RESUMEN
INTRODUCTION: Diabetes is a public health problem. Its global prevalence was 2.8% in 2000 and it will reach 4.4% in 2030 to be 366 million diabetics. In Morocco, this true "epidemic" affects 6.6% of the population. Many epidemiologic studies have shown that patients with diabetes are more susceptible to depression. Diabetes and depression align in a non-accidental way and complicate one another. PATIENTS AND METHODS: We report a cross-sectional study conducted in association with the endocrinology department of the Mohammed VI university hospital during the period spread between April and September 2006. The aim was to evaluate the prevalence of depressive disorders in patients with diabetes and to describe their sociodemographic and clinical profile. The study included 187 patients. The scales used were the Mini International Neuropsychiatric Interview (MINI) and Hamilton's depression. Sociodemographics and diabetic characteristics were evaluated by self-questionnaire. RESULTS: The average age of our patients was 53±14 years and the percentage of females was high: 71.2%. Diabetes type 2 was the most representative (85.6%), diabetes type 1 (11.8%) and gestational diabetes (2.7%). Half of diabetics were treated with an association of healthy dietary measures (MHD) and oral anti-diabetics; 31.6% were under MHD and insulin therapy; 33.2% of patients had acute complications and 43.5% had degenerative complications. Only 11 patients (5.9%) had antecedents of depression. The prevalence of major depressive episode was 41.2%; 27.8% of patients suffered from dysthymia and 21.9% from double depression. Hamilton's depression scale indicates that all depressed patients had mild depression (total of 17 items from 8 to 17). Major depressive episode and dysthymia were frequent in out patients. Dysthymia was predominant in diabetic patients in the 46 to 55 years age group, never been schooled and without any comorbidity. The vast majority of patients with EDM had type 2 diabetes with 89.6%, 7.8% type 1 diabetes and 2.6% gestational diabetes. Most of dysthymic patients had type 2 diabetes with 94.2% against 5.8% type 1 diabetes. DISCUSSION: The association of depression and diabetes was noted in the literature for the first time more than 300 years ago by the English doctor Willis. Compared to the population of non-depressed subjects, patients with depression may be more likely to develop type 2 diabetes. There would be an increase in the release of hyperglycemic hormones in depression, as in the stress response. In addition, patients with depression have insulin resistance during testing tolerance to insulin, and during testing tolerance to glucose. Other hypotheses explain that the depression/diabetes link included biological and genetic resources. CONCLUSION: Diabetes and depressive disorders are public health problems due to their prevalence and their cost. The prevalence of major depressive disorders found among our population of diabetics justifies their research by doctors. The literature promotes appropriate care that would improve the prognosis of diabetes, as well as depression-increased mortality among diabetics.
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Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Trastorno Distímico/diagnóstico , Trastorno Distímico/epidemiología , Adulto , Anciano , Causalidad , Comorbilidad , Estudios Transversales , Trastorno Depresivo/psicología , Trastorno Depresivo Mayor/psicología , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 2/psicología , Diabetes Gestacional/psicología , Susceptibilidad a Enfermedades/diagnóstico , Susceptibilidad a Enfermedades/epidemiología , Susceptibilidad a Enfermedades/psicología , Trastorno Distímico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Embarazo , PronósticoAsunto(s)
Carcinoma Papilar/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Neoplasias Encefálicas/secundario , Carcinoma Papilar/secundario , Diagnóstico Diferencial , Disfonía/diagnóstico , Resultado Fatal , Femenino , Hueso Frontal/patología , Bocio Nodular/diagnóstico , Cefalea/diagnóstico , Humanos , Neoplasias Craneales/secundario , Adulto JovenRESUMEN
Thyrotoxicosis is underdiagnosed because of its low occurrence in series from Africa. The aim of this study was to evaluate the frequency, the demographic data, and the etiological aspects of thyrotoxicosis among hyperthyroidy. Thirty-six patients with thyrotoxicosis (group I) gathered during a period of four years was analysed, as well as 180 hyperthyroidy cases (group II). Cardiothyrotoxicosis was observed with a frequency of 16.6%. The mean age was respectively of 44.5+/-13.3 versus 32.8+/-11.4 years (p<10(-6)). Cardiothyrotoxicosis was related to multinodular goitres (18 cases), a Basedow disease (14 cases), a toxic adenoma (four cases), while the principal cause of hyperthyroidy was toxic adenoma followed by the Basedow disease (72 cases, 40%). Different modes of presentation of cardiothyrotoxicosis were found: cardiac heart failure in 27 cases (75%), permanent atrial fibrillation in 22 cases (61.1%), atrial flutter in two cases, coronary insufficiency in four cases, ventricular extrasystoli (trigeminism) in two cases, second auriculoventricular block in two cases, dilated myocardiopathy in 10 cases (27.7%), ischemic myocardiopathy in four cases, severe mitral regurgitation in one case. This study confirms the relative frequency of cardiothyrotoxicosis, the proportionally weak place of Basedow disease among hyperthyroidy's causes, and role of associated cardiac disease to the hyperthyroid.
Asunto(s)
Cardiopatías/complicaciones , Tirotoxicosis/complicaciones , Adulto , Anciano , Estudios Transversales , Femenino , Cardiopatías/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Tirotoxicosis/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Patients with foot ulcers have a high risk of relapse and amputation. Several studies have reported that 28 to 51% of amputated diabetics will have a second amputation of the lower limb within five years of the first amputation. The purpose of this study was to assess the incidence of factors favoring relapse within two years. MATERIAL AND METHODS: One hundred ten diabetic patients were treated for foot lesions in the Casablanca Ibn Rochd university hospital between 1997 and 2000. Ninety of these patients attended review consultations. RESULTS: There were 42 cases of relapse (46.6%). Male gender predominated in the relapse patients with a sex ratio of 3.2. Mean age at relapse was 55 years; 71.5% of the patients had type 2 diabetes. Lesions observed were neuropathic ulcer (n=23), arterial ulcer (n=6), infected wounds (n=13). Revealing factors were burns and wounds. The main risk factors were neuropathy (n=23, 52%), neuroarteriopathy (n=12, 31%), peur arteriopathy (n=6, 12%). Patients who relapsed (n=42) were significantly different from patients who did not relapse (n=48) for gender, presence or absence of neuropathy, and presence or absence of arteriopathy. DISCUSSION: Secondary preventive measures against these risk factors, medical care, and specialized follow-up were satisfactory in these patients. our findings illustrate the importance of specialized management of diabetic patients with foot lesions. Adequate care of the lesions and preventive measures against risk factors are needed.
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Complicaciones de la Diabetes , Pie Diabético/epidemiología , Úlcera del Pie/epidemiología , Amputación Quirúrgica , Quemaduras , Angiopatías Diabéticas/complicaciones , Pie Diabético/cirugía , Neuropatías Diabéticas/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos , Recurrencia , Estudios Retrospectivos , Caracteres Sexuales , Cicatrización de HeridasRESUMEN
18 patients have been subject to irrigation-drainage of the residual cavity after a treatment of hydatic cyst of the liver. This technic of drainage has been indicated in the most serious forms where the treatment of the residual cavity if difficult or impossible. The post-operative courses were satisfying in 17 cases. One decease has no relation with the technic. The results of the irrigation-drainage are compared to the other methods of treatment. Otherwise, the echography reveals itself to be an excellent mean of valuation and post-operative control.
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Equinococosis Hepática/terapia , Adolescente , Adulto , Equinococosis Hepática/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Irrigación TerapéuticaRESUMEN
Based on a series of 25 cases of hydatid cyst of spleen, the frequency of this localization, the clinical latency and the often serious complications of these lesions are emphasized. Ultrasound was found to be an excellent diagnostic examination. Treatment in all cases was radical excision and therapy to associated lesions, with a simple postoperative course in all cases.
Asunto(s)
Equinococosis/diagnóstico , Enfermedades del Bazo/parasitología , Adulto , Anciano , Equinococosis/etiología , Equinococosis/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esplenectomía , Enfermedades del Bazo/cirugíaRESUMEN
Two cases of hydatid cyst of the thyroid are reported and the rare cases in the literature reviewed. Hydatidosis located in the thyroid is an infrequent finding, even in endemic countries. Finding on clinical examination are usually those of a cold thyroid nodule, and diagnosis is by detection of other sites for the lesion, positive results of immunologic tests, or often only after histology of an operative specimen. The spontaneous course of the affection may be interrupted by complications due either to the size of the lesion or the parasite itself. Treatment is surgical, usually by a hemithyroidectomy.