[Pasteurella multocida meningoencephalitis in a 14-year-old child]. / Méningo-encéphalite à Pasteurella multocida chez un enfant de 14 ans.

Pasteurella multocida is generally responsible for local infections through animal bites. It can be a cause of meningitis, which tends to affect people at the extreme ages of life or suffering from immunodeficiency. A 14-year-old teenager was hospitalized with typical signs of bacterial meningitis. P. multocida was evidenced in the cerebrospinal fluid. Progression was marked by a degradation on the 4th day of treatment, despite intravenous antibiotic therapy with third-generation cephalosporin, followed by a single seizure on the 7th day of treatment. The CT scan and magnetic resonance imaging showed pansinusitis but no intracerebral complications. Later progression was favorable, without neurological sequelae. The mode of contamination was inoculation via the upper airways with sinusitis. P. multocida meningitis is rare. The contamination does not always involve animal trauma.

Implementation and assessment of a training course for residents in neonatology and pediatric emergency medicine.

BACKGROUND AND AIMS: Residents must balance patient care and the ongoing acquisition of medical knowledge. With increasing clinical responsibilities and patient overload, medical training is often left aside. In 2010, we designed and implemented a training course in neonatology and pediatric emergency medicine for residents in pediatrics, in order to improve their medical education. The course was made of didactic sessions and several simulation-based seminars for each year of residency. We conducted this study to assess the impact of our program on residents' satisfaction and self-assessed clinical skills. METHODS: A survey was conducted at the end of each seminar. The students were asked to complete a form on a five-point rating scale to evaluate the courses and their impact on their satisfaction and self-assessed clinical skills, following the French National Health Institute's adapted Kirkpatrick model. RESULTS: Sixty-four (84%) of the 76 residents who attended the courses completed the form. The mean satisfaction score for the entire course was 4.78±0.42. Over 80% of the students felt that their clinical skills had improved. CONCLUSION: Medical education is an important part of residency training. Our training course responded to the perceived needs of the students with consistently satisfactory evaluations. Before the evaluation of the impact of the course on patient care, further studies are needed to assess the acquisition of knowledge and skills through objective evaluations.

[Management of patients under 18years of age by adult intensive care unit professionals: Level of training, workload, and specific challenges]. / Prise en charge de patients mineurs par les équipes de réanimation pour adultes : expérience pédiatrique, estimation de l'activité et difficultés ressenties par les soignants.

In routine practice, intensive care physicians rarely have to manage children under 18years of age, particularly those under 15. This study's objectives were to assess the quality of training in pediatrics of adult intensive care teams, to document the workload generated by care of pediatric patients, and to identify the difficulties encountered in managing minors as patients. A survey was administered in Lower Normandy from 4 April 2012 to 1 September 2012. Physicians, residents, nurses, and nurses' aides practicing in one of the nine intensive care units of Lower Normandy were asked to complete an electronic or paper format questionnaire. This questionnaire assessed their level of pediatric training, the workload management of pediatric patients entailed, and the challenges posed by these patients. One hundred and nine questionnaires were returned (by 26 attending physicians, 18 residents, 38 nurses, and 27 nurses' aides). Eighty-three of the respondents (76%) had no experience in a pediatric unit of any kind. Forty-two percent thought that the pediatric age range lies between 3months and 15years of age. However, more than 50% of respondents would like the upper limit to be 16years or even older. Ninety-three respondents (85%) estimated having some exposure to pediatric patients in their routine practice, but this activity remained quite low. Seventy-three (67%) reported difficulties with the management of these young patients. This survey provides current information regarding the level of training of adult intensive care unit professionals and their concerns about managing patients under 18years of age, both in terms of workload and specific challenges.

[Nager syndrome associated with tetralogy of Fallot: A frequent association?]. / Syndrome de Nager associé à une tétralogie de Fallot : une association fréquente ?

Nager syndrome belongs to a heterogeneous group of disorders involving abnormal development of the extremities, face, and jaw: acrofacial dysostosis (AFD). Fewer than 100 cases of Nager syndrome have been reported to date. Recently, mutations in the 1q21.2 region of the SF3B4 gene (splicing factor 3B subunit 4), which encodes a spliceosomal protein (SAP49) involved in the assembly of the spliceosomal complex U2SNP, have been demonstrated in patients with Nager syndrome. We report the case of a child who had a characteristic association (Pierre Robin sequence, bilateral and symmetrical malar hypoplasia, absent thumbs) clinically diagnosed as Nager syndrome. This child also presented tetralogy of Fallot. This combination is unusual; only two other cases have been described. The karyotype and the CGH-array were normal. After the description in 2012 of several mutations in the SF3B4 gene (1q21.2) in Nager syndrome, a genetic search for our patient revealed the mutation c.1229delC. In 2013, other authors showed the presence of these same mutations in the majority of their patients diagnosed as Nager syndrome. The haploinsufficiency of the SF3B4 region seems to be the major cause of Nager syndrome.

[Verapamil intoxication: beware of the delayed effect]. / Intoxication aigüe au vérapamil : attention à l'effet retard.

Intoxication with calcium channel inhibitory drugs is rare but mortality rates reach 10 %. We report the case of a 5-year-old girl who had ingested five 240-mg tablets of extended-release verapamil (VLP) and a tablet of bromazepam. Thirty hours after the ingestion she had a vasoplegic shock, heart conduction disorders, and metabolic complications. She was treated in pediatric intensive care with continuous epinephrine and insulin and recovered completely 60h after the ingestion. This case underlines the danger of calcium channel blocker overdose, increased by the extended-release mechanism: the drug effect is to slow down gastric motility - which explains the latency of the symptoms - but this also increases the drug absorption, inducing a vicious circle. These mechanisms in calcium blocker intoxication need to be kept in mind in order to decrease the mortality of such accidents.