Aspects cliniques et paracliniques des amputations du pied diabétique au Mali

Introduction. La plaie du pied diabétique est une affection fréquente (10% des motifs d'hospitalisation) et grave, le risque d'amputation étant de 10 à 30 fois plus élevé chez les diabétiques par rapport à la population générale. Elle n'a que peu été étudiée au Mali. Objectif. Décrire les aspects cliniques, thérapeutiques et pronostiques des amputations du pied diabétique au Mali. Méthodologie. II s'agit d'une étude descriptive et transversale qui s'est déroulée à l'Hôpital du Mali du 1er Juillet 2016 au 30 Juin 2017. Elle a porté sur les patients diabétiques présentant une plaie du pied, hospitalisés dans le service de médecine et endocrinologie de l'Hôpital du Mali Les données recueillies et analysées étaient les données sociodémographiques, les données relatives au diabète, les données relatives au pied, les bilans biologiques récents, les radiographies standards, l'échographie doppler artériel des membres. Pour classer le pied atteint, nous avons utilisé la classification de l'Université de Texas. Résultats. Vingt-cinq (25) patients diabétiques ont été recrutés. Le sex ratio était de 0,66. Tous les patients avaient une artériopathie, 96% avaient une neuropathie, et 80% avaient un pied mixte. Un mauvais équilibre glycémique était noté chez 64% des patients ; une ostéite radiologique dans 52% des cas. En outre, 23 patients (92%) avaient un risque d'amputation à 100% selon la classification de l'Université du Texas. 12 patients (46%) avaient été amputés au niveau de la jambe. Nous avons enregistré un décès (4%). Conclusion. L'amputation du pied diabétique affecte surtout la diabétique de sexe féminin avec un mauvais équilibre glycémique. Dans la moitié des cas, elle a lieu au niveau de la jambe

The Pattern and Surgical Management of Diabetic Foot at Muhimbili National Hospital; Dar-es-Salaam; Tanzania

Background:Diabetic foot is one of the chronic consequences of diabetes mellitus and isresponsible for about 50of non-traumatic lower limb amputations.It is thus associated with social devastation to the patients and their families;both emotionally and economically.This study aimed at determining the pattern and the surgical management of patients with Diabetic Foot at Muhimbili National Hospital; from March to December 2008. Methods: All in-patients with diabetic foot who were admitted in the hospital during the study period were included into the study.Results: A total of 67 patients presented with diabetic foot during the study period of 10 months 4.5had Type 1 Diabetes Mellitus and 95.5had Type 2.The mean age of the patients was 52.4 years with a range of 21-75 years.The mean hospital stay was35.5 days.Most patients had a positive family history of Diabetes Mellitus (59.7).Majority of them lacked the known risk factors for foot ulceration such as hypertension;elevated cholesterol levels;trauma and duration of Diabetes Mellitus for longer than 10 years.Wagner Grade 4 and 5 were the most common ulcers encountered and major amputation was done in 44.8of the patients.The mortality rate was relatively high (25.4). Mortality was significantly higher in those with Wagner's Grade ulcers 3 (p-value = 0.0322). Conclusion:Diabetic foot ulceration was found to be a significant cause of morbidity and mortality in our setting.These patients stay in the surgical ward for a prolonged period of time.This causes a significant strain to the provision health services in the hospital.Designing a diabetic foot management protocol and initiating a diabetic foot unit for admission of these patients could reduce the associated morbidity and mortality and improve outcome

Diabetic foot disease in Ethiopian patients: a hospital based study

Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability; morbidity and mortality among diabetic patients and about 15develop foot ulcers in their lifetime. So far; there are few published data in relation to the high-risk diabetic foot in Ethiopian subjects. Methods: A retrospective study was done to determine the various risks as well as antecedent factors; other long term complications; treatment profile and subsequent follow up of 196 patients with diabetic foot disease admitted to the Tikur Anbessa Specialized Referral Hospital from Jan 1999 to Dec 2003. Patients' medical records were reviewed using pre-prepared formats and relevant data were abstracted. The data were analyzed using Epi info version 3.4.3 statistical soft ware. Results: A total of 196 patients were included in this study. The male to female ratio was 3 to 1. The median age was 60 years (IQR; 47-65). Median duration of symptoms before presentation was 21 days (IQR; 14-30) and the median duration of diabetes mellitus was144 months (IQR; 60-216). More than two thirds had type 2 diabetes mellitus. Among 109 patients with identified antecedent risk factors for their foot problem; ill fitting or new shoes attributed in 48(44). Neuro-ischaemic ulcers were seen in 113 (58) of the cases and neuropathic ulcer in 63 (32). Ulcer with cellulitis or gangrene was the most common mode of presentation seen in 92 (47) of the patients. Ninety two (47) patients had amputations. Re-amputation was necessary in 24 (26) of these cases. Less than 40of the total cases had a regular follow up either at a clinic or hospital. Diabetes was diagnosed for the first time in 7 cases (4) on presentation with foot ulcer. The mean glycemic level was poorly controlled in over 80of the cases. The overall mortality rate was 21and sepsis was the most identified cause. Conclusion: Lack of regular patient follow up and diabetes education on foot care; poor glycemic control; delay in patient presentation and surgical intervention as well as patients' refusal to undergo surgical interventions were the reported contributing factors for the observed high mortality. Recommendation: Diabetic education on foot care; emphasis on metabolic control of diabetes; early presentation and surgical intervention when appropriate has to be highlighted in the management of diabetic patients. More studies have to be done in relation to the high-risk diabetic foot particularly in the Ethiopian setting emphasizing on preventive aspects. [Ethiop J Health Dev 2011;25(1):17-21]

Diabetic Septic Foot in Omdurman Teaching Hospital

Objective: To audit the management of diabetic septic foot [DSF] lesions in Omdurman Teaching Hospital, using Wagner classification. Patients and methods: This is a retrospective study on 208 patients with DSF admitted to Omdurman Teaching Hospital, Sudan between June 2006 and May 2007. Data were analyzed manually Results: The male to female ratio was 2:1. The mean age± SD was 56 ± 12.35 year. 16.8% patients were grade 1. 33 (15.9%) patients were grade 2. grades 3, 4, 5 patients were 66 (37 %), 38 (18.3%) and 36 (17.3%) respectively. Major lower limb amputation and mortality were 19.2%, and 6.7% respectively. Conclusion: Preventive measures for patients at risk are highly needed as well early presentation is encouraged when ulcer develops in diabetic foot to avoid subsequent complications