[Familial congenital hypomagnesemia revealed by neonatal convulsions]. / Convulsions néonatales révélant une hypomagnésémie congénitale familiale.

Congenital hypomagnesemia is a rare disease, with an impact on cognitive and neurological development. We report on three familial cases of congenital hypomagnesemia, two boys and one girl who belong to the same consanguineous family. They all presented neonatal seizures and a psychomotor developmental delay. Cerebral computed tomography showed cerebral atrophy and calcifications in one case and magnetic resonance imaging found predominant cerebellar atrophy in the two other cases. All three patients also had hypocalcemia, hyperphosphoremia, and hypomagnesemia. The parathyroid hormone blood level was low in two cases and normal in the third. One 7-month old patient died. The others received a supplementation of calcium and magnesium, which normalized calcemia, phosphatemia but not magnesemia, which remained low despite high doses. They have both developed cognitive and behavioral impairments.

[Cryptococcal meningitis in children: description of 3 cases]. / Cryptococcose neuroméningée de l'enfant : à propos de 3 cas.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

[Prescription errors in a pediatric hospital department in Dakar, Senegal]. / Les erreurs de prescription médicamenteuse dans un service hospitalier pédiatrique a Dakar, Sénégal.

Prescription is the main source of medication error in daily medical practice. The purpose of this study was to determine the distribution and cost of drugs used and causes of prescription errors in one department of the Albert Royer National Children's Hospital Center in Dakar, Senegal. Study was focused on patients admitted from December 1 to March 3, 2009. Based on 792 expected hospitalizations, 1 out of 2 patients was randomly selected to obtain a cohort of 400 patients for whom a total of 1267 prescriptions were written by pediatricians and interns on duty. Prescriptions were evaluated by pediatric professors to identify errors. The types of errors taken into account in this study involved indication, dosage schedule, and treatment duration. A total of 216 (17.0%) errors were identified including 121 cases (9.5%) involving indication mainly for antibiotics (30.5%) and antimalarial drugs (28.9%). Dosage schedule errors were observed in 58 cases (4.5%) involving antibiotics (24.1%) and antifungals (25.8%). These findings confirm the need for an intensive information campaign to prevent medication misuse in countries such as Senegal. Campaigns should be based on training of relevant therapeutic staff to optimize health care and improve availability for everyone.

[Malaria severity criteria and prognostic factors among children in Dakar]. / Critères de gravité et facteurs pronostiques du paludisme chez l'enfant à Dakar.

INTRODUCTION: Severity factors associated with malaria as well as prognostic factors for death were assessed at the Dakar Centre Hospitalier National d'Enfants Albert Royer de Fann (CHNEAR). PATIENTS AND METHODS: A prospective study was carried out from January 1 to December 31, 2007 involving children from 0 to 15 years of age, admitted for plasmodium falciparum malaria with positive thick drop examination, meeting at least one of the WHO 2000 malaria severity criteria. Acidosis was not studied. OUTCOME: The rate of severe malaria cases in our hospital was 6.4%. The sex ratio was 1.4 and the median age of patients at 91 months. A peak was observed during the 4th trimester (75.5%). Convulsions (52.5%) and obtundation (49.4%) were the most common signs of clinical severity while hyperparasitemia and severe anemia ranged at 27.2% and 21.6%, respectively. Lethality was 11.1% and the main death risk factors were young age (p = 0.025), coma (p = 0.007), respiratory distress (p = 0.04), or hypoglycemia (p = 0.001). CONCLUSION: Reducing malaria hospital mortality in Senegal may be obtained by proper management of poor prognostic factors such as coma, respiratory distress, and hypoglycemia.

[Epidemiology and course of splenomegaly in children and adolescents with sickle cell disease in Senegal]. / Aspects épidémiologiques et évolutifs de la splénomégalie chez les enfants et adolescents porteurs de syndromes drépanocytaires majeurs au Sénégal.

Splenomegaly is common in sickle cell disease (SCD) and can lead to complications. In order to evaluate its prevalence and progression in Senegalese children ad adolescents with SCD, we analyzed the records of all patients followed-up at Albert-Royer Children's Hospital in Dakar, Senegal, from January 1991 to December 2005. Age, clinical course specifying size of the spleen beyond the costal margin, and disease progression were the main data recorded. We included 698 patients (94.6% SS, 4.4% SC and 1% S-beta-thalassemia). The subjects' mean age when included in the cohort was 6 years and 11 months. Splenomegaly was observed in 122 patients (17.5 %), measuring 1-17 cm beyond the costal margin (mean, 4.7 cm). Splenomegaly was more frequent in SC patients (32.3 %) compared to SS patients (16.5 %, p=0.025). The frequency was greater in infants aged 0-12 months (25.6 %) and increased from the 1- to 5-year-old age group to the 6- to 10-year-old, before it decreased further. The course of splenomegaly was marked by subsequent reduction in 17.3 % of cases, total reversal in 43.4 %, and no size variation in 39.3 %. Acute splenic sequestration occurred in 3 SS cases aged 27, 29, and 32 months and was managed with blood transfusion. Seven patients (6 SS and 1 SC) aged 4-13 years presented hypersplenism. Splenectomy was performed in 4 of these cases, while the complication reversed after 2 to 3 blood transfusions in the 3 remaining cases. The prevalence of splenomegaly is relatively low in Senegalese children with SCD. The risk of complications requires monitoring the spleen and teaching parents palpation of the baby's abdomen for early management of splenic sequestration.

[Pédiatric haemophilus influenzae b meningitis in Dakar]. / Méningite pédiatrique à haemophilus influenzae b à Dakar.

OBJECTIVE: This study had for aim to determine the etiology of Haemophilus b pediatric meningitis. DESIGN: A retrospective study of 216 biologically confirmed cases was carried out during 6 years (January 1995- December 2000) on children 0 to 15 years of age, hospitalized at the Albert Royer Children Hospital Center. RESULTS: Haemophilus influenzae b is the first cause of pediatric meningitis (19.7%) followed by Nesseria meningitidis (14.5%), and Streptococcus pneumoniae (13.6%). The Haemophilus influenzae b meningitis cases are distributed all year round with a peak between January and March, that is to say, during the dry and cool season. They affect children at an average age of 11.7 months, with a sex ratio of 1.1 for boys. Almost all of the patients live in the low-socio-economic areas of the Dakar suburbs (92.8%). More than 90% of the H. influenzae b isolates are sensitive to ceftriaxone (96%) chloramphenicol (93%), and to ampicillin (91%). Clinical evolution is marked by death (17.8%) and recovery with psychological, sensory, and motor sequels (19.9%). CONCLUSION: This report should help to include the combined vaccine Antihaemophilus influenzae b in the Senegalese Broad Vaccination Program. The final aim is the reduction of morbidity and mortality of infections due to Haemophilus influenzae b.

[Infantile cortical hyperostosis: case report]. / Hyperostose Corticale Infantile : a propos d'un cas.

Infantile cortical hyperostosis (ICH) or Caffey-Silverman disease is affection that attained skeleton most frequently flat bones, contiguous fasciae and muscles. We reported the case of a 3 months old female infant of Mauritanian origin, referred for recurrent osteitis of the left clavicle. The present complaints are incessant snivelling and functional disability of the left upper limb. Examination showed clavicular and mandibular swelling, without fever. Biological check-up showed inflammatory signs. Radiographies showed cortical thickening of the left clavicle and mandible. Interest of such an observation is in the rarity of this affection, its originality as for the striking age limitation, in the disconcerting but suggestive symptomatology, at least in the classical sites and in the possibility of its antenatal diagnosis.

[Epidemiological and clinical aspects of paediatric HIV infections in Albert-Royer Paediatric Hospital (Dakar, Senegal)]. / Aspects épidémiologiques et cliniques de l'infection à VIH de l'enfant au centre hospitalier national d'enfants Albert-Royer à Dakar.

UNLABELLED: Human Immunodeficiency Virus (HIV) infection prevalence rate is estimated at 1.4% in Senegal, and about 3,000 children could be infected. HIV positive children are followed up since 2000 in Albert Royer Hospital (Dakar, Senegal). OBJECTIVES: To describe clinical and epidemiological aspects of HIV paediatric infection, and to evaluate the implementation of high active antiretroviral therapy in HIV positive children in our country. POPULATION AND METHODS: Over a period of three years, the medical reports of 98 infected patients have been collected, 96% with HIV 1 infection. RESULTS: Most of the patients had a maternally transmitted HIV infection (99%). At their enrollment, the median age was 60 months; malnutrition (79%), persistent lymphadenopathy (65%) and skin lesions (64%) were the common clinical manifestations. Thirty-nine percent of the patients were in class C (CDC) and 81% had CD4 cell count< or =25%. Median viral load were 421,852 copies/ml at presentation. Seven infants had a rapid progressive disease with encephalopathy. Thirty-six patients received high active antiretroviral therapy with high observance and good tolerance. CONCLUSION: This study allowed to define clinical and biological profile of paediatric HIV infection in our country and to update the implementation of high active antiretroviral therapy.

[Management of children with sickle cell disease in Africa: experience in a cohort of children at the Royal Albert Hospital in Dakar]. / Prise en charge de la drépanocytose chez l'enfant en Afrique: expérience de la cohorte de l'Hôpital d'enfants Albert Royer de Dakar.

Management of major sickle hemoglobinopathies in industrialized countries has improved significantly over the last few years thanks to strict application of the preventive and curative measures developed as a result of a better understanding of the underlying pathophysiological mechanisms. However patients in Africa have benefited little from progress in the field due to the lack of human and physical resources in sharp contrast with the high prevalence of the disease. The purpose of this study was to analyze problems involved in management of childhood sickle cell disease in Africa based on our experience in a cohort of 556 cases treated over a period of 12 years. The main problems were the same as those encountered in other black African nations, i.e., delayed diagnosis due to a lack of routine neonatal diagnostic screening, difficulty implementing anti-infectious prophylaxis due not only to the high cost of recommended vaccinations not covered by the Expanded Program on Immunization but also to poor compliance with antiobioprophylaxis, and insufficient transfusion facilities hindering application of long-term transfusion protocols when indicated. In addition the high prevalence of digestive-tract parasitosis and malaria raise the need to combine standard preventive measures with routine parasiticidal treatment and malarial prophylaxis adapted to each geographical area. The high frequency of associated iron deficiency requires systematic laboratory testing to identify and treat resulting manifestations during follow-up. An important prerequisite for widespread implementation of appropriate preventive and curative measures in Africa is recognition of sickle cell disease as a priority in public health care policy.

[Major thrombocytosis associated with severe anemia in children. Diagnosis of 9 cases]. / Thrombocytose majeure associée à une anémie sévére chez l'enfant. Disussion diagnostique à propos de 9 cas.

Major thrombocytosis associated with severe anemia is uncommon in pediatrics. We report 9 consecutive cases observed in Albert Royer Children Hospital of Dakar. They were 7 boys and 2 girls 4 to 15 years old (mean age = 10 years). Six patients had a history of geophagia and 3 presented recent emission of worms by the stools. Anemia was clinically well tolerated in all cases. In initial blood count platelet levels varied from 800 10(3) to 1180 10(3)/mm3 (mean = 1032 10(3)/mm3), while hemoglobin level varied from 3.4 to 7.4 g/dl (mean = 4.9 g/dl). Anemia was microcytic, hypochromic and associated with low serum iron level in all patients. We considered the diagnosis of reactive thrombocytosis induced by iron deficient anemia in all cases. Platelet count and red cell indices were progressively normalised with iron treatment and no complication of thrombocytosis was observed. Considering published data, iron deficiency is one of the most frequent causes of reactive thrombocytosis in children. The physiopathologic mechanism, still unknown, could involve cytokines of thrombopoiesis. Reactive thrombocytosis induced by iron deficiency or other factors have usually a benign course and need no specific treatment other than that of the etiology.

[Child asthma in Senegal: epidemiological and clinical features in hospitals]. / Asthme de l'enfant au Senegal: aspects epidemiologiques et cliniques en milieu hospitalier.

This report is a retrospective study carried out from records of diseased of asthma, fallowed up in a paediatric national center of reference during the period from 1st of November 1987 to 31 st of august 1993. The goal was to describe the epidemiological and clinical factors linked to that affection in order to better contribute to improve its managment. For all the diseaseds of this report we notice and analysed the socio economical data, the promoting factors the occurring mode of the disease, the main clinical manifestations of the affection and their consequences. The morbid association and the data of the paraclinical exploration particularly the functional breathing exploration. Thus we noticed that the consultation in a specialized center occurs relatively late because of bad orientation of the deseaseds. In effect the mean age of diseaseds at the first consultation is 7.5 years while the disease begins in average at 3.5 years. By elsewhere we notice that 15% of these diseaseds live in an aggressive mesologic medium. With an atopy in 78.4% of the cases, loaded personal case history in 96.6% of the cases and that the releasing factors are not known for most of them (81.9%). Asthma in our diseaseds is not very frequent (77%) in general with a moderate intensity of crises (69%). However disturbances of physical activity are noted among 23% of the sample which corresponds nearly to the number of subjects with severe respiratory obstruction (25%). We quoted that there is an relation ship between the frequency of the cases the intensity of the crisis and the disturbances of physical activities of the diseaseds (x2:25.9, df = 2, p= 0,000002). Tacking count of all these factors may serve to set up a asthma prevention and treatment project in Senegal based on populations education and care providers training.

[Empyema caused by Staphylococcus aureus in children: the experience of the Albert Royer Children's Hospital at Fann University Hospital, Dakar]. / Pleurésies purulentes à staphylocoque doré de l'enfant. Expérience de l'hôpital d'enfants Albert-Royer du CHU de Fann à Dakar.

We report a retrospective study of 58 cases of empyema caused by Staphylococcus aureus at the Albert Royer Children's Hospital at the Fann University Hospital, between January 1st 1992 and December 31st 1995. Staphylococcus aureus is the principal bacterium responsible for pleural effusions in children (54%), way ahead of Streptococcus pneumoniae (19%). Most of the children affected (86%) are less than 30 months old. Theses infections are often serious due to the resistance of the bacterium to the usual antibiotics, the lack of solid research data and mechanical complications associated with the effusion. Treatment is based on the use of an appropriate bactericidal antibiotic treatment and pleural drainage.

[Treatment of status epilepticus in a developing country]. / Prise en charge de l'état de mal épileptique dans les conditions de pays en développement.

Status epilepticus (SE) is a condition requiring emergency care, which is often poorly managed in developing countries due to the lack of personnel, drugs, and insufficient technical and medical means. This study aims at determining the epidemiologic and etiologic characteristics and the difficulty in treating SE under the existing medical practice conditions in a developing country such as Senegal. A retrospective study was therefore carried out based on SE medical files at the University Hospital of Dakar over the period January 1988 to December 1998, and included several hospital departments, i.e., paediatrics, infectious diseases and neurology. Over an 11-year period 697 cases were recorded; of these, 48.2% of patients were under 5 years of age. The seizures were generalized in 58.2% of cases, partial in 21.2%, partial secondarily generalized, or with an association of both clinical presentations in 20.6% of cases. The etiology was as follows: mainly infectious (67%), followed by resistant and/or unbalanced epilepsy (9.9%), epilepsy of vascular origin (8%), and various other causes. The overall mortality rate was 24.8%. A long period between the onset of clinical symptoms and hospital treatment was noted, with an average time lapse of 16.6 h before treatment. The drugs utilized were diazepam and phenobarbitol, administered by injection. The overall outcome could be improved by better management, i.e., better prevention and an efficient treatment of infectious diseases, a reduction in the time before treatment, and improved means of intensive care.

[Risk factors for low birth weight: influence of maternal age, parity, gestational age, nutritional status and maternal pathology]. / Facteurs de risque du petit poids de naissance: influence de l'âge maternel, de la parité, de la gestité, de l'état nutritionnel et de la pathologie maternelle.

A retrospective study carried on between april 1st and september 31st 1997 has helped in collecting. 69 cases of low birth weight new-born (weight < 2500 g) at Abass Ndao hospital center in Dakar. The above population has been compared to 79 eutrophic new-born of mean birth weight equal to 3047.7 +/- 311 g (witnesses). The goal of this study is to appreciate the relationship between the maternal age, the number of the gestation, the parity, the nutritional status, the maternal pathologies during pregnancy and the low weight at birth. There was no difference between both groups as regards to the mean age (p = 0.44), the mean number of gestation (p = 0.7) and the mean parity (p = 0.48). On the other hand, the weight of the mother is smaller as for the group of low birth weight but the mean body mass index stand at normal in both groups. The pathologies during pregnancy period were obviously more frequent in the group of low birth weight new-born. There is a real need to insist on the preventive measures to be taken and the treatment of the maternal pathologies during pregnancy.