence of Metabolic Syndrome in the Medical-Surgical Emergency Department of the Donka National Hospital

Introduction: The metabolic syndrome (MS) corresponds to the coexistence of several metabolic disorders including three (3) factors out of five (5) in the same individual. These five (5) major criteria are central or abdominal obesity, hypertriglyceridemia, low High-Density Lipoprotein cholesterol (HDLc), hyperglycemia, and elevated blood pressure. It has been the subject of various definitions over the past 10 years. It is a clinical-biological entity recognized by the World Health Organization (WHO) in 1998, the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) in 2001, the International Diabetes Federation (IDF) in 2005, then the IDF Harmonization Consensus in 2009. The objective of this study was to determine the prevalence of metabolic syndrome in the medico-surgical emergency department of the Donka national hospital. Methods: This was a descriptive study, data collection took place from February 5 to July 5, 2022 and, covering all patients aged 16 and over, without distinction of sex, origin received in consultation in the medical unit in the emergency department of Donka and having agreed to participate in the study. Anthropometric, clinical and biological data were recorded. Results: We recruited 107 patients whose age ranged from 20 to 94 years with a mean age of 58.92 ± 13.78 years. The prevalence of metabolic syndrome in our study population was 6.30% with a female predominance of 73.83%. The most frequent components of the metabolic syndrome were abdominal obesity (100%) followed by hyperglycemia (85.98%) and hypertension (85.05%). Among the complications related to the metabolic syndrome, diabetes was found with (46.73%), hypertension (43.93%) and stroke (16.93%). Conclusion: Our results show a significant prevalence of the metabolic syndrome and its main complications, which were diabetes, hypertension and stroke. These data justify early detection and treatment strategies.