Pubertal patterns in children with sickle cell anemia: A case-control study in Cameroon.

BACKGROUND: Puberty may be impaired in children with sickle cell anemia (SCA). Therefore, we aimed to explore the clinical and hormonal features of puberty in Cameroonian children. METHODS: In a case-control study, we included 64 children aged 8-18 years with SCA matched to healthy controls. We assessed height, weight, body mass index, body composition, and Tanner stages. Hormonal measurements included anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, and sex hormones (estrogens/testosterone). We used the Mann-Whitney Wilcoxon test to compare the median values between cases and controls. We looked for associations between the severity criteria of SCA and delayed puberty through multivariate analysis. RESULTS: Delayed puberty was reported in 27.3% of girls and 10% of boys with SCA. The median age of menarche was delayed by 2 years compared to controls. SCA patients had a low lean body mass compared to controls (p = 0.03). Anti-mullerian hormone levels were significantly higher in boys with SCA than those of controls (45.9 ng/mL vs. 17.65 ng/mL; p = 0.018). A history of severe infection, acute chest syndrome, and low hemoglobin level was associated with delayed sexual maturation in children with SCA. CONCLUSION: Our study revealed delayed puberty in children with SCA. Moreover, puberty is affected by the severity of the disease. This highlights the importance of regular monitoring of puberty during the follow-up of these children.

Osteogenesis Imperfecta in neonatal period in Cameroon: A case report.

Early forms of Osteogenesis Imperfecta should be considered as main etiology of bone deformities in newborns. Prenatal diagnosis and genetic counseling should be improved in Africa. Management of these children remains difficult in low-income countries.

Intestinal Parasitic Infections: A Rare Coinfection by Ascaris lumbricoides and Eristalis tenax in a 10-month-old Infant in Cameroon.

We report a rare case of coinfection by intestinal parasitosis and myiasis (Ascaris lumbricoides and Eristalis tenax) in a 10-month-old female infant living in Yaounde, an urban area in a low- and middle-income country. Incidental discovery was made following symptoms of acute vomiting and diarrhea with a massive release of an estimated thirty adult A. lumbricoides worms and E. tenax larvae through nasal, buccal, and anal routes. Diagnosis was based on the macroscopic appearance of the worms and the fly larvae. Treatment with benzimidazoles was initiated, with a resolution of symptoms within one week. This case highlights the challenges of public health eradication guidelines (such as the antihelminthic drugs marketing authorization) in our setting and discusses the protocols of management in less than 1-year-old infants in sub-saharan Africa, a region of high helminthic endemicity.

Chronic cutaneous candidiasis in children: should we stop there? Report of two cases associated with auto-immune polyendocrinopathy syndrome type I.

BACKGROUND: Auto-immune polyendocrinopathy syndrome type I is a rare genetic disease, usually revealed by chronic superficial candidiasis and autoimmune endocrine dysfunction in childhood. CASES PRESENTATION: We report the cases of 2 children, a 4 years-11 months old boy and 13 years old adolescent, admitted and followed up in the endocrinology unit of the Mother and Child Centre of Chantal Biya's Foundation for auto-immune polyendocrine syndrome type 1. CONCLUSION: The occurrence of chronic cutaneous candidiasis in a child should always imply endocrine screening, to exclude auto-immune polyendocrine syndrome type I.

Observational study of disorders of sex development in Yaounde, Cameroon.

Introduction According to the current classification of the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society for Pediatric Endocrinology (ESPE) of Disorders of Sex Development (DSD), etiologies vary around the world. Ethnic or genetic diversity probably explains this variability. We therefore conducted the present study on etiologies of DSDs in a country from central Africa. Methods We carried out an observational retrospective study at the Pediatric Endocrinology Unit of the Mother and Child Centre of the Chantal Biya Foundation in Yaounde, Cameroon from May 2013 to December 2019. All patients diagnosed with a DSD were included, and incomplete files excluded. Results We included 80 patients diagnosed with DSD during the study period. The 46,XX DSD were the most frequent in our study population (n = 41, 51.25%), with congenital adrenal hyperplasia (CAH) as the main diagnosis. The 46,XY DSD accounted for 33.75% and sex chromosome DSD group represented 15% of the study population. Conclusions DSDs are not an exceptional diagnosis in a Sub-Saharan context. 46,XX DSD are the most prevalent diagnosis in our setting. The diagnosis of all these affections is late compared to other centers, justifying advocacy for neonatal screening of DSDs in our context.

Effect of patient education through a social network in young patients with type 1 diabetes in a Sub-Saharan context.

BACKGROUND: Patient education is essential in management of type 1 diabetes (T1D). OBJECTIVE: To evaluate the short-term impact of patient education through WhatsApp on the knowledge of the disease and glycemic control of adolescents and young adults living with T1D in a resource-limited setting. METHODS: A double arm non-randomized clinical trial was carried out in two clinics for diabetes in Cameroon, over a period of 2 months. The intervention consisted in providing four sessions of patient education through WhatsApp to an intervention group compared to a control group with their classic follow-up. We evaluate their knowledge on diabetes, acute events, and glycemic control, before and after intervention. RESULTS: We recruited 54 patients of which 25 subjects and 29 controls. Median age was 19 (17-20) and 19 (17-21) years for the intervention and control group, respectively. There was a significant improvement of knowledge on diabetes in the intervention group from 13/20 to 16/20 (P < 0.01) after 2 months, compared to a slight decrease in control group (from 11.6/20 to 11.3/20 (P = 0.33). The mean proportion of acute complications decreased from 28% to 16% (P = 0.46) in the intervention group, and increased from 7% to 34%, P = 0.01 in the control group. There was no improvement in glycosylated hemoglobin level in both groups. CONCLUSION: Patient education through social network helped to improve knowledge on T1D and to reduce acute complications without an improvement of glycemic control after 2 months.

A hidden face of migration: Diabetic ketoacidosis in a severely malnourished refugee.

Besides violence, the risk of under nutrition and infection, migrant children with noncommunicable chronic diseases face serious challenges in the management of their conditions. Management of diabetic ketoacidosis in a severely malnourished patient includes careful hydration, therapeutic feeding, and monitoring.

Cardiometabolic profile of obese children in a sub-Saharan African setting: a cross-sectional study.

BACKGROUND: Cardiovascular and metabolic consequences of obesity in children, unlike adults, are still not well understood nor have they been subject to extensive research in Africa. We aimed to identify the cardio-metabolic complications associated with childhood obesity at the early phase of the management of obese children in a reference center in Cameroon. METHODS: In this cross-sectional study conducted from November 2013 to September 2014 and based on World Health Organization (WHO) classification of Obesity (BMI > 3SD under 5 years and BMI > 2SD from 5 and above), we included children aged 3 to 17 years who were being followed up for obesity at the pediatric endocrinology unit of the Mother and Child Center of the Chantal BIYA Foundation in Yaounde, Cameroon. A control group composed of children with normal BMI coming for a routine check up or vaccination was matched to the obese subjects. In both groups, we measured waist circumference (WC), blood pressure, fasting lipid profile and fasting glycaemia. We also considered the presence or absence of acanthosis nigricans. Data were analyzed using STATA software version 11.0, and presented as means, medians, compared with parametric and non-parametric statistical tests. RESULTS: We enrolled 38 obese children and 38 controls matched for sex and age. The majority of our participants were boys with a sex ratio of 1.24, and median age was 9.9 years. The median Z score of BMI was 3.21 in obese children. Approximately (n = 35) 90% of obese children (<6% in controls p < 0.001) presented with an abdominal obesity (WC/height ratio > 0.5) and 58% (n = 22) had acanthosis nigricans (5% (n = 2) in controls, p < 0.001). Type 2 diabetes mellitus was found in one participant, hypercholesterolemia in about 16% (n = 6) and high blood pressure in 25% (n = 8) of participants. Metabolic syndrome was present in 19% (n = 4) of obese children aged >10 years. CONCLUSIONS: Obesity in children is associated with early onset metabolic disorders such as dyslipidemia, high blood pressure and type 2 diabetes. The screening and management of these complications is therefore recommended.

Impact of a pioneer diabetes camp experience on glycemic control among children and adolescents living with type 1 diabetes in sub-Saharan Africa.

BACKGROUND: The metabolic impact of participating in a diabetes camp is little known among children and adolescents living with type 1 diabetes in sub-Saharan Africa. We aimed to assess the changes in glycemic control and insulin doses in a group of children and adolescents living with type 1 diabetes in Cameroon during and after camp attendance. METHODS: During a 5-day camp, we collected data on insulin doses, HbA1c, weight and blood glucose at least six times per day in a group of children and adolescents living with type 1 diabetes. We compared the evolution of these parameters 3 and 12 months after camp. RESULTS: Thirty-two campers completed the study. The mean age was 19 ± 2 years and the median duration of diabetes was 2 [IQR: 1.8-5] years. The mean HbA1c was 7.9 ± 2.2 % and the mean insulin dose was 49 ± 20 units/day upon arrival at camp. HbA1c dropped by 0.6 % after 12 months (p = 0.029). Despite the significant (p = 0.04) reduction in insulin dose from 49 ± 20 to 44 ± 18 units/day at the end of camp, hypoglycemic episodes occurred in 26 campers. However, the mean number of hypoglycemic episodes reduced from 1.32 (range: 0-4) on the first day, to 0.54 (range: 0-2) on the last day of camp (p = 0.006). Weight increased by 6 kg (p = 0.028) between 3 and 12 months after camp, but insulin doses remained unchanged. CONCLUSIONS: Attending camp for children and adolescents living with diabetes is associated with a significant decrease in HbA1c twelve months after camp without changes in insulin doses. Including camps as an integral part of type 1 diabetes management in children and adolescents in sub-Saharan Africa may yield some benefits. TRIAL REGISTRATION: ClinicalTrials.gov NCT02632032 . Registered 4 December 2015.

Dyshormonogenesis seems to be more frequent in a group of Cameroonian children with congenital hypothyroidism.

Congenital hypothyroidism is a main congenital endocrine disorder, affecting 1 in 4000 births. It is not well described in sub-Saharan countries, and to draw attention to that issue, we decided to describe affected pediatric patients. We retrospectively analyzed the records of eight patients over a period of 6 years. We analyzed clinical sings of hypothyroidism and psychomotor development; hormonal assays and thyroid ultrasound were performed. We included four boys and four girls aged from 3 to 84 months at diagnosis with a median thyroid-stimulating hormone (TSH) level of 156.5 mUI/L. All except one present with a moderate psychomotor delay. Other clinical signs were classical for hypothyroidism. Thyroid ultrasound performed showed a goiter in half of patients, a normal gland in three of them and a hypoplasic gland in the last one, consonant with dyshormonogenesis. We therefore concluded that dyshormonogenesis seems to be more frequent in our context, and this raised the issue of neonatal screening of hypothyroidism in Africa.

Pediatres et diabete de l'enfant au Cameroun

OBJECTIFS. Dans un contexte dans lequel les maladies infectieuses sont majoritaires; certaines maladies non transmissibles de l'enfant telles que le diabete; sont peu prises en compte dans le systeme sante. De ce fait un enfant atteint a une courte esperance de vie en absence de prise en charge appropriee. Malgre des initiatives d'approvisionnement a faible cout ou gratuitement de l'insuline dans les pays en voie de developpement d'Afrique subsaharienne; la prise en charge des enfants demeure difficile; les donnees sur le sujet restent rares et les actions de plaidoyer quasi absentes. Nous questionnons dans le present article l'implication des pediatres camerounais dans la prise en charge de cette affection en decrivant leurs attitudes et en evaluant leur interet sur la question. METHODOLOGIE. Pour ce faire; un questionnaire leur a ete adresse par internet portant sur le nombre de patients vus et suivis par an; leur attitude devant un nouveau patient. Nous avons egalement; en cotant sur une echelle de 1 a 5; evalue leur interet sur la question et leur avis sur la place a occuper par le diabete de l'enfant dans le systeme de sante des enfants. RESULTATS. Sur les 100 pediatres inscrits au registre de la Societe Camerounaise de Pediatrie; 36 ont rempli le questionnaire en septembre 2013 et 3 ont ete exclus de l'analyse. La majorite travaillait dans les 2 principales villes du pays avec plus de 10 ans d'experience professionnelle. Dans 70% des cas; ils recevaient moins de 5 patients diabetiques par an; et tous ou presque n'en suivaient regulierement aucun. Apres prise en charge d'urgence; les patients etaient dans 36% des cas referes a un endocrinologue d'adulte. Leur interet pour la question etait evalue a 3;5/5 et a 3;7/5 etait la place a accorder au diabete dans le systeme de soins des enfants. Les principales suggestions pour l'amelioration de la qualite de la prise en charge etaient la formation ou recyclage des equipes pediatriques et leur approvisionnement en materiel d'auto surveillance glycemique.CONCLUSION. ce travail montre que les pediatres au Cameroun sont interesses par le diabete de l'enfant mais manquent d'aptitudes adequates. Ils peuvent prendre en charge cette pathologie et leur implication pourrait entrainer des prises de decisions pour l'amelioration des soins des enfants atteints