Evaluation of Intussusception Following Pentavalent Rotavirus Vaccine (RotaTeq) Administration in 5 African Countries.

BACKGROUND: A low-level risk of intussusception following rotavirus vaccination has been observed in some settings and may vary by vaccine type. We examined the association between RotaTeq vaccination and intussusception in low-income settings in a pooled analysis from 5 African countries that introduced RotaTeq into their national immunization program. METHODS: Active surveillance was conducted at 20 hospitals to identify intussusception cases. A standard case report form was completed for each enrolled child, and vaccination status was determined by review of the child's vaccination card. The pseudo-likelihood adaptation of self-controlled case-series method was used to assess the association between RotaTeq administration and intussusception in the 1-7, 8-21, and 1-21 day periods after each vaccine dose in infants aged 28-245 days. RESULTS: Data from 318 infants with confirmed rotavirus vaccination status were analyzed. No clustering of cases occurred in any of the risk windows after any of the vaccine doses. Compared with the background risk of naturally occurring intussusception, no increased risk was observed after dose 1 in the 1-7 day (relative incidence = 2.71; 95% confidence interval [CI] = 0.47-8.03) or the 8-21 day window (relative incidence = 0.77; 95%CI = 0.0-2.69). Similarly, no increased risk of intussusception was observed in any risk window after dose 2 or 3. CONCLUSIONS: RotaTeq vaccination was not associated with increased risk of intussusception in this analysis from 5 African countries. This finding mirrors results from similar analyses with other rotavirus vaccines in low-income settings and highlights the need for vaccine-specific and setting-specific risk monitoring.

Compared outcomes of femoral shaft fracture treatment in school-age children in Sub-Saharan Africa: Primary open reduction and intramedullary K-wire fixation versus traction followed by spica cast.

BACKGROUND: Elastic stable intramedullary nailing has become the treatment of choice for femur shaft fractures in school-age children in developed world. However, in the sub-Saharan Africa, this management is still challenging because of the lack of fluoroscopy in more hospitals. We performed either primary open reduction and intramedullary K-wire fixation (PORIKF) or conservative treatment. The aim of this study was to compare the clinical and functional outcomes of these two procedures employed. PATIENTS AND METHODS: This retrospective study included 62 children with 64 fractures (10 years on an average; range: 6-15 years) treating for femoral shaft fractures either by PORIKF (n = 21; 23 fractures) or skin traction followed by spica cast (n = 41) between 2008 and 2017. Outcomes were assessed using Flynn criteria. Comparisons were made by Fisher and Student's t-test with a significant P < 5%. RESULTS: Outcomes were satisfactory in 21 cases (91%) in the PORIKF group compared with 32 (78%) in the conservative group (P = 0.3012). The average hospital stay was 18.6 days in the PORIKF group, whereas it was 20 in the conservative group (P = 0.0601). The mean time for bone union was 13.9 weeks in the PORIKF group and 13.2 weeks in the conservative group, (P = 0.4346). There was a statistically significant difference between the two groups in terms of major complications (P = 0.0177). One patient had osteomyelitis in the PORIKF group. Unacceptable shortening >2 cm was observed only in the conservative group. The average time to return to daily activities was 30 days shorter in the PORIKF group when compared to conservative group (P < 0.05). CONCLUSION: PORIKF provides better results than conservative treatment. Open reduction did not increase the rate of infectious complication.

Haematogenous osteoarticular infections in paediatric sickle cell trait patients: A reality in a tertiary centre in West Africa.

BACKGROUND: Sickle cell trait (SCT) affects at least 5.2% of the world population, and it is considered asymptomatic by medical practitioners. There is a paucity of data regarding SCT paediatric patients and haematogenous osteoarticular infections (HOAIs). In our practice, some children with SCT presented HOAIs. This study aims to describe the pattern of HOAIs in children with SCT admitted in our unit. MATERIALS AND METHODS: A single-centre retrospective study of medical records of SCT paediatric patients treated for HOAIs between January 2012 and June 2019 was performed. The data extracted were epidemiologic (gender, age at diagnosis, history of haemoglobinopathy and ethnic group), diagnostic (time to diagnosis, type of infection and fraction of haemoglobin S [HbS] at standard electrophoresis of Hb), germs and complications. RESULTS: Among 149 patients with haemoglobinopathy treated for HOAIs, 52 have SCT. The prevalence of SCT patients was 34.9%. Thirty-nine (n = 39) records were retained for the study. The average age at diagnosis was 7.18 ± 4.59 years (7 months-15 years). The Malinké ethnic group was found in 22 (56.4%) cases. The mean HbS fraction was 37.2% ± 4.3% (30%-46%). Septic arthritis and osteoarthritis involved the hip in 11 cases, the shoulder in 4 and the knee in 2. Osteomyelitis was acute in 5 cases (11.1%) and chronic in 16 (35.5%). None of the patients has multifocal involvements. Bacterial identification was positive in 17 cases (37.8%). Staphylococcus aureus was involved in 9 cases (52.9%), and in one case, it was Mycobacterium tuberculosis. This patient has abscess of the psoas. No patient was infected by human immunodeficiency virus. The sequelae were joint destruction (n = 2), epiphysiodesis (n = 5) and retractile scars (n = 2). CONCLUSION: Relatively infrequent in our daily practice, SCT patients present with HOAIs. These infections had characteristics that are not very different from the series of the literature.

Management of femoral neck fractures in children: Experience of a short series in a developing country.

BACKGROUND: Fractures of the femoral neck are rare injuries in children but can have many devastating complications. Their treatment is not standardized, but the objectives are early anatomic reduction to minimize the risk for complications. The aim of this study was to assess outcomes of a short series of femoral neck fractures managed in a resource-limited setting. MATERIALS AND METHODS: The medical charts of 11 children who were managed in our institution for femoral neck fractures between January 2000 and December 2015 were assessed retrospectively. There were two cases (n = 2) of Delbet type I, 5 (n = 5) type II, and 4 (n = 4) type III fractures. Patients were treated either surgically by open reduction and internal fixation (n = 4) or conservatively by traction followed by spica cast (n = 7). Outcomes were assessed using Ratliff system. RESULTS: Femoral neck fracture incidence was one case per year. Of the 11 patients, there were 7 boys and 4 girls, with a mean age 9.4 ± 3.28 years. At the mean follow-up of 3.64 ± 1.97 years (range, 2-8.8 years), outcome was fair to good in 8 (72.7%) and poor in 3 (27.3%) cases. Average union time was 13.5 ± 1.77 weeks. Complication rate was 72.7%. Avascular necrosis occurred in three cases (27.3%). Six patients (54.5%) developed coxa vara, with a mean neck-shaft angle of 102.16° ±12.07° (range, 90°-118°). Five patients (45.5%) had leg length discrepancy with a mean 18 mm (range, 7-35 mm). DISCUSSION: local conditions negatively influenced the management of femoral neck fractures. Conservative treatment led to many complications which increase the cost of management.

[Treatment of epiphyseal fractures of the distal radial in children]. / Traitement des fractures decollements epiphysaires du radius distal chez l'enfant.

OBJECTIVE: To assess the results of treatment on epiphyseal fractures of the distal radius. MATERIAL AND METHODS: A retrospective study of 53 patients treated in the pediatric surgery department on children was conducted between 2002 and 2012 for a distal radius epiphyseal fracture. The mean age of 12.5 years. According to Salter-Harris classification, fractures were classified of type I in 35 patients (66%) and types II 18 (34%) cases. The average treatment time was 1.42 days. Firstly, closed reduction followed by an anti-brachial brachiocephalic palmar cast was performed on patients. Failure of the orthopedic treatment led to open reduction and pin fixation. Post-care results were evaluated on the functional and morphological study of the upper limb. RESULTS: Postoperative complications occurred in 7 patients. Failures of closed reduction were caused by irreducibility due to periosteum interposition in 5 patients with type II fractures and by a redisplacement in 2 patients with type I fracture. In these patients, treatment consisted of a fixation pin by open reduction. Positive results occurred in 49 cases (92.5%) and sequelae occurred in 4 (7.5%) patients. Sequelae were represented by a stiff wrist in 3 cases (5.6%), and limitation of prono-supination in 1 case (1.8%). CONCLUSION: The results of treatment of epiphyseal fractures of the distal radius in children are accompanied by a low rate of complications. But a long-term follow up is required because growth disturbances predominated among the complications.

L'objectif de ce travail était d'évaluer les résultats du traitement des fractures décollements épiphysaires du radius distal chez l'enfant. MATÉRIEL ET MÉTHODES: Etude rétrospective portant sur 53 patients traités dans le service de chirurgie pédiatrique entre 2002 et 2012 pour une fracture décollement épiphysaire du radius distal. L'âge moyen était de 12,5 ans. Les lésions étaient reparties selon la classification de Salter et Harris: type I 35 cas (66%), type II 18 cas (34%). Le délai thérapeutique moyen était de 1,42 jour. En première intention, une réduction par manœuvre externe était réalisée, suivie d'un plâtre brachial anti brachio palmaire. Les échecs du traitement orthopédique ont imposé une réduction chirurgicale par brochage à ciel ouvert. L'évaluation des résultats s'est basée sur l'étude fonctionnelle et morphologique du membre supérieur. RÉSULTATS: Des complications post thérapeutiques ont été observées chez 7 patients. Il s'agissait de 5 cas d'irréductibilité par interposition périostée dans le type II et 2 cas de déplacement secondaire dans le type I. Chez ces patients, le traitement a consisté à une ostéosynthèse par brochage à ciel ouvert. Une consolidation sans séquelle a été observée chez 49 patients (92,5%) et 4 patients (7,5%) ont présenté des séquelles. Les séquelles étaient représentées par une raideur du poignet dans 3 cas (5,6%), une limitation de la prono-suppination dans 1 cas (1,8%). CONCLUSION: Le traitement des fractures décollements épiphysaires du radius distal chez l'enfant s'accompagne d'un faible taux de complications. Il convient d'insister sur l'intérêt d'une surveillance prolongée en raison de la nature évolutive et du caractère imprévisible de trouble de croissance.

Traitement des fractures décollements épiphysaires du radius distal chez l'enfant

L'objectif de ce travail était d'évaluer les résultats du traitement des fractures décollements épiphysaires du radius distal chez l'enfant. Matériel et méthodes: Etude rétrospective portant sur 53 patients traités dans le service de chirurgie pédiatrique entre 2002 et 2012 pour une fracture décollement épiphysaire du radius distal. L'âge moyen était de 12,5 ans. Les lésions étaient reparties selon la classification de Salter et Harris: type I35 cas (66%), type II 18 cas (34%). Le délai thérapeutique moyen était de 1,42 jour. En première intention, une réduction par manœuvre externe était réalisée, suivie d'un plâtre brachial anti brachio palmaire. Les échecs du traitement orthopédique ont imposé une réduction chirurgicale par brochage à ciel ouvert .L'évaluation des résultats s'est basée sur l'étude fonctionnelle et morphologique du membre supérieur. Résultats: Des complications post thérapeutiques ont été observées chez 7 patients. Il s'agissait de 5 cas d'irréductibilité par interposition périostée dans le type II et 2 cas de déplacement secondaire dans le type I. Chez ces patients, le traitement a consisté à une ostéosynthèse par brochage à ciel ouvert.Une consolidation sans séquelle a été observée chez 49 patients (92,5%) et 4 patients (7,5%) ont présenté des séquelles.Les séquelles étaient représentées parune raideur du poignet dans 3 cas (5,6%), une limitation de la prono-suppination dans 1 cas (1,8%). Conclusion: Le traitement des fractures décollements épiphysaires du radius distal chez l'enfant s'accompagne d'un faible taux de complications. Il convient d'insister sur l'intérêt d'une surveillance prolongée en raison de la nature évolutive et du caractère imprévisible de trouble de croissance

Epidemiology of congenital abnormalities in West Africa: Results of a descriptive study in teaching hospitals in Abidjan: Cote d'Ivoire.

BACKGROUND: Congenital abnormalities constitute one of the major causes of infant mortality, particularly in developing countries. The aim of this study was to describe the epidemiology of congenital anomalies in Cote d'Ivoire. MATERIALS AND METHODS: It was a multicentric study of three academic hospitals and the Heart Institute of Abidjan over 10 years. The epidemiologic Data concerned the Parturients, the annual frequency of congenital abnormalities. Distribution of the congenital abnormalities according to the organs, overall mortality and lethality of congenital abnormalities were evaluated. RESULTS: Over 10 years, 1.632 newborns with 1.725 congenital anomalies were recorded. Frequency was 172.5 congenital anomalies per annum. Parturients were less than 35 years in 33% of cases, multigravida in 20%, multiparous in 18% and had a low socio economic status in 96% of cases. Prenatal diagnosis of congenital anomalies was performed in 1.5%. Congenital anomalies were orthopedic in 34%, neurological in 17%, gastrointestinal in 15%, facial in 11.5%, parietal in 13%, urogenital in 9% and cardiac in 0.5% of cases. The overall mortality rate of congenital anomalies was 52% and gastroschisis was the most lethal disease with 100% mortality. CONCLUSION: This descriptive study reveals the low socio economic status of Parturients with congenital anomalies and their poor prenatal diagnosis. These factors explain the very high mortality of congenital anomalies due to a delay management in our country in which medical expenses were borne by parents and where technical platforms remain obsoletes for good resuscitation and neonatal surgery.

Aesthetic, urological, orthopaedic and functional outcomes in complex bladder exstrophy-epispadias's management.

BACKGROUND: Postoperative complications are related to the surgical procedures, of failures of initial bladder closure and influence the urological, aesthetical and orthopaedic outcomes. MATERIALS AND METHODS: We reviewed four patients who underwent complex bladder exstrophy-epispadias repair over a period of 14 years. The outcomes of treatment were assessed using, aesthetic, urological and orthopaedic examination data. Orthopaedic complications were explored by a radiography of the pelvis. RESULTS: Out of four patients who underwent bladder exstrophy surgical management, aesthetic, functional outcomes and complications in the short and long follow-up were achieved in three patients. The first patient is a male and had a good penis aspect. He has a normal erection during micturition with a good jet miction. He has a moderate urinary incontinence, which requires diaper. In the erection, his penis-measures 4 cm long and 3 cm as circumference. The second patient was a female. She had an unsightly appearance of the female external genitalia with bipartite clitoris. Urinary continence could not be assessed; she did not have the age of cleanness yet. The third patient had a significant urinary leakage due to the failure of the epispadias repair. He has a limp, a pelvic obliquity, varus and internal rotation of the femoral head. He has an inequality of limbs length. Pelvis radiograph shows the right osteotomy through the ilium bone, the left osteotomy through the hip joint at the acetabular roof. CONCLUSION: When, the epispadias repair is performed contemporary to initial bladder closure, its success is decisive for urinary continence. In the female, surgical revision is required after the initial bladder closure for an aesthetic appearance to the external genitalia. Innominate osteotomy must be performed with brilliancy amplifier to avoid osteotomy through to the hip joint to prevent inequality in leg length.

[Treatment of complicated childhood osteomyelitis at Yopougon University Hospital, Abidjan (Côte d'Ivoire)]. / Traitement des ostéomyélites compliquées de l'enfant au CHU de Yopougon, Abidjan (Côte d'Ivoire).

BACKGROUND: Complicated osteomyelitis in children is difficult to treat and can lead to important functional sequelae. OBJECTIVE: To report epidemiological, clinical and diagnostic aspects as well as treatment and outcome of complicated osteomyelitis in children. PATIENTS AND METHODS: This retrospective study of complicated osteomyelitis cases treated from March 2000 through March 2004 in the orthopedics unit of the Yopougon University Hospital in Yopougon identified 42 children with complicated osteomyelitis (defined as all acute osteomyelitis lesions that developed any complications). We examined the following types of variables : epidemiologic (age, sex, ethnic origin), clinical (fever, type of complication), diagnostic (full blood count, C-reactive protein, bacteriological, radiological) treatment (antibiotic treatment, surgical and orthopedic treatment), and outcome (cure, sequelae). RESULTS: The sex-ratio was 1:1, and mean age at first consultation in our specialized unit was 7 years and 5 months. Thirty per cent of the children were referred from the haematology unit. The ethnic origin of 60% was Malinke (northern Côte d'Ivoire). Time from initial signs to first consultation in our unit averaged 7 months and ranged from 5 days to 5 years. Fever of 38.5 degrees C or higher was reported for 60% of the children; 32 children (76%) presented osteomyelitis fistula, 10 (24%) osteomyelitis without fistula, and 10 a hemoglobinopathy. Radiography revealed pathological fractures in 13 (31%) cases, sequestrum in 17 (41%), and diaphysitis in 12 (28%). Lesions were found predominantly on the femur and humerus. Staphylococcus aureus and Salmonellae spp. were the principal bacteria involved. Third-generation cephalosporins were combined with aminoglycosides for 19 cases (60%) of osteomyelitis fistula and 3 cases (30%) of febrile osteomyelitis without fistula. Surgical treatment was fistulectomy in 94% of the cases of osteomyelitis fistula and sequestrectomy in 47%. More than half the pathological fractures were treated by immobilization in plaster, and sequestrum was restored by immobilization in plaster in 7 cases. The principal sequela was axial displacement of the limb. CONCLUSION: Complications of acute osteomyelitis are most often caused by diagnostic errors that delay treatment. Surgical treatment of the two principal lesions (fistula and bony sequestrum) followed by combination antibiotic therapy and completed by immobilization in plaster ensures complete recovery in more than half the cases.

[Failures of endoscopic treatment of vesico-ureteric reflux in children using Macroplastique]. / Echecs du traitement endoscopique des reflux vésico-urétéraux (RVU) de l'enfant par injection de Macroplastique.

INTRODUCTION: Macroplastique has been used since 1993 for the endoscopic treatment of vesico-ureteric reflux in children with a failure rate per injected ureteric unit of 21%. The objective of this study was to analyse these failures on the basis of endoscopic findings on injection, ultrasound data at 2 months post-endoscopy and operative findings during the secondary reimplantation. MATERIAL AND METHODS: The authors retrospectively reviewed cases of failure of Macroplastique treatment from September 1993 to December 2002. Only children undergoing subsequent surgical reimplantation were included in the study: 60 cases (57 girls, 3 boys). Another 68 patients also presented recurrence of reflux, but are currently asymptomatic and have not been reoperated. Twenty five patients (42%) initially presented unilateral vesico-ureteric reflux: bilateral injection was performed in 17 of these cases because of the anatomical findings on endoscopy. In 92% of cases, the refluxing ureteric orifice appeared to be abnormal (in terms of position, appearance and the submucosal course of the ureter). RESULTS: Eleven children (18%) presented symptomatic or asymptomatic urinary tract infection before the first clinical and radiological review at 2 months. On the first ultrasound examination, the implant was visualized in the bladder wall in 71% of cases. At reimplantation, the bladder mucosa was inflammatory in 56 patients (94%). The ureteric orifice remained gaping in 38% of cases and the implant appeared to be modified (migration, decreased volume) in 35% of cases. CONCLUSION: Failures of endoscopic treatment by Macroplastique can be due to persistence of pre-existing ureteric anatomical lesions (poor indication, technical error or difficulty) or modification of the injected product. Bladder inflammation and therefore previous or post-endoscopy urinary tract infections may also play a role.