Development, optimization and validation of an analytical method for the determination of voriconazole in plasma by high-performance liquid chromatography-ultraviolet detection: Application for comprehensive study.

OBJECTIVES: Voriconazole is a widely used antifungal agent in clinical settings. However, its use has been associated with neurological side effects in some patients. For this reason, it is crucial to monitor its plasma levels to ensure that they are within the therapeutic range. Thus, in this study, we aimed to develop a simple, fast, and efficient method for the determination of voriconazole in plasma using reversed-phase HPLC-UV. We also aimed to validate the method for its application to routine analysis of immunocompromised patients. MATERIAL AND METHODS: Plasma samples from immunocompromised patients were subjected to deproteinization with acetonitrile followed by centrifugation. Chromatographic separation was carried out on a C18 column with UV detection at 254nm in isocratic mode. The concentrations were calculated by comparing peak areas to those of the internal standard, ketoconazole. The method was validated using the accuracy profile, which uses a calibration curve established for the therapeutic range of 1 to 5.5µg/mL. RESULTS: The developed method was proved to be rapid by giving a short analysis time for voriconazole at around 5.5min. Additionally, no interference with the biological matrix was detected. The obtained recoveries were higher than 90%. The accuracy profile showed that the method was accurate and precise for the determination of voriconazole in plasma. CONCLUSION: The developed method was proved to be simple, efficient, that requires minimal sample preparation. Thus, it can be routinely applied for the therapeutic monitoring of voriconazole.

Une chambre des erreurs comme moyen d'apprentissage dans une faculté de pharmacie.

Background: Hospitalization can expose patients to numerous adverse events associated with their care. To make health care professionals aware of these events, medication errors were simulated using the "room of errors" model. Objectives: To describe the methods of implementing a "room of errors" and to evaluate participants' performance in identifying errors. Methodology: This cross-sectional descriptive simulation study was carried out in the experimental pharmacy of a faculty of pharmacy over 2 days in December 2021 and January 2022. The study involved pharmacy interns and residents at various stages of their internships. Results: Thirty-six interns and 8 residents participated in the "room of errors" workshop. The overall correct response rate was 70.8% (n = 269/380). The error detection rate was 45.3% for pharmacy interns and 57.5% for residents, although this difference was not statistically significant. Certain hazards were identified by the majority of students (soiled compress on the treatment trolley, prescription of acetaminophen to a patient with an allergy to this drug), whereas others were rarely identified (a box containing food in the refrigerator, an empty bottle for hand sanitizer). Respondents to the satisfaction survey mainly considered this workshop to be a useful educational tool and would like to see this type of workshop integrated into their training. Conclusion: The "room of errors" seems to be an effective way of raising awareness about the risks associated with hospitalization and patient safety. This type of tool should be integrated into education and training programs.

Subcontracting sterile pediatric and adult chemotherapy preparations activity: A global risk analysis.

Objective: The main purpose of this study was to carry out a global risk analysis (GRA) on the subcontracting circuit to determine and evaluate the risks linked to the future subcontracting process and to propose corrective actions for the most critical risks to ensure safety. This study must allow to conclude in an objective way to the feasibility or not of this project. Methods: A GRA was performed, conducted by a multidisciplinary working group that met in 20 meetings, corresponding to about 50 h of work. Results: We identified 92 scenarios: 13% of scenarios had an initial criticality C1, 40% C2, and 47% C3. The GRA shows that the riskiest scenarios concern the management, material, and equipment with IT system and logistics with transport. The working group identified 25 corrective actions. After implementing those actions, 85% of scenarios had residual criticality C1, 8.5% C2, and 6.5% had residual criticality C3. The working group chose that it was impossible to subcontract part of the activity. Conclusion: The GRA conducted in this study highlighted the risks related to outsourcing this activity, evaluated and prioritized them, and recommended corrective actions. Therefore, we conclude that subcontracting the totality of sterile preparations would be harmful to patient care quality and reactivity for vital medical emergencies, such as macrophage activation syndrome, preparation of clinical trials, graft rejection therapies, preparation of very short stability chemotherapy, and the pediatric graft conditioning chemotherapy.

[Implementation of a quality management system in a central sterilization unit: experience in the Hospital Tahar Sfar, Mahdia, Tunisia]. / Mise en place d´un système de management de la qualité dans une unité de stérilisation centralisée: expérience de l´Hôpital Tahar Sfar de Mahdia en Tunisie.

In Tunisia, Hospital sterilization guidelines recommend the establishment of a quality assurance system. The purpose of this study is to give an overview of the situation in a sterilization unit in order to assess the adherence to good practice criteria and to identify opportunities for improvement. We conducted a prospective study in the sterilization unit of the Hospital Tahar Sfar, Mahdia in 2019. Two internal audits were conducted under the same conditions and were carried out one year apart. The first audit identified failures and malfunctions and the outlining of an action plan. The impact of the measures undertaken was tested using a second audit. Data collection was carried out by direct observation of the existing resources and practices. Compliance rate was calculated taking into account compliant criteria and applicable criteria. The results of the first audit revealed a compliance rate of around 28.1%. The analysis used to observe deviations made it possible to identify 5 axes of improvement, in particular the implementation of a system of documentation and a quality management system. In total, we prepared 14 documents related to the managerial processes, 26 to the operational processes and 41 to the support processes. The actions put in place enabled to achieve a compliance rate of 60.4%. The approach taken to upgrade sterilization processes made it possible to standardize them while ensuring traceability.

Les médicaments qui interfèrent avec les bilans biologiques : revue de la littérature.

BACKGROUND: Biological assessment is an integral part of the diagnostic process that guides therapeutic management decisions. However, these analyses remain subject to interference from endogenous or exogenous factors, which may alter the results. OBJECTIVE: To provide an up-to-date and comprehensive overview of the most commonly documented types of interference attributable to medications, to ensure reliable interpretation of test results and better management of patients. DATA SOURCES: This comprehensive systematic review of the literature was carried out in 2018. The bibliographic search was carried out in various online databases, specifically PubMed, ScienceDirect and Google Scholar. STUDY SELECTION: Only publications in French or English concerning medicinal products for human use were retained. The investigators' examination of drug-related interference with laboratory tests was limited to blood assays (serum or plasma). DATA EXTRACTION: An Excel spreadsheet was used to analyze the results. A total of 82 articles were selected. The interferences studied affected 47 biological parameters corresponding to various types of assessment: hormonal, hepatic, and renal. DATA SYNTHESIS: The mechanisms reported in the literature identified were analytical (56.9%), physiological (17.82%), and pharmacological (20.11%). The remainder of the mechanisms (5.17%) were not defined. CONCLUSIONS: Clinicians should be vigilant in validating and interpreting laboratory test results for patients receiving these types of drugs. Dialogue between clinicians and biological scientists is the best way to avoid unnecessary additional testing, which is often cumbersome and costly.

[Pain management in cancer patients in a Tunisian hospital]. / La gestion de la douleur chez les patients atteints du cancer dans un hôpital tunisien.

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30 % of cases but under treatment. Relief opioids were prescribed in 43 % of cases to relieve pain. Paracetamol was prescribed in 26 % of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62 % consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

Severe hypersensitivity reaction to etoposide phosphate: A case report.

Hypersensitivity to etoposide phosphate has rarely been documented. We report a case of severe hypersensitivity reaction to etoposide phosphate in an old man. The patient experienced anaphylactic shock and has been hospitalized in intensive care unit. Vigilance is required regarding potential severe reactions with etoposide phosphate formulation.