أنا سعيد أن أحيطكم علما أن الفائزة بالمسابقة التي كنت قد نضمتها ونشرتها هنا في19 أكتوبر2020 والتي طال إبلاغكم بنتيجتها لأنه كما تعرفون فقد كان فيسبوك قد عطل صفحتي لمدة شهر, هي الطالبة أميمة.أ من مدينة أكادير.في إختيار الفائز إعتمدنا على المحتوى وطريقة تقديم الموضوع.
فهنيئا لأميمة مثال للطالبة والطالب المغربي المثابر والقوي العزيمة والناجح. أتمنى من الله العلي القدير أن تهتم الحكومة المغربية بمثل الطالبة أميمة حتى ينتفع بهم الوطن وليس ألمانيا أو أي بلد آخر.
هنيأ لكي أميمة, أتمنى لكي كل النجاح في حياتك الشخصية والمهنية.
لا يفوتني أن أشكر باقي المتسابقات والمتسابقين اللدين لم يحالفهم الحظ وأبشركم أن هناك المزيد من المسابقات والمفاجئات في المستقبل.
Patient is a 20-year-old married woman with one child.
Two years ago, following an auto palpation, she discovered a lump in her left breast.
She consults with a gynecologist and a breast ultrasound was done on 26/09/2019 which notes: “a galactophoritis of the left breast, BIRADS 3.
on 04/12/2019, the patient will undergo a biopsy of the left breast and the result is: “Granulomatous mastitis”.
Corticosteroid therapy with Cortancyl 20 mg was started on 04/12/2019, the dose was 3 tablets per day for several weeks according to the patient.
The pain in the right groin crease began in March 2020, first the pain when walking then pain at rest, to become sleepless at night, the pain made the patient wake up when she wanted to turn over in bed.
The patient stopped seeing her first gynecologist to see another doctor, who reduced the dose of Cortancyl.
Seeing that the pain did not stop but worsened, the patient decided to stop corticosteroids by herself and to go to a third doctor.
On 04/11/2020, the latter prescribes an X-ray of the pelvis, showing: “heterogeneous aspect of the bone web of the right femoral epiphysis making suspect an osteonecrosis of the right femoral head”.
An MRI of the pelvis was performed on 11/11/2020 and confirmed the existence of aseptic osteonecrosis of the right femoral head with dissection under chondral stage 3 of Ficat.
On 20/11/2020, the patient came to my medical office because she was offered surgery and she wanted to confirm if it was the right and only solution to her pain.
the patient came with two young girls from her family without the presence of the husband. the patient is smiling but slightly stressed. Examination of the left breast indeed notes the existence of a small lump at the level of the internal median dial without pain on palpation without local signs of inflammation, the small mass is mobile and not fixed. no galactorrhea. examination of the right breast is normal. the supraclavicular and axillary ganglion areas are free
the patient was sitting on a chair during the questioning, on getting up she was in pain and started to limp on her way to the examination bed.
Examination of the two lower limbs in supine position does not note any shortening or vicious attitude. the flexion-extension of the two lower limbs is not painful. no inflammatory signs in the right groin crease, hernial orifices are free. The abduction movement of the right lower limb and an external rotation of the right foot awaken exquisite pain in the right groin crease. The right knee is free, not painful.
Finally I convinced the patient to trust and fallow the advices of her orthopedist, that she must be accompanied by her husband next time so that the orthopedist answer all their questions about the surgery and after the surgery , (duration of the physiotherapy…..)
Doctors should be more aware of risk factors and side effects when prescribing corticosteroid therapy. The awareness of risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up a patient with osteonecrosis, treatments are determined by lesion characteristics, patient factors, and preference of doctors. Surgical treatment showed better results than conservative therapy in earlier-stage ONFH, and there should be a trend in minimizing the surgical injury and evaluation of treatment for preserving the femoral head with normal function throughout a patient’s life.(1)
1: Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages
Li-Hua Liu, Qing-Yu Zhang, Wei Sun, Zi-Rong Li, and Fu-Qiang Gao
Chin Med J (Engl). 2017 Nov 5; 130(21): 2601–2607.doi: 10.4103/0366-6999.217094
This is a 70-year-old patient I received in my medical practice in a village 20 km from the nearest public hospital. The patient, who was widowed by his condition, was accompanied by his two daughters. Medical history: left facial paralysis, type 2 diabetes and arterial hypertension. The ongoing medical treatment: Medzar 50mg (1-0-0) and Diamicron(2-0-0). Reason for consultation: Respiratory difficulties, productive cough, extreme asthenia, loss of appetite. The patient has also difficulty ensuring his transfers and sleep disorders(insomnia). This symptomatology had been evolving for more than a week according to the patient’s daughters
At the examination: I note that the patient came on foot assisted by his two daughters, from the car that took him to my office. The patient was wearing diapers, conscious, no temporal-spatial disorientation, smiling, no signs of dehydration, no skin crease. GSC: 15/15 , Arterial pressure: 17/8.5 Blood sugar: 117mg/dl , heart rate: 75 BPM. No oximeter in my medical office. the patient has resting dyspnea without orthopnea. Axillary temperature :37°C No oedema of the lower limbs, peripheric pulses present and bilateral. Pulmonary auscultation: crackling in both lung fields and sibilants in the left lung field. ECG: Atrial extrasystole.
My diagnosis hypothesis: Acute lung edema, pneumonia or pulmonary embolism
Patient received a Dexamethasone 4mg intramuscular injection and was immediately referred to a public hospital in Tangier.
The Family chose a private clinic where a Thoracic CT and blood sample were done, here are the results: Blood count: Hyperleucocytosis, neutrophil polynucleosis , lymphopenia. C-reactive protein=155.70mg/dl ,D-dimer=3772ng/ml
Thoracic CT: Aspect in favor of severe Covid 19 pneumonia involving between 50% and 75% of the pulmonary parenchyma.
The clinic advised the family to transfer the patient on their own to the public hospital that treats Covid-19 patients.
It should be noted that the clinic physician after reading the diagnosis on the chest CT authorized the patient to return home pending the result of the blood sample.
أخيرا أنا سعيد بنشر البحث العلمي الذي أجريته سنة 2003في المستشفى العسكري محمد الخامس بالرباط. أنا والعديد من الأطباء العسكريين تم الضحك علينا وإحتقار بحثنا العلمي من طرف مسؤولي كلية الطب بالرباط آنذاك ,ومن ثم إحتقار وتبخيس مدرستنا العسكرية ومفتشية الطب العسكري والجيش الملكي المغربي بأكمله. هادا البحث يبين تميز وتفوق خدمات فريق طب الطوارئ العسكري بالمستشفى العسكري محمد الخامس بالرباط على الصعيد الوطني والعالمي
تعد حالات الطوارئ الحشوية سببًا متكررًا للاستشارة في قسم الطوارئ ، وتنتشر حالات الطوارئ الحشوية في البطن.
يتم استدعاء أطباء الطوارئ المناوبين لإجراء التشخيص الصحيح وبدء فحوصات إضافية قبل إحالة المرضى إلى غرفة العمليات ومن هناك إلى قسم جراحة البطن.
يتألف عملنا من تقييم إدارة بعض حالات الطوارئ الحشوية التي تم إدخالها إلى قسم الطوارئ في مستشفى محمد الخامس العسكري في الرباط بين يناير 2003 وسبتمبر 2003.
Visceral emergencies are a frequent reason for consultation in the emergency department, abdominal visceral emergencies are predominant.
Emergency physicians on duty are called upon to make the correct diagnosis and start additional examinations before patients are referred to the operating room and from there to the visceral surgery department.
Our work consists of evaluating the management of certain visceral emergencies admitted to the emergency department of the Mohammed V military hospital in Rabat between January 2003 and September 2003.