Diabetic hand infections in hospital practice in Bamako, Mali

Sidibé, A.T.; Dembele, M.; Cissé, Ah I; Alwata, F; Ould, MY Ahmedou; Coulibaly, T; Traore, AK; Traore, H. A.; Touré, A; Diallo, Dapa A.

doi:10.1016/s1262-3636(07)70253-7

Cited by 12 publications

(12 citation statements)

References 5 publications

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“…A female preponderance, as found in this study (70%), has been noted by other workers. 19,20 The left upper limb amputation was involved in 70% of the patients, a finding consistent with other reports. 13 A curious finding was the fact that the right lower limb was the involved limb in all 3 patients who had either a concurrent or previous upper extremity amputation.…”

Section: Discussionsupporting

confidence: 90%

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The Tropical Diabetic Hand Syndrome

Nthumba¹,

Cavadas²,

Landín³

2013

Annals of Plastic Surgery

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Tropical diabetic hand syndrome (TDHS) is an aggressive type of hand sepsis that results in significant morbidity and mortality among patients with diabetes in the tropics. This study set out to establish a protocol for the holistic management of TDHS to improve digit/hand salvage and function at AIC Kijabe Hospital. This prospective study examined the following demographics of patients presenting to the authors institution between October 2009 and September 2010 with TDHS: their sex, age, comorbidities, length of in-hospital stay, surgical and medical treatment, total cost of treatment, and immediate postdischarge outcomes. A total of 10 patients (3 men and 7 women) were presented with TDHS during the study period. Surgical procedures included a thorough debridement of the hand at initial presentation, followed by procedures aimed at preserving length and hand function, with digit or hand amputation when there was no possibility of salvage. Three hands were salvaged, without the need for an amputation; 2 of these, however, developed severe stiffness with resultant poor function. Fifty percent of the patients developed considerable disability; 3 of these patients had disabilities of the arm, shoulder, and hand, (DASH) scores of >90 at 6 months after treatment. TDHS appears to be more aggressive in some patients than in others; a multidisciplinary approach, with early involvement of the surgical team, and a radical surgical debridement are essential to improved outcomes. Although the goal of medical treatment (ie, glycemic control) is simple and easily achieved, surgical goals (salvage of limb or life, preservation of hand function) are more complex, costly, and difficult to achieve. Educating health care workers, diabetic patients, and their relatives on hand care is an important preventive measure. Diligence in taking antidiabetic medicine, early presentation, and appropriate care of TDHS are required for meaningful improvement in outcomes of patients with diabetes who develop hand sepsis in the tropics.

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Section: Discussionsupporting

confidence: 90%

“…A third patient with both lower and upper limb amputations had had multiple toe amputations 3 years prior to presentation with TDHS. Bilateral hand sepsis has been reported, 20 but crippling bilateral upper limb amputations have not been reported previously (Fig. 3).…”

Section: Discussionmentioning

confidence: 91%

The Tropical Diabetic Hand Syndrome

Nthumba¹,

Cavadas²,

Landín³

2013

Annals of Plastic Surgery

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“…All other studies were clinic-based surveys or casecontrol studies; the majority were undertaken in diabetes clinics (hospital or primary care) or hospital ophthalmology clinics. studies undertaken in Western Africa took place in Nigeria, except one that covered Nigeria and Ghana [14] and one from Mali [15]. Within East Africa, two studies were conducted in the Seychelles [16,17] and two in Mauritius [7,10]: relatively wealthy, ethnically diverse, small island nations.…”

Section: Designmentioning

confidence: 99%

Epidemiology of diabetic retinopathy and maculopathy in Africa: a systematic review

et al. 2013

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AimTo summarize findings from studies reporting the prevalence and incidence of diabetic retinopathy and diabetic maculopathy in African countries in light of the rising prevalence of diabetes mellitus.MethodsUsing a predefined search strategy, we systematically searched MEDLINE, EMBASE, Science Citation index and Conference Proceedings Citation index, African Index Medicus and the grey literature database ‘OpenSIGLE’ for studies published between January 1990 and February 2011. Included studies reported prevalence or incidence of diabetic retinopathy or diabetic maculopathy of subjects with diabetes resident in African countries.ResultsSixty-two studies from 21 countries were included: three population-based surveys; two cohort studies; five case–control studies; 32 diabetes clinic-based, nine eye clinic-based and 11 other hospital-based surveys. Included studies varied considerably in terms of patient selection, method of assessing the eye and retinopathy classification. In population-based studies, the reported prevalence range in patients with diabetes for diabetic retinopathy was 30.2 to 31.6%, proliferative diabetic retinopathy 0.9 to 1.3%, and any maculopathy 1.2 to 4.5%. In diabetes clinic-based surveys, the reported prevalence range for diabetic retinopathy was 7.0 to 62.4%, proliferative diabetic retinopathy 0 to 6.9%, and any maculopathy 1.2 to 31.1%. No obvious association between prevalence and income level of the country was detected.ConclusionsLarge, community-based cross-sectional and cohort studies are needed to investigate rates and determinants of prevalence of diabetic retinopathy, incidence and progression in Africa. Consensus is needed on the most appropriate methods of identification and classification of retinopathy for research and clinical practice. Estimates of prevalence of diabetic retinopathy, proliferative diabetic retinopathy and maculopathy are comparable with recent European and American studies.

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“…Dans les pays africains la prévalence de l'infection de la main diabétique est de 1,4 à 3,2% avec une prévalence rapportée très élevée au Mali(34,8%) [6].L'infection du membre supérieur chez le patient diabétique est fréquente chez les femmes africaines ; ceci expliqué par le fait qu'elles sont les plus souvent en charge de travaux manuels, comme en Algérie (17 femmes versus 9 hommes) [7][8]. Dans notre série, on note une prédominance féminine expliquée par la fréquence des accidents domestiques chez la femme notamment les piqures par épines, les plaies par couteau, négligence de ces lésions.…”

Section: Discussion:-unclassified