[Study [knowledge, behaviour practices] of 116 mothers on vitamin D supplementation]

In our country, the prevention of rickets is based on daily vitamin D intake from birth to eighteen months .This vitamin D intake has decreased according to our hospital practice. To assess vitamin D supplementation prevalence and to study mother knowledge, attitude and practices about vitamin D and factors that influenced them and to define target population who needs further education. A predefined questionnaire was submitted to 116 mother's child who was aged from two months to three years and were hospitalised for acute disease in Tunis children hospital. The questionnaire was filled by the paediatrician. He included as well questions on vitamin D supplementation and questions on socio- demographics characteristics. 68% of the infants had received vitamin D. The various significant factors who influenced the knowledge about vitamin D were father and mother out of work, low education level, and the living in a deserited area, The factors that influenced significantly the practices were the one parity and the living far away, up to five kilometer, from a primary health care. Given that the supplementation of vitamin D is recommended for all infants the study show that supplementation prevalence is unsatisfactorily low. Various risks factors were identified. In view of the new evidence emerging on additional preventive properties of vitamin D and the resurgence of rickets, its promotion must be discussed anew

[Value of procalcitonin measurement in materno foetal infection]

Materno foetal infection [MFI] remains one of the major causes of neonatal morbidity and mortality. Early detection of neonatal sepsis can be difficult, because the first signs of the disease may be unspecific and similar to symptoms of other non-infectious processes. We aimed to investigate the role of procalcitonin [PCT] in the diagnosis of fetal infection [MFI], and to compare it with those of the C-reactive protein [CRP]. We have conducted a prospective study during 20 months; which concerned 25 new-borns suspected of MFI and admitted before 12 hours of life. All newborn had anamnestic and / or physical signs of possible infection. MFI was confirmed in newborns with positive bacterial analysis. CRP and PCT were determined in the sera at H12, H24, H36 and H48. Newborns were divided into: patients with recognized MFI [group 1], patients with possible MFI [group 2] and non infected newborns [group 3]: The specificity of PCT was 80% versus 27% for the CRP. Negative predictive value of PCT was 85% versus 66% for the CRP. The mean values, at H12, H24, H36 and H48, of PCT for newborn who had MFI were statistically grater than those for no infused group [p <0.05]. No statistical difference was observed concerning CRP values. PCT may a useful tool in early diagnosing of MFI; it has better specificity and negative predictive value than CRP

[Thrombocytopenic idiopathic purpura: predictive factors for chronic disease]

The aim of this study is to determine factors predicting development of chronic thrombocytopenic idiopathic purpura. It was a retrospective study, regarding the cases of PTI diagnosed in "service de medicine infantile C H"pital d'Enfants de Tunis" during 11 years. Acomparison was done between two groups: the first including acute PTI and the second including chronic and recurrent PTI. Factors predicting development of chronic disease were searched by the Fisher test which was significant when p < 0, 05. 33 cases of PTI were diagnosed. The ratio sex was 1.06. The mean age was five years and a half. The disease onset was insidious in three cases; all of them have had a chronic course. An haemorrhagic personnel background was present in three cases. Counselling cause was always petechies and ecchymoses. The mean platelets rate was 14555, 5/mm3. Therapeutics abstinence was carried out in five cases. 20 infants received an initial corticotherapy. The immunoglobulins were prescribed in nine cases, witch six associated to Corticotherapy. Three modes of outcome were discerned: acute PTI [n=23], recurrent PTI [n=4] and chronic PTI [n=6]. Factors predicting development of chronic disease were: haemorrhagic personnel background, an insidious disease onset and the failure of an initial therapeutic abstinence. Acute PTI is the most common. The disease had a chronic or recurrent outcome in 1/3 of cases. The search after factors predicting chronic disease allows an early prognosis. Thus, a best management of the disease can be achieved

[Aetiologies and outcome of bronchiectasis in children: a study of 41 patients]

Bronchiectasis remains an important cause of chronic suppurative lung disease in the developing world. This study is to describe the epidemiological characteristics, clinical features, underlying aetiologies and Outcome of bronchiectasis in the paediatric hospital of Tunis. A retrospective study of 41 children with bronchiectasis was conducted between January 1994 and December 2006. Diagnosis was made in patients with clinical suspicion of bronchiectasis associated with abnormalities on chest X ray [n=37] and/or on high resolution computed tomography [HRCT] [n=36]. Mean age at diagnosis was 5 years 9 months; [range: 6 months-14 years]. Persistent cough and bronchorhea were the most common symptoms. Fourteen patients [34%] had dyspnoea on first presentation, 11 of them [26.8%] had chest deformation and/or finger clubbing. Haemoptysis was noted in only two cases. Mean time to diagnosis from symptom onset was 2.7 years [range: 2 months- 4 years]. The underlying aetiologies were identified in 52% of patients. Cystic fibrosis [17%], previous pneumonic illness [9.7%], primary ciliary dyskinesia [9.7%] and immunodeficiency [9.7%] were the most common causes. After a mean follow-up of 6.6 years, the annual lower respiratory infection rate decreased from 7.2 +/- 3 to 3.1 +/- 2.6 [p<0.05], Twenty one point nine per cent of patients had chronic respiratory failure and five patients required surgery. Delays diagnosis of bronchiectasis remains important in our country. Congenital and indeterminate aetiologies are the most common forms. Prognosis is poor with a high prevalence of chronic respiratory failure

[Cholestasis in infant: a study of the children's hospital of Tunis]

Cholestasis in infant constitutes an heterogeneous group of disease; diagnosis and management are often difficult. The Aim of the study is to describe clinical, paraclinical characteristics and outcome of infants hospitalized for cholestasis in children's Hospital of Tunis. A retrospective study of 94 infants with cholestasis was conducted. Patients were hospitalized in four departments of paediatrics of our hospital between January 1995 and December 2005. Cholestasis complicating severe sepsis and visceral leishmaniasis were excluded. Incidence of cholestasis was 8.5 cases/year which represented 0.72% of the hospitalizations. Sex ratio was 1.08 and mean age at diagnosis was 105 days [extremes: 1 day- 24 months]. Biliary atresia was the most common cause of extra hepatic cholestasis [13.8%]. Normal A GT cholestasis [11.7%], benign neonatal cholestasis [11.7%] and bile duct hypoplasia [9.5%] represented the most common aetiologies of intra hepatic cholestasis. Aetiology remained unknown in 12.7% of cases. Only three infants with biliary atresia had Kasai operation. After a mean follow-up of 6 years, 18% of patients had portal hypertension, 14.8% had hepatic failure and mortality rate was 14.8%. Cholestasis of unknown aetiologies are frequent in our hospital. Poor prognosis, in our study, is due to delay to diagnosis and difficulties in medical and surgical management

[Diagnosis of hyper transaminasemia in childhood]

Elevated serum levels of transaminases must always be considered as an abnormal finding in children. Drugs and toxins must be eliminated first as possible hepatotoxic agents or co-factors. Antiviral hepatitis A immunoglobulin M serology is the first test to perform. However, others viruses with spontaneous benign courses are the most frequent cause. Only if initial presentation is severe or if liver tests remain abnormal after several weeks, other rare diseases can be sought. Aetiologies of persistent cytolysis associated to cholestasis are different in infancy and childhood. Metabolic, auto immune, genetic, muscular, endocrine disorders and obesity may cause isolated persistent hyper transaminasemia. Early diagnosis and management is essential, Isolated elevation of serum amino transferases in healthy looking children with negative investigations is mostly a benign condition that usually resolves within a year. Liver biopsy does not contribute much to diagnosis and is probably unnecessary

[Helicobacter pylori infection in childhood revealed by hematemesis endoscopic and pathologic patterns]

Helicobacter pylon infection frequency in hematemesis was scarcely studied. To asses the frequency of this infection in children with upper gastrointestinal bleeding and to study the endoscopic and histological features. It is a retrospective study including 180 children who underwent an endoscopy for upper gastrointestinal bleeding. Our population was divided in two groups. The group 1 [n=95] has performed gastric biopsy. The group 2 [n=95] has performed gastric biopsy. For each group, we studied the personal and familial history of gastroenterologic disease, the hospital where they come from, the importance of bleeding, the gastro-agressif drugs intake, the endoscopic and histological features. The helicobacter pylon infection was present in 48%of the children. The mean age of these children was 99.8 +/- 42.1 months versus 95.7 +/- 44 months [p=0.13]. The comparison of the two groups according to Hp infection, and the others parameters don't found any differences. All the infected children have chronic gastritis 40/40 versusl3/44 in the non infected children [p>10-6]. The frequency of Hp infection was high in this group of patients with upper gastrointestinal bleeding. It was probably underestimated because the investigation was not complete. We emphasize that Hp infection has to be investigated and systematically eradicated whenever there were severe symptoms like hematemesis indicating therefore organic disease