How do parents of children with type 1 diabetes mellitus cope and how does this condition affect caregivers' mental health?

OBJECTIVE: To evaluate the impact that type 1 diabetes mellitus (T1DM) in children has on parents' mental health and parents' coping with this condition. METHODS: A cross-sectional study involving, at the outpatient examination, 41 caregivers of T1DM patients who had been diagnosed for at least 6 months. We evaluated the parents' coping strategies with the Brief COPE and their depressive and anxiety symptoms with the Hospital Anxiety and Depression Scale (HADS). Glycemic control of patients was assessed using the last glycated hemoglobin (HbA1c) values. RESULTS: The average total score at HADS was 17.62 (SD=6.98). Half of the parents had an anxious score over the cut-off. The more parents were depressed or anxious, the more they used emotion-focused coping (P=0.002 and P=0.00, respectively). The more parents were anxious or depressed, the more they used maladaptive coping strategies such as avoidance and distraction. CONCLUSION: These findings emphasise the key role of healthcare providers in assessing parents' difficulties and taking special care of those who have the most problems.

Living with type 1 diabetes mellitus: How does the condition affect children's and adolescents' quality of life?

OBJECTIVE: Our study aimed to measure the health-related quality of life (QoL) of Tunisian children and adolescents with type 1 diabetes mellitus (T1MD). METHODS: This cross-sectional study included 48 patients aged 3-18 years with T1MD, diagnosed for at least 6 months, and their parents, who underwent outpatient examinations from September to December 2018. The children's QoL was assessed using the PedQL 3.0 Diabetes Module exploring five dimensions: diabetes symptoms, treatment barriers, treatment adherence, worry, and communication problems. Parents shared their perception of their children's QoL through the PedQL 4.0 parents' report (general health and emotional, social, and scholar functioning). Glycemic control was assessed using the last glycated haemoglobin (HbA1c) values. RESULTS: The patients' average QoL score was 80.52 (±13.61) without significant differences between gender and age. The longer the duration of the disease, the worse the glycemic control. Girls and adolescents seemed to have poorer glycemic control. Boys and adolescents had more difficulties in all aspects of QoL. Parents perceived a worse QoL than that reported by their sons/daughters (72.34±16.42; P=0.006). CONCLUSION: These findings emphasize the importance of an interdisciplinary, biopsychosocial, and family-centered care approach to patients with T1MD.

[Recovery of Cushing syndrome revealing McCune-Albright syndrome]. / Guérison d'un syndrome de Cushing révélateur d'un syndrome de McCune-Albright.

Cushing syndrome (CS) is a rare feature of McCune-Albright syndrome. Treatments consist of bilateral adrenalectomy followed by lifelong glucocorticoid and mineralocorticoid treatment. However, cases of spontaneous remission of CS have been reported in the literature. We report a case of McCune-Albright syndrome with CS treated with metyrapone for 30 months with prolonged remission after a 12-year follow-up. Adrenalectomy may be avoided in some cases of CS caused by McCune-Albright syndrome. Metyrapone could be a good alternative to surgical treatment.

[Pediatric Crohn's disease in Tunisia]. / La maladie de Crohn de l'enfant en Tunisie.

UNLABELLED: Crohn's disease occur mainly in adults. However, pediatric onset forms are not rare and have many characteristics. AIM: to study clinical, diagnostic, therapeutic and evolutive characteristics of crohn's disease in tunisian children. METHODS: Retrospective multicenter study conducted in 10 pediatric departments on a period of 10 years (2000-2008) RESULTS : 43 children were included. The sex-ratio was 1.68. The mean age at the onset of the symptoms was 11+/-2.3 years (5-16 years). The age of onset was inferior to 10 years in 25 % of the children. The delay before management was superior to 1 year in 25% of cases. The initial symptoms were dominated by diarrhea (95%). Perineal manifestations were present at diagnosis in 30% of children and extra-digestive manifestations in 53%. Ileocolonic localization was the most frequent (46%). The initial disease flare was moderate in 83% of cases. The treatment was medical in 77 % of cases, nutritional and medical in 18.5%. Maintenance therapy was instituted in 86% of cases and consisted essentially in azathioprin (62%). The mean follow-up was 3 years and 4 months. 60% of the children had at least one acute flare. During evolution, 7% of children had anoperineal surgery and 11% an intestinal resection. CONCLUSION: Crohn's disease seems rare in Tunisia. The time of diagnosis is often delayed. The management is based on immunosuppressive therapy and nutritional support.

[Imported Schistosoma haematobium infection: report of 9 cases]. / La bilharziose urinaire: a propos de 9 cas importés.

BACKGROUND: Schistosomia haematobium infection has been eradicated from Tunisia since 1980. Only some imported cases are noted each year. AIM: The authors report nine cases of Schistosomia haematobium infection diagnosed. METHODS: The diagnosis was carried out within the framework of a survey carried out by the service of Pediatry of the hospital Mongi Slim of Tunis concerning 20 students of African extraction. RESULTS: Hematuria was found in all cases. Schistosomia haematobium infection is diagnosed in all patients by urinary parasitologic examination. Radiological evaluation had revealed mild uroradiologic abnormalities in five patients. All patients were treated by praziquantel. Remission was confirmed by urinary sterilization. Radiologic abnormilities persisted in 3 patients. CONCLUSION: Radiological evaluation and regular follow-up after treatment of students with Schistosomia haematobium infection is required.

[Treatment with metyrapone of Cushing's syndrome revealing McCune-Albright syndrome]. / Traitement par métyrapone du syndrome de Cushing révélant un syndrome de McCune-Albright.

UNLABELLED: Cushing's syndrome reveals McCune-Albright syndrome in a minority of patients. Bilateral adrenalectomy is performed on the majority of cases. CASE REPORT: We present a case of McCune-Albright syndrome revealed by a Cushing's syndrome treated by metyrapone. Results were good, after a 4-year follow up. CONCLUSION: Treatment with metyrapone could be recommended, for some patients, in McCune-Albright syndrome with Cushing's syndrome before chirurgical treatment.

[Helicobacter pylori infection: prospective study for asymptomatic Tunisian children]. / Infection à Helicobacter pylori: étude prospective chez les enfants tunisiens asymptomatiques.

UNLABELLED: The aim of this study was to specify epidemiologic particularities of Helicobacter pylori infection among asymptomatic Tunisian children. POPULATION AND METHODS: A sample of 191 Tunisian healthy children studied for a two-month-period of time in protection center for mothers and children in a Tunis area. The children had benefited of an oriented questionnaire and a serological study of Helicobacter pylori. RESULTS: The prevalence of Helicobacter pylori infection was 30.4% (58 of 191). This prevalence increased with age (21% < 5 years vs 69% > 6 years: p < 0.04). The low socio-economic level and the familial antecedents of peptic illness constitute the main risk factors of Helicobacter pylori infection (p < 0.05). Both ways of transmission: oro-oral and fecal-oral seem to coexist among children.

[Apropos of a mediastinal teratoma invading the lung]. / A propos d'un cas de tératome médiastinal rompu dans le poumon.

Mediastinal mature teratomas are rare in children. Diagnosis is often made in the presence of a complication. We report a case of a mature mediastinal teratoma, complicated by its opening in the lung. The patient was a four-year-eight-month-old girl. She was admitted for fever, cough and dyspnea. The chest radiography showed a large mediastinal mass with calcifications. The CT scans and MRI aided in establishing the diagnosis. Biological tests (alpha-foetoproteins and beta-HCG) confirmed the benignity of the tumor. The child was operated on with full success.

Indicaciones pediátricas actuales de la cisaprida: toma de posesión de la European Society for Pediatric Gastroenterology, Hepathology and Nutrition / Current pediatric indications for cisapride: a position paper by a panel convened by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition

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[Confirmation of the presence of Leishmania infantum MON-80 in Tunisia]. / Confirmation de la présence de Leishmania infantum MON-80 en Tunisie.

A definitive confirmation of the presence in Tunisia of the rare zymodem MON-80 of Leishmania infantum, as a causative agent of infantile visceral leishmaniasis, is reported.

[Bilateral stenosing ureteritis in Henoch-Schnlein purpura]. / Urétérite sténosante bilatérale au décours du purpura rhumatoïde de Henoch-Schönlein.

BACKGROUND: Ureteral complications in Henoch-Schonlein's purpura are rare. They may post difficult problems of diagnosis. CASE REPORT: Bilateral uretal stenosis revealed by low back pain, macroscopic hematuria, leukocyturia and renal failure appeared 15 days after the onset of Henoch-Schönlein purpura in a 14-year-old boy. It was confirmed by ultrasonography; intravenous pyelography showed stenosis of both proximal uretera associated to bilateral hydronephrosis. Treatment with corticosteroids relieved the symptoms and normalized the renal function in restoring patency of both ureters. Nevertheless, the patient was still suffering from mild bilateral hydronephrosis and bilateral renal lithiasis, 2 years later. CONCLUSIONS: Macroscopic hematuria and renal failure, usually indicative of renal involvement in Henoch-Schönlein syndrome can be the first manifestations of the ureteritis exceptionally seen in this vasculitis.

[Symptomatic Helicobacter pylori infection: prospective study of epidemiological, diagnostic and therapeutic aspects in children in Tunisia]. / L'infection symptomatique à Helicobacter pylori: étude prospective des aspects épidémiologiques, diagnostiques et thérapeutiques chez l'enfant en Tunisie.

BACKGROUND: Epidemiology, criteria for diagnosis and treatment of Helicobacter pylori (HP)-related infection in children are still debated. POPULATION AND METHODS: A total of 130 children and teenagers who presented recurrent episodes of unexplained abdominal pain underwent an endoscopic examination. Gastric biopsies were studied for histology and search for HP (Giemsa and Gram staining, testing for urease and culture in an appropriate environment). Serological tests (Elisa) were performed. HP infection was considered as present when two investigations at least proved positive. Infected children were given one drug (amoxicillin, cimetidine or antiacids) or two drugs (amoxicillin plus tinidazole). Clinical and endoscopic control including histological and bacteriological studies were done for the following 12 to 18 months. RESULTS: HP infection was present in 70 children (54%). It was associated chronic gastritis in 64 cases (91%) and with duodenal ulcer in the remaining cases (9%). Recurrent abdominal pain, anorexia, weight loss and family history of peptic diseases were significantly associated with HP infection (P < 0.05). Endoscopic examination was normal in 35 infected children (50%); nodular antritis was inconstant (30%) but always associated with HP-related infection (P < 0.001) as was atrophic or follicular chronic gastritis. Eradication of HP, associated with the disappearance of chronic gastritis, was seen in 53% of children given amoxicillin alone and in 85% of those given amoxicillin plus tinidazole, but never in those receiving cimetidine or antiacids. Relapse of the HP-related infection was observed in four children (16%), 6 to 12 months after the first episode. CONCLUSION: These results show high prevalence of HP-related infections in the Tunisian children who suffer from recurrent episodes of abdominal pain. They also confirm the role of HP in the inflammatory process and the development of gastroduodenal ulcer in children.

Assessment of iron status in children and adolescents with Crohn's disease: value of basic red cell ferritin.

The iron status of 22 children and adolescents with Crohn's disease (mean age: 13 years) was evaluated. Eleven patients were suffering from active disease with inflammation, identified by at least one abnormal value for serum orosomucoid, C-reactive protein or sedimentation rate (group I). Eleven patients were in clinical remission and showed no biological evidence of inflammation (group II). Hemoglobin and red cell indices, erythrocyte protoporphyrin, serum iron, transferrin, serum ferritin and basic red cell ferritin were determined in all patients. The usual indicators of iron status, particularly serum ferritin, were affected by the inflammatory processes, but basic red cell ferritin appeared to be independent of inflammation. Basic red cell ferritin can therefore be considered to be a reliable indicator of iron status in children and adolescents with Crohn's disease.

[Nasal transepithelial difference of potential in mucoviscidosis. Clinical application of the measurement]. / Différence de potentiel transépithélial nasal dans la mucoviscidose. Application clinique de sa mesure.

OBJECTIVES: To demonstrate the value of nasal transepithelial potential difference measurements in the diagnosis and assessment of therapeutic effect in cystic fibrosis. METHOD: Nasal transepithelial potential difference was measured in 50 patients with cystic fibrosis (mean age 10 years) and 21 controls (mean age 8 years). RESULTS: There was a very significant increase in nasal transepithelial potential in cystic fibrosis patients (-28 +/- 8 mv) compared with controls (-8 +/- 3 mv) (p < 0.0001). The sensitivity and specificity of this test for the diagnosis of cystic fibrosis were 92% and 95% respectively. Nasal transepithelial potential difference was positively correlated with age (r = 0.43; p < 0.002) in cystic fibrosis patients but no correlation was found in controls. There was no significant difference in potential differences as a function of sex or Delta F508 genotype (homozygous vs heterozygous; Delta F508 vs non-Delta F508). CONCLUSION: These findings demonstrated the value of transepithelial potential difference in the diagnosis of cystic fibrosis and emphasized its capacity to assess the effect of new therapeutic protocols aimed at modifying C1- and Na+ ion transport. It could be particularly helpful for the interpretation of doubtful sweat tests.

Characteristics and consequences of duodenogastric reflux in children on total parenteral nutrition (TPN) for severe gastrointestinal disorders.

This study was carried out to determine the frequency and composition (biliary and/or pancreactic) of duodenogastric reflux (DGR) in children with severe gastro-intestinal disorders on total parenteral nutrition (TPN), and to assess its consequences in terms of gastric histology (gastric per endoscopic biopsies) and secretion (acid, pepsin and sialic acid output). Sixteen children (mean age: 20 months) with severe gastro-intestinal disorders requiring TPN (mean duration: 9.5 months) were studied. DGR was demonstrated by measuring gastric choline and trypsin outputs. Serum gastrin levels were measured in all patients. Seven children (44%) had a DGR, with a significant increase in choline output (p < 0.02). Trypsin output was elevated in one patient only. Exudative gastritis and increased sialic acid output occurred in the presence and in the absence of DGR. DGR did not alter the basal acid and pepsin secretions. The serum gastrin levels were normal except in one case. These results show that DGR occurs frequently in children suffering from severe gastro-intestinal disorders on TPN, that it is mainly of biliary origin and that exudative gastritis is very frequent but not correlated with DGR. It suggests that DGR causes little injury in children on TPN, perhaps because of their decreased pancreatic secretion.