[Epidemiological Evolution of Type 1 Diabetes in Children: Data from the Register of the Department of Oran, Algeria, 1973-2017]. / Évolution épidémiologique du diabète de type 1 chez l'enfant : données du registre du département d'Oran, Algérie, 1973­2017.

BACKGROUND: Diabetes in children is undergoing a profound change in terms of frequency and age at onset worldwide. Algeria is particularly impacted by the epidemic to the point of appearing in the "top 10" 2016 of countries with very high incidence of T1D. Our study was aimed to present the epidemiological evolution of T1D in children using data from the register of the department of Oran. METHODS: New cases of T1D are children under 15 years old coming from primary care units and pediatric departments. Registration was centralized at the level of the "C" pediatric unit of Oran University Hospital since 1973 with an assessment close to 100%. RESULTS: From 1973 to 2017, 2358 T1D new cases aged less than 15 years at T1D diagnosis have been registered. The average annual incidence under 15 years old for the last 5 years 2013-2017 is 31.12±3.60 cases per 100,000 and 22.62±5.18, 36.92±6.88 et 37.93±6.53 for children 0-4, 5-9 et 10-14 years old, respectively. The average annual evolution was at 12.78% in the last 25 years for the whole group and 15.03, 15.50 and 9.10% for children of 0-4, 5-9 and 10-14 years old, respectively. The estimated prevalence on December 31st 2017 was 207 per 100,000 equivalent to 1 T1D for 482 children under 15. The sex ratio for all cases is 0.94 with non-significant fluctuations. The winter/summer seasonality, significant from 1973 to 2013 in favor of winter months is no longer present starting from 2013. CONCLUSION: We confirm, in agreement with other teams, the outsized increase in the incidence of T1D and the younger age at onset in children under 15 in our country. This evolution, mainly related to environmental problems poses new difficulties to families and teams in charge of the disease.

[Familial Wolfram syndrome]. / Syndrome de Wolfram familial.

Wolfram syndrome (WS) is a rare autosomal recessive progressive neurodegenerative disorder, and it is mainly characterized by the presence of diabetes mellitus and optic atrophy. Other symptoms such as diabetes insipidus, deafness, and psychiatric disorders are less frequent. The WFS1 gene, responsible for the disease and encoding for a transmembrane protein called wolframin, was localized in 1998 on chromosome 4p16. In this report, we present a familial observation of Wolfram syndrome (parents and three children). The propositus was a 6-year-old girl with diabetes mellitus and progressive visual loss. Her family history showed a brother with diabetes mellitus, optic atrophy, and deafness since childhood and a sister with diabetes mellitus, optic atrophy, and bilateral hydronephrosis. Thus, association of these familial and personal symptoms is highly suggestive of Wolfram syndrome. The diagnosis was confirmed by molecular analysis (biology), which showed the presence of WFS1 homozygous mutations c.1113G>A (p.Trp371*) in the three siblings and a heterozygote mutation in the parents. Our observation has demonstrated that pediatricians should be aware of the possibility of Wolfram syndrome when diagnosing optic atrophy in diabetic children.

Effect of feeding yogurt versus milk in children with acute diarrhea and carbohydrate malabsorption.

BACKGROUND: The aim of this study was to compare the effect of infant formula and the same formula subjected to microbial fermentation (yogurt) on the duration of diarrhea in young children with acute watery diarrhea, with or without reducing substances in stools. METHODS: One hundred twelve well-nourished children, aged 3 to 24 months, who were admitted to the hospital with acute watery diarrhea were included in a randomized trial. After appropriate rehydration, they were fed either an infant formula (group M, n = 56) or the same formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus (group Y, n = 56). The two feedings were comparable in lactose concentration (40 to 42 g/L), pH 4.5, flavor, and texture. The groups were subdivided into those with or without reducing sugars in stools at presentation. The presence of reducing sugars in stool was used as a marker of carbohydrate malabsorption. RESULTS: Group M and group Y had comparable clinical characteristics at admission, including the number of patients with reducing sugars in stools (n = 31 in group M and 27 in group Y). The success rate (cessation of diarrhea and appropriate weight gain 7 days after enrollment into the study) was similar in both groups (82% in group M vs. 84% group Y). Clinical failure was 3.6% in both groups. The percentage of patients withdrawn from the study for medical reasons (5.4% in group M vs. 7.1% in group Y) or withdrawn at the parents' request (8.9% in group M vs. 5.4% in group Y) was similar. Duration of diarrhea and number of stools were significantly less in group Y compared with group M. Forty-eight hours after inclusion, diarrhea was still present in 62% of group M versus in 35% of group Y (P < 0.002). In children with reducing sugars in stools, the rate of success (82%) was similar in groups M and Y, but the duration of diarrhea and number of stools per day were significantly decreased in group Y. Forty-height hours after inclusion, diarrhea was still present in 75% of group M patients and in 20% of group Y patients who had reducing substances in the stool. CONCLUSION: Young children with acute watery diarrhea, without malnutrition or associated disease, can be equally well treated with feeding of either infant formula or yogurt. Yogurt feeding is associated with a clinically relevant decrease in stool frequency and duration of diarrhea in children who have reducing sugars in stools.

Prevalence of coeliac disease in diabetic children and their first- degree relatives in west Algeria: screening with serological markers.

Atypical and relatively silent forms of coeliac disease (CD) have been described in insulin-dependent diabetes mellitus (IDDM). Our aim was to evaluate the prevalence of CD-IDDM with serological markers and to investigate the presence of CD in the IDDM first-degree relatives. During 1993-94 we explored 116 IDDM patients reported as new cases and 381 first-degree relatives of IDDM patients. Determination of IgA and IgG antigliadin antibodies (AGA) and IgA antiendomysium antibodies (AEA) was made. Jejunal biopsy was performed in symptomatic patients or in those with positive serological markers, (i) Nineteen IDDM-CD were identified and 5 were suspected. Thus, the prevalence of CD in IDDM patients was between 16.4 and 20%. AGA and/or AEA were abnormal in 13 and normal in 5. Sensitivity was 80% for the three tests when used simultaneously and specificity was 100%. (ii) In the family study, 26 sera of asymptomatic first-degree relatives of IDDM patients were positive for at least one of the serological markers; 13 of them had villous atrophy. Systematic serological screening in IDDM allowed us to detect CD and evaluate the true incidence.

Jejunal response to beta-lactoglobulin in infants with cow's milk allergy.

Weaning is a transient period of life during which maternal proteins are replaced by foreign proteins. Concomitantly, in early postnatal life, both digestive and immune systems undergo a maturation process. Allergy to cow's milk protein may develop in human infants during weaning, determining digestive, respiratory, cutaneous or systemic symptoms. We studied the intestinal response to bovine milk beta-lactoglobulin (beta-LG) in infants with cow's milk allergy, first during the active phase, and then during the symptom-free stage. During the active phase, transepithelial transport of the beta-LG across the intestinal epithelial layer stimulated the sensitized subepithelial immune cells. This stimulation induced a rise in short-circuit current suggestive of an electrogenic chloride secretion and impaired protein handling by the epithelium. These findings underline the dual role of the epithelial layer in intestinal function: on one hand, it takes an active part in allowing dietary antigens to stimulate the submucosal system, and on the other hand becomes the target for mediators involved in food allergy.

[Clinical consequences of replacing milk with yogurt in persistent infantile diarrhea]. / Conséquences cliniques du remplacement du lait par le yaourt dans les diarrhées persistantes du nourrisson.

Persistent diarrhea is an episode of diarrhea that begins acutely but lasts longer than expected for this usually self-limited disease. Treatment of this ill-defined syndrome is not well standardized but immediate intervention is required to minimize the risk of malnutrition with its various consequences. This randomized clinical trial was undertaken to evaluate the clinical efficacy of substituting yogurt for milk, as the only treatment. After a one to two-day observation period during which a standard milk diet was given, 78 children aged 3 to 36 months with confirmed persistent diarrhea of more than 15 days but less than one month duration and negative tests for fecal blood were fed either milk (infant formula) or yogurt (infant formula fermented with Lactobacillus bulgaricus and Streptococcus thermophilus). At inclusion both groups were comparable for age, nutritional status, diarrhea, and lactose hydrogen breath test results. Clinical treatment failure (weight loss greater than 5% in one day or persistent diarrhea after 5 days) was significantly less common in children fed yogurt (15 +/- 6%) than in children fed milk (45 +/- 8%). The beneficial effects of feeding yogurt were apparent within 48 hours in 67 +/- 8% of infants. In conclusion, these data confirm the clinical efficacy of substituting yogurt for milk in young children with persistent diarrhea. They also suggest that yogurt may be a good alternative for the initial treatment of persistent diarrhea.

Effect of feeding yogurt versus milk in children with persistent diarrhea.

Although the pathophysiology of persistent diarrhea in children remains unclear, it has been suggested that it may be related to the composition of the food ingested. Since lactase deficiency and cow's milk protein intolerance are often identified in children with persistent diarrhea, replacement of milk with yogurt should be beneficial. We, therefore, compared the clinical outcome of children (aged 3-36 months) with persistent diarrhea randomly assigned to receive either milk or yogurt for 5 days. Preliminary results on 45 of the 100 children indicated clinical failure, which was determined after a 5% loss of body weight per day or the persistence of diarrhea after 5 days, in only 14% of the children fed yogurt compared to 42% of those fed milk (p less than 0.05). These preliminary results strongly suggest a clinical advantage of feeding yogurt rather than milk in children with persistent diarrhea.

Incidence of Campylobacter infection in infants in western Algeria and the possible protective role of breast feeding.

A case-control study aimed at comparing the incidence of campylobacter infection with that of other enteropathogens in infants was performed in Oran, Western Algeria. During a one-year period, infants consulting in a health centre were included if they had acute diarrhoea. The controls comprised infants going to the same centre for vaccination. Butzler medium Virion was used to look for thermophilic campylobacters. Campylobacters were isolated in 17.7% of the 411 patients and in 14.9% of the 247 controls. No statistically significant difference was found after stratification by age. In contrast, other enteropathogenic bacteria were rarely present. Among the potential factors of clinical expression of infection, breast feeding appeared to have a protective effect which was higher for campylobacter diarrhoea than that observed for other causes of diarrhoea. These data contrast with those previously published in Bangladesh and could be an incentive for promoting breast feeding in this country, where the tradition is decreasing far below the standard which is generally accepted.

[Epidemiology of juvenile insulin-dependent diabetes in Algeria (Wilaya of Oran)]. / Epidemiologie du diabète insulinodépendant juvénile en Algérie (Wilaya d'Oran).

In order to precise the prevalence and incidence of IDDM in a well characterized population, we have ascertained between 1979 and 1988 all juvenile diabetic patients living in the department of Oran (Wilaya of Oran), Algeria, aged less than 20 years at the date of Dec. 31th 1988 who had onset of the disease before 15 years old. Cross comparisons of the data obtained both by a IDDM registry and a questionnaire sent to the practitioners show an excellent correlation. A total of 173 families was studied, including 155 Simplex Families (SF), and 18 Multiplex Families (MF). The prevalence was 0.27 p. 1000 among children aged less than 15 years. The annual incidence (mean = 4.4 p. 100,000) increased regularly from 1.6 p. 100,000 in 1981 to 8.1 p. 100,000 in 1988. The prevalence of IDDM among siblings was 3.8%. The birth order of index cases (first affected siblings) was lower in MF (3.0 +/- 0.4) than both in index cases of SF (4.0 +/- 0.3; p less than 0.01) and in secondary affected siblings of MF (4.8 +/- 0.05; p less than 0.001). The frequency of 2nd degree consanguineous marriages (between first cousins) was greater among the IDDM families compared with control families: 25% vs 11% (RR = 2.9; p less than 0.001).

[Is the dilution of milk necessary in benign acute diarrhea in eutrophic infants?]. / La dilution du lait est-elle indispensable dans les diarrhées aiguës bénignes du nourrisson eutrophique?

Early feeding is generally recommended for children with acute diarrhea. The concentration at which the milk should be given to children weaned at an early age remains a matter of debate. The aim of the study was therefore to evaluate the role of milk dilution in the first 24 hours on the outcome of diarrhea. Sixty-nine well nourished and weaned children, aged 1 to 9 months and with moderate watery acute diarrhea were included after oral rehydration therapy (ORT) in a randomised controlled study to receive either half-strength (diluted group) or full strength (undiluted group) milk. Both groups displayed the same clinical characteristics except for the weight. The outcome of the diarrhea until cessation was the same in the 2 groups. No failure requiring a specific treatment was observed. The duration of diarrhea and the total stool output were not statistically different in the 2 groups, i.e. 39 +/- 7 hrs in diluted vs 47 +/- 8 in undiluted, and 883 +/- 205 g in diluted vs 924 +/- 161 g in undiluted. These results are strengthened by the lack of significant differences in the weight gain, the number and volume of vomiting, the volume of ORT and milk intake. However, the energy intake was significantly higher in the group receiving full strength milk. These results suggest that there is no immediate clinical advantage to dilute the milk in the first 24 hours of feeding well nourished children with moderate acute watery diarrhea, if early feeding is associated with the ORT recommended by the WHO.

[Association of severe intestinal villous atrophy and abdominal non-Hodgkin lymphoma. Apropos of 3 cases]. / Association d'atrophies villositaires intestinales sévères et de lymphomes malins non hodgkiniens à localisation abdominale. A propos de 3 cas.

Malignant lymphoma is a recognized late complication of adult celiac disease. In children, however, the association of lymphoma with celiac disease was so far identified only in one case of an Algerian girl in 1981. We have observed during the last 5 years 78 patients with non-Hodgkin lymphoma, 56% located in the abdomen. In three of these cases, the association of intestinal epithelial atrophy and non-Hodgkin abdominal lymphoma was observed and is reported in this paper.

Macromolecular transport in jejunal mucosa of children with severe malnutrition: a quantitative study.

Small intestinal permeability to horseradish peroxidase (HRP) was assessed in jejunal biopsies of malnourished children. Clinical examination, intestinal function (D-Xylose test), and the histological appearance of the mucosa were assessed in 14 children during the malnutrition phase and in eight children after 3 months of nutritional rehabilitation. Macromolecular permeability was evaluated by measuring transepithelial HRP fluxes from mucosa to serosa (JHRPms) using Ussing chambers. Intact HRP transport, i.e., nondegraded protein transport, was measured by enzyme assay, and tritiated HRP was concomitantly used to measure intact and degraded HRP fluxes (J[3H]HRPms). Electrical parameters (short-circuit current, potential difference, and ionic conductance) were also recorded. Transepithelial HRP fluxes were significantly higher during malnutrition (JHRPms = 8.85 +/- 1.44; J[3H]HRPms = 77.11 +/- 10.66 pmol X h-1 X cm-2) than in the same children after 3 months of nutritional rehabilitation (JHRPms = 2.94 +/- 1.10; J[3H]HRPms = 22.93 +/- 8.15 pmol X h-1 X cm-2). The total ionic conductance, which is an index of paracellular permeability, did not change significantly. Calculated intratissue degradation of the protein did not appear to alter during malnutrition. These results point to a clinical situation in which malnutrition with diarrhea in children is associated with increased intestinal permeability to macromolecules by a mechanism not related to any paracellular leak of the protein, but rather to increased transcellular absorption.