[Sickle cell disease pain management following the World Health Organization's protocol]. / Prise en charge de la douleur drépanocytaire selon les critères de l'Organisation mondiale de la santé.

UNLABELLED: Twenty-four percent of the Gabonese population has sickle cell trait, and 1-3% has sickle cell disease. Patients' management must follow well-defined protocols that take into account the debilitating effect of severe pain episodes. OBJECTIVES: To evaluate the three-step analgesic ladder for control of pain for sickle cell disease pain crises. METHODOLOGY: This is a prospective and descriptive study based on surveys filled between February 2000 and March 2001. Surveys were restricted to sickle cell disease patients having developed pain crises before and during their stay at the hospital. The assessment of the pain was based on the DEGR and EVA scales. The treatment followed the World Health Organisation's analgesic ladder. The criteria used for estimate pain severity and sedation duration were measured before, 2 and 24 h after treatment administration began (H0, H2 and H24) to evaluate its effectiveness. RESULTS: Sixty children were included. All the social layers of the population were represented. The school level was variable. Fifty-six percent of the patients suffered their first pain crisis before they were 1 year old. Thirty-one percent had annual crises and 20% monthly crises. Pain was located in joints in 35% of the cases, and in joints and bones in 15% of the cases. Eighty-one percent of the pain crises were successfully treated in stage I. The passage to stage II occurred in the remaining cases (18.3% of the cases). CONCLUSION: The WHO's three-step analgesic ladder for control of pain is effective for the sickle cell disease pain episodes. Stage I drugs relieved the pain for 81.6% of the patients in a relatively short time (2-16 h). It was not possible to go to stage III.

[Leptospirosis in children of Libreville: difficult diagnosis, apropos of 1 case]. / Leptospirose de l'enfant à Libreville: difficultés diagnostiques, à propos d'un cas.

Leptospirosis is a widespread zoonosis, which is diagnosed less frequently in children than might be expected from the level of exposure to hazards, especially in tropical areas. A 15 1/2-year-old Gabonese boy was admitted following five days of fever, headache, myalgia, abdominal pain, diarrhea, intestinal bleeding, jaundice and conjunctival suffusion. Laboratory data showed abnormal liver and renal function tests, and diagnosis of Plasmodium falciparum malaria was confirmed by thin blood smear. The patient did not clinically improve despite antimalarial treatment and then leptospirosis was suspected. Serologic tests were performed and leptospirosis was later confirmed. Antibiotic treatment (cefuroxim) was given. The outcome was good, liver and renal tests returned to normal in a few days. In tropical area, leptospirosis should be considered in children who are diagnosed with either an unexplained fever, a pseudo-influenza syndrome, or jaundice with hepatorenal involvement and gastrointestinal bleeding.