Impact of the COVID-19 pandemic on pediatricians' clinical activity in Cameroon.

BACKGROUND: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. METHODS: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pre-tested Google Form®. RESULTS: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%), of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (P<0.000). According to the occupancy rate of hospitalisation beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalisation beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (P<0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (P<0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). CONCLUSION: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.

[Retinal manifestations of neuro-malaria or "malarial retinopathy" in Yaoundé]. / Atteintes rétiniennes du neuro-paludisme ou « rétinopathie paludique ¼ à Yaoundé.

AIM: Contribute to the improvement of diagnostic and prognostic approaches to treating children with neuro-malaria in Yaoundé. PATIENTS AND METHOD: A prospective and analytical study carried out in 2 hospitals of Yaoundé from October 2015 to March 2016. All patients aged 3 months to 15 years hospitalized for neuro-malaria in one of the 2 hospitals benefited from a fundus examination. The variables studied were: age, sex, Glasgow or Blantyre score, fundus examination and parasitaemia. For statistical analysis, we used the software R 3.3.0, Chi2, exact of Fisher or Kolmogorov-Smirnov tests with a significance P<5%. RESULTS: Out of the 178 children hospitalized during the study period, 44 had neuro-malaria (24.71%) and 26 (46 diseased eyes) among them presented retinal lesions at a frequency of 14.60%. The mean age was 5.54±3.49 years with a sex ratio of 1.09. The under 5-years-old were the most affected with 31 (70.45%) cases. The fundus lesions of 26 (59.09%) were retinal hemorrhages in 24 (54.54%), retinal whitening and vessel discoloration in 8 (18.18%) respectively. Papillary edema was associated in 4 (9.09%). Macular involvement was noted in 9 cases. These lesions were correlated with age, depth of coma, duration, and clinical course. The rate of parasitaemia did not affect their occurrence. CONCLUSION: Retinal lesions are frequent and serious during neuro-malaria in our environment, especially in children under five. They must therefore be an emphasis in the systematic exam to rule it out for a better prognostic evaluation and a fast and adequate multidisciplinary management.

Accidents vasculaires cérébraux de l'enfant : aspects épidémiologiques, diagnostiques et évolutifs à Cotonou (Bénin)

Objectif : Décrire les aspects cliniques et radiologiques et évolutifs des accidents vasculaires cérébraux (AVC) de l'enfant.Patients et méthode : Il s'est agi d'une étude rétrospective descriptive sur une durée de 10 ans (1er janvier 2006 au 31 décembre 2015) dans le service de pédiatrie du Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU-HKM) de Cotonou. Ont été inclus tous les sujets de moins de 15 ans hospitalisés pour un AVC. Résultats : Au total, 16 cas d'AVC inclus (11 garçons et 4 filles). L'âge moyen au moment du diagnostic était de 8 ans avec des extrêmes de 1 et 15 ans. Le début était aigu chez 13 enfants. Le déficit moteur était du côté droit dans 10 cas et isolé chez 7 enfants. Les autres signes associés étaient un coma (4 cas), une fièvre (2 cas), une aphasie (2 cas), une convulsion (1 cas). La tomodensitométrie cérébrale a permis de faire le diagnostic positif et topographique chez 13 enfants. L'AVC était ischémique chez 11 enfants et le territoire sylvien était concerné dans les tous cas. Les étiologies retrouvées étaient la drépanocytose (13 cas), la cardiopathie congénitale (2 cas) et la suspicion d'une malformation artérioveineuse. L'AVC était une circonstance de découverte de la drépanocytose dans 2 cas. Une récidive était notée chez 3 enfants, 3 enfants étaient décédés et 8 ont gardé des séquelles.Conclusion : L'AVC est une pathologie rare de l'enfant dont la confirmation est tomodensitométrique dans notre contexte. L'AVC ischémique prédomine et la drépanocytose est la cause la plus fréquente dans notre milieu

[Endomyocardial fibrosis in Cameroon: Echocardiographic and clinical description of a pediatric series in Yaoundé]. / Fibrose endomyocardique : description clinique et échocardiographique d'une série pédiatrique camerounaise.

BACKGROUND: Endomyocardial fibrosis is a restrictive cardiomyopathy that causes heart failure. It is characterized by the fibrotic thickening of the endocardium, sometimes involving the myocardium as well. The lesion generally lies at the apices or inflow tracts of one or both ventricles, associated with more or less severe alteration of the valves. It is a disease of the intertropical regions but is not well known in Cameroon. In this study we describe the first series seen in a pediatric hospital in Cameroon. PATIENTS AND METHODS: A retrospective study was conducted in a pediatric hospital in Yaoundé involving children who had been diagnosed with endomyocardial fibrosis after echocardiographic investigation. We collected the clinical and paraclinical data from consultation records and medical files. RESULTS: Between January 2006 to December 2013, we registered 1430 patients with a cardiac anomaly in our center. Endomyocardial fibrosis was found in 46 patients. Neither sex predominated. Ages at the time of diagnosis varied between 2 and 17 years. Most of the patients were between 5 and 15 years old (80.4 %), with a median of 10 years (interquartile range, 7-13 years). The main complaints were breathlessness, cough, abdominal distension, abdominal, and loss of appetite. Apart from the hyperpigmentation of the lips observed in all our patients, dyspnea was the most frequent physical sign and the diagnosis was made at a time when signs of heart failure were preponderant. Growth retardation was found in all the children examined. All patients were underweight with a median weight for age found below the 25th percentile of the norms according to the National Health Statistics. Lower limb edema was absent even in the presence of voluminous ascites. All subjects had hyperpigmented lips. Despite the cyanotic appearance of the lips, pulse oximetry always gave a normal oxygen saturation level and no cyanosis was seen elsewhere. None of the patients had nail clubbing. Fibrosis more often affected the right ventricle (45/46 patients). The apical obliteration by fibrotic material was found in 43 (93.5 %) patients. Moreover, 36 (78.3 %) patients had pericardial effusion: mild to moderate in 32 subjects and abundant in four subjects. Hypereosinophilia was noted in 57.5 % of the patients. Atrial fibrillation was found in six out of 15 patients who had an electrocardiogram done. CONCLUSION: The modes of clinical presentation of endomyocardial fibrosis are not sufficiently well known in our context. Despite its insidious progression, certain signs such as weight loss and hyperpigmented lips could be very helpful for screening and easing orientation of parents and heath personnel, thus enabling early referral for appropriate investigation. The presence of bulky ascites without edema of the lower extremities should be viewed as strongly suggestive.

Neonatal mortality in a referral hospital in Cameroon over a seven year period: trends, associated factors and causes.

BACKGROUND: The fourth Millennium Development Goals targets reduction of the mortality rate of under-fives by 2/3 by the year 2015. This reduction starts with that of neonatal mortality representing 40% of childhood mortality. In Cameroon neonatal mortality was 31% in 2011. OBJECTIVES: We assessed the trends, associated factors and causes of neonatal deaths at the Yaounde Gynaeco-Obstetric and Pediatric Hospital. METHODS: The study was a retrospective chart review. Data was collected from the hospital records, and included both maternal and neonatal variables from 1(st) January 2004 to 31(st) December 2010. RESULTS: The neonatal mortality was 10%. Out-borns represented 49.3% of the deceased neonates with 11.3% born at home. The neonatal mortality rate followed a downward trend dropping from 12.4% in 2004 to 7.2% in 2010. The major causes of deaths were: neonatal sepsis (37.85%), prematurity (31.26%), birth asphyxia (16%), and congenital malformations (10.54%). Most (74.2%) of the deaths occurred within the first week with 35% occurring within 24 hours of life. Mortality was higher in neonates with birth weight less than 2500 g and a gestational age of less than 37 weeks. In the mothers, it was high in single parenthood, primiparous and in housewives and students.. CONCLUSION: There has been a steady decline of neonatal mortality since 2004. Neonatal sepsis, prematurity, birth asphyxia and congenital malformations were the major causes of neonatal deaths. Neonatal sepsis remained constant although at lower rates over the study period.

[Factors associated with the survival of very low birth weight neonates at the Yaounde gynaeco-obstetric and pediatric hospital, Cameroon]. / Facteurs associés à la survie des nouveau-nés de très faible poids de naissance à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé, Cameroun.

OBJECTIVES: The rate of survival of very low birth weight neonates (less than 1500 g) is still low in most developing countries, such as Cameroon. The aim of this study was to assess the maternal and neonatal factors that can influence the survival of neonates with birth weights under 1500 g. MATERIAL AND METHODS: This was a retrospective, descriptive, and analytic study of 397 neonates weighing less than 1500 g who were admitted to the Yaounde gynaeco-obstetric and pediatric hospital from May 2003 to December 2011. The chi-squared test and the odds ratio were used to identify risk factors for death. The threshold of significance was P<0.05. RESULTS: The overall survival rate was 26.5%. The main comorbidities were prematurity (99%), neonatal sepsis (36%), and intrauterine growth retardation (27.2%). The factors that statistically influenced outcome were: parity, birth weight, gestational age, the 5th-min Apgar score, advanced resuscitation at birth, and respiratory distress. CONCLUSION: The survival of neonates weighing less than 1500 g depends on several factors, which if acted upon could improve the survival rate.

[Pasteurella multocida meningitis with cerebral abscesses]. / Méningite à Pasteurella multocida compliquée d'abcès cérébral.

Pasteurella multocida is classically responsible for local soft tissue infections secondary to dog bites or cat scratches. It can be responsible for meningitis in infants and elderly persons. We report the case history of a 5-year-old male child admitted to our pediatric unit for meningitis. Cerebrospinal fluid analysis revealed an infection with P. multocida. The suspected mode of contamination was either from the saliva of a pet dog or through an unnoticed skull fracture sustained after an accident 1 year prior to the occurrence of meningitis. In spite of the neurologic complication (cerebral abscess), the progression was favorable after drainage of the abscess, 5 weeks of parenteral treatment, and 3 weeks of oral antibiotic therapy. Meningitis due to Pasteurella sp. is rare and can lead to neurologic complications. The notion of bites or scratches can be absent and the mode of contamination is sometimes difficult to unveil.

[Clinical and etiological aspects of focal epilepsy in children at Yaoundé Gynaeco-obstetric Hospital (Cameroon)]. / Aspects cliniques et etiologiques de l'epilepsie focale de l'enfant a l'hopital Gyneco-obstetrique et pediatrique de Yaounde (Cameroun).

OBJECTIVE: To describe the clinical and etiological aspects of child focal epilepsy at Yaoundé Gynaeco-Obstetric and Pediatric Hospital (YGOPH) in Cameroon. PATIENTS AND METHODS: It was a cross-sectional descriptive study carried out in pediatric neurology and epileptology unit of YGOPH from October 1st 2011 to March 30th 2012. We included 218 patients aged 0-16 years with a diagnosis of focal epilepsy in whom an electroencephalogram (EEG) was performed. The studied variables were epidemiological, etiological factors, type of epilepsy, EEG abnormalities, abnormalities in brain CT-scan, and probable etiology. RESULTS: The sex ratio was 1.34 M/1F. The mean age of patients was 8 ± 4 years. In 58.71% (128/218) the onset of crises was before the age of five and decreased gradually until adolescence. The EEG showed an epileptic focus in 161 patients (73.85%). The main foci were centro-temporal (19.9%), frontal (19.2%), temporal (14.9%) and fronto-temporal (14.9%). The CT-scan was abnormal in 58 (56.86%) of 102 patients, who performed head CT-scan, with as major abnormalities, brain atrophy and after-effects lesions. Etiological factors were found in 76.15 % of patients, it was mainly neonatal asphyxia (21%), family history of epilepsy (20.6%) and febrile seizures (19.7%). Focal epilepsies were of structural (51.4%), genetic (24.3%) or unknown causes. Neurological abnormalities associated were more frequently in focal epilepsies of structural causes. CONCLUSION: The focal child epilepsies are mostly of structural causes and preferentially temporal and/or frontal in location. The main etiological factors are family history of epilepsy and neonatal asphyxia.

OBJECTIF: Décrire les caractéristiques cliniques et étiologiques de l'épilepsie focale de l'enfant à l'Hôpital Gynéco-obstétrique et pédiatrique de Yaoundé (HGOPY) au Cameroun. PATIENTS ET MÉTHODE: Il s'agissait d'une étude transversale descriptive réalisée dans l'unité de neuropédiatrie et d'épileptologie de HGOPY du 1er octobre 2011 au 30 mars 2012. Elle incluait 218 patients âgés de 0 à 16 ans ayant un diagnostic d'épilepsie focale et chez qui un électroencéphalogramme (EEG) avait été réalisé. Les variables étudiées étaient les données épidémiologiques, les facteurs étiologiques, le type d'épilepsie, les anomalies EEG, les anomalies au scanner cérébral, et l'étiologie probable. RÉSULTATS: Le sex-ratio était de 1,34M/1F. L'âge moyen des patients était de 8 ± 4 ans. Les crises débutaient dans 58,71% (128/218) avant l'âge de cinq ans et diminuaient progressivement jusqu'à l'adolescence. L'EEG révélait un foyer épileptique chez 161 patients (73,85%). Les principaux foyers étaient centro-temporal (19,9%), frontal (19,2%), temporal (14,9%) et fronto-temporal (14,9%). Le scanner était pathologique chez 58 (56,86%) des 102 patients ayant fait le scanner cérébral, avec pour principales anomalies l'atrophie cérébrale et les lésions séquellaires. Les facteurs étiologiques étaient retrouvés chez 76,15% des patients; ils s'agissaient principalement de l'asphyxie néonatale (21%), des antécédents familiaux d'épilepsie (20,6%) et des convulsions fébriles (19,7%). Les épilepsies focales étaient de causes structurelles (51,4%), génétiques (24,3%) ou inconnue. Les anomalies neurologiques associées étaient plus fréquentes dans les épilepsies focales de cause structurelle. CONCLUSION: Les épilepsies focales de l'enfant sont en majorité structurelles et préférentiellement temporales et/ou frontales. Les principaux facteurs étiologiques sont les antécédents familiaux d'épilepsie et l'asphyxie néonatale..

[Sacrococcygeal teratoma of delayed diagnosis: clinical and radiological features of two cases and therapeutic considerations]. / Teratome sacro-coccygien vu tard: aspects cliniques, radiologiques et therapeutique a propos de deux cas.

The sacrococcygeal teratoma is a rare congenital embryonal tumor with high potential for malignant transformation and therefore considered as a neonate surgical emergency. The authors report two cases of sacrococcygeal teratomas with late diagnosis and treatment. The first case was a degenerated sacrococcygeal teratoma revealed by paraplegia in a 17-month-old infant with multiple metastasis and fatal outcome. The second case was a 14-month-old infant with a benign infected form of sacrococcygeal teratoma, successfully treated surgically. The authors highlight the diagnostic difficulties still existing in the tropical environment, and recall the need for a prenatal diagnosis and early treatment.

Le tératome sacro-coccygien est une tumeur embryonnaire congénitale rare à fort potentiel de transformation maligne et donc considéré comme une urgence chirurgicale néonatale. Les auteurs rapportent deux cas de tératomes sacro coccygiens, de diagnostic et de prise en charge tardifs. Dans le premier cas, il s'agissait d'un tératome sacro-coccygien dégénéré révélé par une paraplégie chez un nourrisson de 17 mois avec de multiples localisations secondaires et une évolution fatale. Le deuxième cas concernait un nourrisson de 14 mois avec une forme bénigne surinfectée traitée chirurgicalement avec succès. Les auteurs mettent en relief les difficultés diagnostiques encore existant en milieu tropical, et rappellent la nécessité d'un diagnostic anténatal et d'une prise en charge précoce.

Breastfeeding Practices by Women Attending the Vaccination and Pediatric Out-Patient Clinics at the Yaounde Gynaeco-Obstetric and Pediatric Hospital Cameroon

Despite the well-known benefits of exclusive breastfeeding in sustaining infant well-being; breastfeeding rates still remain low in many countries. We aimed at investigating the practice and determinants of exclusive breastfeeding for the first six months of life in Cameroonian women. METHODS In this cross-sectional study; we interviewed a consecutive sample of 310 mothers at the Yaounde Gynaeco-Obstretic and Pediatric. The study was conducted from 1st September 2011 to 29th February 2012. Variables related to the practice of breastfeeding within the first 6months of life were assessed. Odds ratio was used to determine the predictive variables of exclusive breastfeeding for 6 months. RESULTS The reported rates of exclusive breastfeeding were 84.8 at birth and 23.5 at six months. Medical advice (49.3) and concern for the child's health (42.5) were the two main reasons for practicing exclusive breast-feeding for the first six months of life; while resumption of studies or work (38.4) and the belief that the newborn was not 'satisfied' (34.2) were the main reasons for introducing other foods. Most children (84.5) did not receive any foods first breastfeed. Breast milk substitutes were given to 70.5 of the babies. Most women (87.1) breastfed on demand; and breast pain was the main difficulty in 60.5 of the mothers. Being a housewife was positively associated with exclusive breast-feeding (OR:2.18; 95 CI: [1.25-3.81]; P= 0.005 ). CONCLUSION Exclusive breastfeeding in the first 6 months remains low in this setting. Sensitization and education of mothers during prenatal visits and routine consultations should be reinforced

Intracranial suppurations in the African child: a severe but preventable complication.

INTRODUCTION: Intracranial suppurations (ICS) are collections of pus of infectious origin in the skull. The authors present their experience. PATIENTS AND METHOD: All children operated for ICS at the Central Hospital of Yaoundé from January 2000 to December 2008 were retrospectively included. RESULTS: Thirty-five patients were recruited: 26 (74.29 %) males and 9 (25.71 %) females. These represent 82.9 % of all ICS operated in our institution. ICS represented 14.3 % of intracranial space-occupying lesions. The mean age was 8.34 years. They presented with headaches (80.77 %), altered consciousness (20 %), convulsions (76 %), vomiting (20 %), unilateral motor deficit (69.23 %), speech disorders (12 %), and fever (89.29 %). Bergman's triad (51.86 %) was frequent. The primary infection was: meningitis, eight cases (22.85 %); sinusitis, six cases (17.14 %); head trauma, five cases (14.28 %); otitis media, one case (2.85 %); suppurations of the face, three cases (8.56 %); cardiopathy, one case (2.85 %); and craniotomy, one case (2.85 %). In seven cases (20 %), the origin was unknown. The lesions were empyema in 23 cases (65.71 %), cerebral abscess in 8 cases (22.85 %) and pyoventriculitis in 2 cases (5.72 %). The surgical procedures were burr holes (88.89 % of empyemas) and trepano-puncture-aspiration (75 % of abscesses). The mortality (21.42 %) and morbidity (42.85 %) were recorded. CONCLUSION: ICS are frequent but preventable (early treatment of the primary infection) pathologies of childhood in developing countries. Burr hole drainage (empyemas) and puncture-aspiration (abscesses) are simple, safe, and effective techniques.

Bronchiolite aigüe du nourrisson de moins de 24 mois à Yaoundé (à propos de 296 cas)

OBJECTIFS. Décrire les profils épidémiologiques, cliniques et évolutifs de la bronchiolite aiguë du nourrisson à Yaoundé.MÉTHODES. L'étude était rétrospective et descriptive couvrant la période du 1er janvier 2008 au 31 décembre 2011 à l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé et incluant 296 dossiers médicaux de nourrissons avec diagnostic de bronchiolite aiguë. Les critères d'inclusion étaient les nourrissons reçus en consultation et/ou admis en hospitalisation pour bronchiolite aiguë (1er ou 2ème épisode) et un âge inférieur ou égal à 24 mois. Les variables étudiées étaient d'ordre épidémiologique, clinique et évolutif. RÉSULTATS La bronchiolite aiguë était la troisième infection respiratoire basse (9,4%) et représentait 1,6% des consultations pédiatriques. Les nourrissons du sexe masculin entre 2 et 4 mois étaient les plus touchés, surtout lors de la grande saison des pluies allant de septembre à novembre avec un pic en octobre. Une prévalence saisonnière significative par rapport aux autres mois de l'année a été notée (P<0,001). Une augmentation significative de l'incidence par année a été observée avec un taux de récidive de 19,6%. Les principaux signes cliniques étaient les râles sibilants, la toux, la fièvre, les râles bronchiques, la rhinorrhée, les signes de lutte et la dyspnée. Le pronostic global était favorable dans 98,9% et une létalité de 1,1% a été notée. CONCLUSION. La bronchiolite aiguë est un problème de santé publique qui touche les jeunes nourrissons avec un pic épidémique lors de la grande saison des pluies. Son incidence est en augmentation et son pronostic globalement favorable

Bilateral intraorbital abscesses with intracranial complications in a young Cameroonian girl: a case report.

BACKGROUND: Intraorbital abscess is a very severe infection with ophthalmologic and neurologic complications that are sometimes life-threatening. OBJECTIVE: To report the etiologic, clinical, radiologic, and prognostic features of one case of bilateral intraorbital abscesses with intracranial complications. CASE REPORT: A 15-year-old Cameroonian girl in a comatose state (11/15 on the Glasgow Coma Scale) with meningeal signs, right hemiplegia, right facial palsy, and bilateral exophthalmia was admitted for meningitis and cerebral abscess secondary to orbital cellulitis. A lumbar tap was carried out, no organisms were seen by Gram stain, and culture was negative due to previous antibiotic therapy. A computed tomography scan showed a left internal capsule infarct and a pansinus opacification. Bilateral superior orbitotomies were performed and the abscess evacuated. Microscopy and culture of surgical material were negative. The patient was discharged 4 weeks after hospital admission with a visual acuity of 0.1 in both eyes, aphasia, and right hemiplegia. Nine months later, there was complete visual recovery (visual acuity 1.0 in both eyes). Anterior and posterior segments were normal on slit-lamp examination. There was no aphasia, but right-sided hemiparesis persisted. CONCLUSION: The authors emphasize the need for prevention, early diagnosis, and adequate treatment of orbital cellulitis in order to avoid complications.

[Clinical and CT-scan presentations in tuberous sclerosis complex: report of eight pediatric cases revealed by epilepsy]. / Aspects Cliniques Et Scanographiques De La Sclerose Tubereuse De Bourneville: à propos de huit cas pédiatriques révélés par une épilepsie.

OBJECTIVE: To describe the clinical and CT-scan features of the Tuberous sclerosis complex (TSC) revealed in children by epilepsy. PATIENTS AND METHOD: It was a cross sectional descriptive study carried out in the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Eight consecutive patients consulting for epilepsy between January 2005 and December 20010 with clinical and CT-scan diagnosis criteria of TSC were included in this study. RESULTS: There were two girls and six boys (aged 25months to 14years) with drug-resistant epilepsy and characteristics skin lesions of TSC (hypomelanotic macules, angiofibroma of Pringle, shagreen patches). The delay between the onset of epileptic crisis and the diagnosis of TSC varied from 10 months to 6years. One case of renal involvement and another of ophthalmic involvement were found. Cerebral CT-scan was abnormal for each patient with calcified sub-ependymal nodules in 100%, cortical tubers in 5 patients (62.5%) and one suspicion of giant sub-ependymal atrocytoma. CONCLUSION: Features of TSC are ruled by epilepsy, skin lesions, calcified sub-ependymal nodules and cortical tubers. Thus children presenting with epilepsy, should have a careful dermatological examination to search for TSC lesions. Cerebral CT-scan will afterwards seek for characteristic brain lesions.

Breastfeeding practices in infants in the west region of cameroon.

BACKGROUND: The study was conducted to evaluate the knowledge, attitudes and practices of breast-feeding in the West region of Cameroon. METHODS: A cross sectional descriptive study was conducted in two health facilities on 195 mother-infant pairs, seen at the out patient and vaccination units of the Bafoussam Regional Hospital over a period of one month from 1(st) to 30(th) September 2008. The socio-demographic characteristics of mothers, knowledge on breastfeeding and the practice of breastfeeding were studied. Data was analyzed using the SPSS software. The chi square and student t- test were used for comparison and results considered significant for P< 0.05. RESULTS: Breastfeeding was practised by 99.48% of the mothers. Only 33.8% of the mothers knew that they had to exclusively breastfeed up to 6 months, and 20% effectively breastfed up to 6 months. The mean duration of breastfeeding was 5.06 months and negatively correlated with the number of children and the profession of the mother. In 69.74% of the women, nothing was given to the baby before the first breastfeed. Discontinuation of breastfeeding was done averagely around 15.24 months and earlier in married women and in those with a higher educational level. CONCLUSION: Although the majority of parents practised breast feeding, only a minority understood its benefits, so more should be done to educate the community on the benefits of exclusive breast-feeding for up to six months.

[Clinical, etiological, and therapeutic aspects of febrile convulsions. A review of 325 cases in Yaoundé]. / Aspects cliniques, étiologiques et thérapeutiques des convulsions fébriles. A propos de 325 cas à Yaoundé.

A prospective study of 325 children with febrile seizures was conducted in 2 hospitals in Yaoundé, from 15 January to 15 December 2008. The proportion of patients with febrile seizures among all admitted patients was 6.1%. The mean age was 24.6 months; the peak age of these patients was 12-17 months. The sex ratio was 1.5. The mean temperature on admission was 39.2 degrees C. There was a family history of febrile seizures in 36.4%. Simple febrile seizures were seen in 58.7% and the complex type in 41.3%. Malaria was the main etiology in 67.7%, followed by upper and lower respiratory tract infection in 14.1% and 9.8%, respectively. Lumbar puncture was performed in all patients. The commonest anticonvulsant used to stop seizures was rectal diazepam in 88%. Febrile seizure prophylaxis was administered to 43% of the patients; antipyretics were the most widely used, either alone or combined with rectal diazepam.

Troubles musculo-squelettiques du membre superieur chez les chirurgiens : etude transversale a propos de 120 cas dans les CHU d' Abidjan

OBJECTIF: Preciser l'importance des troubles musculo-squelettiques du membre superieur chez le chirurgien.PATIENTS ET METHODE : Il s'agit d'une etude transversale de type descriptive portant sur 120 chirurgiens. Elle s'est deroulee du 20 fevrier au 05 avril 2006 dans les differents services de chirurgie des 3 CHU d'Abidjan. L'enquete a consiste a faire remplir par les chirurgiens le questionnaire nordique de Kuorinka et al complete par un examen clinique osteo articulaire.RESULTATS :-Les troubles musculo-squelettiques du membre superieur apparaissent tres important chez le chirurgien (taux de prevalence de 57pour cent).-L'articulation la plus touchee est l'epaule; suivi du poignet et la main et enfin du coude.-L'age moyen des chirurgiens etait de 41;23 ans avec des extremes allant de 28 a 58 ans.-Dans la plus part des cas il s'agissait de tendinites; avec une predominance de la tendinite de la coiffe des rotateurs (12 cas sur 20 patients diagnostiques).-Les consequences sont une interruption des activites professionnelles variant de 1 a 7 jours chez 6 sujets (10;1pour cent); et de 8 a 30 jours chez 1 sujet et une reduction des activites de loisir chez 13 sujets (18;8pour cent).-Des facteurs de risque examines; seuls le nombre d'annees d'anciennete professionnelle et la qualite de la table operatoire utilisee ont ete retenus. Cela doit faire envisager d'autres facteurs de risque qui sont tres probablement de type ergonomique.CONCLUSION ET RECOMMANDATIONS: Au terme de ce travail; nous notons que les troubles musculo-squelettiques du membre superieur sont d'une importance capitale chez le chirurgien et doivent etre consideres comme une pathologie professionnelle devant beneficier de mesures preventives de type ergonomique adequates de meme que d'une indemnisation