[Relationship between the obstructive character of the tonsils and the sagittal cephalometric measurements]. / Relations entre le caractère obstructif des amygdales palatines et les mensurations céphalométriques du sens sagittal.

INTRODUCTION: The role of obstructive tonsils in the sagittal dimension of the skeleton-dental abnormalities is widely discussed in the literature but remains controversial. Data on the probable relationship between obstructive tonsils and the presence of these abnormalities were subjective. The objective of this study was to quantify the relationship between the obstructive character of the tonsils and the sagittal cephalometric measurements. MATERIALS AND METHODS: A cross-sectional study was performed in children aged between 6 to 12 years divided into 2 groups (A and B) according to the obstructive character of the tonsils. Cephalometric measurements were recorded on each child. Data were analyzed using SPSS 20.0 for Windows. At Student test was used to compare quantitative variables according to the obstructive character of the tonsils. Significance was set at p = 0.05. RESULTS: Subjects with obstructive tonsils (group B) are significantly more trend to have a convex facial profile and a skeletal class II with more mandibular retrusion and retroclined incisor compared with subjects without obstructive tonsils (group A). CONCLUSION: Early evaluation of children with obstructive tonsils can prevent sagittal dimension of the squeleto-dental abnormalities caused by upper airway obstruction. Thus late and more aggressive treatments which are not always as efficient as when they were performed during childhood will be avoided.

[Portal cavernoma at child about two observations]. / Cavernome portal chez l'enfant a propos de deux observations.

We report two observations of portal cavernoma diagnosed successively in Bamako and Dakar. The first is a 6-year-old male admitted to the service for ascites and abdominal pain. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The clinical examination noted a moderate skin-mucosal pallor, asthenia. The biological assessment returned to moderate normochrome anemia with impaired pancreatic function while renal and hepatic functions were maintained. The abdominal scan performed after two low-contribution abdominal ultrasounds, objected signs in favor of a portal cavernoma with perisplenic and gastric varicose veins. The second is an 8-year-old male child born from an unborn marriage and from a followed pregnancy with premature delivery. His pathological history includes a notion of prematurity that required a stay in neonatology with umbilical catheterization and repeated abdominal pain. He had an acute abdominal episode in March 2015 justifying a surgical hospitalization for suspicion of appendicitis. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The abdominal ultrasound prescribed for this was suggestive of portal cavernoma, later confirmed by abdominal computed tomography.

Nous rapportons deux observations de cavernome portal diagnostiqué successivement à Bamako et à Dakar. Le premier est un enfant de 6 ans de sexe masculin admis dans le service pour ascite et douleurs abdominales. L'examen clinique notait une pâleur cutanéo-muqueuse modérée, une asthénie. Le bilan biologique retrouvait une anémie modérée normochrome normocytaire avec une fonction pancréatique perturbée tandis que les fonctions rénales et hépatiques étaient conservées. Le scanner abdominal réalisé après deux échographies abdominales peu contributives, objectivait des signes en faveur d'un cavernome portal avec varice péri-splénique et gastrique. Le second est un enfant de 8 ans de sexe masculin né d'un mariage non consanguin et issu d'une grossesse suivie avec accouchement prématuré. Il est le 3e enfant de sa fratrie et scolarisé. On retrouve dans ses antécédents pathologiques une notion de prématurité ayant nécessitée un séjour en néonatologie avec cathétérisme ombilical et des douleurs abdominales à répétition. L'enfant a commencé à se plaindre de douleurs abdominales récurrentes vers l'âge de 6 ans. Douleurs de siège péri ombilical sans réveil nocturne dans un contexte de constipation chronique d'allure fonctionnelle. Il a fait un épisode abdominal aigu justifiant une hospitalisation en chirurgie pour suspicion d'appendicite. A l'admission les paramètres cliniques (poids, taille, température, périmètre crânien et température) étaient dans les normes pour l'âge. L'échographie abdominale prescrite à cet effet était évocatrice de cavernome porte, confirmé par la suite par la tomodensitométrie abdominale.

[Morel-Lavallée lesion in orthopaedic surgery (Nineteen cases)]. / Épanchement de Morel-Lavallée en chirurgie orthopédique (À propos de 19 cas).

AIMS: The object of this work is the study of especially ancient clinical forms of the effusion of Morel-Lavallée, to discuss the place of deep fascial fenestration by Ronceray and to propose criteria of therapeutic indication. PATIENTS AND METHOD: Our study concerns a continuous retrospective series over 20 years from 1989 till 2009. Eleven men and eight women, 36.7 year-old on average were treated for an effusion of Morel-Lavallée. The dominant etiology was represented by the accidents of the public highway. The collection was discovered after 41.4 days on average (extremes of 1-180 days). The volume of the collection was on average of 1237cm(3) (extremes 60cm(3)-12L). RESULTS: The conservative treatment concerned all patients who had a recent collection lower than three weeks and three others who had an ancient collection. The surgical treatment was established after all 10 times among which four in first intention and six times after failure of the previous treatment. The cure was obtained in 91% of the patients who had a recent collection by the only conservative method and among four patients by the method of Ronceray. To the three others, it was obtained after iterative unbridlings and talcage treatment. CONCLUSION: The authors insist on certain rare forms met in Africa in particular the "virtual form", the ancient forms and the too plentiful forms (12L). They plead for use deep fascial fenestrations by Ronceray for these last ones.

[Low level educated community health workers training: a strategy to improve children access to acute respiratory treatment in Senegal]. / La formation des agents de santé communautaire instruits: une stratégie pour améliorer l'accès des enfants au traitement des infections respiratoires aiguës au Sénégal.

BACKGROUND: Acute respiratory infections (ARI) are the leading cause of death in childhood. Most of children's deaths happen at home without health level first cares. However in Senegal only health workers are allowed to prescribe antibiotics. A competency-based training was developed to improve and assess the management of acute respiratory infections in young children aged 2 to 59 months by low level educated community health workers (CHWs) in 4 districts of Senegal. The first findings showed the CHWs capable of acquiring the skills needed to effectively manage ARI cases in accordance with the World Health Organization's ARI case management strategy. The aim of this study was to assess the quality of their management after a 1 year follow-up. METHODS: We provided to CHWs 3 days course in ARI management. After the 3-day course, a 4-month follow-up was performed. We organized a 1-day refresher course every month and in every district. In order to assess the quality of management of CHWs we analyzed the management process and compared the CHWs classification to the classification of the first level health facilities. RESULTS: Twenty-three percent (3727/15,965) of IRA cases of district were managed by CHWs. Ninety percent (2738/3042) among them were well classified, well managed and well followed-up. But 28% of severe pneumonia cases were misclassified as pneumonia. About treatment, 22.5% of 'cough or cold' got wrong treatment with cotrimoxazole and 10.3% of severe pneumonia got cotrimoxazole without referral. Less than half of severe pneumonia benefited of the first follow-up and only 18% of the second. CONCLUSIONS: The results highlight that a CHWs low-level educated in French, trained and followed-up could apply the WHO algorithm of IRA management. They could help to give proximal care related to children ARI, to the community. But it seems useful of emphasizing the recognition of danger signs and the follow-up of severe cases.

[Pédiatric haemophilus influenzae b meningitis in Dakar]. / Méningite pédiatrique à haemophilus influenzae b à Dakar.

OBJECTIVE: This study had for aim to determine the etiology of Haemophilus b pediatric meningitis. DESIGN: A retrospective study of 216 biologically confirmed cases was carried out during 6 years (January 1995- December 2000) on children 0 to 15 years of age, hospitalized at the Albert Royer Children Hospital Center. RESULTS: Haemophilus influenzae b is the first cause of pediatric meningitis (19.7%) followed by Nesseria meningitidis (14.5%), and Streptococcus pneumoniae (13.6%). The Haemophilus influenzae b meningitis cases are distributed all year round with a peak between January and March, that is to say, during the dry and cool season. They affect children at an average age of 11.7 months, with a sex ratio of 1.1 for boys. Almost all of the patients live in the low-socio-economic areas of the Dakar suburbs (92.8%). More than 90% of the H. influenzae b isolates are sensitive to ceftriaxone (96%) chloramphenicol (93%), and to ampicillin (91%). Clinical evolution is marked by death (17.8%) and recovery with psychological, sensory, and motor sequels (19.9%). CONCLUSION: This report should help to include the combined vaccine Antihaemophilus influenzae b in the Senegalese Broad Vaccination Program. The final aim is the reduction of morbidity and mortality of infections due to Haemophilus influenzae b.

[Cardiovascular emergencies in Subsaharan Africa]. / Urgences cardiovasculaires en Afrique subsaharienne.

BACKGROUND: The increasing prevalence of cardiovascular diseases in subsaharan Africa and their related mortality and morbidity have been established. A large number of them present as emergencies. The purpose of this first multicentric study was to assess the causes, management and outcome of cardiovascular emergencies in savannah and forest environments. METHODS: A total of 665 patients were included from seven participating centers in seven countries: 417 were classified as belonging to the savannah zone (Dakar, Nouakchott, Ouagadougou, N'djamena) whereas 248 patients were from the forest zone (Abidjan, Libreville, Yaounde). Patients were examinated by one or several cardiologists. Statistical analysis was performed by the Medical Statistic Unit of the Hopital Nord, Marseille (France). RESULTS: There were more men (53.4%) than women (46.6%). 77.7% of the patients lived in urban areas. Most of them had low or very low incomes. Patients reached the hospitals in ambulances only in 6.2% of cases. The remaining others were transported by routine urban vehicle or bicycle or ambulation. The mean delay between the onset of symptoms and the arrival to the emergency unit was 6.8 days. Three immediate situations were preponderant: severe hypertension (32.2%), heart failures NYHA IV (27.5%), stroke (20.3%). Underlying conditions were: mainly chronic hypertension (52.3%), cardiomyopathies (20.6%), valvular heart diseases (11.1%). Coronary heart diseases were rare (6.1%). The observed mortality was 21.2% without any differences in age groups. The most common emergencies resulting in death included: stroke (31.9%), vascular collapses (18.4%), pulmonary embolism (9.2%). The patients from the savannah zone were younger, more often classified in the low or average socioeconomic level. Hypertension was more frequent in forest zones. Valvular heart diseases were more frequent in savannah. Cardiomyopathies were comparable in both zones. Coronary heart disease was slightly more common in the savannah area. DISCUSSION: Compared with patients from western countries, the African patients are younger because some diseases affect young people like rheumatic heart disease or postpartum and infectious cardiomyopathies. The difficulties to reach health care facilities made the outcome more severe. Hypertension and valvular heart disease deserve priority in preventive strategy. Cardiomyopathies have to be studied to precise their causes. Finally, the management of cardiovascular emergencies needs a special care in the hospitals owing to their increasing frequency and their severity.

[Supervision of body composition and cardiovascular parameters in long sprint running athletes (400 m)]. / L'entrainement au sprint long (400 metres plat): suivi de la composition corporelle, des constantes cardiovasculaires et de l'electrocardiogramme des athletes.

INTRODUCTION: The follow-up of performances and the prevention about possible incidents at the athletes make necessary the medical supervision in physical training. The aims of this study are to estimate the effect of a precompetition training program in athletes' body composition, and cardiovascular modifications (in clinical examination and electrocardiogram) MATERIALS AND METHODS: Ten athletes (3 men and 7 women; mean age of 23.6 +/- 3.16 years) of Dakar international Athletics' Center are subjected to a training on a period of 2 months in aerobic dominant followed by a period of 3 months in anaerobic dominant. At the beginning and the end of training program, an electrocardiogram is recorded after blood pressure (BP) measure in lying and standing posture and heart rate (HR) take. The weight, height and cutaneous folds are measured to calculate the body fat percentage, fat body mass, fat-free mass and body mass index. Every athlete has performed the Ruffier test Comparisons are realized by the paired t-test, statistically significant for a p value < 0,05 RESULTS: Significant declines after training interest HR (79.2 +/- 14.7 vs 63.2 +/- 10.25 beat min(-1); p< 0.001), systolic BP in standing posture (11.8 +/- 0.44 vs 10.6 +/- 0.96 mmHg; p= 0.02), and Ruffier index (4.4 +/- 3.28 vs 2.23 +/- 1.62; p= 0.048) whereas the fat-free mass increased (53.14 +/- 8.41 vs 54.16 +/- 9.67 kg; p= 0.046). At the electrocardiogram, the number of athletes having sinusal bradycardia is crossed from 1 to 4; there is no modification as for the two cases of uncomplete right bundle-branch block and the pre-existent left ventricular hypertrophy. Negative T waves in V1 and V2 leads are present in one athlete before training and in two others after. CONCLUSION: The impact of the specific training on body is real, interesting more the cardiovascular system.

[Efficiency of kangaroo care on thermoregulation and weight gain of a preterm newborn cohort in Dakar]. / Efficacite de l'elevage par la methode kangourou sur la thermo- regulation et le gain ponderal d'une cohorte de prematures.

AIM OF THIS STUDY: to evaluate the efficacy of kangaroo method on thermoregulation and weight gain of a cohort of preterm. METHODS: it is a retrospective study based on files of preterm baby weighting below 2000 g, included after discharge to neonatal unit of Aristide Le Dantec maternity for kangaroo method care. Efficiency was appreciated on thermic curve evolution and daily weight gain. RESULTS: 56 preterm babies were including. Mean gestational age was 33 +/- 7,6 weeks and mean birth weight, 1488 +/- 277,6 g (median = 1500 g). Mean temperature was satisfying during follow up and was stable around 37 +/- 0,5 degrees C at discharge of program with mean daily weight gain of 33 +/- 7,6 g. We had only one case of death. CONCLUSION: The results of this study point out efficacy of kangaroo method on thermoregulation, weight gain and survival of preterm babies. We advocate for promotion in developing countries because of its low cost.

[Beckwith-Wiedemann syndrom: a case report in Dakar]. / Le syndrome de Beckwith-Wiedemann. A propos d'un cas a Dakar.

BACKGROUND: Beckwith-Wiedemann syndrome is a congenital syndrome with variable phenotypic expression. It is less commonly described in Africa. We report a case in Dakar universitary hospital center. OBSERVATION: This report is about a two month old child from Mauritania presenting an hemihypertrophy, macroglassia and an umbilical hernia. Glycemia was under normal level showing a mild hypoglycemia (0,6 g/dl). T3, T4 and TSH values were in normal range. Abdominal echography was normal. Our patient was stable at the first clinical examination. CONCLUSION: we advocate for dietetic measures and rigorous clinical follow up, every 3 to 6 month, to screen for recurrent hypoglycaemia and the occurence of an eventual neoplasmic desorders.

[Study of the Consumers' preference on the universal health coverage development strategy through health mutual in Ziguinchor Region, Southwest of Senegal]. / Étude de la préférence des usagers sur les stratégies de développement de la couverture sanitaire universelle à travers les mutuelles de santé dans la région de Ziguinchor au sud-ouest du Sénégal.

In Senegal, the informal and rural sector that accounts for over 80% of the population is covered only up to 7% by a health insurance system. That is why, for the implementation of development strategy of the universal health coverage (UHC) through mutual health insurance providers, the Government of Senegal has focused on this sector. The objective of this study was to assess the consumer's preference on the UHC development strategies through mutual health insurance providers. This was a qualitative and exploratory study based on a literature review, and indepth interview with the heads of households. It was also based on focus groups of people with and without health mutual membership, and the Expert Committee meetings. The results showed that the most critical attributes in the decision-making of consumers to join the health mutual in Ziguinchor were the membership units; the content of the benefit package, the payment modalities of the premium, the premium amount, the availability of transportation, the co-payment level, convention arrangement with health facilities, and health mutual governance. For a successful implementation of the UHC development strategy through health mutual organizations, policymakers should explore the possibility of introducing the modality of payment in kind, the revision of the co-payment amount, and the promotion of equity through the introduction of a differentiated premium contribution by income. They should also establish a crossborder strategy with The Gambia and Guinea-Bissau to improve health care access to people living in the borders. The promotion of innovative funding and risk equalization between health insurance schemes is also recommended. In areas where the microfinance institutions are well organized and structured their substitution to health mutuals should be an option the decision-makers have to explore.

[Kangaroo mother care for low birth weight infants at Albert-Royer National Children Hospital Center of Dakar]. / Les soins kangourou pour nouveau-nés de faible poids de naissance au centre hospitalier national d'enfants Albert-Royer de Dakar.

INTRODUCTION: Kangaroo care (KC) is an effective method to care for low birth weight (LBW) newborns, particularly in developing countries. The objective of this study was to estimate the efficacy of this method and its impact on morbidity and mortality of LBW infants admitted to the KC unit of Albert-Royer National Children's Hospital Center (ARNCHC) in Dakar, Senegal. MATERIAL AND METHODS: This was a retrospective, single-center study from July 2011 to July 2013. We collected sociodemographic, maternal, and obstetrical data, neonatal characteristics and information during KC (age and weight at inclusion, thermoregulation, feeding, growth, and overall progression). Data were entered and analyzed using SPSS version 9.0. RESULTS: We included 135 newborns, with a female predominance (sex ratio: 0.78). One-third of the mothers (35.5%) were primiparous and only 21.1% had a socioprofessional activity and the majority had a low educational level. The mean gestational age (GA) was 33.08±2.06 weeks of amenorrhea and the mean birth weight 1485±370 g. There were 20 term babies with intrauterine growth restriction (IUGR) (14.8%) and 115 (85.2%) preterm newborns, 83 (72.2%) of whom, showed IUGR. The mean duration of conventional care was 12.3 days (range: 4-27 days) and the main complications were respiratory distress (46.2%), infection (36.9%), and necrotizing enterocolitis (15.1%). At KC admission, the mean post-conceptional age was 34.2±2.46 weeks and the mean weight 1445±319 g (minimum, 700 g). The main complications in KC were infections (20.2%), hypoglycemia (18.5%), and gastro-esophageal reflux disease (16.4%). Only 56.3% of the babies were exclusively breastfed. The mean weight gain during the stay in the KC unit was 15.3±9.08 g/kg/day and the mean weight at discharge was 1761±308 g. Only three episodes of hypothermia were noted. The mean duration in the KC unit was 10.2 days (range: 3-24 days). Five babies died (3.7%): one during KC, one at home, and the three others after readmission to neonatology. CONCLUSION: Kangaroo care for LBW infants is highly effective in our context. This method should be spread to a large majority of health centers in the country.

[Epidemiological and clinical aspects of paediatric HIV infections in Albert-Royer Paediatric Hospital (Dakar, Senegal)]. / Aspects épidémiologiques et cliniques de l'infection à VIH de l'enfant au centre hospitalier national d'enfants Albert-Royer à Dakar.

UNLABELLED: Human Immunodeficiency Virus (HIV) infection prevalence rate is estimated at 1.4% in Senegal, and about 3,000 children could be infected. HIV positive children are followed up since 2000 in Albert Royer Hospital (Dakar, Senegal). OBJECTIVES: To describe clinical and epidemiological aspects of HIV paediatric infection, and to evaluate the implementation of high active antiretroviral therapy in HIV positive children in our country. POPULATION AND METHODS: Over a period of three years, the medical reports of 98 infected patients have been collected, 96% with HIV 1 infection. RESULTS: Most of the patients had a maternally transmitted HIV infection (99%). At their enrollment, the median age was 60 months; malnutrition (79%), persistent lymphadenopathy (65%) and skin lesions (64%) were the common clinical manifestations. Thirty-nine percent of the patients were in class C (CDC) and 81% had CD4 cell count< or =25%. Median viral load were 421,852 copies/ml at presentation. Seven infants had a rapid progressive disease with encephalopathy. Thirty-six patients received high active antiretroviral therapy with high observance and good tolerance. CONCLUSION: This study allowed to define clinical and biological profile of paediatric HIV infection in our country and to update the implementation of high active antiretroviral therapy.

[Active rheumatic heart disease: findings from an 17-case series in the University Hospital Center of Dakar, Senegal]. / Cardiopathies rhumatismales evolutives a propos de 17 cas colligés au CHU de Dakar.

This report is based on retrospective review of the charts of 18 patients with pre-existing active rheumatic heart disease compiled over a period of two years (January 2000 to December 2001). The purpose of this study was to determine the incidence of acute degenerative joint disease, to describe the clinical features and natural course of the disease, and to highlight the main points in the fight against degenerative joint disease and rheumatic heart disease. The prevalence of active rheumatic disease was 3.7%. Mean patient age was 15.5 years (range: 8 to 25 years). Female sex was predominant with 13 girls and 4 boys (sex ratio: 3.25). The most common clinical symptoms were migratory polyarthritis involving large joints in 14 cases (82.3%) and left heart insufficiency in 13 (76.4%). Additional clinical findings included oscillating fever in 8 cases (47.05%), tooth decay in 11 (73.3%), and poor buccodental hygiene in 14 (93.3%). Blood tests to evaluate inflammation demonstrated high values in all patients with mean ASLO titer of 950 UI/l, mean serum fibrin level of 7.8 g/l, and mean C-reactive protein level of 28.5 mg/l. The erythrocyte sedimentation rate was high in 15 cases (88.2%). In addition to showing heart valve disease, electrocardiography demonstrated first-degree atrioventricular block in 1 case. Chest x-ray revealed cardiomegaly in 15 cases (88.2%). Doppler ultrasonography of the heart showed isolated rheumatoid disease in 11 cases (64.7%). All patients responded favourably to treatment with corticosteroids and penicillin. The incidence of recurrence of active disease was high (70.5%) thus supporting use of high loading doses. Rheumatic heart disease is a public health problem in Africa and requires appropriate preventive measures.

[Prevalence and determinants of anemia in young children in French-speaking Africa. Role of iron deficiency]. / Prévalence et déterminants de l'anémie chez le jeune enfant en Afrique francophone--implication de la carence en fer.

Anemia and iron deficiency are major public health issues worldwide and particularly in Africa. Reliable information about their prevalence and associated factors is required to allow for effective actions. In this study, we used data from recent (2006-2012) large population health surveys, carried out in 11 French-speaking African countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, Ivory Coast, Gabon, Guinea, Mali, Niger, Democratic Republic of Congo, and Senegal). Hemoglobin (Hb) was assessed and demographic and health-related parameters were obtained from nation-representative samples of children aged 6-59 months. Anemia (Hb<11g/dL) was found in 72.4% of the children (60.2-87.8%), with no gender difference but a slightly lower incidence in older children (62% at age 4-5 years versus 85% at age 9 months), especially for the more severe forms (2.1% versus 8.7%, respectively). Anemia was only slightly but significantly affected by location (75.5% in rural areas versus 67.3% in towns), income (79.8% in lower quintile of income versus 62.3% in higher quintile), or maternal education (74.1% in children from non-educated mothers versus 62.4% in children whose mothers had secondary education). Nearly 50% of women of child-bearing age had anemia. In the countries that report this information, less than 50% (17-65%) of children consumed iron-rich foods regularly and only 12% (7.4-20.5%) received iron supplementation. Infection and parasitism are known to affect some markers of iron status, because of the inflammatory reaction, thereby making the diagnosis of iron deficiency difficult. In the study countries, acute respiratory diseases and diarrhea affected 6.2 and 15.6% of children aged between 6 and 59 months, respectively; their distribution according to age and location is very different from the one of anemia, which is also the case for the distribution of malaria. It is thus likely that a large part of the anemia observed in young children is due to iron deficiency, although further research is needed to confirm this. This fully justifies the nationwide programs of iron fortification of flour, currently undergoing in most countries of French-speaking Africa. Their formal evaluation is still pending but the initial data suggest some efficacy, although far from optimal. It is thus likely that a more holistic approach, including iron fortification, actions against undernutrition and parasitism in children, and actions in favor of improving young women's iron and nutritional status, together with appropriate communication and education objectives, would be more effective.

[Dehydration and malnutrition as two independent risk factors of death in a Senegalese pediatric hospital]. / Déshydratation et malnutrition : deux facteurs de risque de décès indépendants chez l'enfant sénégalais hospitalisé

UNLABELLED: Inpatient mortality is an indicator of the quality of care. We analyzed the mortality of under 5-year-old hospitalized children in the pediatric ward of Aristide Le Dantec Hospital for updating our data 10 years after our first study. METHODS: We analyzed the data of the children hospitalized between 1 January and 31 December 2012. For each child, we collected anthropometric measurements converted to a z-score related to World Health Organization growth data. Logistic regression-generating models built separately with different anthropometric parameters were used to assess the risk of mortality according to children's characteristics. RESULTS: Data from 393 children were included. The overall mortality rate was 10% (39/393). Using logistic regression, the risk factors associated with death were severe wasting (odds ratio [OR]=8.27; 95% confidence interval [95% CI]) [3.79-18], male gender (OR=2.98; 95% CI [1.25-7.1]), dehydration (OR=5.4; 95% CI [2.54-13.43]) in the model using the weight-for-height z-score; male gender (OR=2.5; 95% CI [1.11-5.63]), dehydration (OR=8.43; 95% CI [3.83-18.5]) in the model using the height-for-age z-score; male gender (OR=2.7; 95% CI [1.19-6.24]), dehydration (OR=7.5; 95% CI [3.39-16.76]), severe deficit in the weight-for-age z-score (OR=2.4; 95% CI [1.11-5.63]) in the model using the weight-for-age z-score; and male gender (OR=2.5; 95% CI [1.11-5.63]) and dehydration (OR=8.43; 94% CI [3.83-18.5]) in the last model with mid-upper arm circumference (MUAC). Dehydration and malnutrition were two independent risk factors of death. The protocols addressing dehydration and malnutrition management should be audited and performed systematically for each child's anthropometric measurements at admission.

[Electrocardiographic recording of long duration (Holter) of 24 hours during idiopathic cardiomyopathy of the peripartum]. / Enregistrement électrocardiographique de longue durée (holter) des 24 heures au cours de la cardiomyopathie idiopathique du péripartum.

The idiopathic myocardiopathy of the peripartum (IMPP) is a frequent disease in the Soudano-Sahelian zone of Africa whose evolution is loaded with many complications hemodynamic, thrombo-embolic and rhythmic. The prevalence and the meaning of the rhythm disorders are unknown. The aims of this prospective study are to measure and to describe the prevalence of the anomalies observed in Holter ECG of 24 hours. It's about a description cross-sectional study realized at the Cardiology Department (CHU Dakar) and 19 patients with IMPP were included, from October 2000 to July 2002. A recording ECG of 24 hours (Holter) was realized on all the patients. The average age was 29.4+/-6.9 years with a low socio-economic level (100%). The diagnosis of IMPP done before childbirth in 4 cases (21%) and the post partum on 15 patients (78.9%). The dyspnea was constant, the chest pain in 12 cases (63.1%) and palpitations in 8 cases (42%). The average rate of hemoglobin was of 10.85+/-2.05 g/dL. The standard electrocardiogram recorded a sinusal tachycardia (68.4%), a cavitary hypertrophy (78.8%), and disorders of the repolarization (47.3%). The cardiac echo-Doppler noted a cavitary dilatation (84.2%), a constant alteration of the left ventricular systolic function with a fraction of average ejection of 29.7+/-10.3%. The anatomy of the valves was normal. The recording Holter ECG of 24 hours recorded a sinusal tachycardia in 17 cases (89.4%), ventricular extrasystoles on 7 patients (36.8%), 4 cases of ventricular tachycardia non-sustained and double ventricular extrasystole on 1 patient, auricular extrasystoles in 4 cases (21%) and 1 case of auriculo-ventricular block of the first degree. The study of heart rate variability founded a mean value of 106 ms.

[Left ventricular aneurysm in human immunodeficiency virus infection: a case report]. / Anévrisme ventriculaire gauche au cours de l'infection par le virus de l'immuno-déficience humaine. A propos d'une observation.

The authors report the case of a 30 year old man with a left ventricular aneurysm who was seropositive to HIV 1 and HIV 2. The patient was stage IVC 1 (AIDS related complex) by the "Center for Disease Control" classification. The clinical presentation was pyrexia, loss of weight, micropolyadenopathy and cardiac failure. The electrocardiogramme showed low voltage in the peripheral leads with a QS morphology in S2, S3 and aVF and abrasion, of the R wave in the precordial leads. Doppler echocardiography demonstrated a large left ventricular aneurysm with a wide neck. Despite treatment with a diuretic, angiotensin converting enzyme inhibitor and anticoagulants, the patient died suddenly. Autopsy confirmed the wide necked left ventricular aneurysm. This would appear to be the first report of this form of cardiac disease during HIV infection. However, a simple coincidence of the two pathologies cannot be excluded.

[Progressive spinal amyotrophy type I or Werdnig-Hoffman disease. Apropos of 5 cases in Dakar (Senegal)]. / L'amyotrophie spinale progressive de type I ou maladie de Werdnig-Hoffmann. A propos de 5 cas dakarois (Sénégal).

Type I spinal muscular atrophy or Werdnig-Hoffman disease is rarely described in black populations. We report five such cases diagnosed in a paediatric outpatient clinic in Dakar. We conducted a retrospective study relating to patients examined for hypotonia progressing since birth for whom the electromyogram had made it possible to confirm an involvement of the peripheral nerve without nerve conduction anomaly. Mean age of diagnosis was 12.3 +/- 7.6 months. Respiratory distress was noted for 2 patients. A family background of similar symptomatology was found in 1 case and consanguinity in 2 cases. Only 1 case of death occurred whereas the 4 other patients were lost to follow-up. The diagnosis of spinal muscular atrophy must be considered in the presence of any severe hypotonia in infants.

[Echocardiographic aspects in pediatric patients with sickle cell disease]. / Aspects échocardiographiques au cours de la drépanocytose en milieu pédiatrique.

BACKGROUND: Cardiovascular involvement is not well studied in children with sickle cell disease. The aim of this study was to evaluate the echocardiographic parameters of children with sickle cell disease. PATIENTS AND METHODS: We performed a transversal and case-control study including 80 subjects of six months to 16 years of age divided into four groups of 20 children each: heterozygous sickle cell disease, homozygous sickle cell anemia, anemia of other causes than sickle cell, and healthy children. All children had a complete physical examination, biological screening including hemogram and hemoglobin electrophoresis, chest x-ray, electrocardiogram, and Doppler echocardiogram. Data were compared using the chi 2 method and the Student's t-test. RESULTS: The mean age was 8.5 years and the sex-ratio was 1. Echocardiographic abnormalities were observed in seven patients with anemia unrelated to sickle cell, 15 children with heterozygous anemia and all the homozygous patients. The main abnormalities were: left ventricular enlargement (ten homozygous patients, one heterozygous subject, five of the patients with another cause of anemia), increased contractility of the heart (18 homozygous patients, seven heterozygous patients, five in the anemia group) and mild to moderate mitral or tricuspid regurgitation (12 homozygous, five heterozygous and five patients in the anemia group). One homozygous child had a dilated and hypokinetic cardiomyopathy with pulmonary hypertension. The parameters of left ventricular systolic function and left heart chamber dimensions were lower in the control group (P < 0.04). DISCUSSION: This study shows the frequency of heart chamber dilatation with left ventricular hyperkinesis usually described in the literature. The lack of case of chronic cor pulmonale may be due to the young age of our patients. One case of dilated and hypokinetic cardiomyopathy suggests that other causes than anemia should be considered, particularly myocardial ischemia, which could not be demonstrated because of our limited investigative methods. CONCLUSION: These results emphasize the frequency of the heart involvement in sickle cell disease, particularly in the homozygous type, and point out the importance of the cardiologic screening of these patients.

[Sickle cell disease in children in Dakar, Senegal]. / Les syndromes drépanocytaires majeurs en pédiatrie à Dakar (Sénégal).

AIM OF THE STUDY: To determine the socioeconomic, clinical and biological aspects of sickle cell disease (SCD) in Senegalese children and adolescents, we retrospectively analysed all records of follow-up attending patients in the Albert Royer Children Hospital of Dakar (Senegal). RESULTS: Homozygous sickle cell (SS) was the most frequent genotype (307 cases). Sickle cell hemoglobin C (13 cases) and sickle cell beta-thalassemia (three cases) were uncommon. Patients were aged from five months to 22 years (mean age: eight years). Most of them came from poor families. The mean number of children was five in patients' families, with at least two cases of SCD in 60% of them. Immunization against hepatitis B virus (10.2%), Haemophilus influenzae b (8.4%), Salmonella (8.7%) and Streptococcus pneumoniae (21.4%) was insufficiently performed, because of its relatively high cost. Only 30% of the patients had received a blood transfusion. Painful crises occurred less than three times a year in 74% of the cases. Complications such as acute chest syndrome (1%), stroke (1%), cholelithiasis (9%), meningitis (0.4%), septicemia (2%) and osteomyelitis (6%) were rare. Mean steady state hemoglobin (Hb) and hemoglobin F(HbF) levels were 8.27 +/- 1.36 g/dL and 6.8 +/- 5.9% respectively among SS patients. No correlations were found neither between Hb and HbF nor between these parameters and the frequency of complications. Eleven patients (1.1% per year of follow-up) died, and infection was the main cause of death (73%). CONCLUSION: In comparison with published data, SCD seems to have mild severity in Senegalese children and adolescents in spite of poor follow-up conditions. In addition to genetic factors, environmental factors might have an important role in disease tolerance.