D. Diédhiou

Efficacy and safety of denosumab for the treatment of osteoporosis: A systematic review

Denosumab is an anti-RANK ligand (RANKL) monoclonal antibody approved for the treatment of postmenopausal osteoporosis and prevention of skeletal metastasis complications. Administered subcutaneously every 6 months, it reduces the risk of vertebral fracture by 70% and of hip fracture by 40%. Its safety profile is acceptable. Denosumab may be used to treat patients with moderate to severe renal insufficiency. It has anti-fracture activity equivalent to that of zoledronic acid, but no residual effect, and no action at all beyond 6 months. In France, denosumab is reimbursed as a second-line treatment after a first attempt with bisphosphonate.

Epidemiological, Clinical and Therapeutic Characteristics of Hypertensive Type 2 Diabetics at the Marc Sankale Center of Dakar

Introduction: High blood pressure (hypertension) and diabetes mellitus are two major risk factors for cardiovascular disease, which is increasing rapidly in Africa and worldwide. Africa has the highest prevalence rate of hypertension in the world, with 46% of adults over the age of 25 with. Hypertension is common in type 2 diabetes and increases cardiovascular risk. The association of these two pathologies has many particularities in the sub-Saharan subject. The work related to this entity in Africa shows a frequency between 30% and 60%. The objective was to describe the epidemiological, clinical and therapeutic characteristics at the Medical Clinic II of the Abass Ndao Hospital Center in Dakar. Patients Methods: This was a cross-sectional, descriptive and analytical study conducted from 01 December 2016 to 31 January 2017. It focused on patients with cardiothyrosis. Epidemiological data, cardiovascular risk factors, and cardiothoracic characteristics were evaluated. Results: 303 cases were recorded with a prevalence of 42%, an average age of 61.63 years, a sex ratio of 0.22. The age group of [60 - 70] years was the most representative at 36.30%. The BMI (Body Mass Index) average was 27.06 kg/m2. Obesity was 25% and 35% were overweight. Dyslipidemia consisting of an increase in LDL cholesterol > 1 g/l in 79%, a hypercholesterolemia in 57%, a decrease in HDL cholesterol in 13.23% and a hypertriglyceridemia in 28%. Patients with three cardiovascular risk factors accounted for 93.72%. The average fasting glucose level was 2.85 g/l. Hyperglycemia was noted in 65%. The glycosylated hemoglobin is greater than 7% in 47%. The duration of diabetes was less than 5 years in 133 patients or 44%. 70% of patients were treated with oral antidiabetic drugs. Insulin was used in 21.1%. Hypertension was mild in 24.1%, moderate in 23.8% and severe in 14.8%. Hypertension treated with monotherapy was 49%, combination therapy was 43%. Converting enzyme inhibitors (CEI) were used in 44%; 20% were Calcium inhibitors and 7 were treated by Angiotensin II Receptor Antagonists (ARA). The inhibitor association of the conversion enzyme/calcium inhibitors (CEI/CI) is in 22%. Statins are used in 23%. The degenerative complications concerned four cases of acute edemas of the lower limbs (AELL), four cases of stroke (AVC). 37% had a balance of the blood pressure and among them 19.5% had followed a monotherapy and 33% a combination therapy. Conclusion: The combination of hypertension and diabetes is common in Africa and increases cardiovascular mortality. Training in the management of diabetes and other cardiovascular risk factors is needed.

Increased Prevalence of Type 2 Diabetes–Related Complications in Combined Type 2 Diabetes and Sickle-Cell Trait

OBJECTIVE The prevalence of type 2 diabetes (T2D) is rapidly increasing in sub-Saharan Africa, where sickle cell trait (SCT) is also frequent. Although SCT is generally considered a benign condition, evidence suggests that SCT could exaggerate vascular dysfunction in T2D. However, it remains unclear whether SCT could increase the risk of the development of T2D complications. Therefore, this study was conducted to determine whether T2D complications were more prevalent among Senegalese individuals with SCT and T2D than among those with T2D only. RESEARCH DESIGN AND METHODS Rates of hypertension, retinopathy, peripheral neuropathy, peripheral artery disease, and impaired renal function as well as arterial stiffness, blood rheology, and concentrations of plasma advanced glycation end products (AGEs) and cytokines were compared between groups of Senegalese individuals with combined SCT and T2D (T2D-SCT) (n = 60), T2D (n = 52), SCT (n = 53), and neither T2D nor SCT (control) (n = 56). Human aortic endothelial cell (HAEC) expression of inflammatory and adhesion factors was measured after treatment with tumor necrosis factor-α and subjects’ plasma. Effects of AGE inhibition or tiron on HAEC expression of E-selectin were measured. RESULTS Retinopathy, hypertension, and reduced renal function were more prevalent, and arterial stiffness, blood viscosity at high shear rates, and thixotropic index were higher, in the T2D-SCT group compared with the other groups. Multivariable analysis showed that plasma AGE concentration was significantly associated with arterial stiffness. E-selectin expression was elevated in HAECs treated with T2D-SCT plasma compared with the other groups, but AGE inhibition reversed this. CONCLUSIONS SCT could potentially augment the risk of the development of T2D-related complications, including retinopathy, nephropathy, and hypertension.

Caractéristiques cliniques, bactériologiques, et évolutives des infections de la main chez le sujet diabétique. Étude prospective sur 71 cas au Sénégal.

Resume Les infections de la main chez le diabetique, decrites sous le nom de « Syndrome de la main diabetique tropicale », sont moins courantes que les atteintes du pied, mais exposent egalement a des consequences invalidantes majeures. L’objectif de notre etude etait de determiner leurs caracteristiques epidemiologiques, cliniques, etiologiques et evolutives, a la Clinique medicale II de l’hopital Abass Ndao de Dakar (Senegal). Il s’agissait d’une etude prospective, descriptive, sur 6 mois (janvier a juin 2014), incluant tous les diabetiques porteurs d’une infection de la main, recus a la salle de pansements du service. Au total, 71 patients diabetiques ont ete inclus, soit 41 femmes et 30 hommes, d’un âge moyen de 50,1 ans ; il s’agissait d’un diabete de type 2 dans 61 (85,9%) cas, l’anciennete moyenne du diabete etait de 8 ans, la glycemie moyenne de 2,93 g/L. Les complications du diabete associees (recherchees uniquement chez les patients ayant une couverture financiere suffisante) etaient : neuropathie peripherique (13 cas), arteriopathie obliterante des membres inferieurs (8 cas) et retinopathie (2 cas). L’atteinte de la main etait consecutive a un traumatisme dans 30 (42,2%) cas. Les lesions se repartissaient en : phlegmon (34 cas), panaris (20 cas), abces (11 cas), onyxis et peri-onyxis (3 cas), gangrene (2 cas). La localisation etait : paume de la main (34 cas), dos de la main (10 cas), doigts (28 cas). Les germes en cause etaient principalement les Staphylocoques et les Klebsielles. L’amputation a ete necessaire dans cinq cas. Trois cas de deces ont ete constates. En conclusion, les infections de la main chez le diabetique necessitent une prise en charge precoce et intensive. Le pronostic est assombri par la severite des lesions et le retard du traitement. Sa prevention doit etre favorisee.