Objective: Describe the design and implementation of an electronic medical record-E-INTMED-customized for Internal Medicine in Dakar, Senegal. Methodology: This study was carried out in a public teaching hospital in Dakar Senegal. It entailed collaboration between physicians specialized in various fields in Internal Medicine and Computer Scientists to carry out the compilation of data and their electronic transcription to produce a prototype which met users' needs. Results: E-INTMED software is structured around several hierarchical tables allowing users to register and store all relevant patients' information. E-INTMED structures patient's data to provide a clear overview of their medical history and users' activity performance. E-INTMED makes medical users' life so much easier. Users can generate and send letters and prescriptions quickly and efficiently using the customized templates which they can modify or create new ones. In addition to these capabilities, all of the features expected in an Internal Medicine EHR are handled by E-INTMED, such as lab orders and results, mechanisms for continuity of care, embedding and access to images and documents, and so much more. E-INTMED provides medical students with a number of educational, practical and administrative advantages. Conclusion: Computerization of medical records has become a necessity today. Crossing the line to Electronic medical records could help to improve medical practice and medical training.
We report a rare association of seronegative myasthenia gravis and a Biermer's anemia (or pernicious anemia). A Senegalese patient of 31 years has been followed for a vitamin B12 deficiency anemia, 12 months before his hospitalization in our department. She has been admitted for an intense and invalidating fatigability in spite of the correction of anemia, associated to a right ptosis. This clinical picture has electively been improved to the prostigmine test. The electromyography had revealed a compatible decrement with a diagnosis of myasthenia. The positivity of the antibodies anti gastric parietal cells and the twice negativity of the antibody against acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) had permitted to deduct a diagnosis of seronegative myasthenia and Biermer's anemia. The evolution was favorable under substitutive B12 vitamin therapy associated to corticotherapy and azathioprine. We insist on the research and the early treatment of a myasthenia, in a context of Biermer's anemia, before suggestive clinical signs in spite of the negativity of the anti-Rach antibodies and anti-Musk.
We report four observations of myasthenia gravis associated with other autoimmune diseases. Myasthenia gravis can be associated with all autoimmune diseases with a predominance of dysthyroidism. Among the autoimmune diseases associated with myasthenia gravis in our series, there were associations with hyperthyroidism, sjogren syndrome, Biermer's disease. You would have to know how to look for another autoimmune disease in front of all myasthenia gravis by looking for the slightest sign of appeal that could point you towards another pathology.
Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD's treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjögren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.
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