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The coral Acropora spp., known for its reef-building abilities, is a simultaneous hermaphroditic broadcast spawning species. Acropora spp. release gametes into seawater, activating sperm motility. This activation is mediated by adenylyl cyclase (AC) and protein kinase A (PKA). Notably, membrane-permeable cAMP (8-bromo-cAMP) promotes sperm motility activation of Acropora florida. While the signal transduction for PKA-dependent motility activation is highly conserved among animals, the downstream signaling of PKA remains unclear. In this study, we used mass spectrometry (MS) analyses to identify sperm proteins in the coral Acropora digitifera, as well as the serine/threonine residues of potential PKA substrates, and then, we investigated the conservation of these proteins from corals to vertebrates. We identified 148 sperm proteins of A. digitifera with typical PKA recognition motifs, namely RRXT and RRXS. We subsequently used ORTHOSCOPE to screen for orthologs encoding these 148 proteins from corals to vertebrates. Among the isolated orthologs, we identified positive selection in 48 protein-encoding genes from 18 Acropora spp. Subsequently, we compared the conservation rates of the PKA phosphorylation motif residues between the orthologs under positive and purifying selections. Notably, the serine residues of the orthologs under positive selection were more conserved. Therefore, adaptive evolution might have occurred in the orthologs of PKA substrate candidates from corals to vertebrates, accompanied by phosphorylation residue conservation. Collectively, our findings suggest that while PKA signal transduction, including substrates in sperm, may have been conserved, the substrates may have evolved to adapt to diverse fertilization conditions, such as synchronous broadcast spawning.
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Antozoários , Proteínas Quinases Dependentes de AMP Cíclico , Evolução Molecular , Espermatozoides , Animais , Masculino , Antozoários/genética , Antozoários/fisiologia , Antozoários/enzimologia , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Proteínas Quinases Dependentes de AMP Cíclico/genética , Espermatozoides/metabolismo , Espermatozoides/fisiologia , Filogenia , Transdução de Sinais , Motilidade dos Espermatozoides/genética , Motilidade dos Espermatozoides/fisiologiaRESUMO
Reef-building corals provide the structural basis for one of Earth's most spectacular and diverse but increasingly threatened ecosystems. The reef-building coral genus Acropora may have undergone substantial speciation during the Pleistocene climate and sea-level changes. Here, we aimed to evaluate the speciation history of four morphologically similar tabular Acropora species (Acropora aff. hyacinthus, A. cf. bifurcata, A. cf. cytherea, and A. cf. subulata) using an integrative approach with morphology, genetic, and reproduction methodology. Extensive morphological analyses showed that these four species are distinct and exhibited high gamete incompatibility, preventing hybridization. Furthermore, population structure and principal component analyses with SNPs (>60,000) indicated that these species were genetically distinct, and the ABBA-BABA test did not support introgression among these species. Many of their coding and noncoding RNA sequences showed high genetic variance at loci with high Fst values along the genome. Comparison of these orthologs with those of other Acropora species suggested that many of these genes are under positive selection, which could be associated with spawning time, gamete, and morphological divergence. Our findings show that the speciation of tabular Acropora occurred without hybridization, and the divergence accompanying the rapid evolution of genes in species-rich Acropora could be associated with speciation.
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Antozoários , Ecossistema , Animais , Filogenia , Antozoários/genética , Deriva Genética , Hibridização Genética , Especiação GenéticaRESUMO
Insects in the orders Hemiptera and Thysanoptera transmit viruses and other pathogens associated with the most serious diseases of plants. Plant viruses transmitted by these insects target similar tissues, genes, and proteins within the insect to facilitate plant-to-plant transmission with some degree of specificity at the molecular level. 'Omics experiments are becoming increasingly important and practical for vector biologists to use towards better understanding the molecular mechanisms and biochemistry underlying transmission of these insect-borne diseases. These discoveries are being used to develop novel means to obstruct virus transmission into and between plants. In this chapter, we summarize 'omics technologies commonly applied in vector biology and the important discoveries that have been made using these methods, including virus and insect proteins involved in transmission, as well as the tri-trophic interactions involved in host and vector manipulation. Finally, we critically examine the limitations and new horizons in this area of research, including the role of endosymbionts and insect viruses in virus-vector interactions, and the development of novel control strategies.
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Transmissão de Doença Infecciosa , Genômica , Interações Hospedeiro-Patógeno , Insetos Vetores/virologia , Doenças das Plantas/virologia , Vírus de Plantas/fisiologia , Animais , Genoma de Inseto , Genômica/métodos , Proteínas de Insetos , Proteômica/métodosRESUMO
Objective: Surgical resection of neuroendocrine tumor liver metastases has been proven to improve survival, but the benefit of microwave ablation as an alternative or adjunct to surgery has yet to be assessed. Our hypothesis is that ablation is equal to surgery in terms of local recurrence and survival. Methods: We conducted a retrospective analysis including all patients treated with microwave ablation and/or surgical resection for neuroendocrine liver metastases in our institution between 2008 and 2017. Results: A total of 47 patients and 68 treatments were analyzed, including 34 liver resections, 20 ablations, and 14 combined procedures. A total of 130 individual metastases were treated with ablation, representing a median of 4 per session (range 1-30). While no major complications occurred after ablation, we observed 11 minor and 3 major complications after open surgical resection (P = .0135). Length of stay was significantly shorter after ablation (P = .0008). The majority of patients (33/47, 70.2%) underwent curative procedures, 14 patients underwent (29.8%) debulking procedures. There was no difference in local recurrence rate between tumors treated with ablation or resection. Liver-only disease progression was detected in 29% of the patients and overall progression was detected in 66% of the patients. The mean survival was not significantly different between patients treated with ablation only versus resection with or without ablation (P = .1570). Overall survival was mean 75.3 months (6 to 374 months). Conclusion: Depending on the extent of the liver metastases, microwave ablation might be a safe alternative or addition to resection for neuroendocrine tumor liver metastases with low morbidity and high local efficiency. Abbreviations: CT = computed tomography; MWA = microwave ablation; NET = neuroendocrine tumor; PET = positron emission tomography; RFA = radiofrequency ablation; RFS = recurrence-free survival; SMWA = stereotactic microwave ablation.
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Carcinoma Neuroendócrino/cirurgia , Ablação por Cateter , Neoplasias Hepáticas , Micro-Ondas , Carcinoma Neuroendócrino/secundário , Humanos , Neoplasias Hepáticas/secundário , Recidiva Local de Neoplasia/cirurgia , Ablação por Radiofrequência , Estudos Retrospectivos , Resultado do TratamentoRESUMO
UNLABELLED: Demonstrating direct interactions between host and virus proteins during infection is a major goal and challenge for the field of virology. Most protein interactions are not binary or easily amenable to structural determination. Using infectious preparations of a polerovirus (Potato leafroll virus [PLRV]) and protein interaction reporter (PIR), a revolutionary technology that couples a mass spectrometric-cleavable chemical cross-linker with high-resolution mass spectrometry, we provide the first report of a host-pathogen protein interaction network that includes data-derived, topological features for every cross-linked site that was identified. We show that PLRV virions have hot spots of protein interaction and multifunctional surface topologies, revealing how these plant viruses maximize their use of binding interfaces. Modeling data, guided by cross-linking constraints, suggest asymmetric packing of the major capsid protein in the virion, which supports previous epitope mapping studies. Protein interaction topologies are conserved with other species in the Luteoviridae and with unrelated viruses in the Herpesviridae and Adenoviridae. Functional analysis of three PLRV-interacting host proteins in planta using a reverse-genetics approach revealed a complex, molecular tug-of-war between host and virus. Structural mimicry and diversifying selection-hallmarks of host-pathogen interactions-were identified within host and viral binding interfaces predicted by our models. These results illuminate the functional diversity of the PLRV-host protein interaction network and demonstrate the usefulness of PIR technology for precision mapping of functional host-pathogen protein interaction topologies. IMPORTANCE: The exterior shape of a plant virus and its interacting host and insect vector proteins determine whether a virus will be transmitted by an insect or infect a specific host. Gaining this information is difficult and requires years of experimentation. We used protein interaction reporter (PIR) technology to illustrate how viruses exploit host proteins during plant infection. PIR technology enabled our team to precisely describe the sites of functional virus-virus, virus-host, and host-host protein interactions using a mass spectrometry analysis that takes just a few hours. Applications of PIR technology in host-pathogen interactions will enable researchers studying recalcitrant pathogens, such as animal pathogens where host proteins are incorporated directly into the infectious agents, to investigate how proteins interact during infection and transmission as well as develop new tools for interdiction and therapy.
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Interações Hospedeiro-Patógeno , Luteoviridae/fisiologia , Mapas de Interação de Proteínas , Proteômica/métodos , Proteínas de Plantas/metabolismo , Nicotiana , Proteínas Virais/metabolismoRESUMO
AIM: The aim of this study was to establish the spermiological profile of patients treated for infertility at Sikasso Hospital. MATERIAL AND METHODS: This was a prospective descriptive cross-sectional study, which took place from January to December 2022 at Sikasso Hospital. Interpretation of spermiological parameters was based on standards established by the World Health Organization in 2010. RESULTS: We enrolled 41 patients, 51.22% of whom had disturbed spermiological parameters. The abnormalities were azoospermia (21.92%), asthenooligozoospermia (12.20%), asthenozoospermia (7.32%), oligozoospermia (7.32%) and asthenonecrozoospermia (2.44%). These anomalies were mainly observed in the 34-44 age group (47.62%). CONCLUSION: This study revealed significant disturbances in spermiological parameters, with azoospermia being the most frequent abnormality.
BUT: L'objectif de cette étude était d'établir le profil spermiologique des patients suivis pour infertilité à l'hôpital de Sikasso. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale prospective descriptive, qui s'est déroulée de janvier à décembre 2022 à l'hôpital de Sikasso. L'interprétation des paramètres spermiologique a fait recours aux normes établies par l'Organisation mondiale de la santé en 2010. RESULTATS: Nous avons colligé 41 patients dont 51,22% avaient ses paramètres spermiologiques perturbés. Les anomalies étaient l'azoospermie (21,92%), l'asthénooligozoospermie (12,20%), l'asthénozoospermie (7,32%), l'oligozoospermie (7,32 %) et l'asthénonécrozoospermie (2,44 %). Ces anomalies étaient observées majoritairement dans la tranche d'âge 34-44 ans avec 47,62%. CONCLUSION: cette étude a révélé des perturbations importantes des paramètres spermiologiques et l'azoospermie a constitué l'anomalie la plus fréquente.
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Azoospermia , Infertilidade Masculina , Oligospermia , Masculino , Humanos , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/terapia , Estudos Transversais , BiologiaRESUMO
INTRODUCTION: Diabetes is a chronic hyperglycemia which can be discovered with specific organic complications particularly affecting the eyes, kidneys, nerves, heart and vessels. Globally, the prevalence of stroke in people with diabetes is approximately 10%. OBJECTIVE: Study the epidemiological and clinical aspects of stroke in patients with type 2 diabetes. METHODOLOGY: We made a descriptive and analytical study by a retrospective survey over a period of 10 years, in the department of internal medicine at the university Hospital ofPoint G. We focused on all hospitalized patients with type 2 diabetes, in whom the diagnosis of stroke was retained. RESULTS: At the end of the study 24 patients out of 492 diabetes hospitalized in to the period met our inclusion criteria, representing a frequence of 4.9%. The mean age was 64.67 ± 13.409 years with a sex-ratio of 1.4. The reason for hospitalization was muscle weakness in 54.2% of patients. Eighty-seven point five percent (87.5%) of patients were already known to have diabetes before the weakness. Stroke was the mode of discovery of diabetes in 12.5%. Over 70% of our patients had hyperglycemia at the time of admission. Ischemic stroke was seen in 75% of patients. CONCLUSION: Stroke is a great complication of diabetes witch, can be a way discovery of type 2 diabetes.
INTRODUCTION: Le diabète est une hyperglycémie chronique qui peut être découvert avec des complications organiques spécifiques touchant particulièrement les yeux, les reins, les nerfs, le cÅur et les vaisseaux.L'AVC en ai une de ces complications. À l'échelle mondiale, la prévalence de l'AVC chez les diabétiques est d'environ 10%. OBJECTIF: Étudier les aspects épidémiologiques et cliniques de l'accident vasculaire cérébral chez les patients diabétiques de type 2. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive et analytique sur la base d'une enquête rétrospective de 10 ans, dans le service de médecine interne du CHU du Point G. Elle a porté sur tous les patients diabétiques de type 2 hospitalisés dans le service de médecine interne, chez qui le diagnostic de l'AVC a été retenu. RÉSULTATS: Au terme del'étude 24 patients répondants à nos critères sur 492 diabétiques soit une fréquence de 4,9%. L'âge moyen était de 64,67 ± 13,409 ans avec un sex-ratio de 1,4. Le motif d'hospitalisation était un déficit moteur chez 54,2% des patients. Quatre-vingt-sept virgule cinq pourcent (87,5%) des patients étaient déjà connus diabétiques avant le déficit. L'AVC a été le mode de découverte du diabète chez 12,5%. Plus de 70% de nos patients avaient une hyperglycémieau moment à l'admission. L'AVC ischémique était observé chez 87,5% des patients. CONCLUSION: L'AVC est une complication redoutable du diabète, il peut être le mode de découverte d'un diabète de type 2.
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INTRODUCTION: Sars Cov 2 infection is a complex viral infectious lung disease that can be complicated by damage to other organs. CASE REPORT: This is a type 2 diabetic patient, overweight and hypertensive, who consults in an emergency for a meningeal syndrome in a context of fever and cough, in whom laboratory and para-clinical investigations have concluded diagnosis of severe Sars cov2 pneumonia complicated by meningeal syndrome. Resuscitation under antibiotic therapy and immunosuppressant treatment associated with risk factor treatments led to a cure without serious complications. CONCLUSION: Sars Cov 2 pneumonia complicated by meningism is serious, early management combining antibiotic therapy and immunosuppressive treatment improves the prognosis.
INTRODUCTION: L'infection à Sars Cov2 est une pneumopathie infectieuse virale complexe qui peut se compliquer d'atteinte d'autres organes. OBSERVATION DE CAS: Il s'agit d'une patiente diabétique de type 2, en surpoids et hypertendue, qui consulte aux urgences pour un syndrome méningé dans un contexte de fièvre et de toux, chez qui les explorations biologiques et para cliniques ont conclu au diagnostic de pneumopathie sévère à Sars cov2 compliquée de méningite. La prise en charge en réanimation sous antibiothérapie et traitement d'immuno-suppresseur associées aux traitements des facteurs de risques ont conduit à une guérison sans complication grave observée. CONCLUSION: La pneumopathie à Sars Cov2 compliquée de méningisme est grave, la prise en charge précoce associant l'antibiothérapie et le traitement d'immunosuppresseur améliore le pronostic.
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INTRODUCTION: Diabetes is a chronic hyperglycemia which can be discovered with specific organic complications particularly affecting the eyes, kidneys, nerves, heart and vessels. Globally, the prevalence of stroke in people with diabetes is approximately 10%. OBJECTIVE: Study the epidemiological and clinical aspects of stroke in patients with type 2 diabetes. METHODOLOGY: We made a descriptive and analytical study by a retrospective survey over a period of 10 years, in the department of internal medicine at the university Hospital ofPoint G. We focused on all hospitalized patients with type 2 diabetes, in whom the diagnosis of stroke was retained. RESULTS: At the end of the study 24 patients out of 492 diabetes hospitalized in to the period met our inclusion criteria, representing a frequence of 4.9%. The mean age was 64.67 ± 13.409 years with a sex-ratio of 1.4. The reason for hospitalization was muscle weakness in 54.2% of patients. Eighty-seven point five percent (87.5%) of patients were already known to have diabetes before the weakness. Stroke was the mode of discovery of diabetes in 12.5%. Over 70% of our patients had hyperglycemia at the time of admission. Ischemic stroke was seen in 75% of patients. CONCLUSION: Stroke is a great complication of diabetes witch, can be a way discovery of type 2 diabetes.
INTRODUCTION: Le diabète est une hyperglycémie chronique qui peut être découvert avec des complications organiques spécifiques touchant particulièrement les yeux, les reins, les nerfs, le coeur et les vaisseaux.L'AVC en ai une de ces complications. À l'échelle mondiale, la prévalence de l'AVC chez les diabétiques est d'environ 10%. OBJECTIF: Étudier les aspects épidémiologiques et cliniques de l'accident vasculaire cérébral chez les patients diabétiques de type 2. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive et analytique sur la base d'une enquête rétrospective de 10 ans, dans le service de médecine interne du CHU du Point G. Elle a porté sur tous les patients diabétiques de type 2 hospitalisés dans le service de médecine interne, chez qui le diagnostic de l'AVC a été retenu. RÉSULTATS: Au terme del'étude 24 patients répondants à nos critères sur 492 diabétiques soit une fréquence de 4,9%. L'âge moyen était de 64,67 ± 13,409 ans avec un sex-ratio de 1,4. Le motif d'hospitalisation était un déficit moteur chez 54,2% des patients. Quatre-vingt-sept virgule cinq pourcent (87,5%) des patients étaient déjà connus diabétiques avant le déficit. L'AVC a été le mode de découverte du diabète chez 12,5%. Plus de 70% de nos patients avaient une hyperglycémieau moment à l'admission. L'AVC ischémique était observé chez 87,5% des patients. CONCLUSION: L'AVC est une complication redoutable du diabète, il peut être le mode de découverte d'un diabète de type 2.
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Ductus arteriosus aneurysm (DAA) in adulthood is a rare entity. We retrospectively reviewed our medical records from the past 10 years and identified 8 cases of adult DAA (6 males and 2 females aged between 69 and 89 years; mean, 76 years), using multiplanar reconstruction and three-dimensional reconstruction CT images. The aneurysm was suspected incidentally in all cases based on the results of chest radiographic screening or post-operative follow-up CT for lung or colon cancer. All eight patients were asymptomatic but had a history of or concurrent hypertension (n = 5, 62.5%), diabetes mellitus (n = 3, 37.5%), cerebrovascular disease (n = 3, 37.5%), ischemic heart disease (n = 1, 12.5%), and cardiac failure (n = 1). All patients had no history of trauma (n = 8, 100%). Six had a history of cigarette smoking. The aneurysm size ranged from 2.0 × 4.0 to 6.3 × 5.3 cm (mean, 3 × 5 cm). The surgical procedures used were four cases of total arch replacement and two cases of thoracic endovascular aortic repair. Two patients were not surgically treated. The median follow-up was 14.5 months (range, 2 months to 9 years). In the two patients who were not surgically treated, the aneurysm enlarged in one, and remained unchanged in the other. Of the six surgically managed cases, one was lost to follow-up, and another patient died of an unrelated cause. The remaining four cases had no enlargement of the aneurysm. No ruptures were reported in any of the cases. DAA should be considered when a saccular aneurysm is located in the minor curvature of the aortic arch and extending toward the left pulmonary trunk in adult patients. Differentiating adult DAA is important, because it is associated with a high risk of rupture due to the fragile nature of true aneurysms.
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PURPOSE: Portal venous system thrombosis is a complication of partial splenic artery embolization, and pre-treatment risk assessment is thus important. The purpose of this study was to identify the risk factors for portal venous system thrombosis after partial splenic artery embolization. MATERIALS AND METHODS: We retrospectively analyzed 67 consecutive patients who underwent contrast-enhanced computed tomography before and after first partial splenic artery embolization between July 2007 and October 2018. As risk factors, we investigated age, sex, hematological data, liver function, steroid use, heparin use, and findings from pre- and post-treatment computed tomography. Uni- and multivariate analyses were performed to evaluate the relationship between thrombus appearance or growth and these factors. Values of p < 0.05 were considered significant. RESULTS: Partial splenic artery embolization was technically successful in all 67 patients. Nine patients showed appearance or growth of thrombus. Univariate analysis showed maximum diameter of the splenic vein before treatment (p = 0.0076), percentage of infarcted spleen (p = 0.017), and volume of infarcted spleen (p = 0.022) as significant risk factors. Multivariate analysis showed significant differences in maximum diameter of the splenic vein before treatment (p = 0.041) and percentage of infarcted spleen (p = 0.023). According to receiver operating characteristic analysis, cutoffs for maximum diameter of the splenic vein and percentage of infarcted spleen for distinguishing the appearance or growth of thrombus were 17 mm and 58.2%. CONCLUSION: Large maximum diameter of the splenic vein before partial splenic artery embolization and high percentage of infarcted spleen after partial splenic artery embolization were identified as risk factors for portal venous system thrombosis. LEVEL OF EVIDENCE: Level 4, Case Series.
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Embolização Terapêutica/efeitos adversos , Veia Porta/fisiopatologia , Artéria Esplênica/fisiopatologia , Veia Esplênica/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos , Trombose Venosa/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION: High blood pressure is a major cardiovascular risk factor. Patients with cardiovascular risk factors are at risk of developing COVID-19. The objective of this study was to determine epidemiology of Covid-19 infected in patients with high blood pressure. PATIENTS AND METHOD: Descriptive cross-sectional study from April 2020 to June 2020 about patients hospitalized for Covid 19 by PCR diagnosis at the Hopital du Mali Bamako and having high blood pressure. Admission registry and patient charts were used to collect data. RESULTS: We collected 78 out of 484 in patients which mean hospital frequency of 16.11%. The mean age was 55.21 +/- 14.61 years. Sex ratio M / F was 1.36. Patients were followed for high blood pressure in 59% of cases. Medical history was ischemic heart disease in 2.6% and dilated cardiomyopathy in 2.6%. Main functional signs were cough in 41.02% and lost of taste in 11.53%. High blood pressure on admission was grade 2 in 37.2% and grade 3 in 3.8%. Treatments received were calcium channel blockers 41.02%, inhibitors of the reninangiotensinaldosterone system 16.66% and combinations 15.38%. Hospital mortality was 10.3%. There was no statistically significant difference in mortality between known hypertensive patients and de novo hypertensive patients. There was also no statistically significant difference in mortality by grade of hypertension. CONCLUSION: High blood pressure can be associated to Covid 19. Treatment is based on calcium channel blockers and reninangiotensinaldosterone system inhibitors. It has an impact on the prognosis of the disease with significant mortality.
INTRODUCTION: L'hypertension artérielle (HTA) est un facteur de risque cardiovasculaire majeur. Dans la littérature elle est fréquemment retrouvée chez les patients atteints de la COVID-19.L'objectif de cette étude est de décrire l'épidémiologie de cette association chez les patients hospitalisés pour Covid-19. PATIENTS ET MÉTHODE: L'Etude est transversale et descriptive ; elle a été réalisée sur la période du 1erAvril 2020 au 30 Juin 2020. Elle a concerné les patients hospitalisés pour Covid 19 avec un test PCR positif à l'hôpital du Mali de Bamako et ayant une HTA. Les registres d'admission et les dossiers des patients ont servi pour la collecte des données. RÉSULTATS: Nous avons colligé 78 sur 484 patients hospitalisés soit une fréquence de 16,11%. L'âge moyen était de 55,21 +/- 14,61 ans. Le sex ratio H/F était de 1,36.Les patients étaient suivis pour HTA dans 59% des cas. Les antécédents médicaux étaient la cardiopathie ischémique chez 2,6% et la cardiomyopathie dilatée chez 2,6%. Les principaux signes fonctionnels étaient la toux chez 41,02% et l'agueusie chez 11,53%. L'HTA à l'admission était de grade 2 dans 37,2% des cas et de grade 3 dans 3,8% des cas. Les traitements reçus étaient les inhibiteurs calciques 41,02%, les inhibiteurs du système rénine angiotensine aldostérone 16,66% et les associations 15,38%. La mortalité hospitalière était de 10,3%. Il n'y avait pas de différence statistiquement significative concernant la mortalité entre les patients connus hypertendus et les patients hypertendus de novo. Il n'y avait pas non plus de différence statistiquement significative concernant la mortalité selon le grade de l'HTA. CONCLUSION: l'HTA peut être associée au Covid 19. Le traitement est basé sur les inhibiteurs calciques et sur les inhibiteurs du système rénine angiotensine aldostérone. Elle a un impact sur le pronostic de la maladie avec une mortalité importante.
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Absent SRY gonadal dysgenesis (negative) is the set of clinical and biological manifestations linked to the lack of development of the testes in humans. Authors report the first case of gonadal dysgenesis SRY-negative 46, XX male with gynecomastia documented in Mali. CASE OBSERVATION: This is a 15 years old boy of a deaf-mute brother, no family consanguinity. He was referred to the hospital because of severe bilateral gynecomastia. Hypergonado-tropic hypogonadism condition was investigated by hormonal laboratory assessment and the result of cytogenetic analysis carried out in France revealed a karyotype SRY-negative 46, XX isch Yp11, 3. The patient received psychological assistance and substitutive treatment based on testosterone. Reconstructive surgery was also conducted to correct urogenital malformations. CONCLUSION: Diagnosis of 46, XX male syndrome is rare and need cytogenetic analysis. In Mali, cost and availability of this technique make diagnosis difficult and care inadequate for patients.
La dysgénésie gonadique à SRY absent (négatif) est l'ensemble des manifestations clinico-biologiques liées à l'absence de développement des testicules chez l'homme. Les auteurs rapportent le premier cas de dysgénésie gonadique type 46, XX male à SRY Négative avec gynécomastie documenté au Mali. OBSERVATION: Il s'agissait d'un jeune garçon de 15 ans, avec antécédents d'un frère sourd-muet, sans consanguinité familiale, qui a consulté pour gynécomastie bilatérale marquée. Devant l'hypogonadisme hypergonadotrope objectivé sur le bilan hormonal, une étude cytogénétique réalisée en France a montré un caryotype à 46, XX isch Yp 11,3 à SRY Négative. La prise en charge repose sur une assistance psychologique, le traitement substitutif en testostérone et la chirurgie réparatrice des malformations uro-génitales. CONCLUSION: Le diagnostic du syndrome 46, XX mâle est rare et le diagnostic est cytogénétique. Le coût et l'accessibilité de cette technique au Mali rendent le diagnostic difficile et la prise en charge inefficiente.
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INTRODUCTION: The objective of this study was to determine the incidence of the operating site infection, precise the etiologies and identify the risk factors. PATIENTS AND METHOD: This was a prospective study conducted at the department of orthopedics and traumatology at the hospital of Sikasso. The study was conducted from January 2016 to December 2018. The infection criteria were those of CDC from Atlanta. RESULT: This study was conducted on 140 patients including 105 men and 35 women with an average age of 40, 1 years old (3 and 88 years old). We have made 150 interventions including 131 osteosynthesis, 14 arthroplasties and 5 corrective osteotomies. The global incidence of the operating site infection was of 19, 3% with a 13, 4% incidence in surgery class I, 21, 4% in the class II, 26, 5% in the class III and 50% in the class IV. . It was superficial in 18 cases (62, 1%) and deep in 11 cases (37, 9%). The average post-surgery hospitalization duration was 13 days (5 and 70 days in extreme cases). The isolated germs were Staphylococcus aureus in 6 cases (37,5 %), Pseudomonas aeruginosa in 3 cases (18,7 %), Enterobacter cloacae in 3 cases (18,7%), Escherichia Coli in 2 cases (12,5 %,), Klebsiellapneumoniae in 1 case (6,3%) and Proteus mirabilis in 1 case (6,3%). They were 100% sensible to imipramine. 90% of the cases were resisting to ampicillin and penicillin G. CONCLUSION: The incidence of the ISO in our department was high. The risk factors of Operating Sites Infections were: hospitalization duration beyond 2 days, ASA Score over 2 days long, the surgical intervention class and the operation duration higher than 3 hours.
INTRODUCTION: Le but de cette étude était de déterminer l'incidence de l'infection du site opératoire, de préciser les étiologies et d'identifier les facteurs de risque. PATIENTS ET MÉTHODE: Il s'agissait d'une étude prospective réalisée dans le service de chirurgie orthopédique et traumatologique de l'hôpital de Sikasso. L'étude s'est déroulée de Janvier 2016 à décembre 2018. Les critères d'infection ont été ceux du CDC d'Atlanta. RÉSULTATS: Cette étude concernait 140 patients dont 105 hommes et 35 femmes d'âge moyen de 40,1 ans (extrêmes : 3 et 88 ans). Nous avions réalisé 150 interventions dont 131 ostéosynthèses, 14 arthroplasties et 5 ostéotomies de correction. L'incidence globale de l'infection du site opératoire était de 19,3% avec une incidence 13,4% dans la classe de chirurgie I, 21,4% dans la classe II, 26,5% dans la classe III et 50% dans la classe IV. Elle était superficielle dans 18 cas (62,1%) et profonde dans 11 cas (37,9%). La durée moyenne d'hospitalisation post-opératoire était de 13 jours (extrêmes 5 et 70 jours). Les germes isolés étaient le Staphylococcus aureus 6 cas (37,5 %) le Pseudomonas aeruginosa 3 cas (18,7 %), l'Enterobacter cloaca e3 cas (18,7%),l' Escherichia Coli2 cas(12,5 %,), le Klebsiella pneumoniae 1cas (6,3%)et le Protéus mirabilis 1 cas (6,3%). Ils étaient sensibles à l'imipenem dans 100 %. Ils étaient résistants à l'ampicilline, à l'amoxicilline et pénicilline G dans 90% des cas. CONCLUSION: L'incidence des ISO dansnotre service était élevée. Les facteurs de risques des ISO que nous avions identifiés ont été la durée d'hospitalisation supérieure à deux jours, le Score ASA supérieur à 2, la classe de l'intervention chirurgicale et la durée opératoire supérieure à 3 heures.
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INTRODUCTION: Hyperprolactinemia, which is a supra-physiological secretion of prolactin, is the most common anterior pituitary disorder encountered in clinical practice. Its incidence and prevalence are poorly defined in Africa and the rest of the world. The objectives were to study the clinical, paraclinical, etiological and therapeutic aspects of hyperprolactinemia at the Mali hospital. METHODOLOGY: This was a 5-year cross-sectional study. Data collection was retrospective (July 2011 to October 2015) and prospective (December 2015 to July 2016). RESULTS: We collected 37 cases of hyperprolactinemia. The sex ratio was 0.85. The average age was 37.32 years with extremes ranging from 15 to 74 years. The clinical picture was dominated in women by amenorrhea (80%), galactorrhea (70%), headache (55%), hypofertility (50%), visual disorders (25%) and in men by decreased libido (64.7%), gynecomastia (47.1%), headache (47.1%), visual disorders (41.2%) and erection disorders (29.4%). Basal prolactinemia was greater than 100ng/ml in 45.9% of patients. Cerebral CT had objectified: 11 cases of macroadenomas and 5 cases of pituitary microadenomas. The main causes of hyperprolactinemia were: prolactin pituitary adenoma (43.24%); hypothyroidism (5.40%) and estrogen-progestin use in 5.40%. For treatment, 64.9% of patients were placed on cabergoline; 27% on bromocriptine and 8.10% on simple clinical and biological monitoring. CONCLUSION: Hyperprolactinemia is a condition that exists in our health care facilities. Clinicians should consider this in the face of galactorrhea amenorrhea or decreased libido. It is also necessary to improve the technical platform for better care.
INTRODUCTION: L'hyperprolactinémie, qui est une sécrétion supra physiologique de prolactine est en clinique le désordre hypophysaire antérieur le plus fréquemment rencontré. Son incidence et sa prévalence sont peu définies, en Afrique et dans le reste du Monde. Les objectifs étaient d'étudier les aspects cliniques, paracliniques, étiologiques et thérapeutiques de l'hyperprolactinémie à l'hôpital du Mali. MÉTHODOLOGIE: Il s'agissait d'une étude transversale de 5 ans. La collecte des données a été rétrospective (juillet 2011 à octobre 2015) et prospective (décembre 2015 à juillet 2016). RÉSULTATS: Nous avons colligés 37 cas d'hyperprolactinémie. Le sex ratio était de 0,85. L'âge moyen était 37,32 ans avec des extrêmes allant de 15 à 74 ans. Le tableau clinique était dominé chez les femmes par l'aménorrhée (80%), la galactorrhée (70%), les céphalées (55%), l'hypofertilité (50%), les troubles visuels (25%) et chez les hommes par la baisse de la libido (64,7%), la gynécomastie (47,1%), les céphalées (47,1%), les troubles visuels (41,2%) et les troubles de l'érection (29,4%). La prolactinémie basale était supérieure à 100ng/ml chez 45,9% des patients. La tomodensitométrie cérébrale avait objectivé : 11 cas de macroadénomes et 5 cas de microadénomes hypophysaires. Les principales causes de l'hyperprolactinémie étaient : l'adénome hypophysaire à prolactine (43,24%) ; l'hypothyroïdie (5,40%) et la prise d'oestroprogestatifs chez 5,40%. Pour le traitement, 64,9% des patients étaient mis sous cabergoline ; 27% sous bromocriptine et 8,10% sous simple surveillance clinique et biologique. CONCLUSION: L'hyperprolactinémie est une pathologie qui existe dans nos structures de santé. Les cliniciens doivent y penser devant une aménorrhée galactorrhée ou une baisse de la libido. Il est aussi nécessaire d'améliorer le plateau technique pour une meilleure prise en charge.
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INTRODUCTION: Lifestyle changes have played an important role in increasing the prevalence of obesity. The objectives were to describe the epidemiological, clinical and progressive aspects of obesity in patients of the Mali hospital. PATIENTS AND METHOD: this is a descriptive study with retrospective collection of data from the medical records of patients hospitalized in the Medicine and Endocrinology department. Our patients benefited from weight gain, height, waist measurement and hip measurement with calculation of the body mass index. RESULTS: the study concerned 90 obese patients out of 1515 hospitalized (5.94% of frequency). The mean age was 42 ± 5 with extremes 10 and 74. The sex ratio was 0.38. Obesity was mixed: 75.4% of men, 60% of woman; Android in 36% of men, 18% of women and the only child aged 10 had morbid obesity. The reason for hospitalization was complications of obesity in 13.30%. The psychological reactions collected were: anxiety 54.40%, indifference 40% and shame 5.60%. There were 68.90% complications including 37.80% cardio metabolic (hypertension associated in 51.10%). The lipid assessment carried out showed hyper LDLdemia: 70%; HDL hypoemia: 67.80%, hyper triglyceridaemia: 66.70%. Our patients received dietary and dietary advice. No drug or surgical treatment has been initiated despite the indication. We recorded 3.30% of deaths. CONCLUSION: The epidemiological and clinical description, diagnosis and evaluation of the repercussions of obesity are easy in our daily practice. However, care remains insufficient due to the inadequacy of the technical platform, the lack of financial means and the prejudices of our patients (ignorance of obesity as a disease).
INTRODUCTION: Le changement du mode de vie a joué un rôle important dans l'augmentation de la prévalence de l'obésité. Les objectifs étaient de décrire les aspects épidémiologiques, cliniques et évolutifs de l'obésité chez les patients de l'hôpital du Mali. PATIENTS ET MÉTHODE: il s'agit d'une étude descriptive avec recueil rétrospectif des données à partir des dossiers médicaux des patients hospitalisés dans le service de Médecine et d'Endocrinologie. Nos patients ont bénéficié d'une prise de poids, de la taille, du tour de taille et du tour de hanche avec calcul de l'indice de masse corporelle. RÉSULTATS: l'étude a concerné 90 patients obèses sur 1515 hospitalisés (5.94% de fréquence). L'âge moyen était 42 ans ± 5 avec des extrêmes 10 et 74 ans. Le sex - ratio était de 0,38. L'obésité était de type mixte : 75.4% des hommes, 60% de femme ; androïde chez 36% des hommes, 18% de femme et la seule enfant âgée de 10 ans avait une obésité morbide. Le motif d'hospitalisation était les complications de l'obésité dans 13,30 %. Les réactions psychologiques recueillies étaient : l'inquiétude 54.40%, l'indifférence 40% et la honte 5.60%. Il y avait 68.90% de complications dont 37.80% cardio métaboliques (HTA associée dans 51.10%). Le bilan lipidique réalisé montrait une hyper LDLdémie : 70% ; une hypo HDLdémie : 67.80%, une hyper triglycéridémie : 66.70%. Nos patients ont reçu des conseils hygiéno-diététiques. Aucun traitement médicamenteux, ni chirurgical n'as été instauré malgré l'indication. Nous avons enregistré 3.30% de décès. CONCLUSION: La description épidémio-clinique, le diagnostic et l'évaluation du retentissement de l'obésité sont faciles dans notre pratique quotidienne. Cependant la prise en charge reste insuffisante du fait de l'insuffisance du plateau technique, le manque de moyen financier et les préjugés de nos patients (méconnaissance de l'obésité comme une maladie).
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INTRODUCTION: Dysthyroidism (hyperthyroidism or hypothyroidism) in children and adolescents is much rarer than in adults. The purpose of our study was to study the epidemiological, clinical, paraclinical, etiological and etiological aspects and to specify the therapeutic and evolutionary modalities of this condition. METHOD: This was a five-year descriptive, retrospective and prospective study of children and adolescents under 18 years of age with dysthyroidism. RESULTS: We collected 90 children and adolescents with dysthyroidism (hyperthyroidism 77.8% (n=70) and hypothyroidism 22.2% (n=20). For hyperthyroidism (n=70): the average age was 13.07 years and the sex ratio was 0.16. The family history of dysthyroidism was found in 24.3% (n=17). Clinical manifestations were dominated by tachycardia 88.57% (n=62), weight loss 87.14% (n=61), vibrating pulse 87.14% (n=61) and palpitation 81.42% (n=57). Bilateral exophthalmos was present in 70% of patients (n=49) with palpebral retraction in 51.42% (n=56). Goitre was present in 54 patients (77.1%). It was diffuse in 62.9% (n=44) and nodular in 12.9% (n=9). Basedow's disease represented the first etiology with 84.3% (n=59), followed by toxic multinodular goitre12, 9% (n=9). Sixty-eight patients (97.1%) received medical treatment with synthetic antithyroid drugs. Clinical remission was achieved in 64.3% (n=45) and 54.3% of patients were in biological euthyroidism at 6 months follow-up. For hypothyroidism (n=20): the average age was 10.70 years and the sex ratio was 0.53. Six family cases of hypothyroidism and three cases of family goitre were found. The clinical picture was dominated by signs of hypo metabolism at hypersomnia type 95% (n=19) and anorexia 75% (n=15). The skin was dry in 60% (n=12). A staturo-weight delay in 65% (n=13), behavioural disorders in 55% (n=11), weight gain in 40% (n=8) and puberty delay in 10% (n=2). Goitre was nodular in 25% (n=5) with cervical adenopathy present in 15% (n=3). Hashimoto's thyroiditis accounted for 45% (n=9) of etiologies followed by iodine deficiency disorders in 15% (n=3) and iatrogenic causes (2 cases of thyroidectomy). All patients were started on hormone replacement therapy for life. Five patients with large multinodular goiter received total thyroidectomy in addition to medical treatment. Euthyroidism was observed in 55% (n=11) of patients at 6 months follow-up. CONCLUSION: Dysthyroidism in children and adolescents exists in our health facilities. Its management is deficient because of the technical and financial platform. Our public health decision-makers must help implement a screening strategy to facilitate faster diagnosis and treatment.
INTRODUCTION: La dysthyroïdie (hyperthyroïdie ou hypothyroïdie) chez l'enfant et l'adolescent est beaucoup plus rare que chez l'adulte. Notre étude avait pour but d'étudier les aspects épidémiologiques, cliniques, paracliniques, étiologiques et de préciser les modalités thérapeutiques et évolutives de cette affection. MÉTHODE: Il s'agissait d'une étude descriptive, rétrospective et prospective de cinq ans portant sur les enfants et adolescents âgés de moins de 18 ans présentant une dysthyroïdie. RÉSULTATS: Nous avons colligé 90 enfants et adolescents présentant une dysthyroïdie (hyperthyroïdie 77,8% (n=70) et hypothyroïdie 22,2% (n=20).Pour l'hyperthyroïdie (n=70) : l'âge moyen était de 13,07 ans et le sex ratio de 0,16. L'antécédent familial de dysthyroïdie était retrouvé dans 24,3% (n=17). Les manifestations cliniques étaient dominées par la tachycardie 88,57% (n=62), l'amaigrissement 87,14% (n=61), le pouls vibrant 87,14% (n=61) et la palpitation 81,42% (n=57).L'exophtalmie bilatérale était présente chez 70% des patients (n=49) avec rétraction palpébrale dans 51,42% (n=56). Le goitre était présent chez 54 patients (77,1%). Il était diffus dans 62,9% (n=44) et nodulaire dans 12,9% (n=9). La maladie de Basedow représentait la première étiologie avec 84,3% (n=59), suivie du goitre multinodulaire toxique12, 9% (n=9). Soixante-huit patients (97,1%) ont bénéficié d'un traitement médical par antithyroïdien de synthèse. La rémission clinique était obtenue chez 64,3% (n=45) et 54,3% des patients étaient en euthyroïdie biologique au bout 6 mois de suivi. Pour l'hypothyroïdie (n=20) : l'âge moyen était de 10,70 ans et le sex ratio à 0,53. Six cas familiaux d'hypothyroïdie et trois cas de goitre familial étaient retrouvés. Le tableau clinique était dominé par les signes d'hypo métabolisme à type d'hypersomnie 95% (n=19) et d'anorexie 75% (n=15). La peau était sèche dans 60% (n=12). Un retard staturo-pondéral dans 65% (n=13), les troubles du comportement dans 55% (n=11), la prise pondérale chez 40% (n=8) et le retard pubertaire chez 10% (n=2). Le goitre était nodulaire chez 25% (n=5) avec présence d'adénopathies cervicales dans 15% (n=3). La thyroïdite d'Hashimoto représentait 45% (n=9) des étiologies suivies des troubles dus à la carence iodée dans 15% (n=3) et des causes iatrogéniques (2 cas de thyroïdectomie). Tous les patients ont été mis sous traitement hormonal substitutif à vie. Cinq patients ayant un volumineux goitre multinodulaire ont bénéficié en plus du traitement médical une thyroïdectomie totale. L'euthyroïdie était observée chez 55% (n=11) des patients au bout 6 mois de suivi. CONCLUSION: La dysthyroïdie chez les enfants et les adolescents existe dans nos structures de santé. Sa prise en charge est déficiente à cause du plateau technique et financier. Nos décideurs en santé publique doivent aider à la mise en place d'une stratégie de dépistage pour faciliter le diagnostic et le traitement plus rapide.
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The authors are reporting here a documented case of hyperparathyroidism leading to hypercalcemia diagnosed spontaneously. A 75-year old female patient with has been treated since 3-4 years with metformin and ramipiril fortype 2 diabetes and high blood pressure, respectively. She was seen in our endocrinology outpatient visit for tingling in the arms associated with cervical pain with increasing intensity over the last six months. The patient's mother was diabetic and her father had high blood pressure. The diagnostic of primary hyperparathyroidism, resulting from a diffuse hyperplasia of the parathyroid gland, was retained after medical, biological, chirurgical and anatomo-pathological investigations. The blood level of PTH1-84 was 916.60pg/ml Normal value=15-68.3pg/ml. CONCLUSION: Diffuse poly-arthralgia in the neck and the lower limbs may not always be due to arthrosis in elderlies. Further investigation such as the dosage of blood level of calcium and PTH are required.
Les auteurs rapportent un premier cas d'hyperparathyroïdie primaire de découverte fortuite documentée au Mali et responsable d'hypercalcémie. Il s'agissait d'une patiente âgée de 75 ans, diabétique de type 2 depuis trois ans traitée par metformine et hypertendue depuis 4ans traitée par ramipril ; venue en consultation externe en endocrinologie pour fourmillement brachial et douleur cervicale diffuse augmentant progressivement d'intensité depuis 6 mois. Aux antécédents familiaux de diabète chez la mère et hypertension artérielle chez le père. Apres les investigations médicaux, biologiques, chirurgicaux anatomopathologiques le diagnostic retenu fut une hyperparathyroïdie primaire (PTH1-84= 916,60pg/ml (N=15-68, 3pg/ml) causée par hyperplasie diffuse de la glande parathyroïde. CONCLUSION: La présence de poly arthralgie diffuse cervicale et des membres inférieurs peut ne pas être seulement due à une arthrose chez le sujet âgé. Cela mérite une investigation plus approfondie telle que le dosage de la calcémie et de la PTH.
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Oxidative stress represents an imbalance between the endogenous antioxidant defenses and the production of pro-oxidant molecules. The present study describes oxidative stress markers (oxidant and antioxidant) metabolic disturbances in diabetic and non-diabetic patients at the Internal Medicine and Endocrinology ward of hospital of Mali. MATERIALS AND METHODS: We conducted a descriptive case / control study involving 30 diabetic and 30 non-diabetic patients. Studied markers were Glutathione erythrocyte peroxidase (GPX), intra erythrocyte Superoxide dismutase (SOD), plasmatic uric acid, direct and total bilirubins, albumin and markers for diagnosis and monitoring of diabetes. RESULTS: Non-diabetic patients (9%) had higher glutathione peroxidase levels compared diabetics (3%) (p = 0.005). An increase in superoxide dismutase was observed in 73.3% of diabetics versus 40% of nondiabetics (p = 0). The albumin, uric acid and bilirubin levels were identical in both populations. Glycated hemoglobin was significantly correlated with microangiopathies (p = 0.0058) and macro angiopathies( p=0,0007) in diabetics. CONCLUSION: The study showed an increase in antioxidant defenses in diabetics by the elevation of superoxide dismutase and a relative normalization of glutathione peroxidase.
INTRODUCTION: Le stress oxydant est un déséquilibre entre les défenses antioxydantes endogènes et la production de molécules pro-oxydantes. L'objectif principal était d'étudier les différents marqueurs du stress oxydatif (oxydant et antioxydant) chez les sujets diabétiques et non diabétiques au niveau du service de médecine interne et d'endocrinologie de l'hôpital du Mali à Bamako. MATÉRIELS ET MÉTHODES: l'étude était transversale avec comparaison entre 30 sujets diabétiques et 30 sujets non diabétiques. Les marqueurs étudiés : Glutathion peroxydase érythrocytaire (GPX), la Superoxyde dismutase (SOD) intra érythrocytaire, l'acide urique plasmatique, Les bilirubines directes et totales, l'albumine ainsi que quelque marqueur de diagnostic et de suivi du diabète. RÉSULTATS: Trois pour cent de nos diabétiques avaient un taux de glutathion peroxydase élevé contre 9% des non diabétiques (p =0,005) ; augmentation de la Superoxyde dismutase des diabétiques 73,3% contre 40% des non diabétiques (p =0). Taux d'albumine, acide urique et la bilirubine identiques dans les deux populations ; hémoglobine glyquée était corrélée significativement aux complications dégénératives micro angiopathies (p=0,0058) et macro angiopathies (p=0,00017) chez les diabétiques. CONCLUSION: l'étude a montré une augmentation des défenses antioxydantes chez les trente diabétiques par l'élévation de la Superoxyde dismutase et normalisation relative du glutathion peroxydase.
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INTRODUCTION: The diabetic foot wound is a real public health problem, 10% of the reasons for hospitalization. The risk of amputation is 10 to 30 times higher in diabetics than the general population. OBJECTIVE: To study the problem of amputations of the diabetic foot. METHOD: This was a descriptive and cross-sectional study that took place in the Department of Medicine and Endocrinology of the Mali Hospital from July 1st, 2016 to June 30th, 2017. RESULTS: Twenty-five (25) diabetic patients were enrolled in our study. The sex ratio was 0.66. At admission, 100% of our patients had arterial disease, 96% neuropathy, and mixed foot in 80%. Poor glycemic control in 64% of patients; osteitis in 52% of cases; 92% of the patients had a 100% amputation risk according to the University of Texas classification. Nearly half or 46% of patients had amputations in the leg. We recorded 1 death case that is 4%. CONCLUSION: The problem of amputation of diabetic feet is a function of the poor equilibrium and progressive neurological and vascular complications of diabetes.
INTRODUCTION: La plaie du pied diabétique constitue un réel problème de santé publique, 10% des motifs d'hospitalisation. Le risque d'amputation est de 10 à 30 fois plus élevé chez les diabétiques que la population générale. OBJECTIF: Etudier la problématique des amputations du pied diabétique. MÉTHODE: II s'agissait d'une étude descriptive et transversale qui s'est déroulée dans le service de médecine et d'endocrinologie de l'hôpital du Mali du 1er Juillet 2016 au 30 Juin 2017. RÉSULTATS: Vingt-cinq (25) patients diabétiques ont été recrutés dans notre étude. Le sex ratio était de 0,66. A l'admission, 100% de nos patients avaient une artériopathie, 96% une neuropathie, et un pied mixte dans 80%. Un mauvais équilibre glycémique chez 64% des patients ; l'ostéite dans 52% des cas; 92% des patients avaient un risque d'amputation à 100% selon la classification de l'université du Texas. Près de la moitié soit 46% des patients ont été amputé au niveau de la jambe. Nous avons enregistré 1 cas de décès soit 4%. CONCLUSION: La problématique de l'amputation des pieds diabétiques est fonction du mauvais équilibre et des complications évolutives neurologiques et vasculaires du diabète.