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

Gunshot injuries in a Nigerian hospital

Background: Gunshot injuries are major problems worldwide from the medical and economic perspectives and are associated with profound morbidity and significant mortality. Many previousstudies were focused on specific sites of injury but this study was aimed at the pattern and presentation of the gunshot injuries. Patients and Methods: This was a combined retrospective and prospective study of gunshot injuries in a Nigerian hospital. The medical records of patients with gunshot injuries between January and December 2004 were reviewed. Prospectivedata collection was done between January and October 2005. Results: Total number of patients was 38 and male: female ratio was 18:1. Thirty (78.9) were below the age of 40 years. The locally made dane gun was the instrument of attack in 24 (63.1) and 19 (50.0) of the patients were victims of armed robbery. The most frequently injured sites were the extremities of which the lower limb was 28 (73.7) and the upper limb was in 10 (26.3) patients. Conclusion: It was concluded that gunshot injuries occur more below age of forty years and the limbs were more injured. Armed robbery attack contributed to about half of the attacks and injuries results mainly from locally made dane guns. It was found that pistols were usually loaded with multiple pellets thus there could be multiple entry and exit wounds in patients attacked with pistol in our environment