Detection of microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus (DM) which is associated with high morbidity and mortality. There is high rate of bacteria colonization especially in those with tendencies for poor wound dressing. This is accompanied by high rate of inappropriate antibiotic usage. The aim of this study is to characterize microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria, and to determine the antibiotic susceptibility of these isolates. Methodology: This was a descriptive cross-sectional study of consecutively enrolled diabetic patients with foot ulcers in two tertiary healthcare facilities in Enugu, Nigeria, between May 2021 and February 2022. A structured questionnaire was used to obtain socio-demographic and clinical data of the patients. Pus samples and/or tissues were collected from the ulcer lesion of each patient for aerobic and anaerobic microbial cultures and biochemical identification using standard conventional techniques. Results: A total of 310 diabetic patients with foot ulcers were recruited into the study, with 62.3% (193/310) males and 37.7% (117/310) females, and mean age of 56.0±13.9 years. Bacteria and yeast were isolated from samples of 280 (90.3%) patients while samples of 30 (9.7%) patients had no microbial growth. Males had higher frequency of microbial isolates (90.7%, 175/193) than females (89.7%, 105/117), while the age group ≤ 40 years had higher frequency of microbial isolates (100%, 43/43) compared to other age groups, although the differences are not statistically significant (p>0.05). The distribution of the isolates showed that 15.7% (44/280) were monomicrobial while 84.3% (236/280) were polymicrobial. The highest single isolate was Bacteroides fragilis with 5.0% (14/280), followed by Staphylococcus aureus with 3.2% (9/280). Bacteroides fragilis and S. aureus occurred as the highest combined bacteria isolates with 5.7% (16/280). Most of the patients were colonized by combination of bacterial isolates. The susceptibility indicates that most of the anaerobic bacteria were sensitive to metronidazole while S. aureus isolates were resistant to ofloxacin at a rate of 65.0%. Conclusion: The findings in this study showed that there is high bacteria and fungi colonization of foot ulcers of diabetic patients in Enugu, Nigeria. Routine care of wounds especially frequent changes of dressing materials and the use of potent antiseptics, are recommended.

Quality of Life of Type 2 Diabetic Patients attending a Tertiary Hospital in South-South Nigeria

Background: Type 2 Diabetes mellitus affects the quality of life of individuals and their ability to function. It affects the physical, social and mental well-being of patients with immediate and delayed complications.This study determined the quality of life of type 2 diabetic patients attending a tertiary hospital in south-south Nigeria.Methods:This was a descriptive cross-sectional study conducted among type 2 diabetic patients attending the medical outpatient clinic of the University of Port Harcourt Teaching Hospital between September and November 2019. Purposive sampling technique was used to select a total of 347 participants for the study following ethical approval. WHOQOL-BREF questionnaire was used to measure the QoL of the participants. Data were analyzed using SPSS version 23.0. Descriptive data were presented in frequency distribution tables while summary statistics were done using mean and standard deviation for continuous variables and in proportions for categorical variables. Results:Results revealed that majority of the type 2 diabetic patients were females (53.3%) and between the ages of 51-60 years. 27.2% of them had poor overall QoL with the score of <45% while 65.7% had fair overall QoL with a score of 45-65 %. 7.1% had good overall QoL with a score of ≥65%. Conclusion:Majority of the type 2 diabetic patients had fair QoL while the least had good QoL. There is urgent need for increased health awareness and education of diabetic patients regarding diabetic care.

Causes infectieuses de décompensation du diabète: « un prédateur infectieux se cache chez tout diabétique en Afrique¼ / Infectious causes of diabetes decompensation: "an infectious predator hides in any diabetic in Africa"

Introduction : Les infections survenant chez les sujets diabétiques ont été longtemps considérées comme une des causes de l'accroissement de la morbidité et de la mortalité. Elles représentent un motif de plus en plus fréquent d'admission dans le service de médecine interne du Centre Hospitalier Régional et Universitaire de Thiès. Les mécanismes sont plus ou moins élucidés par l'influence de l'hyperglycémie sur les fonctions des polynucléaires neutrophiles. Le but de cette étude est de déterminer les particularités épidémiologiques des infections chez les diabétiques. Patients et Méthode : Il s'agissait d'une étude rétrospective avec recueil de données réalisée sur 24 mois (1er janvier 2016 au 31 décembre 2018) au service de Médecine Interne du Centre Hospitalier Régional et Universitaire de Thiès. Cette étude incluait tous les patients diabétiques quel que soit le genre et le type de diabète, âgés de 15 ans et plus, présentant une infection comme facteur principal de décompensation. Résultats : Durant la période d'étude 2350 patients ont été hospitalisés dans le service de médecine interne dont 390 diabétiques. Parmi eux, 138 patients ont répondu à nos critères d'inclusion soit une prévalence de 35,38%. La moyenne d'âge de nos malades était de 53,49 ans ± 15,65 ans avec un sex-ratio H/F était de 0,70 en faveur des femmes (81 femmes contre 57 hommes). Les infections responsables de la décompensation étaient à localisation cutanéo-muqueuse (30,4%), pulmonaire (22,4%), uro-génitale (18,11%), buccodentaire (10,11%), ORL (1,44%), phanérienne (0,72%). Ailleurs, une infection aux pieds était retrouvée chez 43 patients soit 31,15% des cas. Plusieurs infections pouvaient être présentes chez un même malade. Le diabète était déséquilibré dans 86,2 % (n=94) des cas avec une HbA1c moyenne à 10, 5 % à l'admission Nous n'avons pas noté de corrélation entre l'infection et l'ancienneté du diabète (p =0, 60), l'infection et le type de diabète (p = 0,50) et paradoxalement entre l'infection et le déséquilibre du diabète (p=0,70). Conclusion : Le dépistage des infections chez le diabétique en déséquilibre chronique ou diabétique de novo doit être systématique car généralement ces infections peuvent être asymptomatiques.

Introduction: Infections in people with diabetes have long been considered one of the causes of increased morbidity and mortality. They represent an increasingly frequent reason for admission to the Department of Internal Medicine of the Regional and University Hospital of Thies. The mechanisms are more or less elucidated by the influence of hyperglycemia on neutrophil polynuclear functions. The purpose of this study is to determine the epidemiological characteristics of infections in diabetics. Method: This was a retrospective study with data collected over 24 months (1 January 2016 to 31 December 2018) at the Internal Medicine Department of the Regional and University Hospital of Thies. This study included all diabetic patients, regardless of gender and type of diabetes, aged 15 years and older, with an infection as the primary decompensation factor. Result: During the study period 2,350 patients were hospitalized in the Internal Medicine Department, 390 of whom were diabetic. Of these, 138 patients met our inclusion criteria, a prevalence of 35.38%. The average age of our patients was 53.49 years 15.65 years with a sex-ratio H/F was 0.70 in favor of women (81 Women versus 57 Men). The infections responsible for decompensation were dermal localization (30.4%), pulmonary (22.4%), urogenital (18.11%), oral (10.11%), ENT (1.44%), phanerian (0.72%). Elsewhere, a foot infection was found in 43 patients or 31.15% of cases. Several infections could be present in the same patient. Diabetes was unbalanced in 86.2% (n=94) of cases with an average HbA1c of 10.5% at admission We did not find a correlation between the infection and the age of diabetes (p =0, 60), the infection and the type of diabetes (p = 0.50), and paradoxically between the infection and the imbalance of diabetes (p = 0.70). Conclusion: The detection of infections in diabetics in chronic imbalance or de novo diabetics must be systematic because generally these infections can be asymptomatic.

Time to Diabetic Retinopathy and Its Risk Factors among Diabetes Mellitus Patients in Jimma University Medical Center, Jimma, Southwest Ethiopia

Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the eye. Globally, diabetic retinopathy affects more than 103.12 million people. Diabetic retinopathy is among the leading causes of vision loss at the global level, including in Ethiopia. Therefore, the study aimed to assess the time to develop diabetic retinopathy and identify factors associated with diabetic retinopathy among diabetes patients. METHODS: A retrospective study was conducted from September 1, 2021, to January 30, 2022. Data was collected using semi structured questionnaire. The Cox proportional hazard model were used to determine the median time to develop diabetic retinopathy and identify predictors of diabetic retinopathy. Data was analyzed using R software. RESULTS: A total of 373 diabetes patients were included in this study. The prevalence of diabetic retinopathy was 41.3%. The median time was 41 months, ranging from 39 to 73 months. Elder age (HR=3.17, 95%CI: 1.53, 6.58), being male (HR=2.34, 95%CI: 1.35,6.15), previous family history of diabetes (HR=4.16, 95%CI: 2.19, 8.37), longer duration of diabetes (HR=2.86, 95%CI: 1.41, 5.31) received only insulin therapy (HR=3.91, 95%CI: 1.36, 7.94), and high systolic blood pressure (HR=2.32; 95%CI: 1.12, 4.39) were statistically significant factors related to development of diabetes retinopathy. CONCLUSIONS: More than half of diabetic patinets in this study were developed retinopathy diabetes within a few months of being diagnosed. As a result, we advocate that the best way to preserve our vision from diabetic retinopathy is to maintain our diabetes under control, and the high-risk population receive early screening for diabetes

Clinical profile and outcome of hyperglycaemic emergencies at a rural hospital in southern Nigeria

We have documented the clinical pattern of hyperglycaemic emergencies (HGEs) and predictors of outcome at a tertiary hospital in a rural setting in Nigeria. In a 2-year retrospective review, we identified 88 patients with HGEs. Fifty-four (61%) were females, and mean age was 55 years. Forty-seven (53%) had hyperglycaemic hyperosmolar states (HHS), 34 (39%) had diabetic ketoacidosis (DKA), and 7 (8%) had a mixed type of HGE. The commonest precipitating factor was infection and was seen in 39 (44.3%) patients; 28 (32%) were newly diagnosed with diabetes. The mortality rate overall was 34% and the case fatality rate of DKA, HHS, and mixed-type HGE was 23%, 38%, and 57% respectively. Elevated urea was a predictor of poor outcome; while age, gender, and the presence of chronic diabetes complications were not predictors of outcome. We conclude that the mortality rate in HGEs is high, and that elevated urea is a predictor of poor outcome.Effective diabetes education, prompt recognition of symptoms, and treatment of metabolic derangements in HGEs may reduce morbidity and mortality

Complications aigues métaboliques du diabète sucré dans le Service de Réanimation Polyvalente du Centre Hospitalier Universitaire Yalgado Ouédraogo de Ouagadougou au Burkina Faso

Objectif : Etudier les complications aiguës métaboliques (CAM) du diabète sucré dans le Service de Réanimation Polyvalente (SRP) du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) au Burkina Faso.Patients et méthodes : Etude rétrospective sur une période de cinq ans (1erjanvier 2008 au 31 décembre 2012). La population d'étude était constituée des patients admis dans ledit service pour une CAM du diabète sucré. Résultats :Soixante-six patients ont été retenus pour l'étude.La fréquence d'admission pour des CAM de diabète était de 6,5% avec un âge moyen de 55 ± 17 ans et une prédominance masculine (sex-ratio=1 ,06). Les principaux motifs d'admission étaient lecoma grave (62,1%), détresse respiratoire (81,8%) et déshydratation (15,1%).La mauvaise observance thérapeutique était retrouvée dans 64,5%.L'acidocétose constituait 59,1% des CAM suivie de l'hypoglycémie (27,3%) et du syndrome d'hyperglycémie hyperosmolaire(SHH) (13,6%). L'hyperglycémie moyenne était de 26, 31 mmol/L et l'hypoglycémie moyenne de 1,3 ± 0,7 mmol/L. Une cétonurie (69,1%) et une glycosurie (67,8%) étaient observées. Les complications étaient associées à un âge avancé (p= 0.003).L'infection constituait le principal facteur de décompensation. La durée moyenne de séjour était 5,8 ± 5,6 jours.La mortalité globale (54,55%) était liée à la gravité du coma (p=0,007).Conclusion : Les CAM du diabète sucré sont relativement fréquentes dans le SRP du CHU-YO à Ouagadougou. Le taux de mortalité est élevé. Une prise en charge précoce et adaptée pourrait améliorer le pronostic vital

Correlation between Retinopathy; Nephropathy and Peripheral Neuropathy among Adult Sudanese Diabetic Patients

Diabetes Mellitus is a worldwide common metabolic disorder. Increasing prevalence of diabetes; lack of proper education about the nature and course of the disease and necessary control are the main factors for an early onset of micro vascular complications. Objective: To correlate between retinopathy; nephropathy and neuropathy; among adult Sudanese diabetic patients at Elshaab Teaching hospital; Ahmed Gasim Teaching hospital and Gabber Abu Eleaz centre; from December 2006 to September 2008. were included. Result: Male to female ratio was1.4:1.Common age group affected was 60-69 (32.4).Common duration of diabetes mellitus was 20-24 years (23.9).All patients who had diabetes for 25 years or more had developed complications (19.7).The commonest long term microvascular complication was found to be retinopathy (71.2); followed by neuropathy (69) and nephropathy (50.7).It was found that (47.6) of our patients had the three complications. Conclusion: Long-term micro vascular complications affect male more than female; with average age of onset 60-69 years. All patients who had diabetes for 25 years or more had developed complications. Retinopathy is the most common micro vascular complication; followed by neuropathy. There is a significant correlation between retinopathy; nephropathy and neuropathy in association with the duration and control of blood glucose level

Footcare practices among Nigerian diabetic patients presenting with foot gangrene

Diabetic foot ulceration and gangrene is a major cause of morbidity andmortality. This study has examined potential preventive footcare practices in a cohort of diabetic patients presenting with foot gangrene. One hundred and two (102) diabetic emergencies presented during the study period. Diabetic foot gangrene accounted for 27 (26%) of these cases. There were 18 males and 9 females (M:F = 2:1), with a mean age of 52+13 years. The mean duration of ulceration was 4±3 weeks and mean ulcer­gangrene interval was 1.2±0.5 weeks. Only 9 patients (33%) had been exposed to any form of footcare education, 15 patients (55%) treated their ulcers by unorthodox means, and 63% of the patients practiced no significant footcare. More widespread education and awareness is needed to prevent the continuing and serious problem of diabetic foot gangrene and consequent lower limb amputation

Etude epidemiologique et therapeutique des amputations consecutives aux complications du diabete

Introduction : Les complications du diabete constituent la 2 eme cause d'amputation apres les sequelles de traitement traditionnel avec complications fonctionnelles; esthetiques et psychologiques. Cette etude a pour but de determiner la frequence hospitaliere des amputations consecutives aux complications du diabete; de decrire les suites operatoires et le type d'appareillage utilise Materiels et methode : 20 cas d'amputations consecutives aux complications du diabete (ACCD) colliges du 1 octobre 2006 au 30 septembre 2007 a l'hopital Nianankoro Fomba de Segou . Resultats : la frequence etait de 31;25de toutes amputations avec un age moyen de 57 ans et un sexe de 1;87 .Un antecedent d'hypertension etait retrouve dans 18 cas(90);la notion de tabagisme 4 cas (20) ;7 (35) patients avaient un indice de masse corporelle compris entre 25 et 30 kg/ m2 et 15(75) etaient de diabete type II .La duree moyenne d'evolution variait de 5 et 9 ans .La jambe et le pied ont ete les sieges les plus frequents :15 cas(75).Le stade 5 de Wagner etait le plus frequent 12 cas (60) et une glycemie comprise entre 3 et 4;99 g /l dans 12 cas(60).Le staphylococcus aureus a ete le germe le plus frequemment retrouve dans nos prelevements 12 cas (60).La jambe a ete le niveau d'amputation le plus frequent 35(7 cas).15 (75) patients ont eu une evolution favorable .Nous avons enregistre 5 (15) de deces .La bequille a ete l'appareil de locomotion utilise dans 11 cas (55) Conclusion : Une prise en charge precoce du diabete permet d'eviter les complications

Screening and identifying diabetic patients at risk of foot ulceration: use of the Semes­Weinstein monofilament

The diabetic foot can present with many different problems and the most important clinically are ulceration, amputation, and Charcot neuropathy. The majority of lower limb amputations in patients with diabetes are preceded by foot ulceration. Neuropathy results in loss of protective sensation and the use of 5.07/10 g Semmes­Weinstein monofilament is a simple device that detects patients with insensate feet. Clinical and demographic parameters of all consenting consecutive type 2 diabetes patients were documented. A history of the presence of peripheral neuropathy and sensory modalities of light touch, vibration sense, and joint position were assessed and the 5.07/10 g Semmes-Weinstein monofilament was used to detect patients with insensate feet. A total of 117 patients were examined (mean age 58 years, diabetes duration 6 years: there were 51% males and 49% females, and mean fasting plasma glucose was 8.1±2.9 mmol/L. Ninety-three (79%) presented with a history of peripheral neuropathy and 96% had one or more impaired sensory modality. The use of the monofilament showed impairment in 49%. Twenty-seven (23%) of these had severe peripheral neuropathy. The most frequent site of loss of sensation was the heel (31%). We concluded that the prevalence of peripheral neuropathy in our patients is high. Most patients walked sometimes barefoot, which may account for a high occurrence of foot ulceration. The Semmes-Weinstein monofilament should be routinely used in diabetes clinics

Diabetic complications and glycaemic control in remote North Africa

Background: Delivery of diabetes services in resource-poor areas of Africa is difficult. Control is often poor and complications are common. However, adequate robust surveys are uncommon, particularly in remote rural areas. This makes needs assessment difficult and health-care planning impossible. Aim: To accurately assess the glycaemic control and burden of complications in a group of diabetic patients from a remote area of a resource-limited north African country. Design: Prospective cohort study. Methods: Over a 6-week period, all patients attending the diabetic clinic at Mekelle Hospital in northern Ethiopia were intensively assessed, using imported western technology as necessary. Glycated haemoglobin (HbA1c), lipid profile, serum creatinine and urinary albumin­creatinine ratio were measured. Complications were assessed as accurately as possible, including examination of fundi by an ophthalmic specialist, and biosthesiometry for neuropathy. Results: There were 105 patients, mean (± SD) age 41 ± 16 years and diabetes duration 7 ± 6 years. There were 74 (70%) males, and 69 (66%) on insulin. Median body mass index was low at 20.6 kg/m2, but mean HbA1c high at 11.3 ± 2.8% (68% had an HbA1c over 10.0%). Cataract (12%), retinopathy (21%), neuropathy (41%) and microalbuminuria (51%) were common; but nephropathy (2%) was rare, as was large vessel disease (6% had peripheral vascular disease, and none had coronary artery disease or cerebrovascular disease). Risk factors such as hypertension (5%) and smoking (2%) were uncommon, and lipid profiles were generally good. Discussion: We conclude that in this severely resource-limited area of North Africa, glycaemic control amongst diabetic patients is very poor. Neuropathy, retinopathy and microalbuminuria are common; but large vessel disease risk factors are beneficial, and macroangiopathy prevalence is low. Scattered populations, shortage of drugs and insulin and lack of diabetes team care are major factors behind these serious issues of diabetic control and complications

The Prevalence of Neurological Complications among Adult Sudanese Diabetic Patients

"The objective of this study was to identify the prevalence of neurological complications among adult Sudanese diabetic patients attending the outpatient clinics of El Shaab Teaching Hospital in Khartoum. Methods: This is a descriptive cross sectional hospital based study; it was conducted at El Shaab Teaching Hospital; Khartoum; Sudan during the period from ebruary !!"" to #ctober !!$.esultset '!! diabe(c pa(ents were included in the study; $ were male and )* females. +ore than *;- were above the age of ); years and ;$- were in the age group );- $"". The pa(ents were from di/erent tribes and di/erent states. Sixty percent of the patients were from the northern Sudanese states while the rest of patients were from eastern and western states. Seventy seven percent of the patients had type diabetes mellitus and 7*.""- of them had diabetes for more than one year. Hypertension was found in *- of our pa(ents. The study revealed that $!- of the diabe(c pa(ents have neurological manifesta(ons. The main neurological complication found was peripheral sensory-motor neuropathy. Conclusion: There is significant positive correlation between age; duration of diabetes; glycaemic control and occurrence of the neurological complications."

Knowledge of Foot Care in People with Diabetes in a Tertiary Care Setting

Background. The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with `at risk' feet (ARF) to those with `normal/not at risk' feet (NARF) and so assess whether the education effort by the clinic is effective. Methods. Patients attending the clinic completed an interviewer-assisted questionnaire with 11 questions concerning foot care knowledge. A knowledge score for each patient was calculated. Results. Possible scores ranged from 4 to 11 (maximum 11). The mean score for the ARF group was 8.9 (standard deviation (SD) 1.4) (range 4 - 11) compared with 8.9 (SD 1.4) for the NARF group (range 5 - 11) (p0.05). The most substantial difference between the two groups was that the ARF group gave 20more correct answers than the NARF group with regard to frequency of foot inspection (daily) (p=0.025). Conclusions. Both groups of patients had a reasonable knowledge regarding foot care. The patients at risk were more aware of the need for daily foot inspection

Antidiabetic Effect of Ceiba Pentandra Extract on Streptozo-Tocin-Induced non-Insulin-Dependent Diabetic (NIDDM) Rats

The aim of this work was to investigate the effect of daily oral administration of root bark methylene chloride/methanol extract of Ceiba pentandra (Linn) in streptozotocin-induced type-2 diabetic rats; and the effect of this treatment on the physiological and metabolic parameters that are related in diabetic animals. The diabetic rats were separated into four groups and each given the following samples by gavage; daily for 28 days: vehicle (diabetic control); Ceiba pentandra extract at the dose of 40 mg/kg; Ceiba pentandra extract at the dose of 75 mg/kg and glibenclamide (5 mg/kg). All the parameters were also determined in healthy (non diabetic) rats for comparison. The methylene chloride/methanol extract of Ceiba pentandra treatment significantly reduced the intake of both food and water as well as the levels of blood glucose; serum cholesterol; triglyceride; creatinine and urea; in comparison with diabetic controls. The treatment also improves impaired glucose tolerance but no effect was observed in the level of hepatic glycogen. The effect of Ceiba pentandra (40 mg/kg) was more prominent when compared to glibenclamide in lowering blood glucose; with the added benefit of considerably reducing serum cholesterol and triglyceride concentrations. The results of this experimental animal study indicated that Ceiba pentandra possesses antidiabetic activity; and thus is capable of ameliorating hyperglycaemia in streptozotocin-induced type-2 diabetic rats and is a potential source for isolation of new orally active agent(s) for anti-diabetic therapy

Anti-Retroviral Therapy Induced Diabetes in a Nigerian

Background:Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection.This has led to increased life expectancy in HIV infected individuals on one hand; and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipi- daemia; lipodystrophy; insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. Objective: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. Methods: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. Conclusion: Awareness and high index of suspicion is required to identify the metabolic complications of ART