[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

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

[Abdominal tuberculosis in children [55 cases]]

55 cases of abdominal tuberculosis were diagnosed during 10 years: tuberculous enteroperitonitis [20 cases], asitic forms [10 cases], mesenteric adenopathy [10 cases], multifocal abdominal involvement [15 ceses]. The diagnosis was based on a positive histological or bacteriological examination of abdominal or extraabdominal involvement, or on the association of their suggestive radiological aspects. The manifestations of the disease were frequent. Malnutrition and symptoms of intestinal malabsorption were common. The abdominal masses cause serious problem of differential diagnosis with abdominal lymphome in child. In most cases, one or several other tuberculous sites exist, particulary respiratory. The prognosis was good after antituberculous treatment and a nutritional management without conjuction of corticosteroides

[Mothers knowledge and practicise of the growth monitoring and children growth]

In order to sensitize mothers in promoting their children's good nutritional status by a nutritional education system, an inquiry realised during the summer of 1990 about 100 mothers of children under 5 years of age permitted the evaluation of the level of mothers knowledge and practices. It was noticed: The non agreement of the mothers impression with the reality of their children's nutritional status [30%]. The uselessness, according to mothers, of continuing the monitoring of growth chart after one year [30%], and after two years [28%]. Weight gain by weighing represented only one among many other indicators of good growth. Concerning the means of acquiring child's good growth, although the majority of mothers stated the illnesses [88,6%] and the insufficient nutrition [84,5] as the main causes of bad growth few of them mentioned vaccinations [4%] and prolonged breastfeeding [5%], no mother stated the pregnants and the nurses good nutrition, nor progressive weaning; The unrecognition of the usefulness[67%], the interest, and the way of using the growth chart. Sixty-one per cent [61%] of mothers did not weigh their children regularly. Even in the case of weighing, the mother was given neither explications nor information's concerning the nutritional status of their child professionals of health. Mothers education in growth monitoring domain is a necessity. Improvement of the communication's quality between professionals of health and mothers is an urgency

[Risk factors of diarrhoea persistent in children In Casablanca]

This retrospective study of persistent diarrhoea was performed to identify the possible risk factors of persistent diarrhoea. 103 children who developed persistent diarrhoea were compared the 252 cases with acute diarrhoea. There were no significant sex related differences in the incidence of the disease. The mean age and the season distribution were similar. The persistent diarrhoea was significantly correlated with stool bloody. Interruption breastfeeding during diarrhoea [P < 10-3]. Malnutrition [rapport weight/age < 75% NCHS Normes] was strongly associated with persistent diarrhoea [p < 1.15-6], septicemia and death were the most frequent complications of persistent diarrhoea. Prevention of malnutrition and correct measures for the prevention of acute diarrhoea could help to reduce the risk of the persistent diarrhoea

Successful treatment of multiresistant klebsiella meningitis by cefotaxime

The authors report on the successful treatment of multiresistant klebsiella pneumoniae meningitis by cefotaxime. Because of their high antibacterial activity and their adequate diffusion into the cerebrospinal fluid, the "third generation cephalosporins" are suitable for treatment of gram negative meningitis