[The alexithymia questionnaire for children (AQC): Psychometric properties in a sample of 105 adolescents hospitalized in an adolescent psychiatric department]. / Le questionnaire d'alexithymie pour enfants (QAE) : étude sur une population clinique de 105 adolescents hospitalisés en pédopsychiatrie.

OBJECTIVE: The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale. METHOD: One hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12-18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ2 (ratio of χ2 and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ2<3 and RMSEA<0.05. Cronbach α were also calculated. RESULTS: Fit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ2 and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ2-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ2-difference=151.447, delta df=114, P<0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items. CONCLUSION: The Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

[Prostaglandins and the immune response at the intestinal submucosal level. A potential site for interference with the repeated use of paracetamol and ibuprofen at a young age?]. / Les prostaglandines et l'immunité du chorion sous-muqueux intestinal. Questions à propos de l'usage répété du paracétamol et de l'ibuprofène en bas âge.

Immune deviations have been shown to exponentially increase in young children. As a consequence, research investigating possible environmental reasons for this increase is considered a public health priority. An improved understanding of the immunity of the intestinal submucosal lamina propria has demonstrated the importance of prostaglandins (PGE2s) on its local development with general immune consequences further on. PGE2s appear at this intestinal submucosal level from the metabolism of arachidonic acid mediated by type-2 cyclooxygenases (COX2s) situated in the membranes of many immune cells. The potential risk of repeated inhibition of PGE2 synthesis at a young age has been demonstrated in experiments with animals systemically exposed to a non-steroidal anti-inflammatory drug (NSAID). The repeatedly exposed animal cannot develop tolerance to food antigens and exhibits autoimmune deviations. Acetaminophen (paracetamol) and ibuprofen are analgesic and antipyretic medications given to children either alone or in combination, most often without medical prescription. Recently, it has been demonstrated that paracetamol, like ibuprofen, also carries, besides its central action, a non-selective inhibitory action on peripheral COXs. However, this inhibitory action only relates to physiological concentrations of arachidonic acid and explains the difference in their respective anti-inflammatory effects. Since recently published data have repeatedly reported an increase of immune deviations associated with paracetamol exposure at a young age, it appears important to better understand the possible negative impact of excessive and repetitive inhibitions of the physiological synthesis of prostaglandins by COX2s in childhood during which all immune mechanisms are built up at the intestinal submucosal level. Therefore, a well-designed prospective strategy for pharmacovigilance of these COX inhibitors repeatedly given during childhood is urgently needed.

[Case report: congenital adrenal hyperplasia and ambiguous genitalia due to 3 beta-hydroxysteroid dehydrogenase deficiency]. / Le cas clinique du mois. Hyperplasie congénitale des surrénales et hermaphrodisme masculin causés par un déficit en 3 bêta-hydroxystéroïde déshydrogénase.

3 beta-hydroxysteroid dehydrogenase deficiency is a disorder of steroid biosynthesis resulting in decreased production of all 3 groups of adrenal steroids. The symptomatology includes congenital adrenal hyperplasia disorders and ambiguous genitalia in 46, XY males. 3beta-HSD deficiency is a rare autosomal recessive genetic disorder. Much heterogeneity exists in the clinical presentation of this disorder.

[Pneumomediastinum in children]. / Le pneumomédiastin chez l'enfant.

Pneumomediastinum in children is diagnosed in two circumstances: cervical subcutaneous emphysema or radiological findings. The predominant symptoms are dyspnoea, stabbing chest pain, sore throat and dysphagia. Traumatic injuries and pulmonary diseases such as asthma are the most common causes of pneumomediastinum. It may rarely result from iatrogenic manoeuvres or acidocetosis. Spontaneous mediastinal emphysema is seldom reported in children. Chest X-ray films are essential investigations. The treatment is directed towards the underlying cause, with conservative management being sufficient in most cases. However, the risk of surveying of pneumothorax or tension pneumomediastinum justifies close clinical follow-up in a specialised care unit. The onset of these pathologies necessitates a more aggressive therapy by aspiration through percutaneous catheter placed in the mediastinum.

Nail matrix arrest in the course of hand, foot and mouth disease.

UNLABELLED: Onychomadesis describes complete nail shedding from the proximal portion; it is consecutive to a nail matrix arrest and can affect both fingernails and toenails. It is a rare disorder in children. Except for serious generalised diseases or inherited forms, most cases are considered to be idiopathic. Few reports in literature concern common triggering phenomena. We present four patients in whom the same benign viral condition in childhood appeared as a stressful event preceding onychomadesis. In each case, spontaneous complete healing of the nails was achieved within a few weeks. CONCLUSION: Onychomadesis and/or onycholysis is a newly recognised complication in the course of viral infections presenting clinically as hand, foot and mouth disease, and because of mild forms, is probably underestimated.

[Aglossia-adactylia with jejunal atresia]. / Aglossie-adactylie avec atresie jejunale.

Case report of a newborn with the aglossy-adactyly syndrome associated with complete jejunal atresia. Review of the literature does not allow any conclusion concerning the etiology of the observed malformations. The jejunal atresia, present in this case is probably coincidental. Attention is drawn on the possibility of prenatal diagnosis of obstruction of the digestive tract by ultrasound whenever pregnancy is complicated by hydramnios.