Prise en charge des patients atteints de COVID 19: analyse des prescriptions médicamenteuses au CHU Gabriel Touré / Management of patients with Covid 19: analysis of prescription drugs at Gabriel Touré University Hospital

La COVID-19 est une infection virale qui s'est propagé dans tout le monde. Pour la prise en charge des cas, le Mali a créé des sites de traitement dont celui du CHU Gabriel Touré. Objectif : C'était d'analyser les prescriptions médicamenteuses pour le traitement de la COVID-19 au CHU Gabriel Touré. Méthodologie : L'étude était rétrospective et descriptive et a concerné la période d'avril à septembre 2020. Elle s'est déroulée au Centre de Traitement COVID-19 du CHU Gabriel Touré et à la Pharmacie Hospitalière de cet hôpital. Les ordonnances et les registres d'hospitalisation ont servi à collecter les données. Résultats : Au total, 29 patients ont été hospitalisés. L'âge médian était de 44ans, 75,90% des patients présentaient au moins une pathologie associée à la COVID-19. Le nombre d'ordonnances était de 333 comportant 870 lignes de prescriptions dont 33,21% de traitements standards et 66,79% pour les pathologies associées avec 86,23% disponibles à la Pharmacie Hospitalière. Le phosphate de chloroquine, dosé à 250mg, était administré à 500mg deux fois quotidiennement. Dans les directives nationales le phosphate de chloroquine était à 100mg pour 200mg trois fois quotidienne. La vitamine C non prévue dans les directives a été prescrite à tous les patients. La classe des médicaments du sang et des organes hématopoïétiques a été les plus prescrits (31,49%). Le coût moyen des traitements était de 65602±106858 FCFA avec maximum de 567860 FCFA. Une évaluation des prescriptions dans les autres sites de traitement est nécessaire.

COVID-19 was declared a pandemic in March 2020. For case management, Mali has created several treatment sites including the site of the CHU Gabriel Touré. Aims: The objective of the study was to analyse drug prescriptions for the COVID-19 treatment at the CHU Gabriel Touré. Methods: We performed a retrospective and descriptive study from April to September 2020. Drug prescriptions and hospital records were used to collect data. Prescriptions and hospital records were used to collect data. Results: A total of 29 patients were hospitalized. The median age was 44 years, 75.90% of patients had at least one pathology associated with COVID-19. The number of prescriptions was 333 comprising 870 lines of prescriptions including 33.21% for standard treatments, and 66.79% for associated pathologies. with 86.23% available at the Hospital Pharmacy. Chloroquine, dosed at 250mg, was administered at 500mg twice a day. The national guidelines from the treatment of COVID19 recommends 200mg of chloroquine in two doses. Vitamin C was prescribed for all patients although not included in the national guidelines. The class of drugs for the blood and blood-forming organs was the most prescribed (31.49%). The average cost of treatments was 65,602 ± 106,858 FCFA with a maximum of 567,860 FCFA. An evaluation of prescriptions in other treatment sites is necessary.

Compliance of Healthcare Providers with National Treatment Guidelines for HIV/AIDS

Background: Evidence had shown that low compliance with treatment guidelines by healthcare providers may result in incomplete care of patients thereby defeating the aim of HIV disease management and control. Objectives: This study was conducted to compare the compliance of a site ART treatment team with the National Guidelines' recommendation on criteria for treatment initiation and regimen change among HIV/AIDS experienced patients. Methods: In a retrospective observational double cohort study; the medical records of all adults HIV/AIDS positive and treatment experienced patients (N=267) whose ART regimen were either substituted or switched between January 2008 and June 2009 were evaluated for the fulfilment of criteria required before treatment initiation and change of therapy. Results: The level of compliance with guidelines' recomendations for therapy initiation ranged from 0% - 84.3% (mean= 31.4%; median = 23.2%; SD =21.5%) while compliance with guidelines' recommendations for regimen change ranged from 0% - 61.4% (mean= 31.4%; median = 3.8%; SD =21.5%). There was 100% and 89.2% compliance with 'what to start' and 'when to start' respectively. Conclusions: Majority of the patients were given appropriate ART regimen at the right time based on the guideline recommendations but compliance with guideline's recommendations for therapy change was poor. The extent of compliance with guideline's recommendations is critical to success of HIV/AIDS control programme

Southern African Guidelines on the Safe Use of Pre-Exposure Prophylaxis in Persons at Risk of Acquiring HIV-1 Infection

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline; it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations; including MSM; transgender persons; heterosexual men and women; HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective; safe; biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa; given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition; whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk; rather than continually and lifelong; as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion; but are not extensively covered in these guidelines

Nurses' compliance with prevention of mother-to-child transmission national guidelines in selected sites in Kinshasa, Democratic Republic of Congo

Background: The Democratic Republic of Congo (DRC) implemented a prevention of mother-to-child transmission (PMTCT) of HIV infection programme in maternal; newborn and child health (MNCH) services in 2001 with nurses as key personnel. To date there is no informationin the DRC and specifically in Kinshasa with respect to compliance with PMTCT national guidelines.Aim: The study aimed at describing nurses' compliance with the PMTCT national guidelines in selected PMTCT sites of Kinshasa.Methods: A descriptive cross-sectional study was conducted in Kinshasa with 76 nurses in 18 selected PMTCT sites. The nurses' compliance with PMTCT national guidelines was assessed using a healthcare provider self-reporting questionnaire developed by the researchers.Results: The study showed that the mean score of nurses' compliance with PMTCT nationalg uidelines was 74% (95% CI: 69% - 78%) which progressively decreased and was significantly different across different MNCH services (p = 0.025). With respect to categories of PMTCT recommendations; nurses were compliant with those related to education in labour and delivery; and antenatal services. Sociodemographic characteristics such as training; length of service and category of nurses did not influence nurses' compliance score.Conclusion: These findings showed that nurses were noncompliant with PMTCT national guidelines; with the score level being 80% or more in the three MNCH services/units. Improvement of nurses' 'compliance with the PMTCT national guidelines requires effective monitoring of full integration of PMTCT as routine activities in MNCH care

Ethical Guidelines for Military-Based Health Research: an Unmet Need in Africa?

"Background: Achieving the highest standards of ethics in military health research is a challenging but crucial undertaking. The military environment is complex and African military health professionals struggle to maintain a balance between ethics and military ethos. The objective of this paper is to review ten existing research ethics guidelines for their application to the military context; and describe the need for guidance in military research ethics in sub-Saharan Africa.Method: To achieve this; five prominent international research ethics guidelines and five African guidelines were selected using some inclusion/exclusion criteria. Thereafter; designed topics were used in analyzing them for their strengths and weaknesses in providing protection for military research participants.Results: Out of the five international guidelines reviewed; only the Council for International Organization of Medical Sciences (CIOMS) mentions the ""armed forces"". Similarly; the only African national guideline that specifically mentions the ""armed forces"" is the Ugandan national guideline.Conclusions: We conclude that national and international guidelines for human subject research may be too general and not suitable for research with military populations. There is a need for additional guidance in research ethics for militaries in sub-Saharan Africa."

Guideline on the Management of Occupational and Non-Occupational Exposure to the Human Immunodeficiency Virus and Recommendations for Post-Exposure Prophylaxis: 2015 Update

This guideline is an update of the post-exposure prophylaxis (PEP) guideline published by the Southern African HIV Clinicians Society in 2008. It updates the recommendations on the use of antiretroviral medications to prevent individuals who have been exposed to a potential HIV source; via either occupational or non-occupational exposure; from becoming infected with HIV. No distinction is made between occupational or non-occupational exposure; and the guideline promotes the provision of PEP with three antiretroviral drugs if the exposure confers a significant transmission risk. The present guideline aligns with the principles of the World Health Organization PEP guidelines (2014); promoting simplification and adherence support to individuals receiving PEP

The Implementation of Guidelines in a South African Population with Type 2 Diabetes

Objective: The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus; using national treatment guidelines.Design: Cross-sectional study.Setting and subjects: The study consisted of 666 patients with type 2 diabetes mellitus; attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.Outcome measures: Using a public sector database; retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis; and if they were receiving oral hypoglycaemic and/or insulin therapy. Age; gender; race; blood pressure; haemoglobin A1c (HbA1c) and fasting lipids were captured and measured. The history of patients' previous coronary artery disease; strokes; nephropathy; neuropathy and retinopathy was recorded.Results: The mean age of the patients was 63 years [standard deviation (SD) 11.9]; 55of whom were females. The HbA1c was 8.8 (SD 2.5). 26.2 of patients attained HbA1c levels of 7. Of the total patients; 45.8 met a 130/80 mmHg blood pressure target; and 53.8 a low-density lipoprotein (LDL) cholesterol of 2.5 mmol/l. Only 7.5 obtained the combined target for HbA1c ; blood pressure and LDL cholesterol.Conclusion: Traditionally; type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet; as many as 80

South African Hypertension Practice Guideline 2014 : Review Article

Outcomes : Extensive data from many randomised; controlled trials have shown the benefit of treating hypertension (HTN). The target blood pressure (BP) for antihypertensive management is systolic 140 mmHg and diastolic 90 mmHg; with minimal or no drug side effects. Lower targets are no longer recommended. The reduction of BP in the elderly should be achieved gradually over one month. Co-existent cardiovascular (CV) risk factors should also be controlled. Benefits : Reduction in risk of stroke; cardiac failure; chronic kidney disease and coronary artery disease. Recommendations : Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. Lifestyle modification and patient education are cornerstones of management. The major indications; precautions and contra-indications are listed for each antihypertensive drug recommended. Drug therapy for the patient with uncomplicated HTN is either mono- or combination therapy with a low-dose diuretic; calcium channel blocker (CCB) and an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB). Combination therapy should be considered ab initio if the BP is ? 160/100 mmHg. In black patients; either a diuretic and/or a CCB is recommended initially because the response rate is better compared to an ACEI. In resistant hypertension; add an alpha-blocker; spironolactone; vasodilator or ?-blocker

The Cost of Nephroblastoma Treatment in South Africa: A Very Cost-Effective Investment with Guidelines for the Rest of Africa

Background. Nephroblastoma is one of the most common childhood malignancies in Africa; but with a survival rate significantly lower than in developed countries. In African countries with a small gross domestic product (GDP) per capita; the cost of treating nephroblastoma may be prohibitive. Objectives. To determine the direct costs of treatment of nephroblastoma in South Africa (SA) and to propose a more cost-effective approach to investigations and treatment for the disease in Africa. Methods. Data from 2000 - 2010 from two SA paediatric oncology units were retrospectively analysed. The costs included investigations; chemotherapy and radiotherapy; comparing early-v. advanced-stage disease. In both units; the nephroblastoma International Society of Paediatric Oncology (SIOP) protocol was used. Results. Stage I disease was the most common; followed by stage IV. The total cost of diagnosis; staging and treatment of stage I disease was ZAR9 304.97 (EUR882.80 or USD1 093.40); compared with a five-times higher cost for stage IV (ZAR48 293.62 (EUR4 581.9 or USD5 674.9)). Treating one patient averted more than 32 disability adjusted life years. The investigation and treatment of early- and advanced-stage disease is very cost-effective when compared with the local GDP per capita. Conclusion. The cost of investigation and treatment of nephroblastoma remains a challenge everywhere; but especially in Africa. However; it is a very cost-effective disease to treat and children in Africa should not be denied treatment

Pattern of Blood Transfusion Request and Utilization at a Nigerian University Teaching Hospital

Introduction: Provision of adequate safe blood is challenging in developing countries due to paucity of voluntary blood donors; poor facilities for storage and blood component preparation as well as inappropriate blood ordering and utilization. Appraisal of pattern of blood transfusion requests and utilization helps highlight shortcomings that could be addressed toward judicious use of blood. Aims: To determine the pattern of blood transfusion requests and utilization at a Nigerian Teaching Hospital. Materials and Methods: Blood request forms and cross-match worksheets at the blood bank of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto were analyzed over a 3-month period. Number of blood units requested; cross-matched; or transfused and the cross-match to transfusion ratio (CTR) for clinical units were computed. Results: Of the 1703 units of blood requested for 986 patients; 94.42 (1608) were cross-matched but only 34.51 (555) were transfused giving a CTR of 2.90 for the hospital. The CTR for the various clinical units were: O and G - 3.40; Surgery - 3.11; Trauma center - 2.74; Emergency - 2.61; Medicine - 2.02; and Pediatrics - 1.97. Conclusions: The overall CTR of the hospital is high indicating suboptimal transfusion practice. Introducing transfusion guidelines and type and screen with abbreviated cross-match method can help toward apt requisition and utilization of blood thereby reducing wastages

Professional portfolio development

Continuous professional development is a concept which most professionals view as a daunting task. Creating a professional portfolio enables any professional to track professional development and to document the development and achievements regarding one's career. Literature on the subject of professional portfolios mostly refers to the teaching profession. However; the basic principles remain the same and this article attempts to set a guideline for occupational health and safety professionals to create professional portfolios

Evaluation of Drug Use and Patient Care Practices in a Referral Health Facility in Yenagoa; Bayelsa State; Nigeria

Background: Evaluation of drug use and patient care practice is a very vital aspect of patient care. It also measures the quality of care provided by health practitioners for patients. Data from this study is very essential in healthcare management and planning. Objectives: To assess drug use and patient care practices at the outpatient section of a referral hospital in Yenagoa; south-south; Nigeria; using WHO drug use indictors. Methods: The study was conducted at Federal Medical Centre; Yenagoa; Bayelsa State. A total of 2450 prescriptions from the outpatient pharmacy were selected by systematic sampling and retrospectively studied. A prospective study of the patient care practices and health facility indicators; which include consultation and dispensing times; revenue time; Patient's knowledge of their medications and availability of key essential drugs; was also undertaken. Data collected was analyzed using WHO guideline for assessment of drug use in healthy facilities. Results: The average number of drugs prescribed per encounter was 3.4; Percentage of encounters with at least an antibiotic prescribed was 35.5. Injections were prescribed in 22of encounters. 62of drugs were prescribed by generic name while 87of drugs prescribed were from the essential drug list. The mean consultation and dispensing times were 11.5 and 3.5 minutes respectively. Two out of every three patients interviewed knew both the names and the duration of their medications while four out of every five knew the correct dosage of their medications. Conclusion: Many of the prescribing and patient care indicators assessed were found to be inappropriate and need to be improved upon. . There was high tendency of poly- pharmacy and over prescription of antibiotics. The patients' knowledge of vital aspects of medication management was found to be inadequate. The overall picture of drug use suggests that the indicators at this facility are not yet at the optimal level

Non-Steroidal Anti Inflammatory Drugs Usage in Orthopaedics and Trauma Practice A Guide and Review

Background: Non steroidal anti-inflammatory drugs NSAIDs) are a group of heterogeneous compounds with nti inflammatory; analgesic and often times anti pyretic roperties. They are weak organic acids and are the most commonly used drugs in Orthopaedic/Trauma practice. hey provide mild to moderate pain relief. SAID share common therapeutic and side effects irrespective of the class or group to which an individual rug may belong. These side effects are many and varied nd constitute a major concern in their usage since most f them are life threatening. Th SAIDs are also one of the most commonly abused rugs. The abuses stem mostly from poor prescription abit by the health professionals. he poor prescription habit by the professionals and aissez-a-faire attitude to NSAID Usage informed the need this review which addresses the issues; controversies and preventive strategies to reduce the complications in Orthopedics/Trauma practice. Methods: Literature on the subject was reviewed extensively using manual library internet search. Publications from local and international Journals spanning a period of over thirty years were reviewed. The internet search was done using pubmed and ortholink search engines. Results: NSAIDs act locally at the site of origin of pain by inhibiting the cyclooxygenase enzymes and induce no change in mood and dependency. The inhibition of the Cox enzymes can be reversible or irreversible and leads to inhibition of prostaglandin synthesis. All the therapeutic and most of the side effects of NSAIDs result from the inhibition of the cyclooxygenase pathway. Thus the Cox-2 selective inhibitors have lesser side effects than the non selective Cox inhibitors; though there is recent evidence linking them with adverse cardiovascular events. There is paucity of information in literature on the guidelines of the prescription/usage of NSAIDs; and the preventive strategies in orthopedics and traumatology. Conclusion: NSAIDs are the most commonly prescribed group of drugs in orthopedics and trauma practice. They constitute a great asset to any Doctor who deals with pains associated with inflammation which they relief quite effectively. NSAID Usage is froth with significant life threatening complications. A high index of suspicion of the possibility of occurrence of these complications; adherence to proper prescription guidelines and preventive strategies; change of the laissez-a-faire attitude of the professionals to NSAID prescription and appropriate monitoring of the patients on the drugs are paramount in improving their safety profiles. Orthopedic and Trauma surgeons need to be aware of the serious side effects and the role of preventive strategies in the use of NSAIDs

Revision of the National Guideline for First-Line Comprehensive Management and Control of Sexually Transmitted Infections:What's New and Why?

A revised national guideline for the management and control of sexually transmitted infections (STIs) has recently been published by the national Department of Health according to the Essential Drugs List. Since 2004; there has been a marked rise in resistance to ciprofloxacin among Neisseria gonorrhoeae isolates in several South African cities; requiring a change from quinolones to cephalosporins to treat presumptive gonorrhoea. In keeping with WHO recommendations; acyclovir has been added as part of first-line therapy for the management of genital ulceration. The national guideline has been revised accordingly in order to improve management of several key STI syndromes

Poor Knowledge on New Malaria Treatment Guidelines among Drug Dispensers in Private Pharmacies in Tanzania: the Need for Involving the Private Sector in Policy Preparations and Implementation

Objective: To assess the knowledge of dispensers in private pharmacies on new malaria treatment guidelines which involved switching from chloroquine (CQ) to sulfadoxine pyrimethamine (SP) and from SP to artemether-lumefantrine. Methods: A structured questionnaire was used for data collection and the questions focused on whether the subjects were involved in the preparation or implementation of the guidelines or had undertaken any training on how to dispense new antimalarial medicines as recommended in the introduced new treatment guidelines. Results: The study revealed that none of the participants had been involved in the preparation of the treatment guidelines; nor had they undertaken any training on their implementation. As many as 49of the visited private pharmacies were found to continue stocking and selling CQ tablets and injections. Only 30 and 7knew the correct dose regimen of SP and ALU respectively and none of them knew the condition of taking ALU with a fatty meal for improved absorption. Conclusion: Lack of involvement of the pharmaceutical personnel working in the private pharmacies; from the preparation of new malaria treatment guidelines to their implementation; contributed to their poor knowledge and skill on how to correctly dispense the medicines