Epidemiologic and clinical characteristics of diabetic foot ulcer among patients with diabetes in Afghanistan: An IDF supported initiative.

AIM: The aim is to illustrate epidemiological and clinical characteristics of diabetic patients with foot ulcer (DFU) in Kabul diabetic medical center (KDMC), Afghanistan. METHOD: It is a descriptive study explaining the characteristics of diabetic patients with DFU admitted to KDMC, between 1/9/2019 to 31/8/2020 which is a center for management of diabetic patients including DFU. The university of Texas diabetic classification for DFU was used. RESULTS: Totally 3159 patients admitted to KMDC of whom 47.4% were females and 96.7% type 2 diabetes. The proportion of DFU was 9.2%. The patients' mean age was 55.4 ± 10.6 years and 78% were coming from Kabul. Prevalence of smoking and snuff use were 8.6% and 5.6% respectively. Majority of females 93% were housewives. The duration of diabetes was 5-19 years. Almost two-third were under glycaemia and HbA1c control and 9.2% had history of amputation. The common symptoms were burning, aching, numbness and tingling. The most common cause of DFU was both neuropathy and arteriopathy. After treatment 16% were referred for orthopedic procedures. CONCLUSIONS: DFU affects almost one-tenth of diabetics while a significant number of patients attend at late stage requiring orthopedic treatment. Monitoring of diabetic patients to prevent DFU is important is recommended.

Molecular epidemiology of bovine tuberculosis in Northern Ghana identifies several uncharacterized bovine spoligotypes and suggests possible zoonotic transmission.

OBJECTIVE: We conducted an abattoir-based cross-sectional study in the five administrative regions of Northern Ghana to determine the distribution of bovine tuberculosis (BTB) among slaughtered carcasses and identify the possibility of zoonotic transmission. METHODS: Direct smear microscopy was done on 438 tuberculosis-like lesions from selected cattle organs and cultured on Lowenstein-Jensen media. Acid-fast bacilli (AFB) isolates were confirmed as members of the Mycobacterium tuberculosis complex (MTBC) by PCR amplification of IS6110 and rpoß. Characterization and assignment into MTBC lineage and sub-lineage were done by spoligotyping, with the aid of the SITVIT2, miruvntrplus and mbovis.org databases. Spoligotype data was compared to that of clinical M. bovis isolates from the same regions to identify similarities. RESULTS: A total of 319/438 (72.8%) lesion homogenates were smear positive out of which, 84.6% (270/319) had microscopic grade of at least 1+ for AFB. Two hundred and sixty-five samples (265/438; 60.5%) were culture positive, of which 212 (80.0%) were MTBC. Approximately 16.7% (34/203) of the isolates with correctly defined spoligotypes were negative for IS6110 PCR but were confirmed by rpoß. Spoligotyping characterized 203 isolates as M. bovis (198, 97.5%), M. caprae (3, 1.5%), M. tuberculosis (Mtbss) lineage (L) 4 Cameroon sub-lineage, (1, 0.5%), and M. africanum (Maf) L6 (1, 0.5%). A total of 53 unique spoligotype patterns were identified across the five administrative regions (33 and 28 were identified as orphan respectively by the SITVIT2 and mbovis.org databases), with the most dominant spoligotype being SIT1037/ SB0944 (77/203, 37.93%). Analysis of the bovine and human M. bovis isolates showed 75% (3/4) human M. bovis isolates sharing the same spoligotype pattern with the bovine isolates. CONCLUSION: Our study identified that approximately 29% of M. bovis strains causing BTB in Northern Ghana are caused by uncharacterized spoligotypes. Our findings suggest possible zoonotic transmission and highlight the need for BTB disease control in Northern Ghana.