Mortality at the pediatric emergency unit of the Mohammed VI teaching hospital of Marrakech.

BACKGROUND: The death of a child at the emergency ward is one of the most difficult problems that the clinicians of these wards have to deal with. In our country the published data concerning the causes and the factors related to pediatric mortality especially in the pediatric emergency wards is very rare. This study aimed to study the epidemiology of the pediatric mortality in the pediatric emergency department (PED), to determine its rate and identify its most frequent causes. METHODS: It is a retrospective and descriptive study, over five years (1st January 2012 and 31st December 2016) including all children aged from 0 to 15 years old who died at the PED in the Mohamed VI Hospital in Marrakech. RESULTS: During the period of the study a total of 172.691 patients presented to the PED, among which 628 died (pediatric mortality rate: 3.63%). The masculine gender was predominant (n = 383) with a gender ratio of 1.59. Two-thirds of the patients died in the first 24 h (n = 421). The median of time from admission to death was around 12 h. Majority of the deceased children (n = 471, 75%) were from a low socioeconomic status. The most frequent cause of admissions for deceased patients in the PED was respiratory distress (n = 296, 47%) followed by neurological disorders (n = 70, 11%). Neonatal mortality (≤ 1 month of age) was predominant (n = 472, 75.1%), followed by postnatal mortality (1 month to 1 year old) (n = 73, 11.6%). The most frequent causes of pediatric mortality, whatever the age range, were dominated by neonatal pathologies (n = 391, 62.3%), followed by infecious causes bronchopulmonary infections included (n = 49, 7.7%), birth deformities (n = 46, 7.3%) while traumas were merely at 0.9% (n = 6). The most frequent causes of neonatal mortality were neonatal infections (n = 152, 32.2%) and prematurity (n = 115, 24.4%). CONCLUSION: Our data once again underline the crucial importance of prevention. This requires correct follow-up of the pregnancies, an adequate assistance of births, and perfecting healthcare provision to newborns in order to attain proper assistance.

Management of periorbital cellulitis at the Pediatric Emergency Department: A ten years study.

Periorbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the prognosis for vision and survival. PURPOSE: The goal of this study was to analyze the epidemiological and therapeutic features and outcomes of periorbital cellulitis cases treated in the pediatric emergency department. PATIENTS AND METHODS: A retrospective study including all the children aged between 1 month and 15 years treated for periorbital cellulitis in the Pediatric Emergency Department of the Mohamed VI University Teaching Hospital in Marrakech over a period of 10 years (January 1, 2010-December 31, 2019). RESULTS: In all, 168 cases of periorbital cellulitis were recorded, with an increasing of the number of cases, from 2 in 2010 to 39 in 2019. The most affected age bracket was the group under 5 years of age (62.5%). The most frequent mode of entry was sinusitis (22%). Preseptal cellulitis was most common (76.7%). The main clinical signs found in orbital cellulitis were proptosis (64%) and chemosis (35.8%), versus conjunctival hyperemia (78%) in preseptal cellulitis. Ophthalmoplegia was present in two cases of orbital cellulitis. The right side was most affected (44%). An orbital CT scan was performed in all cases in our study, showing preseptal cellulitis in 129 patients (76.7%), orbital cellulitis in 14 cases (8.3%), subperiosteal abscess in 20 cases (12%) and orbital abscess in 5 cases (3%). Prior treatment with non-steroidal anti-inflammatory medication was noted in 6%. The most commonly used antibiotic was amoxicillin-clavulanic acid. Steroid treatment was prescribed in 6% of cases. Surgical treatment was indicated in 12 patients (7.1%). The mean hospital length of stay was 3 days for the preseptal cases and 8 days for the orbital cases. All patients had good outcomes with medical and/or surgical treatment. With follow-up of over one year, no complications were noted. CONCLUSION: The majority of our cases had positive outcomes, highlighting the advantage of early diagnosis, adapted antibiotic treatment and multidisciplinary care, rendering surgery rarely necessary.

[Necrotic lesion of the lip and cough with fever: cutaneous and pulmonary anthrax]. / Une lésion nécrotique de la lèvre et une toux fébrile chez un nourrisson marocain.

Anthrax disease is an anthropozoonosis caused by Bacillus anthracis. It appears in three clinical forms: pulmonary, intestinal, and cutaneous. We report a case of pulmonary and cutaneous anthrax in a one-year-old Moroccan infant.

[Characteristics of the children with epilepsy followed in the Marrakech University Hospital]. / Caractéristiques des enfants ayant une épilepsie suivis au CHU de Marrakech.

INTRODUCTION: Epilepsy is one of the most frequent neurological diseases in the pediatric population. Many epidemiological studies have been published, but with rather discordant results, because of methodological differences. In our context, epilepsy constitutes a public health problem. National epidemiological data are scarce. OBJECTIVES: To describe the characteristics of children with epilepsy, to analyze the risk factors and to assess the impact of the disease on schooling. METHODS: This was a retrospective study concerning 592 children attending the Mohammed VI university hospital center pediatric unit A outpatient clinic for epilepsy from August 2003 to December 2007. RESULTS: Epileptic syndromes were classified according to the criteria of the International League Against Epilepsy of 1989. Prevalence of epilepsy was 8.5%. Average age was 6 years 7 months. Age of seizure onset ranged from 2 months to 14 years. Male gender predominated. Antecedents were dominated by peri- and neonatal complications. Parental consanguinity and a family history of epilepsy were found in 19.2 and 11.6% of cases, respectively. Schooling was perturbed in more than one-third of the school-age children. Generalized seizures were most common (70.5%). Association with cerebral palsy was present in 18.6% of cases, with mental retardation in 4.7%. The epilepsy was idiopathic for 41% of the children, symptomatic for 39% and cryptogenic for 20%. Generalized epileptic syndromes were the most frequent, epilepsy absence (12%), Lennox-Gastaut syndrome (6%), West syndrome (5.5%) and myoclonic epilepsy (4%). The most common partial epileptic idiopathic syndrome was benign childhood epilepsy with centrotemporal spikes. Single-drug therapy was the rule for first intention treatment (96.8%). Sodium valproate was the antiepileptic drug most widely used (82%). Treatment led to resolution of the seizures in 76% of the children. CONCLUSION: Preventive measures should be reinforced in our context with a considerable proportion of children presenting neonatal risk factors. Efforts should be made to improve schooling for children with epilepsy.

[Diarrheal disease in the region of Marrakech, Morocco]. / Enquête sur la prise en charge de la maladie diarrhéique dans la région de Marrakech (Maroc).

OBJECTIVES: Diarrhea is the second cause of child morbidity and mortality in Morocco after acute respiratory infection. Each child suffers from 4 to 8 episodes of diarrhea per year. The purpose of this study was to evaluate the knowledge as well as diagnostic and therapeutic practices of general practitioners regarding children presenting with diarrhea. METHODS: Study was based on an epidemiologic survey using a written questionnaire completed by general practitioners in state-run hospitals in the Marrakesh (Tensift El Haouz) region. The anonymous questionnaire containing items on the epidemiological, clinical, laboratory, and therapeutic aspects was distributed in all 5 medical districts in the region. RESULTS: Analysis of reponses concerning therapeutic practices showed heavy reliance on oral rehydration that was prescribed by 98.2% of general practitioners. Dietary analysis was performed by only 24% of practitioners and blood/stool testing was not systematically ordered. Only 3% of practitioners recommended early resumption of feeding. However, data showed excessive use of additional laboratory tests (57.8%) and prescription drugs (48.8%). Overprescription mainly involved antiemetics and anti-diarrheals (77.7%). CONCLUSION: This study demonstrates an urgent need to develop a strategy to improve the quality of dietary management of diarrhea by general practitioners and rationalize prescription drug use. A continuing medical education program would be useful to increase the awareness of general practitioners and reduce child/infant morbidity and mortality relating to this disease.

[Acrocallosal syndrome without psychomotor abnormality: a case report]. / Syndrome acro-calleux sans retard mental: à propos d'un cas.

We report a case of acrocallosal syndrome in a 7-month-old female patient born to consanguineous parents, who presented with agenesis of the corpus callosum, polydactyly, and minor craniofacial dysmorphism. This case is similar to two other occurrences described in the literature, with no psychomotor development delay and hypotonia.

A Rare Cause of Hypovolemic Shock in Prepubertal Girl: Vaginal Leech Infestation.

Vaginal bleeding in girls is an alarming symptom for both parents and pediatricians. Serious underlying causes should be always evoked. Case Report. We describe here a 9-year-old girl who was admitted at our emergency department for vaginal bleeding and severe anemia. No history of trauma and no evidence of prior abuse were reported by the parents. Full Blood Count showed profound anemia (hemoglobin at 4 g/dl). The child was managed as a hypovolemic shock and resuscitated with intravenous fluids and urgent blood transfusion. Gynecologic examination found a live leech at the vulva and the extraction was facilitated by applying a saline solution. The child was clinically stable and discharged home the next day with ambulatory treatment. Conclusion. This case emphasizes that a through external genital exam with possible exam under anesthesia should be undertaken in all girls with unexplained vaginal bleeding and that in those living in rural areas without potable water, leech infection should be considered.

[Moyamoya disease in children: a case report]. / Maladie de Moyamoya : à propos d'un cas pédiatrique.

Moyamoya is an angiogenic disorder and a rare cause of stroke. It is a progressive narrowing of cerebral arteries at the base of the brain involving the intracerebral portion of the internal carotid arteries, where it leads to development of collateral arteries, causing a "cigarette smoke" aspect. Ischemic events are more frequent in pediatric pathology, where hemorrhagic manifestations account for only 10%. The prognosis is severe, even worse than when onset of symptoms is earlier. We present the case of an 8-year-old child, who had presented recurrent hemiparesis since the age of 3 years; the brain CT scan and magnetic resonance imaging objectified injury sequelae. The MRA revealed stenosis of the internal carotid artery consistent with Moyamoya. In conclusion, the diagnosis of Moyamoya disease is now accessible to modern brain imaging techniques (MRI and MRA), easily achievable in children. The natural course of the disease involves the neurological and vital prognosis in young children, due to repeated ischemic attacks. Their identification would facilitate early diagnosis in order to treat neurosurgically, leading to a better neurological and cognitive prognosis.

[Survey on passive smoking in children in Agadir]. / Enquête sur le tabagisme passif chez l'enfant à Agadir.

INTRODUCTION: The aim of the study was to assess children's exposure to tobacco smoke at home, at school and in public places, to study its risks and to educate parents about the dangers of passive smoking. METHODS: This is a survey conducted in October 2007 among children enrolled in pre-school and primary school in the city of Agadir, Morocco. The data was gathered by a written questionnaire completed by parents at home. RESULTS: The survey covered 776 children. The response rate to the questionnaires was 88%. The father was a smoker in 28.9% of cases, against 0.7% for the mother. The prevalence of childhood exposure to tobacco was 34.1% at home, 36.4% in public places and 30.1% in schools. Concerning pregnant women, passive smoking and/or active was associated with a significantly increased risk of respiratory distress in newborn babies and hospitalisations in the neonatology department. In infant and child, involuntary inhalation of tobacco smoke involved an increased risk of sudden infant death syndrome and recurrent respiratory symptoms. However, its noxious effects were not found in the case of child asthma and tumour. CONCLUSION: Passive smoking is a real public health problem and smoking is a dangerous but also a preventable source of pollution.

[Prevalence of anti-hepatitis A virus antibodies in chidren in Marrakech]. / Prévalence des anticorps de l'hépatite A chez l'enfant dans la région de Marrakech.

OBJECTIVE: To determine the prevalence of anti-hepatitis A virus (HAV) antibodies among Moroccan children and to examine some of the factors influencing its transmission. METHODS: 150 children, aged six months to 14 years, were tested for anti-HAV IgG (indicating past infection). A questionnaire concerning personal and epidemiological data relating to hepatitis A was completed. RESULTS: The overall prevalence of anti-HAV antibodies was 51%. There was no significant difference between male and female children. The proportions of children positive for HAV-IgG varied significantly with age: 70.3% in the 7-14 age range were positive compared with 45.2% aged 6 years and less. Urban inhabitants did not have a higher prevalence than rural residents did. Socioeconomic factors were significantly correlated with the prevalence of anti-HAV-IgG, the father's level of education having the strongest influence. CONCLUSION: The high overall HAV prevalence in children confirms that Morocco is an intermediately endemic area for HAV infection. Morocco is entering a transitional phase and the introduction of hepatitis A vaccination in early childhood may reduce the prevalence of this infection and prevent outbreaks.