Complications macro-angiopathiques du diabete a l’hopital du Mali de Bamako

Introduction-objectif: Le diabète est un facteur de risque cardiovasculaire (FRCV) majeur, responsable de complications cardiovasculaires dont la  prise en charge est complexe. L’objectif de l’étude est d’évaluer les  complications macro-angiopathiques du diabète.Patients et Méthodes: Etude transversale, descriptive et analytique de 18 mois, concernant les patients diabétiques (type 1 avec 5 ans d’évolution et type 2).Résultats: Nous avons colligé 275 patients diabétiques. L’âge moyen de nos patients était de 59 ans. Le sex ratio était de 0,82. Le diabète était de type 2 chez 93,09% des patients. La durée moyenne d’évolution du diabète était de 6 ans. L’HbA1c était supérieure à 7% chez 51,64% des patients. 77,46% avaient au minimum 2 FRCV associés au diabète. La dyslipidémie était le FRCV le plus fréquent associé au diabète (51,27%). Quatre-vingt-trois (83) patients sur 275 avaient au moins une  macroangiopathie (fréquence hospitalière de 30,18%). L’artériopathie oblitérante des membres inférieurs (AOMI) était présente chez 49 patients, l’accident vasculaire cérébral (AVC) chez 28 patients et la coronaropathie chez 17 patients. Nous avons noté un lien statistiquement significatif entre durée d’évolution du diabète, et deux complications macro-angiopathiques (AOMI p:0,001 et AVC p:0,05). Le mauvais équilibre glycémique et le nombre de FRCV étaient corrélés aux complications macroangiopathiques (AOMI, AVC, coronaropathie) de façon significative avec p<0,05.Conclusion: Le diabète est une maladie métabolique responsable de complications macro-angiopathiques. Sa prise en charge précoce ainsi qu’une correction des autres FRCV permettent d’éviter ou de ralentir ces complications.Mots clés : Diabète, Macro-angiopathies, Hôpital Du Mali.  Macrovascular complications of diabetes at the hôpital du Mali of Bamako Introduction-Aim: Diabete is a major risk cardiovascular factor (FRCV). It is a chronic disease responsible of cardiovascular complications with a complex management. The objective of the study is to evaluate the macrovascular complications of diabetes.Patients and methods: It is a cross-sectional, descriptive and analytical study of 18 months, concerning diabetic patients (type 1 with 5 years of evolution and type 2).Results: We collected 275 diabetics patients. Mean age of our patients was 59 years. Sex ratio was 0.82. Diabetes was type 2 in 93.09%. Mean duration of diabetes was 6 years. HBA1C was greater than 7% in 51.64%. 77.46% had at least 2 cardiovascular risk factors associated with diabetes. Dyslipidemia was the most common cardiovascular risk factors associated with diabetes (51.27%). 83 of 275 patients had at least one macrovascular complication (hospital frequency of 30.18%). Peripheral artery disease (PAD) was present in 49 patients, stroke in 28 patients, and coronary artery disease in 17 patients. We noted a statistically significant link between the duration of diabetes, and two macrovascular complications (PAD p: 0.001 and stroke p: 0.05). The poor glycemic balance and number of  cardiovascular risk factors were correlated with macrovascular complications (AOMI, stroke, coronary artery disease) significantly with p < 0.05.Conclusion: Diabetes is a metabolic disease responsible of macrovascular complications. Early care and correction of other cardiovascular risk factors can prevent or slow these complications.Keywords: Diabetes, Macrovascular complications, Hôpital Du Mal

Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain >= 14 days): a multi-country, prospective, non-experimental case-control study (vol 15, 338, 2015)

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Diagnosis of neglected tropical diseases among patients with persistent digestive disorders (diarrhoea and/or abdominal pain ≥14 days): Pierrea multi-country, prospective, non-experimental case-control study

Background: Diarrhoea still accounts for considerable mortality and morbidity worldwide. The highest burden is concentrated in tropical areas where populations lack access to clean water, adequate sanitation and hygiene. In contrast to acute diarrhoea (<14 days), the spectrum of pathogens that may give rise to persistent diarrhoea (≥14 days) and persistent abdominal pain is poorly understood. It is conceivable that pathogens causing neglected tropical diseases play a major role, but few studies investigated this issue. Clinical management and diagnostic work-up of persistent digestive disorders in the tropics therefore remain inadequate. Hence, important aspects regarding the pathogenesis, epidemiology, clinical symptomatology and treatment options for patients presenting with persistent diarrhoea and persistent abdominal pain should be investigated in multi-centric clinical studies. Methods/Design: This multi-country, prospective, non-experimental case-control study will assess persistent diarrhoea (≥14 days; in individuals aged ≥1 year) and persistent abdominal pain (≥14 days; in children/adolescents aged 1-18 years) in up to 2000 symptomatic patients and 2000 matched controls. Subjects from Côte d'Ivoire, Indonesia, Mali and Nepal will be clinically examined and interviewed using a detailed case report form. Additionally, each participant will provide a stool sample that will be examined using a suite of diagnostic methods (i.e., microscopic techniques, rapid diagnostic tests, stool culture and polymerase chain reaction) for the presence of bacterial and parasitic pathogens. Treatment will be offered to all infected participants and the clinical treatment response will be recorded. Data obtained will be utilised to develop patient-centred clinical algorithms that will be validated in primary health care centres in the four study countries in subsequent studies. Discussion: Our research will deepen the understanding of the importance of persistent diarrhoea and related digestive disorders in the tropics. A diversity of intestinal pathogens will be assessed for potential associations with persistent diarrhoea and persistent abdominal pain. Different diagnostic methods will be compared, clinical symptoms investigated and diagnosis-treatment algorithms developed for validation in selected primary health care centres. The findings from this study will improve differential diagnosis and evidence-based clinical management of digestive syndromes in the tropics. Trial registration: ClinicalTrials.gov; identifier: NCT02105714