[Evaluation of the glycemia of low-weight newborns within the 24th hour of life at Lomé University Hospital (Togo)]. / Évaluation de la glycémie des nouveau-nés de petits poids avant la 24(e) heure de vie au CHU-Tokoin de Lomé

OBJECTIVE: To assess the glycemia of low-weight newborns (LWNBs) during their first 24h of life as well as their mother's glycemia. PATIENTS AND METHOD: This was a cross-sectional prospective study within a case-control group, conducted at Lomé University Hospital (nationwide main hospital) from January to May 2006. One hundred thirty-nine LWNBs and 150 eutrophic term newborns (ETNBs), 98 mothers of LWNBs (MLWNBs), and 145 mothers of ETNBs (METNBs) were screened and monitored on glycemia dosage. RESULTS: The average glycemia level of the LWNBs (0.34 ± 0.27g/l) was significantly greater than the ETNBs' glycemia level (0.30 ± 0.14 g/l); it was nearly the same for the mean glycemia level of the MLWNBs (0.82 ± 0.2g/l) and the METNBs (0.77 ± 0.1g/l). Neonatal hypoglycemia during the first 24h of life was less frequent (RR=0.8) in the LWNBs (61.15%) than in the ETNBs (80%). The positive correlation between gestational age and glycemia was higher in the ETNBs (r=0.17) than in the LWNBs (r=0.07). This positive correlation between birthweight and glycemia was lower in the LWNBs (r=0.17) compared to the ETNBs (r=0.37); this was not the case within the group of the ETNBs (r=0.02) compared to the group of the LWNBs (r=0.34) concerning the correlation between the glycemia of mothers and newborns. CONCLUSION: The early hypoglycemia was much greater in the ETNBs compared to the LWNBs. Therefore, it is necessary to systematically start breastfeeding all newborns within their first hours of life whatever their gestational age, in order to solve these metabolic disorders.

[Primary results of antiretroviral treatment among HIV/AIDS infected children in Lomé (Togo)]. / Traitement antirétroviral des enfants infectés par le VIH/sida à Lomé (Togo): premiers résultats.

UNLABELLED: Since 2004 in Togo HIV/AIDS infected children have, free of charge, access to antiretroviral drugs according to the national program. The aim of this study was to investigate the clinical, biological and prognosis aspects of anti-retroviral treatment on HIV/AIDS infected children. PATIENTS AND METHOD: We conducted a cross sectional study on 72 HIV/AIDS infected children with anti-retroviral treatment, under the supervision of clinicians within 3 associations specialized in the management of subjects infected by HIV/SIDA at Lomé (Togo). RESULTS: The average age of children was 6 years 9 months. The middle age to HIV screening was 4 years 2 months. The sex ratio was 1.05. The majority of these children (79.2%) were orphans of at least 1 of their parents. All the children were stemmed from families with modest income. The transmission mother to child was the way of HIV contamination found among all the children. To a certain extent, all the children were infected by the HIV 1. Most of the children (66.7%) receiving an antiretroviral treatment for at least 6 months were asymptomatic and had no more immunodeficiency. After 15 months, the children have gained 464 CD4/mm(3). The initial protocols antiretroviral prescribed among children were: zidovudine-lamivudine-abacavir (36.1%), lamivudine-didanosine-nevirapine (30.5%), lamivudine-stavudine-nevirapine (29.2%), zidovudine-lamivudine-didanosine (4.2%). The digestive disorders have been the first side effects (83.4%). The rate of good observance was middle (51%) and lowered with the increased age of children, and the period of the anti-retroviral treatment. CONCLUSIONS: Antiretroviral treatment among HIV/AIDS infected children is giving good results in Togo. But many efforts remain to increase the number of beneficiaries.

[Foreign bodies of the esophagus: etiologic and therapeutic aspects. Experience at the CHU of Lomé (Togo)]. / Corps étrangers oesophagiens: aperçu étiologique et thérapeutique. Expérience du CHU de Lomé (Togo).

AIM: To give details of the management of esophageal foreign bodies (EFB) at our hospital. DESIGN: Retrospective case review. SETTING: ENT ward of Tokoin Teaching Hospital, Lome, Togo. PATIENTS: All 105 patients admitted to the hospital for ingestion of foreign bodies between January 1990 and December 1993. The outcome for each patient was determined by examining hospital records of demographic information, identification of the foreign body and the removal procedure used. RESULTS: EFBs accounted for 6.5% of all hospital admissions. The objects ingested included coins (59.0% of cases), particularly in 2 to 5 year-old children, fish bones (12.4%), meatballs, meat bones and dentures, particularly in adults. The foreign objects were mostly removed by esophagoscopy, but sharp objects required esophagotomy (2.9%). One patient died (0.9% of cases) due to mediastinitis caused by perforation of the esophagus by a chicken bone. CONCLUSION: Community health education programs, increasing awareness of household accidents might reduce the number of emergency hospital admissions for ingestion of foreign bodies.

[Pediatric AIDS at the University Hospital Center-Tokoin (Lomé): the role of protein-calorie malnutrition and a formulation trial of a clinical diagnostic score]. / Sida pédiatrique au CHU-Tokoin (Lomé): place de la malnutrition protéino-énergétique et essai d'élaboration d'un score de diagnostic clinique.

Two cross-sectional studies were carried out in the pediatric ward of the Tokoin Teaching Hospital, Lome. One study determined the prevalence of HIV infection in the 49 malnourished patients treated in the ward in February to March and between August and December 1994. The other was carried out between July 1994 and January 1995 and included 57 other hospitalized children fulfilling at least one of the WHO's pediatric AIDS criteria. The aim was to draw up a screening system for pediatric AIDS based on clinical scores that would be more sensitive than and as specific as the WHO criteria. We tested these criteria and the other signs used in the suggested scoring system using the reference test, HIVchek. The seroprevalence of HIV was 28.6% in malnourished children and transmission was probably exclusively from mother to child. It was difficult to distinguish pediatric AIDS from protein energy malnutrition on clinical grounds, although some of the associated morbidities, including anemia, adenopathy and splenomegaly, were highly suggestive of pediatric AIDS. The second study showed that: 1) the sensitivity of the WHO criteria was low; 2) the best positive predictive values were obtained in cases of polyadenopathy and confirmed HIV infection of the mother. Both these criteria were relatively infrequent; 3) there were 6 criteria significantly associated with HIV infection, each being given a point score according to its Yule coefficient: chronic cough (4 points), chronic diarrhea (3 points), chronic fever (2 points), oropharyngeal candidiasis (2 points) and marasmus (1 point). A score of 4 points was the threshold for suspicion of pediatric AIDS. Our scoring system was more sensitive than the WHO criteria and had similar specificity and positive predictive value. We stress the importance of preventive measures against HIV infection, particularly for women of child-bearing age and suggest a new score test and appropriate clinical definitions for infants and older children.

[The use of Doppler echocardiography in the diagnosis of congenital heart disease in the Pediatric Department of CHU-Tokoin, at Lomé (Togo)]. / Apport de l'échocardiographie-Doppler dans le diagnostic des cardiopathies congénitales dans le service de pédiatrie du CHU-Tokoin, à Lomé (Togo).

Currently, echography coupled with Doppler is a primary technique in the diagnosis of congenital heart disease. Since September 1993, the pediatric ward of the Tokoin teaching hospital of Lome has been equipped with this technology. During the following 23 months, there were 299 examinations with Doppler-echocardiography among the consultations of 15,082 children. Eighty-two cases of congenital heart defects were detected in 73 children, aged between 3 days and 13 years, of whom 79.4% were between 7 days and 30 months old. In all cases, either pulsed or continuous Doppler-echocardiography was performed at the request of doctors treating symptoms suggestive of cardiac disease, such as heart murmur (67%) and cyanopathy (22%). The noncyanotic cardiopathies found were ventricular septal defects (24%), patent ductus arteriosus (21%), interatrial septal defects (18%) and atrioventricular canal defects (9%). The most frequent cyanotic cardiopathy detected was Fallot's tetralogy (19.5%). Thus, early diagnosis and management of congenital heart disease is facilitated by systematic examination of newborns and sustained collaboration between pediatricians, obstetricians and cardiologists.

[Laryngeal papillomatosis in children: therapeutic problems apropos of 39 cases at the Lomé University Hospital Center]. / Papillomatose laryngée de l'enfant: problèmes thérapeutiques à propos de 39 cas au CHU de Lomé.

The retrospective study about 39 cases of laryngeal papillomatosis emphasizes the management difficulties due to slenderness of therapeutical resources, delayed consultations because of health under education of the community and patients' discouragement during treatment of such a relapsing disease. Consequently, tracheostomy was needed immediately (25.64%), breaking of the voice (48.72%) was noted as well as school backwardness. The use of laser and interferon in laryngeal papillomatosis treatment is for the future in Togo.