Report on paediatric care in the Moroccan military mission in the Gaza Strip.

This report aims to describe the epidemiologic findings of the workload associated with paediatric consultation of the Moroccan Military field hospital in the Gaza Strip. The patient Administration System and Biostatistics Activity database was reviewed and queried for all patients < 15 years of age who were consulted in the Moroccan Army hospital in the Gaza Strip between November 2012 to February 2013. Paediatric consultations during the study period were 7420 (19.9%) out of 37 227 consultations. The largest proportion of children were from 2 to 13 years old (3066 of 7420 children; 41.3%). Combined, pulmonary and gastroenterology diseases were the main causes for consultations (60.4%). Paediatric patients with threatening life injuries form part of the primary responsibility of military medical facilities during wartime. The findings may guide future military medical care planning, particularly in war zones suffering a lack of basic infrastructure, with special a need for medical supplies and drugs.

[Vomiting associated with weight stagnation and convulsions: urea cycle disorder should be suspected]. / Vomissements associés à une stagnation pondérale et convulsions: penser à une anomalie du cycle d'urée.

In some inherited metabolic diseases, in particular in urea cycle disorders, which are usually diagnosed in neonatal period or in childhood, vomiting is often the first symptom. We report a case of late revelation of urea cycle disorder in a 13 years old female patient hospitalized for convulsions and failure to thrive. The patient underwent an interview revealing chronic vomiting associated with behavioral disorders, ideomotor slowdown and headaches. Clinical examination showed ataxia. Lumbar puncture and head CT scan were normal. The patient had substantially elevated blood ammonia level at 75 micromoles/L (11-50). Chromatography of amino acids in the blood showed increased glutamine and alanine. Chromatography of amino acids in the urine showed increased basic amino acids evoking a deficit of the urea cycle due to deficit of the enzyme argininosuccinate lyase. The patient was treated as an emergency, exclusively with glycolipid-diet and sodium benzoate, allowing improvement of patient's clinical condition and weight resumption. The seizures were controlled by phenobarbital. Family interview revealed that patient's sister, aged 20 years, had a 3-year history of seizures treated with phenobarbital. She underwent metabolic assessment in our department, which showed the same urea cycle abnormality as hes sister. Urea cycle deficiency should be suspected in patients of any age with encephalopathy associated with epilepsy, vomiting, weight stagnation and hyperammonemia. The diagnosis is very often made during severe neurodigestive attack involving vomiting, attack and/or seizures.

[Double aortic arch: about two cases]. / Double arc aortique: à propos de deux cas.

Double aortic arch is a rare anomaly of the aortic arch. It is due to the absence of involution of the caudal dorsal aorta. The disease usually begins to show itself in very early clinical signs, already detectable in the neonatal period. Angiography is of great interest to its diagnosis as well as to the choice of the therapeutic approach. Only surgical treatment allows to eliminate tracheoesophageal compression. Surgical mortality rate is low thanks to the progress of postoperative resuscitation. We here report two cases of double aortic arch in order to highlight the contribution of imaging in the difficult diagnosis of this anomaly.

Grisel's syndrome: a rare complication following traditional uvulectomy.

A case is reported of an eight-month-old female patient who had traditional uvulectomy for sore throat complicated by Grisel's syndrome. She was admitted into the hospital one week after uvulectomy with Torticolis. Grisel's syndrome is a nontraumatic atlantoaxial subluxation, usually secondary of an infection or an inflammation at the head and neck area, or after surgery in the same area. Patients typically suffer from painful torticollis. Diagnosis of Grisel's syndrome is largely based on suspicion of the patient who has recently undergone surgery or has a history of an infection in head and neck area. Physical examination and imaging techniques assist in diagnosis. Thus, clinicians should be aware of acute nontraumatic torticollis if patient had a recent surgery in the head or neck area or undergone an upper respiratory tract infection. In this paper, a case of an eight-month-old female patient who had Grisel's syndrome after uvulectomy is discussed. This case is reported to highlight this neurogical threatening complication following traditional uvulectomy as well as highlighting the unnecessary morbidity and mortality associated with this persisting mode of treatment in Africa.