randomized, controlled trial of nebulized 5% hypertonic saline and mixed 5% hypertonic saline with epinephrine in bronchiolitis

Bronchiolitis is a public health problem in the word and in Tunisia. Nebulized hypertonic saline seems to have some benefits in bronchiolitis. The aim of this study is to evaluate the efficacy of nebulized 5% hypertonic saline alone or mixed with epinephrine in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from February 2012 to Mars 2012. A total of 94 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive 5% nebulized hypertonic saline, mixed 5% hypertonic saline with standard epinephrine 0,1% or normal saline [placebo] at admission and every 4 hours during hospitalization. There were no significant difference between nebulized 5% hypertonic saline, mixed 5% hypertonic saline with epinephrine or normal saline at baseline, T30 min, T60 min, and T120 min after start study in Wang severity score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized 5% hypertonic saline or mixed 5% hypertonic saline with epinephrine are safety but does not appear effective in treating moderately ill infants with the first acute bronchiolitis

Les corps etrangers tracheobronchiques a propos de 107 cas

Introduction : L'inhalation du corps etranger (Ce) est un accident domestique grave survenant surtout chez le petit enfant et peut occasionner une detresse respiratoire aigue necessitant une prise en charge therapeutique urgente. Le but de notre travail est d'analyser les aspects cliniques et therapeutique des Ce tracheo-bronchiques vus en urgence. Patients et methode ; etude retrospective regroupant 107 enfants ages de moins de 15 ans; presentant une symptomatologie respiratoire aigue (= 3 jours); admis au service d'OrL; CHU Farhat Hached Sousse; pour bronchoscopie rigide devant la suspicion d'inhalation d'un Ce; entre janvier 2000 et Decembre 2011. Resultats : nous avons retrouve en moyenne 9 cas de Ce par an. L'age moyen de nos patients etait de 30 mois avec des extremes allant de 6 mois a 15 ans. Parmi ces enfants; 70 avaient un age compris entre 1 et 3 ans. Le syndrome de penetration a ete retrouve dans 77;6 des cas. Le symptome le plus frequent etait une toux dans 74;8 des cas. Deux patients ont presente un etat d'asphyxie aigue. La diminution du murmure vesiculaire a ete retrouvee dans 39;2 des cas. L'examen clinique et la radiographie pulmonaire etaient normaux dans 24;3 des cas. Un Ce radio-opaque a ete retrouve dans 5 cas. L'emphyseme obstructif unilateral a ete retrouve dans 39;2 des cas. Les grains de tournesol etaient les plus frequents; notes dans 26;2 des cas; suivis par les cacahuetes dans 15 des cas. Le Ce etait bronchique dans la majorite des cas avec une predominance du cote droit; 62;6 contre 33;7 du cote gauche. La bronchoscopie rigide a ete pratiquee pour l'extraction des Ce chez tous nos patients. Il n'y avait pas de deces dans notre serie. Conclusion : L'inhalation d'un Ce chez l'enfant est une pathologie grave qui engage le pronostic vital. Il faut l'evoquer devant meme des anomalies non specifiques et une endoscopie bronchique doit etre faite au moindre doute

[Risk factors of children overweight and obesity]

The increase of the prevalence of children obesity in some countries as Tunisia, necessitate to welling known risk factors for obesity, to prevent and early management. To determine the prevalence of overweight and of obesity in a group of 4-6 year-old school children in Monastir and to investigate the association with possible risk factors. A descriptive transversal study including 121 children aged 4-6 years old [637 males, 698 females], was conducted in 10 Kindergartens in Monastir, in 2011. Personal data such as age, sex, birth weight, breastfeeding history and parental data including parental weights and heights, parental education level and occupation were collected by questionnaires completed by parents. Height and weight were measured with a weighing-scale and body mass index [BMI; kg/m2] was calculated. The prevalence of overweight and obesity was defined based according to the curves of the french reference of Rolland Cachera. Prevalence of overweight and obesity was 9.1% and 11.6% respectively. Parental factors associated with overweight were: parental obesity: 44% vs 17% [p=0.005] [OR = 3.65: 1.27-10.57], artificial feeding: 68% vs 33% [p=0.0016] [OR= 4.25: 1.51-12.27], and the early diversification of food before the age of 6 months: 88% vs 65% [p=0.029] [OR= 3.84: 0.98 - 17.66]. Exclusive breast feeding duration >/= 6 months is probably protector factor against obesity: 0% vs 21% [p=0. 01] [OR=0: 0.00 < OR < 0.78]. We found no significant difference between overweight and non-overweight schoolchildren in frequency of high degree educated mother and father, birth weight, breakfast intake, eating habits and exercise. However overweight children intake high-caloric food, low in fiber, with troubles of nutritional comportment, and a sedentary lifestyle. Risk factors for obesity, well known in most industrialized countries, necessitate to be more understood in Tunisia, to place a preventive strategy included supervision of children weight, nutritional education and promote physical activity and reducing the time spent watching television

[Hadling the cases of school failure in an educational institute in Zaghouan]

To assess the main reasons for the school failure in a school in Zaghouan, how to handle these issues, to evaluate the work of the school social office. A retrospective study included 86 failure cases in a school in Zaghouan, handled by the school social office for three years [2004 - 2007]. He has detected the principals' causes of school failure, detected by the educational staff or by the listening office. The causes of failure are mainly social [46%] as family problems and low income. These families received financial aids and free treatment cards. Discussions have been made with the parents in order to make them more conscious. The pedagogical reasons [28%] however are usually relationship' problems between the student and his teacher or the student and the administration, the three subjects were informed so that attitudes could be changed in the purpose of helping the student. Twelve students [14%] have a psychological case, depression and over worrying, led in some cases to addiction. These cases were diagnosed and transferred to specialized clinics. Sense and chronic diseases [12%], are considered as health reasons for school failure and caused several absences in the school. The school physicist took care of these cases by handing them medical guidance cards while observing the diagnose progress. As school results, 56 cases turned satisfaisant which is 65% of all cases. The school failure became a priority of the "School Health" institute. That puss to create the school social program, his aim is protecting the students from all dangers, early school leaving and social disintegration, and delinquency. Thus, all parts must be responsible for the school failure, teachers, parents, students, psychiatrists and physicists, as well as introducing the social school work and listening offices and missions to the parents, students and teachers in order to guarantee the success of the operations

[Hold in charge of children pain in Tunisien hospital services]

Children pain has been under estimated for long time. We attend, since a few years, a particular interest for the relief of the pain children. Our study is exhaustive, about doctors practicing in tunisien hospital services. A questionnary was addressed about children pain evaluation and treatment. We have177 answers included in 48 hospital services. The aim of this study is to perform a diagnostic of the situation about knowledge, attitude and practice of these doctors concerning children pain. Children pain stay under estimated by practitioner in 51 per cent of the cases. It's never evaluated in 64,4 per cent, and 85 per centof them haven't any evaluation methods for children pain. In 67 per cent of the cases, therapy protocol is not written. The treatment with morphin is never used in 36, 4 per cent. Authors suggest a strategy based on doctors formation, editing evaluation and therapeutically protocol and creation of a comity versus pain in each service

[Smoker teenahers in colleges of Zaghouan]

The aim of this study is to evaluate the rate of smoker adolescents in Zaghouan, to seek for the smoking reasons, the used arguments, recording to them, to stop, and show their knowledge about prevention. A prospective study included 266 teenagers scolarised: 194 boys and 72 girls [aged from 12 to 16 years] from 3 colleges located in Zaghouan during 2006. A questionnaire was drawn up on these adolescents. It contains three parts: tabagic habits of smoking teenagers, the reasons of smoking and information about prevention. Twenty six percents of students are smokers, this percentage increases with the scholar level. They have parents' authorization in 18%of cases and have at least one smoker in their environment in 74%of cases. From whose who have tried tobacco, 65%became smokers. The most invoked causes are calming character of cigarettes and the pleasure to smoke. The first cigarette is smoked just for curiosity. The middle age of smoking initiation is 12 years. Twenty three percents of smoking students have tried to stop. The reasons are the dangerous character for health and the cost of tobacco. Adolescents prefer to use shocking pictures to self-sensitize [66%]. Some pupils suggest calling smoker persons who are victims of tobacco to talk about their experiences. Adolescents' smoking is a Public Health priority in Tunisia. The rate of smoking. its cost and its bad health risks encourage us to make preventions, especially the education and information for children and help adolescents to stop smoking

[Nutritional practices of young children]

This study is to evaluate the nutritional practice in a region of Zaghouan, and to show determinants of inappropriate food behaviors. A retrospective study included 160 children [aged from 3 to 5 years], from 4 kindergartens situated in the region of Zaghouan, during 2007. A questionnaire was drawn up, filled by parents or medical staff, concerning food behaviors. They are weight up and height. Sixty nine percents [69%] of children were breast fed, during 6-12 months in 50%. Diversified food is early before 3 months in 52%of children, and before 6 months in 70%. They are essentially flour in 53%. Vegetal food is introduced in a median age of 3, 5 months, fruits at the age of 4 months. An overweight was found in 12, 5%of the cases, and an obesity in 9,5%. The majority [85, 7%] was never breast fed persons, and have abnormal food habits in 91%of the cases: early diversified food rich in flour and low in essential elements. Later, the evaluation of food practice have many failures, exposing the children to obesity, related to caloric food, rich of sugar[87,5%], lipid [75%], low in fiber [37.5%] and eating in front of the television [75%]. Children food behaviors depend on parents' habits, the medical board dietetics and the composition of industrial production

[Protective effect of breast-feeding in childhood obesity]

The aim of this study is to evaluate the frequency of obesity in children scolarised in Zaghouan, and to show the protective effect of breast feeding. A retrospective study, included 162 children [aged 2 to 6 years], from 3 kindergartens situated in Zaghouan, during 2006. A questionnaire was drawn up, filled out by parents, concerning the breast feeding, the duration, the family antecedents of obesity, and the nutritional practices. Obesity is defined by a Body Mass Index [BMI] >/= 97 centile referring to curve of the centiles of BMI for the age [Rolland Cachera]. 86% of children were breast fed. 85 children [52%] were nursed by breast exclusively 6 months or over [A group]. 54 [34%] are exclusively breast-fed lower than 6 months [B group]. 23 [14%] were never breast fed [group C]. An overweight was found in 20 children [12%]. This overweight is noted respectively in 8%, 9% and 8/23 in the groups A, B and C. Our results showed that there is a statistically significant relation between the BMI and the breast feeding [P< 10 -8]. Breast feeding has probably a protective effect against obesity of the child [Odds Ratio = 0,17]. Promotion of the breast-feeding and information on its methods and its control are a public health priority, it protects the child and his mother from certain diseases and prevents from childhood obesity. OMS recommends an exclusive breast feeding until the 6 months age, and to continue if possible until the 2 years

[Cutaneous dirofilariasis: two Tunisian cases report]

Cutaneous dirofilariasis is a zoonosis which mainly occurs in dogs and cats. Human dirofilariasis is rare. At our knowledge, only five cases of human dirofilariasis were reported in Tunisia. We report here two new cases of cutaneous dirofilariasis arising in two 19 and 21 year-old patients. The first one was admitted for surgical excision of a paraombilical cutaneous nodule. The second patient presented with multiple erythematous and pruriginous papules. In both cases, the histological examination revealed the presence of a worm diagnosed as Dirofilaria repens. The evolution was favourable after surgical resection in the first case and spontaneously in the second case