incidence of serious adverse events in a Tunisian hospital: a retrospective medical record review study

Aim: To describe the epidemiology of serious adverse events [SAE] reported in the division of internal medicine at the Mongi Slim university hospital in Tunis, to analyze their causes and contributing factors and compare them to that reported in literature so as to establish prevention strategies when these events were deemed preventable

Methods: This retrospective study collected the medical records of randomly selected 500 index hospitalizations. Records review was conducted in two stages: a primary review that aimed to detect hospitalizations where a SAE was likely to have occurred then a secondary review which purpose was to confirm the presence of the SAE, to determine its nature and its preventability

Results: SAE were detected in 5.2% of hospitalizations with a preventability of 57.7%. These events were responsible for a prolongation in 27.0% of hospitalizations and disability in 15.4% of cases. They were the cause of admission in 42.9% of hospitalizations in which a SAE occurred. The SAE consisted in adverse drug events in 73.0% of cases, healthcare-associated infections in 19.0% of cases, non-surgical procedures in 4% of cases and pressure ulcers in 4.0% of cases. Age and number of comorbidities were identified as the main risk factors for the occurrence of SAE

Conclusion: Awareness of the extent and severity of the problem of iatrogenesis is necessary because it is a prerequisite to establishing a culture of patient safety among caregivers

[Neuroacanthocytosis: a diagnosis that should be considered]

Neuroacanthocythosis regroup heterogeneous neurodegenerative diseases. These conditions share neurological, hematological and even systemic features. In spite of the genetic progress, their pathogenesis is still unknown. To report a new case of neuroacanthocythosis. A 37-year-old woman was admitted for orofacial choreatic movement disorder. These movements were associated to dysarthria, lip and tongue mutilation, areflexia and raised plasma creatine kinase level. Examination of blood smear reveled 10% of acanthocytosis. Neuro-acanthocytosis diagnosis, precisely chorea-acanthocytosis, was done. Neuro-acanthocytosis should be considered in any movement disorder in order to attempt a genetic counseling

phenomene de Raynaud: etude multicentrique de 124 cas

The authors report 124 cases of Raynaud phenomenon observed between 1982 and 1992, dealing with 92 women and 32 men. In patients aged above 50 years, the mean etiology was artery diseases. In patients aged under 40 years, the main etiology was connective tissu disease and Raynaud's disease. The clinical characteristics of the group are compared to those reported in the litterature. These observations allowed the authors to conclude to a pratical measure in front of Raynaud phenomenon

thrormbopenies majeuers induites par l'heparine a propos de 3 observations

Heparin-induced thrombocytopenia [the main risk of which is thrombosis] remains at the present time a diagnostic challenge and a therapeutic dilemma. Based on 3 personal cases, the authors describe the clinical, biological physiopathological and therapeutic features of this thrombocytopenia. The origin, dose and mode of administration of the heparin did not appear determinant in the induction of the thrombocytopenia which is detected between the 6th and 10th day of treatment and is characterised by thromboembolic events [3 extensive venous thrombosis, 1 arterial embolism, 1 pulmonary embolism, 1 disseminated intravascular coagulation, I cutaneo-mucous purpura]. A platelet aggregant factor was found in the plasma of these patients. Major heparin-induced thrombocytopenia requires discontinuation of heparin