[Short-term prognosis of heart diseases managed at the pediatric intensive care unit of the Brazzaville University Hospital]. / Pronostic immédiat des cardiopathies prises en charge dans le service des soins intensifs pédiatriques du CHU de Brazzaville.

OBJECTIVE: To determine the main heart diseases of children admitted to our pediatric intensive care unit. PATIENTS AND METHODS: This cross-sectional study was conducted in 2011 (January to December) in the pediatric intensive care of the Brazzaville University Hospital. RESULTS: The study included 42 children, 27 of them girls (64.3%). Their mean age was 2.6 ± 3.4 years, and the mean age of their mothers 26.6 ± 5.1 years. The reasons for admission were dyspnea (n = 34, 81%), fever (n = 21, 50%), edema syndrome (n = 8, 19%), squatting (n = 5, 12%), impaired consciousness (n = 4), seizures (n = 3, 7.1%), shock (n = 2, 4.8%), and malaise (n = 1, 2%). Associated signs included coughing (n = 30, 71.4%), impaired general condition (n = 14, 33.3%), cyanosis (n = 9, 21.4%), and chest deformity (n = 15, 35.7%). Heart failure was found in 28 cases (66.7%), as was congenital heart disease. The main heart diseases were ventricular septal defects (n = 13), cardiomyopathy (n = 9), and the tetralogy of Fallot (n = 6). The most common factors of decompensation were anemia (n = 12, 28.6%) and bronchopneumonia (n = 11, 26.2%). The immediate mortality rate was 23.8%. CONCLUSION: The heart diseases in children admitted in critical situations usually required surgical care, not available in our country. Rapid treatment is possible by strengthening South-South cooperation with neighboring countries where cardiac surgery is available.

[Priapism in children and adolescents with homozygous sickle cell disease in Brazzaville]. / Priapisme chez l'enfant et l'adolescent drépanocytaire homozygote à Brazzaville.

OBJECTIVE: To determine the prevalence of priapism, assess knowledge and appreciate its characteristics in childhood sickle cell disease. METHODOLOGY: A case-control study was conducted at the University Hospital of Brazzaville (Department of Pediatrics, Hematology and Clinical Urology). The cases consisted of 202 sickle cell anemia who are at least 5 years. Witnesses consisted of 112 children with sickle cell disease not of the same age from the same family as the previous. RESULTS: Priapism was found in 68 (34%) affected children, divided into 54 cases (79.4%) of chronic intermittent priapism and 14 cases (20.6%) of acute priapism. In the control group no cases were observed (p=0.001). Priapism was known by six (3%) patients in the group of children with sickle cell disease. In the control group, it was known by 25 (22.3%) children. It was seen in the group of sickle cell disease as any: 113 children (56%), a natural phenomenon that can occur in life: 57 children (28%), a complication of sickle cell disease: 26 children (13%). In the control group, it was considered a natural phenomenon that can occur in life: 60 children (53.6%), a complication of sickle cell disease: 52 children (46.4%). The average age of priapism occurred in the first episode was 10.4±9.5 years. CONCLUSION: The importance of the prevalence of priapism, and insufficient knowledge needed strengthening information, education and communication with children and their parents.

[Tooth decay in school environment at Brazzaville (Congo)]. / La carie dentaire en milieu scolaire a Brazzaville (Congo).

AIM: To determine the frequency of dental caries and habits that can be the cause of this disease in Brazzaville. METHODS: A prospective study was conducted in primary schools between February and May 2010. This study involved a sample of 307 students of both sexes, aged 4-15 years from school in the city of Brazzaville. RESULTS: Prevalence of dental caries was 53.4% and the index of DMFT 2.06. Use of toothbrush was 99.4%. Two children (0.7%) brushed their teeth three times a day. There was a statistical link between regularity of brushing and occurrence of caries. The prevalence of caries was of 53% in children who brushed once a day and 12.8% in those who brushed twice a day. No decay was noted in those who brushed three times a day (p = 0.001). The DMFT was 2.06 in children who used non-fluoridated toothpaste and 1.13 in those who used the fluoridated toothpaste (p = 0.002). CONCLUSION: To ensure students a better oral hygiene and healthier teeth, a module in oral health education in schools is one of the way to fight against this public health problem.

[Discharge of children against medical advice at CHU of Brazzaville (Congo)]. / Les sorties contre avis médical en pédiatrie au CHU de Brazzaville (Congo).

In a prospective study conducted from January to December 2010 in the Teaching Hospital of Brazzaville (Congo), we compared the discharge of hospitalized children against medical advice at the parents' request (group 1 - cases) with those admitted during same period with routine discharge (group 2 - controls). Two hundred and seven (7.7%) hospitalized children, 117 boys and 90 girls, were discharged at the parents request. The mean age was 18.0 ± 13.5 months (range: 1 month-5 years). Among these patients, 150 (72.5%) children were from biparental families, and 30.9% of children were the first and/or only child of the household. Among the parents of Congolese nationality, 147 (71%) had a secondary school level education, including 66.7% of mothers and 58% of the fathers 59.9% of children were admitted between 15 and 7 hours, and 75.4% were hospitalized during working days. The duration of hospitalization did not exceed 3 days in 147 cases (71%). The main reasons for hospitalization were digestive disorders (27%), fever (16.4%), convulsions (11.1%) and anaemia (11.1%). Among patients discharged against medical advice, 34.8% left on the first day of hospitalization (72 cases), 36.7% before the start of treatment (76 cases of which 36 during check-up) and 63.3% during treatment (131 cases). The main reasons for discharge request were improvement in the clinical condition improvement (30.9% of cases), lack of money (28% of cases), supposed insufficient medical care (7.7% of cases), unsatisfactory hospitalization conditions (6.3% of cases), care of other children at home (6.3% of cases), traditional and/or religious beliefs (5.8% of cases) and disagreements with nurses (5.3%). Patients discharge against medical advice was correlated strongly with the educational level of parents, age of the child, delay of consultation, time of admission, rank of the child in family and nationality of parents. Discharge against medical advice is associated to the distrust between the patients and nurses. Improvement of hospitalization conditions in our hospitals, improvement of the socioeconomic status of Congolese and establishment of national social security seem to be the main determinants of reduction of discharge against medical advice.

[Scarification in children hospitalized in Congo]. / Scarifications chez l'enfant hospitalisé au Congo.

OBJECTIVE: The purpose of this report is to describe the epidemiologic, prognostic and clinic features of scarification in children in Congo. MATERIAL AND METHOD: A transversal study of scarification was conducted from January 1, 2006 to December 31, 2008 in children hospitalized in neonatology and pediatrics department of Loandjili General Hospital. RESULTS: During the study period, therapeutic scarifications were observed in 130 patients including 74 (56.9%) girls. Median age was 17 months (range, 1 month to 9 years). Multiple scarifications were observed in 31.5% of cases. The main site of scarification was the hypochondrias (82.4%) followed by the flanks (14.6%) and hemithorax (13.8%). Scarification was performed for curative purposes in 114 cases (88%; p 0.001) and prophylaxis in the remaining cases. The main indications for curative scarifications were big belly in 46 cases, ponderal stagnation in 23 and recurrent bronchitis in 22. The most frequently used scarification instrument was a razor blade in 102 cases (78.5%). Risk factors included being the oldest sibling child and low socioeconomic level. In all cases, the influence of the grandparents was clear. Complications were treated in 34 cases including local infection in 26 cases, distant infection (particularly severe sepsis) in 7 cases and pulmonary-pleurostaphylococci in one case. CONCLUSION: These findings show that scarification is still common in the Congo. Because of potential complications and therapeutic inefficiency of scarification, an effort should be made to eliminate this practice.

Activites de cardiologie pediatrique a Brazzaville : bilan de 2 ans

Les auteurs ont rapporte leur experience de 62 maladies cardiovasculaires de l'enfant de 0 a 15 ans colliges en 2 ans. Les maladies cardiovasculaires ont represente 2;1 pour cent des admissions et ont ete dominees par les cardiopathies rhumastimales (27 cas); suivies des cardiopathies acquises non rhumatismales (27 cas dont pericardites purulentes); et des cardiopathies congenitales (17 cas). L'indication chirurgicale a ete posee dans 27 cas et 23 enfants ont ete deja operes. Deux enfants (3;2 pour cent) sont decedes : un opere et un sans indication chirurgicale. Les facteurs de gravite des maladies cardiovasculaires chez l'enfant ont ete ensuite discutes

Ingestions accidentelles de produits toxiques chez l'enfant : a propos de 308 cas observes au centre medico-social d'Elf Congo; Pointe-Noire

A partir de 308 cas d'intoxications colliges en 6 ans chez l'enfant de 0 a 5 ans; les auteurs ont evalue a 6;3 pour cent la frequence hospitaliere de cette pathologie. Les toxiques les plus souvent en cause etaient le petrole : 213 cas (69;2 pour cent) et les medicaments : 63 cas (20;4 pour cent). L'indigestion avait lieu au domicile familial dans 268 cas (87 pour cent) et le delai de prise en charge therapeutique etait compris entre 2 et 6 heures dans 55;8 pour cent. Les auteurs insistent sur la prevention des intoxications par l'education pour la sante