Medical erros: talk them over for remedy

Error is human but prevention of medical errors is possible. Reduction of the iatrogenic risk to ensure the security of medical and paramedical healthcare must comply with certain regulations. Good medical practices should be developed and medical teams constant alertness to this risk and its prevention should be heightened

[Maple syrup urine disease: a study of three affected families]

Maple syrup urine disease [MSUD] is a rare inborn error of amino acid metabolism inherited as an autosomal recessive trait secondary to a deficiency of the enzyme branched chain 2 keto deshydrognase complex [BCKAD] The disease is associated with severe and catastrophic illness in the newborn period typically the infants are well at birth and after two or three days of ingestion of milk the babies begin to manifest poor feeding and spitting We report three observations of three families collected in le Centre de Maternity et de Neonatology de Tunis during 15 years The three patients are boys, their parents are relatives and one of the patients had a brother who died in the neonatal period All the patients became day one lethargic hypotonic and presented seizures two of them had perinatal asphyxia In a family the diagnostic of the disease was obtained in the second sibling affected both admitted in our unit The last patient was referred from Libya with the diagnostic of meningitis Illness resulted in death in the three patients Even MSUD is rare it is important to think to the disease in the typical form

[Positive response to inhaled milrinone of a severe neonatal pulmonary hypertension after a failure of inhaled nitric oxide]

We report a case of a new-born with a simple transposition of great arteries complicated by severe pulmonary hypertension which has responded to inhaled milrinone after a failure of inhaled nitric oxide. Mohamed born by cesarean section at 35 weeks, wheing 2650g, has presented a severe respiratory distress due to a simple transposition of great arteries complicated by pulmonary hypertension and a severe hemodynamic distress. He required artificial ventilation with an inspiratory oxygen fraction equal to 1 and vasoactive drugs. There was no response of pulmonary hypertension to inhaled nitric oxide. Inhaled milrinone at the dosage of 50 microg/kg/4h was attempted in the aim to research a selective pulmonary vasodilation. Response was immediately positive with a progressive decrease in inspiratory oxygen fraction without decrease in arterial systemic pressure. Despite, we can not be certain that this amelioration was imputed to inhaled milrinone, this case pushes to conduct animal and eventually human essays in the objective to test the relation between inhaled milrinone and selective pulmonary vasodilation

[Newborn of myasthenic mother - a report of three cases]

Neonatal myasthenia gravis is a rare neuromuscular disease. It can be congenital or transient. We report three cases of sick new-borns of myasthenie mother. Clinical manifestations vary. Two of the new-borns have severe disorders and died despite symptomatic treatment. The third one had no respiratory insufficiency. He had only hypomimia and inability to swallow, so that prognosis was better. With this observation, we will discuss some pathophysiological and clinical particularities, as well as the treatment and the prognosis of the neonatal myasthenia gravis

[Infant of diabetic mother, new epidemiology in [le centre de maternite et de neonatalogie] Tunis]

We retrospectively studied all infants of diabetic mothers [IDM] [n=326] born in the "Centre de Maternite et de Neonatologie de Tunis [CMNT]" during 2001. The purpose was to establish the epidemiological trends of IDMs and to analyze main perinatal complications. IDM group was compared for some variables to a control one of infants of non diabetic mothers [INDM]. Gestational Diabetes represented 80.2% of all diabetic mothers. Systemic hypertension associated to or preceding pregnancy was noted in 33.1% of IDMs. Delivery by caesarian section occurred in 54% of cases in the IDM group vs 29% in INDM group [p=0.0001]. Fetal macrosomia was the most frequent complication in IDM group [41.1%]. Congenital malformations were noted in 3.4% of IDM group and were more frequent if diabetes was pregestational. Other complications were frequently noted in IDM group such as prematurity [30.1%], hypertrophic cardiomyopathy [8.5%]; respiratory distress [13.1%] which was dominated by transient tachypnea. Metabolic complications where represented by hypoglycemia and hypocalcaemia [32.6% and 22.6% respectively]. Hyperbilirubinemia was observed in 8.3% and in 1.2% respectively in IDM and INDM groups. Neonatal lethality was 4% and perinatal lethality was 5.5% in IDM group. Comparing our results to the first studies carried out in the 80s in the CMNT, we noted significant decrease, in term of perinatal morbidity and mortality. This was explained by extension of screening policies associated with the multidisciplinary management of diabetic mothers and their offspring

[Harlequin's foetus]

We repport six cases of harlequin foetus. Clinical foetal appearance is typical. The evolution is signalled by foetal death. Antenatal using skin biopsy is possible after 19 weeks of amenorrhoea