Impact of computerized physician order entry system on parenteral nutrition medication errors in a teaching neonatal intensive care unit.

OBJECTIVES: Parenteral nutrition (PN) offers a quality therapeutic option when enteral feeding is non-tolerated or impossible. However, it can be associated with an increased risk of medical errors, especially in sensitive populations such as newborns. This study aimed at determining the impact of the implementation of a computerized physician order entry (CPOE) system on PN medication errors in the neonatology department in the largest teaching hospital in Tunisia. MATERIEL AND METHODS: The frequency of medication errors in PN, in a teaching neonatal intensive care unit, was prospectively reviewed by a pharmacist between December 2018 and March 2019 in a two-phase interventional study (pre and post locally developed CPOE System implementation). RESULTS: Implementation of CPOE system decreased PN order errors from 379 to 147 representing a 61.1% reduction. The decreases on PN order errors per stage, i.e. prescribing and preparation, were form 207 to 22 (89.4%), and from 117 to 66 (43.6%), respectively. Mean nutrients intakes were in conformity to the recommended daily intakes during the CPOE phase of the study. CPOE is a protective tool against prescription and preparation errors. It significantly impacted all items of the ordering process. CONCLUSIONS: In addition to the rigorous application of the recommendations, the CPOE system allows to reduce the risk of PN medication errors. This improves the safety and quality of medicines in newborns.

Potential of some autochthonous wild plants of Burundi for vegetable oil and valuable compounds production / Potencial de algumas plantas silvestres autóctones do Burundi para a produção de óleos vegetais e compostos valiosos

Abstract Twelve species of indigenous plants have been studied in order to valorize some natural resources of Burundi (Eastern Africa) to investigate possibilities of vegetable oil production. Physicochemical properties and oil contents were determined from seeds harvested through five ecogeographic zones. From oilcake extracts, total sugars contents, proteins (TPrC), polyphenolic (TPhC), and flavonoids were quantified using spectrophotometry. Furthermore, antioxidant activity of oilcake extracts was assessed by 2, 2-diphenyl-b-picrylhydrazyl (DPPH) radical-scavenging and ferric reducing antioxidant power (FRAP) assays. All oil contents obtained were found to be quite similar to those of common oleaginous seeds. The two highest were found in Parinari curatellifolia (61.44 ± 4.81% Dry Matter) and Myrianthus arboreus (48.26 ± 5.96% DM). More than half of the species have shown TPrC ranging from 10 to 24% dry matter of oilcake (DM). Brachystegia longifolia was revealed exceptionally stronger antioxidant potential: effectiveness antiradical of 163.06 ± 26.29 mL/μg.min (DPPH assay) and reducing power of 2618.21 ± 161.22 GAE/100 g DM (FRAP assay). TPhC were positively correlated (p < 0.05) to the antioxidant activity. This pioneering work on these wild species highlight the potential for producing vegetable oil and valuable biomolecule sources likely for food, cosmetics, pharmacy and industry.

Resumo Doze espécies de plantas indígenas foram estudadas para valorizar alguns recursos naturais do Burundi (África Oriental), para investigar as possibilidades de produção de óleo vegetal. As propriedades físico-químicas e o conteúdo de óleo foram determinados com base em sementes colhidas em cinco zonas ecogeográficas. A partir de extratos de bagaço de óleo, os teores de açúcares totais, proteínas (TPrC), polifenólicos (TPhC) e flavonoides foram quantificados por espectrofotometria. Além disso, a atividade antioxidante dos extratos de bagaços foi avaliada por ensaios de 2,2-difenil-b-picrilhidrazil (DPPH) e antioxidante redutor de ferro (FRAP). Todos os conteúdos de óleo obtidos foram encontrados para ser bastante semelhantes aos das sementes oleaginosas comuns. Os dois maiores foram encontrados em Parinari curatellifolia (61,44 ± 4,81% de matéria seca [MS]) e Myrianthus arboreus (48,26 ± 5,96% de MS). Mais da metade das espécies mostrou TPrC variando de 10% a 24% de MS de tortas. Brachystegia longifolia revelou um potencial antioxidante excepcionalmente mais forte: eficácia antirradical de 163,06 ± 26,29 mL/μg.min (DPPH assay) e poder redutor de 2.618,21 ± 161,22 GAE/100 g de MS (ensaio FRAP). TPhC correlacionaram-se positivamente (p < 0,05) com a atividade antioxidante. Este trabalho pioneiro sobre essas espécies selvagens destaca o potencial para a produção de óleo vegetal e fontes valiosas de biomoléculas para alimentos, cosméticos, farmácia e indústria.

Potential of some autochthonous wild plants of Burundi for vegetable oil and valuable compounds production.

Twelve species of indigenous plants have been studied in order to valorize some natural resources of Burundi (Eastern Africa) to investigate possibilities of vegetable oil production. Physicochemical properties and oil contents were determined from seeds harvested through five ecogeographic zones. From oilcake extracts, total sugars contents, proteins (TPrC), polyphenolic (TPhC), and flavonoids were quantified using spectrophotometry. Furthermore, antioxidant activity of oilcake extracts was assessed by 2, 2-diphenyl-b-picrylhydrazyl (DPPH) radical-scavenging and ferric reducing antioxidant power (FRAP) assays. All oil contents obtained were found to be quite similar to those of common oleaginous seeds. The two highest were found in Parinari curatellifolia (61.44 ± 4.81% Dry Matter) and Myrianthus arboreus (48.26 ± 5.96% DM). More than half of the species have shown TPrC ranging from 10 to 24% dry matter of oilcake (DM). Brachystegia longifolia was revealed exceptionally stronger antioxidant potential: effectiveness antiradical of 163.06 ± 26.29 mL/µg.min (DPPH assay) and reducing power of 2618.21 ± 161.22 GAE/100 g DM (FRAP assay). TPhC were positively correlated (p < 0.05) to the antioxidant activity. This pioneering work on these wild species highlight the potential for producing vegetable oil and valuable biomolecule sources likely for food, cosmetics, pharmacy and industry.

La prise en charge d´un afflux massif de brûlés en provenance d´une prison pour mineurs au Maroc.

Massive influx of burns (thermal, chemical or electrical) is a potential crisis situation in the world in peacetime. In fact, burn is one of the most frequently encountered injuries following natural or human disasters. The management of a massive influx of burn victims is considered to be a real challenge, not only from a medical point of view but also from a logistical and organizational point of view. It is an exceptional event requiring exceptional organization and planning in advance, including systematically training medical and paramedical personnel, without forgetting ambulance and fire workers as they will be the first to arrive at the scene. Planning must necessarily include equipment for fast and effective support. We will present our experience in managing a massive influx of burns from a juvenile detention centre. We share it in order to help establish a better plan to deal with these rare but challenging situations.

Impact des maladies mentales préexistantes sur l'évolution et la survie chez les brûlés : étude cas-témoins.

Psychiatric disorders in burn victims are well known and studied, but few articles treat the impact of pre-existing psychiatric pathologies on the evolution of burns. The aim of our study is to compare the evolution in terms of complications, length of stay and survival between patients with and without pre-existing mental disorders. This is a bi-centric case-control study (N = 92), conducted at the Plastic Surgery Department of Rabat University Hospital, and the Plastic Surgery Department of the Tangier-Morocco Regional Hospital, between January 2012 and February 2018. Characteristics of the patients were collected and two groups of patients were identified and compared (n = 67): a preexisting mental disorder group (n = 22) and a control group (n = 45). TBSA (total body surface area) burned and 2nd and 3rd degree burned TBSA were significantly greater in the group with a history of mental disorders compared to the control group (p = 0.012, p <0.001, p = 0.014). Mean length of stay before discharge was greater (p = 0.005). Finally, mortality in the group with pre-existing mental illness was 31.8% versus 6.7% in the control group (p = 0.011). Patients with pre-existing mental disorders seem to present worse burns and need more time to recover from them, resulting in higher morbidity and mortality and a higher cost of care. The systematic screening of burned patients in search of a psychiatric diagnosis and early management of these disorders could improve the prognosis and quality of life of these patients.

Aspects cliniques et thérapeutiques des brûlures par brasero traditionnel.

The traditional brazier remains a means of cooking and warming for thousands of families in isolated rural areas in Morocco. From simple burns due to accidental contact to limb carbonizations, these burns are all the more serious when they are secondary to epileptic seizures or carbon monoxide poisoning. The sequelae are important in the associated forms, mainly because of delay in management and non-adherence to therapeutic protocols by patients of low socioeconomic status.

Potential of some autochthonous wild plants of Burundi for vegetable oil and valuable compounds production

Abstract Twelve species of indigenous plants have been studied in order to valorize some natural resources of Burundi (Eastern Africa) to investigate possibilities of vegetable oil production. Physicochemical properties and oil contents were determined from seeds harvested through five ecogeographic zones. From oilcake extracts, total sugars contents, proteins (TPrC), polyphenolic (TPhC), and flavonoids were quantified using spectrophotometry. Furthermore, antioxidant activity of oilcake extracts was assessed by 2, 2-diphenyl-b-picrylhydrazyl (DPPH) radical-scavenging and ferric reducing antioxidant power (FRAP) assays. All oil contents obtained were found to be quite similar to those of common oleaginous seeds. The two highest were found in Parinari curatellifolia (61.44 ± 4.81% Dry Matter) and Myrianthus arboreus (48.26 ± 5.96% DM). More than half of the species have shown TPrC ranging from 10 to 24% dry matter of oilcake (DM). Brachystegia longifolia was revealed exceptionally stronger antioxidant potential: effectiveness antiradical of 163.06 ± 26.29 mL/g.min (DPPH assay) and reducing power of 2618.21 ± 161.22 GAE/100 g DM (FRAP assay). TPhC were positively correlated (p 0.05) to the antioxidant activity. This pioneering work on these wild species highlight the potential for producing vegetable oil and valuable biomolecule sources likely for food, cosmetics, pharmacy and industry.

Resumo Doze espécies de plantas indígenas foram estudadas para valorizar alguns recursos naturais do Burundi (África Oriental), para investigar as possibilidades de produção de óleo vegetal. As propriedades físico-químicas e o conteúdo de óleo foram determinados com base em sementes colhidas em cinco zonas ecogeográficas. A partir de extratos de bagaço de óleo, os teores de açúcares totais, proteínas (TPrC), polifenólicos (TPhC) e flavonoides foram quantificados por espectrofotometria. Além disso, a atividade antioxidante dos extratos de bagaços foi avaliada por ensaios de 2,2-difenil-b-picrilhidrazil (DPPH) e antioxidante redutor de ferro (FRAP). Todos os conteúdos de óleo obtidos foram encontrados para ser bastante semelhantes aos das sementes oleaginosas comuns. Os dois maiores foram encontrados em Parinari curatellifolia (61,44 ± 4,81% de matéria seca [MS]) e Myrianthus arboreus (48,26 ± 5,96% de MS). Mais da metade das espécies mostrou TPrC variando de 10% a 24% de MS de tortas. Brachystegia longifolia revelou um potencial antioxidante excepcionalmente mais forte: eficácia antirradical de 163,06 ± 26,29 mL/g.min (DPPH assay) e poder redutor de 2.618,21 ± 161,22 GAE/100 g de MS (ensaio FRAP). TPhC correlacionaram-se positivamente (p 0,05) com a atividade antioxidante. Este trabalho pioneiro sobre essas espécies selvagens destaca o potencial para a produção de óleo vegetal e fontes valiosas de biomoléculas para alimentos, cosméticos, farmácia e indústria.

[Management of eyelid carcinomas: Retrospective bicentric study of 64 cases and review of the literature]. / Prise en charge des carcinomes des paupières : étude bicentrique rétrospective sur 64 cas avec revue de littérature.

PURPOSE: To study the epidemiologic, clinical and histological aspects of eyelid carcinomas in our context, and to evaluate our surgical management on an oncological, functional and aesthetic level. PATIENTS AND METHODS: This work is a retrospective bicentric study extended over a 5-year period between January 2009 and December 2013, including 64 patients with eyelid carcinoma undergoing surgery in the Plastic and Reconstructive Surgery Department at the Avicenne University Hospital of Rabat and in the ENT/Head and Neck Surgery Department at the Hassan II University Hospital of Fez. RESULTS: The study included 25 men and 39 women with a mean age of 60.6 ± 15.33 years. Advanced age and chronic sun exposure were the most important risk factors. The most commonly involved site was the lower eyelid (53%). Histological examination emphasized the very high prevalence of basal cell carcinoma (90.62%). Surgical treatment was performed in all our patients followed by an extemporaneous and/or standard histological examination of the surgical specimen. Exenteration was performed in one patient with adjuvant radiation therapy. Reconstruction incorporated a variety of techniques, of which total skin graft and Mustardé flap were the most common in our series. Aside from a few complications, the postoperative results were satisfactory for the majority of our patients. CONCLUSION: Malignant tumors of the eyelids, of which basal cell carcinoma is the most common, pose a therapeutic problem where surgery remains the most utilized treatment option. The best treatment is prevention and diagnosis of early lesions to improve prognosis and to avoid worse outcomes.

Boltzmann equations and ab initio calculations: comparative study of cubic and wurtzite CdSe.

The electronic and optical properties of CdSe in two phases, cubic and wurtzite, have been studied by first principal calculations using the density functional theory. The optical parameters such as transmittance, optical absorption, refractive index and extinction coefficient have been investigated. We have calculated also the band structure, and total/partial density of state using the full potential-linearized augmented plane wave method with the local density approximation, generalized gradient approximation and the modified Becke-Johnson functional (mBJ), implemented in the Wien2k package. With the mBJ approximation the gap found for cubic and wurtzite structure is direct and is equal to 1.85 and 1.7 eV respectively, what corresponds to the experiment results. The optical absorption is significant in the ultraviolet field while it becomes low beyond 600 nm in the visible light for CdSe in different structures. From λ = 400 nm the transmittance is stable and reaches 80 %. With Boltztrap package, we have investigated also that with increasing temperature, the electrical conductivity increases. During the calculation, the cubic structure has presented an isotropy. While for wurtzite CdSe, the propagation of waves into system is different in xx and zz directions. These results can be exploited in several applications of CdSe in optoelectronic devices.

Giant hydronephrosis and secondary pyelonephritis induced by Salmonella dublin in a Holstein calf.

Hydronephrosis occurs as a congenital or an acquired condition following obstruction of the urinary tract. In this study, a four month old male Holstein calf with emaciation, growth retardation and a poor dry scruffy hair coat was examined because of remarkable distention of right abdomen. At necropsy, right kidney was hydronephrotic as a very big fluid-filled round pelvis with the presence of multilocular cysts bulged from the cortical surface. With sectioning, more than 10 L of bloody fluid poured out from this sac. Microscopic examination showed severe atrophy of cortical tissue and fibrosis of the medulla. Also, the dilated pelvis was composed of fibrinous exudate and necrosis of epithelium associated with multifocal aggregations of neutrophils and bacterial microcolonies. In a culture and serotyping of isolated bacteria, Salmonella dublin was determined. In conclusion, S. dublin induced pyelonephritis secondary to congenital giant hydronephrosis is the first report in cattle in the world.

[Anterolateral diaphragmatic hernia: case report]. / Hernie diaphragmatique congénitale antérolatérale : à propos d'un cas.

Congenital anterolateral diaphragmatic hernia is rare, with few cases reported in the literature. This anomaly is usually associated with left pulmonary hypoplasia. Treatment is surgical and prognosis depends on the presence and severity of associated malformations. We report a case of an intraoperative discovery of this unusual type of diaphragmatic hernia in an infant.

Pre-incisional, post-incisional and combined pre- and post-incisional local wound infiltrations with lidocaine in elective caesarean section delivery: a randomised clinical trial.

The objective of this study was to compare maternal and fetal outcomes in caesarean deliveries received pre-incisional, post-incisional or combined pre- and post-incisional local wound infiltrations with lidocaine. In a randomised, double-blind clinical trial, candidates of elective caesarean section received local wound infiltration with an anaesthetic mixture including 1% lidocaine pre-incisionally (n = 94), post-incisionally (n = 92) or both (n = 95). Postoperative pain, duration of analgesia, number of postoperative rescue analgesic demands, time to ambulation, time of first breast-feeding and neonatal Apgar score were compared. Main outcome variables were comparable between the pre- and post-incisional groups. Pain scores and duration of analgesia were significantly lower in the mixed group. Time of breast-feeding and number of analgesic demand were significantly lower in 'mixed' group than those in pre- and post-incisional groups, respectively. The other variables were comparable. Combined pre- and post-incisional local wound infiltration in post-caesarean pain relief is superior to each one alone.

[Glomus tumor of the finger pulp: an unusual pediatric case]. / Tumeur glomique pulpaire de l'enfant : à propos d'un cas inhabituel.

Glomus tumor is a rare benign tumor. Diagnosis is often delayed because of the absence of specific symptoms and confirmation can only be made by histological study. Treatment is always surgical. We report a clinical case of glomus tumor of the thumb pulp in a 6-year-old girl, and we discuss clinical, radiological and histological aspects of this tumor.

Healthcare costs of methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa infections in veterans: role of vitamin D deficiency.

Methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (P. aeruginosa) infections are frequently associated with hospitalization and increased healthcare costs. Vitamin D deficiency may contribute to increased costs for patients with these infections and there is evidence that vitamin D may have an antimicrobial role. To evaluate the role of vitamin D deficiency in the costs incurred with these infections, we studied the relationship of serum 25(OH)D levels to healthcare costs in veterans in the southeastern United States. Patients with both infections were vitamin D deficient to a similar extent and so were combined for further analysis. Vitamin D deficient patients had higher costs and service utilization than those who were not vitamin D deficient. Those with vitamin D deficiency had higher inpatient costs compared to the non-deficient group, and this difference was across most categories except for the number of inpatient hospitalizations or total number of days as an inpatient. Vitamin D deficiency was not significantly related to outpatient cost or service utilization parameters. We conclude that vitamin D deficiency is intimately linked to adverse healthcare costs in veterans with MRSA and P. aeruginosa infections. Vitamin D status should be assayed in patients with these infections.

[Occupational asthma in the Tunisian central region: etiologies and professional status]. / L'asthme professionnel dans la région du centre tunisien : étiologies et devenir professionnel.

OBJECTIVE: To study the etiologies of occupational asthma and determine its impact on the professional status of asthmatic subjects. METHODS: The authors carried out a descriptive study on all of the cases of asthma recognized as an occupational disease and declared in the private sector over nine years (2000-2008) in the Tunisian central region. RESULTS: Cases (219) of occupational asthma were listed, accounting for 16.8% of all of the occupational diseases recognized during the period studied. Occupational asthma concerned young adults (40±8.2 years), with a predominance of women (67.7%). The textile sector dominated (74.9%). The majority of the employees were exposed to high molecular weight allergens (82.3%) and cotton dust was the principal offending agent (75.3%). Involuntary unemployment was observed in about half of the cases (46.6%) and was associated with an age lower or equal to 35 years (p = 0.01) and under 15 years of professional seniority (p=0.03). CONCLUSION: Occupational asthma in the Tunisian central region prevails in the textile sector thereby justifying the reinforcement of preventive measures in this branch of industry.

[Self-closing flaps in the treatment of scalp burns due to high-voltage electricity]. / Lambeaux autofermants pour le traitement des brulures electriques du scalp par haut voltage.

Electrical burns caused by high voltage are responsible for extensive tissue damage. This damage continues in the days following the accident because of the heat deriving from the Joule effect and vascular microthrombosis. In such cases of destruction of the periostum and the calvarium we use coverage flaps. From June 1997 to June 2008, 15 patients were treated for loss of scalp substance due to high-voltage electric burns. The loss, in the tonsural region and varying in size from 9 to 11 cm, was reliably covered per primam in the first week following the accident using axial and multiple coverage flaps. We report the experience of the Division of Plastic Surgery, Ibn-Sina, Rabat, Morocco.

[Severe burns of lower limb due to association of hot water and citrullus colocynthis]. / Brulure grave du membre inferieur par l'association d'eau chaude et de citrullus colocynthis.

The case is reported of a patient suffering from severe burns through having used Citrullus colocynthis as a medicinal plant together with hot water. This led to carbonization of the foot and to its amputation. A description of the plant and its toxicity is given.

Heat transfer and fluid flow in microchannels and nanochannels at high Knudsen number using thermal lattice-Boltzmann method.

The present paper deals with the two-dimensional numerical simulation of gaseous flow and heat transfer in planar microchannel and nanochannel with different wall temperatures in transitional regime 0.1≤Kn≤1 . An atomistic molecular simulation method is used known as thermal lattice-Boltzmann method. The results of simulation are presented in four cases corresponding to the Fourier flow, shear-driven flow (Couette flow), pressure-driven flow (Poiseuille flow), and mixed shear-pressure-driven flow in the developing and fully developed regions. The mixed shear-pressure-driven flow is divided into two subcases with shear stress and pressure gradient acting in the same and the opposite directions. Normalized temperature and velocity profiles across the channel, distribution of local wall Nusselt number, and friction coefficient are illustrated. Using this method, nonlinear pressure distribution in the streamwise direction, reduction in mass flow rate, C(f) Re, and Nu by increasing the Knudsen number are studied. It is seen that for Couette flow, Nu over the hotter plate is greater than the cooler plate, but for the pressure-driven flow with stationary wall temperature dependency of viscosity and thermal conductivity causes this trend to be reversed. The reversed flow appearance in the velocity profile is captured in the case of opposite shear-pressure-driven flow.

Healthcare costs of Staphylococcus aureus and Clostridium difficile infections in veterans: role of vitamin D deficiency.

Clostridium difficile and staphylococcal infections are associated with increased morbidity, mortality and healthcare costs. Vitamin D deficiency may also contribute to increased healthcare costs. There is increasing evidence that vitamin D may have an antimicrobial role. We examined the relationship of serum 25(OH)D levels to staphylococcal and C. difficile infections to determine if vitamin D deficiency was associated with adverse outcomes. In the outpatient setting, vitamin D deficiency in patients with C. difficile and staphylococcal infections were associated with significantly increased total outpatients costs and fee-based consultation. Laboratory expenses had a trend towards higher costs in the vitamin D-deficient group but did not reach statistical significance. The differences were most clearly seen in the in-patient group with enhanced laboratory, pharmacy and radiology costs. These differences resulted in vitamin D-deficient patients with C. difficile or staphylococcal infections having costs more than five times higher than the non-deficient patients. The total length of hospital stay was four times greater in the vitamin D-deficient group. In addition, the total number of hospitalizations was also significantly greater in the vitamin D-deficient group. Surgery costs demonstrated a tendency to be higher in the vitamin D-deficient group but failed to reach statistical significance. Vitamin D deficiency is intimately linked to adverse health outcomes and costs in Veterans with staphylococcal and C. difficile infections in North East Tennessee. We recommend that vitamin D status be checked in patients with these infections and appropriate therapy be instituted to restore vitamin D level to normal in an expeditious manner.

[Expanded scalp flap in cicatricial areas affected by burns sequelae - an observation]. / Lambeau Expanse du Cuir Chevelu dans la Couverture des Alopecies Cicatricielles sur Sequelles de Brulures. A Propos d'une Observation.

Les séquelles esthétiques des alopécies cicatricielles sur séquelles de brûlures sont responsables de préjudices empêchant parfois la réinsertion sociale du patient, surtout chez les sujets de sexe féminin. Le cuir chevelu permet la réalisation de lambeaux permettant de couvrir ces alopécies. Les Auteurs décrivent le cas d'une jeune patiente victime d'une alopécie cicatricielle sur séquelles de brûlures chez qui ils ont réalisé un lambeau expansé du cuir chevelu et mettent le point sur la prise en charge de ces lésions à travers ce cas clinique et une revue de littérature.