Evaluation of Practice of Prescription of the Corticotherapy in the Department of Internal Medicine of the University Hospital of Point G from 2009 to 2013

Introduction: It is estimated that about 0.2% to 0.5% of French populations received a long-term systemic corticosteroid therapy. In Mali, from March, 2007 to February, 2008, in National Center for Disease Control and Prevention, 19.2% of hospitalized patients (24/125) received long-term corticosteroid therapy. Until now, the department of internal medicine of the university hospital of Point G hasn’t done any research on the corticosteroid therapy specially. Therefore, we initiated this work to evaluate our practice of prescription of corticosteroid. The target of the study was to evaluate practical activity of prescription of corticosteroid of internal medicine. Methods: Based on all hospitalized patient materials of the department of internal medicine of Point G regional university central hospital during January 2009-December 2013, we initiated this retrospective and descriptive study. This study was based on all hospitalized patients receiving corticosteroid in the time of re-searching, without distinguishing their sex or age. Results: During the period of study, the department of internal medicine of point G regional central hospital had received coide was prednisone. Solid tumors represented 31.25% (20 cases) of the dis-eases treated, followed by systemic lupus erythematosus with 15.62% (10 cas-es). In addition, there are two cases of adrenals insufficiency (3.1%). In Point G internal medicine, pre-therapy evaluation and methods about corticosteroids therapy were insufficient and different.


Introduction
Corticosteroid is a derivative compounded by natural hormones, cortisol and prednisone, whose characters are a stronger anti-inflammatory power and, conversely, a lesser mineralocorticoid effect.
In Mali, during March 2007-February 2008, in the National Center for Disease Control and Prevention 19.2% of hospitalized patients (24/125) received long-term corticosteroid therapy [3].
Since 1948 when glucocorticoid was firstly applied to therapy, it has been a top-ranking method of anti-inflammation therapy. The anti-inflammation power of its derivative (corticosteroid) for therapy was stronger than cortisol [4]. In the treatment of quantities of diseases, compounded glucocorticoid had a stronger power of anti-inflammation and immunosuppression at certain pharmacological doses. But it was necessary to add compounded glucocorticoid beyond physical dosage for above effects, and there were quantities of side-effect. Consequently, the cost of therapy cannot be neglected. Glucocorticoid has many effects for water-electrolyte balance as well as the metabolization of carbohydrates, proteins, and lipid. Besides, it must be considered while prescribing that treatments using glucocorticoid depress functions of the hypothalamic-pituitary-adrenal axis or the corticotropic axis [5]. Glucocorticoid (GC) had a quantitative and qualitative influence on the immune system and could destroy cellular immunity, but exerted almost no influence on humoral immunity. At the same time, there was a harmful influence on actors with inflammatory reactions [6]. Dosage and duration of treatment had a certain influence on reactions of hypothalamus-pituitary and the infection risk of corticosteroid treatments and the individual factors which are difficult to determine at present were also pretty important. Now it is difficult to define the least therapeutic dosage or the minimum therapeutic time to avoid its side-effect [5] [6].
So it was clear that corticosteroid treatments must obey a certain number of A. K. Traoré et al. Open Journal of Internal Medicine rules to avoid accidents and incidents. It was not rare that patients receiving systemic corticosteroid treatments also received supplements of vitamins, calcium and potassium, gastric protection and biphosphonate treatments. Doctors would provide the patients with advices nutrition and health protection, such as changing into the diet of low-sodium, low-carbogydrate and rich-protein as well as increasing regular physical exercise. Among above suggestions, it was rational to prevent osteoporosis by supplements of calcium and potassium, which belonged to recommendations agreed by two sides while other medication and methods of the diet were not recommendations [1] suggested. At present, the department of internal medicine of Point G regional central hospital has not researched corticosteroid treatments specially. So what about our current practice? Therefore, we initiated this work to evaluate our practice of prescription of corticosteroid used by patients.
The target of this evaluation was to define Point G regional central hospital's frequency of prescription of corticosteroid, to define different treatment methods of using corticosteroid on the department of internal medicine and related side-effect, and to analyze assistant measures related to corticosteroid.

Methods
We made a descriptive study with a retrospective screening of our database concerning 64 hospitalized patients' in to the department of internal medicine of the Universitary Hospital of Point G in Bamako-Mali, from January 2008 to December 2013.
The inclusion of the patients have been was exhaustive, and concerned all the patients receiving corticosteroid treatment.
For all of them, we collect: -The socio-demographics data (age, sex); -The biologic data before and after corticosteroid treatment (Blood glucose, serum potassium, serum calcium, blood fat, polynuclear rate and rate of lymphocyte); -Information about treatment (duration and posology of the corticoid treatment, supplement of potassium, calcium and vitamin D, Gastric protectionpronton-pomp inhibitors); -The side-effects during corticosteroid treatment (acute adrenal insufficiency and rebound phenomenon); -The diet with low sodium (control of carbohydrate and lipid, diet with rich protein); -The regular exercise; -The evolution of the treatment; -Related data gaining and analysis was done using Epi info software.

Results
From January 2009-December 2013, the department of internal medicine of point G regional central hospital received 2155 patients totally, and 64 have been  (Table 1).
As pretreatment assessment, only 2 patients (3.12%) had carried out all of the standard balance (NFS, electrolytes, calcium, blood glucose and serum protein).
In the department of internal medicine of Point G, pre-therapy evaluation and methods about corticosteroids therapy were insufficient and not standardized (

Discussion
Because this investigation was retrospective, it was difficult to be explained or contrasted with other rare cases in this domain. Regarding international bibliographies, we have seen less than 15 studies about the general prescription of corticotherapy.
In our study, the frequency of prescription of corticosteroid was 2.9%. Petersen found that the frequency in the UK was 0.85% [2]. Fardet estimated that 0.2% to 0.5% of French populations used prescriptions of corticosteroid [1]. The difference could be caused by quantities of samples (the study of Petersen was Open Journal of Internal Medicine  [1], the incidence of nodular vasculitis and connective tissue was highest.
In this study, 81.25% of cases were suggested to have a low-salt diet, while 80% of cases were suggested so in the study of Fardet [1].
The lower carbohydrate, a diet with rich-protein or regular exercise were not asked in prescriptions in the range of this study.
In the study of Fardet, 40% of physicians wrote prescriptions of a low-sugar

Conclusion
Recently the frequency of prescriptions of corticosteroid increased year by year.
Related assistant measures and pre-treatment evaluation were largely different and insufficient. It needed cooperation with other researches and common suggestions of two sides to deal with this problem.