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

Late onset systemic lupus erythematosus

Late onset systemic lupus erythematosus [SLE] after 50-year-old is rare. We report a case of 84-year-old woman presenting with systemic lupus revealed by pleural effusion associated with renal involvement. The pleural effusion, renal abnormalities and the immunological abnormality improved within 4 weeks after prednisone therapy [1 mg/kg/day]. The late onset lupus differs from those with early onset, in terms of mild clinical presentation and favourable prognosis. Our observation is exceptional due to the very late onset of the lupus and involvement of a major organ, the kidney, which is usually exceptional in this age

Erytheme noueux: Quelle enquete etiologique?

Erythema nodosum has been described in association with a number of diseases setting a problem of etiologic diagnosis. Patients and We have evaluated 96 erythema nodosum hospitalized between 1987 and 1995 in 7 medical centers with a follow up of 23 weeks. 59% of patients were less than 40 years old.92% were females. lesions were bilateral in 95% of cases. Legs were interessed in all cases and arms in 23%. Presenting most often in spring and autumn [63%]. Fever [50%], arthrlagias [68%], arthritis [18%] and biologic inflammatory syndrome have no value of etiologic orientation. Streptococcemia [n = 28], iatrogenic causes [n = 8], Behcet disease [n =7], tuberculous and non tuberculous mycobact‚rias - except leprosy - [n = 5], pregnancy [n =2], ulcerative colitis [n= 1], Takayasu disease [n = 1] and IgA nephropathy [n =1] were causes founded. In 43 cases [44%] no etiology was determined. Precise and oriented medical interview and physical examination, search of micorscopiq hematuria, chest radiograph, intradermal test for tuberculin, determination of antistreptodornases B, search of mycobacterias in sputum is adequat in majority of cases for etiologic investigations