[Inhaled corticosteroids and statural growth in asthmatic children]

By its anti-inflammatory effect on the bronchial mucous membrane, the use of inhaled corticoids [IC] had significantly improved medicosocial care of asthmatic patients. In paediatrics, the most important problem is about growth. The aim of this study is to evaluate the effect of prolonged IC on asthmatic's growth. This study was conducted in the Unit 2 of Casablanca Children Hospital. One hundred children followed for moderate or severe asthma and treated by high doses of IC [500 to 1500 micro/day] for a minimum of 1 year were enrolled in the study. Height of patients has been regularly monitored, in order to establish their growth velocity. Height has been measured in standard deviation [SD] and compared to the reference curves of Sempe and Pedron. Prescribed corticoid molecules were Budesonide, Fluticasone Monopropionate and Beclometasone Dipropionate. Average duration of treatment was 3.3 years [from 12 months to 9 years]. In 84% of children, the initial height varied between -1 and +1 SD. Growth velocity after one year of IC was reduced in 51% of cases. In 78 patients, growth velocity was normal. Height referred to age and gender was normal in 99% at the last checking. One case of height growth retardation [-45D] was reported in a child who had initial height at -2SD. this study shows that the impact of IC on height remains exceptional. Even if the growth velocity has been slowed down during the first year of treatment, most often it recovered afterwards without consequence on final height. These results seem in line with other studies. The benefits of IC among children far out weight the incurred risks

[Wolcott-Rallisson syndrome: diabetes mellitus and epiphyseal dysplasia]

Wolcott-Rallison syndrome [SWR] is a rare autosomal recessive disorder. This syndrome is characterized by early infancy insulin-dependent diabetes associated with spondylo-epiphyseal dysplasia, severe growth retardation and other frequent multisystemic manifestations: facial dysmorphia, hepatic and renal dysfunction, mental retardation, cardiovascular abnormalities and neutropenia. Death occurs early in the first ten years of life. The syndrome results from mutations in the gene encoding the eukaryotic translation initiation factor 2-a kinase 3 [EIF2AK3]. We report a family case of WRS in a Moroccan girl who was born from healthy consanguineous parents. Diabetes began at the age of 2 months. Later, she developed spondylo-epiphyseal dysplasia, hepatic dysfunction and she died at 3 year-old of a renal failure. A same case was identified in the siblings with similar characteristics. Through this case, we have to pay attention to the existence of neonatal diabetes which etiopathogeny is different from the child classical auto-immune type I diabetes

Does tuberculosis protect against allergy in children? A controlled study of 108 cases

The "hygiene hypothesis" suggests that early childhood infections might prevent atopic diseases later. The aim of this study is to evaluate asthma and rhino-conjunctivitis prevalence in children with confirmed tuberculosis in the early childhood. All children with confirmed tuberculosis between 1992 and 1997 were recruited from Casablanca Saada Tuberculosis Diagnosis Center register. The families completed questionnaire about anamnestic and clinical manifestations of asthma and rhino-conjunctivitis. All children with clinical evidence of atopy had skin prick-tests. A control group age-matched, sex-matched and geographically matched had the same questionnaire and the same explorations. 54 children, from 6 to 17 year-old, were enrolled and completed the questionnaire. 24 children [44%] had a familial history of atopy. Passive smoking was found in 72% of them. Twelve children had clinical symptoms of atopy, confirmed by skin prick-tests, versus 21 in control group [p=0.06]. Four of them had asthma, versus 11 in control group [p=0.005]. There was no significant difference between the two groups for rhino-conjunctivitis. This study shows that early childhood tuberculosis does not protect against atopy. But it seems that asthma occurs less frequently in case of early childhood tuberculosis. These results confirm recent experimental and epidemiological studies that suggest that mycobacterium tuberculosis decreases the risk of asthma, and need to be confirmed by largest studies in our country

rare cause of children's vascular cerebral ischemic strije: sickle cell disease

Ischemic cerebral infarctions are uncommun in childhood. Aetiologies are numerous. The etiologic diagnosis is difficult and this case further proves it. Amina, 9 years old, is admitted in Pediatrics 2 of Children's Hospital in Casablanca, for polyarthralgia evolving for one year, with right hemiplegia. Right hemiconvulsions had preceded the neurologic motor deficency. Cerebral scanner shows ischemic lesions confirming the ischemic stroke. Etiologic screening allowed elimination of systemic diseases, high blood pressure, congenital heart diseases and rythm disorders. Haemoglobin electrophoresis confirmed the homozygote sickle cell disease showing a high 84% rate of S haemoglobinemia. Split in four groups: cardiac, vascular, hematologic and metabolic diseases. But a large number stays idiopathic. The ischemic stroke is confirmed at once by cerebral scanner. Then in case of no evident aetiology, the first step involves monitoring of blood pressure and cardiac check-up, followed by hemoglobin electrophoresis. Appropriate questionning and well examination after stroke in children are very important. In our case, semiologic features of pain which were acute, none inflammatory and none mechanical, along with mongoloid facies, were suffisant to lead to the real diagnosis. The particularity of our patient is that she was not known for suffering from sickle cell disease, and it was the stroke that revealed it. It's difficult to suggest a plan for diagnosis evaluation for children who undergo an acute cerebral ischemic stroke, but a thorough questionning and examination can be helpful to make the etiologic diagnosis. However a first strategie is proposed

Reliability of ultrasonography in the diagnosis of acute intestinal intussusception in children

Ultra-sound imaging finding of the invaginated bud are described in 111 young children referred with a suspected acute intestinal intussusception [A.I.I.] during a period of 32 months. An initial group of 30 children were examined by ultrasonography and a barium enema for diagnostic and possible therapeutic purposes. The second series of 81 children had a therapeutic enema only when ultra-sound images provided a positive diagnosis. The authors consider that the overall accuracy for ultrasonography in A.I.I. was 100%, and suggest an algorithm for pratical decisions in A.I.I. in children