Risk Factor for Malnutrition in Children Aged 6 to 59 Months Hospitalized in a Pediatric Ward in the South of the Sahara

Malnutrition is a major public health problem in Mali, along with the country’s political and security instability. We initiated this work with the objective of determining the frequency as well as the risk factors favoring the occurrence of malnutrition in children aged 6 - 59 months hospitalized in the pediatrics department of the Gabriel Touré University Hospital in Bamako, country reference service to identify potential interventions to plan. A cross-sectional study was carried out over a period of 4 months. A bivariate logistic regression analysis allowed us to identify risk factors with degree of significance if p < 0.05. During the study period, 2888 children were hospitalized, including 348 aged 6 to 59 months, or a frequency of 12.04%. One in two children was malnourished, i.e. a frequency of 50%. It more frequently affected infants aged between 6 and 23 months with a frequency of 33.7%, with a hospital frequency of growth retardation which was 23% including 14.7% of severe form. The emaciation was 27% of which 18.7% were severe form. The underweight was 42.2% with 31% in severe form. We found the diet inequality in all malnourished and non-malnourished children. A bivariate analysis showed that children with an out-of-school mother have a 2.4-fold risk of being malnourished (OR = 2.425;CI = 1.9 - 4.2;p < 0.03). Also children from households with no stable income (non-salaried father) have twice the risk of children from a household with stable income (OR = 2.120;IC = 1.1 - 4.1;p < 0.002). Finally, inappropriate nutrients (early introduction of food and early weaning) have been strongly associated with the occurrence of malnutrition. The prevalence of malnutrition reflects the way children eat. Emphasis should be placed on nutritional education and financial stability in households.

Subcutaneous Emphysema Associated with Pneumomediastinum and Complicated Pneumopericardium in a 14-Month-Old Infant

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Invasive <i>Haemophilus influenzae</i>Type b (Hib) Infections in Children in the Pediatric Department of the University Hospital Gabriel Touré(UH-GT)

Introduction: According to Mali’s National Immunization Center, the Haemophilus influenzae b (Hib) vaccine coverage rate was 90% in 2015. Our work aimed to study invasive bacterial infections due to Haemophilus influenzae type b in children aged 0 - 15 years hospitalized in the pediatrics department of the UH-GT. Method: We carried out a retrospective descriptive study from January 2017 to December 2018 (i.e. 2 years) among children aged 0 - 15 years and hospitalized for Haemophilus influenzae type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid). Results: Thirty-three cases of Hib infections were collected giving a frequency of 0.2% and the age group 3 months to 3 years was the most affected (72.73%). Children who received no vaccine accounted for 21.21%. The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the bacterium in 100% of cases, against 72.72% in the blood culture Meningitis was the most frequent pathology (78.79%) and the lethality was high (21.21%). Conclusion: Despite the introduction of the Hib vaccine in the routine immunization program in Mali, Hib infections remain with a high lethality linked to meningitis.

Etiology of Pediatric Jaundice: Observation in the Pediatric Ward of the Gabriel Toure University Hospital

Objective: Pediatric jaundice is caused by various conditions. Although some data is available on this issue, data from Mali is insufficient. The present retrospective observational study was an attempt to determine the etiology of pediatric jaundice in the pediatric department of Gabriel Touré teaching hospital in Bamako, Mali. Methods: We reviewed all pediatric patients with jaundice who were hospitalized and treated in this department during January 1 to December 31, 2016 (n = 168). Result: Pediatric jaundice patients accounted for 1.88% of the hospitalized patients, with median age of 6 years and male/female ratio being 1.6. Infectious, cholestatic, and hemolytic jaundice accounted for 75%, 11% and 10%, respectively. Malaria and sickle cell disease accounted for 67% and 9%, respectively. Hepatomegaly and splenomegaly were observed in 49 (29%) and 23 (13.7%) patients, respectively. Of 168, 9 patients died. Conclusion: Infectious jaundice, especially jaundice due to malaria, was the most frequent. However, variety of etiologies was observed, of which the practitioners should be aware. The observation presented here may become fundamental data in health-policy making in this area.

Ossified Subdural Chronic Hematoma: Two Cases Report and Literature Review

Ossified subdural chronic hematoma (OSCH) is a rare disease that accounts 0.3% to 2% of subdural chronic hematoma which is common. The surgical management depends on his clinical expression. The aim of this study is to highlight the surgical procedure because the management of this type of lesion has no consensus. The authors reported two cases of OSCH which were successfully excised with good outcomes. Taking care during the procedure of dissection from parenchyma is the key for this surgery.

Brainstem Tuberculoma Reactivated during Pregnancy and Postpartum

Pregnancy, which is responsible for the decline in immunity, and the immediate postpartum period can lead to reactivation or worsening of tuberculosis. We report a case of a patient who consulted for neurological disorders in the context of a deterioration in general condition. The CT scan revealed a brainstem lesion which was successfully treated like a tuberculosis. However, reactivation has been observed in the postpartum period of a pregnancy contracted during anti-tuberculosis treatment. Further clinical improvement has been achieved with anti-tuberculosis treatment. Pregnancy and the immediate postpartum had led to a transient decline in immunity in part by decreasing in the inflammatory activity of type 1 helper T cells so that the fetus, which is a foreign body, was accepted by the maternal body. This decline in immunity during pregnancy and the immediate postpartum period due to immune reconstitution had been responsible for a high degree of vulnerability, usually characterized by a significant exacerbation of tuberculosis symptoms and an unfavorable course of disease.

Hematological Profile of Newborns Hospitalized for Neonatal Bacterial Infection in the Neonatology of the Pediatric Department of Gabriel Toure Teaching Hospital Bamako, Mali

The blood count is an easily achievable routine exam and will it have specifics in the event of a neonatal bacterial infection? Hence, the present study with the objective of determining the profile of the hemogram of newborns hospitalized for early bacterial neonatal infection. Material and methods: This was a cross-sectional study that took place from June 27 to September 03, 2016 in the neonatology department of teaching hospital Gabriel Toure. Included were all neonates hospitalized for early neonatal bacterial infection (ENBI) and who had a blood count. Results: We included 227 patients, 64.8% of whom were premature. The sex ratio was 1.4. The infants were less than 24 hours old in 93.6% of the cases. The mean hemoglobin level was 16.435 g/dl [8.8 - 22.26]. Erythrocytopenia was found in 18.5% of cases. Anemia was present in 17% of newborns. The average leukocyte was 15.228·103/mm3 [1.4 - 72]. Hyperleukocytosis and leukopenia were found in 12.32% and 6.6% respectively. Neutropenia and lymphopenia were present in 14.5% and 30.8%. There was a correlation between leukocytosis of negative blood cultures (23/27) (p = 0.030). For Neutrophils, neutrophilia was more observed in term neonates and neutropenia in premature infants (p = 0.03). Monocytosis was present in 13.6% of cases. One quarter (25.5%) of newborns had thrombocytopenia. Conclusion: Hematological variations did not allow a specific profile of newborns hospitalized for early neonatal bacterial infection to be identified.

Nonsurgical treatment of infratentorial subdural empyema: A case report

Infratentorial subdural empyemas are rare. It is an important neurological infection requiring immediate neurosurgical treatment. The nonsurgical treatment of subdural empyema has been reported sporadically. In this paper the authors report the nonsurgical treatment of a case of infratentorial subdural empyema. The patient with left recurrent otitis was hospitalized with symptoms of headache and fever of 3 weeks duration. Examination revealed that the patient had Glasgow Coma Scale score of 15, fever, mild cerebellar signs, no focal deficit, and abundant suppuration from the left ear. A contrast-enhanced CT scan showed an infratentorial supracerebellar hypodense fluid collection with the peripheral rim enhancement to the left of the midline that mimicked a subdural empyema. Routine hematological investigation revealed polymorphic leukocytosis and elevated erythrocyte sedimentation rate. After the left mastoidectomy and antibiotic treatment, the patient recovered with complete resolution of the subdural empyema on CT scan.

Intraventricular tuberculoma: A case report

Intracranial tuberculomas are one of the most serious formsof tuberculosis disease after meningitis tuberculosis. It incidence varies around 0.15% - 0.18% in the development world to 5% - 30% of intracranial masses in some under developments areas. These tuberculomas, of course ubiquitous, are mostly diagnosed in the adulthood and usually located in the cerebellum and the cerebral hemispheres. Intra ventricular involving is uncommon and just 10 cases had been described in the literature. We report a case of an intraventricular tuberculoma in a 26- year-old man and we discuss the pathogenesis and the radiological findings according this location.

Hospital Acquired Infections at the Service of Pediatric Surgery in Gabriel TouréAcademic Hospital, Bamako, Mali

Introduction:?Health care-associated infection is an infection acquired during the care delivered in the hospital or in any other care establishment which was neither present, nor in incubation at the admission of the patient or at the time of delivering the care or which does not manifest itself only after the patient has been discharged or an infection contracted by the professional in the course of his duties. Objectives:?To identify mean causative germs?and to determine their sensitivity to antibiotics and to identify the risk factors of?health care-associated infection.?Material and methods:?It was about a prospective longitudinal study conducted from November 1, 2017 to April 1, 2018?(6 months) in all children admitted to the pediatric surgery service. Non-consenting parents and outpatient necrosectomy case have not been included in this study.?Results:?This study included 200 patients, of whom 30 experienced the hospital acquired infections with an infection rate of 15%. The surgical site infection was the most common type, with 16 cases (53.3%), followed by burns in 13 cases (43.3%) and urinary tract infection in 1 case (3.3%). The average age of patients with infection was 56.33 ± 48.66 months with extremes of 1 and 180 months. The sex ratio was 1.30 for infected patients and was 1.83 for uninfected patients. The main bacteria responsible for surgical site infection were: Escherichia coli?(4 cases), Acinetobacter baumanii?(3 cases), Klebsiella pneumoniae?(2 cases), Staphylococcus aureus?(2 cases), Enterobacter cloacae?(1 case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis?(1 case). Among burn patients, the most frequent germs were: Acinetobacter baumanii?(7 cases), Klebsiella pneumoniae?(6 cases), Staphylococcus aureus?(6 cases), Escherichia coli?(4 cases), Pseudomonas aeruginosa?(2 cases) and Enterobacter faecalis?(2 cases). Escherichia coli?was?noted only in the case of urinary tract infection. Antibiotics tested were: amoxicillin, amoxicillin associated with clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin.?Germs were resistant to amoxicillin in 88.9% of cases, sensitive to the amoxicillin-clavulanic acid combination in 85% of cases, sensitive to tobramycin and gentamicin. Recruitment methods and length of hospitalization were the risk factors noted. Conclusion:?Massive awareness among all healthcare providers should be conducted on the adoption of standard precautions for the prevention of health care-associated infections and on the rules of antibiotics prescription to reduce the incidence of health care-associated infection and slow the resistance of germs to antibiotics.

Rupture of a Posterior Fossa Dermoid Cyst Overlying the Torcular with Extracranial Extension: Technical Note

Intracranial dermoid cysts are congenital benign neoplasms mostly diagnosed in the pediatric?hood and usually involve the midline structures. They count approximately less than 1% of all intracranial neoplasms and are believed to arise from ectopic cell rests incorporated in the closing neural tube. These dermoid cysts, especially those involving the posterior fossa and overlying the torcular, are uncommon. We report perhaps the first case of this entity in a third-year-old boy and discuss the physiopathogenesis, the imaging features and the best technical note to manage this cyst in this location.

Surgical Complications of Pica Syndrome: About 03 Cases

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.