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Biomedical subjects

F T Lester

Publications and source records attributed to F T Lester.

At least 19 recordsLinked to original sources
PubMed1995

Amputations in patients attending a diabetic clinic in Addis Abeba, Ethiopia.

During 18 years, 1976 to 1994, 43(1.9%) of the 2,250 patients registered in the Diabetic Clinic at Yekatit 12 Hospital, Addis Abeba, Ethiopia (six patients) required an amputation at diagnosis or during the course of diabetes mellitus. Male to female ratios was 2:1; eight patients had Type 1 and 35 Type 2 diabetes. Diabetic peripheral neuropathy was the underlying condition in at least 21 of the 43 patients; only five cases of ischaemic gangrene were seen. Mean ge at amputation was 37.4 +/- 8.7 years in Type 1 patients and 58.6 +/- 12.1 in Type 2. Twenty-three of the 43 are now dead, 12 of the deaths having been due to sepsis in patients who refused an amputation in the face of progressing gangrene. Eleven of the 43 still attend regularly up to 11 years after an amputation. Most patients who needed below-knee amputations did not regain independence because of difficulty obtaining prostheses.

Adolescent↗
PubMed1993

A search for malnutrition-related diabetes mellitus among Ethiopian patients.

OBJECTIVE: To search for evidence of MRDM among Ethiopian patients. RESEARCH DESIGN AND METHODS: We reviewed the records from March 1976 to January 1991 of 1835 Ethiopian diabetic patients registered consecutively in the Diabetic Clinic of Yekatit 12 Hospital in Addis Ababa, Ethiopia. RESULTS: Of those aged 15-30 at onset, 41.3% had a BMI < 19 kg/m2 at diagnosis, and 55% of the latter had a history of normal weight before the onset of symptoms. The frequency of KA was similar in the very thin patients and others of the same age-group, and only 1 patient required > 1.5 IU insulin in 24 h. Pancreatic calcification was observed in only 4 middle-aged men with histories of alcohol abuse, and the very thin patients did not have other stigmata of malnutrition. Of the 1604 patients > or = 18 yr of age at diagnosis, only 21 of 1116 who knew their previous weight had a BMI < 19 kg/m2 before the onset of diabetic symptoms, and most of the 178 patients with a BMI < 19 kg/m2 on treatment had been normal or even overweight. In regression analysis, the factors associated with weight loss before diagnosis were the duration of symptoms in type I diabetes patients and the need for insulin from diagnosis, poverty certification, and symptom duration in type II diabetes patients. Weight gain with treatment was related to female sex, the duration of symptoms, and the absence of tuberculosis in type I diabetes patients and related to an address/birthplace not in Addis Ababa in type II diabetes patients. CONCLUSIONS: The undernutrition at presentation is probably caused by the untreated diabetic state and is reversible with treatment, even if the patient is poor and/or lives in a rural area. No convincing cases of MRDM fulfilling the published definition could be found.

Adolescent↗
PubMed1993

Clinical features, complications and mortality in type 2 (non-insulin dependent) diabetic patients in Addis Abeba, Ethiopia, 1976-1990.

Clinical features and prognosis in 1386 consecutively registered Ethiopian Type 2 (non-insulin-dependent) diabetic patients seen between 1976 and 1990 in the Diabetic Clinic in Yekatit 12 Hospital in Addis Abeba, Ethiopia, are described. Of the 1386, 52% (95% confidence interval CI 2%) were diagnosed diabetic between the ages of 40 and 59, and only 7% CI 1.4%) at age 60 or more. 51% have always been treated with oral hypoglycaemic agents, 5% with diet alone, 8% (CI 1.4%) with insulin within one year of diagnosis, and 26% (CI 2%) after varying durations on tablets. In marked contrast to the leanness of the general Ethiopian population, 53% (CI 5%) of the 408 women who knew their previous body weight had body mass index (BMI) of > 29.9 kg/m2 before the onset of diabetes, and a further 35% (CI 5%) BMI of 25.0 to 29.9; corresponding figures for 568 men were 14% (CI 3%) and 52% (CI 4%). Of the 1386, 23% (CI 3%) knew of at least one diabetic relative. Hypertension was present in 24%, in a quarter of whom it was associated with nephropathy. At last visit, 15% (CI 1%) were known to have diabetic retinopathy, 9.2% (CI 1.5%) nephropathy and 10.5% (CI 1.6%) neuropathy, all three commoner with long duration of diabetes. During the 15 years, 12% of these patients have died, with mean duration of known diabetes at death of 12.5 (CI 1.5) years. Mean age at death was 56.1 (CI 3.3) in women and 57.6 (CI 2.6) in men. The overall mortality rate was 14.9 per 1000 person-years of diabetes. Multivariate survival time analysis found 5 year survival from diagnosis of diabetes of 97% (CI 6%), 12 year survival of 65% (CI 9%) and 20 year survival of 70% (CI 7%).

Adult↗
PubMed1992

Clinical features, complications and mortality in type 1 (insulin-dependent) diabetic patients in Addis Ababa, Ethiopia, 1976-1990.

Clinical features, complications and prognosis of 431 consecutively registered Ethiopian Type 1 (insulin-dependent) diabetic patients seen in the Diabetic Clinic in Yekatit 12 Hospital in Addis Ababa, Ethiopia, from 1976-1990 are reported. Male:female ratio was 1.4:1; mean age at diagnosis was 18.1 years (confidence interval (CI) 1.6) in women and 21.4 (CI 1.2) in men. A history of ketoacidosis at some time was present in 38 per cent, in 11 per cent at diagnosis of diabetes. Tuberculosis was the most common complicating illness, occurring at some time in 16.5 per cent of patients. In addition, 9.5 per cent (CI 4 per cent) were known to have diabetic retinopathy, 6.0 per cent (CI 2 per cent) nephropathy and 7.9 per cent (CI 2 per cent) neuropathy at their last clinic visit. During the 15 years of the study, 9.7 per cent of the patients have died, with a mean duration of diabetes at death of 9.2 years (CI 1.8), and an overall mortality rate of 15.5/1000 person-years of diabetes. Five-year survival was 96 per cent (CI 3 per cent), 15-year survival 82 per cent (CI 9 per cent), and 20-year survival 63 per cent (CI 17 per cent), calculated using the Cox proportional hazards model; prognosis was better in those diagnosed at a younger age (p = 0.029) and in those with a body mass index of > 19 kg/m2 on treatment (p = 0.096).

Adolescent↗
PubMed1991

Clinical status of Ethiopian diabetic patients after 20 years of diabetes.

By January 1990, over a period of 14 years, the Diabetic Clinic at Yekatit 12 Hospital, Addis Ababa had registered 1699 diabetic patients, of whom 204 were first diagnosed in or before 1969. Of these, 68 are known to have died after 11 to 36 years of diabetes (29% in renal failure), and 69 have been lost to follow-up for 3 or more years. Of the 121 who had been diabetic at least 20 years when last seen, 67 are attending, 18 are lost to follow-up, and 36 have died. Of these 121, 36.4% were known to have neuropathy, 29.8% nephropathy, and 45.5% retinopathy. Only 7 (5.8%) were Type 1 patients compared with 18.8% of the whole diabetic clinic, and most were obese Type 2 diabetic patients from Addis Ababa itself. Most of the 67 still attending after 20 to 34 years of diabetes are independent and fully employed, suggesting that the prognosis of diabetes may not be as dismal as has been generally reported from African countries. However, the survivors were mainly economically better-off Type 2 diabetic patients from the capital.

Age Factors↗
PubMed1990

Insulin injection technique can be taught without hospitalization.

Although hospitalization of the diabetic may be seen as a failure of management, and places the patient in an artificial situation, admission for initiation of insulin therapy is the custom in most Ethiopian hospitals. From January 1987 to January 1988, 144 diabetics were taught insulin injection technique in the Diabetic Clinic of Yekatit 12 Hospital in Addis Ababa, Ethiopia, by two nurses in early morning, six days weekly, sessions. Of these, 85 were inpatients aged 6 to 73 years from all wards, admitted because of ketoacidosis, intercurrent illnesses or rural home. The 59 outpatients, aged 7 to 70 years, attended each morning, and started therapy with 8 to 12 units of Lente insulin daily, the dose being increased every 2 or 3 days by small increments until control was attained. These outpatients needed an average of 4.7 mornings (range 1-13) to learn the technique, and an additional 3 to 4 weeks of frequent checkup to achieve control: several continued their jobs while learning. The method failed with 2 very symptomatic patients; there were no severe hypoglycaemic reactions or other complications. In addition to the financial saving for patients, and reduction of hospital bed use by diabetics, the patients helped and encouraged each other, learning faster than when taught individually as "ill" inpatients.

Adolescent↗
PubMed1990

Nutritional status of young adult Ethiopians before onset and after treatment of diabetes mellitus.

Young diabetics in tropical countries are often undernourished, insulin-requiring and ketosis-resistant, and are sometimes considered to have a distinct type of diabetes. Therefore, a survey of young adult diabetics attending Yekatit 12 Hospital, Addis Ababa, was made to determine clinical features and the relation between their diabetes and their nutritional state. In May, 1988, 894 of 1490 registered diabetic patients were attending regularly, of whom 248 became diabetic between the ages of 15 and 35 years. Many had been followed for 6 years or more. Of the 248,69 males and 29 females (39.5%) had body mass index (BMI) of less than 18 kg/m2 at diagnosis of diabetes. However, only 3.5% of the 199 who knew their pre-diabetic weight had been less than 18 kg/m2; 13.8% of males and 48.5% of females had been obese. At their last attendance, 50% of those whose BMI at diagnosis was less than 18 were of normal weight and only 13% had gained no weight. Of the 98 with BMI less than 18 at diagnosis, and the further 18 less than 18 kg/m2 by the time insulin was started, ketosis occurred at some time in 22%. Only 1 patient takes more than 1.5 units of insulin per kg per day, and 30% of those needing 1.0 to 1.5 U/kg have had tuberculosis. Only 15 of the 116 patients who had BMI less than 18 failed to gain weight on treatment. It is concluded that, in most, the malnutrition at presentation was due to the diabetic state and did not precede the diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Actinomycosis of the ear.

A case of primary actinomycosis of the ear in a 15 year old Ethiopian girl is described and discussed.

Actinomycosis, Cervicofacial↗
PubMed1988

Macrovascular disease in middle-aged diabetic patients in Addis Ababa, Ethiopia.

To define the prevalence of large vessel disease in Ethiopian diabetic patients, the protocol of the World Health Organisation Multinational Study of Vascular disease in Diabetics was used in the Diabetic Clinic of Yekatit 12 Hospital, Addis Ababa: 221 of the possible 261 patients aged 35 to 54 years were examined during 6 months. One hundred seven were diagnosed diabetic 1 to 6 years before study, 74, 7 to 13 years and 40, 14 years or more before the study. Forty-two percent were taking insulin; 18% had retinopathy, 7% heavy albuminuria. Body mass index (BMI) of less than 18 kg/m2 was found in 13.6%; 6.4% of men had BMI more than 27 and 50% of women more than 25. Only 30 patients had ever smoked cigarettes. The plasma cholesterol was less than 6.72 mmol/l in 90% of the 221 patients. Vascular disease led to the diagnosis of diabetes in 3 patients. At study, 19.9% were hypertensive but only 5% at the time of diagnosis. Only 1 patient had had ischaemic gangrene, 1 a stroke, 4 intermittent claudication, 4 angina pectoris and 1 a myocardial infarction. Electrocardiograms, centrally Minnesota-coded in London, were interpreted as Coronary Disease Probable in only 6 patients, and Coronary Disease Possible in 25; the other 190 tracings were normal. It is concluded that macrovascular disease is uncommon in middle-aged Ethiopian diabetic patients in Addis Ababa.

Angina Pectoris↗
PubMed1988

The serum amino acid spectrum of insulin-dependent diabetics and controls from Ethiopia.

The serum amino acid spectrum was examined in healthy men and insulin-dependent diabetics from Ethiopia. Comparison of serum amino acids of controls from Gondar with Ethiopians after adaptation to a free European diet revealed a marginal low protein nutrition, but not the characteristic changes of malnutrition or experimental starvation. There was no apparent nutritional deficiency of sulphur-containing amino acids in Ethiopians. Insulin-dependent diabetics showed significantly elevated serum levels of BCAA indicating an accelerated protein catabolism in recent-onset insulin-deficient patients and known diabetics respectively, most of them in poor metabolic condition. Serum glutamine levels were reduced, suggesting a considerable renal contribution to the hyperglycaemia/glucosuria of diabetics. The data may be best explained by the low residual insulin secretion at diabetes onset or by the poor degree of metabolic control of known Ethiopian diabetics.

Adult↗
PubMed1986

The frequency of islet cell surface antibodies in newly diagnosed diabetics from Ethiopia.

Forty-three newly diagnosed diabetic patients from Ethiopia were studied for the frequency of islet cell surface antibodies and other clinical features which are relevant to the aetiopathogenesis and classification of diabetes mellitus. In preliminary investigations of a small number of controls and noninsulin-dependent diabetics we found, as expected, no circulating antibodies. Four first-degree relatives of ICSA-positive sibs were negative, too. However, 3 out of 7 known insulin-treated diabetics displayed ICSA in the blood serum. In our study of newly diagnosed diabetics we found ICSA in 39% (17/43). Five patients who were assigned to the NIDDM subclass had no antibodies. 37 diabetics required insulin treatment after clinical diagnosis and 16 (43%) of these were ICSA-positive. There were no differences in the assessed clinical parameters between ICSA-positive and -negative patients. One ICSA-positive patient initially controlled with oral hypoglycaemic agents became insulin-dependent within our study period. Our observations in newly diagnosed diabetics from Ethiopia revealed a lower frequency of ICSA than in Caucasians, however, the results provide evidence for the occurrence of auto-immune phenomena in the aetiopathogenesis of diabetes mellitus in this ethnic group.

Adult↗
PubMed1986

Childhood diabetes mellitus in Ethiopians.

Of 1088 consecutive Ethiopian diabetic patients registered over 9 years 80 (7.4%) were diagnosed at or before age 15 years. There were 48 girls and 32 boys, with mean age of onset of 10.1 years. Diabetes had been present 10 years or less in 62, 11 to 20 years in 15, and more than 20 years in only 2. Twenty-two were rural, 27 had poverty certificates. Twenty-three have known diabetic relatives. The original mode of presentation could not be verified in 16, 7 presented in ketoacidosis, 5 were diagnosed by a diabetic relative, and the rest presented with the rapid onset of classical symptoms. To date, 43 have been ketoacidotic at least once. No pancreatic calcification was seen in 34 abdominal radiographs. Three of 6 newly diagnosed patients tested had islet cell surface antibodies. Three cases, initially suggestive of 'tropical malnutrition diabetes', evolved into typical type 1 diabetes. Serious complicating illnesses were tuberculosis (6), bacterial endocarditis (1) and rhinocerebral mucormycosis (1). Six patients have had metabolic cataracts. Ten patients (12%) have died, 4 of ketoacidosis and 4 of diabetic nephropathy. Childhood diabetes mellitus in Ethiopians is clinically very similar to type 1 diabetes elsewhere.

Adolescent↗
PubMed1985

Insulin therapy: problems in an African country.

Major problems of metabolic control are encountered in the 40% of Ethiopian diabetic patients who require insulin. Important contributory factors include the cost of insulin, its erratic supply, and difficulties with handling syringes and obtaining sterility. Economic and social factors also aggravate poor dietary control, a situation exacerbated by religious customs. Geographical and manpower problems contribute to the problem through unsatisfactory follow-up arrangements.

Costs and Cost Analysis↗