Diabetes-associated dermatological manifestations in primary care and their association with vascular complications.

INTRODUCTION: Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications. METHODS: Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD). RESULTS: 213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001). CONCLUSION: In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.

[The nurse mobilised in the face of precarity in the rural environment]. / L'infirmière mobilisée face à la précarité en milieu rural.

In the rural environment, faced with people in situations of precarity, the nurse is an ideal partner for health professionals, as a general practitioner working in a centre for emergency housing and social reintegration explains.

Practice variation in the management of distal deep vein thrombosis in primary vs. secondary cares: A clinical practice survey.

INTRODUCTION: Distal deep-vein thromboses (iDDVT) are infra-popliteal DVTs. They are as frequent but less serious than proximal DVT. Their management is debated. METHODS: Clinical practice survey among a random selection of 111 general practitioners (GP) and 56 vascular medicine physicians (VMP) working in Languedoc-Roussillon (France) to assess and compare iDDVTs management by GP and VMP. RESULTS: In case of DVT, GP manage their patients alone in 35% of cases. In case of collaborative management, VMP initiate and stop anticoagulants (>74% of cases) whereas GP monitor anticoagulation (>76% of cases). With iDDVT, there was no difference between GP and VMP in terms of use (94% vs. 92%) and intensity of anticoagulation (full dose: 99%vs.100%). Duration of anticoagulation differed: GP modulated less frequently duration of anticoagulation in presence of a transient risk factor (58% vs. 90%, p<0.05) or according to the deep-calf or muscular location of iDDVT (6% vs. 36%, p<0.05) and treated more frequently iDDVT as long as proximal DVT (49% vs. 13%, p<0.05). When comparing GP, there was no significant difference in terms of therapeutic management between those who used to manage DVT alone and those who used to manage in collaboration with a thrombosis expert. CONCLUSION: Treatment of iDDVT differed between GP and VMP. Half of GP don't modulate treatment according to anatomical location or to the provoked/unprovoked character of DVT. Given the low frequency of exposure to DVT in general practice, systematic referral to a thrombosis expert rather than continuous medical formation program seems appropriate to improve management.

[Medical and social management of homeless individuals. A one year prospective observational study in the south part of France, Pyrénées-Orientales]. / Prise en charge médico-sociale de personnes sans domicile fixe: etude observationnelle prospective d'un an dans les Pyrénées-Orientales.

In 2007, a national survey estimated to up to 800,000 the number of homeless individuals in France. Ten percent of them live constantly in the street; often very dissocialized and in precarious conditions. Thereby it remains difficult for homeless to have access to a medical and social support. In order to identify the medical and social needs of this population, we performed a one year observational prospective study in two reception centres in Perpignan. 629 (99%) out of 635 answers were analysed. The most represented age group is 39-49 years (29,2%) with an over-representation of males (82,7%). The most frequent pathologies are psychological distress (43,9% of requests, including anxious problems 23%, and sleep disturbances 24,4%). Medical affections represented 15,7% of the cases (mainly nutritional deficiency), and skin diseases 15,%. Addictive behaviour was frequent including tobacco (84%), alcohol (17%), and drug addiction (9%). 21,7% of this population had a regular work, and 97,8% with fixed term contracts, but 45,1% did not have any health cover 17,6% of homeless did not obtain any answer to their medical request (lack of suitable medicine, or an impossibility to pull out further tests in order). To solve some aspects of that problem, family doctor can rely on a medical and social network (PASS, MAO, ANPAA).