Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study.

BACKGROUND: It is not yet known how antibiotics may affect Serious Bacterial Infections (SBI). Our aim is to describe the presentation, management, and serious bacterial infections (SBI) of febrile children on or off antibiotics. METHODS: Retrospective, cohort study of febrile Emergency Department patients, 0-36 months of age, at a single institution, between 2009and 2012. RESULTS: Seven hundred fifty-three patients were included: 584 in the No-Antibiotics group and 169 (22%) in the Antibiotics group. Age and abnormal lung sounds were predictors for being on antibiotics (OR 2.00 [95% CI 1.23-3.25] and OR 1.04 [95% CI 1.02-1.06] respectively) while female gender, and lower temperatures were negative predictors (OR 0.68 [95%0.47-0.98] and OR 0.47 [95% CI 0.32-0.67] respectively). Antibiotics were prescribed by a physician 89% of the time; the most common one being Amoxicillin/Clavulanic Acid (39%). The antibiotic group got more blood tests (57% vs 45%) and Chest X-Rays (37% vs 25%). Overall, the percent of SBIs (and pneumonias) was statistically the same in both groups (6.5% in the No-antibiotic group VS 3.6%). CONCLUSIONS: Children presenting on antibiotics and off antibiotics were significantly different in their presentation and management, although the overall percentages of SBI were similar in each group. Further investigations into this subgroup of febrile children are needed.

[Venous thromboembolism: What other risk factors in a North African population? A study of 276 cases]. / La maladie veineuse thromboembolique : quels autres facteurs de risque dans une population nord-africaine ? Une étude de 276 cas.

INTRODUCTION: Venous thromboembolism is a multicausal disease. Understanding interactions between risk factors is the key to advance knowledge about the etiology of venous thrombosis. These interactions are still unclear. In addition to traditional risk factors, there is data about many other risk factors, recorded with few populations based prospective epidemiologic studies or punctually reported. Interactions between these risk factors remain unclear. The aim of our work is to identify and analyze combinations of risk factors. METHODS: This is a retrospective, single-center study, which investigates the etiology of venous thromboembolism, on the records of patients hospitalized in internal medicine for venous thrombosis, over a period of 12 years. RESULTS: We selected 276 cases. The average age was 51 years. At least, we found one traditional risk factors in 87 % of cases, 34 patients had no traditional risk factors. Suspected risk factors were found in 81 % of cases and there was at least one punctually reported factor in 34 % of cases. The combination of risk factors mostly found was association of traditional and suspected risk factors. In more than 50 % of patients, we noted at least, more than one traditional or one suspected risk factors. Among 18 patients presenting only suspected risk factors, there was at least combination of 3 risk factors per patient. CONCLUSION: The role of suspected risk factors in the occurrence of venous thrombosis was not negligible in this work. Our data suggest a hypothesis that it's through their association that suspected risk factors might be able becoming comparable to traditional risk factors.

La radiothérapie postopératoire du cancer du larynx: Étude clinique et résultats thérapeutiques à propos de 164 cas

But:Étudier les caractéristiques épidémiologiques, cliniques et anatomopathologiques, ainsi que les résultats thérapeutiques des cancers laryngés traités par radiothérapie postopératoire.Méthodes: Une étude rétrospective a été menée entre Janvier 1995 et Décembre 2010 colligeant 164 patients atteints d'un cancer laryngé traités à Sousse (Tunisie).Résultats :L'âge médian était de 60 ans. La prédominance masculine était marquée avec un sex- ratio de 26,4. Il s'agissait d'un carcinome épidermoïde dans 98,2%. Tous les patients ont eu une laryngectomie totale ou partielle associée à un curage cervical uni ou bilatéral. Tous les patients ont eu une radiothérapie postopératoire. La dose totale délivrée variait de 50 à 74 Gy avec une fraction de 1,8- 2 Gy/ séance. Avec un recul moyen de 55 mois, 49,4 % des patients étaient en vie en situation de rémission complète. Les probabilités de survie globale à trois, cinq et dix ans étaient respectivement de 77 % et 73 %, 69%. Les facteurs pronostiques de survie globale et de survies sans récidive locorégionale retenus, en analyse uni-variée, étaient : La radicalité du curage ganglionnaire, l'atteinte ganglionnaire histologique et l'effraction capsulaire.Conclusion :Le cancer du larynx est un cancer fréquent occupant la première place des cancers des voies aéro-digestives chez l'homme en Tunisie. Notre étude présume que l'absence d'atteinte ganglionnaire, la sélectivité de l'évidement ganglionnaire et l'absence d'effraction capsulaire sont des facteurs pronostic favorables de survie globale et de contrôle local

[Temporary tatooing: black henna or harkous?]. / Tatouage éphémère: henné noir ou harkous?

Contact sensitization to natural henna (Lawsonia inermis) long used as a skin dye in powder or paste form has rarely, if ever, been observed. Recently a number of anaphylactoid reactions to PPD contained in paints used for temporary tattoos have been described. The purpose of this article is to present 8 cases involving 4 children and 4 adults who developed contact dermatitis after temporary tattoo using "harkous" that contains no henna. The authors review the literature about temporary tattooing. "Harkous" is a mixture of nut gall and clove to which PPD is sometimes added. Many reports have described cases of contact dermatitis due to "black henna". Most of these cases have involved tourists returning from trips.

Gastric atrophy and Helicobacter pylori infection in children.

AIM: To assess the prevalence of gastric atrophy (GA) in Tunisia (a high prevalence region for Helicobacter pylori), and describe its histological, clinical and endoscopic features in children. METHODS: 345 children, 151 male and 194 female, mean age 8.6 +/- 3.7 years, underwent upper gastrointestinal (UGI) endoscopy with gastric biopsies for recurrent abdominal pain (n=232, 67.2%), vomiting (n=72, 20%) associated with or without upper gastrointestinal bleeding (n=59, 17.1%) and miscellaneous causes (n=53, 15.4 %). Biopsies performed both in the gastric antrum (n=2) and corpus (n=2) were analysed for histological assessment according to the updated Sydney classification system and bacterial culture. A positive result was recorded where histology and/or culture were positive, confirming the presence of H. pylori infection (H. pylori +ve). A negative result was recorded when both tests were concomitantly negative (H. pylori -ve). RESULTS: 9.3% (32/345) of the total population, and 14.5% (32/221) of chronic gastritis patients exhibited GA, M/F: 16/16, mean age (SD) 9.4 (3.4) years. Amongst the 32 children with GA, 30 (93.7%) were H. pylori +ve and 2 (6.3%) were H. pylori -ve. GA was localised in the antrum (n=26, 81.2%), the fundus (n=2, 6.3%) and was also seen in both (n=4, 12.5%). GA was categorised as mild, grade 1 (n=18, 56.3%); moderate, grade 2 (n=13, 46.6%); and severe, grade 3 (n=1, 3.1%). GA was associated with mild active gastritis in 18 cases (56.3%). The prevalence of moderate or severe antral GA was detected in 9/26 (34.6%) of H. pylori +ve vs. any of H. pylori -ve (p=0.4), whereas GA in the corpus was detected in 1/2 (50%) vs. none, respectively. None exhibited intestinal metaplasia. There were no clinical features specific to this pathology. UGI endoscopy in GA patients showed nodular gastritis (n=17, 53.1%), congestive gastritis (n=9, 28.1%), and normal tissue (n=6, 18.8%). GA was significantly associated with H. pylori infection (p<0.0001) and nodular gastritis (p<0.005). CONCLUSION: GA was found in 9.3% of Tunisian children undergoing UGI endoscopy and was significantly associated with H. pylori infection and nodular gastritis.

Foetus-in-fetu: an unusual cause of abdominal mass in the newborn.

Foetus-in-fetu (FIF) is a rare congenital condition in which a vertebrate foetus is incorporated within its twin. The authors report the case of a newborn girl with prenatal ultrasonographic diagnosis of an intra-abdominal mass. Abdominal ultrasonography and computed tomography of the abdomen showed a heterogeneous cystic mass containing multiple calcifications. The patient had a laparotomy at 18 days of age with excision of a well-encapsulated 6 x 5 cm retroperitoneal mass, containing many organs. Anatomicopathologic examination showed a relatively well-differentiated FIF attached to an amniotic sac by a rudimentary umbilical cord. Encephalon, coroidal plexus, vertebral bodies, rudimentary limbs, thyroid gland and teeth were identified. The postoperative period was uneventful.

[Congenital cystic adenomatoid malformation of the lung. Report of 3 cases with late presentation]. / Malformation adénomatoïde kystique congénitale du poumon: à propos de trois cas de révélation tardive.

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare congenital developmental abnormality, representing about 25% of all congenital lung lesions. In many cases, respiratory distress occurs during the neonatal period, and in about 80- 85% of patients, CCAM is diagnosed before the age of two years due to respiratory infection. It is very rare that presentation is delayed until adulthood. We report three cases of CCAM presenting in adults. The diagnosis was based on clinical and radiological findings in one case and two patients were not diagnosed until surgery. The lesion was present in the right lung in two and in left lung in one patient. All patients underwent surgical resection. The result of histopathological examination confirmed CCAM Stocker type 1, without malignancy. The post operative follow up showed an excellent recovery. Clinicians and pathologists need to be aware of the fact that CCAM can be present for the first time in adolescents or in adults. The clinical diagnosis is suggested by radiographic findings and is confirmed at pathology as surgery is generally indicated.

[Severe corrosive oesophagitis : are high doses of methyl prednisolone efficient to prevent oesophageal caustic stricture in children?]. / Les oesophagites caustiques severes. Les doses elevees de solumedrol sont-elles efficaces pour prevenir les stenoses caustiques ?

BACKGROUND: Corrosive oesophagitis stricture is the long term complication of severe corrosive oesophagitis. The aim of our study was to evaluate the effect of a high doses of steroids on incidence and quality of oesophageal stricture. PATIENTS AND METHODS: We reviewed the case histories of 28 children seen at children hospital from 31 December 1991 to 31 december 2001. These children has second and third degree oesophageal burns and they were treated by systemic Methylprednisolone (1000mg/1,73/m2 SC). RESULTS: the frequency of stricture was 12/26 (46%). Ten children required A mean of 6,7 (5,74) dilatation range (1 - 17). One patient required an oesocoloplasty. The frequency of stricture in the group treated early before the 24th hour and after the 24th hours was (9/21) (47,4%) versus (3/7) (42,9%). This difference was not significant (P = 1). The frequency of stricture in the group treated less than 21 days and more than 21 days was 6/17 (40%) versus 6/9 (66,7%). This difference was not significant (P = 0,400). High doses of methyl prednisolone seems to decrease the risk of oesophageal stricture. We found no difference between the children treated before the 24th hours and those treated after the 24 hours and those treated less than 21 days and those more than 21 days.