Diabetes mellitus foot ulcer and associated factors among Type 2 diabetes patients in a Tertiary Institution in Southwest Nigeria.

Aim: This study aims to assess the proportion of diabetic foot ulcer (DMFU) and associated factors among patients with type 2 diabetes in a tertiary hospital in Southwest Nigeria. Methods: A pretested semi-structured interviewer-administered questionnaire adapted from the STEPwise Approach to Surveillance of Noncommunicable Disease Risk Factors of WHO.14 was used for data collection from a sample of 181 patients with type 2 diabetes mellitus. Sociodemographic, behavioral, clinical, and laboratory variables were collated from the participants. Chi-square test and logistic regression were used to identify the predictors of DMFU. Results: A total of 166 patients had their questionnaires completed. The mean age (standard deviation) of the respondents was 62.6 (14.3) years. The proportion of DMFU was 18.7%. More than two-third (71.1%) of our respondents had clinical symptoms suggestive of peripheral neuropathy while 34.3% of the patients seen in the study had evidence of peripheral vascular disease on duplex Doppler ultrasound. Male patients were about five times more likely to have DMFU than female patients (adjusted odds ratio [AOR] =5.27; 95% confidence interval [CI] = 1.001-27.841). Those with duration of diabetes ≥10 years were more likely to have DMFU than those with disease duration <10 years (AOR = 15.47; 95% CI = 1.201-199.314). Patients with fasting blood glucose (FBG) of ≥ 7.2 mmol/L were about four times more likely to have DMFU than those with FBG of <7.2 mmol/L (AOR = 4.19; 95% CI = 1.618-18.463). Conclusions: The proportion of DMFU was 18.7%, and the predictors identified included sex, duration of disease, and FBG level.

Résumé Objectif: Cette étude vise à évaluer la proportion de l'ulcère du pied diabétique (DMFU) et des facteurs associés chez les patients atteints de diabète de type 2 dans un hôpital tertiaire du sud-ouest du Nigéria. Méthodes: Un questionnaire prétesté à un intervieweur semi-structuré adapté à l'approche par étapes de la surveillance des facteurs de risque de maladie non transmissibles de l'OMS.14 a été utilisé pour la collecte de données à partir d'un échantillon de 181 patients atteints de 17 diabète de type 2. Les variables sociodémographiques, comportementales, cliniques et de laboratoire ont été rassemblées auprès des participants. Le test du chi et la régression logistique a été utilisé pour identifier les prédicteurs du DMFU. Résultats: Un total de 166 patients ont réussi leurs questionnaires. L'âge moyen (écart-type) des répondants était de 62,6 (14,3) ans. La proportion de DMFU était de 18,7%. Plus de deux tiers (71,1%) de nos répondants présentaient des symptômes cliniques suggérant une neuropathie périphérique tandis que 34,3% des patients observés dans l'étude avaient des signes de maladie vasculaire périphérique sur l'échographie Doppler duplex. Les patients masculins étaient environ cinq fois plus susceptibles d'avoir du DMFU que les patientes (rapport de cotes ajustée [AOR] = 5,27; intervalle de confiance à 95% [IC] = 1,001­27,841). Ceux qui ont une durée de diabète ≥ 10 ans étaient plus susceptibles d'avoir du DMFU que ceux souffrant de durée de la maladie <10 ans (AOR = 15,47; IC à 95% = 1,201­199,314). Les patients atteints de glycémie à jeun (FBG) ≥ 7,2 mmol / L étaient environ quatre fois plus susceptibles d'avoir du DMFU que ceux avec FBG de <7,2 mmol / L (AOR = 4,19; IC à 95% = 1,618­18,463). Conclusions: La proportion de DMFU était de 18,7% et les prédicteurs identifiés comprenaient le sexe, la durée de la maladie et le niveau de FBG. Mots-clés: Ulcère du pied, Nigéria, diabète sucré de type 2.

A 10-Year Old Girl with Resistant Hypertension without Significant Indication of an Underlying Renal Cell Carcinoma, Misdiagnosed as Malaria.

BACKGROUND Blood pressure (BP) is not routinely screened in children in clinical practice. Renal cell carcinoma (RCC) is a rare cause of renal hypertension and accounts for less than 0.3% of all childhood tumors. The clinical manifestation of hypertension in children requires a high index of suspicion, as does RCC, which can have many different manifestations. CASE REPORT We report the case of a 10-year-old girl with 1-year history of persistent symptoms of recurrent episodes of headache and excessive sweating and a 6-months history of weight loss and loss of appetite. She was repeatedly managed as having malaria in the center where she was referred, without recovery. Persistent high BP was discovered in our center, which ranged between 180/120 and 200/120 mmHg. This was not controlled by 3 different classes of drugs. Abdominal ultrasonography showed a right kidney with a well circumscribed lower pole mass with internal echoes, compressing the pelvicalyceal system. Abdominal computed tomography revealed a huge, circumscribed, expansile, isodense mass arising from the renal cortex in the lower pole of the right kidney. Intraoperative findings included a mass seen at the lower pole of the right kidney with histology diagnosis of RCC. Other laboratory tests were normal. To date, the patient remains normotensive and symptom-free after nephrectomy. CONCLUSIONS The nonspecific clinical manifestation found in this case show the need for hypertension screening in children. The resolution of symptoms after nephrectomy confirms RCC as the underlying cause of symptoms, making this case a unique presentation.