Asthme par inhalation de fumées de cuisson de crevettes

We report a case of allergic asthma induced by professional exposure to shrimp cooking vapors in a 19-year-old patient. The patient's medical history revealed an anaphylactic shock seven years ago caused by ingestion of fish food. The diagnosis of asthma induced by seafood cooking vapors is based on clinical history and the positivity of the allergy work-up. Complete eviction of shrimps and redeployment resulted in clinical improvement.     

Mortality of myocardial infarction

Coronary disease is a major cause of death and disability. From 1975 to 2000, coronary mortality was reduced by half. Better treatments and reduction of risk factors are the main causes. This phenomenon is observed in most developed countries, but mortality from coronary heart disease continues to increase in developing countries. In-hospital mortality of ST elevation myocardial infarction (STEMI) is in the range of 7 to 10% in registries. In infarction without ST segment elevation (NSTEMI), in-hospital mortality is around 5%. More recent studies found a similar in-hospital mortality for STEMI and NSTEMI. Because of patient selection and monitoring, mortality in clinical trials is much lower. After adjustment for the extent of coronary disease, age, risk factors, history of myocardial infarction, the excess mortality observed in women is fading. Many clinical, biological and laboratory parameters are associated with mortality in myocardial infarction. They refer to the immediate risk of death (ventricular rhythm disturbances, shock…), the extent of infarction (number of leads with ST elevation on the ECG, release of biomarkers, ejection fraction…), the presence of heart failure, the failure of reperfusion and the patient's baseline risk (age, renal function…). Risk scores, and more specifically the GRACE risk score, synthesize these different markers to predict the risk of death in a given patient. However, their use for the treatment of myocardial only concerns NSTEMI. Only a limited number of mechanical or pharmacological interventions reduces mortality of heart attack. The main benefits are observed with reperfusion by thrombolysis or primary angioplasty in STEMI, aspirin, heparin, beta-blockers, angiotensin converting enzyme inhibitors. Some medications such as bivalirudin and fondaparinux reduce mortality by decreasing the incidence of hemorrhagic complications. The guidelines classify interventions according to their benefit and especially their ability to reduce mortality. Organized care systems that improve implementation of guidelines also reduce mortality. Finally, some new therapeutic approaches such as post-conditioning and new therapeutic classes offer encouraging prospects for further reducing the mortality of myocardial infarction.     

Quoi de neuf en allergologie pédiatrique en 2005 ? Partie 2. Allergie respiratoire : épidémiologie (une revue de la littérature internationale d'octobre 2004 à octobre 2005)

Risk factors for asthma are genetic factors, parental history of atopy and asthma, conditions of pregnancy and delivery, maternal smoking and frequent use of paracetamol during pregnancy, personal history of atopy and infectious diseases of the respiratory tract, and in utero exposure to high levels of domestic pollutants. Farm children are less prone to develop asthma, except for children exposed to pigs during the first years of life. The impact of allergen exposure on asthma risk depends on allergens. As far as cat allergens are in concern, the risk of asthma is increased in children exposed to low to moderate levels, but decreased in heavily exposed children. However, this effect is highly variable from one child to another one. Allergic rhinitis is underdiagnosed and undertreated in asthmatic children, and increases the risk and the severity of asthma. Risks of asthma persistence and relapse are influenced by the timing, severity and persistence of early wheezing. A large number of young adults are in clinical remission but have persistent abnormalities of their respiratory functions, suggesting that these patients are at risk of subsequent relapse. Finally, several studies suggest the end of the asthma "epidemics" in most European countries. However, other studies show that, although declining in adolescents, the incidence of asthma is still increasing in young children.     

Rigid bronchoscopy for pin extraction in children at the Children's Hospital in Rabat, Morocco

Purpose

The aim of this work is to present the clinical and therapeutic aspects of pin inhalation in the airways, as well as the benefit of rigid bronchoscopy for extraction in children.

Materials and methods

Five hundred and twenty-four cases of inhaled foreign body are identified in the multipurpose pediatric intensive care unit in the children's hospital in Rabat between January 2005 and December 2010. Thirty-six (6.8%) of them are due to pin inhalation. A retrospective study was conducted to define the epidemiological characteristics, clinical treatment and outcome of pin inhalation in the airways.

Results

Thirty-six cases of pin inhalation are identified, all females. The age varies from 10 to 15 years. The consultation period is 2 days. Symptoms are dominated by coughing and stinging sensation. In 61.11% (22 cases), the pin is lodged in the right airways, in 22.22% (eight cases) in the left airways and in 5.5% (two cases) at the trachea. In 63.8% (23 cases), the pin is removed at the first attempt. We did not record any severe complications. No deaths recorded.

Conclusion

Pin inhalation is a common occurrence in young girls. The extraction can be done safely by rigid bronchoscopy under general anesthesia. Particular attention should be paid to prevention and educational programs to reduce the incidence of pin inhalation.     

Profile of tobacco use among the teachers of Sousse, Tunisia

Objective

To examine the prevalence of tobacco use among the teachers in the region of Sousse (Tunisia) and to identify the factors, which determine this behavior.

Patients and methods

It is a transactional study; using a self-administered and pre-tested questionnaire to 800 teachers.

Results

The population being studied was made up of 739 teachers including 50.6% of professors. The sample was 35.4% male and the average age was of 45.3 ± 8.1 years. The total prevalence of tobacco use was 17.8% (41.4% among men and 4.7% among women). Half of these teachers smoked in their school establishments and in the presence of their pupils. The multivariate analysis had made it possible to identify four factors, which determine the profile of tobacco use in our teachers; these factors were: the sex, the age, knowledge and attitudes.

Conclusion

It's necessary to intervene with the teachers of the town of Sousse with specific trainings on the topic of the tobacco use and dispose their adapted tools which will be used in the educational programmes of tobacco use prevention in schools.     

Induction de tolérance orale aux aliments chez l’enfant : aspects pratiques

Specific oral tolerance induction (SOTI) to food is a new topical-therapeutic approach of food allergy. When successful, it improves significantly the patients’ quality of life. SOTI’s practical aspects for child are discussed from our recent experience concerning cow milk, hen’s egg and wheat. Family’s motivation and education are crucial questions to achieve SOTI correctly. A detailed information of possible side effects is essential.     

Interest of coronary flow reserve of the LAD during dobutamine stress echocardiography

Aim of the study

To assess the value of the coronary flow reserve (CFR) in the left anterior descending artery (LAD) during dobutamine stress echocardiography in the diagnosis of significant LAD stenosis (more than 70%).

Method

Retrospective study of 81 patients with a positive stress echocardiography who underwent a coronarography.

Results

Measurement of coronary flow reserve was able in half echocardiographic exams. Medium Pic diastolic velocity was 0.33 m/s (SD 0.20), medium maximal diastolic velocity during stress was 0.62 m/s (SD 0.20), medium CFR was 2.25 (SD 0.65). In 50 patients LAD was not seen; in five of them LAD was occluded. The predictive positive value (PPV) of a low coronary flow reserve to detect LAD stenosis is 66.7% and the negative predictive value (NPV) is 65.4%. An abnormal anterior contraction during stress echo with a low reserve has a PPV of 75% for the diagnosis of significant IVA stenosis and a normal contraction during stress with normal coronary flow reserve means a NPV of 65%. We did not show a significant correlation between low coronary flow and abnormal contraction during stress echocardiography (kappa 0.51).

Conclusion

Coronary flow reserve of LAD during stress echo is feasible but does not really improve exam performance to detect significant IVA stenosis. This measurement remains to be clear in coronary patients management.     

Accessory pathway ablation in children: indications and results

Introduction

Radiofrequency ablation of accessory pathways (AP) has become a first-line treatment, except in young children where the indications are discussed because of radiation risks and complications of catheterization. The purpose of the study was to evaluate the indications and results of radiofrequency AP ablation in children and teenagers.

Methods

Electrophysiological study (EPS) was performed in 145 patients aged from 5 to 18 years (13.5 ± 3) with a preexcitation syndrome (PS).

Results

AP ablation was indicated in 66 children (group 1); others represent the group I. Group I was older and less frequently asymptomatic. All children with a spontaneous malignant form had an ablation. Group 1 has a faster conduction through the AP than group 2. The induction of reentrant tachycardia (RT), atrial fibrillation and the presence of a malignant form is more common in group 1. Failures or reappearances of WPW after ablation were frequent (20, 26%) related to a younger age (15 ± 3 vs 17 ± 4) (< 0.05). In group 2, one 18-year-old teenager with untreated RT died before ablation. Asymptomatic children are well with disappearance of PS in two. Medically treated symptomatic children are well.

Conclusion

If spontaneous malignant forms, symptoms with drugs or practice of competitive sport are indications of AP ablation, it is recommended to wait for adolescence in other children.     

Isolated tuberculosis of the sternum in children: case report

Tuberculosis of the sternum is rare in children, and is often difficult to diagnose, however its prognosis remains good following treatment. Here we have the case of a young 14-year-old girl, who over the past 1 month has had swelling of the sternum combined with a fever of 38.5 °C. Computed tomography revealed sternal lysis and swelling of the soft tissue. The histopathological examination of the bone harvesting confirmed the diagnosis of tuberculous osteitis. Anti-bacillary treatment permitted favorable progression. Tuberculous osteitis of the sternum is a rare condition. Contamination can occur through contiguity or reactivation of a latent focus. Confirmation is established by histopathological and/or bacteriological sampling. Treatment is essentially medical.