Prise en charge de la malnutrition aigüe chez l'enfant dans un hôpital secondaire sahelien

La malnutrition chez les enfants de moins de cinq ans est un problème majeur de santé publique dans les pays à faibles revenus, et contribue de manière significative à la mortalité dans cette tranche d'âge.Le but de ce travail était d'évaluer le profil épidémioclinique et thérapeutique des enfants malnutris pris en charge au centre de santé de référence de Nara.Méthode:IL s'est agi d'une étude rétrospective et descriptive,allant du 01/01/2016 au 31/12/2016.Tous les enfants d'âge compris entre 6 mois et 59 mois, admis pour malnutrition aigüe ont été inclus.Résultats:La malnutrition a été diagnostiquée chez quatre cent soixante un enfant, soit 15% des consultations et 50% des hospitalisations.L'âge médian était de 26 mois (2 mois 93 mois). Le sex ratio était 0,92 (M=222;F=239).Dixneuf pour cent des patients ont eu un sevrage progressif (n=90), et il a été brutal chez 371patients, soit 80%. La répartition des patients selon le Z score était le suivant: Z-score <-1 (n=15;3%), Z-score <-2 (n=46; 10%), Z-score <-3 (n=400; 87%). Le périmètre brachial moyen était de 105mm (99mm-124mm). A l'admission, l'hypoglycémie a été notée chez 45% (n=204). Les cas de marasme représentaient 80% (n=367) kwashiorkor 10% (n=48). La forme mixte de la malnutrition a représentée10% (n=46). Les pathologies associées à la malnutrition étaient: les pneumopathies (n=219; 47%), lepaludisme (n=115;25%) et les gastroentérites (n=68; 15%).Le F75 a été administré majoritairement pendant 3 mois dans 93% des cas. Pour la phase 2 du traitement, le Plumpy Nut et le F100 ont été respectivement administré à 88% et 12%.Le taux de récupération nutritionnelleétait de 95% (n=435).Cinq pour cent des patients sont décédés (n=26). La pneumonie a été la cause du décès dans 85% des cas. Le taux de guérison pour les cas de marasme et de kwashiorkor était respectivement de 94% et 93%.Conclusion:la malnutrition aigüe demeure fréquente et préoccupante en milieu pédiatrique sahelien. Une meilleure connaissance des mères sur le sevrage et la diversification alimentaire permettront d'améliorer l'état nutritionnel des enfants

Effects on employees of controlling working hours and working schedules.

BACKGROUND: High levels of control over working time and low variability in working hours have been associated with improved health-related outcomes. The potential mechanisms for this association remain unclear. AIMS: To examine how work-time control and variability of working times are associated with fatigue recovery, sleep quality, work-life balance, and 'near misses' at work. METHODS: Manufacturing sector employees completed a questionnaire that assessed work-time control, work-time variability, fatigue recovery, sleep quality, work-life balance and the frequency of near misses in the past 6 months. Mixed model analysis of covariance and multiple logistic regression analysis tested the main effects of work-time control and variability and their interaction, while adjusting for age, sex, work schedules, and overtime work in the past month. Subscales of work-time control were also investigated (control over daily working hours and over days off). RESULTS: One thousand three hundred and seventy-two completed questionnaires were returned, a response rate of 69%. A significantly higher quality of sleep and better work-life balance were found in the 'high control with low variability' reference group than in the other groups. Significantly better recovery of fatigue was also observed in the group having control over days off with low variability. While near misses were more frequent in the group with high control over daily working hours coupled with high variability compared with the reference group this was not significant. CONCLUSIONS: High work-time control and low variability were associated with favourable outcomes of health and work-life balance. This combined effect was not observed for the safety outcome addressed here.

[Intestinal invagination occurring during pregnancy: 1 case]. / Invagination intestinale sur grossesse: 1cas.

Acute intestinal invagination is a rare pathology in adults; even more so on specific fields as in pregnant women. Therapeutic indications depend on the duration of the invagination. We noted a cases of acute intestinal invagination after 72 hours of evolution in a multiparous 35 year old woman, 27 weeks pregnant, successfully treated by surgery and tocolysis.

L'invagination intestinale aigue est une pathologie rare chez l'adulte, elle l'est encore plus sur des terrains particuliers comme chez la femme enceinte. Les indications thérapeutiques dépendent de la durée d'évolution de l'invagination. Nous rapportons un cas d'invagination intestinale aigue après 72heures d'évolution chez une multipare de 35ans enceinte de 27semaines traitée avec succès par chirurgie et tocolyse.

Relationship of bone health to yearlong physical activity in older Japanese adults: cross-sectional data from the Nakanojo Study.

INTRODUCTION: We determined associations between bone health and the quantity and quality of habitual physical activity in a cohort of 172 free-living Japanese aged 65-83 years (76 men, 96 women). METHODS: The number of steps taken and the intensity of physical activity were measured every 4 s throughout each 24-h period for 1 year, using a specially adapted accelerometer that distinguished up to 11 levels of physical activity (expressed in metabolic equivalents, METs). At the end of the year, a quantitative ultrasonic technique assessed each participant's osteosonic index (OSI, reflecting bone stiffness in the calcaneus). RESULTS: The data were significantly described by linear and exponential regression models which showed that in both sexes the OSI score increased with increasing daily physical activity, up to the observed maximum values of approximately 14,000 steps/day and 50 min/day at an intensity >3 METs. However, when data were categorized into quartiles of physical activity, OSI scores were not significantly greater in persons exceeding recommended minimum standards of habitual physical activity (corresponding to counts of around 6,900 and 6,800 steps/day and durations >3 METs of around 18 and 16 min/day in men and women, respectively). All who met such criteria (with the exception of a few women) had OSI scores above the threshold for a clinical diagnosis of osteoporosis. Multivariate-adjusted logistic regression analyses predicted that men and especially women who engaged in <6,800 steps/day and <16 min/day of moderate-intensity physical activity were, respectively, 4.9-8.4 and 2.2-3.5 times more likely to sustain fractures than those participating in >8,200 steps/day and >25 min/day of activity >3 METs. CONCLUSION: Causation cannot be inferred from a cross-sectional study. Nevertheless, we suggest that from the viewpoint of bone health, elderly people should be encouraged to engage in low- and moderate-intensity habitual physical activity, taking >7,000 steps/day with a duration >15 min/day at >3 METs.

Decreased fractal component of human heart rate variability during non-REM sleep.

The physiological significance of the fractal component of short-term, spontaneous heart rate variability (HRV) in humans remains unclear. The aim of the present study was to gain further information about the respective fractal components by extracting them from HRV, blood pressure variability (BPV), and instantaneous lung volume (ILV) time series via coarse graining spectral analysis in nine healthy subjects during waking and sleep states. The results show that the contribution made by the fractal component to the total variance in the beat-to-beat R-R interval declined significantly as the depth of non-rapid eye movement (non-REM) sleep increased, that the ILV time series was largely periodic (i.e., nonfractal), and that BPV was unaffected by sleep stage. Finally, the fractal component of HRV during REM sleep was found to be quite similar to that seen during waking. These results suggest that mechanisms involving electroencephalographic desynchronization and/or conscious states of the brain are reflected in the fractal component of HRV.

The subcoracoid impingement syndrome: clinical, semeiologic and therapeutic considerations.

Subcoracoid impingement is a relatively obscure syndrome. Guided by studies conducted by Gerber and Patte since 1985, the authors began to select cases of periarticular disease of the shoulder in which there was clinical evidence of involvement of the subcoracoid space. These patients underwent repeated clinical examination, radiographic examination according to Bernageau, CT scan, and Arthro-CT. All patients were tested with a novocaine infiltration into the subcoracoid space. This paper contains a precise diagnostic protocol that has evolved from the studies conducted by Gerber and Patte. Of the 23 patients selected, 3 were advised to undergo surgical widening of the subcoracoid space, consisting of resection of the coracoacromial and coracohumeral ligaments and special, reductive coracoidplasty.

The surgical treatment of recurrent anterior dislocation of the shoulder.

The authors analysed the results obtained in 94 recurrent dislocations of the shoulder submitted to surgery between 1979 and 1988 according to the Latarjet method. After considering the reasons for selecting this method, they discuss some aspects of the physiopathology of recurrent dislocation and instability of the shoulder. the principles of the Latarjet method are described and the Patte modification, used by the authors since 1986, is briefly illustrated. The long-term results were evaluated according to the walch and Duplay evaluation scheme. Sixty-nine patients with a follow-up ranging from a minimum of 1 year to a maximum of 9 were reviewed. The results were excellent or good in 93% of the cases.

[XXXXY syndrome: clinical-radiological findings in one patient (author's transl)]. / Su una osservazione di sindrome XXXXY: rilievi clinico-radiologici.

A case of XXXXY syndrome in a 15 year old male is reported. Clinical findings (mental retardation, muscular hypotonia, hypogonadism, characteristic facies), chromosome analyses as well as fingerprint ridge counts were typical of the syndrome. Several radiological abnormalities were found. It is noteworthy that features consistent with epiphysial dysplasia were present. In the patient's kindred a case of "cri du chat" syndrome and a 5:9 balanced translocation were discovered.