Comparison of regular with NPH insulin vs. premix insulin in children and adolescents with type 1 diabetes in a resources-limited setting: a retrospective data analysis.

OBJECTIVES: Few studies addressed the efficacy of human insulin regimens (mostly premix insulin) used in many low-and-middle income countries on glycemic control of children and adolescents with diabetes. The aim of this study was to assess the efficacy of the premix insulin on the glycated hemoglobin (HbA1c) in comparison to the regular with NPH insulin scheme. METHODS: A retrospective study was carried out from January 2020 to September 2022 on patients with type 1 diabetes aged below 18 years followed in Burkina Life For A Child program. They were categorized into three groups, on regular with NPH insulin (Group A), on premix insulin (Group B) and on regular with premix insulin (Group C). Outcome was analyzed based on HbA1c level. RESULTS: Sixty-eight patients with a mean age of 15.38 ± 2.26 years and the sex ratio (M/W) 0.94 were studied. There were 14 in Group A, 20 in Group B, and 34 patients in Group C. The mean HbA1c value in the corresponding insulin regimen was 12.8 ± 1.39%, 9.87 ± 2.18%, and 10.66 ± 2.1%, respectively. Glycemic control was better in Groups B and C than Group A (p<0.05) but there was no difference between groups B and C. CONCLUSIONS: Our results indicate that the use of premix insulin gives a better glycemic control than NPH insulin. However, further prospective study of these insulin regimens with a strengthening education strategy and glycemic control by continuous glucose monitoring and HbA1c is required to corroborate these preliminary findings.

[Cerebral-meningeal hemorrhage secondary to snakebite envenomation: about two cases at the Sourô Sanou Teaching Hospital in Bobo-Dioulasso, Burkina Faso]. / Hémorragie cérébro-méningée secondaire à une envenimation par morsure de serpent : à propos de deux cas au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Burkina Faso.

Background: Envenomation by snakebite is a public health problem in developing countries. Neurovascular complications are uncommon. We report two cases of hemorrhagic stroke at the Sourô Sanou Teaching Hospital in Bobo-Dioulasso, which complicate an envenomation. Clinical description: The first patient was a 60-year-old woman with no history, who had been admitted 2 hours after snakebite for gingivorrhagia and consciousness disorders. Clinical examination found coma (GCS 7/15) and tetraparesis. The second patient was a 50-year-old woman with no history, who had been admitted one week after snakebite with digestive bleeding. Clinical examination found right hemiplegia and meningeal syndrome. Both patients presented hemorrhagic stroke on brain CT-scan but hemostasis assessment was normal. They received polyvalent antivenom and symptomatic treatment. The outcome was favorable for survival but with sequelae like tetraparesis for first patient and hemiparesis for second patient. Discussion - Conclusion: The hemorrhagic strokes are rare complications of snake envenomation. Venomous toxins can directly lead to the rupture of intracranial vessels apart of abnormalities of hemostasis. However, the morbidity and mortality related to envenomation by snake bite remains high in our environment.