[Epidemiologic profile of skin diseases in Tunisian children]

Skin diseases are fairly common in children and can be related to a heavy morbidity. However, very little data about the epidemiology of pediatric skin diseases are available in the literature. retrospective study about 2007 children seen at the dermatological outpatient's department of children's hospital of Tunis between January 1997 and December 2004. The children's sex, age and diagnosis were noted. the median age was 5 years 2 months +/- 4.5 years [range 3 days, 18 years]. Infants and preschool children represented 67.3per cent of the study population. There was 1023 boys and 984 girls [sex-ratio: 1.03]. There were 2100 skin diseases in the 2007 children. Skin infections constituted the largest group [35.3 per cent] followed by allergic skin diseases [26.3 per cent]. Among skin infections, viral infections were most prevalent [31.2 per cent], followed by fungal infections [28.2 per cent], bacterial infections [21.1 per cent] and parasitic infections [19.4 per cent]. Atopic dermatitis was the most prevalent allergic disease. It was also the most prevalent dermatosis in the infant group. The number of children with atopic dermatitis decreased with age, suggesting that this condition tends to clear with age. epidemiologic data are useful in monitoring changes in diseases trends in children and planning healthcare programs for them

[Chronic hepatitis B: a study of 15 cases]

The aim of this study is to describe clinical, biological, histological aspects and outcome of children with chronic hepatitis B [CHB], and to analysis treatment modalities. a retrospective study of 15 children with CHB was conducted between January 1992 and December 2003. All patients had HBs Ag> 6 months, fourteen had Hbe Ag. Initial histological examination was performed in eight cases. intrafamilial horizontal transmission was noted in five cases. Fifty three percent of patients presented symptoms: asthenia [57 percent], anorexia [1 case], loss of weight [1 case], digestive disturbance [3 cases], abdominal pain [5 cases]. Cytolysis was noted in eight patients [53, 3 per cent], they had positive Ag Hbe. Liver emzymes were increased in eight cases [53.3%], they had positive Hbe Ag, mean rate of AST was 95.6 UI/I [extremes: 56 -251], mean rate of ALT was 118,8 Ul/l [extremes: 50 - 204]. Four patients had chronic active hepatitis and four had chronic persistent hepatitis. Three patients received I'interferon a; seroclearance was noted in two patients without negativation of HBs Ag. Twelve patients didn't receive any antiviral therapy, liver emzymes were decreased in three patients, seroclearance of HBe Ag was noted in five cases and HBs Ag elimination was noted in only one patient. Chronic hepatitis B is often asymptomatic and transmitted horizontaly. Antiviral therapy must be indicated in children with viral replication and active chronic hepatitis. Large vaccination at birth reduces vertical transmission and prevalence particularly in endemic areas

[Multiple carboxylase deficiency]

Multiple carboxylase deficiency is a syndrom in which biotin-dependant carboxylases show diminished activity du to a lack of biotin or autosomal recessively inherited disorders of biotin metabolism. The clinical picture involves the nervous system, skin, respiratory system, digestive system, and immune system. This syndrome is fatal in the absence of prompt diagnosis and treatment with biotin. Authors report the case of 2-month-old child explored for myoclonic seizures that do not respond well to classic anticonvulsivant therapy, hypotonia, skin problems with alopecia, appeared at age of one month. The laboratory examinations showed hyperammonemia and hyperlactacedemia.Multiple carboxylase deficiency was suspected and treatment with biotin [5mg/day] achieved a rapid improvement of the seizures and the skin problems

[Surgical aspects of intussusception due to lymphoma in children]

Introduction: Bowel's intussuception is a rare kind of child Burkitt lymphoma revelation mode. The management of this situation is full of traps. The retrospective study of 6 observations aims to analyse the clinical, evolutionary and therapeutic side of this revelation mode

Results: Four boys and two girls, aged from three to seven years with an average of 5 years, had Burkitt lymphoma revealed by a Bowel's intussusception. The abdominal ultrasound find the secondary cause in 3 cases .One patient had a full-column barium enema All the cases had a laparotomy. Three cases had a surgical resection. A biopsy of mesenteric lymph nodes was done in 3 cases. A chemotherapy was initiated as soon as we made the diagnosis .There was no after effects in all the cases. No recurrence was noted until two years and a half after the treatment

Conclusion: The diagnosis of lymphoma must be suspected when the bowel's intussuception occurs in more than 5 years old children. A biopsy must be done in the event of suspicion of lymphoma. The surgical procedure must be adapted to each case

[Doose syndrome or myoclonic-astatic epilepsy: two new Tunisian cases]

Myoclonic astatic epilepsy belongs to the epilepsies with generalized seizures. It occurs in 1-2 per cent of all childhood epilepsies up to age 9. The disease is characterized by age of onset mostly between 2 and 6 years and by various clinical and EEG criteria [myoclonic or astatic seizures, 4-7 Hz background rhythm, polyspikes and waves in electroencephalogram]. The authors report two cases answering these criteria. It is about 2 old boys respectively of 2 years and a half and of 18 months during first seizures. Attacks were polymorphic associating myoclonic seizures, absences and astatic crises causing traumatism. These attacks are associated to clonic generalized seizures in one case. The electroencephalograph showed a thorough rhythm of 4-7 Hz. Cerebral imaging was normal at the 2 childs. The psychomotor development is normal in spite of the rebel character of crises justifying the use of several therapeutic alternatives during the evolution