Introduction: Haemorrhagic manifestations rarely represent the mode of onset of lupus and are a therapeutical and diagnosis emergency. We report 6 cases of haemorrhagic manifestations disclosing lupus. Patients and me...Introduction: Haemorrhagic manifestations rarely represent the mode of onset of lupus and are a therapeutical and diagnosis emergency. We report 6 cases of haemorrhagic manifestations disclosing lupus. Patients and methods: It’s about a retrospective, descriptive and multicentric study ranged from 1st January 2014 to 5th January 2019. Were included in the study all cases of lupic disease revealed by hemorrhagic disorders, recorded in 3 Internal Medicine Departments in Dakar: DalalJamm, Dantec, Pikine. The diagnosis of lupus was made on the basis of the 1997 modified classification criteria of ACR for SLE. Results: We gathered 6 cases of women affected by lupic disease. The mean age was 32 years old with extremes ranged from 17 to 56 years. According to haemorrhagic disorders, the diagnosis of lupus was automatically made in 5 of the cases and it took 6 months to confirm the last one. Haemorrhagic features were ruled by purpura (3/6 cases) and nose-bleeding associated with gumbleeding (2/6 cases), epistaxis and melena (1/6 case), hypermenorrhea (1/6 case), cerebral haematoma (1/6case). Cutaneous (5/6), articular (4/6), renal (2/6) and serous (2/6) disorders specially represented the other manifestations. Biological findings showed cytopenia with 3 cases of anaemia, 1 case of leucopenia and 6 cases of thrombopenia. The average of the platelet count was at 20,000 cells/mm3 with extremes ranged from 1000 to 35,000 cells/mm<sup>3</sup>. Thrombocytopenia was related to autoimmune thrombocytopenic purpura in 3 cases, to Evans’ syndrome in 2 cases, to macrophage activation syndrome in 1 case. Immunological investigations found the presence of antinuclear antibodies (1/6), anti-dsDNA (2/6) and anti-Sm (4/6). All patients received a bolus of Solumedrol followed by an administration of Prednisone at a dosage of 1.5 mg/kg (3 cases) and 1 mg/kg to the other patients. A transfusion of platelet concentrates was performed for all of them. The evolution was favorable in 4 cases. Two patients died according to a septic and haemorrhagic shock. Conclusion: We report 6 cases of haemorrhagic manifestations disclosing lupus. Cutaneomucous location was more frequent and was related to moderate to severe thrombocytopenia with the presence of anti-Sm antibodies.展开更多
Introduction: Systemic diseases have been the subject of few studies in the African literature and have probably been under-estimated. The objective of our study was to specify their spectrum, their epidemiological as...Introduction: Systemic diseases have been the subject of few studies in the African literature and have probably been under-estimated. The objective of our study was to specify their spectrum, their epidemiological aspects and diagnostic delay in Internal Medicine Departments of Dakar (Senegal). Material and Method: It was a multicentric retrospective and descriptive study regarding all systemic diseases during 119 months from 1st January 2005 to 30 November 2014 in 5 hospital centers down Dakar. Systemic diseases were retained according to their international consensus criteria. Results: During the studying period, 726 patients were included with 632 women and 94 men (sex ratio of 0.14). The average age was 43.76 years. Inflammatory rheumatoid family history was noted in 10.06% of cases. Rheumatoid arthritis (RA) was the predominant affection, recorded on 564 patients, isolated or associated with other systemic diseases. It was followed in a decreasing order, in the systemic auto-immune diseases sub-groupe, by systemic lupus (56 cases), Sj?gren’s syndrome (32 cases), Systemic Sclerosis (26 cases), Idiopathic inflammatory myopathies (21 cases), Undifferentiated connective tissue diseases (20 cases), Anti Phospholipid’s syndrome (6 cases) and Mixed connective tissue disease (6 cases). A diagnosis of systemic vasculitis was recorded in 19 patients. The other systemic affections were represented by systemic sarcoidosis (8 cases), Adult-onset Still’s disease (03 cases), amyloidosis (02 cases) and 02 cases of systemic syndrome associated to immunodeficiency. The mean diagnostic delay duration before the diagnostic was 3.46 years. Conclusion: Systemic diseases in internal medicine are characterized by their diversity, the clear predominance of RA, and significant diagnostic delay.展开更多
Introduction: The extended administration of corticoids by oral way for a length of more than 3 months defines the long-term-corticosteroid-therapy. This one, used in numerous indications, displays most often at the r...Introduction: The extended administration of corticoids by oral way for a length of more than 3 months defines the long-term-corticosteroid-therapy. This one, used in numerous indications, displays most often at the risk of undesirable effects linked sometimes to the habits of prescription of the doctors. Patients and Methods: In order to study the prescription modalities of this treatment, we conducted a cross-sectional, multicentric and descriptive study from June 1st, 2017 to August 1st, 2017, over a period of 2 months. It involved a questionnaire given to medical specialists of all medical specialties and practicing in the University Hospital of Dakar. Results: 170 doctors were interviewed. Dermatologists and internists were mostly found 19.4% and 18.8% or 33% and 34% doctors. Systemic autoimmune diseases alone accounted for 48% of prescription reasons. Prednisone was prescribed in 88% of cases. The immunosuppressive dose of 1 mg/kg was most often prescribed. Practitioners very heterogeneously prescribe most adjuvant measures to prolonged systemic corticosteroid therapy. Thus, the recommendation of a low-sodium diet (38% of physicians), and the systematic prescriptions of proton pump inhibitors (44.7% of physicians) and vitamin-calcium supplementation were frequently performed by physicians (34% of physicians). While the low carbohydrate diet was advocated by less than a quarter of doctors and the prevention of pneumocystosis and osteoporosis were rare (respectively 61% and 52% of prescribers did not). Conclusion: The global analysis of the habits of our medical specialists concerning the use of long-term glucocorticoids reflected a diversity of indications, heterogeneity of practices, with certain habits not in accordance with the usual recommendations.展开更多
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 liter...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 Sjôgren, 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.展开更多
Introduction: Venous thromboembolic disease (VTE) is a real public health problem worldwide. The practice guide produced periodically by the American College of Chest Physicians (ACCP) has become the international sta...Introduction: Venous thromboembolic disease (VTE) is a real public health problem worldwide. The practice guide produced periodically by the American College of Chest Physicians (ACCP) has become the international standard. However, thromboprophylaxis remains underused. Methodology: We carried out a descriptive cross-sectional study. The goals of that study were to evaluate the effectiveness of the practice of thromboprophylaxis in the various medical services of the Dakar Public Hospitals. Our investigation was conducted for two weeks in September 2017. Results: 160 patients were included (81 men and 79 women) in our series, with male predominance: sex ratio of 1.02. The average age was 48. Infectious pathologies were the predominant clinical pictures (35% of cases). The thromboembolic risk factors (RF) mainly found were represented by prolonged bed rest, followed by cardiovascular (RF): age greater than 60 years (31.2%), hypertension (8.8%), obesity (4.4%) and diabetes (3.8%). The thromboembolic RF of patients hospitalized in these medical services has been evaluated empirically. We noted a lack of use of the VTE risk assessment scores. 40.9% (n = 56) of patients received overall VTE prophylaxis, a rate corresponding to almost half of those at risk (51.4%). This result reflects an under-use of thromboprophylaxis in the Dakar medical environment and a low level of adherence by practicians to the guidelines on VTE prophylaxis. Conclusion: It is therefore recommended to develop a national strategy to assess patients at risk for VTE, as well as measures to educate and inform doctors about the appropriate forms of thromboprophylaxis.展开更多
文摘Introduction: Haemorrhagic manifestations rarely represent the mode of onset of lupus and are a therapeutical and diagnosis emergency. We report 6 cases of haemorrhagic manifestations disclosing lupus. Patients and methods: It’s about a retrospective, descriptive and multicentric study ranged from 1st January 2014 to 5th January 2019. Were included in the study all cases of lupic disease revealed by hemorrhagic disorders, recorded in 3 Internal Medicine Departments in Dakar: DalalJamm, Dantec, Pikine. The diagnosis of lupus was made on the basis of the 1997 modified classification criteria of ACR for SLE. Results: We gathered 6 cases of women affected by lupic disease. The mean age was 32 years old with extremes ranged from 17 to 56 years. According to haemorrhagic disorders, the diagnosis of lupus was automatically made in 5 of the cases and it took 6 months to confirm the last one. Haemorrhagic features were ruled by purpura (3/6 cases) and nose-bleeding associated with gumbleeding (2/6 cases), epistaxis and melena (1/6 case), hypermenorrhea (1/6 case), cerebral haematoma (1/6case). Cutaneous (5/6), articular (4/6), renal (2/6) and serous (2/6) disorders specially represented the other manifestations. Biological findings showed cytopenia with 3 cases of anaemia, 1 case of leucopenia and 6 cases of thrombopenia. The average of the platelet count was at 20,000 cells/mm3 with extremes ranged from 1000 to 35,000 cells/mm<sup>3</sup>. Thrombocytopenia was related to autoimmune thrombocytopenic purpura in 3 cases, to Evans’ syndrome in 2 cases, to macrophage activation syndrome in 1 case. Immunological investigations found the presence of antinuclear antibodies (1/6), anti-dsDNA (2/6) and anti-Sm (4/6). All patients received a bolus of Solumedrol followed by an administration of Prednisone at a dosage of 1.5 mg/kg (3 cases) and 1 mg/kg to the other patients. A transfusion of platelet concentrates was performed for all of them. The evolution was favorable in 4 cases. Two patients died according to a septic and haemorrhagic shock. Conclusion: We report 6 cases of haemorrhagic manifestations disclosing lupus. Cutaneomucous location was more frequent and was related to moderate to severe thrombocytopenia with the presence of anti-Sm antibodies.
文摘Introduction: Systemic diseases have been the subject of few studies in the African literature and have probably been under-estimated. The objective of our study was to specify their spectrum, their epidemiological aspects and diagnostic delay in Internal Medicine Departments of Dakar (Senegal). Material and Method: It was a multicentric retrospective and descriptive study regarding all systemic diseases during 119 months from 1st January 2005 to 30 November 2014 in 5 hospital centers down Dakar. Systemic diseases were retained according to their international consensus criteria. Results: During the studying period, 726 patients were included with 632 women and 94 men (sex ratio of 0.14). The average age was 43.76 years. Inflammatory rheumatoid family history was noted in 10.06% of cases. Rheumatoid arthritis (RA) was the predominant affection, recorded on 564 patients, isolated or associated with other systemic diseases. It was followed in a decreasing order, in the systemic auto-immune diseases sub-groupe, by systemic lupus (56 cases), Sj?gren’s syndrome (32 cases), Systemic Sclerosis (26 cases), Idiopathic inflammatory myopathies (21 cases), Undifferentiated connective tissue diseases (20 cases), Anti Phospholipid’s syndrome (6 cases) and Mixed connective tissue disease (6 cases). A diagnosis of systemic vasculitis was recorded in 19 patients. The other systemic affections were represented by systemic sarcoidosis (8 cases), Adult-onset Still’s disease (03 cases), amyloidosis (02 cases) and 02 cases of systemic syndrome associated to immunodeficiency. The mean diagnostic delay duration before the diagnostic was 3.46 years. Conclusion: Systemic diseases in internal medicine are characterized by their diversity, the clear predominance of RA, and significant diagnostic delay.
文摘Introduction: The extended administration of corticoids by oral way for a length of more than 3 months defines the long-term-corticosteroid-therapy. This one, used in numerous indications, displays most often at the risk of undesirable effects linked sometimes to the habits of prescription of the doctors. Patients and Methods: In order to study the prescription modalities of this treatment, we conducted a cross-sectional, multicentric and descriptive study from June 1st, 2017 to August 1st, 2017, over a period of 2 months. It involved a questionnaire given to medical specialists of all medical specialties and practicing in the University Hospital of Dakar. Results: 170 doctors were interviewed. Dermatologists and internists were mostly found 19.4% and 18.8% or 33% and 34% doctors. Systemic autoimmune diseases alone accounted for 48% of prescription reasons. Prednisone was prescribed in 88% of cases. The immunosuppressive dose of 1 mg/kg was most often prescribed. Practitioners very heterogeneously prescribe most adjuvant measures to prolonged systemic corticosteroid therapy. Thus, the recommendation of a low-sodium diet (38% of physicians), and the systematic prescriptions of proton pump inhibitors (44.7% of physicians) and vitamin-calcium supplementation were frequently performed by physicians (34% of physicians). While the low carbohydrate diet was advocated by less than a quarter of doctors and the prevention of pneumocystosis and osteoporosis were rare (respectively 61% and 52% of prescribers did not). Conclusion: The global analysis of the habits of our medical specialists concerning the use of long-term glucocorticoids reflected a diversity of indications, heterogeneity of practices, with certain habits not in accordance with the usual recommendations.
文摘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 Sjôgren, 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.
文摘Introduction: Venous thromboembolic disease (VTE) is a real public health problem worldwide. The practice guide produced periodically by the American College of Chest Physicians (ACCP) has become the international standard. However, thromboprophylaxis remains underused. Methodology: We carried out a descriptive cross-sectional study. The goals of that study were to evaluate the effectiveness of the practice of thromboprophylaxis in the various medical services of the Dakar Public Hospitals. Our investigation was conducted for two weeks in September 2017. Results: 160 patients were included (81 men and 79 women) in our series, with male predominance: sex ratio of 1.02. The average age was 48. Infectious pathologies were the predominant clinical pictures (35% of cases). The thromboembolic risk factors (RF) mainly found were represented by prolonged bed rest, followed by cardiovascular (RF): age greater than 60 years (31.2%), hypertension (8.8%), obesity (4.4%) and diabetes (3.8%). The thromboembolic RF of patients hospitalized in these medical services has been evaluated empirically. We noted a lack of use of the VTE risk assessment scores. 40.9% (n = 56) of patients received overall VTE prophylaxis, a rate corresponding to almost half of those at risk (51.4%). This result reflects an under-use of thromboprophylaxis in the Dakar medical environment and a low level of adherence by practicians to the guidelines on VTE prophylaxis. Conclusion: It is therefore recommended to develop a national strategy to assess patients at risk for VTE, as well as measures to educate and inform doctors about the appropriate forms of thromboprophylaxis.
