Correlation between insulin-based and C-peptide based homeostatic model assessment of insulin resistance in adults without diabetes in a sub-Saharan African setting: a cross-sectional study.

OBJECTIVE: To assess the correlation between the insulin-based and C-peptide based HOMA-IR in the general population without diabetes in sub-Saharan Africa as well as to identify factors associated with IR. RESULTS: This was a cross-sectional study in urban settings in Yaoundé, Cameroon. We included 84 people with a body mass index (BMI) ≥ 18.5 Kg/m² and without diabetes (females: 72.6%; mean age: 37 years). IR was assessed using the following formulae: HOMA-IRINS = fasting insulin (mU/ml) x fasting plasma glucose (FPG) (mmol/L)/ 22.5; HOMA-IRCP1 = fasting C-peptide (mU/ml) x FPG (mmol/L)/ 22.5; and HOMA-IRCP2 = 1.5 + (FPG (mg/dl) x fasting C-peptide (ng/ml))/ 2800. Correlation (rho) between HOMA-IRINS and C-peptide based HOMA-IR was investigated using the Spearman rank test. The median (25th -75th percentiles) HOMA-IRINS, HOMA-IRCP1, and HOMA-IRCP2 were: 1.94 (1.36-3.50), 0.18 (0.11-0.27) and 9.91 (6.81-14.52), respectively. There was no correlation between the insulin-based and C-peptide-based HOMA-IR indices: rho = 0.043, p = 0.697. IR (HOMA-IRINS ≥ 2.8) was associated with obesity: A BMI ≥ 30 Kg/m² (adjusted odds ratio (aOR): 16.9, 95% confidence intervals (CI): 3.1-92.5) and being a student (aOR: 8.9, 95%CI: 2.1-38.2) were associated with IR.

Bacterial profile of diabetic foot infections and antibiotic susceptibility in a specialized diabetes centre in Cameroon.

Introduction: bacterial profile of diabetic foot infections and the antibiotic susceptibility are essential in the prescription of empirical antibiotics before the results of cultures of deep wound samples are available. The aim of this study was to determine the microbiological profile and antibiotic susceptibility of bacteria isolated from infected diabetic foot ulcers in patients attending the Yaoundé Central Hospital, Cameroon. Methods: we retrospectively analyzed the records of patients hospitalized between 2008 and 2013 for diabetic foot infections. The main outcomes were the bacteriological profile and susceptibility patterns of isolates from positive culture of deep wound sample before antibiotherapy, carried out in the national reference laboratory. Eligible clinical records of patients were retrieved from the hospitalization registry. Results: a total of 101 patient records were analyzed. The mean age of patients was 57.1 ± 9.1 years. There were more males (64.4%), mostly with type 2 diabetes (99%), with a median duration of 9 years (IQR: 4 - 14 years). Their median blood sugar on admission was 246 mg/dL. Five percent of patients died and 23% had a major amputation. Two hundred and twenty-five (225) germs were isolated, with an average of 2.25 germs per patient. Gram-negative bacteria were more frequent (75.2%). These were mainly Morganella morganii (13.8%), Klebsiella pneumonia (12%), Escherichia coli (11.6%), Proteus spp. (10.7%), and Pseudomonas aeruginosa (8.9%). Gram-positive bacteria (24.8%) were mainly Staphylococcus aureus (9.3%), Streptococcus spp. (7.6%), and Enterococcus spp. (7.1%). Gram-negative bacteria showed a high resistance to amoxicillin-clavulanic acid (78%), fluoroquinolones (55%), and gentamycin (50%). They were susceptible to imipenem (95%), amikacin (88%), and show moderate susceptibility to third generation cephalosporins (62%). Gram-positive bacteria were susceptible to vancomycine (94%), and moderately susceptible to pristinamycine (82%) and fusidic acid (67%). Conclusion: Gram-negative bacteria were more frequently associated with diabetic foot infections, and were frequently resistant to the usually prescribed antibiotics, but remain susceptible to imipenem and amikacin. Our findings should be considered when prescribing empirical anti-biotherapy for diabetic foot infections in our setting.

Unexpected low burden of coronavirus disease 2019 (COVID-19) in sub-Saharan Africa region despite disastrous predictions: reasons and perspectives.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the development of a highly contagious disease called coronavirus disease (COVID-19). Ten months after the onset of the pandemic, America and Europe remain the most affected regions. Initially, experts predicted that Africa, the poorest continent with the most vulnerable population and health system, would be greatly affected by the ongoing outbreak. However, 240days after the first confirmed case, Africa is among the least affected region, with lower than expected incident cases and mortality. In this review, we discuss possible explanations and reasons for this unexpected low burden of COVID-19 in Africa. We focus on the characteristics of the virus, specificities of the sub-Saharan African population and local environment.