Factors influencing the awareness of diabetic foot risks.

INTRODUCTION: The aim of the present study was to identify factors influencing diabetic patients' awareness of the risk of foot problems. METHODS: We performed a prospective study of diabetic patients hospitalized or seen in consultation. Various factors were analyzed in order to identify those related to the patients' level of awareness of risk factors in diabetic foot. RESULTS: Ninety-one patients were included (mean age: 48; male/female gender ratio: 0.63). Over 50% of the study population was not aware of the risks of diabetic foot. Educational level and socioeconomic status had an impact on awareness of good foot health and care. Poor knowledge of the degenerative complications of diabetes was associated with age, a low educational level and low socioeconomic status. DISCUSSION: Our results revealed low levels of patient awareness concerning the potential severity of diabetic foot and the means of preventing foot problems. The patients gave a range of explanations for this marked lack of awareness; including a lack of information and financial constraints. Hence, patient education is still a major aspect of prevention in diabetes. CONCLUSION: In diabetes, there is still a need for easily assimilated, locally provided patient education.

[Bilateral inguinal lymphadenopathy and erythema nodosum: an uncommon presentation of cat scratch disease]. / Adénopathies inguinales bilatérales et érythème noueux: une présentation originale de la maladie des griffes du chat.

Cat scratch disease is usually revealed by a proximal lymphadenopathy related to the inoculation site. We report a 22-year-old female who presented with erythema nodosum and bilateral inguinal lymphadenopathy. Serologic test and lymph node PCR detection for Bartonella henselae were negative. Nevertheless, the patient received doxycycline and clinical manifestations rapidly resolved. A follow-up detection of IgM and IgG against Bartonella henselae performed 1 month later was positive. This case report illustrates an original presentation of cat scratch disease and reminds us the lack of sensitivity of laboratory investigations.

[Treatment of alopecia areata with prednisone in a once-monthly oral pulse]. / Traitement de la pelade par bolus oral mensuel de prednisone.

BACKGROUND: Various modalities have been used in the treatment of alopecia areata (AA), including pulsed oral corticosteroids. The aim of this study was to evaluate the efficacy and safety of pulsed oral prednisone in the management of AA. METHODS: This was a prospective study in patients with progressive AA affecting more than 40% of the scalp. All patients received 5mg/kg (300 mg) oral prednisone once a month for 3 to 6 months and were examined for adverse effects. Hair growth was classified as complete, cosmetically acceptable, incomplete or no growth. RESULTS: Thirty-four patients (18 men) with a mean age of 12+/-3 years were included. AA was ongoing for a mean 2 (1-17) years. Thirteen (38%) patients presented multifocal AA, six universalis (20%), six multifocal with ophiasic pattern (18%), six totalis (18%), and three ophiasic (6%). Six patients (18%) had no regrowth. At 3 months, incomplete or cosmetically acceptable response was noted in 28 patients (82%). At 6 months, 14 patients (41%) presented complete response, eight patients (23%) had a persistent incomplete response, and six patients (18%) had a persistent cosmetically acceptable response. Adverse effects were noted in five patients (15%). Variables predictive for no-growth response were nail involvement (P=0.001), associated dysimmunity (P=0.017), and universalis form (P=0.050). CONCLUSION: A once-monthly oral pulse of 300 mg prednisone appears effective and safe. It can be recommended as first-line treatment for widespread AA.

[Baker Rosenbach erysipeloid appearing as a granulomatous cheilitis]. / Erysipéloïde de Baker-Rosenbach prenant l'aspect d'une chéilite granulomateuse.

BACKGROUND: Baker-Rosenbach's erysipeloid is a skin infection caused by Erysipelothrix rhusiopathiae. It occurs essentially in humans exposed to animals colonized with this germ such as swine. The typical skin lesion, an erythematous macule generally localized to inoculation site, frequently in the extremities, quickly resolves spontaneously. The lips are an atypical site of this infection. We describe a case of chronic granulomatosis cheilitis in a farmer caused by E. rhusiopathiae. CASE REPORT: A 40-year-old farmer, a wild-boar hunter and chronic smoker with no history of tuberculosis, injury or insect bites, presented at our dermatology unit with ulcerative macrocheilitis of the lower lip ongoing for 1 year. Its surface was purulent. A biopsy specimen showed non-caseating epithelioid granulomas. Laboratory and radiological screening for tuberculosis, sarcoidosis and Crohn's disease, and parasitological examination for Leishmaniasis proved negative. Bacteriological examination identified E. rhusiopathiae and labial Baker-Rosenbach's erysipeloid was diagnosed. The lesion healed after 15 days of treatment with parenteral penicillin G (12m IU/d), totally disappearing after 3 months. DISCUSSION: Swine erysipelas usually occurs in man as Baker-Rosenbach's erysipeloid. This localized form of infection with E. rhusiopathiae is the most frequent and the lesion typically observed is a violaceous plaque, less inflammatory with induration; spontaneous regression occurs after a mean 3 months. To our knowledge, this case is the first report of ulceration associated with macrocheilitis. Histologically, the granuloma directed our investigation towards the principal aetiologies of granulomatosis cheilitis, such as tuberculosis considering the epidemiological context, sarcoidosis or Crohn's disease. The diagnosis of erysipeloid was supported by epidemiological evidence (occupational exposure), isolation of the germ at the lesion and its regression on treatment with penicillin G. CONCLUSION: Diagnosis of E. rhusiopathiae infection was confirmed by bacteriology. However, the hypothesis concerning the pathogenesis of its chronic course in our patient remains a subject of discussion.

Oto-Rhino-Laryngology (ORL) tumor presentation in a case of systemic AA amyloidosis.

A 64-year-old male with no underlying disease presented with the development of multiple skin nodules, loss of sensation in the extremities, hoarseness, macroglossia, and pain in the oral cavity. Direct laryngoscopy showed nodules involving the oral cavity, oropharynx, supraglottic region, and vocal cords. Biopsy from skin nodules showed amyloid deposits staining with Congo red. Immunohistochemical staining was used for AA protein and was positive. Biopsy from the oral floor was also positive for amyloid. Oto-Rhino-Laryngology (ORL) involvement has been reported in approximately 40 percent of AL amyloidosis patients, but does not appear to be frequent in AA amyloidosis. Cutaneous manifestations in AA amyloidosis are rare, although cases with lesions presenting as purpura are reported occasionally; we are not aware of other cases of ORL nodular involvement in systemic AA.

[Maffucci syndrome and extensive verrucous epidermal nevi in the same leg]. / Syndrome de Maffucci et hamartome épidermique étendu sur le même membre.

BACKGROUND: Maffucci syndrome is a rare disorder characterized by multiple enchondromas associated with soft tissue haemangioma. We report a case of Maffucci syndrome associated with epidermal verrucous nevus. CASE REPORT: A 33-year-old woman, with no previous history of note, had presented multiple episodes of vascular tumefaction of the toes and verrucous lesions of the right lower limb since childhood. Clinical examination revealed multiple pain-free and round haemangiomas on the toes; some were hard and evocative of chondromas while others were soft and suggested angiomas. In addition, there was an epidermal verrucous nevus of the right lower limb. Skeletal examination revealed multiple phalangeal enchondromas. A diagnosis of Maffucci syndrome associated with epidermal verrucous nevus was made. DISCUSSION: Maffucci syndrome is a rare form of sporadic dysplasia characterized by superficial haemangiomas and cartilaginous tumours (enchondromas), with just over one hundred published cases to date. Localization in the bones of the hands is seen in 89% of cases, in contrast with our observation. While epidermal verrucous nevus may be associated with neurological or osseous anomalies, to our knowledge, association of epidermal verrucous nevus with Maffucci syndrome has not previously been described; the present association could of course be fortuitous.

[Juvenile dermatomyositis: 4 case studies]. / La dermatomyosite juvénile: à propos de 4 cas.

Juvenile dermatomyositis is a rare disease. The estimated incidence is 2 to 3 cases per million population. Before the use of corticosteroids, prognosis was poor for most patients. Today, despite a better prognosis, the side effects of long-term treatment still burden the outcome of the disease. The diagnosis of this entity is difficult and often delayed due to its rarity. It has been shown that the delay in diagnosis and care is a major factor for poor prognosis. Cutaneous findings are often inaugural, allowing early diagnosis. This study's aim was to share our 10-year experience with juvenile dermatomyositis.

Measurement properties of the short form 36 and health-related quality of life after intensive care in Morocco.

BACKGROUND: Intensive care patients have a health-related quality of life (HRQL) that differs from the normal population. The aim of this study was to evaluate the measurement properties of the Arabic version of the short form (SF)-36 and study the HRQL determinants in adult patients 3 months after discharge from an intensive care unit (ICU). METHODS: A prospective cohort study after ICU discharge. At 3-month follow up, the SF-36 was administered in consultation or by telephone. Multitrait scaling analysis was used to confirm the hypothesized scale structure of the SF-36. Reliability was tested using (i) measuring internal consistency; and (ii) the test-retest reliability assessed using an intraclass correlation coefficient. Construct validity was tested by known-groups comparison using one-way analysis of variance (ANOVA) and analysis of covariance (ANCOVA). RESULTS: A total of 145 survivors answered the SF-36. Item internal convergency was higher than 0.40 (0.77-0.99; 100% scaling success) and item discriminant validity was perfect (100% scaling success) except for physical functioning (81% scaling success). Cronbach's alpha exceeded 0.70 in all eight scales (0.84-0.99). Test-retest reliability conducted in 73 patients was above 0.80. Acceptability to patients appeared reasonable although considerable interview time was required to administer the SF-36. Construct validity was confirmed by lower scores being reported by women, older age and a high level of comorbidities groups. When adjusted for background data, ICU variables were not associated with the SF-36 scores. CONCLUSIONS: The Arabic version of the SF-36 appears to be a robust tool in ICU. Background variables are the only significant determinants of HRQL 3 months after medical ICU discharge.

[Evaluation of the reality of capillary glycemia measurement in an intensive care unit]. / Evaluation de la fiabilité de la mesure de la glycémie capillaire dans une unité de soins intensifs.

BACKGROUND: The usual glycemic supervision based on repeated measures of the capillary glycemia with the strip of which reliability can be taken at fault especially in critically ill patients. The objective of this work was to evaluate the reliability of capillary glycemia measurement in intensive care unit. MATERIAL AND METHODS: [corrected] The study was performed in a medical intensive care unit, during six months (July to December 2004). The capillary glycemias were carried out with only one blood glucose monitor and were compared with the referenced glycemias. The correlation between two methods was carried out by the parametric Pearson coefficient. The error percentage of the blood glucose monitor was calculated. The agreement of two methods was evaluated by Bland and Altman test. RESULTS: Were performed 245 glycemic pairs for 198 patients, their mean age was 42.6 +/- 14.6 years, 30(15%) among them were diabetics. The referenced glycemia was 8.7 +/- 5.5 mmol/L and the capillary glycemia was 8.3 +/- 4.6 mmol/L. The correlation coefficient was 0.97 (p<0.001); 56 percent of the values had an error percentage lower than 10, 27 percent between 10 and 20%, and there were 17 percent discordant values with an error percentage higher than 20. The method of Bland and Altman objectived a skew of 0.40 mmol/L and a bad precision of +/- 2.90 mmol/L. CONCLUSION: The reliability of capillary glycemias was not satisfactory with bad precision and high percentage of discordance. The capillary glycemias must be interpreted with precaution in intensive care unit.