Common clinical features of diabetic foot ulcers: perspectives from a developing nation

Foot ulceration is a prominent cause of diabetes mellitus morbidity and mortality in developing countries. This is an observational study in which 47 consecutive diabetes mellitus patients with foot ulcers were studied over a 2-year period. Each patient's medical history, physical examination findings, and hematological and radiological features were documented. The mean age of the patients was 56 (11) years. The majority of the patients (40, 85%) had type 2 diabetes mellitus; 25% of patients with type 2 diabetes mellitus were diagnosed when they presented with foot ulceration. Grades 2 and 3 Wagner lesions were the most frequently noted grades of foot ulceration. The risk factors/precipitants of foot ulceration included neuropathy, vasculopathy, spontaneous blisters, walking unshoed, and wearing inadequate shoes. Prominent hematologic abnormalities included anemia and leucocytosis. Diabetes mellitus foot ulceration often occurs in middle-aged Nigerians with diabetes mellitus, and this diabetes mellitus complication may be present at diagnosis of type 2 diabetes mellitus. Subcutaneous emphysema, osteolysis, and soft tissue swelling are often documented radiological features of DFU in our patients.     

A fluorodeoxyglucose avid mediastinal parathyroid adenoma masquerading as metastatic bladder cancer

A 64-year old male with a prior medical history of bladder transitional cell carcinoma treated with a cystoprostatectomy and adjuvant platinum-based chemotherapy 10 years earlier underwent a surveillance positron emission tomography (PET) scan that revealed a metabolically active 2-cm nodule in the superior mediastinum, anterior to the origin of the innominate artery. The lesion was removed due to concerns of metastatic disease using a cervical mediastinoscope. Final pathology revealed an ectopic mediastinal parathyroid adenoma. The combination of the rare presentation, uncommon surgical approach and pathology makes this case unique.     

Frequency and Correlates of Sexual Dysfunction in Women with Diabetes Mellitus

IntroductionSexual dysfunction (SD) in women with diabetes mellitus (DM) is an important but understudied aspect of DM complications in women with DM.AimThis report is an attempt to document the prevalence, clinical correlates, and determinants of SD in a cross sectional study of women with diabetes mellitus (DM).Main Outcome MeasuresThe main outcome measures were demographic, clinical parameters, psychological morbidity, and frequency of SD.MethodsA total of 58 married women with type 2 DM and 30 age‐matched women who did not have DM had their sexual function and psychological status assessed using the Female Sexual Function Index (FSFI) and General Health questionnaires (GHQ 12) respectively. Glycemic control was assessed using glycosylated hemoglobin.ResultsThe prevalence of SD in women with DM and in the control population was 88% and 80%, respectively. The mean (standard deviation) FSFI score in the women with DM was significantly lower than that of the control group (16.2 [9.5] vs. 21 [8.5], P = 0.02). Women with DM attempted sex less frequently than those in the control group. Poor mental health status which was found to be associated with SD was noted more in women with DM than those in the control group.Conclusions.SD is high in women with and without DM. A possible determinant of SD in women with DM is psychological morbidity. Ogbera AO, Chinenye S, Akinlade A, Eregie A, and Awobusuyi J. Frequency and correlates of sexual dysfunction in women with diabetes mellitus.     

An assessment of the disease burden of foot ulcers in patients with diabetes mellitus attending a teaching hospital in Lagos, Nigeria

The major part of the burden of people with diabetes mellitus (DM) is their impaired quantity and quality of life. This is due to acute and chronic complications of which diabetic foot ulceration (DFU) takes the greatest toll. Most studies on the disease burden of DFU were carried out in developed countries, and to date, no indigenous study has addressed the burden of foot ulceration in Nigerians with DM. This study attempted to determine the disease burden of this important DM complication. The study was carried out at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. The working definition of disease burden encompassed prevalence, morbidity, mortality, and the direct economic costs of diabetes mellitus foot syndrome (DMFS). For determination of the estimates of prevalence, the "capture-recapture" and intensive case-counting methods were used, mortality and morbidity were determined from records of admissions, and associated deaths over a 3-year period (1998-2000). The direct economic costs of foot ulceration were derived from the costs incurred from in-patient days, tests, drugs/medications, surgery, and other miscellaneous units of services. The total number of people with DM seen in LUTH from 1998 to 2000 was 1500, the hospital prevalence of DFU using the capture-recapture method being 9.5%. A total of 7253 medical admissions were made in this 3-year period, and of this number 827 (11.4%) were DM related. DFU-related admissions were 97 in number, and this made up 1.3% and 11.7% of the total medical and diabetes admissions, respectively. During this period, a total of 61 lower limb amputations were carried out and 26 (42.6%) of these were DM related. The proportion of medical deaths due to DMFS deaths was greater than the proportion of medical admissions due to DFU (P = .007). The case fatality of individuals with DFU was approximately 53%. A total number of 20 patients with DM foot ulcers were hospitalized during a 1-year period of the study (2003-2004). The majority had type 2 DM. A large majority (65%) of these patients had some form of surgery in addition to medical management of their condition. Mean costs for successfully treating a patient with DMFS was Nigerian Naira (NGN) 180,581.60. The total costs incurred ranged from NGN 20,400.00 to NGN 278,029.00. Drugs or medications accounted for the majority of the total costs incurred by the patients (46.9%).     

In vivo antimalarial activity of Vernonia amygdalina

Extracts from the leaves and root bark of Vernonia amygdalina are assessed for antimalarial activity against drug-sensitive Plasmodium berghei in mice. A standard inoculum of 1 x 10(7) infected erythrocytes is used, and leaf and root-bark extracts of 500 mg/kg, 250 mg/kg or 125 mg/kg are used in a four-day suppression test and a Rane test of established infection. Leaf extract produced 67% suppression of parasitaemia in the four-day test, while root-bark extract produced 53.5% suppression. These results are significant when compared to a placebo (P<0.001).