Arrêt cardio-respiratoire de l'enfant. Aspects épidémiologiques, thérapeutiques et pronostiques au Sénégal

Introduction : L'Arrêt Cardio-Respiratoire (ACR) est un évènement fréquent dans les services d'urgences et de réanimation pédiatrique. Bien que de nombreuses données soient rapportées dans plusieurs régions du monde, peu sont disponibles en Afrique subsaharienne. L'objectif de cette étude était d'évaluer les aspects épidémiologiques, thérapeutiques et le pronostic des enfants victimes d'ACR au CNHEAR.Patients et méthodes : Il s'agissait d'une étude prospective sur 1 an, concernant les enfants âgés de 0 à 15 ans, ayant présenté un ACR et bénéficié de manœuvres de réanimation au CNHEAR. Les données ont été saisies et analysées avec le logiciel Epi info 3.5.4 et SPSS 24.0. Résultats : Cent-soixante-dix-neuf (179) cas d'ACR ont été enregistrés. Les motifs de consultation les plus fréquents étaient la fièvre et la détresse respiratoire (38,5% chacun). Le délai de consultation moyen était de 3,5 jours. Quarante-neuf virgule sept pour cent (49,7%) avaient consulté dans une structure périphérique avant d'atteindre le niveau central et 13,9% étaient transportés par un transport médicalisé. Les principales circonstances ayant conduit à l'ACR étaient la détresse respiratoire (45,2%), la défaillance hémodynamique (48,7%), et les troubles métaboliques (19,6%). Les pathologies sous- jacentes étaient dominées par le sepsis 20,1%. Au plan thérapeutique, 71,5% avaient eu un massage cardiaque externe. Au décours de la réanimation initiale, le retour à une activité cardio-circulatoire spontanée était de 60,9%. L'évolution secondaire était marquée par la récidive de l'ACR chez 71,6% et finalement le décès de 85,3%. Au final, sur les 179 enfants ayant fait un ACR et bénéficié d'une réanimation, 16 (8,9%) ont survécu et ont été suivis en ambulatoire.Conclusion : La survie après ACR pédiatrique au Sénégal est faible. Des efforts importants restent à faire, notamment une amélioration des ressources matérielles ainsi que des compétences et la formation continue des praticiens en vue d'une meilleure prise en charge des enfants gravement malades

[Malignant infantile osteopetrosis revealed by choanal atresia: A case report]. / Ostéopétrose maligne infantile révélée par une atrésie des choanes : à propos d'un cas.

Malignant infantile osteopetrosis is a rare genetic disease characterized by increased bone density due to osteoclastic dysfunction. We report on the case of a 3-month-old girl who was referred to our hospital by the ENT department for severe anemia in the context of bilateral choanal atresia. Clinical examination showed failure to thrive, anemia, respiratory distress, bilateral choanal atresia, and chest deformation. The abdomen was soft with large hepatosplenomegaly. We noted a lack of eye tracking, no optical-visual reflexes, and left nerve facial paralysis. The blood count showed normocytic normochromic anemia with severe thrombocytopenia. The infectious work-up and blood smears were negative. The skeleton X-ray showed diffuse bone densification of the skull, long bones, pelvis, vertebrae, and ribs. The facial bone CT confirmed membranous choanal atresia. The molecular biology search for the TCIRG1 gene mutation was not available. The patient had supportive treatment (transfusion, oral steroid, vitamin D, oxygen, nutrition). Bone marrow transplantation was indicated but not available. She died at 6 months in a context of severe anemia and bleeding. Malignant infantile osteopetrosis is rare and symptoms are nonspecific. Diagnosis should be considered in young infants presenting refractory anemia, particularly in the context of choanal atresia. Bone marrow transplantation remains the only curative treatment.

[Medicinal plants in Senegal and oral diseases: use and interest]. / Plantes médicinales au Sénégal et affections bucco-dentaires: utilisation et intérêt.

The end of the last century and the present decade is characterized by an evolution of the concept of health and illness in the public domain. The World Health Organization defines traditional medicine as "comprising various practices, approaches, knowledge and beliefs incorporating medicinal herbal, animal and/or mineral, spiritual therapies, applied alone or in combination to maintain well-being and to treat, diagnose or prevent disease. In dentistry, the plants used are numerous. The objective of this work is to describe the herbal medicine used against oral diseases. To conduct this study, 10 articles and theses, a brief, 2 books, 4 reports and 2 clippings on traditional medicine/herbal medicine were consulted. Several African plants, in the form of use, can help relieve or treat dental pain and have positive effects against dental caries and periodontal diseases. The geographic and financial accessibility associated with the lack of qualified personnel are the plants could be an alternative in the management of certain oral diseases.

[Food habits and oral hygiene of students. Investigation of 150 students in university housing]. / Habitudes alimentaires et d'hygiène orale des étudiants. Enquête auprès de 150 étudiants en résidence universitaire.

The objective of this study is to describe the food intake and the oral hygiene habits of 150 Senegalese students living in a university campus. According to Miller, we realised a four days survey. We noted an increase of sugar drinks; tea is the most consumed drink. The results showed also that the toothbrush as means of oral hygiene supplanted the traditional means such as "cure dents" or water rinse with finger.

Traditional tea drinking in Senegal. A real source of fluoride intake for the population.

Tea drinking after meals is a traditional practice in Senegal where more than 80% of the population from 15 to 60 years old drink tea. According to the tradition, in one session, each tea consumer has to drink 3 cups of decocted tea. The content of a cup is about 30 ml of liquid. Some people drink tea three times daily, that is to say after each meal. Tea plant is rich in fluoride. To determine the effective intake of the Senegalese population from this source, we measured the fluoride concentration not only for each component of the prepared tea but also for each cup of prepared tea. For this study, we used the two main kinds of tea existing locally. The analyses have been done at Rochester, NY Eastman Dental Center, Oral Biology Dept Fluoride Laboratory using the Taves Microdiffusion Method and the fluoride Ion Specific Electrode. The results so that the mean total fluoride concentration of each cup, from the first to the third one, is: 4.0 mg F-/L, 7.436 mg F-/L and 1.230 mg F-/L. It means that on an average in one session, a Senegalese tea consumer has a daily fluoride intake of 1.139 mg F-/L when taking in count the total fluoride and drinking only 90 ml of tea. If we consider the ionic fluoride the amount of daily ingested fluoride for someone who takes only 3 tea-pots of 30 ml each, is 0.830 mg. To conclude, we state that this traditional practice may have a caries preventive effect. Further studies will be grateful for that practice when setting up a caries preventive program in our country. We will also be careful in extending that practice to children less than 8 years old because it might cause dental fluorosis as in Senegal the optimal dose of fluoride is 0.8 mg F-/L.