Split hand/foot malformation (SHFM), formerly known as ectrodactyly is a rare congénital anomaly, its incidence varies from 1/8.500 to 1/25.000 live birth. It mainly affects the development of the limbs, its clin...Split hand/foot malformation (SHFM), formerly known as ectrodactyly is a rare congénital anomaly, its incidence varies from 1/8.500 to 1/25.000 live birth. It mainly affects the development of the limbs, its clinical variability is standard, can present as an isolated feature or as a syndrome associated with other congenital anomalies. Our objective was to present the two cases of SHFM, and to review the literature on the clinical aspects and discuss a probable origin. The father went to school and is a driver because the malformations concerned only the fingers, were less severe, and did not prevent the realization of certain simple gestures of the daily life. On the other hand, the malformations of the fingers of the newborn were severe and the absence of the thumbs compromised the later prehension function. Also the association of a microglossia and a cleft palate contributed to a weight loss that justified hospitalization. The clinical presentation of split hands and feet is variable and the prognosis depends on the type of anomaly. Familial cases suggest a probable genetic origin. Genetic testing is necessary to establish genetic counseling.展开更多
<p> <span style="font-family:""><span style="font-family:Verdana;">The purpose of our study was to evaluate the morbidity-morality of rare neonatal digestive emergencies in o...<p> <span style="font-family:""><span style="font-family:Verdana;">The purpose of our study was to evaluate the morbidity-morality of rare neonatal digestive emergencies in order to improve their management.</span><b><span style="font-family:Verdana;"> Observations: </span></b><span style="font-family:Verdana;">7 newborns ranging in age from 6 hours to 3 weeks were treated for rare digestive pathologies</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">between January 2013 and July 2017 (a period of 3 years and 6 months)</span><span style="font-family:""> </span><span style="font-family:Verdana;">in the Department of</span><span style="font-family:""> </span><span style="font-family:Verdana;">Pediatric surgery of Brazzaville University Center, Congo.</span><span style="font-family:""> </span><span style="font-family:Verdana;">Males were predominant (5 versus 2 females). Pathologies listed were: 1 antenatal volvulus of the small intestine, 1 annular pancreas and 5 gastric perforations. The average time of care in the operating room was 12 hours. The newborns were hospitalized in the pediatric surgery department in 28.6% of cases (n</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">2), and 71.4% (n</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">5) in the neonatology department. The antenatal volvulus of the intestine and annulus pancreas were integrated into a nosologic entity named</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">neonatal occlusion (NNO). The postoperative outcomes were simple for 4 patients (57.14%) while 3 patients died immediately after surgery (42.86%). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Neonatal surgical emergencies are still difficult to manage in our context. The lack of knowledge of these rare pathologies, which delays their management, considerably increases morbidity-mortality. The critical analysis of this series highlights diagnostic and therapeutic difficulties particularly with gastric perforations, hence the interest of better popularization of pediatric surgery.</span></span> </p>展开更多
<strong>Objective:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To determine the prevalence of proteinuria in children living ...<strong>Objective:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To determine the prevalence of proteinuria in children living with HIV (CLHIV) and identify associated factors. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">This was a cross-sectional, descriptive and analytical study carried out from April to August 2017 in the HIV care centres in Brazzaville and Pointe-Noire. The study included CLHIV with dipstick urinalysis test “Combur</span><sup><span style="font-family:Verdana;">10</span></sup><span style="font-family:Verdana;"> Test</span><sup><span style="font-family:Verdana;">®</span></sup><span style="font-family:Verdana;"> M”. </span><b><span style="font-family:Verdana;">Re</span><span style="font-family:Verdana;">sults: </span></b><span style="font-family:Verdana;">Thirty seven CLHIV on HAART presented a proteinuria, 21.8%. Children were male gender in 21 case</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> (56.8%) and female gender in 16 cases (43.2%). Mean age was 10.9 ± 3.9 years. The children were infected with type 1 virus in 35 cases (94.6%), vertical transmission in all the cases (100%). Children were living with HIV for about 2 to 4 years of average n = 18 (48.6%)</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> and they were WHO clinical stage 2 in 18 cases (48.6%). 13 children (35%) had CD4 level < 200 cells/mm</span><sup><span style="font-family:Verdana;">3</span></sup><span style="font-family:Verdana;">. All CLHIV (100%) were on HAART thus 20 (37.7%) on the combination of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP). This combination AZT, 3TC, NVP was a protective factor regarding the occurrence of proteinuria (OR: 0.43;IC (95%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Proteinuria </span><span style="font-family:Verdana;">is less observe</span></span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> in CLHIV on HAART. Systematic screening and early management of proteinuria during follow</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">up of these children improve their survival</span><span style="font-family:Verdana;">.</span>展开更多
Background: Severe hypoglycemia is a lifethreatening iatrogenic complication in the management of diabetic ketoacidosis, however, few studies have described how often this complication occurs. Objective: To identify t...Background: Severe hypoglycemia is a lifethreatening iatrogenic complication in the management of diabetic ketoacidosis, however, few studies have described how often this complication occurs. Objective: To identify the risk factors for severe hypoglycemia in children treated for diabetic ketoacidosis and to describe the sociodemographic, clinical characteristics and outcome of these children. Methods: From January 2013 to December 2017, 69 children admitted to pediatric intensive care unit with a diagnosis of diabetic ketoacidosis were enrolled in a retrospective and prospective study. Data of children with and without severe hypoglycemia were compared. Data were analyzed using Epi Info 7.1.5.0. Results: Out of 69 children enrolled, 10 (14.5%) had severe hypoglycemia (girls: 60%, median age 144 months (interquartile range, 108?-?168 months)). Episodes of severe hypoglycemia occurred during the first 48 hours of hospitalization in 8 (80%) children and during the late night shift in 6 (60%) children. Causes of severe hypoglycemia were: excessive insulin dose (60%), inappropriate infusion solution (70%), failure to properly monitor blood glucose levels (40%). Severe hypoglycemia risk factors were: age p?= 0.00004;OR = 42.0 [95% CI: 6.3?-?279]) and severe malnutrition (p?= 0.002;OR?=?10.9 [95% CI: 2.4 -?48.6]). Of 8 (11.6%) children died, 4 had severe hypoglycemia (p?= 0.01;OR = 8.8 [95% CI, 1.7 -?44.8]). Conclusion: The importance and severity of severe hypoglycemia require preventive measures to control risk factors.展开更多
Objective: To analyze placentas and newborns of patients with high blood pressure (HBP). Materials and Methods: Case-control study conducted from 1 January to 31 October 2017 in University Hospital of Brazzaville (bir...Objective: To analyze placentas and newborns of patients with high blood pressure (HBP). Materials and Methods: Case-control study conducted from 1 January to 31 October 2017 in University Hospital of Brazzaville (birth room, anatomy and pathology laboratory) and Faculty of Health Sciences of Brazzaville (laboratory of anatomy and organogenesis). It concerned 40 placentas freshly delivered and newborns of patients with HBP compared to 40 placentas and newborns of patients without HBP. The variables analyzed were related to mothers, placentas and the newborns. Results: The patients were similar in age (26.9 ± 1.2 years VS 26.5 ± 1.1 years, p = 0.17) and parity (1.26 ± 0.7 VS 1.61 ± 0.3, p = 0.26). The type of hypertension in the cases was dominated by pre-eclampsia (68%). A significant reduction in placental measurements was more observed in case of HBP: weight (431 ± 37 g VS 503 ± 26 g, p < 0.05), diameter (17.40 ± 1.2 cm VS 19.25 ± 1 cm, p < 0.05), and area (239.82 ± 15.7 cm2 VS 292.1 ± 22.2 cm2, p < 0.05). The macroscopic lesions were calcifications (75% VS 43.8%, p < 0.05) and the retro placental hematoma cup (18.8%) among the cases. Microscopic lesions were more observed in hypertensives: infarction (68.8% VS 18.8%, p = 0.004) and endarteritis (93.8% VS 12.5%, p < 0.05). The characteristics of newborns were significantly different between the two populations: prematurity (34.3% VS 9.3%, p < 0.05), mean weight (2577 ± 102 g VS 3060 ± 109 g, p < 0.05), the average APGAR score (6.7 ± 1.6 VS 7.8 ± 0.9, p 0.05). Conclusion: High blood pressure affects the placenta and the newborn. The placenta deserves to be systematically examined.展开更多
Introduction: Jaundice is a major symptom during neonatal time. It is defined by a bilirubin ≥ 50 mg/l. Objectives: To determine the frequency of neonatal jaundice at the Brazzaville University Hospital, to determine...Introduction: Jaundice is a major symptom during neonatal time. It is defined by a bilirubin ≥ 50 mg/l. Objectives: To determine the frequency of neonatal jaundice at the Brazzaville University Hospital, to determine the main etiologies, to evaluate the management, to specify the evolution. Patients and Method: It was a prospective and descriptive study that was conducted in the Neonatology Department and Biochemistry Laboratory of the University Hospital of Brazzaville, from 1st August 2015 to 31st July 2016. It included newborn children admitted into the neonatal unit for treatment of jaundice. The variables studied were epidemiological, clinical, etiological therapy and outcome. Results: The frequency of the neonatal jaundice is 7.2%. The hyperbilirubinemia as not conjugated was found in 99.1% of cases. The main causes are bacterial neonatal infection n = 102 (47.9%), the physiological icterus n = 46 (21.6%) and the ABO incompatibility n = 40 (18.8%). The treatment consists of the phototherapy in all cases. Each phototherapy session lasts 3 hours n = 99 (56.9%), 6 hours n = 58 (33.3%) and 12 hours n = 17 (9.8%). The average duration of the administering of the therapy is of 3 ± 2 days. Hyperbilirubinemia encephalopathy occurred in 62 (29.1%) cases, including 49 cases of kernicterus. The death occurred in 70 (32.9%) children. Conclusion: The importance and the gravity of the neonatal jaundice require primary preventive means based on proper care in pregnancy and the birth. While the secondary prevention includes high index of suspicion, comprehensive diagnostic equipment availability to prevent acute bilirubin encephalopathy.展开更多
文摘Split hand/foot malformation (SHFM), formerly known as ectrodactyly is a rare congénital anomaly, its incidence varies from 1/8.500 to 1/25.000 live birth. It mainly affects the development of the limbs, its clinical variability is standard, can present as an isolated feature or as a syndrome associated with other congenital anomalies. Our objective was to present the two cases of SHFM, and to review the literature on the clinical aspects and discuss a probable origin. The father went to school and is a driver because the malformations concerned only the fingers, were less severe, and did not prevent the realization of certain simple gestures of the daily life. On the other hand, the malformations of the fingers of the newborn were severe and the absence of the thumbs compromised the later prehension function. Also the association of a microglossia and a cleft palate contributed to a weight loss that justified hospitalization. The clinical presentation of split hands and feet is variable and the prognosis depends on the type of anomaly. Familial cases suggest a probable genetic origin. Genetic testing is necessary to establish genetic counseling.
文摘<p> <span style="font-family:""><span style="font-family:Verdana;">The purpose of our study was to evaluate the morbidity-morality of rare neonatal digestive emergencies in order to improve their management.</span><b><span style="font-family:Verdana;"> Observations: </span></b><span style="font-family:Verdana;">7 newborns ranging in age from 6 hours to 3 weeks were treated for rare digestive pathologies</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">between January 2013 and July 2017 (a period of 3 years and 6 months)</span><span style="font-family:""> </span><span style="font-family:Verdana;">in the Department of</span><span style="font-family:""> </span><span style="font-family:Verdana;">Pediatric surgery of Brazzaville University Center, Congo.</span><span style="font-family:""> </span><span style="font-family:Verdana;">Males were predominant (5 versus 2 females). Pathologies listed were: 1 antenatal volvulus of the small intestine, 1 annular pancreas and 5 gastric perforations. The average time of care in the operating room was 12 hours. The newborns were hospitalized in the pediatric surgery department in 28.6% of cases (n</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">2), and 71.4% (n</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">5) in the neonatology department. The antenatal volvulus of the intestine and annulus pancreas were integrated into a nosologic entity named</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">neonatal occlusion (NNO). The postoperative outcomes were simple for 4 patients (57.14%) while 3 patients died immediately after surgery (42.86%). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Neonatal surgical emergencies are still difficult to manage in our context. The lack of knowledge of these rare pathologies, which delays their management, considerably increases morbidity-mortality. The critical analysis of this series highlights diagnostic and therapeutic difficulties particularly with gastric perforations, hence the interest of better popularization of pediatric surgery.</span></span> </p>
文摘<strong>Objective:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">To determine the prevalence of proteinuria in children living with HIV (CLHIV) and identify associated factors. </span><b><span style="font-family:Verdana;">Patients and methods: </span></b><span style="font-family:Verdana;">This was a cross-sectional, descriptive and analytical study carried out from April to August 2017 in the HIV care centres in Brazzaville and Pointe-Noire. The study included CLHIV with dipstick urinalysis test “Combur</span><sup><span style="font-family:Verdana;">10</span></sup><span style="font-family:Verdana;"> Test</span><sup><span style="font-family:Verdana;">®</span></sup><span style="font-family:Verdana;"> M”. </span><b><span style="font-family:Verdana;">Re</span><span style="font-family:Verdana;">sults: </span></b><span style="font-family:Verdana;">Thirty seven CLHIV on HAART presented a proteinuria, 21.8%. Children were male gender in 21 case</span></span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> (56.8%) and female gender in 16 cases (43.2%). Mean age was 10.9 ± 3.9 years. The children were infected with type 1 virus in 35 cases (94.6%), vertical transmission in all the cases (100%). Children were living with HIV for about 2 to 4 years of average n = 18 (48.6%)</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> and they were WHO clinical stage 2 in 18 cases (48.6%). 13 children (35%) had CD4 level < 200 cells/mm</span><sup><span style="font-family:Verdana;">3</span></sup><span style="font-family:Verdana;">. All CLHIV (100%) were on HAART thus 20 (37.7%) on the combination of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP). This combination AZT, 3TC, NVP was a protective factor regarding the occurrence of proteinuria (OR: 0.43;IC (95%). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Proteinuria </span><span style="font-family:Verdana;">is less observe</span></span><span style="font-family:Verdana;">d</span><span style="font-family:Verdana;"> in CLHIV on HAART. Systematic screening and early management of proteinuria during follow</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">up of these children improve their survival</span><span style="font-family:Verdana;">.</span>
文摘Background: Severe hypoglycemia is a lifethreatening iatrogenic complication in the management of diabetic ketoacidosis, however, few studies have described how often this complication occurs. Objective: To identify the risk factors for severe hypoglycemia in children treated for diabetic ketoacidosis and to describe the sociodemographic, clinical characteristics and outcome of these children. Methods: From January 2013 to December 2017, 69 children admitted to pediatric intensive care unit with a diagnosis of diabetic ketoacidosis were enrolled in a retrospective and prospective study. Data of children with and without severe hypoglycemia were compared. Data were analyzed using Epi Info 7.1.5.0. Results: Out of 69 children enrolled, 10 (14.5%) had severe hypoglycemia (girls: 60%, median age 144 months (interquartile range, 108?-?168 months)). Episodes of severe hypoglycemia occurred during the first 48 hours of hospitalization in 8 (80%) children and during the late night shift in 6 (60%) children. Causes of severe hypoglycemia were: excessive insulin dose (60%), inappropriate infusion solution (70%), failure to properly monitor blood glucose levels (40%). Severe hypoglycemia risk factors were: age p?= 0.00004;OR = 42.0 [95% CI: 6.3?-?279]) and severe malnutrition (p?= 0.002;OR?=?10.9 [95% CI: 2.4 -?48.6]). Of 8 (11.6%) children died, 4 had severe hypoglycemia (p?= 0.01;OR = 8.8 [95% CI, 1.7 -?44.8]). Conclusion: The importance and severity of severe hypoglycemia require preventive measures to control risk factors.
文摘Objective: To analyze placentas and newborns of patients with high blood pressure (HBP). Materials and Methods: Case-control study conducted from 1 January to 31 October 2017 in University Hospital of Brazzaville (birth room, anatomy and pathology laboratory) and Faculty of Health Sciences of Brazzaville (laboratory of anatomy and organogenesis). It concerned 40 placentas freshly delivered and newborns of patients with HBP compared to 40 placentas and newborns of patients without HBP. The variables analyzed were related to mothers, placentas and the newborns. Results: The patients were similar in age (26.9 ± 1.2 years VS 26.5 ± 1.1 years, p = 0.17) and parity (1.26 ± 0.7 VS 1.61 ± 0.3, p = 0.26). The type of hypertension in the cases was dominated by pre-eclampsia (68%). A significant reduction in placental measurements was more observed in case of HBP: weight (431 ± 37 g VS 503 ± 26 g, p < 0.05), diameter (17.40 ± 1.2 cm VS 19.25 ± 1 cm, p < 0.05), and area (239.82 ± 15.7 cm2 VS 292.1 ± 22.2 cm2, p < 0.05). The macroscopic lesions were calcifications (75% VS 43.8%, p < 0.05) and the retro placental hematoma cup (18.8%) among the cases. Microscopic lesions were more observed in hypertensives: infarction (68.8% VS 18.8%, p = 0.004) and endarteritis (93.8% VS 12.5%, p < 0.05). The characteristics of newborns were significantly different between the two populations: prematurity (34.3% VS 9.3%, p < 0.05), mean weight (2577 ± 102 g VS 3060 ± 109 g, p < 0.05), the average APGAR score (6.7 ± 1.6 VS 7.8 ± 0.9, p 0.05). Conclusion: High blood pressure affects the placenta and the newborn. The placenta deserves to be systematically examined.
文摘Introduction: Jaundice is a major symptom during neonatal time. It is defined by a bilirubin ≥ 50 mg/l. Objectives: To determine the frequency of neonatal jaundice at the Brazzaville University Hospital, to determine the main etiologies, to evaluate the management, to specify the evolution. Patients and Method: It was a prospective and descriptive study that was conducted in the Neonatology Department and Biochemistry Laboratory of the University Hospital of Brazzaville, from 1st August 2015 to 31st July 2016. It included newborn children admitted into the neonatal unit for treatment of jaundice. The variables studied were epidemiological, clinical, etiological therapy and outcome. Results: The frequency of the neonatal jaundice is 7.2%. The hyperbilirubinemia as not conjugated was found in 99.1% of cases. The main causes are bacterial neonatal infection n = 102 (47.9%), the physiological icterus n = 46 (21.6%) and the ABO incompatibility n = 40 (18.8%). The treatment consists of the phototherapy in all cases. Each phototherapy session lasts 3 hours n = 99 (56.9%), 6 hours n = 58 (33.3%) and 12 hours n = 17 (9.8%). The average duration of the administering of the therapy is of 3 ± 2 days. Hyperbilirubinemia encephalopathy occurred in 62 (29.1%) cases, including 49 cases of kernicterus. The death occurred in 70 (32.9%) children. Conclusion: The importance and the gravity of the neonatal jaundice require primary preventive means based on proper care in pregnancy and the birth. While the secondary prevention includes high index of suspicion, comprehensive diagnostic equipment availability to prevent acute bilirubin encephalopathy.
