[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