Adherence to ready-to-use food and acceptability of outpatient nutritional therapy in HIV-infected undernourished Senegalese adolescents: research-based recommendations for routine care.

BACKGROUND: Ready-to-use food (RUF) is increasingly used for nutritional therapy in HIV-infected individuals. However, practical guidance advising nutrition care to HIV-infected adolescents is lacking, so that little is known about the acceptability of such therapy in this vulnerable population. This study assesses the overall acceptability and perception of a RUF-based therapy and risk factors associated with sub-optimal RUF intake in HIV-infected undernourished adolescents in Senegal. METHODS: Participants 5 to 18 years of age with acute malnutrition were enrolled in 12 HIV clinics in Senegal. Participants were provided with imported RUF, according to WHO prescription weight- and age-bands (2009), until recovery or for a maximum of 9-12 months. Malnutrition and recovery were defined according to WHO growth standards. Adherence was assessed fortnightly by self-reported RUF intake over the period. Sub-optimal RUF intake was defined as when consumption of the RUF provision was < 50%. RUF therapy acceptability and perceptions were assessed using a structured questionnaire at week 2 and focus group discussions (FGDs) at the end of the study. Factors associated with sub-optimal RUF intake at week 2 were identified using a stepwise logistic regression model. RESULTS: We enrolled 173 participants, with a median age of 12.5 years (Interquartile range: 9.5-14.9), of whom 61% recovered from malnutrition within the study period. Median follow-up duration was 66 days (21-224). RUF consumption was stable, varying between 64 and 57% of the RUF provided, throughout the follow-up. At week 2, sub-optimal RUF intake was observed in 31% of participants. Dislike of the taste of RUF (aOR = 5.0, 95% CI: 2.0-12.3), HIV non-disclosure (5.1, 1.9-13.9) and food insecurity (2.8, 1.1-7.2) were the major risk factors associated with sub-optimal RUF intake at week 2. FGDs showed that the need to hide from others to avoid sharing and undesirable effects were other constraints on RUF feeding. CONCLUSIONS: This study revealed several factors reducing the acceptability and adherence to RUF therapy based on WHO guidelines in HIV-infected adolescents. Tailoring prescription guidance and empowering young patients in their care are crucial levers for improving the acceptability of RUF-based therapy in routine care. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03101852, 04/04/2017.

Development and Characterization of PBSA-Based Green Composites in 3D-Printing by Fused Deposition Modelling.

Fused deposition modelling is a rapidly growing additive manufacturing technology due to its ability to build functional parts with complex geometries. The mechanical properties of a built part depend on several process parameters. The effect of wood content on the properties of 3D printed parts has been studied. Four types of filaments using poly(butylene succinate-co-adipate) (PBSA) with different reinforcement levels of Typha stem powder 0%, 5%, 10%, and 15% by weight were used for 3D printing. The density of the filaments and parts printed in this study increased with the Typha stem powder content. The thermal stability, mechanical performance, and viscoelastic properties of the different biocomposite filaments and 3D printed objects were analysed. The results show an increase in the crystallisation kinetics and a slight decrease in the thermal stability of the biomaterials. Compared to virgin PBSA FDM filaments, the PBSA biocomposite filament filled with Typha stem powder showed an increase in the tensile strength of the parts and specimens from 2.5 MPa to 8 MPa and in the modulus of elasticity from 160 MPa to 375 MPa, respectively, with additions of 5%, 10%, and 15% by mass. The addition of Typha stem fibres generated an increase in the elastic behaviour and relaxation time of the biomaterial structure, visualised by increases in the values of the viscosity components. The surface morphology reveals a decrease in the porosity of the printed samples.

[Predictive factors of mortality in intensive care at the Hospital Principal of Dakar / Senegal]. / Facteurs predictifs de mortalite en reanimation a l'Hopital Principal de Dakar/Senegal.

OBJECTIVES: To analyze the main causes and risk factors of death in intensive care. PATIENTS AND METHOD: Prospective observational study in the intensive care units in Hospital Principal of Dakar from July to December 2018 including all patients who died 24 hours after admission. Demographic, clinical, severity (IGSII, APACHE II, MPM) and organ failure (SOFA, LODS) scores were collected. A multiparametric comparison was made between deceased and surviving patients. RESULTS: The overall mortality was 25.86% correlated with the probability of death (MPM): 26.4%. The mean age was 50.98 [8-94 years] with a sex ratio of 1.15. The majority of deaths (79.26%) occurred outside of duty hours and 70.7% had at least one medical history. The mean severity scores were for IGSII 40.12 +/- 17.25 and for APACHE II 18.31 +/- 8.49. The mean visceral failure scores were for SOFA 7.02 +/- 4.44 and for LODS 5.73 +/- 3.35. Complications were dominated by nosocomial infections (48.78%) and are responsible for 37.8% of deaths. The mean length of stay was 7.30 days +/- 7.46. Age, the existence of organ failure, the use of vasopressors, the occurrence of nosocomial infections and the absence of a senior doctor were correlated with mortality. CONCLUSION: The intensive care unit mortality rate is 25.86%. Advanced age, the existence of organ failures and the occurrence of a nosocomial infection are factors in the occurrence of death.

OBJECTIFS: Analyser les principales causes et les facteurs de risque de décès en réanimation. PATIENTS ET MÉTHODE: Etude prospective observationnelle dans les services de réanimation de l'hôpital Principal de Dakar de Juillet à Décembre 2018 incluant tous les patients décédés 24 heures après l'admission.Nous avonsétudiés, les données démographiques, cliniques, les scores de gravité (IGSII, APACHE II, MPM) et de défaillance d'organe (SOFA, LODS).Une comparaison multiparamétrique a été faite entre les patients décédés et survivants. RÉSULTATS: La mortalité globale était de 25,86% corrélée avec la probabilité de décès (MPM) de 26,4%. L'âge moyen était de 50,98 [8-94 ans] avec un sex-ratio H/F : 1,15. La majorité des décès (79,26%) était survenue durant la nuit, les week-end et jours fériés, l'activité étant assurée en ce moment par l'équipe de garde constituée de deux médecins en fin de spécialisation en anesthésie-réanimation et un médecin sénior d'astreinte pouvant être appelé en cas de nécessité. Des antécédents pathologiques avaient été retrouvés chez 70,7% des patients décédés.Le score de gravité IGSII était en moyenne de 40,12 +/- 17,25 et l'APACHE II de 18,31 +/- 8,49. Le score de défaillance viscérale moyen était pour le SOFA de 7,02 +/-4,44 et pour le LODS de 5,73+/-3,35. Les complications étaient dominées par les infections nosocomiales (48,78%) et sont associées à 37,8% des décès (p<0,0001 et OR [IC 95%] 22,8 [7,6-68,2]). La durée moyenne de séjour était de 7,30 jours +/-7,46. L'âge, la défaillance d'organe, l'utilisation de vasopresseurs, l'infection nosocomiale étaient corrélés à la mortalité. CONCLUSION: Le taux de mortalité en réanimation est de 25,86%. L'âge avancé, l'existence de défaillance d'organe et la survenue d'une infection nosocomiale sont des facteurs de survenue de décès.

Estimating the total incidence of type 1 diabetes in children and adolescents aged 0-19 years from 1990 to 2050: a global simulation-based analysis.

BACKGROUND: Previous studies of type 1 diabetes in childhood and adolescence have found large variations in reported incidence around the world. However, it is unclear whether these reported incidence levels are impacted by differences in country health systems and possible underdiagnosis and if so, to what degree. The aim of this study was to estimate both the total and diagnosed incidence of type 1 diabetes globally and to project childhood type 1 diabetes incidence indicators from 1990 to 2050 for each country. METHODS: We developed the type 1 diabetes global microsimulation model to simulate the natural history and diagnosis of type 1 diabetes for children and adolescents (aged 0-19 years) in 200 countries and territories, accounting for variability in underlying incidence and health system performance. The model follows an open population of children and adolescents in monthly intervals and simulates type 1 diabetes incidence and progression, as well as health system factors which influence diagnosis. We calibrated the model to published data on type 1 diabetes incidence, autoantibody profiles, and proportion of cases diagnosed with diabetic ketoacidosis from 1990 to 2020 and assessed the predictive accuracy using a randomly sampled test set of data withheld from calibration. FINDINGS: We estimate that in 2021 there were 355 900 (95% UI 334 200-377 300) total new cases of type 1 diabetes globally among children and adolescents, of which 56% (200 400 cases, 95% UI 180 600-219 500) were diagnosed. Estimated underdiagnosis varies substantially by region, with over 95% of new cases diagnosed in Australia and New Zealand, western and northern Europe, and North America, but less than 35% of new cases diagnosed in west Africa, south and southeastern Asia, and Melanesia. The total number of incident childhood cases of type 1 diabetes is projected to increase to 476 700 (95% UI 449 500-504 300) in 2050. INTERPRETATION: Our research indicates that the total global incidence of childhood and adolescent type 1 diabetes is larger than previously estimated, with nearly one-in-two children currently undiagnosed. Policymakers should plan for adequate diagnostic and medical capacity to improve timely type 1 diabetes detection and treatment, particularly as incidence is projected to increase worldwide, with highest numbers of new cases in Africa. FUNDING: Novo Nordisk.

[Clinical and paramedical features of epilepsy in children at the Ziguinchor Peace Hospital: a documentation review]. / Aspects cliniques et paracliniques de l´épilepsie de l´enfant à l´Hôpital de la Paix de Ziguinchor: étude documentaire.

Epilepsy poses a public health problem in Senegal. The purpose of the study was to describe the clinical and paramedical features of epilepsy in children at the Ziguinchor Peace Hospital (ZPH). We conducted a literature review of the medical records of children with epilepsy, from January 1, 2015 to December 31, 2018. Patients aged < 15 years followed up for epilepsy at the ZPH were included. Incomplete medical records were excluded. Data from fifty-five (37 boys and 18 girls) children were collected; 70.9% of them were ≤5 years of age. Mean age of patients was 4.3 years. Patients were from rural (60%) and disadvantaged families (67.3%). Seizures were generalized (72.7%) and focal (27.3%). Eighteen patients had idiopathic epilepsy, 17 had non-idiopathic epilepsy. Etiological factors were dominated by abnormalities associated with pregnancy and childbirth (29.1%). Epilepsy is common at the ZPH. It is most common in rural areas among boys under the age of 5 years from disadvantaged families. Generalized tonic-clonic and focal seizures are the most frequent clinical state and abnormalities associated with pregnancy and childbirth are the most commonly found etiologies.

[Adrenocorticotropic hormone (ACTH) insensitivity syndrome: about a case]. / Syndrome de résistance à l'Adrénocorticotrophine Hormone (ACTH): à propos d'un cas.

Adrenocorticotropic hormone (ACTH) insensitivity syndrome is one of the rare causes of adrenal insufficiency in children. All described inherited ACTH insensitivity forms are of autosomal recessive origin. In our resource-poor Countries, many of these rare diseases are ignored or not diagnosed due to inadequate technical equipments. We report the case of a 4-month old infant hospitalized for refractory hypoglycaemias. Despite the patient had generalized and severe melanodermia, digestive disorders and ion channel disorders the diagnosis of cortisol deficiency was only diagnosed retrospectively during respiratory arrest with favorable outcome under hydrocortisone therapy. This study aims to highlight the clinical, laboratory and therapeutic features of peripheral cortisol deficiency, without enzymatic blocks, including this adrenocorticotropic hormone (ACTH) insensitivity syndrome.

[Idiopathic nephrotic syndrome (INS) in children in Dakar: about 40 cases]. / Le syndrome néphrotique idiopathique (SNI) de l'enfant à Dakar: à propos de 40 cas.

INTRODUCTION: This study aimed to analyze the diagnostic, therapeutic, and evolutionary features of nephrosis in children in a pediatric department in Dakar. METHODS: The study was carried out in the Department of Pediatrics at the Aristide Le Dantec Hospital. We conducted a retrospective study over a period of 3 years from 1 January 2012 to 31 December 2014. All patients aged 2-12 years with idiopathic nephrotic syndrome were included in the study. RESULTS: Forty cases of nephrosis were collected, that is to say a prevalence of 23% among patients with kidney disease treated in the Department of Pediatrics. The average age was 7.11 ± 3.14 years. 72.5% (n=29) of patients suffered from pure nephrotic syndrome. Lower limb edema was present in 100% of patients, oliguria in 55% (n=22) and high blood pressure (HBP) in 5% (n=2) of cases. Median proteinuria was 145,05 ± 85,54 mg/kg/24 hours. Median protidemia was 46,42 ±7.88 g/L and median albumin was 17.90 ± 7.15 g/L. Thirty nine patients were treated with prednisone-based corticosteroid therapy. Corticosensitivity was retained in 77% (n=30) patients and corticoresistance in 13% (n=5) of cases. The factor of poor response after corticosteroid therapy was initial proteinuria greater than 150 mg/kg/day (p = 0.024). Renal biopsy was performed in 18% (n=7) of patients which showed focal and segmental hyalinosis in 57.2% (n=4). Cyclophosphamide and azathioprine were associated with corticosteroids in 10% (n=4) of cases respectively. The overall remission rate was 89.8%. The evolution toward chronic renal failure was observed in three patients. CONCLUSION: Nephrosis accounted for almost one quarter of all cases of kidney disease treated in our Department. It has high overall remission rate. The only factor contributing to poor response after corticosteroid therapy was high levels of initial proteinuria. Focal and segmental hyalinosis was the most frequently found lesion diagnosed by renal biopsy.

[Epidemiological, clinical and hematological profiles of homozygous sickle cell disease during the intercritical period among children in Ziguinchor, Senegal]. / Profils épidemiologiques, cliniques et hématologiques de la drépanocytose homozygote SS en phase inter critique chez l'enfant à Ziguinchor, Sénégal.

Sickle cell disease poses a public health problem in Senegal. It mainly affects children and adolescents. This study aimed to determine the epidemiological, clinical and hematological profiles of homozygous (SS) sickle cell disease in a cohort of children followed-up at the Peace Hospital in Ziguinchor. We conducted a retrospective study of the medical records from children with sickle cell disease. All patients aged between 2 months and 21 years with sickle cell disease SS during the intercritical period, hospitalized during the study period from 1st January 2015 to 31 August 2017 were included in our study. Compound heterozygous patients (SC, S Beta Thalassemia) were not included. We collected 46 medical records of patients with sickle cell disease SS (20 girls and 26 boys). The average age of children was 8,0 years [11 months-21 years]. Approximately 1/3 of children (39.1%) had an age less than or equal to 5 years. There was an ethnic diversity showing a predominance of the Diola (30.2%) followed by the Mandinga (27.9%) and the Poular (25.6%). The average age of children with first crisis was 35,5 months [7-192 months]. More than 1/3 of children (41.3%) had had first crisis before their second anniversary. In the child, first crisis was dominated by vaso-occlusive crisis (32.6%) followed by hand-foot syndrome (30.4%). Clinical signs during the intercritical period were pallor 95.6%), jaundice (36.9%) and splenomegaly (21.7%). Mean white blood cell count was 12465 leucocytes/mm3 [5340-26900]. Hyperleukocytosis greater than 10 000 leucocytes/mm3was found in 34 patients (73.9%). All patients had anemia with an average hemoglobin of 08,6 g/dl [05,7-11,8]. Hemoglobin S rate ranged between 54.6 and 98.4%. Diagnosis and medical management of sickle cell disease SS are delayed in Ziguinchor. Neonatal screening may lead to improve early management of patients in the region.

[Hyperthyroidism in children at the University Hospital in Dakar (Senegal)]. / L'hyperthyroïdie de l'enfant au centre hospitalier universitaire de Dakar (Sénégal).

INTRODUCTION: Hyperthyroidism in children is rare and constitutes a problem because of its psychosomatic impact. This study aimed to present an overview of the state of knowledge on these aspects in children from Dakar. METHODS: We conducted a multicenter, descriptive study over a period of 15 years. We evaluated the epidemiological, clinical and etiologic aspects of hyperthyroidism in children. RESULTS: 239 patients were included in the study with a prevalence of 2.4%, a sex ratio (M/F) of 0.36 and an average age of 10.8 years. The inclusion criteria were being the eldest son in a family(26.3%), being advanced (36.9%) or delayed (12.5%) in maturation, having short stature (40.1%). It was caused by Graves' disease in 90.3% of cases with psychoaffective factor in 22.1%. On a clinical point of view tachycardia (92.4%), goiter (91.1%), exophthalmia (81.8%), weight loss (69.8%) prevailed but with bed-wetting (30.2%) and psychic manifestations (3.1%). Cardiovascular and cutaneous manifestations were positively associated with age (p < 0.05). Goiter was associated with female sex (p = 0.005), cardiovascular (p = 0.02), neuropsychic (p = 0.03), skin (p = 0.03) signs and diarrhea (p = 0.03). Free T4 was correlated with age (p = 0.007), diarrhea (p = 0.021), anxiety (p = 0.024), heart rate (p = 0.00) and Graves' disease (p = 0.04). More voluminous the goiter, higher the free T4 (p = 0.007). CONCLUSION: Hyperthyroidism in children differs from that in adults because of induction factors, growth disturbances and enuresis. Age and sex seem to favor the clinical picture of thyrotoxicosis and its associated signs.

[Congenital hypothyroidism in Dakar: about 28 cases]. / Hypothyroïdie congénitale à Dakar: à propos de 28 cas.

Child hypothyroidism has been little studied in Senegal. The aim of this study was to evaluate the epidemiological, diagnostic and evolutionary aspects of congenital hypothyroidism. We conducted a descriptive-analytical retrospective study of all children treated for congenital hypothyroidism at the Albert-Royer National Children's Hospital Center over the period from 2001 to 2014 (14 years). We collected and analyzed socio-demographic, clinical and evolutionary data from patient medical records. A total of 28 patients were included in the study, an average of 2 cases per year. The average age of discovery of hypothyroidism was 54.25 ± 43 months with a female predominance (Sex-ratio 0.47). Only 2 cases of hypothyroidism were diagnosed in the neonatal period. Consanguinity was present in 68% of patients. Clinical signs were dominated by the delay in psychomotor acquisitions (96%), hypothermia (46%), cranio-facial dysmorphia (43%) and goiter (39%). Growth retardation was constant beyond 6 months. The etiologies were dominated by hormonosynthesis disorders (84.21%). During the study period, mean SD of patients had decreased from -3.5 SD to -2.25 SD for a median treatment duration of 28 months. Mental retardation was present in 73% of cases. Growth retardation and mental retardation were more severe as the diagnosis was late. Our results confirm the inadequacy of early management of patients. It is urgent to implement a routine neonatal screening system in order to improve the mental prognosis of this condition.

[Hemolytic-uremic syndrome (HUS) in children at the University Hospital Center in Dakar: about four cases]. / Syndrome hémolytique et urémique de l'enfant au Centre Hospitalier Universitaire (CHU) de Dakar: à propos de quatre observations.

Hemolytic-uremic syndrome (HUS) is a common cause of organic acute renal failure (ARF) in children. It is a progressive complication of acute gastroenteritis (AGE), especially caused by Escherichia coli in children. This study aimed to describe the clinical, therapeutic and evolutionary aspects of this affection in four children. We collected four cases of HUS. The average age was 10,5 months (5-15mois), exclusively boys. Clinical examination revealed a hemolytic anemia (pallor and jaundice), oligoanuria and edematous syndrome (2 cases), arterial hypertension (1 patient), AGE associated with severe dehydration and hypovolemic shock (2 patients), consciousness disorders. ARF was found in all patients as well as thrombocytopenia and schizocytes smear. Direct Coombs test was negative. Hyperkalemia was found in 3 patients, of whom 1 with hyperkalemia level of more than 9.2 mmol/L, hyponatremia at 129 mmol/l (1 patient) and hypernatremia at 153 mmol/l (1 patient). HUS was secondary to pneumococcal pneumonia (1 patient) while AGE was secondary to E. coli (1 patient). The treatment was mainly symptomatic and included fluid restriction, transfusion of red cell concentrates, diuretics, peritoneal dialysis and hemodialysis. The evolution was marked by the onset of chronic renal failure (1 patient) after 6 months of follow-up and by recovery (1 case). Three patients died. HUS is the most common cause of organic acute renal failure in newborns. Diagnosis is essentially biological, treatment is mostly symptomatic.