Prevalence and factors associated with carotid atherosclerosis in a Malagasy population with Type 2 diabetes mellitus: A cross-sectional retrospective study

AIM

Our study aims to determine the prevalence and factors associated with carotid atherosclerosis in Malagasy Type 2 diabetes mellitus (T2DM).

METHODS

This was a cross-sectional retrospective study, carried out over a period of 30 months. The diagnosis of carotid atherosclerosis is established by the presence of a carotid plaque increased carotid intima-media thickness ≥1.1 mm on Doppler ultrasound.

RESULTS

We included 132 T2DM. The prevalence of carotid atherosclerosis was 63.6% (38.6% carotid plaque and 25% intima-media thickening). After univariate analysis, the factors associated with carotid atherosclerosis were age ≥70 years (3.28 [1.18-10, 62]), previous intake of oral antidiabetics (0.33 [0.14-0.73]), insulin (0.28 [0.11-0.66]) and angiotensin receptor blocker (0.45 [0.20-0.98]), and current smoking (5.93 [1.64-32.6]). After adjustment for age and gender, previous intake of oral antidiabetics (0.29 [0.13-0.64]), insulin (0.27 [0.12-0.61]) and angiotensin receptor blocker (0.40 [0.19-0.86]), and current smoking (5.98 [1.61-22.1]) were associated with carotid atherosclerosis.

CONCLUSION

Smoking cessation, education on therapeutic compliance and comprehensive management of all cardiovascular risk factors and T2DM are therefore essential in order to reduce the occurrence of carotid atherosclerosis.

Urinary tract infection in diabetics hospitalized in Befelatanana Hospital, Antananarivo: Epidemiological, clinical, biological profiles and risk factors for multidrug-resistant bacterial infection

Key Clinical Message

The main type of urinary tract infection in hospitalized diabetics in Antananarivo is acute pyelonephritis; Escherichia coli is the most isolated uropathogen; imipenem, amikacin, fosfomycin and ceftriaxone are the major antibiotics for which Escherichia coli retain good sensitivity; Type 2 diabetes is predictive factor for infection by multidrug resistant bacteria.

Abstract

This study aimed to describe the epidemiological-clinical profiles of diabetics hospitalized for bacterial urinary tract infections in the Endocrinology Department of Befelatanana Hospital, to identify the main bacteria responsible, their antibiotic sensitivity profile and the factors associated with multidrug-resistant bacterial infection. A cross-sectional study was conducted between March 2017 and March 2020 involving all diabetics hospitalized for documented community-acquired bacterial urinary tract infection during this period. The hospital prevalence of urinary tract infections was 4.64%. The mean age of the patients was 59.06 ± 14.26 years and the sex ratio was 0.15. The main sign was fever (55.76%). The main clinical form was uncomplicated acute pyelonephritis (38.46%). Fifty-seven bacterial uropathogens were isolated. The most frequent was Escherichia coli (77.19%). Escherichia coli was sensitive to ertapenem and nitrofurantoin in 100% of cases, to Amikacin in 97.5% of cases, to Fosfomycin in 94.4% of cases and to Ceftriaxone in 80.65% of cases. Thirteen patients were infected with multidrug-resistant bacteria, all of them are extended-spectrum beta-lactamase-producing Enterobacteriaceae. Only the type of diabetes was associated with multidrug-resistant bacteria infection. The epidemiological-clinical and biological characteristics of urinary tract infections in our diabetics are similar to those reported in the literature. Compliance with the rules of proper antibiotic use is imperative to limit the emergence and spread of multidrug-resistant bacteria.

Epidemiological-clinical and paraclinical particularities of acute coronary syndrome without persistent ST-segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population

INTRODUCTION

This study aimed at determining the epidemiological-clinical and paraclinical particularities of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in Malagasy with type 2 diabetes mellitus (T2DM).

METHODS

This was a retrospective, descriptive and comparative study between patients with and without T2DM, carried out over a period of 38 months. The diagnosis of NSTE-ACS was retained in front of the association of chest discomfort, electrical abnormalities and elevations beyond fivefold the upper reference limit of high-sensitivity cardiac troponin.

RESULT

With 130 patients included, the overall prevalence of NSTE-ACS was 4.1%, of which 68 patients (52.3%) had T2DM. Compared to without T2DM, NSTE-ACS in T2DM was characterized by young age (p = .0002), high-frequency hypertension (OR 2.92 [1.23-7.25]; p = .0041), overweight/obesity (OR 4.39 [1.72-12.4]; p = .0002) and microalbuminuria (p < .0001), accelerated heart rate (p = .0104), atypical chest discomfort (OR 5.57 [2.21-15.7]; p < .0001), pulmonary crepitations (OR 2.25 [1.02-5.14]; p = .0224), high GRACE score (p = .0016), damage of extensive anterior leads (OR 2.11 [1.02-4.98]; p = .0402) and septal lead (OR 3.64 [1.41-10.3]; p = .0015), significant increase in cardiac troponin (p < .0001), high left ventricular filling pressure (OR 3.39 [1.51-7.90]; p = .001).

CONCLUSION

NSTE-ACS in T2DM is frequent, with an atypical clinical and severe paraclinical presentations. Adequate and multidisciplinary management of cardiovascular risk factors, including T2DM, could thus minimize the occurrence of NSTE-ACS and improve this profile.

[Epidemiologic-clinical, biological and radiological features of pulmonary tuberculosis in patients with diabetes in Antananarivo, Madagascar]

Pulmonary tuberculosis is frequently associated with diabetes mellitus and, sometimes, it may present with atypical signs. The purpose of this study is to identify the epidemiological, clinical, biological and radiological features of pulmonary tuberculosis in patients with diabetes versus patients without diabetes in order to improve treatment. We conducted a retrospective, cross-sectional descriptive and analytical study in the Department of Endocrinology and Pneumology at the Joseph Raseta Befelatanana University Hospital Center and in the Department of Respiratory Diseases at the Soavinandriana Hospital Center in Antananarivo, Madagascar. It involved patients diagnosed with pulmonary tuberculosis who presented a positive bacilloscopy exam from January 2018 to January 2020 (25 months). In our study, the overall prevalence of diabetes among TB patients was 20.31 %. Older age, insidious clinical course, severe biologic inflammatory syndrome, fewer caves but more systematized opacities and diffuse radiological lesions in the basal zone (more commonly unilateral right lesions) were mainly detected in patients with diabetes compared to patients without diabetes. Knowledge of signs of pulmonary TB in patients with diabetes can help health care workers to make a diagnosis, even in patients with atypical signs. Moreover, as the majority of pulmonary tuberculosis occur in patients with unstable diabetes, a good glycemic balance can certainly reduce its incidence.

[Prevalences of metabolic syndrome and cardiovascular risk factors in type 2 diabetics hospitalized in the Department of Endocrinology, Antananarivo]

Metabolic syndrome (MS) is considered as a cardiovascular risk factor and has become a major public health issue. It exacerbates the risks, which are already high among diabetics. The purpose of this study is to determine the rates of metabolic syndrome and other cardiovascular risk factors (CRFs) in type 2 diabetics. We conducted a cross-sectional descriptive and analytical study in the Department of Endocrinology at the Befelatanana General Hospital, Antananarivo, over a period of 7 months. The diagnosis of MS was based on IDF harmonized criteria (2009). A total of 219 patients with type 2 diabetes were involved in the study, of whom 189 had metabolic syndrome (86.30%). MS was predominant in female patients (55.88%). On average, the mean age of patients was 58,58 years, BMI was 24.28 kg/m2 and abdominal circumference was 87,40 cm. Diabetes developed, in average, over 4.36 years (75.8% of patients had imbalance). Apart from hyperglycemia, arterial hypertension (AH) was the most common component of MS, followed by hypoHDLemia, abdominal obesity and hypertriglyceridemia between the two genders. Other most commonly reported cardiovascular risk factors associated with diabetes were dyslipidemia, followed by overweight or obesity, albuminuria and smoking. Overweight or obesity were cardiovascular risk factors significantly associated with MS. MS rate was very high in type 2 diabetics with several other CRFs. Adequate management of these risk factors is necessary to reduce the number of patients with MS as well as its consequences in order to improve survival.

[Case of thyroid ectopia in the hyoid region in a young Malagasy girl]

L'ectopie thyroïdienne est une pathologie rare liée à une défaillance de migration de la glande thyroïde lors de son développement embryonnaire. Elle est le plus souvent asymptomatique. Nous rapportons un cas d'ectopie thyroïdienne à localisation hyoïdienne chez une jeune fille malgache, révélée par une gêne esthétique, associée à une hypothyroïdie infraclinique. Le diagnostic était confirmé par l'échographie cervicale et la scintigraphie au technétium 99m. Même si l'hypothyroïdie est infraclinique, une hormonothérapie substitutive est de règle permettant ainsi d'obtenir une euthyroïdie biologique et de maintenir la bonne évolution clinique.