Tracking medication pathway as per better securing drugs' use in three clinical departments at the university hospital of monastir [Tunisia]

In Tunisia, few studies have an interest to the assessment of medication errors and the implementation of preventive measures. The aim of this study was to evaluate the barriers existing in hospital pharmacies in order to prevent medication errors and to help institutions to make improvement actions. First step: a clinical audit was conducted by observation against a set of standards that are representing a guideline. Second step: interview with health professionals to identify their perceptions about medication safety. Third step: in this step we develop adverse events scenarios according to results of the clinical audit in order to be investigated by the field practice. Fourth step: organizing a multi-professional feedback meeting to raise health professional's awareness and to make them more conscientious about adverse drug events negative consequences and invite them to contribute in the establishment and implementation of corrective solutions. In the participating departments medical prescription did not include patient information's [age, weight medical background]. Nurses do not verify systematically duration of prescription and administration route. Health professionals interview revealed that physician's have lack of awareness about prescription rules. Lack of communication was the main nurse's problem that requires improvement. This project has led to a first overview of the situation of medication use in Tunisia. Results will be used to create a dynamic process to improve the medication system safety

[Determinants of risky sex practices among consultants of a Voluntary Counseling and Testing Centre]

Thirty years after the discovery of human immunodeficiency virus [HIV], knowledge and practices must be improved. Contribute to reducing the risk of virus transmission. A study about the determinants of risky practices was conducted among the consultants of the Voluntary HIV Counseling and Testing Centre [VCTC] in Monastir University Hospital. We performed a cross sectional descriptive study with a total of 241 consultants who used the services of the VCTC during the period from January 1, 2008 to December 31, 2011. Data gathering was based on a self-administered questionnaire. Consultant's mean age was 27.4 +/- 8 years with a male predominance. Three patients out of four were single and 65% have at least secondary-level education. Knowledge about the risk of HIV infection after an unprotected sex and drug use by injection were reported by 94.3% and 76.7% of the participants respectively. Risky sex practices were adopted by 89.3% of the subjects. At least secondary school level, knowledge of risk factors of contamination and fear of the virus transmission were identified as determinants of safe sexual practices [0,004 < p < 0,032]. Improving knowledge of populations at risk for HIV is a privileged axis to lead to a reduction of infectious risk in our country

Evaluating the therapeutic care of HIV infection in Tunisia

Our aim is to determine different therapeutic response profiles in Tunisian HIV- 1 infected patients, to identify those with therapeutic failure and to compare the results of the genotypic resistance test used in Tunisia [INNO LiPA Test] with those of automatic sequencing to evaluate its efficacy. The retrospective survey concerns 392 infected patients enrolled from January 2001 to December 2006. Evaluation of HIV INNO LiPA test was performed by comparing these test results with those of automatic sequencing in 36 plasmatic samples for 13 infected patients with therapeutic failure. on the basis of the HIV viral load evolution, 57.55% of patients present a good therapeutic response and 42.44% a bad one. Patients with therapeutic failure require genotypic resistance test. A comparison of HIV INNO LiPA test and direct sequencing showed a strong concordance between the two tests results either for reverse transcriptase gene or protease gene. However, the uninterruptible results obtained by INNO LiPA test [8.79% of analysed codons] and the limited number of analysed codons were the defaults of INNO LiPA technique .the contribution of INNO LiPA technique in the knowledge of the epidemiological HIV resistance profiles of virus strains of HIV infected individuals failing therapy was considerable. However, due to INNO LiPA technique limitations, sequence analysis must be considered a more complete assay for the monitoring of antiretroviral resistance of HIV infected patients

Psoas Abscess Reviewed

Psoas abscesses are rare. In the absence of specific symptoms and signs, their diagnosis was usually difficult. Medical imaging advances have helped in their diagnosis and treatment. Eleven cases of psoas abscess were reviewed retrospectively. We tried to determine epidemiologic and clinical features and therapeutic alternatives for this entity. Mean aged 27 years. Three of the 11 cases occurred in females. An underlying disease was observed in three cases. Associated clinical features were fever [n = 11], lumbar pain [n = 10], and psoOtis [n = 5]. Diagnosis was confirmed by ultrasonography [n = 10] and computed tomography [n = 1]. Blood culture was positive in 6 out of 11 cases: Staphylococcus aureus [n = 5] and Klebsiella pneumonia [n = 1] Staphylococcus aureus was isolated in 6 abscess pus. Antibiotics were prescribed in all cases for a mean length of 61 days, in association with percutaneous drainage in 5 cases, surgical drainage in one case and abscess puncture in one case. Outcome was favourable in all cases, psoas abscess - Staphylococcus aureus - imaging n drainage

urgences infectieuses dans un service d'urgences medicales

The aim of this study is to evaluate the frequency of infectious urgencies and the quality of their management in an emergency medical service. During the period of study, 21737 consultants are recorded, from which 2011 for an infectious urgency [9.25%], pharyngitis with rhinitis excluded. 692 patients are hospitalized and 1074 receive ambulatory antibiotics. Therapeutic urgencies are the most frequent infectious urgencies [48.4%], followed by protection urgencies [46.3%], urgencies due to antibiotics [5.2%] and prevention urgencies [0.1%]. The conduct is considered correct for 1379 cases [68.5%] and incorrect for 500 cases [25%]. Main incorrect conducts are the absence of follow-up [81.6%] and the maladjusted antibiotherapy [11.8%]. These results incite, mainly, to the improvement of the professional training of emergency physicians and their communication with their colleagues of the other sanitary structures