Prescription de l'oxygène dans le service d'urgence d'un hôpital de référence de Mahajanga

Introduction : L'oxygène est un médicament. Une prescription non appropriée peut occasionner une insuffisance ou un excès d'apport source de dépenses hospitalières dans les pays en développement. L'objectif était d'évaluer la prescription de l'oxygénothérapie dans un service d'urgence et de soins intensifs et d'observer les modalités d'utilisation pour permettre d'ajuster les objectifs et les cibles thérapeutiques en prenant comme référence les recommandations. Matériels et Méthodes : Il s'agit d'une étude prospective descriptive sur trois mois, en 2018, de la prescription de l'oxygène au service des urgences et de soins intensifs dans un hôpital de référence de Mahajanga. Quatre obus et quatre extracteurs étaient les sources d'oxygène pour 18 lits d'accueil, de déchoquage et de soins intensifs. Ni un générateur d'oxygène ni des matériels de ventilation spécifique n'étaient disponibles. L'étude statistique a été réalisée avec le logiciel SPSS® v.20, le test Khi2 utilisé pour la comparaison des valeurs avec un seuil de signification p˂0,05. Résultats : Sur 599 admissions, 244 patients (40,7%) bénéficiant d'un apport en oxygène ont été inclus dans l'étude. L'âge moyen était de 47,6 ans avec prédominance masculine (sex-ratio de 1,4). Une saturation d'au plus 90% a été retrouvée dans 25% des cas. Les 40% des patients ont été référés pour une « oxygénothérapie ¼. Les pathologies en cause étaient neurologiques dans 34,4% des cas, touchant la tranche d'âge de 40 à 60 ans (p=0,006), respiratoires pour 21,7% et cardio-vasculaires dans 13,9%. Les lunettes à oxygène étaient utilisées à 71,7%, l'obus à oxygène à 69,3% dans les premières 24 heures (p=0,001). La mortalité était de 22,5% avec 60,6% des patients décédés qui avaient une saturation en oxygène de 90% au maximum (p=0,05). Conclusion : Un algorithme standard avec une saturation pulsée en oxygène ciblée et des techniques plus appropriées auraient permis d'économiser l'oxygène hospitalier et de réduire la mortalité.

Background: Oxygen is a drug. An inappropriate prescription can lead to insufficient or excessive intake, which is a source of hospital expenditure in low-income countries. The aim of the study was to assess the prescription of oxygen therapy in an emergency and intensive care unit and to observe the modalities of its use to allow adjustment of the therapeutic objectives and targets according to the current recommendations. Materials and Methods: We conducted a prospective descriptive study over three months, in 2018, of the prescription of oxygen in the Emergency and Intensive Care Department, of a referral hospital in Mahajanga. Four oxygen cylinder and 4 concentrators were available as oxygen sources for 18 beds intended for patient reception, destock and intensive care. The hospital did not have an oxygen generator or specific ventilation equipment. The statistical study was carried out with SPSS® v.20 software, the Khi2 test used for the comparison of values with a significance level p˂0.05. Results: Of 599 admissions, 244 patients (40.7%) receiving oxygen were included in the study. The average age was 47.6 years with a male predominance (sex ratio : 1.4). Oxygen saturation ≤90% was found in 25% of cases. The 40% of patients were referred for "oxygen therapy". The main disease were neurological in 34.4%, affecting the age group of 40 to 60 years (p=0.006); respiratory for 21.7% and cardiovascular in 13.9%. Nasal cannulas were used in 71.7%, the oxygen cylinder in 69.3% in the first 24 hours (p=0.001). Mortality was 22.5% of which 60.6% had oxygen saturation ≤90% (p=0.05). Conclusion: Using a standard algorithm with targeted SpO2 and more appropriate techniques would have saved hospital oxygen and reduced mortality.

Availability of Antimalarial Drugs and Evaluation of the Attitude and Practices for the Treatment of Uncomplicated Malaria in Bangui; Central African Republic

National malaria management policy is based upon the availability of effective and affordable antimalarial drugs. This study was undertaken to evaluate the quality of the treatment of uncomplicated malaria cases in Bangui; an area with multidrug-resistant parasites; at a time preceding implementation of a new therapeutic policy relying on the artemisinin derivative combined treatment artemether-lumefantrine. A cross-sectional study was carried out in Bangui city to assess availability of antimalarial drugs and the performances of health workers in the management of uncomplicated malaria. Availability of drugs was recorded in all drugs wholesalers (n=3); all pharmacies in health facilities (n=14); private drugstores (n=15); and in 60 non-official drug shops randomly chosen in the city. Despite a limited efficacy at the time of the survey; chloroquine remained widely available in the official and nonofficial markets. Artemisinin derivatives used in monotherapy or in combination were commonly sold. In health care facilities; 93of the uncomplicated malaria cases were treated in the absence of any laboratory confirmation and the officially recommended treatment; amodiaquine-sulfadoxine/pyrimethamine; was seldom prescribed. Thus; the national guidelines for the treatment of uncomplicated malaria are not followed by health professionals in Bangui. Its use should be implemented while a control of importation of drug has to be reinforced

Method Development and Validations: Characterization of Critical Elements in the Development of Pharmaceuticals

Although a thorough validation cannot rule out all potential problems; the process of method development and validation should address the most common ones. Examples of typical problems that can be minimized or avoided are synthesis impurities that co-elute with the analyte peak in an HPLC assay; a particular type of column that no longer produces the separation needed because the supplier of the column has changed the manufacturing process; an assay method that is transferred to a second laboratory where they are unable to achieve the same detection limit; and a quality assurance audit of a validation report that finds no documentation on how the method was performed during the validation. Problems increase as additional people; laboratories; and equipment are used to perform the method. When the method is used in the developer's laboratory; a small adjustment can usually be made to make the method work; but the flexibility to change it is lost once the method is transferred to other laboratories or used for official product testing. This is especially true in the pharmaceutical industry; where methods are submitted to regulatory agencies and changes may require formal approval before they can be implemented for official testing. The best way to minimize method problems is to perform adequate validation experiments during development

Evaluation of 17 Medicinal Plants from Northern Cote d'Ivoire for their in Vitro Activity against Streptococcus Pneumoniae

A total of 20 Cote d'Ivoire plant extracts; belonging to 17 different species out of 11 families; were investigated for their antibacterial activity against Streptococcus pneumoniae (Pneumococcus). The plants were selected on the base of their ethnomedicinal use; in Northern Cote d'Ivoire; against various infections such as upper track diseases. From all the crude extracts tested; only 7 from 6 plant species showed a promising in vitro bactericidal activity against peumococcus; some of which were resistant to penicillin. The most active extracts were from Erythrina senegalensis (Fabaceae); Piliostigma thonningii (Caesalpiniaceae); Waltheria indica (Sterculiaceae); Andira inermis (Fabaceae); Uapaca togoensis (Euphorbiaceae); Keetia hispida (Rubiaceae) and Combretum molle (Combretaceae). This is the first report of the antipneumococcal activity of the tested plant species. The results of this preliminary investigation support the traditional use of the active plants in the treatment of pneumococcal infections. The most active could be candidates for isolation of compounds which could develop into new lead structures for drugs against Streptococcus pneumoniae

Quality of Antimalarial Drugs in Sudan: Results of Post-Marketing Surveillance

Background: Every government allocates a substantial proportion of its total health budget to drugs. This proportion tends to be greatest in developing countries, where it may exceed 40%. This indicates the importance of assuring the quality of medicines. This study was conducted to assess the quality of antimalarial drugs in Sudan. It was a part of a comprehensive study to test the quality of medicines in Sudanese market (post- marketing surveillance). Methods: Six states in Northern, Eastern, Western and Central Sudan were chosen for samples collection to represent all Sudanese market. The sampling procedure was designed in a way to determine whether these products were adversely affected by the transport and storage conditions at the periphery. Official inspectors (pharmacists) at state level were responsible for sample collection, coding and transportation to the National Drug Quality Control Laboratory at Khartoum for analysis. Results: The results identified several significant problems of substandard products in all states. They included percentage failures ranging from 0% to 100% for different antimalarial drug products. Conclusion: This data indicates significant problems of substandard antimalarial products circulating in the Sudanese market. This appears to be due to non-suitable distribution mechanisms as well as non-suitable storage conditions. Non-compliance with Good Manufacturing Practice (GMP) guidelines by manufacturers in production also seemed to have contributed to this

Efficacy of artemether-lumfantrine (Co-Artesianer) suspension in the treatment of uncomplicated Plasmodium falciparum malaria among children under 5 years in eastern Sudan

PURPOSE : the aim of the present study was to investigate the efficacy of artemether-lumfantrine (Co-Artesianer) suspension for the treatment of uncomplicated Plasmodium falciparum malaria in children (aged 6-59 months) in Kassala in eastern Sudan. METHOD: This was a prospective clinical trial where the artemether-lumfantrine (Co-Artesianer) suspension was given for three days and the patients were followed-up for 28 days. RESULTS: Forty-eight patients were enrolled in the study and 43 of them completed the 28-days follow-up. Treatment rapidly cleared parasitemia and fever. The overall 28-day cure rate was 100 percent and no clinical or parasitological failures were observed among these patients. Mild side effects were observed in three (7 percent) children. CONCLUSION: Artemether-lumfantrine (coartem) suspension appears to be efficacious and safe for the treatment of uncomplicated malaria

Evaluation des deux derniers protocoles antituberculeux (2RHZ/4RH et 2RHZE/4RH) utilisés en Côte d'Ivoire

"Notre etude est de type retrospectif dont l'objectif general et devaluer le traitement de la tuberculose apres deux mois de traitement. L'evaluation se faisant sous forme de comparaison des resultats du (("" nouveau protocole"" (2RHZE/4RH) avec ceux de "" l'ancien "" protocole (2RHZ1'4RH); nous avons considere deux periodes d'etude a savoir: - Mai a Juillet 2001 (pour l'ancien protocole) ; -Mai a Juillet 2002 (pour le nouveau protocole). Pour la premiere periode nous avons collige 899 nouveaux cas de TPM+ et pour la deuxieme periode; nous avons collige 912 cas. Nos resultats etaient les suivants : Au niveau de l'activite du laboratoire : La lecture des lames tirees a retrouve seulement 2.02pour cent d'erreur. Au niveau de l'evolution bacteriologique : Les resultats sont respectivement avec l'ancien protocole et le nouveau protocole les suivants: *Au deuxieme mois (Le taux de negativation est de 89;90pour cent en 2001 contre 91;86 en 2002 ; Les perdus de vue sont de 12;90pour cent contre 12.50pour cent). *Au quatrieme mois (Les taux de negativation; chez les malades positifs au 2eme mois sont de 84.48pour cent en 2001 contre 87;76pour cent en 2002 ; Du 2eme mois au 4emc mois 9;52pour cent des malades en 2001 sont perdus de vue contre 10;34pour cent en 2002). *Au sixieme mois (a la fin du traitement) 20;36pour cent de l'ensemble des malades en 2001 et 20.72pour cent des malades en 2002 sont perdus de vue. Parmi les malades ayant termine leur traitement avec des frottis; 94;30pour cent sont declares gueris en 2001 contre 95;72pour cent en 2002. Dans l'ensemble les perdus de vue dominaient dans les groupes des sujets de sexe masculin (14.50pour cent); des sujets VIH-positif (8;72pour cent); les sujets ages de plus de 55 ans et les malades dont l'etat clinique a evolue favorablement."

Reevaluation de l'efficacite et de la tolerance du Pamoate de Pyrantel dans le traitement de la necatorose au Senegal

L'etude de la tolerance et de l'efficacite du Pamoate de Pyrantel (Vermintel) s'est deroulee au Senegal dans la region de Ziguinchor et a interesse 40 patients parasites par N. americanus. Le Pamoate de Pyrantel a ete administre a la dose de 20 a 25 mg/kg de pc par jour durant 2 jours consecutifs; soit sous forme de comprimes; soit sous forme de suspension buvable. La tolerance du produit a ete excellente dans 65 pour cent des cas et bonne chez les autres (35 pour cent); puisque les effets secondaires ont ete benins et de breve duree. En ce qui concerne l'efficacite du traitement; elle a ete excellente puisque les signes imputables a la necatorose avaient disparu dans 90;4 pour cent des cas a l'examen de controle a J14. Sur le plan parasitologique; en depit d'un taux de guerison de 20;4 pour cent a J14; l'efficacite peut etre consideree comme bonne. En effet; un taux de reduction du nombre d'oeufs excretes de 90;6 pour cent a ete obtenu chez les sujets non gueris; ce qui correspond a une baisse importante de la charge parasitaire. Les resultats ainsi obtenus dans le traitement de la necatorose au Senegal peuvent etre consideres comme satisfaisants. Ils pourraient cependant etre ameliores en administrant des doses plus importantes

Analyse clinique du traitement du plasmodium falciparum a l'artesunate

Depuis le mois de decembre 1992; les auteurs ont traite 30 malades atteints de paludisme a plasmodium falciparum par l'artesunate en perfusion; en comparaison avec un autre groupe de malades qui; cette fois; ont ete traites par du quinimax en perfusion egalement. De part et d'autre ces groupes de malades ont supporte le traitement pendant 3 jours. Les malades soumis a l'artesunate ont eu chacun une dose totale de 240 mg. Ceux soumis au quinimax ont eu chacun 2400 mg au total. Le temps moyen de l'artesunate pour faire baisser la temperature et eliminer le plasmodium est plus court et plus rapide que celui du quinimax. Le taux de recidive avec l'artesunate est tres faible et les effets secondaires sont pratiquement rares. Il est vrai que c'est un nouveau medicament; mais nos observations montrent deja qu'il est d'une tres bonne qualite; tres efficace comme antipaludeen; et que les praticiens peuvent l'utiliser sans crainte pour le moment

Community-based chemotherapy for schistosomiasis using a pyrazinoisoquinoline (PZQ) in Southern Sierra Leone

The object of the study was the efficacy of Pyrazimoquinoline (Praziquantel) as an antischistosomicidal drug on the prevalence of schistosomiasis in a community-based chemotherapy trial. The study; which for the first time in Sierra Leone evaluated the efficcacy of Praziquantel; was undertaken in five (5) chiefdoms in Moyamba district. Parasitological surveys were conducted on 483 individuals; randomly selected by stratified sampling. Individuals found positive for S. haematobium and S. mansoni infection were treated with Praziquantel orally; at the recommended dose of 40mg/kg two weeks after parasitological examination. A follow-up parasitological survey to assess the impact of therapy was performed 10 weeks after the administration of the drug