Diabetes knowledge and associated factors in adolescents and young adults with type 1 diabetes in Ouagadougou (Burkina Faso).

BACKGROUND: Type 1 diabetes (T1D) in youth is becoming a public health problem in Sub-Saharan Africa, including Burkina Faso. However, little is known about the level of knowledge of these patients on T1D. This study aimed to evaluate the knowledge of diabetes in adolescents and young adults about the disease, and identify the factors associated in Burkina Faso. METHODS: A cross-sectional survey was conducted from April to June 2020 among youth with T1D, aged 10 to 30 years, and regularly followed in the internal medicine department of Yalgado Ouedraogo University Hospital of Ouagadougou, Burkina Faso. Data were collected using the French AJD (Aide aux Jeunes Diabétiques) validated diabetes knowledge and skills (DKS) questionnaire designed to test participants' accuracy in knowledge about six different themes of T1D, as generalities of diabetes, hypoglycemia and hyperglycemia, management of insulin treatment, and self-monitoring blood glucose (SMBG). DKS level was determined by calculating the scores, and univariate and multivariate logistic regression were used to explore factors influencing DKS scores. This level was classified as insufficient or low ≤ 25/50, regular 26-39/50, and adequate or good ≥ 40/50. RESULTS: Sixty-three participants with a mean age of 19.05 years and a sex ratio (W/M) of 1.17 were included in our study. The mean HbA1c level was 9.79%, and 43 (68.23%) patients had an insufficient DKS level. The mean global DKS score of correct answers was 23.63/50. The percentage of correct answers was respectively 50% for the item "generalities of diabetes", 32.4% for the item "hypoglycemia and hyperglycemia", 67.72% for the item "diet", 37.34% for the item "management of insulin treatment" and 44.97% for the item "SMBG". In univariate analysis, a better patient DKS level was associated with university education and long duration of diabetes care follow-up (> 10 years, p < 0.05). Only increasing age remain associated with a better knowledge score (p < 0.05) in multivariate analysis. CONCLUSION: This study is an important first step in identifying areas for intervention efforts about therapeutic education for youth with type I diabetes in Burkina Faso.

Incidence, prevalence, and mortality of type 1 diabetes in children and youth in Burkina Faso 2013-2022.

AIM: There are no data on type 1 diabetes (T1D) incidence and prevalence in Burkina Faso. We aimed to determine these in persons aged <25 years (y) since the implementation of Life for a Child (LFAC) program in 2013. PATIENTS AND METHODS: Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, abrupt onset of symptomatic hyperglycemia, need for insulin replacement therapy from diagnosis, and no suggestion of other diabetes types. RESULTS: We diagnosed 312 cases of T1D <25y in 2013-2022. Male-to-female ratio was 1:1. T1D incidence <25y per 100,000 population/year increased from 0.08 (CI 95% 0.07-0.60) in 2013 to 0.34 (CI 95% 0.26-0.45) in 2022 (p=0.002). Incidence <15y/y rose from 0.04 (CI 95% 0.01-0.10) to 0.27 (CI 95% 0.18-0.38) per 100,000/year in 2013 and 2022, respectively (p < 0.002). Prevalence per 100,000 population <25y was 0.27 (CI 95% 0.19-0.37) in 2013 and rose to 1.76 (CI 95% 1.546-1.99) in 2022 (p<0.0001). Mortality rate was 20 (CI 95% 13-29.6) per 1,000-person y. CONCLUSIONS: There is a low but sharply rising T1D incidence and prevalence rates in children and youth in Burkina Faso since LFAC program implementation. It is very likely this is partly due to improved case detection. Mortality remains substantial.

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.

Pituitary function and the response to GH therapy in patients with Langerhans cell histiocytosis: analysis of the KIMS database.

Objective: To analyze the effectiveness and safety of growth hormone (GH) replacement treatment in adult patients with Langerhans cell histiocytosis (LCH) and GH deficiency (GHD) enrolled in KIMS (Pfizer International Metabolic Database). Patients and methods: Patients with LCH and GHD were studied at baseline and some of them after 1 year of GH treatment. The effectiveness of GH is presented as change after 1 year of treatment (mean, 95% CI). The LCH population was compared to two other groups of patients enrolled in KIMS, granulomatous and lymphocytic hypophysitis. Results: At baseline, 81 adults with LCH (27 with childhood onset, 56% females), mean age at GHD onset of 29 (15) years were studied. Diabetes insipidus was diagnosed in 86% of patients. Analysis of 1 year of GH treatment was possible in 37 patients. One-year cross-sectional values for the GH dose were 0.39 (s.d.± 0.21) mg and -0.5 (-1.2 to 0.2) for insulin-like growth factor-1 s.d. Total cholesterol decreased 0.9 (-1.5 to -0.3 (mmol/L); P < 0.05); AGHDA-QoL-score (n = 20) was improved by 2.8 points (-5.6 to 0.0; P < 0.05), while mean BMI increased 0.6 ± 3 kg/m2 (95% CI: -0.2 to 1.4). All these effects did not differ from the two other groups after adjusting for age, gender, and baseline values. In 20 of 77 patients included in the safety analysis, 36 serious adverse events were reported during 435 patient-years (82.8/1000); no new safety signals were reported. Conclusion: After 1 year of GH treatment in patients with LCH, metabolic variables and quality of life improved, with no new safety signals.

Endocrine manifestations in a cohort of 63 adulthood and childhood onset patients with Langerhans cell histiocytosis.

OBJECTIVE: Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasm which can infiltrate any organ or tissue. Endocrine involvement has mostly been described in case reports and small retrospective studies. We aimed to describe endocrine manifestations in a large cohort of adulthood onset (AO) and childhood onset (CO) patients with LCH. DESIGN: Single-center observational study conducted between January 2002 and December 2017 at Pitié-Salpêtrière University Hospital (Paris, France), a tertiary care hospital. METHOD: Clinical, biological and morphological evaluations of pituitary, gonadal, adrenal and thyroid function evaluations performed in 63 consecutive patients with LCH (AO patients: 40, CO patients: 23). Fifty-eight patients underwent follow-up assessments. RESULTS: Complete pituitary evaluation was performed in 38/63 patients (60.3%); at least one anterior pituitary dysfunction (APD) was found in 63.2% of them. In this subgroup of patients, the most prevalent deficiencies were diabetes insipidus (DI) and GHD (55.3% each), followed by gonadotropin deficiency (34.2%) and thyrotropin deficiency (23.7%). In the subgroup of the 25 incompletely evaluated patients, we found DI in 44%, GHD in 50%, gonadotropin deficiency in 30.4% and thyrotropin deficiency in 16%. APD was more common in CO patients (P = 0.003) but was not systematically associated with DI regardless of the age of onset. Endocrine dysfunction was most often permanent; moreover, occurrence of new deficiencies has been described during follow-up. CONCLUSION: The spectrum of endocrine disorders appears to be large in LCH (both in AO and CO patients) and should be evaluated carefully at diagnosis and during follow-up. APD was not always associated with DI.

Aspects épidémiologiques, cliniques et facteurs pronostiques des accidents vasculaires cérébraux ischémiques chez le sujet âgé à Bobo-Dioulasso, Burkina Faso / Epidemiological, clinical and prognosis aspects of ischemic stroke in the elderly in Bobo-Dioulasso, Burkina Faso

Contexte et objectif. Le risque d'accident vasculaire cérébral (AVC) augmente avec l'âge. Notre objectif était d'identifier les caractéristiques épidémiologiques, cliniques et les facteurs liés au pronostic vital des sujets âgés hospitalisés pour AVC ischémique (AVCI) au Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso. Méthodes. Il s'est agi d'une étude rétrospective portant sur une période allant du 1er janvier 2017 au 31 décembre 2019 et concernant tous les patients âgés de 65 ans et plus hospitalisés pour AVCI. Résultats. Au total, 153 dossiers médicaux ont été colligés. L'âge moyen était de 73,9 ans. Le sex-ratio M/F était de 1,25. Les facteurs de risque cardiovasculaire étaient principalement l'hypertension artérielle chronique (61,4 %), l'alcoolisme (21,5 %), le diabète (14,3 %), et l'antécédent d'AVC (13,7 %). Le déficit moteur était le principal motif de consultation. La pathologie athéromateuse était la principale étiologie. La durée moyenne d'hospitalisation était de 16,2 jours. Le taux de mortalité intrahospitalière était de 16,9 %. La médiane de survie était de 53 jours. Les facteurs prédictifs de la mortalité étaient l'âge (p= 0,017; HR= 2,81; IC 95 %: 1,21-6,54) et le coma (p= 0,010; HR= 4,68; IC 95 %: 2,05- 43,94). Conclusion. L'AVCI chez la personne âgée à BoboDioulasso est marqué par une mortalité intrahospitalière élevée. L'optimisation de la prise en charge des patients âgés pourrait contribuer à la réduction significative de la mortalité des AVC.

Context and objective. Strokes risk increases with age. The most common one is ischemic stroke. Our objective was to identify epidemiological, clinical features and the factors linked to the prognosis for survival of older patients hospitalized for ischemic stroke in Sourô Sanou Teaching Hospital of Bobo-Dioulasso. Methods. This was an analytical historical study on older patients aged ≥ 65 years, hospitalized for ischemic stroke at Sourô Sanou Teaching Hospital of Bobo-Dioulasso during the period from January 1st , 2017 to December 31st, 2019. Results. A total of 153 patients has been involved in this study. The intrahospital ischemic stroke frequency was 68. 61 % of all strokes in elderly. The average age was 73.98 years. The sex ratio M/F was 1.25. Chronic high blood pressure (61.43 %), alcoholism (21.56 %), diabetes (14.37 %), and history of stroke (13.72 %) were the most frequent cerebrovascular risk factors in past medical history. The motor deficit represented the main reason for consultation. Atheromatous pathology was the main etiology. The mean duration of hospitalization was 16.21 days. The intrahospital mortality was 16. 99 %. Median survival was 53 days. The predictive factors of mortality were the age (p= 0.017; HR= 2.81; IC 95 %: 1.21-6.54) and coma (p= 0.010; HR= 4.68; IC95 %: 2.05-43.94). Conclusion. Stroke in the elderly at Bobo-Dioulasso is responsible for a high death rate. Optimization of management for elderly patients could contribute to a significant reduction of stroke mortality

Profiles of Elderly People Infected with HIV and Response to Antiretroviral Treatment in Burkina Faso: A Retrospective Cohort Study.

BACKGROUND: In sub-Saharan Africa, few studies exist on elderly HIV-positive populations. Therefore, we aimed to examine the profiles of elderly people living with HIV (PLHIV) in Burkina Faso and their response to antiretroviral therapy (ART). METHODS: We reviewed the monitoring and treatment of PLHIV over the age of 50 years and then compared with the monitoring and treatment of PLHIV under 50 years. RESULTS: A total of 3367 patients were included. The median age of elderly people was 54.5 years and of young people was 34.9 years ( P = .03). In both the groups, screening was performed following clinical suspicion (64.9% in elderly versus 56% in young people; P < .001). Cardiovascular risk factors were generally more significant in the elderly people. The risk of death while on ART was 2.3 times higher in elderly people ( P < .001). CONCLUSION: HIV infection in older people occurs in those who already have some cardiovascular risk factors. Particular attention should be given to multidisciplinary care for the elderly individuals.

Features of Metabolic Syndrome and Its Associated Factors during Highly Active Antiretroviral Therapy in Ouagadougou (Burkina Faso).

BACKGROUND: To study the features of metabolic syndrome (MS) and its associated factors during highly active antiretroviral therapy (HAART), in Ouagadougou. METHODS: It was a cross-sectional study from March to November 2011 in Yalgado Ouédraogo hospital. A nonprobability sample of adults receiving antiretroviral drugs for at least 6 months was studied. Pregnancy, ascites, or abdominal mass were noninclusion criteria. Metabolic syndrome met the criteria of International Diabetes Federation 2005. RESULTS: The authors studied 300 patients. Metabolic syndrome was diagnosed in 54 (18%) patients: mean age 44.8 ± 7.4 years, sex ratio 0.17, and mean duration of HAART 71 ± 30.9 months. The current anomaly of MS was low high-density lipoprotein (HDL)-cholesterol in 37 patients (68.5%), and the common profile of MS was high waist circumference + low HDL-cholesterol + abnormal blood pressure (29.6%). Associated factors were protease inhibitor regimens (P = .000), female gender (P = .004), age > 42 years (P = .001), and lipodystrophy (P = .01). CONCLUSION: Cardiovascular risks should be regarded during the care of HIV-infected patients.

[Tuberculous sacroiliitis: about two cases]. / Sacroillite tuberculeuse: à propos de deux cas.

Tuberculous sacroiliitis is rare and of difficult diagnosis. We here report two cases. The first patient was a 40-year old woman with HIV infection; the diagnosis was based on histological evaluation after surgical biopsy. The second patient was a 25-year old man living in prison whose diagnosis was established on the basis of clinical, biological, radiological reasonings and of the effectiveness of the treatment; tuberculin intradermal reaction was phlyctenular. CT scan was essential to establish the lesion diagnosis by showing edge erosion and soft tissue abscess The patients received medical and anti-tuberculosis treatment.

Risk Factors for Early Mortality on Antiretroviral Treatment of Elderly People Infected with HIV in Burkina Faso.

BACKGROUND: Age is a key determinant of mortality due to diseases including HIV infection. METHODS: A retrospective and descriptive cohort study used a computerized database to compare HIV-infected patients diagnosed in late adulthood to a group of patients diagnosed before their 49 years of age, without matching the characteristics of HIV infection. The study included patients who visited the day hospital (outpatient clinic) of the Sanou Souro Teaching Hospital of Bobo-Dioulasso, in Burkina Faso, from January 2007 to December 2011. Older adults were defined as those aged 50 years and more. RESULTS: Participants in the study consisted of 2572 patients (265 older adults and 2307 young patients living with HIV. Based on Markov chain method, 32.1% of the older adults living with HIV were found to be seroconvert at 50 years or older. The median follow-up time on antiretroviral treatment (ART) was 32.7 months (range 0.03-65.4 months). Two hundred and ninety-five (11.5%) patients died, including 21.1% of older adults and 10.4% of young (P < .01). World Health Organization stage 3 or 4 and the lowest CD4 count reached <200 cells/mm(3) were the factors associated with early mortality of older adults on ART. CONCLUSION: Mortality rate of older adult patients living with HIV in Burkina Faso is high. Early diagnosis, early treatment, and primary prevention of HIV infection in the older adults are the main keys that could help reduce such mortality.

Characteristics and follow-up of newly managed HIV-infected patients in the national referral center in Ouagadougou, Burkina Faso.

BACKGROUND: In sub-Saharan countries, HIV testing and treatment facilities are available, especially at subsidized rates for the past few years. METHODS: A prospective and descriptive review was conducted at Yalgado Ouédraogo Teaching Hospital Internal Medicine department in Ouagadougou, using personal case report forms, between June 2009 and August 2010 in all newly diagnosed adults with positive HIV antibody. RESULTS: The study participants consisted of 191 patients at a median age of 37 years (range, 18-65 years) and sex ratio (men/women): 0.66. In all, 110 (57.6%) patients were symptomatic. Fourteen patients were lost to follow-up. Of the 177 patients, 144 had CD4 count <350 cells/mm(3) and all have been treated. At the ninth month, weight gain and immune restoration were significant (P < .01); only 79 of the 144 patients had viral load measurement, and 76 of the 79 were undetectable. Mortality rate of treated patients was 6.25%. CONCLUSION: Laboratory tests and highly active antiretroviral therapy make the management of patients easier, but a majority of them still presented late and were still lost to follow-up. Nevertheless, we have excellent treatment success.

Characteristics and factors associated with the clinical forms of lipoatrophy during highly active antiretroviral therapy in Ouagadougou, Burkina Faso.

BACKGROUND: We aimed to study the factors associated with clinical forms of lipoatrophy in patients receiving highly active antiretroviral therapy (HAART) in Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso. METHODS: This cross-sectional review from March 10 to November 10, 2011, included a nonprobability sample of HIV-infected adults receiving antiretroviral (ARV) medications for at least 6 months and monitored in the internal medicine department. The diagnosis of lipoatrophy was clinical. RESULTS: Three hundred patients were included. The sex ratio was 0.4 and the mean age was 42.1 ± 8.5 years. The mean duration of HAART was 73.2 ± 30.9 months. In all, 97 (32.3%) patients had lipoatrophy: 75 (25%) isolated and 22 (7.3%) mixed syndrome. Facial lipoatrophy was frequent (61.8%). Isolated lipoatrophy was associated with male sex (P = .002) and body mass index ≤25 (P < .05). Mixed syndrome was associated with female sex (P = .002), age >42 years (P < .05), physical activity (P = .003), smoking (P = .001), stavudine (d4T; P = .0001), or protease inhibitors (P = .01). CONCLUSION: Prevention of lipoatrophy associated with HAART requires the exclusion of modifiable risk factors that we identified.

Résistance bactérienne au cours des infections urinaires chez les patients diabétiques au CNHU-HKM de Cotonou, Bénin

Introduction : La prévalence et le risque d'infection urinaire sont élevés chez le patient diabétique. L'objectif de notre travail était d'identifier les germes responsables d'infection urinaire et d'étudier leur comportement vis-à-vis des antibiotiques testés. Méthode: Il s'agissait d'une étude transversale et descriptive ayant porté sur les comptes rendus de 78 cas d'examen cytobactériologique des urines (ECBU) réalisés sur une période de 45 mois s'étendant de janvier 2012 à septembre 2015. Le diagnostic de l'infection urinaire a été retenu en présence d'une bactériurie positive c'est-à-dire une bactériurie du milieu de jet ≥ 105 cfu/ml chez la femme et ≥ 104 cfu/ml chez l'homme ou une bactériurie d'urines prélevées dans une sonde à demeure ≥ 102 cfu/ml. Résultats: Sur les 666 diabétiques hospitalisés, 78 avaient réalisé un ECBU et parmi les ECBU réalisés 46 étaient positifs. L'âge moyen des patients inclus dans notre travail était de 53,1 ± 15,7 ans avec des extrêmes de 22 ans et 87ans. Le sexe féminin était plus représenté (58,4%) soit une sex ratio de 0,71. L'Escherichia coli était le germe le plus fréquent (47,83% des cas), suivi du Klebsiella pneumoniae (19,57% des cas), du Streptococcus agalactiae (6,52% des cas), Staphylococcus epidermidis (4,3%). Concernant les betalactamines testées, le taux de résistance était de 85% pour l'ampicilline, 84% pour l'amoxicilline, 91% pour l'oxacilline, 59% pour la ceftriaxone et 10% pour l'imipénème. Quant aux quinolones, le taux de résistance était de 74% pour la norfloxacine et 67% pour la ciprofloxacine. De faibles taux de résistance ont été retrouvés pour la nétilmicine (33%), le thiamphénicol (28%) et la nitrofurantoine (26%). Conclusion: Le germe le plus fréquent était l'Escherichia coli. Le taux de résistance bactérienne était très élevée pour les betalactamines et les quinolones mais relativement plus faible pour les phénicolés, les aminosides et les nitrofuranes. Ces données devraient être prises en compte lors de toute antibiothérapie à visée urinaire surtout probabiliste