Cardiac Echography in Pediatrics at the Regional Hospital of Diourbel: Indication and Result

Childhood heart disease is a real public health problem. In our contexts, care remains a major challenge. Doppler echocardiography remains the essential examination for diagnosis. The objective of our study was to describe the different clinical indications for cardiac ultrasound in children and the main pediatric heart diseases at the Diourbel Heinrich Lübke Regional Hospital. This was a descriptive and analytical retrospective study spanning from 2020 to 2022;covering a series of 140 cases. The study was carried out using patient clinical observation sheets and consultation sheets. We identified 140 ultrasounds. The average age of patients was 35.96 months with extremes of 0.03 months and 192 months. The female sex was predominant, with an M/F sex ratio of 0.72. Ultrasound was systematically requested in 67.14% of the study population. The indications found were mainly: heart murmur, polymalformative syndrome, respiratory failure, bronchiolitis, cardiomegaly, suspicion of heart disease, cardiomegaly, pre-therapeutic and pre-operative assessment. A total of 71 cardiac abnormalities were found in 65 patients, i.e. a prevalence of 46.42%. Congenital heart disease was more frequent (found in 49 patients, a prevalence of 35%) and was dominated by the CIA. There was a female predominance in almost all heart diseases except in the case of endocarditis where codominance is found. Our study has made it possible, through echocardiography, to evaluate the indications for echocardiography in children, to determine the prevalence of heart disease in children and also to assess the relevance of requests for echocardiography.

Impact of Delivery Mode on Morbidity in Preterm Infants with Very Low Birth Weights (<1500 Grams)

The mode of delivery and gestational age for very-low-birth-weight (VLBW) preterm infants are not yet well established and are constant topics of debate. Objective: To analyze the impact of delivery mode on morbidity in preterm infants weighing less than 1500 g. Results: Among 21,957 births, 81 were analyzed;53 were delivered vaginally, and 28 were delivered by cesarean section. The median maternal age, gestational age and body mass index among those delivered vaginally and by cesarean section were 20 years and 22.5 years, 27.6 weeks and 30.1 weeks, and 26.0 kg/m2 and 27.8 kg/m2, respectively. With respect to neonatal blood gas parameters, for those born vaginally and by cesarean section, the median pH was 7.32 and 7.24, the pCO2 was 41.5 mmHg and 51.1 mmHg, and the pO2 was 22.3 mmHg and 16 mmHg. The median fetal weight among those born by cesarean section and vaginally were 1180 g and 955 g, respectively. The median Apgar scores at the first and fifth minutes among those born by cesarean section and vaginally were 5.00 and 8.00 and 4.50 and 7.00, respectively. Conclusion: There was no significant difference between the results of vaginal and cesarean delivery for VLBW infants. Thus, further studies on this subject are needed.

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information;10 Histoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp case. The average age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age range from 6 months to 14 years. Around 60% of the patients were older than 5 years, of which, more than two-thirds were HIV positive children without antiretroviral therapy, who presented an invasive fungal infection at the time of HIV diagnosis. These infections are endemic in Guatemala, so the distribution was mostly uniform. Around 80% of the patients had some disease related to immunodeficiency and 70% were infected with human immunodeficiency virus (HIV). The microbiological isolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and urine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal, neurological and weight loss. Mortality rate was 53% (from them, 62% were HIV positive). From these patients, an87% did not receive antifungal treatment in time due to late diagnosis of the infection. Conclusions: These infections should be considered when treating pediatric patients from tropical regions, with nonspecific systemic symptoms and signs, lymph node involvement and hematological alterations related to the mononuclear phagocytic system, mainly if they are patients infected by HIV in an advanced stage, infants, or children with a disease that weakens the immune system. When there is a high suspicion of a fungal infection, screening for HIV is mandatory;cultures should be taken early and together with rapid diagnostic tests. An antifungal treatment should be started immediately and then modified accordingly to laboratory results.

Assessment of Practice of Colonoscopy in Pediatrics in Brazzaville, Congo

Background: In Congo, there is no pediatric gastroenterology department and the activity of colonoscopy has never been evaluated. The aim of this study is to report the indications and the results of pediatric colonoscopy in Brazzaville. Methods: A retrospective study was conducted from January 2016 to August 2017 by analyzing reports of colonoscopy performed in the gastroenterology department in Brazzaville. Sex, prescribers, indications and results of colonoscopy were the variables study. Results: over the 19-month period, 489 colonoscopies have been performed, in which 13 (2.7%) colonoscopies were performed in children under 17 years, with an average age of 9.8 ± 4.6 (8 males and 6 females) and the extreme ranging from 1 - 17 years. The sex ratio (H/F) was 1.6. The prescribers were gastroenterologist (n = 4), pediatrician (n = 4), surgeons (n = 2), general practitioners (n = 2), pediatric students (n = 1). Chronic bowel inflammatory diseases and polypectomy was the most frequent conditions for colonoscopy indication. Seven (7) colonoscopies were normal. 4 cases were recto-polyps, and 2 cases were ulcerative colitis. Conclusion: pediatric colonoscopy is a powerful diagnostic and therapeutic means. The pediatricians should think about it to improve the management of children with digestive symptoms that meet the indications of pediatric colonoscopy.

Epidemioclinical Profile and Immediate Outcome of Low Birth Weight at the Reference Health Center in Commune VI of the District of Bamako, Mali

Introduction: Low birth weight is responsible for 9.1 million child deaths each year worldwide. It is the leading cause of perinatal and infant mortality. The objective of this work was to determine the epidemio-clinical profile as well as the future of low birth weight at the Reference Health Center of commune VI in the district of Bamako, Mali. Methods: Our study was descriptive and prospective over a year from April 1, 2018 to March 31, 2019. Data were taken from hospital records and newborn referral/evacuation forms. Data processing was performed using Epi Info software version 3.5.4 and Word. Results: The frequency of low birth weight was 34.94%. Multiparity accounted for 47.84%, sex ratio was 0.93, maternal arterial hypertension was present in 41.66%, genitourinary infection was in 58.37% and delivery was by low way in 86.12%. The majority of newborns had a gestational age between 28SA-33SA (56.52%) and a weight between 1501-1999 grams (47.36%). Mortality accounted for 18.66%. Conclusion: Low birth weight is common in our settings with modifiable risk factors. Practitioners must play on them to minimize its importance.

SARS-CoV-2 Antibody Seroprevalence in Children and Workers from Belgian French-Speaking Primary Schools

Purpose: During the COVID-19 pandemic, closing schools was discussed to limit the virus transmission, despite a lack of evidence on the role of young children in the virus spread. We undertook a study among Belgian primary schools to assess the SARS-CoV-2 antibody seroprevalence and its relationship with local incidence, school size, and socioeconomic status (SES). Methods: Schools were purposively selected using three criteria: an area with either a low or a high COVID-19 incidence, either a small or a large size, and either a low or a high SES. 932 (/2488, 38%) children and 242 (/444, 55%) staff signed informed consent. COVID-19 antibodies were tested using rapid finger prick tests. Results: Children participation was positively correlated with staff (r = +0.33;95% CI [−0.34;0.78]), and strongly with SES (r = +0.81;95% CI [0.40;0.95]). Seroprevalence was 21% in children (191/922) and 25% in staff (61/240). Seroprevalence did not correlate with local cumulative incidence (children: r = +0.06;95% CI [−0.59;0.67];staff: r = +0.26;95% CI [−0.40;0.74]). In staff, seroprevalence was higher in schools with higher SES (r = +0.37;95% CI [−0.29;0.79]), but not in children (r = −0.10;95% CI [−0.66;0.53]). Conclusion:The lower seroprevalence in children suggests they are lower transmitters than adults, but poor socioeconomic levels were less representative.

Children and Workers Well-Being in Belgian French-Speaking Primary Schools during the COVID-19 Pandemic

Purpose: During the COVID-19 pandemic, a significant number of measures were taken worldwide to limit the transmission of SARS-CoV-2, and in many ways, changed human life. All these measures had harmful consequences and impacted the well-being of many people. Children were one of the most vulnerable groups. We conducted the present study to assess children’s and staff’s well-being in French-speaking primary schools in Belgium during the COVID-19 pandemic. Methods: A 37-question questionnaire for each child based on the Revised Children’s Manifest Anxiety Scale (RCMAS), and a 14-question questionnaire for each staff based on the Hospital Anxiety and Depression (HAD) scale was undertaken in order to assess the well-being. Multiple logistic regressions were performed to assess the relationship between RCMAS or HAD and other explanatory variables. Staff reported their perception of their current life and their future life in 5 years on a Visual Analogue Scale (VAS). Results: A total of 231 children and 221 staff in 11 primary schools answered the well-being questionnaire between January and May 2021. 53% (122/231) of children had symptoms of anxiety. Girls reported more anxiety symptoms than boys (≥10: 59%;Adj OR = 2.25;95% CI [1.28;4.03]). 52% (120/231) of children had a definite state of social desirability. According to age, the youngest (6 - 7 years) children were more likely to have social desirability (≥5: 71%;Adj OR = 3.44;95% CI [1.53;8.09]) compared to the oldest (10 - 12 years). Children who did not practice outdoor/street activities were more likely to have social desirability (≥5: 60%;Adj OR = 2.59;95% CI [1.38;4.99]). In schools with a higher local incidence of SARS-CoV-2, children were more likely to have social desirability (≥5: 64%;Adj OR = 2.15;95% CI [1.13;4.17]). In schools with a lower socioeconomic status, children were more likely to have social desirability (≥5: 72%;Adj OR = 2.74;95% CI [1.23;6.37]). Higher RCMAS anxiety (r = −0.18;p −0.23;p −0.20;p Conclusion: Our results showed that the well-being of children was impacted during the COVID-19 pandemic. Special attention must be focused on the most vulnerable groups, as the consequences can be catastrophic in the long term.

Premature Puberty Revealing an Ovarian Tumor in a Five-Year-Old Girl

Background: Ovarian tumors in the girl child are sometimes revealed by the development of secondary sexual characteristics. The authors report the case of a five-year-old girl in whom the disease was revealed by early puberty. Case presentation: A five-year-old girl with an enlarged abdomen for about four months. The onset of pain and the sensation of a mass prompted the consultation. The development of secondary sexual characteristics (SSC) noted by the family had not been mentioned. The patient was classified as pubertal stage 2 according to the Tanner classification. An abdominal ultrasound and a CT scan showed a large left ovarian mass, an enlarged uterus for the patient’s age and a normal right ovary. The hormonal workup was not contributive. The treatment consisted only of a left salpingo-ovarectomy, without complementary chemotherapy. Anatomic pathological examination of the surgical specimen concluded to a juvenile tumor of the granulosa. The evolution was good with a beginning of regression of the HSC one month after the ovarectomy. Discussion: Granulosa tumors are sometimes secretory cancers, generally with a low potential for malignancy and therefore a very good prognosis. Surgery based on total adnexectomy is the first-line treatment. The large size of the tumor, the presence of ascites and capsular rupture are factors of poor prognosis, hence the importance of early diagnosis. Conclusion: Routine comprehensive physical examination should be de rigueur for abdominal masses in girls, especially in the context of various beliefs that may impede early referral to care.

Extraocular retinoblastoma in Indian children:clinical,imaging and histopathological features

AIMTo study eyes with extraocular dissemination (EORB), with the following aims: first to establish the mean lag period and to understand various reasons for delayed presentation, second to study their imaging profiles and third to analyze histopathological features of eyes enucleated after neoadjuvant chemotherapy.

Early Childhood Development (0 - 6 Years Old) from Healthy to Pathologic: A Review of the Literature

Early childhood development involves an appropriate global intervention concerning the different areas of development such as: physical, cognitive, language and socio-emotional [1]. Especially during the first six years of life in an adequate environment rich in exchange and interaction. We will present in this article a review of the literature concerning normal early childhood development, focus firstly in normal development’s steps, the importance of first experiences and first aid with a stable and caring attachment figure. second, we will describe the various developmental disorders, occurring during this age group which extends from birth to 6 years and based on the DSM5 classification, namely that developmental delay may concern only one aspect of development (e.g. language delay or motor delay specifically) or concern the different aspects of development (overall development delay). The dynamics of development is also important to clarify because schematically we contrast the pathologies fixed to progressive pathologies (where we find the concepts of stagnation or regression in the development of the child). We will discuss in the third chapter, the interest of early detection as well as the multiple clinical and psychometric diagnostic tools, which aim to detect any delay or disorder in order to initiate appropriate care and minimize the long-term consequences.

Cryptoccocal Neuromeningitis in Immunocompetent Infant in Bonassama District Hospital, Douala: A Case Report

Cryptococcosis is rare in children. We report a case of cryptococcal meningitis in an infant whose mother works as a poultry farmer (chicken farm). The infant was received in the context of fever with convulsions. We performed a lumbar puncture and started antibiotic treatment. Cerebrospinal fluid (CSF) analysis was performed including Indian ink staining. CSF results showed the presence of yeast and we replaced antibiotics with fluconazol-based treatment. After the loss of sight and the appearance of a motor deficit, a brain scan was performed showing cerebral edema. Several lumbar punctures were performed for 02 weeks until partial recovery of visual acuity and motor deficit. This case highlights the importance of taking into account the patient’s history when making the diagnosis. In our case, the working conditions and the employment of the mother guided the realization of the Indian ink coloring of the CSF. Treatment with fluconazol continued for 22 weeks with a completely regained visual acuity and gradual improvement in motor deficit despite limited resources.

Epidemiology of Renal Failure in Children at the Pediatric University Hospital Charles De-Gaulle of Ouagadougou (Burkina Faso)

Objective: Renal failure (RF) is a serious condition that is still insufficiently evaluated in our context. We wanted to know its epidemiology at the Pediatrics University Hospital Center Charles De-Gaulle (PUHC-CDG) of Ouagadougou. Patients and Methods: We retrospectively studied all children aged from three to fifteen years old who were diagnosed with renal failure (RF) in the Department of Medical Pediatrics, from January 1, 2011 to December 31, 2013. RF was defined by a glomerular filtration rate (GFR) less than 80 mL/min/1.73m2, estimated by the formula of Pottel et al., which ignored the size that was rarely found in the medical records. The department constantly lacked pediatric blood pressure monitors or urinary strips. Results: In total, 119 cases of RF (3.3% of all admissions) were collected. They were about acute RFs (ARFs), chronic RFs (CRFs), and Unclassified RFs (URFs), respectively in 28.6%, 2.5% and 68.9% of cases. The overall average age of patients was 6.7 ± 3.4 years old. The average GFR was 35.2 ± 22.2 mL/min/1.73m2. The mechanism of ARF was presumed to be organic in 26 cases (76.5%). The most common presumed etiology was malaria (47.9%). Twelve patients (10.1%) died. Conclusion: RF was common at the PUHC-CDG but it was unclassified in over half of the cases. The diagnosis was based on the estimation of the GFR by Pottel et al.’s formula which was a good alternative to the Schwartz’s formula. The improvement of human and material resources would certainly help for a screening and characterization of RF at the PUHC-CDG.

Studying gaze abnormalities in autism: Which type of stimulus to use?

Background: Eye-tracking has been used to investigate social perception in autism spectrum disorder (ASD) with variable results. This heterogeneity may be due to the types of stimuli used. In this study, we investigated whether the use of moving vs static stimuli or human actors vs cartoons characters would be more sensitive in detecting gaze abnormalities and discriminating children with ASD from typically developing children. Methods: We studied 18 children with ASD (mean age = 12.9 ± 2.9) and 21 typically developing controls (mean age = 11.3 ± 2.5). Gazes were tracked using Tobii-T120 eye-tracker. Four different types of stimuli were presented: movie with human actors, cartoon movie, picture with human actors and cartoon picture. To identify the type of stimuli that best discriminate the ASD group from the control group, a two-way ANOVA was performed using ecological dimension [human-actors/cartoon] and presentation form [movie/picture] as factors. Results: Children with ASD presented significantly less fixations to eyes and faces in the movie with human actors and in the picture with human actors. Children with ASD also presented significantly more fixations to non-social backgrounds in the movie with human actors and in the cartoon movie. A significant ecological effect was observed for the reduction in fixations to the eyes [human-actors > cartoon]. A significant presentation form effect was observed for the increased fixations to the non-social background [movie > picture]. Conclusions: The direct comparison of gaze behavior across four different types of stimuli demonstrates that gaze abnormalities in ASD depend on the type of stimuli that is used. Our results suggest that general gaze abnormalities in children with ASD are better detected when using dynamic stimuli, and finer details of these abnormalities, especially looking less to the eyes, are better detected in a more ecologically relevant situation presenting human characters.

Expression of multidrug resistance proteins in retinoblastoma

AIM： To elucidate the mechanism of multidrug resistance in retinoblastoma, and to acquire more insights into in vivo drug resistance.METHODS： Three anticancer drug resistant Y79 human RB cells were generated against vincristine, etoposide or carboplatin, which are used for conventional chemotherapy in RB. Primary cultures from enucleated eyes after chemotherapy（PCNC） were also prepared. Their chemosensitivity to chemotherapeutic agents（vincristine, etoposide and carboplatin） were measured using MTT assay. Western blot analysis was performed to evaluate the expression of p53, Bcl-2 and various multidrug resistant proteins in retinoblastoma cells.RESULTS： Following exposure to chemotherapeutic drugs, PCNC showed less sensitivity to drugs. No significant changes observed in the p53 expression, whereas Bcl-2 expression was found to be increased in the drug resistant cells as well as in PCNC. Increased expression of P-glycoprotein（P-gp） was observed in drug resistant Y79 cells; however there was no significant change in the expression of P-gp found between primary cultures of primarily enucleated eyes and PCNC. Multidrug resistance protein 1（Mrp-1） expression was found to be elevated in the drug resistant Y79 cells as well as in PCNC. No significant change in the expression of lung resistance associatedprotein（Lrp） was observed in the drug resistant Y79 cells as well as in PCNC.CONCLUSION： Our results suggest that multidrug resistant proteins are intrinsically present in retinoblastoma which causes treatment failure in managing retinoblastoma with chemotherapy.

Seronegative disseminated Bartonella spp. infection in an immunocompromised patient

An 11 year old, hispanic girl with a history of B-cell acute lymphoblastic leukemia was admitted to the hospital for symptoms compatible with Bartonella henselae infection. The first molecularly diagnosed case of disseminated Bartonella henselae infection was reported in an immunocompromised patient in Lima, Peru. The analysis was confirmed by Polymerase Chain Reaction and automated sequencing of a liver biopsy sample, even though the serologic tests were negative. In conclusion, Bartonella spp. infection should have a particular diagnostic consideration in immunocompromised patients with fever of unknown origin and further investigation regarding the patient's past exposures with cats should also be elicited.

Feasibility of iFISH patterns in hematologic malignancies among Congolese patients at Kinshasa University clinics

Objective: To analyze the feasibility of detecting Ph1 in leukemia patients in the Kinshasa University Clinics in the Democratic Republic of Congo, at KU Leuven, Belgium.Methods: Bone marrow and peripheral blood samples with chronic myeloid leukemia,acute myeloid leukemia or acute leukocytes leukemia were obtained from 32 patients in Kinshasa University clinics in the Democratic Republic of Congo and transferred to KU Leuven in Belgium for i FISH feasibility. Ph^1 was detected by using a remote analysis of interphase fluorescence in situ hybridization(i FISH).Results: Out of the 32 patients involved in this study, 65.6%(n = 21) of the cases were successfully tested, of which 52.4%(n = 11) were i FISH positives for the variant t(9;22)(presence of Ph^1) in chronic myeloid leukemia samples and 47.6%(n = 10) negatives in all subtypes of hematological malignancies. However, there was a female predominance in chronic myeloid leukemia samples Ph^1-positives by i FISH, whereas no sexual influence was observed on acute subtypes of leukemia.Conclusions: i FISH analysis is feasible on samples obtained from remote sites in the Democratic Republic of Congo. However, the optimization of the sample storage is necessary to further improve i FISH's performance.

A Possible Hypoallergenic Cereal in Wheat Food Allergy and Baker’s Asthma

Background: Wheat is a potent allergen source and is one of the causes of baker’s asthma and food allergy. The best strategy for managing food hypersensitivity involves strict avoidance of the trigger. However, wheat is quite difficult to avoid. Several alternative strategies for the treatment of food allergy are under study. Spelt is a possible hypoallergenic crop that may be tried in patients with wheat allergy. Methods: We have evaluated the allergenic IgE hypersensitivity mediated by spelt in wheat allergic patients. Overall, 66 patients who suffered from baker’s asthma or food allergy (45 males and 21 females, mean age 28.6 ± 12.9 years) were included. We have also compared its reactivity with standard- ized extracts from wheat and with purified non-specific lipid transfer proteins from wheat (Tri a 14) and from peach (Pru p 3). Immunodetection with spelt and common bread wheat extracts (Triticum aestivum, cultivar Astral) was per- formed. Fresh wheat and spelt grain extracts were used both for oral and bronchial challenge and skin tests. Specific IgE detection to different cereals was performed using the Immuno CAP System (Phadia, Uppsala, Sweden). The bronchial challenge was positive with wheat Astral in 44 (67%) patients, all of them suffered from asthma. Thirteen (29.54%) of these 44 patients had negative the challenge with spelt. The oral challenge with wheat Astral was positive in 22 (33%) patients with wheat food allergy, and the same test was positive in only in 6 of them with spelt (27.3%). The diagnostic yield (sensitivity, specificity and predictive values) of routine tests in determining spelt allergy by specific positive challenge responses was determined. Prick tests for spelt versus positive challenge tests had a good sensitivity (94%, 86.5 - 99.4;95%CI) and specificity (86%, 84 - 90;95% CI) for the diagnosis of spelt allergy. Immunodetection detected minor differences among different extracts. Conclusion: In summary, the prick test and bronchial and oral challenges both efficiently detected sensitization to spelt and their levels were related to more severe clinical profiles, but the wheal area was significantly lower with spelt (p 0.001) and the percentage of positive challenge tests decreased. Our results suggest that spelt is an old crop that may be tried in patients with wheat allergy.

Fever among Children with Sickle-Cell Disease: Findings from the General Pediatric Ward of the Owendo Pediatric Hospital in Libreville, Gabon

Sickle-cell disease (SCD) represents a substantial public health problem in Gabon. Fever is one of the principal reasons for the hospitalization of children afflicted by major sickle-cell disorder, since it can be a clinical reflection of severe infections that have the potential to become life threatening. Objectives: Identification of the main causes of fever in children with SCD in our clinical setting, with the aim of optimizing treatments. Patients and Methods: This is a retrospective study of all the medical files for children with SCD that were admitted to our ward, over a two year period, due to fever (>38.5°C) lasting more than 24 hours. Only those files that contained at least the following five fundamental medical examinations were retained for further evaluation: Complete Blood Count (CBC), blood smear, blood culture, urine culture and chest X-ray. Out of a total of 118 admissions (103 patients), 87 (73.7%) were due to the incidence of fever. The medical files of 11 patients were deemed to be unusable. Seventy-six episodes of fever were observed among 69 children, of which 42 were male and 27 female (sex ratio of 1.5). Among these, seven (10%) were admitted twice. Results: The age groups that were most affected included 12 - 18 year-olds (30 cases: 43.5%) and 6 - 12 year-olds (26 cases: 37.7%). The most common accompanying symptoms were bone and joint pain (43.4%), asthenia (22.4%), cough (19.7%), vomiting (17%) and headache (15.8%). The specific cause of the fever could not be pinpointed in 29 cases (38.1%). Aside from these cases, the main causes of fever were malaria (30.3%) and bronchopulmonary infections (22.4%). The white blood cell count was >20,000/mm3 in 47% of respiratory infections, 43.5% of the cases involving malaria and 55.2% of cases of fever with unknown cause. Hemoglobin levels were <5g/dl for 52.2% of the cases involving malaria and 22.6% for those of unknown origin. For four patients, all less than 10 years of age, the disease was fatal. Conclusion: For the majority of fever episodes, the underlying cause could not be determined. Nonetheless, malaria was identified as one of the principal identifiable causes of fever among children with SDC in Libreville. Treatment for malaria upon admission, and the promotion of preventative measures, therefore seems to be appropriate for our clinical setting. In light of the large number of unresolved cases, systematic prescription of broad-spectrum antibiotics may also be called for.

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.

Persistence of Pleural Effusions and Empyemas after Pneumococcal Conjugate Vaccine Implementation in Uruguay

In Uruguay a post pneumococcal conjugate vaccine implementation surveillance of hospitalized children with pneumonia showed an increase of complicated pneumonias, while uncomplicated pneumonias decreased. Out of 151 pleural effusions, 62 were empyemas requiring drainage, the rest of cases were treated with antibiotics with a favorable outcome. Patient’s vaccinated status varied. Pneumococcal etiology was poorly documented. The few identified sero-types were 1 and 3, a fact that urges PCV13 use for their control.