Arrêt cardio-respiratoire de l'enfant. Aspects épidémiologiques, thérapeutiques et pronostiques au Sénégal

Introduction : L'Arrêt Cardio-Respiratoire (ACR) est un évènement fréquent dans les services d'urgences et de réanimation pédiatrique. Bien que de nombreuses données soient rapportées dans plusieurs régions du monde, peu sont disponibles en Afrique subsaharienne. L'objectif de cette étude était d'évaluer les aspects épidémiologiques, thérapeutiques et le pronostic des enfants victimes d'ACR au CNHEAR.Patients et méthodes : Il s'agissait d'une étude prospective sur 1 an, concernant les enfants âgés de 0 à 15 ans, ayant présenté un ACR et bénéficié de manœuvres de réanimation au CNHEAR. Les données ont été saisies et analysées avec le logiciel Epi info 3.5.4 et SPSS 24.0. Résultats : Cent-soixante-dix-neuf (179) cas d'ACR ont été enregistrés. Les motifs de consultation les plus fréquents étaient la fièvre et la détresse respiratoire (38,5% chacun). Le délai de consultation moyen était de 3,5 jours. Quarante-neuf virgule sept pour cent (49,7%) avaient consulté dans une structure périphérique avant d'atteindre le niveau central et 13,9% étaient transportés par un transport médicalisé. Les principales circonstances ayant conduit à l'ACR étaient la détresse respiratoire (45,2%), la défaillance hémodynamique (48,7%), et les troubles métaboliques (19,6%). Les pathologies sous- jacentes étaient dominées par le sepsis 20,1%. Au plan thérapeutique, 71,5% avaient eu un massage cardiaque externe. Au décours de la réanimation initiale, le retour à une activité cardio-circulatoire spontanée était de 60,9%. L'évolution secondaire était marquée par la récidive de l'ACR chez 71,6% et finalement le décès de 85,3%. Au final, sur les 179 enfants ayant fait un ACR et bénéficié d'une réanimation, 16 (8,9%) ont survécu et ont été suivis en ambulatoire.Conclusion : La survie après ACR pédiatrique au Sénégal est faible. Des efforts importants restent à faire, notamment une amélioration des ressources matérielles ainsi que des compétences et la formation continue des praticiens en vue d'une meilleure prise en charge des enfants gravement malades

Syndrome d'activation macrophagique secondaire chez l'enfant. Rapport de 5 cas sénégalais

Le Syndrome d'Activation Macrophagique (SAM) est défini comme la traduction clinico-biologique d'une prolifération et d'une activation non-spécifique des macrophages du système réticulo-histiocytaire avec phagocytose des éléments figurés du sang. Nous rapportons 5 cas de SAM secondaires chez des enfants hospitalisés dans le service de pédiatrie de l'hôpital Aristide le Dantec entre août 2015 et avril 2016. Il s'agissait de 3 filles et 2 garçons âgés de 7 ans à 14 ans. Cliniquement, la fièvre, l'altération de l'état général et la splénomégalie étaient constantes. Quatre patients ont présenté des adénopathies et chez 2 patients une hépatomégalie a été retrouvée. Au niveau de l'hémogramme, l'anémie était constante, la thrombopénie et la leuco-neutropénie étaient retrouvées chez 3 patients et le frottis sanguin révélait 36% de blastes chez un patient. L'hémophagocytose médullaire était retrouvée chez tous les patients, l'hyper ferritinémie était constante et chez trois patients une hypertriglycéridémie avec un taux élevé de lactate déshydrogénase (LDH) ont été notés. Le diagnostic était surtout guidé par le médullogramme et basé sur les critères de l'hemophagocytic histiocytosis et les étiologies étaient infectieuses et néoplasiques. Chez trois patients, le SAM était d'origine infectieuse et les germes retrouvés étaient le Streptococcus, l'Escherichia coli et le Mycobacterium tuberculosis alors que les deux autres cas étaient d'origines néoplasiques secondaires à une leucémie aiguë myéloïde et à un lymphome hodgkinien. Le traitement était basé sur l'antibiothérapie (cas 1 et 2), les antituberculeux (cas 3) et la chimiothérapie (cas 4 et 5). L'évolution était favorable chez tous nos patients

La détresse respiratoire du nouveau-né à terme au service de néonatologie du Centre hospitalier d'enfants Albert Royer de Dakar, Sénégal

Introduction : La Détresse Respiratoire (DR) est fréquente en néonatalogie, souvent liée à des difficultés d'adaptation ou à l'infection. Objectifs : Décrire les aspects épidémiologique, clinique, thérapeutique et pronostique de la détresse respiratoire du nouveau-né à terme au service de néonatologie Centre hospitalier National d'Enfants Albert Royer de Dakar (CHNEAR).Patients et méthode : Etude rétrospective, descriptive du 1er janvier au 31 décembre 2014, concernant les nouveau-nés à terme hospitalisés pour détresse respiratoire. Résultats : Nous avons colligé 214 cas de DR, soit une fréquence de 34,8% des nouveau-nés à terme. Le sex-ratio était de 1,06 et l'âge moyen de 8,5 jours. L'accouchement était fait par césarienne dans 39 cas (18,2%) et 132 nouveau-nés (61,5%) étaient eutrophiques. Une réanimation en salle de naissance avait été nécessaire pour 86 nouveau-nés (40,2%). La DR était précoce en salle de naissance dans 75 cas (35,0%) et 107 nouveau-nés (50%) étaient admis avant 48 heures de vie. Le transfert était fait par transport en commun dans 92 cas (42,8%). La DR était sévère chez 102 nouveau-nés (47,7%). La SpO2 moyenne était de 78% sous oxygène à l'admission. Les principales étiologies étaient l'infection néonatale (118 cas ; 55,1%), l'asphyxie périnatale (53 cas ; 24,8%), l'inhalation méconiale (30 cas ; 14,0%), les cardiopathies congénitales (29 cas ; 13,5%), la bronchiolite aiguë 20 cas ; (9,3%), l'atrésie des choanes (9 cas ; 4,2%). Une ventilation artificielle était réalisée pour 45 nouveau-nés (21,0%). La létalité était de 31,8% (68 décès). Cette létalité était significativement associée à l'existence d'une détresse respiratoire en salle de naissance (p = 0,007 ; OR 2,2), d'une hypertension artérielle pulmonaire (p <0,001 ; OR 5,1), d'un pneumothorax (p < 0,001 ; OR 3,3), d'une inhalation méconiale (p = 0,006 ; OR 4,0), et d'une cardiopathie congénitale (p = 0,004 ; OR 3,7). Conclusion : Les détresses respiratoires néonatales sont fréquentes et sont associées à une létalité élevée. La prise en charge en salle de naissance, pendant le transfert et en néonatologie doit être améliorée

Intoxication collective familiale à l'oxyde de carbone à Dakar

L'intoxication au monoxyde de carbone (CO) est un accident grave et potentiellement mortel, d'origines domestique ou professionnelle. Elle est encore fréquente dans les pays en voie de développement, favorisée par l'utilisation du charbon de bois comme combustible domestique. Nous rapportons une histoire d'intoxication collective familiale dramatique, survenue dans une petite famille de cinq membres, habitant la banlieue dakaroise. Le jour de l'intoxication, toute la famille avait dormi dans la même chambre, chauffée par un fourneau avec du charbon mal consumé, portes et fenêtres fermées. La mère était la première à se réveiller au petit matin, avec des céphalées et des vomissements transitoires. Le père et la benjamine de 12 mois, qui étaient couchés en hauteur sur un lit, avaient été retrouvés décédés. La carboxyhémoglobinémie post-mortem était élevée pour les deux (23,3% pour le père et 50,8% pour la fille). Les garçons, âgés de 4 et 5 ans, qui avaient dormi par terre avec la maman, avaient survécu, mais avaient présenté une symptomatologie neurologique (troubles de la conscience, irritabilité) et digestive (vomissements, cytolyse hépatique) avec une alcalose respiratoire.Ce drame familial est une preuve que l'intoxication au CO est une réalité au Sénégal, car les risques liés à la mauvaise utilisation du charbon sont encore largement méconnus par les populations. Des campagnes de sensibilisation doivent être organisées pour prévenir ces accidents graves. Les conditions d'habitat des populations doivent aussi être améliorées

Isolation of lactobacilli and bifidobacteria species from human breast milk

Bacterial colonization of the infant gut is a gradual process that exerts a strong influence on the health status of the host. The source of bacterial diversity in breast fed babies remains unclear. For many decades, breast milk has been regarded as a sterile body fluid which exerts its influence on the infant's microbiota environment via presenting only some growth factors and optimal conditions for helping the growth of bacteria. However, in recent years, breast milk has been hypothesized to be a source of commensal bacteria for the infant gut. This study aimed at searching for bacteria in breast milk to assess the role of breast milk as their probable source. Samples of breast milk were obtained from 50 lactating women and were tested for the presence of different bacteria, using specific media and specific biochemical reactions. Culture of the 50 breast milk specimens showed growth of different species of lactobacilli in 100% of the specimens and bifidobacteria in the milk of 14 mothers [28%]. Breast milk can be a source of lactobacilli and bifidobacteria for the infants

Isolation of enterococci and streptococci species from human breast milk

Bacterial colonization of the infant gut is a gradual process that exerts a strong influence on the health status of the host. The source of bacterial diversity in breast fed babies remains unclear. For many decades, breast milk has been regarded as a sterile body fluid which exerts its influence on the infant's microbiota environment via presenting only some growth factors and optimal conditions for helping the growth of bacteria. However, in recent years, breast milk has been hypothesized to be a source of commensal bacteria for the infant gut. This study aimed at searching for bacteria in breast milk to assess the role of breast milk as their probable source. Samples of breast milk were obtained from 50 lactating women and were tested for the presence of different bacteria, using specific media and specific biochemical reactions. Culture of the 50 breast milk specimens showed growth of different species of enterococci and streptococci in 60% and 84% of the specimens; respectively. Breast milk can be a source of enterococci and streptococci for the infants

indirect immunological effect of concurrent human schistosomiasis and fascioliasis on helicobacter pylori pathogenesis

The impact of Schistosoma mansoni and Fasciola parasitic infections on H. pylori induced pathogenesis was studied in 20 patients exclusively having H. pylori infection alone. The patients were compared to 20 patients having schistosomiasis mansoni co-infected with H. pylori and to another 20 patients having fascioliasis co-infected with H. pylori. 15 patients exclusively having schistosomiasis mansoni alone and 15 patients exclusively having fascioliasis alone were also included in the study. All patients were subjected to thorough medical examination, parasitological, endoscopic and histopathological studies. The results showed that severe gastritis was significantly more common in the patients exclusively infected with H. pylori alone. Chronic atrophic gastritis and intestinal metaplasia or precancerous lesions were present in patients with exclusively H. pylori infection. We may conclude that the concomitant of parasitic diseases with H. pylori infection probably reduce the gastroduodenal pathogenesis through indirect immune response

Protein C, protein S and antithrombin III assessment in Egyptian thalassemic children

Enhanced years of survival have led to the unmasking of management related complications with the recognition of the existence of a chronic hypercoagulable state in thalassemic patients. This study aims at determining the levels of the three main antithrombophilic factors namely protein C, protein S and antithrombin III in Egyptian children with beta thalassemia major. Sixty children with beta thalassemia major with a mean age of 12.2 +/- 1.88 years and male: female ratio 1.7: 1 were enrolled in the study. They were subjected to history taking, clinical examination and laboratory investigations including levels of ferritin by IRMA, protein C, protein S, and antithromobin III by ELISA. Protein C was deficient in 16 [26.7%] of cases, protein S was deficient in 8 [13.3%] of cases while none had deficiency of antithrombin III. None of our cases had a history of thromboembolic events. These abnormalities were not related to the state of HCV infection or to the type of chelation whether oral or subcutaneous. Protein C deficiency was present more in older patients. Abnormalities in protein C, protein S are frequently observed even without manifesting hypercoagulable states in our studied thalassemia major children

Histological evaluation of local verapamil hydrochloride injection in the prevention of keloid recurrence after excision

Keloids occur as the result of an exaggerated wound healing of skin following various types of injury. In addition to presenting a cosmetic concern, they are extremely difficult to treat. The aim of the present work was to assess histologically the efficacy of verapamil hydrochloride [a calcium channel blocker] local injection on prevention of recurrence of surgically excised keloid. 40 keloid subjects divided into two equal groups: Group I; subjected to only surgical excision of their keloids. Group II; subjected to intradermal verapamil injection for 2 months after surgical excision of keloid. Skin biopsies from the healed wound of both experimental groups were taken after 3 months [subgroups Ib, IIb] and 6 months [subgroups Ib, IIb] postoperatively. Tissue specimens were also collected from the excised keloids. Informed consents were taken from subjects of both groups including all steps of the study. The obtained specimens were further processed for light microscopic study by haematoxylin and eosin [H and E] and trichrome stains. Semithin sections and electron microscopic examination were also done. Examination of the healed skin after keloid surgical excision [group Ia. Ib], showed prominent neutrophils and mast cells. Large spindle- shaped fibroblasts with dilated cisternae of endoplasmic reticulum were frequently encountered among coarse collagen bundles denoting accelerated rate of collagen production. This appearance may point to local histological recurrence of keloid. On the other hand, verapamil- injected skin after keloid excision [verapamil- injected group IIa, IIb] revealed little collagen in the dermal interstitium forming thin dispersed fibrils. Ultrastructuraly, the dermal fibroblasts of this group exhibited oval to rounded outlines and showed few narrow cisternae of endoplasmic reticulum. The verapamil- induced cell rounding is related to the calcium- dependent change in the cytoskeleton of fibroblasts. This appearance is associated with decreased synthesis and secretion of the extracellular matrix. Verapamil injection provided a satisfactory tool for prevention of recurrence of surgically excised keloid

Prevalence study of conduct disorder and comorbid attention deficit hyper active disorder

Prevalence estimated of conduct disorder, one of the most frequent diagnosed psychiatric conditions in children, vary widely from 0.2% to 8.7%. To find out the prevalence of conduct disorder and its comorbid ADHD in schoolchildren in Bahrain and Saudi. A total 180 students selected randomly were subjected to Conduct disorder scale, demographic questioners, ADHD scale and smi structure interview with the parents. Conduct disorder was found in 4.58 ; the ratio of boys to girls being 4,5:1childhood onset was found in 73% and adolescents onset in 27% mild CD was found in 36%, moderate in 64% and sever conduct disorder in none Comorbid attention deficit disorder was found in 36% hyperactive- impulsive being predominant. The prevalence of CD was 4058% more common in boys, the majority have childhood onset, and one third had comorbid ADRD

Epidemiological, clinical and prognostic profile of acute bacterial meningitis among children in Alexandria, Egypt.

PURPOSE: To address the epidemiological characteristics and clinical indices that may predict the prognostic profile of meningitis among children. METHODS: Children admitted to Alexandria fever hospital with clinical diagnosis of meningitis/meningoencephalitis during the period 2002-2003 were recruited for the study. They were subjected to clinical examination as well as CSF bacteriological and serological investigations. RESULTS: Three hundred and ten patients (195 males and 115 females) were included. About 65.2% of them were infected with acute bacterial meningitis (ABM) and 34.8% were infected with aseptic meningitis. In this study, ABM was caused by Haemophilus influenzae (21%), Streptococcus pneumoniae (13.9%), Neisseria meningitidis (14.2%) and other undetermined bacteria (16.1%). ABM showed significant association with age group 1-9 years (66.3%), low socio-economic class (96%), working mother (83.2%), more than two smokers in the family (62.9%) and cold seasons (fall 35.1% and winter 48.5%). Aseptic meningitis showed significant association with age group 3-15 months (100%) and previous immunization (81.5%). The overall case fatality rate was 10.3%; 13.9% for ABM and 3.4% for aseptic meningitis. 7.1% of all survivors developed epileptic attacks. Predictors for death or epilepsy events were high WHO meningitis score (>or=9), decreased CSF glucose level (<10 mg/dL), more smokers in the family, generalised seizures, infancy (<1 year of age) and working mothers. CONCLUSION: This study highlights the importance of several predictors of the outcome of meningitis in children. It is concluded that quick and simple scoring scales, such as the WHO scale, are not only applicable but valuable prognostic tools for meningitis in children.

Effect of nutritional regimen for moderate burn patients on graft take

Early and individually estimated nutritional care plan is considered to be an important component of therapy for burn healing and graft take. This study aimed to determine the effect of nutritional regimen for moderate burn patients on graft take. It was carried out at the Burns Units of the Main University Hospital in Alexandria. Fifty recent moderate burned patients within 12 hours post burn were included. Included patients were divided sequentially into a control [n=30] and an experimental [n=20] groups and they were uncomplicated with any condition or disease that recommends special dietary regimen. Four tools were developed and used for data collection. A nutritional assessment sheet, food intake record, graft checklist, and dietary plans were done individually for the experimental group. Weekly modifications were done as required. Calculations of caloric requirements were based on Curreri formula [25 Kcal x weight [Kg]] + [40 Kcal x% TBSA]. Adequate level of caloric intake was attained by all patients of the experimental group versus only 20% of patients of the control group. Half of the control group reached the satisfactory level, however the intake of the rest percentage [30%] was unsatisfactory. The majority of both control and experimental groups [90% and 100%] respectively reached the adequate level of fat intake. Unsatisfactory level of fat intake was recorded by only 10% of the patients of control group. Adequate level of food intake-especially calories and proteins, showed significant relationship with graft take among burned patients despite the deterioration which was noticed in the nutritional indicators as anthropometric measurements and laboratory investigations

Dysregulation of blood lymphocyte subsets and natural killer cells in schistosomal liver cirrhosis and hepatocellular carcinoma

Immunological factors are important in the pathogenesis of a wide spectrum of hepatobiliary diseases. Using flow cytometry, we determined the changes in lymphocyte subsets and natural killer cells in 123 individuals [81 patients with liver disease and 42 healthy volunteers]. The liver diseases included periportal fibrosis [PPF, 10 patients]. liver cirrhosis [LC, 31 patients], and hepatocellular carcinoma [HCC, 40 patients]. Schistosomiasis and viral hepatitis B and C were the putative etiological agents of liver diseases. Immunophenotyping by indirect immunofluorescence was conducted using monoclonal antibodies to CD3 [T-lymphocytes], CD4 [helper/inducer T-cells], CD8 [suppressor/cytotoxic T-cells] and CD 57 [natural killer cells] cell surface markers. Immunophenotyping of PPF patients showed no significant changes in all markers compared with the healthy controls. However, there was a significant decrease [P<0.01] in CD3 and CD4 T-cells, and a highly significant increase [P<0.001] in CD 57 T-cells in patients with LC or HCC. In addition, LC and HCC patients showed no significant change in CD8 T-cells compared with controls. The progression of liver diseases is associated with a dysregulation of cellular immune responses. T-lymphocytes and natural killer cells may play a role in the immunopathogenesis of LC and HCC

Defective growth hormone (GH) secretion and short-term treatment in Noonan syndrome.

Auxological and endocrine data from 12 prepubertal children (3 males, 9 females) with Noonan syndrome (NS) were compared with those of 15 children with constitutional short stature (CSS), 20 children with partial GH deficiency (GHD), and 6 children with Turner syndrome (TS). Four children with NS were treated with human growth hormone (hGH) (n = 4) (25 units/m2 week, divided on daily s.c. doses). In children with NS, the peak serum GH response to clonidine (5.4 +/- 2.7 ug/L) and glucagon (7.4 +/- 3.4 ug/L) were significantly lower than those for children with CSS (14.8 +/- 3.4 and 12.8 +/- 2.8 ug/L respectively). Nine out of the 12 (75%) children with NS did not mount normal GH peak (10 ug/L or more) after provocation. The 12-h integrated GH secretion in the 3 children with NS who had normal GH response to provocation (2.7 +/- 0.7 ug/L) was markedly lower compared to that for children with CSS (6.7 +/- 1.2 ug/L). The serum insulin-like growth factor-1 (IGF-I) concentrations were lower in children with NS (67 +/- 32 ng/ml) vs CSS (165 +/- 35 ng/ml), but not different from those for GHD children (59 +/- 33 ng/ml). In 4 children with NS, hGH therapy for a year increased height growth velocity from 4.1 +/- 0.3 cm/yr to 7.4 +/- 0.6 cm/yr and height standard deviation score (Ht SDS) from -2.2 +/- 0.6 to -1.45 +/- 0.3. This growth acceleration was accompanied by an increase in IGF-I concentration (from 52 +/- 21 ng/ml to 89 +/- 25 ng/ml). In summary, these results prove a defect of the GH secretion in children with NS and suggest that GH therapy has an important role in the management of their short stature.

Spectrophotometric and spectrofluorometric determination of prazosin

Three simple and accurate methods have been developed for the determination of prazosin in tablets.the first method is based on the formation of anion-pair salt between the drug and bromocresol purple with subse quent absorbance measurements at 410 nm.the second depends on the reaction of prazosin with mercurochrome [mer] in aqueous alkaline medium to give an antense red color measured at 562 nm.the third method is based on the fluorescence quenching of mer in an aqueos neutral buffered medium. The decrease in mer intensity was directly proportional to prazosin concentration. The different experimental parameters were carefully studied and incorporated into the procedure. Under the described condition ranges of 2-10, 5-10 and 0.05-0.2 micro gml-l for the three methods, in order

Microbiological study of eikenella corrodens isolated from patients and healthy individuals

A total of 99 strains of E. corrodens were isolated in this research. Seventy strains were isolated as flora from 392 normal individuals [17.85%] and 29 strains from 539 in pure form in 2 of the 29 clinical specimens [6.8%], otherwise It was mixed with other bacteria. Most of the isolations were from the mouth [74] but the organism was also recovered from 11 wounds, 7 abscesses and 7 samples of sputum, fluid and transtracheal aspirate. The most common form of E. corrodens infection was the clenched first injuries [33.3%] followed by human bite wounds [20%] and periodontitis [20%]. It is found that colonies of only 71.7% of our isolates were pitting the surface. A comparative growth was studied on 10 media incubated in 3 atmospheres. Chocolate and blood agar found to be the best media using 5% CO[2], Fifty strains tested for 9 biochemical reactions, gave typical results as found by other authors. MIC has been done for 20 strains by the agar dilation and microtiter broth dilution methos E. corrodens found highly susceptible to penicillin and cefoxitin but fairly resistant to clindamycin

New staining mount versus KOH mount in direct examination of clinical specimens for dermatophytes by modified phase contrast microscopy

This study is based on the use of phase contrast [PC] objective 40X aligned with the light annulus of turret condenser for 100X instead of 40X. This procedure has been resulted in an improved visualization of dermatophytic elements in skin scrapings and hair specimens in the form of 3-dimensional image. Consequently, different fungal elements and confusing artefacts could be easlly verified owing to good delineation of surface variations of such structures. Two preparations for each specimen have been examined; one as KOH mount and second with the new staining mount formulated by the author. Cultures have been done for all specimens. Seventy cases were studied; 16 hair and 54 skin scales specimens. Out of 16 hair specimens, by KOH mount, 8 cases of endothrix type of hair invasion and 4 cases of ectothrix have been observed by the modified phase contrast [MPC] microscopy compared with 9 cases of endothrix and 3 cases of ectothrix observed by the brightfield [BF] and phase contrast [PC] microscopy. After staining, 8 endothrix and 4 ectothrix cases have been noted by BF, PC and MPC. Culture results found correlated more with results of MPC and staining. Out of 54 skin specimens, after KOH mount, 53.7%found positive for dermatophytes by MPC as compared with 50% by BF and PC. After use of the staining mount, positivity was increased up to 64.8% by MPC as compared with 51.9% by BF and 53.7% by PC

Detection of interleukin 8 and auto antibodies to interleukin 8 in the serum of patients with lichen planus

An enzyme linked immunosorbant assay ELISA was used to determine the serum concentration of interleukin 8 and auto antibodies to interleukin 8 in fifteen patients with oral lichen planus only, seven patients with oral and skin lichen planus as well as ten healthy control subjects. Interleukin 8 was detectable in the serum of eleven of fifteen patients with lichen planus and five of seven patients with oral and skin lichen planus but none of the healthy controls showed detectable serum interleukin 8. Significantly, elevated auto antibodies to interleukin 8 were detected in two patients groups. However, their values did not correlate significantly with clinical condition of the disease including affected side; distribution and the duration. The results of this work may [lend] support the role of immune mechanism in the etiopathogenesis of oral lichen planus