[Adverse reactions to antibiotics: a retrospective study of three years in the regional pharmacovigilance center of Sfax]

Adverse reactions to antibiotics constitute a real public health problem. In this work, the frequency, types, predisposing factors and severity of adverse reactions to antibiotics have been analysed. Our retrospective study gathers all adverse reactions to antibiotics produced by spontaneous reporting to the regional pharmacovigilance center in Sfax in the south of Tunisia, for a period of three years. Among 249 cases of drug adverse effects, 82 [32.93%] were related to antibiotics. The age ranged from 5 to 86 years. There were 55 women and 27 men. Seventy [85.36%] adverse reactions to antibiotics among 82 were immune-allergic. In 60 cases [73.17%] patients had medical history of atopy, drug allergy, autoimmunie diseases or chronic conditions requiring poly-medication. 54 patients [65.85%] were taking 3 or more medications. Severe forms have been observed in 12 patients among 82 [14.63%]. Poly-therapy, chronic illness and advanced age are factors favouring the occurrence of adverse reactions to antibiotics. Our results have highlighted the increased risk in patients with a history of allergy to an antibiotic to develop an allergy to another antibiotic

[Acute cholestatic hepatitis induced by amoxycillin-clavulanic acid combination]

Cholestatic hepatitis associated with amoxicillin-clavulanic acid is probably underestimated. The time interval between stopping treatment and the first manifestations may hinder diagnosis. We report a case of cholestatic hepatitis induced by the association amoxicillin-calvulanic acid. A 15-year-old man without significant past medical history received a six-day-course of amoxicillin-calvulanic acid for acute bronchitis. Nine days after completing his treatment, he developed a jaunadice with fever. The biological tests showed conjugated bilirubin of 23 mg/dl without hepatic cytolysis. Extrahepatic obstruction and viral causes were excluded. The clinical symptoms resolved within ten days. The mechanism of amoxicillin-clavulanic- acid- induced hepatitis is probably immunoallergic. Clavulanic acid component of the combination is most likely the cause of hepatitis. Symptoms may appear even a few weeks after stopping the drug. So practitioners should think about this risk, if such symptoms appear even after stopping the drug

[Primary type 1 hyperoxaluria - about two particular cases]

Primary hyperoxaluria type I is an autosomal recessive disease due to congenital defect in alanine glyoxylate aminotransferase [ACT]. It is a rare disorder in witch only combined liver-kidney transplantation is curative. Our two cases of primary type I hyperoxaluria were particular by the early renal failure, thrombocytopenia and intestinal invagination. On the basis of our two cases we discuss diagnostic and therapeutic methods

Impact of diet habits on clinical and biological characteristics of type 2 diabetics originating from south and costal regions

Type 2 diabetes is a very frequent pathology in our country. The objective of this study was to compare two diabetic populations recruited in the Monastir [M] and Sfax [S] areas. The aim of our study was to evaluate the effect of the diet on the evolution of the disease. The duration of diabetes was longer in the sample from Sfax and their levels for glycated haemoglobin and triglycerides were higher: 8.51 +/- 2.8 vs 10.2 +/- 3.6% [p=0.035] and 1.7 +/- 1.1 vs 2.6 +/- 1.3 mmol/l [p=0.006] respectively for group M and S. Total cholesterol, LDL-cholesterol and Apo AI levels were significantly higher in the M. group. Total homocysteine plasmatic levels were also significantly higher in the Monastir sample compared to the one from Sfax: respectively 23.3 +/- 15.4 vs 14.8 +/- 5.92 micro mol/l [p=0.002]. The protein food intake was positively correlated to the plasmatic homocysteine level only in the M. group [r= 0.439, p<0.001]. Olive oil consumption proved to be beneficial with a lowering of both systolic and diastolic blood pressure in the 2 groups [Monastir: r= -0.113, p<0.05 and Sfax: r= -0.403, p<0.001]. An appropriate and early management following the [Mediterranean diet] is called for in type 2 diabetes

[Idiopathic thrombocytopenic purpura. Study of 61 cases]

Idiopathic thrombocytopenic purpura [ITP] represented the most frequent cause of children's thrombocytopenia. Until our days universal management of ITP does not exist. We performed retrospective and then prospective study of 61 children admitted for ITP during 15 years. The aim of the study was to precise the epidemiological, clinical and therapeutic profiles and propose management algorithm. The incidence of ITP was 0.34 per cent. The mean age was 6 years with male predominance. Initial thrombocytopenia was inferior than 10.000/mm3 in 44,2 per cent of cases. Spontaneous recovering was noted in 17 cases. Oral prednisone therapy with 2mg/kg/day during 21 to 35 days and 4mg/kg/day during 4 days was performed respectively in 21 and 19 cases. Intravenous immunoglobulin and methylprednisolone pulse therapy was performed respectively in 17 and 5 cases. Splenectomy was successfully performed in 3 cases. Chronic ITP was noted in 13 cases. Acute ITP without hemorrhagic syndrome should be treated in first stage with oral prednisone at 4mg/kg/day during 4 days. In case of failure, a second cure may be prescribed. If not we return to intravenous immunoglobulin

[Bronchiectasis in children - about 29 cases]

Bronchiectasis is defined by a permanent dilatation of the bronchi. The aim of this study was to precise the epidemiological, clinical particularities, evolution and management of bronchiectasis. It is a retrospective study of 29 children admitted in the pediatric departement of the university hospital in Monastir, for bronchiectasis withing a period of 11 years [1992-2002]. The mean age of children was 6 years and 51,7% of them were female. The clinical signs were dominated by recurring disease of the lungs, chronic cough and expectoration. The X ray radiography of the chest was abnormal in all cases [nests sign in 55,2% of cases]. The bronchiectasis was bilateral in 55,18% of cases and unilateral in 44,82% of cases. Causes were found in 65,5% of cases [congenital bronchiectasis in 20,7% of cases]. The management was firstly medical in all cases and surgical in 20,7% of cases. The outcome was favorable in 69% of cases and unfavorable in 31% of cases. Mortality rate, post surgical recurrence and aggravation of the disease were observed respectively in 10,3%, 3,4% and 17,3% of cases. The management of broncheactasisis still based on prevention. We insist on vaccination, bronchoscopy after any inhalation of foreign body and adequate treatment of respiratory infections in children

[Epilepsy in children with cerebral palsy. About 42 cases]

Epilepsy is known to have a higher association with cerebral Palsy and it's often severe. This retrospective study described 42 children with cerebral Palsy and epilepsy between 1985 and 1998 in Pediatric Department of Monastir. The mean age of patients was 6 years. The first seizure occurred during the first year of life in 47.6%. Generalized epilepsy was the predominant form [61%], followed by partial epilepsy [34.1%] and west syndrome [4.9%]. Polytherapy was required for 46.4% of patients and seizures control was achieved

[Compartive study of the effectiveness of ordinary phototherapy [OP] versus intensive phototherapy [IP] in the treatment of hyperbilirubinemia due to abo incompatibility]

Jaundice is the common clinical sign in neonatal medicine. Its causes were dominated by ABO incompatibility. The aim of the study was to compare the effectiveness of ordinary phototherapy [OP] versus intensive phototherapy [IP] in the treatment of hyperbilirubinemia due to ABO incompatibility. A total of 104 newborns infants with haemolytic hyperbilirubinemia were evaluated. Group I [G I], 52 infants treated with OP or OP and exchange transfusion and group II [G II], 52 infants treated with IP or IP and OP. Our study demonstrated that the overall percentage decline rate of unconjugated serum bilirubin was 0.31 %/h in G I and 0.7 %/h in G II. Median duration of phototherapy was shorter in G II [16h vs 47.3h]. The use of continue OP was reduced in G II [7 vs 31 cases]. Exchange transfusion was no longer used in G I. Also we found significant decrease of the mean duration of hospitalisation in G II [4.54 vs 5.15 days] This study showed that in G II of jaundiced babies treated with IP, kernicterus was totally eliminated also the need of exchange transfusion. The use of IP reduced mother-baby separation