L’activité sportive chez un jeune en surpoids : une prescription ?

As far as taking care of obese people is concerned, advising young overweight children to do more exercise seems to be relevent. And yet some problems emerge. People associate sport with mockery and it often rhymes with physical and moral suffering. That's why it's necessary to pay attention to children's feelings about it. When they try to avoid sport, they think they protect themselves from the other, who has ultimately become the prosecution, blaming them for their difference. That can create a lot of frustration. As psychologists and teachers in the adapted physical activity area, we work as a group, especially during our therapy session. Then, the physical activities that we propose are talked about in therapy. They can look at it from the outside as they are expressing their difficulties, from previous or present experiences. Sport must be associated with game, pleasure, self-satisfaction and most of all with the communication with the other. They’re accompanied according to their need and we aim at integrating them progressively in a sports association. Besides, a psychological support often proves itself required and beneficial. Moreover, guilty parents feel like they are being judged. Their inability to encourage their child to do any sport echoes their own fear. So we must take their feelings into account so they don’t feel even less capable and more guilty. Offering to verbalise their problems and respecting everyone's feelings make them consider they have a choice, and it enables them to realize that sport can be a source of personal achievement.     

Méthode et soins kangourou

The kangaroo-mother method was initiated by colombian pediatricians in 1979. This method is based on a permanent skin to skin contact of low birth weight infants with their mother. It has spread out in many developping countries as an alternative cheap method for the care of low birth weight infants with several advantages: temperature regulation, prolonged breast-feeding, promotion of mother-infant interaction, decreased mortality. The kangaroo method has been adapted in European countries as kangaroo care that consists in daily mother-infant skin to skin contact during few hours. Introducing the incubator in the mother's room is an other derivative of the method which allows prolonged early contact of the mother with her infant. A major interest of these methods is that they favour parent-infant interaction; however this requires qualified and devoted staffs.     

Anomalie de la jonction pyélo-urétérale de diagnostic anténatal : traitement chirurgical ou médical ?

The ureteric-pelvic junction (UPJ) is an uropathy that his management had profoundly evolved during these last thirty years, both from the point of view of the care and diagnosis.

Purpose

The purpose of this study is to discuss a diagnostic and therapeutic strategy of this uropathy.

Patients and methods

This study concerning 53 children (59 UPJ with antenatal diagnosis) brought together in the unity of paediatric surgery of 1999 in 2008. We classified the patients according to their care: group I: surgical at once; group II: medical then secondarily surgical; group III: purely medical.

Results

This study was about 34 boys and 19 girls with a sex ratio of 1.8. The UPJ was noticed in 26 cases to the left. The vesico-ureteral reflux was the most frequent associated abnormality (five cases). The majority are a part of the group I (42%). The anteroposterieur diameter in the ultrasound was on average 32.65 mm for the group I while it was respectively 25.86 and 14 mm for the group II and III. The differential renal average function in the scintigraphy (DTPA or MAG III) was normal (46%) in the group III while was 35 and 38% respectively in the group I and II. The nephrogram was obstructive in 72 and 75 % of the cases respectively in the group I and II and only in 16 % of the cases in the group I. The final comparison of the differential renal function between the group I, and the group II, does not show a significant difference (P < 0.005). Thirty-three patients benefited from an initial medical supervision. Only sixteen children (48%) had pyeloplasty.

Conclusion

The big frequency of the spontaneous improvements at the infant by simple tissular maturation (30% in this series), and the low incidence of the postoperative complications of the patients operated late do not authorize any more the premature pyeloplasty in front of an antenatal diagnosis UPJ.     

L'absence de style est le meilleur style en rédaction médicale

The author describes this conception of medical writing. Based upon a critical analysis of articles recently published in the Archives de Pédiatrie, he underlines the main principles which have to be respected for the writing of a medical article. This paper will be completed in an article entitled « The different redactional forms in medicineto be published in the next issue (January 1988) of the journal.     

Torsion testiculaire périnatale : à propos de dix cas

Perinatal testicular torsion (PTT) is a rare disease. Two entities have been described: prenatal or postnatal. The aim of this study is to recall the different etiopathogenic and histological features of this disease, to highlight the difficulties of diagnosis and discuss treatment modalities and finally to establish a treatment protocol of PTT.

Patients and methods

This is a retrospective study through which we studied 10 patients admitted in the pediatric surgery department of Monastir hospital between 1990 and 2009.

Results

Seven newborns had the antenatal testicular torsion form and three had the postnatal form. The main clinical symptom was the scrotal swelling. The controlateral vaginal hydrocele was found in 50% of cases. Doppler ultrasonography was performed in five cases and found a PTT with no blood flow in four of the five cases. The no surgical treatment was opted for a single patient and semi-urgent surgical treatment by scrotal incision has been practiced for the nine other cases. The PTT was extravaginal in all the cases. The surgical procedure consisted of an ipsilateral orchiectomy in 100% of cases and we have realized a contralateral orchiopexy in six of the nine cases operated. Pathological examination found a hemorrhagic infarction in seven cases and testicular necrosis in three cases. The postoperative and subsequent evolution was favorable in all cases.

Conclusion

The PTT is a rare disease occurring in utero and during the first month of life. Its pathogenesis is still poorly understood and the therapeutic approach is controversial.     

Évolution du résultat des explorations fonctionnelles respiratoires chez les enfants atteints de dysplasie bronchopulmonaire

Background.

Reports of short- and medium-term evolution of Lung Function Tests (LFT) in infants with bronchopulmonary dysplasia (BPD) are still scarce.

Population and methods.

The results of the first (before 3 months of corrected age) and the second (between 3 and 9 months of corrected age) LFT in 22 premature infants with BPD (gestational age; 31 ± 2.5 weeks; birth weight: 1570 ± 440 g; duration of mechanical ventilation: 46 ± 24 days; total duration of oxygen therapy: 88 ± 47 days) were compared to those obtained in 27 normal infants for the first LFT and 10 normal infants for the second LFT, similar to the patients for birth weight and corporeal index (CI).

Results.

In the first LFT, major abnormalities were an increased thoracic gaz volume (TGV) (165 ± 42 vs 122 ± 24 mL; P < 0.001) and TGV CI ratio (1.25 ± 0.31 vs 0.89 ± 0.17 mL/kg/m²; P < 0.0001) a decreased pulmonary compliance (2.49 ± 1.46 vs 11.60 ± 4.50 mL/cmH₂O; P < 0.0001) and specific pulmonary compliance (0.015 ± 0.10 vs 0.100 ± 0.042 mL/cmH₂O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (20.4 ± 12.1 vs 10.5 ± 5.3 cmH₂O/L/s; P < 0.001). In the second LFT, an increased TGV (235 ± 62 vs 166 ± 28 mL; P < 0.01) and TGV CI ratio (1.64 ± 0,65 vs 0.98 ± 0.11 mL/kg/m²; P < 0.05), a decreased pulmonary compliance (2.68 ± 2.0 vs 15.2 ± 5.7 mL/cmH₂O; P < 0.0001) and specific pulmonary compliance (0.013 ± 0.010 vs 0.106 ± 0.050 mL/cmH₂O/mL de TGV; P < 0.0001), an increased total pulmonary resistance (17.1 ± 9.6 vs 8.6 ± 4.9 cmH₂O/L/s; P < 0.05) were noted when compared with the control group results. Major abnormalities of the blood gases were hypoxemia (63 ± 10 vs 85 ± 20 mmHg; P < 0.05), hypercapnia (38.5 vs 31 ± 4 mmHg; P < 0.0001) during the first LFT. Hypoxemia (77 ± 14 vs 90 ± 14 mmHg) and hypercapnia (37 ± 4 vs 29 ± 5 mmHg) continued in the second LFT. Thoracic distention and total pulmonary resistances in infants with BPD did not improve but their pulmonary compliance (P < 0.0001) and PaO₂ (P < 0.01) between the first and second LFT did it. Infants who had been ventilated for a hyaline membrane disease (HMD) were more hypoxic on the second LFT (P < 0.05) than those who had been ventilated for other causes. Statistically significant relationships were found between thoracic distention and duration of positive inspiratory pressure (P < 0.05; r = 0.43), duration of positive expiratory pressure (P < 0.05; r = 0.45), total oxygen therapy duration; between total pulmonary resistance and duration of mechanical ventilation with high frequency (P < 0.05; r = 0.52); between hypoxemia and duration of oxygen therapy with FiO₂ ≥ 60% (P < 0.05; r = 0.54).

Conclusions.

This study shows prolonged clinical and functional abnormalities of the respiratory functions requiring longer follow-up.     

Épidémiologie du syndrome hémolytique et urémique aigu postdiarrhéique de l'enfant dans quatre départements français

Background.

Epidemiology of the hemolytic uremic syndrome (HUS) is best known in the English-speaking countries than in France.

Population and methods.

The attack rate of the HUS following acute gastro-enteritis in children was studied between 1982 and 1993 in four French departments (total population: 1,758,000). Investigations were performed with the cooperation of all the pediatric hospitals in each department. The pediatric population (0–4 years of age) remained stable at 4.8 to 5.3% during the study. Forty-nine children (22 girls, 27 boys) were included in this retrospective study.

Results.

All patients had hemolytic anemia with schizocytosis; thrombocytopenia was observed in 46/49 cases. Acute renal failure occurred in 48 cases. Twenty-five children required peritoneal dialysis (cumulative duration = 339 days). Four children (8.1 %) died. One patient is still in chronic renal failure after 3 years. Age at disease was less than 1 year in 18 cases, 1–2 years in 13, 2–3 years in nine, 3–4 years in six and 4–10 years in three. The attack rate for the 1982–1993 period for the patients less than 5 years of age was 51.7/100,000 (50.2–54). The mean of annual attack rate in the same group was 4.61/100,000 (range: 1.1–11.3), higher than the annual attack rate of acute HUS in Great Britain (3.1/100,000), Canada (3.1/100,000) and USA (2.7/100,000).

Conclusions.

The attack rate of HUS was similar inside each department even though country vs city dwellers and liverstock were unequally distributed.     

Peut-on améliorer le sommeil des enfants ? Une recherche action en éducation pour la santé à l'école maternelle

An educational project in nursery schools was carried out with the aim to improve children's sleep. Its effectiveness was tested in terms of awareness of families and length of sleep of children. The method was a prevention trial based on the random division of classes of 3-year old into two groups (intervention group and control group) comprising children enrolled in nursery schools in the Rhône region (France) in 1992. The project, lasting 2 years, relied on physicians from the community (Maternal, Child Health Service and School Health Service), their role being to mobilise the teaching teams, distribute specific teaching tools and raise awareness of families to respect the sleep patterns of children, during routine medical examinations. The study was carried out in 140 nursery schools with 1,500 children in each group. The evaluation was based on the application of a logistical regression model taking potentially confounding factors into account, and an analysis in sub-groups in order to demonstrate the effectiveness of intervention on particularly exposed groups. The results show: 1) the feasability of such an intervention among nursery school children on a large scale, 2) the effectiveness of the action, with a reduction of the risk of “poor knowledge” among parents (OR = 0.76), particularly in urban areas, and a reduction in the risk “short nights” in the sub-group of children who had “little sleep at 3 years” in low social class families (OR = 0.50).     

La lithiase urinaire du nourrisson : étude de 14 cas

Background

Diagnosis of urolithiasis in infancy is uncommon. It imposes rational exploration resting on medical history, clinical features, radiologic assessment, metabolic investigation and stone analysis.

Aim

The aim of this study is to evaluate epidemiologic and etiologic features of the urolithiasis in infancy.

Methods

It's a retrospective study including 14 cases of urolithiasis in infants, enrolled in pediatric department of Charles-Nicolle Hospital during fourteen years (1995–2008).

Results

The median age was 13 months. Thirty five percent of the patients had a positive family history of urolithiasis. The main presenting symptoms were urinary tract infection (four cases) and macroscopic hematuria (three cases). Radio-opaque urolithiasis were diagnosed in nine patients (64%), multiple stones in four patients (28%). Six of patients were diagnosed as having metabolic urolithiasis, four anatomic, two infectious and two idiopathic.

Conclusion

In our study, metabolic causes remain the first cause of urolithiasis in infancy.     

Transplantation hépatique chez une adolescente atteinte de mucoviscidose

Background.

Orthotopic liver transplantation (OLT) is an effective treatment for patients with cystic fibrosis end stage liver disease, especially those with only mild pulmonary involvement. Long-term follow-up in such transplanted patients is still lacking.

Case report.

A 15-year-old girl with cystic fibrosis received an OLT because of severe decompensated cirrhosis. She had been colonized by Pseudomonas aeruginosa for 3 years and had pancreatic insufficiency; she also had mild glucose intolerance. Postoperatively she developed diabetes mellitus requiring insulin therapy for 9 months. Oral ciclosporin was poorly absorbed so that she was given a new emulsion of ciclosporin (Neoral^®) that was better absorbed. A rapid pubertal catch-up was obtained but the patient remained colonized by Pseudomonas aeruginosa.

Conclusion.

This 3-year post-operative follow-up confirms that OLT can represent a good alternative in those patients with severe liver disease and mild pulmonary involvement.     

Paludisme sévère de l'enfant au Togo

Background

The definition of severe malaria is no longer limited to cerebral malaria, but is as well extended to other clinical forms of the disease. This work analyses epidemiological, clinical and evolutive aspects of severe malaria in Togo.

Patients and methods

This study included 549 children, aged from O to 15 years, hospitalized in 1994–5 in the pediatric department of the Lome-Tokoin University Teaching Hospital for severe malaria as defined by World Health Organization (WHO) criteria.

Results

The hospitalization frequency was 7.44%; the maximum frequency was from 1 to 5 years of age, but 6.56% of patients were more than 10 years old The most frequent clinical form was that of severe anemia, fallowed by cerebral complications, as seen in many African countries. The death rate was 18.94% and the proportional mortality was 8.21%; 2.73% of the patients had neurological sequelae (behaviour disturbances in five cases, aphasia in four, hemiplegia in three, munchment in one, oculomotor paralysis in one, and cerebellar ataxia in one). Hypoglycemia was fairly frequent (11.6%) and was associated with a poor prognosis.

Conclusion

It is possible to improve severe malaria prognosis in Africa by insisting not only on better equipment in intensive care wards, but also on improved and early management of hypoglycemia.     

Évaluation des connaissances et des pratiques d’hygiène des mains au niveau de l’unité de néonatologie et soins intensifs du service de médecine infantile et néonatologie de l’hôpital Nord, Marseille

Background

The hygiene of hands stays the basic measure to reduce the incidence of the hospital-borne infections. Its importance is major in a service of neonatology. Our work aimed at estimating the knowledge and the practices on the hygiene of hands.

Method

The study was realized at the level of the unit of neonatology and the intensive care of the service of infant medicine and neonatology of the north hospital of Marseille and took place from 1st till 15 August 2008.

Results

We questioned 55 persons of the staff, seek attendants and observed 30 persons. Near the quarter of the staff (23.6%) think that the solutions hydro-alcoholic are less effective than the simple wash of hands and more half (the 51%) than they are less effective than the hygienic wash. In respectively 20% and 36% of the cases, the staff underestimates the duration of the procedure of wash of hands and the hydro-alcoholic friction. In 58.1% of the cases, the staff ignores that the hydro-alcoholic solutions can be used in all the situations where hands are not soiled. Attendants seems to have a good knowledge of the hydro-alcoholic solutions. They know the indication about it in 56.2% of the cases and think that they are effective in 50% of the cases. The staff seems to have a good theoretical knowledge (87.2 in 96.4%) measures of hygiene of hands to be before adopted and after the most current gestures in the unit. There is an inobservance of the hygiene of hands in 33.3% of the cases. None of the persons outside the service practised a measure of hygiene of hands. A bad quality of the wash of hands concerning the contagion at the end of procedure was found in 64.7% of the cases and it in all the observed categories.

Conclusion

There is a real lack of information of the staff about the hygiene of hands. For the improvement of the quality of the care, the evaluation of the practices and the training of the staff turn out indispensable.     

Connaissances et pratiques de mères sénégalaises vivant en milieu rural ou suburbain sur l’alimentation de leurs enfants, de la naissance à l’âge de six mois

Breastfeeding practice is very common in Senegal. Indeed, it is the way nearly 100% of women feed their child. However, in 42% of cases, this practice is accompanied by early water administration (before sixth months). This is very often because of socio-cultural representations. Our work aimed to describe and analyze knowledge and practices of a sample of women on children feeding, from birth to six months of age.

Population and methods

It was a cross-sectional prospective study carried out from May 1st to June 30th, 2009. Qualitative data were recoded by face-to-face interviews with the mothers of six to 12 months old infants who frequented the two sites of the Institute of social and preventive paediatrics of the Cheikh Anta Diop university of Dakar (Senegal): the one being in the suburbs of Dakar (Pikine) and the other in a rural area (Khombole). Several topics were addressed: general knowledge on infants feeding, exclusive breastfeeding and the difficulties encountered in its practice, food introduced during exclusive breastfeeding and factors associated with their use.

Results

The study dealt with 44 mothers. The average time of first breastfeeding after birth was 6 ± 12 h (range: 1 to 72 h). The first food received by the newborn was the mother's milk for 64% of the mothers (n = 28). The 16 other mothers (36%) administered the “Tokental” (traditional drink for the newborn) before the first breastfeeding. Thirty-eight mothers held information about exclusive breastfeeding. Early breastfeeding was carried out by 22 mothers (50%). Exclusive breastfeeding up to six months was done by 29 mothers (66%). The reasons put forward by the 15 other mothers to choose another food are various. Among the factors influencing the practice of exclusive breastfeeding, the educational level of the mothers appeared, even if the difference were not statistically significant.

Conclusion

The practice of exclusive breastfeeding and early breastfeeding do not seem to be limited by knowledge but by sociocultural representations. Among the factors limiting the early breastfeeding, the most important seems to be the “Tokental”. To improve the practices on infants feeding, it would be important to reinforce information by healthcare professionals about newborn babies.     

Psychological interventions in cystic fibrosis and asthma

Cystic fibrosis and asthma have many psychosocial implications for patients and their relatives. These can stem from parental adaptational problems following diagnosis, negative illness perceptions, feeling 'different' and other associated developmental intrusions. In asthma, psychological factors arising from a variety of sources are known to 'trigger' attacks. For adolescents, psychological problems are hallmarked by loss (e.g. of identity, independence and peers) which results in re-appraisals of self-worth, depression and anxiety.Early intervention strategies and screening are crucial in ameliorating unsuccessful emotional adaptation and preventing chronic psychological morbidity. Behavioural and cognitive-behavioural interventions are particularly effective for both treatment-related behavioural problems (e.g. procedural distress, and poor feeding behaviour) and some psychological disorders (e.g. anxiety and depression). However, outcome depends on patients' motivation to change and willingness to collaborate. Where this is absent, less directive, but nonetheless effective, psychotherapies are utilised. Family therapy is also considered useful in addressing family dysfunction when thought to be intrinsic to the emotional problems.     

Liver disease in children with cystic fibrosis

Identification, evaluation and treatment of liver disease are increasingly important challenges in children with cystic fibrosis (CF). Liver disease usually presents at puberty and is receiving more attention with improved life expectancy. The abnormal CF transmembrane regulator protein in the apical surface of the biliary epithelium causes the disease. Hyperviscous bile accumulates in the biliary tree causing cholangiocyte and hepatocyte injury, stimulating focal fibrosis. Fibrosis is thought to lead on to cirrhosis over a period of years, a process which is usually asymptomatic. Steatosis and biliary tree anomalies including cholecystitis also occur. Clinical signs of liver disease appear late, by which time cirrhosis may be established. Early diagnosis would allow interventions to be evaluated but there is no gold standard for screening. Currently, regular clinical assessment, measurement of liver enzymes, ultrasound and liver biopsy are all used to evaluate liver disease in CF. Bile acid therapy reverses many markers of the disease but there is no good evidence that progression to cirrhosis can be prevented. A few children with cirrhosis decompensate (demonstrated by falling plasma albumin or coagulopathy) but they do well with liver transplantation. Children with portal hypertension as the sole manifestation of CF liver disease can be effectively managed with a programme of variceal obliteration or porto-systemic shunts.     

Epithelial antimicrobial peptides and proteins: their role in host defence and inflammation

Various antimicrobial mechanisms act in concert to protect the lung from infection by forming an efficient host defence system. Most microbial challenges are counteracted by elements of the innate immune system and antimicrobial peptides and proteins have been identified as key components of innate immunity. Although phagocytes are an important cellular source of these so-called endogenous antibiotics, it is now recognized that the airway epithelium is also a major site of synthesis. Antimicrobial peptides and proteins kill a wide variety of micro-organisms. Their importance is illustrated by the observation that in cystic fibrosis changes in the airway surface fluid may result in a dysfunction of these components. Recent studies have revealed other functions of these molecules showing they may link innate and adaptive immunity and appear to be involved in the regulation of inflammation and tissue repair.