Bourse aiguë de l'enfant en chirurgie pédiatrique du chu Gabriel touré / Acute bursa of the child in pediatric surgery at the teaching hospital Gabriel Touré

La bourse aiguë est une urgence médico-chirurgicale de part ses nombreuses étiologies menaçant le pronostic fonctionnel des testicules et leurs annexes. Objectifs : Identifier les causes des bourses aiguës de l'enfant et décrire leurs aspects cliniques et thérapeutiques. Matériels et méthode : Il s'agissait d'une étude descriptive retroprospective allant du 1er janvier 2010 au 31 Décembre 2015 portant sur tous les enfants âgés de 0 à 15 ans reçus et traités pour bourse aiguë dans le service de Chirurgie Pédiatrique du CHU Gabriel Touré. Résultats: En 6 ans, nous avons enregistré 42 patients soit une fréquence de 1,4% des urgences chirurgicales. L'âge moyen était de 2,98 ans (24jours-14 ans). La prématurité a représenté 11,9 % des cas. La tuméfaction scrotale douloureuse était le principal motif de consultation (76,2%), Les principales étiologies étaient la HISE (90,5%), le traumatisme scrotal (4,7%), l'orchiépididymite (2,4%) et la torsion testiculaire (2,4%). Le traitement était chirurgical dans 97,6% des cas. L'évolution après 3 mois était simple dans 97,6% des cas. Conclusion: La bourse aigue de l'enfant est une pathologie peu fréquente touchant surtout les nourrissons. La hernie inguino-scrotale étranglée était la principale étiologie. Le diagnostic doit être précoce et le traitement adéquat afin de reduire la morbi-mortalité

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages. Objectives: Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects. Materials and method: This were a retrospective descriptive study from January 1, 2010, to December 31, 2015, on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré. Results: In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main a etiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases. Conclusion: Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality

The characterization of a hospitalized population at the pediatric emergency service of mother and child hospital, Marrakech, Morocco

Introduction: the pediatric emergency department is the first contact between the population and the hospital. Consequently, its dysfunction influences the quality of general health care. However, any successful policy must first be based on convincing results hence the need to better explore this service, diagnose the various dysfunctions, and survey disease trends to identify the needs of the local population. In this perspective, we propose to describe the epidemiological profile of children hospitalized at the emergency service of the Mother-Child hospital, University Hospital Centre Marrakech, and establish the prevalence table for childhood pathologies. Methods: a retrospective study was carried out in pediatric emergency services for 1658 hospitalized patients between March 2015 and December 2018. The collected data concerns mainly the socio-demographic, clinical profile, evolution status, mode of admission, and medical history. Results: the characterization of the studied population by sex and age showed a predominance of Male with a sex ratio of 1.36, infants with 625 patients. Concerning the final diagnosis, the most frequent pathologies affected the respiratory system in 28% of cases, then the digestive system (11.3%), while infectious pathologies represented 10.7% of admissions. The death rate in the emergency department was 7.4%. Multivariate analysis of the data showed a statistically significant relationship between the final diagnosis (16 diseases by a system according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and age, season, and weight. Thus, for the association between Diseases of the digestive system and weight (aOR=1.052, 95% CI= 1.019-1.086, p=0.02). While for Diseases of the skin and subcutaneous tissue and the autumn season (aOR=11.37, 95% CI= 1.272-<101.777, p=0.03) and age has a negative significance for most diseases. Conclusion: the epidemiological profile study will allow knowledge of patient´s pathologies typology for a well-supported and better definition of needs.

Drug dosing errors in simulated paediatric emergencies ­ Comprehensive dosing guides outperform length-based tapes with precalculated drug doses

Background: The accuracy of drug dosing calculations during medical emergencies in children has not been evaluated extensively. The objectives of this study were to evaluate the accuracy of drug dose calculations using the Broselow tape, the PAWPER XL tape plus its companion drug-dosing guide, a custom-designed mobile phone app and no drug-dosing aid (control group). Methods: This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used the three methods to estimate the children's weight and calculate drug doses. The accuracy of and time taken for the drug dose determinations were then evaluated for each of the methods. Results: The overall accuracy of drug dose determinations was extremely and potentially dangerously low in the control group in which no dosing guide was used as well as in the Broselow tape group (<20% of doses were correct). The accuracy was significantly higher with the PAWPER XL tape group and the mobile app group (47% and 31% respectively). The times taken to obtain the required information did not differ in a clinically meaningful magnitude. Conclusions: Both an accurate weight estimation and a dosing guide with comprehensive information were necessary to produce an accurate prescription. The information on the Broselow tape was not sufficient for this purpose. The current guidelines recommending the use of tapes with limited information should be revised. The results from the comprehensive dosing guides were substantially better, but still had a lower proportion of accurate prescriptions than desirable. The role of training in every aspect of the emergency paediatric weight estimation and drug dosing procedure cannot be underestimated and should be routine in any environment where emergency care may be needed

Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique

Introduction The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results : 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for 'green'/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for 'red'/urgent (IQR 2­40 min). Conclusion : In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings

HIV Infection among children aged two years to less than eighteen years admitted to the Emergency Pediatric Unit in a tertiary health facility in Lafia North-Central Nigeria

BACKGROUND: Human Immunodeficiency virus (HIV) is a retrovirus that impairs the immune system by attacking the body's natural defense from infections and diseases. Pediatric HIV continue to be a major public health problem despite the global decline in its seroprevalence rates. The decline in the incidence of new HIV infections is particularly lower in children with a 52% reduction in the last ten years. This is attributed to a wider coverage in the use of antiretroviral therapy (ART) and the prevention of mother to child transmission of HIV (PMTCT) programs. Several programs designed at curtailing mother to child transmission of HIV are yielding positive result. This is not unexpected since most of the HIV infections among children were acquired via maternal to child transmission. With this, the study sets out to determine the prevalence of new HIV infection among patients admitted to the Emergency Pediatrics Unit (EPU) using the provider-initiated testing and counseling approach. METHODS: A prospective cross-sectional descriptive study was conducted at the mini laboratory attached to the EPU of the Dalhatu Araf Specialist Hospital Lafia Nasarawa State between 1st August 2017 to 31st July 2018. Using non-probability sampling, categorical variables were analyzed as frequencies and percentages. The association between categorical variables were analyzed using chi square.RESULTS: A total of 964 children ranging in age from two to less than eighteen years were screened. The total number of males was 550 (57.1%) while females was 414 (42.9%) with a male to female ratio of 1.3:1. Five (0.5%) children were newly diagnosed with HIV of the 964 children tested for the infection. CONCLUSION: The incidence of HIV infection among children admitted into our Emergency Pediatric Unit was 0.5%, comparable to some earlier reports

Prevalence and outcome of hypoglycemia in children attending emergency pediatric unit of a specialist hospital in Nigeria

Background: Hypoglycemia is a common metabolic problem encountered in pediatric emergency admissions. The absence of clinical symptoms does not preclude the presence of hypoglycemia as presentation may vary from asymptomatic to central nervous system and cardiopulmonary disturbances. If untreated, hypoglycemia can result in permanent neurological damage or even death. Objectives: The objective of the study is to determine the prevalence, associated factors and outcome of hypoglycemia in pediatric emergency admissions at Ahmad Sani Yariman Bakura Specialist Hospital, Gusau, Nigeria. Materials and Methods: The study was a prospective cross­sectional study involving children aged 1 month­13 years. Blood glucose was determined at admission using Accu­Chek® Active Blood Glucose Meter, and hypoglycemia was defined as blood glucose levels <2.8 mmol/L (<50 mg/dL). Age of the patients, sex, interval of last meal, presenting complaints diagnoses were recorded. Results: A total of 154 children were studied.Thirty (19.5%) were infants and 71 (46.1%) were under­fives. Eighty­seven (56.5%) were males with male to female ratio of 1.3:1.The prevalence of hypoglycemia was 22.1%. The predominant disease conditions the children with hypoglycemia presented with were severe malaria, acute diarrheal disease, and sepsis. The prevalence of hypoglycemia was significantly higher among children whose last meal was 8 h and above before presentation (42.9%). Children who presented with hypoglycemia were significantly more likely to die (odds ratio [OR] =13.3; 95% confidence interval [CI] =4.6­38.7). Among those with hypoglycemia, males were significantly more likely to die (OR = 4.2, 95% CI = 1.0­18.0). Hypoglycemia was significantly associated with mortality in children with severe malaria and pneumonia (P = 0.04 and 0.01, respectively). Conclusion: The prevalence of hypoglycemia is still high in our emergency admissions. It is associated with significant mortality especially among male children and those presenting with severe malaria and pneumonia. We recommend that hypoglycemia sought for and promptly treated in children presenting to emergency to reduce mortality

Clinico-demographic factors associated with diarrhoeal disease outcome in under-five children: A Nigerian tertiary hospital experience

Objectives: To determine the proportion of under-5 children presenting with diarrhoeal disease, and the clinico demographic variables associated with the outcome at the emergency paediatric ward (CHER) of the Nnamdi Azikiwe University Teaching Hospital, Nnewi, South- East Nigeria.Methods: Clinical and demographic details of patients with diarrhoeal disease as obtained from the Paediatrics emergency ward log book over an 18month period were analyzed using SPSS and Microsoft excel software packages. The clinical variables (non-parametric) were tested for degree of association with mortality using Spearman's rank correlation. Chi square and Fischer exact test were used to determine presence of significant differences between certain variables. A p value <0.05 was deemed significant. Results: One thousand, one hundred and sixty three out of 1,513 children admitted within the period were aged below 5 years. Acute diarrheal disease accounted for 32% and 38% respectively of morbidity and mortality in these under-five children, with a case fatality rate of 18.3%. The mean age at presentation was 11.96 months with a male to female ratio of 1.4:1. Presentation with fast breathing (Odds Ratio {OR} 2.6), convulsion (OR 2.5), loss of consciousness (OR 4.3), increased severity of dehydration, presence of one or more comorbidities (OR 4.68) and a co-diagnosis of sepsis (OR 3.23) significantly affected the outcome. (p< 0.05 in all these). Educational status of the mothers also significantly affected the outcome. (F=9.08, p=0.023)Conclusion: Intensified effort should be made to sensitize the public about dangers of inappropriate therapy and late hospital presentation of children with diarrhoeal disease. These will reduce mortality-heralding complications

Prevalence and predictors of hypoxaemia in hospitalised children at the emergency unit of a resource constrained centre

Background: Hypoxaemia is often poorly detected and treated in emergently-ill children in resource-poor centres because of the non-availability of pulse oximeters and similar facilities to detect it. This study sets out to determine the prevalence and simple predictors of hypoxaemia among children with or without respiratory features at the emergency unit of the Wesley Guild Hospital, Ilesa, Nigeria.Methods: Children aged one month to 14 years were consecutively recruited and prospectively studied over an eight month period. All the children had their peripheral oxygen saturation (SpO2) measured at presentation using a portable pulse oximeter (Nellcor(R) N-200, USA) and hypoxaemia was defined as SpO2 < 90%. Relevant history and examination findings were compared among hypoxaemic and nonhypoxaemic children. Multivariate analysis was used to predict the presence of hypoxaemia.Results: Four hundred and two children were recruited with male to female ratio of 1.3:1 and105 (26.1) presented with respiratory features. Eighty three (20.6%) were hypoxaemic including 40 (38.1%) of those with respiratory features at admission. Infancy, chest in-drawing, cyanosis and grunting were associated with hypoxaemia (p < 0.05) among those with respiratory features, while infancy, pallor and tachycardia were significant among those with no respiratory features. Grunting (OR = 7.875; 95% CI=1.029- 15.797; p = 0.045) and Cyanosis (OR =13.579; 95% CI = 1.360- 14.379; p = 0.009) independently predict hypoxaemia among the children with respiratory features.Conclusion: Hypoxaemia occurred in approximately one out of five ill children admitted to the emergency unit of the WGH, Ilesa and was significantly associated with mortality. Emergently ill children with cyanosis and grunting especially infants should preferentially be placed on oxygen therapy even when hypoxaemia cannot be confirmed