Mamadou Sarr

Syndrome hémolytique et urémique de l'enfant au Centre Hospitalier Universitaire (CHU) de Dakar: à propos de quatre observations

Hemolytic-uremic syndrome (HUS) is a common cause of organic acute renal failure (ARF) in children. It is a progressive complication of acute gastroenteritis (AGE), especially caused by Escherichia coli in children. This study aimed to describe the clinical, therapeutic and evolutionary aspects of this affection in four children. We collected four cases of HUS. The average age was 10,5 months (5-15mois), exclusively boys. Clinical examination revealed a hemolytic anemia (pallor and jaundice), oligoanuria and edematous syndrome (2 cases), arterial hypertension (1 patient), AGE associated with severe dehydration and hypovolemic shock (2 patients), consciousness disorders. ARF was found in all patients as well as thrombocytopenia and schizocytes smear. Direct Coombs test was negative. Hyperkalemia was found in 3 patients, of whom 1 with hyperkalemia level of more than 9.2 mmol/L, hyponatremia at 129 mmol/l (1 patient) and hypernatremia at 153 mmol/l (1 patient). HUS was secondary to pneumococcal pneumonia (1 patient) while AGE was secondary to E. coli (1 patient). The treatment was mainly symptomatic and included fluid restriction, transfusion of red cell concentrates, diuretics, peritoneal dialysis and hemodialysis. The evolution was marked by the onset of chronic renal failure (1 patient) after 6 months of follow-up and by recovery (1 case). Three patients died. HUS is the most common cause of organic acute renal failure in newborns. Diagnosis is essentially biological, treatment is mostly symptomatic.

Hypothyroïdie congénitale à Dakar: à propos de 28 cas

Child hypothyroidism has been little studied in Senegal. The aim of this study was to evaluate the epidemiological, diagnostic and evolutionary aspects of congenital hypothyroidism. We conducted a descriptive-analytical retrospective study of all children treated for congenital hypothyroidism at the Albert-Royer National Childrens Hospital Center over the period from 2001 to 2014 (14 years). We collected and analyzed socio-demographic, clinical and evolutionary data from patient medical records. A total of 28 patients were included in the study, an average of 2 cases per year. The average age of discovery of hypothyroidism was 54.25 ± 43 months with a female predominance (Sex-ratio 0.47). Only 2 cases of hypothyroidism were diagnosed in the neonatal period. Consanguinity was present in 68% of patients. Clinical signs were dominated by the delay in psychomotor acquisitions (96%), hypothermia (46%), cranio-facial dysmorphia (43%) and goiter (39%). Growth retardation was constant beyond 6 months. The etiologies were dominated by hormonosynthesis disorders (84.21%). During the study period, mean SD of patients had decreased from -3.5 SD to -2.25 SD for a median treatment duration of 28 months. Mental retardation was present in 73% of cases. Growth retardation and mental retardation were more severe as the diagnosis was late. Our results confirm the inadequacy of early management of patients. It is urgent to implement a routine neonatal screening system in order to improve the mental prognosis of this condition.

Anemia among Apparently Healthy Senegalese Children Aged 9-15 Months

In Senegal, despite its high frequency, there is no real program to fight against anemia among infants. This work was carried out in the Dakar suburb from 1 st September, 2009 to 27 th January, 2010 among apparently healthy children aged 9-15 months at the time of their immunization against yellow fever and measles. They showed no known chronic condition or acute infection at the time of the survey. The objectives were to study the diet, prevalence, type and risk factors of anemia. The questionnaire was about whether the father and the mother were working and about the children’s diet during the first six months of their life. All the children underwent anthropometric measurements (weight and height) and a complete blood count. We considered children as anemic if the hemoglobin rate was below 11g/dl. Of the 245 children, 212 were anemic, which was a prevalence of 86.5%. This anemia, frequently of the microcytic hypochromic type (68. 86%) was significantly (p < 0.0003) observed among the children of housewives compared with those whose mothers were employed. Among anemic children, 60.8% were only taking breast milk with or without cereal porridge as a food supplement. The absence of consumption of protein, vegetables, fruits and dairy products was a risk factor for the occurrence of anemia (p <0.0001). In total, at the time immunization is stopped, almost all Senegalese children, while apparently healthy, still face nutritional anemia. The adverse consequences of anemia on child health require the implementation in developing countries of a specific program of struggle against anemia. The activity of vaccination might be the best opportunity to provide the nutritional education these mothers need.