Plateforme Télé-Enseignement de l'Université Oran 1 Ahmed Ben Bella

L'insuffisance rénale aiguë (IRA) est une pathologie peu fréquente en réanimation pédiatrique par rapport à l'adulte. Elle constitue un événement grave du fait que la mortalité qui lui est associée reste élevée et constante malgré les progrès réalisés. Peu de livres ont abordé l'insuffisance rénale aigue en milieu de réanimation chez l'enfant. Nous nous sommes intéressés à mettre le point sur les différents aspects de l'insuffisance rénale aigue chez l'enfant, tant sur le plan étiologique, que pronostic auxquels le réanimateur ou l 'urgentiste peuvent être confrontés. Ce manuscrit est destiné aux étudiants, aux jeunes médecins, aux résidents réanimateurs, aux internes des services d'urgences qui sont régulièrement confrontés à des situations d'IRA chez l'enfant, et s'est axé beaucoup plus sur le pronostic, les facteurs de risque de l'IRA chez l'enfant et sur la stratégie préventive selon nos pratiques et les nouvelles mises à jour dans la discipline qui nous espérons répondre à votre attente.

Introduction: Source of discomfort and dissatisfaction, the rules of pre-operative fasting have evolved a lot in recent years. Objective: To evaluate the duration of preoperative fasting in children and the degree of parental support for this strategy. Materials and Methods: Prospective mono-centric study on the implementation of a preoperative fasting strategy in children. Pediatric surgery department of the Teaching University Hospital (TUH) of Sidi-Bel-Abbès over a period of three years from July 2015 to June 2018. Included were all children from 6 months-15 years, who are asked the indication of anesthesia for minor surgery. We gathered the respect and understanding of the parents of preoperative fasting. Results: One thousand three children were included in the study, the mean age was: 62.01 ± 44.14 months, the sex ratio was 3.6/1 with male predominance. The majority of children were under six years old. The socio-cultural level of parents was medium to high in 88.4% of cases. The mean duration of preoperative fasting was 6.9 ± 4.16 hours and ranged from 2 hours to more than 11 hours. Almost 70% of children had a six-hour fast during the second year. Discussion: In our work, the vast majority of parents respected the pre-op fasting of their children. The improvement in the duration of preoperative fasting was done through a follow-up protocol by the entire pediatric surgery team. The application of the rules of fasting by parents must be strict and simple.

Background: Malondialdehyde (MDA) is a marker of oxidative stress (OS) and one of the major alternative complement pathway (ACP) activators associated with systemic lupus erythematosus (SLE) activity. ACP is the principal mediator of SLE inflammation and progression. Aim of the work: To investigate the association between the ACP functional activity and plasma MDA in SLE patients. Patients and methods: Sixteen consecutive SLE patients were analyzed for their complement profile and oxidative stress measurement. 60 healthy subjects were included as a control group. The Complement components C3, C4 and properdin-factor B (PfB) were assessed, ACP activity was assayed according to alternative hemolytic 50 (AH50). Plasma total lipid peroxide quantification was performed by assessing the plasma MDA. Total antioxidant capacity was measured with oxygen radical absorbance capacity (ORAC). OS ratio was calculated by dividing the total antioxidant capacity by MDA. Results: Sixteen patients (13 females and 3 males) with a mean age of 27.86 ± 6.26 years and a disease duration 69.65 ± 54.65 months were included. There was a significant increase of MDA in the patients (MFI = 613 ± 56.21) compared to the control (MFI = 460 ± 37.85) (p = 0.003). C3 was significantly consumed and MDA increased in the low AH50 compared to the normal AH50 patients (p = 0.02 and p = 0.01 respectively). AH50 significantly negatively correlated with the C3 (p = 0.02) and MDA (p = 0.048). There was lack of any association between ORAC and ACP. Properdin factor B significantly negatively correlated with C3 (p = 0.007). Conclusions: These initial results encourage future in-depth studies on the association of OS–ACP in SLE pathogenesis.

Treatment of atypical hemolytic uremic syndrome (aHUS) by the complement C5 inhibitor eculizumab (Soliris®) is highly effective but unfortunately, associated with an economic pressure on the health care systems even in high incomes countries. Despite spacing infusions having been proposed as the unique solution to minimize this economic impact, no reliable laboratory assays are available to tailor such therapy optimization. We aimed to propose and evaluate a complement composite marker for eculizumab efficacy monitoring in aHUS. We have retrospectively analyzed complement profiles data of eight aHUS patients under eculizumab from the International Registry of HUS/Thrombotic Thrombocytopenia Purpura, and calculated a novel marker “C3:CH₅₀ ratio” by dividing C3 value by CH₅₀ one for each sample during induction and maintenance periods. The results significance was compared to the currently used biomarkers for eculizumab tailoring. In contrast to the current biomarkers used for eculizumab efficacy monitoring like CH₅₀ and soluble or deposit membrane attack complexes, “C3:CH₅₀ ratio” seems to be the most interesting one since its value at pre-eculizumab dosage equaled 0.92 ± 0.2 while the post-eculizumab one increased significantly to reach 24.54 ± 10.7; P < 0.001. Furthermore, this ratio correlated negatively with platelets count (r = −0.722, P = 0.018) while no correlation was found within the thrombotic microangiopathy (TMA) biomarkers and complement blockade for the other parameters that change in pre and post-eculizumab therapy. As far as we know, this is the first study that suggests a post-eculizumab parameter correlating simultaneously with drug’s activity (complement inhibition) and disease activity (platelets counts). Nonetheless, the limited number of patients enrolled in this study should be considered in larger studies to guide eculizumab optimization by indicating the time when subsequent withdrawal or infusion spacing is allowed or recommended.

Background and Objectives: The cancellation of elective surgery in children leads to costly waste for the institution and causes emotional stress for the child and his family. The objective of this work is to analyze the evolution of the last-minute cancellation rate of outpatient surgery in children, as an indicator of quality, its causes and to evaluate the effectiveness of the improvement program cancellations. Materials and methods: A prospective, mono-centric descriptive study that took place in the pediatric surgery department of the University Hospital Center (UHC) Abdelkader Hassani of Sidi-Bel-Abbès. The study spanned a period of 2 years (2013-2015) to identify cancellations in pediatric outpatient surgery. We recorded all admissions to the operating room, and cancellations. Reasons for cancellation were categorized into two broad categories: patient-related and facility-related cancellations. Results: Over a two-year period, 2487 patients were scheduled for elective surgery at the Pediatric Surgery Department of Sidi-Bel-Abbès University Hospital, of which 1162 children were eligible for outpatient surgery 46.7%, 159 interventions were canceled (13.7%). The average age of patients who have been canceled is 5 years. Patient reasons, administrative reasons accounted for respectively 58.5%, 41.5% on all cancellations. The cancellation concerned more than 61.8% urogenital surgery, 22.5% orthopedic surgery. Conclusion: Through the quality improvement program, significant reductions have been reported, the cancellation rate has dropped from 20.4% to 3.5%. If the rate has become lower compared to other rate in the world, the impact can be significant by improving institutional resources and waiting lists.

Ce troisième millénaire a vu la naissance d’un nouvel ordre mondial appelé la mondialisation ou la globalisation, qui se marque par l'émergence de nouvelles idées et concepts dominés par le libéralisme économique ,l'ouverture du marché et le développement technologique mondiale qui a eu la plus grande influence dans le domaine de la communication et de l'information comme la télévision de diffusion par satellite ,l'Internet et les téléphones intelligents ; ce qui rend le monde un petit village ouvert sur toutes les populations de diverses cultures , c’est la raison pour laquelle s'est effondré un grand nombre de normes et de valeurs. Par conséquence la famille et l'école sont les plus importantes institutions de la socialisation des individus affectés par la mondialisation qui a imposé des nouvelles circonstances économiques et sociales , et , la famille algérienne est devenue de plus en plus consommatrice , hommes et femmes de niveau socio-intellectuel différents procurent leurs éducation et la socialisation de leur enfant à l’école, qui celle-ci est affectée à son tour par des contraintes organisationnelles, pédagogiques, managériales et humaines. Pour ces raisons l’élève est devenue la victime des accusations mutuelles entre la famille et l'école et aucun ne veut assumer ces responsabilités.

Since December 2019, severe acute respiratory syndrome due to coronavirus-2 (SARS-CoV-2), responsible for the COVID-19 disease, has been recognized as a causative agent of severe pneumonia in the adult population mainly. At this point, there is very little pediatric data available. Children are clearly under-represented in terms of frequency, with patients<20 years of age accounting for only 1 to 2% of documented cases in Italy and China . At the end of April 2020, in Europe (United Kingdom, France, Belgium, Italy and Spain) but also in the United States and Australia, in the midst of the Covid-19 pandemic, resuscitation services reported a significant increase in the number (however little high) of “pediatric cases of myocarditis with circulatory failure and an upsurge in atypical Kawasaki disease without heart failure” .We report an observation of a child admitted to pediatric intensive care unit at EHU Oran for consciousness disorders after a covid 19 infection producing a pseudokawasaki form.

Le méthotrexate(MTX) est un cytostatique utilisé pour le traitement des tumeurs solides et des hémopathies malignes. Son élimination est essentiellement rénale et sa toxicité peut se voir pour des doses >500mg /m². Notre objectif est décrire l’aspect évolutif de la néphrotoxicité au méthotrexate à travers 02 vignettes cliniques.

L’Insuffisance rénale est un problème de santé publique, sa fréquence est en croissance progressive dans l’ouest Algérien. Nous nous sommes intéressés à cette étude afin de relater notre expérience dans la prise en charge difficile, d’exposer nos réflexions et d’émettre des propositions concrètes pour une prise en charge optimale. Notre objectif primaire est de définir les caractéristiques épidémio-cliniques des enfants dialysés à l’admission et décrire le profil évolutif. Notre travail est une étude rétro prospective monocentrique sur une période de 20 ans, s’étalant du 01/09/1994 au 01/09/2014 colligeant 266 dossiers des enfants admis en unité d’hémodialyse pédiatrique. L’âge de nos patients varie de 3 ans-18ans, l’âge médian est de 11,05± 2,79 ans, et le sex ratio est de 1,3. 33% étaient des Glomérulopathies, dans 21 % l’IRCT était secondaire à une néphropathie de reflux .Puis les causes génétiques représentaient 15% et 29% restaient de causes indéterminées. A l’admission, à l’initiation de la première séance de dialyse dans le cadre de l’urgence ,20% de nos patients étaient comateux, 71 % étaient en surcharge hydrosodée compliquant une HTA sévère, un OAP et une péricardite. 11,5% de nos patients initialement traités par la modalité de l’hémodialyse périodique (après un temps médian en hémodialyse de 02 mois) ont été transférés en dialyse péritonéale chronique ambulatoire (DPCA) pour problème d’abord vasculaire chez l’enfant très jeune, l’intolérance hémodynamique et pour certain l’impossibilité de prise en charge dans plusieurs structures de dialyse du sud ouest Algérien. 5% de nos enfants sont décédés. L’insuffisance cardiaque globale (OR = 0,51 ; IC 95 % : 0,20–0,93), le sepsis (p=0,003) et l’hypertension artérielle maligne compliquée d’un accident vasculaire cérébral (p=0,045) étaient les facteurs prédictifs du décès. 3% des enfants ont été greffés à partir d’un don parental dont un a reçu une greffe rénale en pré emptive. Même si l’effectif présenté est peu nombreux, il a posé des problèmes de prise en charge en amont de la réanimation, d’ou l’intérêt de dépister précocement les maladies dites évitables, de poser précocement le diagnostic, de développer d’autres centres de dialyses pédiatriques et d’encourager la greffe rénale à partir des morts encéphaliques

LA REVUE MEDICALE DE L’HMRUO 2015  V2 N°3 Pages 162-169

ISSNISSN 2392-5078

https://atrss.dz/ressources/fichiers_produits/fichier_produit_457.pdf

http://www.atrss.dz/Document%20en%20format%20word%20et%20pdf/revue_hmruo%20n3-2015.pdf

Background-Tuberous sclerosis of Bourneville (TSB) is a rare genetic disease, transmitted in the autosomal dominant mode characterized by the development of benign tumors in different tissues: skin, kidney, heart, brain and eye. The classic triad in children includes skin spots, epilepsy and mental retardation. Méthods-The authors report a clinical sticher of an infant admitted for lateralized convulsive seizures complicated by malignant arterial hypertension and whose etiological diagnosis of tuberous sclerosis of bourneville was made in a setting etiological assessment of a malignant arterial hypertension. complicated by convulsive encephalopathy. Results- A . O 36 months old, the eldest of siblings of 02, of non-consanguineous parents. Psychomotor development was normal. A notion of epilepsy in the maternal uncle was reported in family history. The beginning of the symptomatology went back to the age of 07 months old ,by the occurrence of convulsions type syndrome WEST.02 days before admission, a state of convulsive illness motivated his transfer to the intensive care unit in May 2014. At admission: a stage IIa coma, a PA at 160 / 120 mmHg, an achromic skin placard of the sacral region, and the inner thighs.Pulmonary auscultation found some crackling rales at the two bases of the pulmonary field.An exploration report of the HTA found: on the abdomino - pelvic ultrasound a left nephromegaly. A renal scintigraphy with DMSA found a silent kidney on stenosis of the right renal artery. Blood creatinine, urine dosing of AMVs were unremarkable.Cerebral MRI revealed subependymal nodules along the lateral walls of the lateral ventricles The child was nephrectomized on the right. The histological study of the nephrectomized specimen revealed multiple angiomyolipomas in the cortex.The child was put out on day 25, under dual antihypertensive and anticonvulsant therapy.The death of the child occurred at home, 05 months following discharge of hospital, as part of a convulsive hypertensive encephalopathy refractory to treatment. Conclusions- TSB is an autosomal dominant disorder.Its diagnosis is radiological clinico.The clinical manifestation is polymorphic. The prognosis is closely related to neurological manifestations. Vigabantrin treatment proves better control of convulsions.A multidisciplinary approach would improve the therapy and quality of life of patients. Keywords Infant, convulsive encephalopathy, malignant hypertension, achromic spots, cortical tubers, renal cysts