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The endothelial protein C receptor (EPCR)–rs867186 G allele has been linked to high plasma levels of soluble EPCR (sEPCR) and controversially associated with either susceptibility or resistance to severe and cerebral malaria. In this study, quantitative enzyme-linked immunosorbent assay and sequencing were used to assess sEPCR levels and EPCR-rs867186 polymorphism in blood samples from Beninese children with different clinical presentations of malaria. Our findings show that sEPCR levels were higher at hospital admission than during convalescence and that EPCR-rs867186 G allele was associated with increased sEPCR plasma levels, malaria severity, and mortality rate (P < .001, P = .03, and P = .04, respectively), suggesting a role of sEPCR in the pathogenesis of severe malaria.

Growth response, carcass characteristics and meat quality of West African Dwarf (WAD) sheep fed Shea Cake Meal (SCM) supplement was investigated. A total of 24 WAD sheep of average body weight ranges from 11-12.65 kg comprising of twelve (12) males and twelve (12) females were randomly allotted to four dietary treatments with six animals per treatment in a completely randomized design in a twelve (12) weeks experimental period. Treatment 1 was control and had no inclusion of SCM. Treatments 2, 3 and 4 had 10%, 15% and 20% inclusion of SCM. Results were significantly different (P

The blood profile and histology of selected tissues (kidney, lungs, intestine, and epididymis) of Balami Sheep fed Shea Cake meal supplement was investigated. A total of thirty-two (32) sheep of the average weight range of 11.75-14.75kg comprising an equal number (16) of males and females were randomly allotted to four dietary treatments in a completely randomized experimental design with eight sheep per treatment for twelve weeks duration. Treatment 1 (T1) was a control diet and had zero inclusion level of Shea cake meal (SCM), while treatments 2,3, and 4 had 10%,15%, and 20% inclusion of SCM, respectively. At the twelfth week of the experiment, two blood samples of 5ml each were taken from each animal from the jugular vein. The first set was preserved in Ethylene Diamine Tetra Acetic Acid (EDTA) bottle for haematological parameters, while the second samples were preserved without EDTA for serum examination. Representative samples of tissues were randomly selected and slaughtered for gross microscopic examination. There was a significant difference (P

The EPCR-rs867186-G allele has been linked to high plasma level of soluble-EPCR and controversially associated with either susceptibility or resistance to severe and cerebral malaria. In this study, quantitative-ELISA and sequencing were used to assess sEPCR levels and EPCR-rs867186 polymorphism in blood samples from Beninese children with different clinical presentations of malaria. Our findings show that sEPCR levels were higher at admission to hospital than during convalescence and that EPCR-rs867186-G-allele was associated with increased sEPCR plasma levels, severe malaria and mortality (p-values .0001, = .03 and = .04, respectively), suggesting a role of sEPCR in the pathogenesis of severe malaria.

Cytoadhesion and sequestration of Plasmodium falciparum infected red blood cells (iRBC) in the microvasculature of vital organs are a major cause of malaria pathology. Several studies have provided evidence on the implication of the human host intercellular adhesion molecule-1 (ICAM-1) as a major receptor for iRBCs binding to P. falciparum erythrocyte membrane protein 1 (PfEMP1) in the development of severe and cerebral malaria. The genetic polymorphism K29M in the immunoglobulin-like domain of ICAM-1, known as ICAM-1To provide more conclusive results, the genetic polymorphism of ICAM-1The results showed that in this cohort of Beninese children, the ICAM-1

Objectives Maternal depression occurs in 13–20% of women from low-income countries, which is associated with negative child health outcomes, including diarrheal disease. However, few studies have investigated its impact on child risk of infectious disease. We studied the impacts of maternal depressive symptoms and parent–child interactions, independently, on the risk of Plasmodium falciparum malaria and soil-transmitted helminth infection in Beninese children. Methods Our population included mothers and children enrolled in a clinical trial during pregnancy (MiPPAD) in Benin. The Edinburgh Postnatal Depression Scale (EPDS) assessed maternal depressive symptoms and the home observation measurement of the environment (HOME) assessed parent–child interactions. Blood and stool sample analyses diagnosed child malaria and helminth infection at 12, 18, and 24 months. Negative binomial and Poisson regression models with robust variance tested associations. Results Of the 302 mother–child pairs, 39 (12.9%) mothers had depressive symptoms. Median number of malaria episodes per child was 3 (0–14) and 29.1% children had at least one helminth infection. Higher EPDS scores were associated with lower HOME scores; relative risk (RR) 0.97 (95% confidence interval (CI) 0.95, 0.99), particularly with lower acceptance, involvement, and variety subscales; RR 0.92 (95% CI 0.85, 0.99), RR 0.82 (95% CI 0.77, 0.88), RR 0.93 (95% CI 0.88, 0.99), respectively. However, neither exposure was associated with risk of parasitic infection in children. Conclusions for Practice Maternal depressive symptoms are associated with poor parent–child interactions, particularly acceptance of behavior, involvement with children, and variety of interactions, but these exposures do not independently impact risk of parasitic infection in children.

Background: Metabolic acidosis (MA) is a common finding on the surgical ward, more so in the intensive care unit. Diseases affecting the major organ systems of the body and higher grades of surgery are common risk factors for MA. It is associated with poor treatment outcome. Aim: To determine the risk factors and clinical correlates of metabolic acidosis and assess its relationship with treatment outcome. Methodology: A retrospective study at the “Tristate Heart and vascular Center” in Ilishan-Remo South west Nigeria, on patients that had cardiac and vascular surgeries from January 2015 to December 2019. Three hundred and forty two participants took part in the study. The demographic, clinical and laboratory findings were entered. Statistical analysis was with Student’s t-test and Chi square. Results: Two hundred and six males and 136 females were studied. The incidences of metabolic acidosis prior to induction, on post-operative day one (POD1) and on POD28 were 20.7%, 39.8% and 14.1% respectively. Nine (2.6%) participants died during admission, of this, 6 (66.7%) had MA at presentation but all (100%) had MA on POD1. The Risk factors for MA were advanced age, comorbidities, open heart surgery, elevated systolic blood pressure and low eGFR. Metabolic acidosis was a risk factor for prolonged hospital stay, perioperative death and declining kidney function which was commoner among participants with preexisting kidney dysfunction. Conclusion: The incidence of metabolic acidosis was 20.7% at induction of anesthesia, rose to 39.8% on POD1 and by POD28, it has significantly reduced to 14.1%. While advancing age and comorbidities were risk factors for MA, the occurrence of MA increased the risk of declining kidney function, prolonged hospital stay and death.

Background: Malaria-related deaths could be prevented if prompt diagnosis and prognostic biomarkers are available to allow rapid adequate treatment. Understanding of the mechanisms implicated in the progression from P. falciparum asymptomatic and uncomplicated malaria infections to severe life-threatening disease is necessary to identify such indicators. Methods: Using quantitative ELISA, we assessed the plasma concentrations of Procalcitonin, Pentraxine 3, Ang-2, sTie-2, suPAR, sEPCR, and sICAM-1 in a cohort of 337 Beninese children who presented with pediatric malaria to investigate the potential association with clinical manifestations and outcomes. Results: The molecules showed higher levels in children with severe or cerebral malaria compared to those with uncomplicated malaria. Plasmas concentrations of PTX3, PCT and the soluble receptors suPAR, sTie-2, sICAM-1 were significantly higher in children with deep coma as defined by a Blantyre Coma Score < 3 (P p=0.037, p=0.035, and p=0.002 respectively).Conclusion: Our findings indicate the ability of these seven bioactive molecules to discriminate among the clinical manifestations of malaria and therefore, given their potential utility as prognostic biomarkers for severe and fatal malaria, they might be useful to improve severe cases management.

Background: Few biomarkers for sepsis diagnosis are commonly used in neonatal sepsis. Whilst host response is increasingly recognized in sepsis pathogenesis and prognosis, there is a need for evaluating the accuracy of new biomarkers targeting host response in regions where sepsis burden is high and medico-economic resources are scarce. The objective of the study is to evaluate diagnostic and prognostic accuracy of biomarkers of neonatal sepsis in Sub Saharan Africa. Methods: Prospective multicentre study conducted between April 2016 and March 2018 in three University hospitals and two sub-urbans healthcare centres in the south Benin region. Patients were followed from birth to 3 months of age. Accuracy of transcriptional (CD74, CX3CR1), proteic (PCT, IL-6, IL-10, IP-10) biomarkers and clinical characteristics to diagnose and prognose neonatal sepsis were measured. At delivery, cord blood from all consecutive newborns were sampled and analysed, and infants were followed for a 12 weeks’ period. Results: From April 17, 2016 through March 12, 2018, a total of 581 newborns were enrolled. One hundred and seventy-two newborns developed neonatal sepsis (29.6%) and death occurred in forty-nine infants (8.4%). Among all tested biomarkers and clinical criteria, CD74/IP-10 ratio showed the best accuracy for neonatal sepsis diagnosis, while PCT accuracy was low. Among biomarkers and clinical criteria studied, only CD74 and PCT were independently associated with mortality, with CD74 showing an elevated predictive accuracy. Conclusion: Cord blood PCT had a low accuracy for diagnosing early onset neonatal sepsis in Sub Saharan African neonates, while CD74/IP-10 ratio had the best diagnostic accuracy. CD74 expression at birth had the best accuracy in prognosing sepsis mortality.Trial registration: Clinicaltrial.gov registration number: NCT03780712. Registered 19 December 2018. Retrospectively registered

Background/Purpose Kangaroo Mother Care (KMC) is cost-effective and has proven to reduce the mortality of low birth weight neonates (LBWs) in low- and middle-income countries (LMICs), but its uptake is low in Sub-Saharan Africa where neonatal mortality is high. KMC units were implemented in 4 hospitals of Benin as part of a multifaceted intervention co-funded by USAID Benin (2015-2017) to decrease neonatal mortality. Our study looks at the sustained impact of KMC units on LBWs in Benin, 2 …

Background: Hypertension (HPT) is a major public health problem. Many studies have attempted to investigate HPT in school children. Few, however, have targeted hospital HPT. We conducted this study to describe the epidemiologic characteristics, etiologies, management, and outcome of hospital HPT in our setting. Methods: This was a prospective and descriptive study carried out from March 01 through June 30, 2017 in the pediatric departments of two university hospitals: Centre National Hospitalier Universitaire Hubert K. Maga and Centre Hospitalier Universitaire de la Mere et de L’Enfant Lagune of Cotonou, Benin. Every consecutive patient aged 3 to 18 years who was admitted to the two hospitals for any reason had his (her) BP measured. Every patient with HPT was reviewed for demographics, history and clinical examination, and laboratory investigations as appropriate. Management was done accordingly. Outcome was also recorded. Results: The hospital frequency of HPT was 1.98% (31 cases/1565 admissions). The male/female ratio was 1.06 (16 males, 15 females). Mean age was 8.5 years ± 4.39 (range, 3 to 16 years). 74.19% patients had Body mass index within -2SD and +2SD. Only one patient had BMI above +3SD. The main etiologies found were renal: acute tubular necrosis (45.16%), acute glomerulonephritis (16.13%), and acute pyelonephritis (12.90%). Diuretics (64.5%), were the main antihypertensive drugs used. A single drug therapy was used in 35.4%, a two-drug therapy in 32.2% and a three-drug therapy in 9.6% of cases. Length of hospital stay was more than one week in 70.97% of cases. Hospital death rate for HPT was 19.35%. The outcome was not known in one patient due to exit from hospital against medical advice. All the other patients fully recovered at one month post-discharge follow-up. Conclusion: HPT presents as a symptomatic disease in our hospitals; it has a renal etiology in most cases and has significant death rate despite treatment. Advocacy with health authorities must be the way out of issues of HPT management in our setting.

IntroductionIn 2016, an estimated 216 million cases and 445 000 deaths of malaria occurred worldwide, in 91 countries. In Benin, malaria causes 26.8% of consultation and hospitalisation motif in the general population and 20.9% in children under 5 years old.The goal of the NeuroCM project is to identify the causative factors of neuroinflammation in the context of cerebral malaria. There are currently very few systematic data from West Africa on the aetiologies and management of non-malarial non-traumatic coma in small children, and NeuroCM will help to fill this gap. We postulate that an accurate understanding of molecular and cellular mechanisms involved in neuroinflammation may help to define efficient strategies to prevent and manage cerebral malaria.Methods and analysisThis is a prospective, case-control study comparing cerebral malaria to uncomplicated malaria and non-malarial non-traumatic coma. This study takes place in Benin, precisely in Cotonou for children with coma and in Sô-Ava district for children with uncomplicated malaria. We aim to include 300 children aged between 24 and 71 months and divided in three different clinical groups during 12 months (from December 2017 to November 2018) with a 21 to 28 days follow-up for coma. Study data, including clinical, biological and research results will be collected and managed using CSOnline-Ennov Clinical.Ethics and disseminationEthics approval for the NeuroCM study has been obtained fromComité National d’Ethique pour la Recherche en santéof Benin (n°67/MS/DC/SGM/DRFMT/CNERS/SA; 10/17/2017). NeuroCM study has also been approved byComité consultatif de déontologie et d’éthiqueof Institut de Recherche pour le Développement (IRD; 10/24/2017). The study results will be disseminated through the direct consultations with the WHO’s Multilateral Initiative on Malaria (TDR-MIM) and Roll Back Malaria programme, through scientific meetings and peer-reviewed publications in scientific or medical journals, and through guidelines and booklets.

The goal of this study was to evaluate using the molecular diagnosis, infection transmission rate of HIV in children born to HIV-1 positive mothers as part of the prevention of mother-to-child transmission (PMTCT) in Benin. The sample consisted of 524 dried blood spots (DBS) of children born to HIV-1 positive mothers, from 30 sites (PMTCT) taken between October 2009 and June 2010. The diagnosis of HIV-1 was performed by the qualitative detection of viral nucleic acids (RNA and DNA) in DBS on filter paper using the Abbott RealTime(®) HIV-1 Qualitative assay. We found that 51 DBS were positive (9.7%) and 473 were negative (90.3%). The failure rate of PMTCT among 420 mothers who received antiretroviral prophylaxis was 6.7% (28/420). This failure rate was significantly higher among children born to infected mothers on antiretroviral monotherapy than on triple therapy (HAART). The results of our study enrich the data in the literature on highly active antiretroviral chemoprophylaxis to reduce the transmission of HIV-1 from mother to child.

Introduction La morbidite et la mortalite dues au paludisme ont diminue ces 20 dernieres annees, alors que les infections virales du systeme nerveux central ont ete recemment identifiees comme une cause importante d’hospitalisation avec coma en Afrique de l’Est, ou le paludisme est endemique. Notre objectif etait de decrire l’etiologie, la prise en charge et le pronostic des comas non traumatiques chez le jeune enfant au Benin. Materiels et methodes Cette etude prospective a ete menee dans deux hopitaux universitaires. Tous les enfants VIH-negatifs âges de 2 a 6 ans, ayant un coma avec score de Blantyre inferieur ou egal a 2 ont ete inclus. En plus d’un bilan a la recherche des signes de gravite du paludisme, une hemoculture, une PCR syndromique « fievre tropicale » (Fast Track Diagnosis, Luxembourg) et une analyse du liquide cephalorachidien (LCR), comprenant une PCR multiplex (Biofire, Merieux, France) et une recherche d’adenovirus, ont ete effectuees. Tous les enfants atteints de paludisme ont ete traites avec de l’artesunate par voie intraveineuse. Les patients ont egalement eu acces a d’autres traitements, dont des transfusions sanguines, prescrits a la discretion du medecin. Resultats Entre mars et novembre 2018, 84 enfants ont ete inclus, dont 50 filles (sex-ratio : 0,68) avec un âge moyen de 43 ± 13 mois. Une fievre etait rapportee chez tous les patients, avec une duree d’evolution moyenne de 4 (1–14) jours. Pour 90 % d’entre eux (76/84), des soins avaient ete dispenses par un professionnel de sante avant l’admission, mais seuls 11 enfants avaient recu un traitement oral antipaludeen adequat. Le paludisme etait la seule cause de coma identifiee chez 72 patients (86 %). Six avaient une co-infection (1 meningite purulente decapitee, 1 bacteriemie a Staphylococcus aureus, 1 bacteriemie a Streptococcus, 1 encephalite a West Nile Virus, 1 encephalite a HHV6 et 1 encephalite a adenovirus) et 6 avaient un coma non palustre (1 bacteriemie a E. coli, 1 dengue, 4 indetermines). Vingt enfants (23 %) ont recu une antibiotherapie par ceftriaxone, et la plupart (58/84) ont recu des transfusions sanguines. Le taux de letalite etait de 30 % (26/84), dont 19 deces (23 %) dans les 24 heures suivant l’admission. Sur les 49 enfants suivis a j28, 20 (41 %) avaient des difficultes a marcher, 2 des difficultes a voir, et 1 des difficultes a entendre. Conclusion Le neuropaludisme reste de loin la cause la plus frequente de coma non traumatique dans la zone etudiee, avec un taux de letalite eleve malgre un acces a des soins standardises. Pour la plupart des enfants, le parcours de soin n’a pas abouti a un traitement antipaludeen precoce et efficace. Le paludisme doit etre prevenu, mais les efforts de prevention ne doivent pas releguer au second plan le renforcement necessaire des capacites de prise en charge des formes potentiellement fatales de la maladie.

Growth disorders are frequent in human and are represented mainly by malformation recognizable pre and postnatally. These malformations contribute to infant morbidity and mortality. They could occur in any organ and system. While seated in limbs, they could lead to severe functional difficulties as it was seen in this observation with forearm and legs agenesis. No case was reported before in Benin.Les anomalies de développement sont fréquentes dans l'espèce humaine et se manifestent surtout par des malformations reconnaissables avant et après la naissance. Elles participent pour une part non négligeable à la morbidité et la mortalité infantile. Elles peuvent toucher tous les organes et systèmes. Lorsqu'elles siègent au niveau des membres, elles peuvent déterminer des séquelles fonctionnelles gravissimes comme c'est le cas dans cette observation que nous rapportons marquée par une agénésie des avant-bras et des jambes. Une telle anomalie n'a jamais été rapportée par le passé au Bénin.

To describe the profile of HIV-infected children.This was a cross-sectional, descriptive and analytic study involving 317 infected children, monitored from January 1st, 2002 to July 31st, 2010 at CNHU of Cotonou.The average age was 89.1 months with a sex ratio of 0.91. Orphans of at least one parent represented 31.3% of cases. Vertical transmission was predominant (86.1%). Only 9.5% of patients benefited from PMTCT. They were all infected with HIV 1. According to the WHO classification, 52% were at stage 3 or 4 and 56% had advanced to severe immunodeficiency. 61% had suffered from opportunistic infections, and 53% had benefited from antiretroviral therapy. Following the study, 54% of participants had continued follow-up visits, 23% lost contact with the CNHU, 18% died and 5% were referred to another site. Factors associated with outcome were antiretroviral therapy (p0.0001), clinical (p0.0001) and immunological stage (p = 0.0042) on admission.Our findings suggest strengthening the PMTCT program, screening and early management of an HIV infection.Décrire le profil des enfants infectés par le VIH.Etude transversale, descriptive et analytique portant sur 317 enfants infectés, suivis de Janvier 2002 à Juillet 2010.L'âge moyen des enfants était de 89,1 mois ; le sex ratio de 0,91. Ils étaient orphelins d'au moins un parent dans 31,3% des cas. La transmission était essentiellement verticale (86,1%). Seulement 9,5% avaient bénéficié d'une prophylaxie antirétrovirale pour la PTME. Ils étaient tous infectés par le VIH 1. Selon la classification de l'OMS, 52% étaient à un stade clinique 3 ou 4 et 56% avaient un déficit immunitaire important ou sévère. 61% avaient souffert d'infections opportunistes, et 53% avaient bénéficié du traitement antirétroviral. Quant à leur devenir, 54% avaient continué le suivi, 23% étaient perdus de vue, 18% étaient décédés et 5% transférés sur un autre site de prise en charge. Les facteurs associés au devenir étaient le traitement antirétroviral (p0,0001), les stades clinique (p0,0001) et immunologique (p = 0,0042) à l'admission.Ce profil suggère le renforcement du programme de la PTME, un dépistage et une prise en charge précoces.

In this study, the objective was to determine the proportion of severe anemia and hypoglycemia in severe malaria in children and to identify factors influencing death.This is a descriptive and analytic cross-sectional study with prospectively collected data from January to December 2009. It included children from one month to fourteen years of age hospitalized in the Parakou Regional Hospital Center in Benin for severe malaria according to the World Health Organization (WHO) criteria.Among the 1838 cases, 968 cases (52.6%) had either severe anemia or hypoglycemia or both. Among these, 89% were under 5 years. Biologically, the mean parasite density was 40 062/mm3 and the mean hemoglobin rate was 4.94 g/dl. The average blood glucose was 0.45 g/l. The mortality rate was 8.2%. Death occurrence rate was significantly higher in under five children's group hospitalized for severe anemia and/or hypoglycemia compared to those of the same age group with others forms of severe malaria (p=0,000081).This work suggests the importance of hypoglycemia and anemia among factors associated with death in children's severe malaria.Dans cette étude, l'objectif était de déterminer la part des anémies sévères et des hypoglycémies dans le paludisme grave de l'enfant et d'identifier les facteurs influençant le décès.Il s'est agit d'une étude transversale descriptive et analytique menée de Janvier à Décembre 2009. Elle a inclus les enfants de un mois à quatorze ans révolus hospitalisés dans le Service de Pédiatrie du Centre Hospitalier du Borgou à Parakou (Bénin) pour paludisme grave selon la définition de l'Organisation Mondiale de la Santé (OMS).Parmi les 1838 cas, 968 cas (52,6%) avaient présenté soit une anémie sévère, soit une hypoglycémie, soit les deux à la fois. Le taux d'hémoglobine moyen était de 4,94 g/dl avec une glycémie moyenne de 0,45g/l. Le taux de décès était de 8,2%.Ce travail a confirmé l'importance de l'hypoglycémie et de l'anémie parmi les facteurs associés au décès au cours du paludisme grave de l'enfant.

Introduction: In the North-Benin, there are three agents causing pediatric purulent meningitis outside the neonatal period. These are: Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. The aim of this research work was to investigate bacteria serotypes that caused childhood purulent meningitis in the pediatric unit of the Borgou a Regional University Teaching Hospital (CHUD-Borgou) located in Parakou (North-Benin). Patients and Methods: Through a prospective and descriptive study centered on children aged 0 to 5 years old suspected of meningitis and hospitalized, the cerebrospinal fluid (CSF) samples of those children were analyzed at the WHO reference laboratory in Banjul for serotyping by real time polymerase chain reaction (RT/PCR). Results: Among the 1396 children hospitalized during that period, 366 were suspected of meningitis and had benefitted from lumbar puncture. Among those 366 suspected cases, 51 cases of purulent meningitis were confirmed after CSF cytobacteriological and biochemical test at the CHUD-Borgou laboratory. Among 51 CSF samples in which purulent meningitis was confirmed, 44 were sent to Banjul. In addition, 310 CSF samples from non-confirmed cases of meningitis were also sent to Banjul. In the whole set of samples sent for real time PCR, 151 cases of Streptococcus pneumoniae (42.7%) were found, 5 cases of Neisseria meningitidis (1.4%) and 1 case of Haemophilus influenzae (0.3%) were also encountered. As regards Streptococcus pneumonia, the serotypes encountered were: 1, 3, 4, 5, 7F, 8, 9V, 9V/9A, 9N/9L, 14, 18C, 19A, 23F, 33F as well as non typed and non typable serotypes. As for Neisseria meningitidis, only serogroup A was found in it. For Haemophilus influenzae, only serotype b was identified. Conclusion: Four non vaccine serotypes (8, 9V/9A, 9N/9L and 33F), non typed and non typable serotypes which are not covered by 13-valent pneumococcal conjugate vaccine (PCV 13) were identified. This highlights the need to enhance surveillance of pediatric purulent meningitis and serotyping by RT/PCR of all CSF samples in order to adapt if necessary future new pneumococcal vaccines to circulating non vaccine serotypes.

Introduction Cette etude est centree sur la prise en charge des comas pediatriques non traumatiques dans une zone urbaine de l’Afrique de l’Ouest. Dans un contexte de recul de la mortalite palustre, une etude systematique des etiologies de comas est attendue. Une etude realisee au Malawi a montre une prevalence elevee d’infections virales du systeme nerveux central (SNC). L’analyse des liquides cerebro-spinaux (LCS) des enfants inclus a ete systematiquement proposee. Materiels et methodes C’est une etude prospective bicentrique. Les criteres d’inclusion etaient un âge compris entre 24 et 71 mois et des troubles de la conscience avec un score de Blantyre ≤ 2. Les criteres d’exclusion etaient un test de diagnostic rapide VIH positif, l’absence de consentement parental, une origine traumatique ou toxique du coma, une pathologie neurologique preexistante. Tous les enfants inclus avaient un bilan biologique sanguin incluant une recherche du paludisme (goutte epaisse (GE)). Ils etaient eligibles a une ponction lombaire en l’absence de contre-indication. Outre l’analyse bacteriologique et cytochimique, une PCR multiplex (14 cibles) a ete realisee sur les LCS. Resultats De mars a novembre 2018, 85 enfants ont ete inclus et 73 (85,9 %) LCS ont ete preleves. Le geste etait contre-indique pour 9 enfants et pour 3 d’entre eux, la tentative s’est soldee par un echec ; 11 des 12 enfants sans analyse du LCS avaient une GE positive. Parmi les 10 LCS (13,7 %) montrant une reaction cellulaire > 10 elements/mm3, seul un prelevement avait les caracteristiques d’une meningite purulente decapitee. Aucun examen direct ou culture ne s’est revele positif. Huit de ces enfants (80 %) avaient une GE positive. Parmi les 63 LCS sans pleiocytose, 2 cultures polymicrobiennes ont ete interpretees comme des contaminations. Cinquante-cinq (87,3 %) de ces enfants avaient une GE positive. La PCR a ete realisee sur 62 LCS et a objective une co-infection virale par un herpes virus humain type 6 HHV6 (GE positive) ; aucune autre etiologie infectieuse n’a ete retrouvee. Conclusion Les atteintes infectieuses bacteriennes ou virales du SNC constituent une tres faible proportion des etiologies de comas pediatriques non traumatiques dans cette population. Les atteintes neurologiques dues au paludisme demeurent de tres loin la premiere etiologie et les co-infections semblent rarissimes.

This study was carried out to investigate the effect of heat treatment (Normalizing and Hardening) on the mechanical properties of springs. The springs were made from mild steel rod having a diameter of 6 mm, a total of 15 springs were made. The springs were then subjected to various heat treatment processes which included; normalizing, hardening and tempering. The heat treated springs were then subjected to various test in other to determine their mechanical properties, these included; impact toughness test, hardness test and tension test. The normalized spring had more strength, was harder and was much tougher than both the annealed and as received springs. The water quenched springs were the hardest of all the heat treated springs, were very brittle and had the lowest percentage elongation. Their strength was also lower than that of the normalized and as received springs. The water quenched and tempered springs had better mechanical properties required for spring making, they had the optimum combination of hardness, strength and toughness when compared with the other heat treated springs.

Le paludisme grave chez le nourrisson de moins de six mois est rare et peut etre associe a une infection bacterienne. Nous rapportons ici des cas dans cette tranche d’âge dont certains etaient associes a une infection bacterienne. L’etude est retrospective, descriptive et analytique portant sur 47 nourrissons hospitalises au CNHU du 1er janvier 2006 au 31 juillet 2010. L’incidence hospitaliere du paludisme grave etait de 0, 3%, 0, 3%, 0, 2%, 0, 05% et 0, 4%, respectivement, au cours des annees 2006, 2007, 2008, 2009 et jusqu’en juillet 2010. Les principaux signes de gravite du paludisme retrouves etaient l’anemie severe (91, 5%), les convulsions (44, 7%), l’hyperparasitemie (23, 4%) et coma (8, 5%). Chez 18 enfants, il y avait une infection bacterienne associee. Les plus frequentes etaient la pneumonie (huit cas) et la gastro-enterite (six cas). Tous les nourrissons avaient ete traites par de la chlohydrate de quinine, 42 (89, 5%) transfuses et 18 avaient recus une antibiotherapie appropriee parce que suspects d’infection bacterienne.

Il s’agissait d’une ´etude r´etrospective descriptive portant sur les patients rec¸us en consultation de g´en´etique m´edicale de Septembre 2004 `a Aoˆut 2007. Les patients b´en´eficiaient des examens dysmorphologique et physique, des bilans cytog´en´etiques et/ou mol´eculaires, des interventions th´erapeutiques et un suivi `a long terme. Les variables ´etudi´ees ´etaient les donn´ees sociod´emographiques et cliniques. Soixante et seize patients ont ´et´e rec¸us durant la p´eriode avec une pr´edominance masculine (57,89%). Les motifs de consultation ´etaient domin´es par le retard psychomoteur (38,15%), la dysmorphie faciale (30,26%) et les malformations (19,73%). Les principales malformations portaient sur les extr´emit´es et la face. Les pathologies confirm´ees comprenaient des aberrations chromosomiques (46,05%) avec une pr´edominance de la trisomie 21 et des maladies monog´eniques (7,89%). Le rendement de nos recherches pourrait ˆetre am´elior´e par l’acc`es `a la technique FISH. C’est une exp´erience quasi unique en Afrique de l’ouest et permet d’apporter des r´eponses aux personnes souffrant d’affections h´er´editaires.Mots Cl´es g´en´etique clinique ; retard psychomoteur ; dysmorphie ; malformation ; aberration chromosomique ; maladie monog´enique

Resume Le syndrome de Down qui est le plus frequent et le plus connu des syndromes malformatifs de l’espece humaine existe au Benin. Dans le but d’etudier les aspects epidemiologiques, cliniques et cytogenetiques du syndrome, une etude prospective a ete realisee sur les enfants recus en consultation de Genetique Medicale dans le service de Pediatrie du Centre National Hospitalier et Universitaire de Cotonou pour trisomie 21 de janvier 2007 a decembre 2008. Ainsi, le diagnostic de syndrome de Down est pose chez l’enfant a l’âge moyen de 12 mois ; l’âge maternel moyen est de 36 ans au moment de l’accouchement. Les principales particularites physiques cranio-faciales, des extremites et des organes genitaux externes retrouvees sont : le nez epate (100%), les fentes obliques en haut et dehors (100%), les oreilles dysplasiques (100%), la bouche ouverte en permanence (100%), le cou court et large (95%), la brachydactylie (95%), la langue protruse (85%) et le pli palmaire transverse unique (85%). Le bilan malformatif cardiaque et renal a permis d’identifier cinq cas de communication inter ventriculaire, un cas de canal atrioventriculaire et un cas de tetralogie de Fallot chez les 20 enfants dont le dossier medical etait a jour. La forme cytogenetique etait representee par la trisomie 21 libre avec la formule 47, XX, +21 ou 47, XY, +21 (90%) et la trisomie 21 par isochromosome 21 (46, XX, (21; 21)(q10 ;q10), +21). Tous les enfants atteints ont ete enroles dans un programme de suivi a long terme. Le taux de letalite etait de 5%. Le philtrum long et/ou profond et/ou large constituait une particularite des enfants de notre serie. Le suivi d’une plus large serie permettra d’elucider cette liaison non classique.

The A-project concept was originally proposed by Prof Aziz Bousfiha during the first IPIC Congress in Estoril, November 2013. This one day training programme was inspired by the European J Project but has been designed to suit African needs in training African health care professionals in the diagnosis and management of primary immunodeficiency disorders. As such, a protocol that governs and guides the execution of this training programme was developed in December 2013 to guide the A-project activities. This protocol was gradually improved to meet the training needs of the majority of continent. It is now proposed that 3 levels of A-project are held to cope with different levels of expertise as follows

Background Artemether-lumefantrine (AL) dispersible formulation was developed for the treatment of uncomplicated Plasmodium falciparum malaria in infants and children weighing 5 to 28 days and

Objective To determine the effect of helminth infection during pregnancy on the cognitive and motor functions of one-year-old children. Methods Six hundred and thirty five singletons born to pregnant women enrolled before 29 weeks of gestation in a trial comparing two intermittent preventive treatments for malaria were assessed for cognitive and motor functions using the Mullen Scales of Early Learning, in the TOVI study, at twelve months of age in the district of Allada in Benin. Stool samples of pregnant women were collected at recruitment, second antenatal care (ANC) visit (at least one month after recruitment) and just before delivery, and were tested for helminths using the Kato-Katz technique. All pregnant women were administered a total of 600 mg of mebendazole (100 mg two times daily for 3 days) to be taken after the first ANC visit. The intake was not directly observed. Results Prevalence of helminth infection was 11.5%, 7.5% and 3.0% at first ANC visit, second ANC visit and at delivery, respectively. Children of mothers who were infected with hookworms at the first ANC visit had 4.9 (95% CI: 1.3–8.6) lower mean gross motor scores compared to those whose mothers were not infected with hookworms at the first ANC visit, in the adjusted model. Helminth infection at least once during pregnancy was associated with infant cognitive and gross motor functions after adjusting for maternal education, gravidity, child sex, family possessions, and quality of the home stimulation. Conclusion Helminth infection during pregnancy is associated with poor cognitive and gross motor outcomes in infants. Measures to prevent helminth infection during pregnancy should be reinforced., Author Summary The WHO recommends anthelmintics for pregnant women after their first trimester but the benefits remain unequivocal. Although the consequences of helminth infection during pregnancy on the health of pregnant women have been well studied, the impact on the early development of offspring has been understudied. Studies suggest that helminth infection in children may be associated with poor cognitive development, but very little is known whether a similar consequence exists for offspring of women infected with helminths during pregnancy. From our study, we found that women who had intestinal worm infection at least once during pregnancy, had children with lower cognitive and motor scores. Moreover, hookworm infection in pregnant women prior to receiving anthelminthic treatment was associated with poor gross motor functions of children at one-year of age. Based on the findings of this study, measures to prevent helminth infections during pregnancy should be reinforced.

Ring 9 Chromosome Syndrome in Black African Infant Ring chromosomes are rare entities, usually associated with phenotypic abnormalities in correlation with the loss of genetic material. Ring 9 chromosome syndrome is very rare. The majority of reported cases revealed a less distinct clinical picture of shortness of stature, microcephaly and mental retardation. A minority had the clinical pattern of patients with the deletion of the short arm of chromosome 9 syndrome. We reported here a black female African with malformation and a mixture of major features in ring 9 and deletion of the short arm of chromosome 9 syndrome characteristics upon ring shape by one of chromosome 9 at cytogenetic evaluation.

Loss of endothelial protein C receptor (EPCR) occurs at the sites of Plasmodium falciparum-infected erythrocyte sequestration in patients with or who died from cerebral malaria. In children presenting with different clinical syndromes of malaria, we assessed the relationships between endogenous plasma soluble EPCR (sEPCR) levels and clinical presentation or mortality. After adjustment for age, for treatment before admission, and for a known genetic factor, sEPCR level at admission was positively associated with cerebral malaria (P = .011) and with malaria-related mortality (P = .0003). Measuring sEPCR levels at admission could provide an early biological marker of the outcome of cerebral malaria.

International audience; Objective: To investigate the factors associated with HIV 1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Design: Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. Methods: HIV-infected women were enrolled in the second trimester of pregnancy. Socioeconomic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Results: Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. Conclusions: This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.

International audience; Objective: Few tools are available to screen or assess infant's cognitive development, especially in French-speaking Africa. This study evaluated the use of the French translation of the Mullen Scales of Early Learning (MSEL), and the "Ten Questions" questionnaire (TQ) in 1-year-old children in Benin, a francophone country.Methods: A cross-sectional study was conducted in 3 health centers serving a semirural area in Benin. Three hundred fifty-seven children aged 12 months and their mothers were enrolled in 2011. Infant development was assessed at local health centers followed by a home visit to collect information on socioeconomic status, maternal Raven score, maternal depressive symptoms, and mother-child interactions (Home Observation for the Measurement of the Environment [HOME] Inventory), and to administer the TQ.Results: The infant's gender (female), the HOME, and maternal education were associated with a higher Early Learning Composite score in multivariate analyses (p = .02, p = .004, p = .007, respectively). The HOME and family wealth were also associated with the Gross Motor Scale (p = .03 and p = .03, respectively). Mothers were more likely to report difficulties on the TQ when the child presented lower score on the MSEL. When considering the Gross Motor Scale as the gold standard to define moderate delays, the 2 combined motor-related questions on the TQ showed good sensitivity and specificity (76.5 and 75.7).Conclusion: In a low-resource rural setting in Africa, the TQ effectively identified 3 quarters of 1-year-old infants with delayed development. After this screening, the MSEL may be useful for further assessment as it showed good feasibility and sensitivity to known risk factors for poor child development.

Introduction: The Pediatric Unit of the Borgou Regional Hospital (CHD-Borgou) in Parakou has initiated treating HIV-infected children with Anti-Retroviral (ARV) drugs since 2005. This study aimed to describe the profile and the future of the HIV-infected children who were provided medical care at the Pediatric Unit of the CHD-Borgou from 2005 to 2009. Patients and methods: It is a retrospective study with descriptive and analytical objective, carried out from January 2005 to December 2009 on 105 HIV-infected children from both sexes cared in that Unit. Results: HIV infection represented 0.43% of the children brought for medical examination during the study period. Among these children, 82.9% were at clinical stages 3 or 4 on inclusion into patient panel and 76.2% had severe immunodeficiciency. The proportion of children on Anti-Retroviral Therapy (ART) was 69.1%. The main opportunistic infections found were digestive (30.3%), pulmonary (28.5%), dermatological (24.1%) and ENT (10.5%) ones. The problems identified included lack of early diagnostic tools, frequent shortage of antiretroviral drugs, treatment or therapeutic failures, causes related to poor compliance and follow up. The lost of follow up rate was 39%. Death rate was 33.3%. Death was significantly associated with the advanced clinical stage of disease on admission (p=0.002), with age at the time of screening (p=0.017) and with follow up duration (p=0.000). Conclusion: Despite the difficulties noted, this study showed that, in limited resources settings like ours, it is possible to improve the clinical outcome of HIV infected children. The high mortality rate noted related to the delayed HIV diagnosis can be reduced by strengthening the Prevention of Mother to Child Transmission (PMTCT) program.

Introduction: Systematic testing is considered a good tool to decrease HIV-related morbidity and mortality. To be efficiently implemented in children, this testing needs to be accepted by parents. The objective of this study was to measure the acceptability of HIV testing by the parents of children seen on routine health visitor admitted to hospital. Methods: This was a cross-sectional prospective, descriptive and analytic study carried out at the pediatric ward of the university hospital CNHU-HKM of Cotonou, Benin, from 1st March to 31st August 2010. HIV testing was proposed, after counseling, to a group of 312 parents (mother or father) of apparently healthy children recruited at immunization clinic or on routinehealth visit, and to another group of 376 parents of sick children admitted to hospitalization. Results: Eighty-three point four percent of children seen on routinehealth visits and 34.4% of those hospitalized were less than 12 months old (age limits of 1-84 months and 1-180 months respectively). Sex ratio was 1.04 and 1.24 in respective groups. Among parents addressed, there were one father in the healthy children’s group and 98 in the hospitalized one’s group. HIV testing acceptability was 95.8% in the healthychildren’s group (n=199) and 49.2% in the hospitalized children’s group (n=191). Mothers of hospitalized children were less receptive to the testing (31.65%, n=88) than those of apparently healthy children (4.2%, n=13) [p

BackgroundPlasmodium falciparum erythrocyte membrane protein-1 (PfEMP-1) is a highly polymorphic adherence receptor expressed on the surface of infected erythrocytes. Based on sequence homology PfEMP-1 variants have been grouped into three major groups A-C, the highly conserved VAR2CSA variants, and semi-conserved types defined by tandem runs of specific domains ("domain cassettes" (DC)). The PfEMP-1 type expressed determines the adherence phenotype, and is associated with clinical outcome of infection.MethodsParasite isolates from Beninese children or women presenting with, respectively, CM or PAM were collected along with samples from patients with uncomplicated malaria (UM). We assessed the transcript level of var genes by RT-qPCR and the expression of PfEMP-1 proteins by LC-MS/MS.ResultsVar genes encoding DC8 and Group A PfEMP-1 were transcribed more often and at higher levels in cerebral malaria vs. uncomplicated malaria patients. LC-MS/MS identified peptides from group A, DC8 PfEMP-1 more frequently in cerebral malaria than in uncomplicated malaria and pregnancy-associated malaria samples.ConclusionThis is the first study to show association between PfEMP-1 subtype and disease outcome by direct analysis of parasites proteome. The results corroborate that group A and specifically the PfEMP-1 types DC8 are universally associated with cerebral malaria. This is a crucial observation for promoting studies on malaria pathogenesis.

OBJECTIVE To investigate the disease burden, clinical features, treatment and outcomes of Plasmodium falciparum malaria in neonates and infants weighing

The femoral hypoplasia-unusual facies syndrome is a very rare association of femora and facial abnormalities. The most common features include hypoplasia of the femora and a characteristic facies with a short nose, long philtrum, thin upper lip and micrognathia. Maternal diabetes mellitus has been mainly identified as the causal agent. We reported the first case in a black African and discuss prenatal diagnosis and aetiology.

To study the epidemiologic, clinic, biologic and therapeutics aspects of pleural effusion at National university healty center (CNHU) of Cotonou.From January 2004 to December 2008, we have conduct a retrospective study in the pediatric service of Cotonou’s CNHU. 15 children less than 5 years old were included in the study. A chest X ray radiography have been done for all the children at the hospitalization. Epi info and chi square test were used for the statistical study.Pleural effusion’s incidence is growing in the service and in this statement children old less than 5 years are more concerned. Fever, chest and abdominal complaints were the most clinical sign.The diagnosis of pleural effusion was established in 56.3% and Staphylococcus aureus was found. Antibiotic, pleural puncture and blood transfusion were used as therapeutics method. Mortality rate was 5.6%. In conclusion, pleural effusion management in Cotonou CHNU is suffering by the etiologic diagnosis of the disease.

BACKGROIUND: Tuberculosis (TB) is a public health problem. Knowing its patterns could help address it more efficiently.To determine the hospital incidence, presentation, management, and outcome of TB in our setting.We conducted a chart review of children with TB during a five-year period at the University Hospital CNHU-HKM, Cotonou, Benin.Hospital prevalence of TB among hospitalised children was 0.2%. The mean age was six years, with a male:female ratio of 1.4:1. The common clinical features were: cough (78.1%), long standing fever (81.2%), growth retardation (65.6%), pulmonary consolidation (53.1%) and hepatosplenomegaly (34.4%). The skin tuberculin test was positive in only 40.6% of cases. Co-infection with HIV was present in 51.8% of cases. Mycobacterium tuberculosis could be identified in only 21.8% of cases. Twenty-six (81.2%) pulmonary tuberculosis (PTB) cases were diagnosed, eight (25%) of which were associated with extra pulmonary TB. Six (18.7%) presumed isolated extra PTB were also diagnosed. Eight-month treatment regimen was used in most patients, with mortality rate of 9.3%.Although TB hospital prevalence seems low in our setting, management needs to be improved according to guidelines.

Familial Tumoral Calcinosis (FTC) is a rare autosomal recessive disorder of the phosphocalcic metabolism caused by mutations in the FGF23 or GALNT3 genes. We have identified a Beninese family in which two brothers present FTC caused by a homozygous AT transversion at the acceptor splice site in intron 1 of GALNT3 gene. We report on the clinical, biochemical, histopathological and molecular spectrum of the disorder in this family. The particularly severe phenotype, the amelogenesis imperfecta, and the carbapatite deposit observed in these patients, seem to be characteristic of our observations.

The jurisprudence administrative law in the United States has, over time come to encompass a unique organic confluence of public law, social policy, economic reality and a rational judicial philosophy, all of which have left an indelible impression on the existential fabric of the modern administrative structure of the country. The leverage of these factors, in combination with the massive growth in the overall size and reach of the federal government as it reshaped itself and developed newer and bigger agencies, programs and policies over the last few decades, has pioneered a distinct juridical movement towards a less positivist and more pragmatic understanding of judicial administration, and away from the conservative traditionalism of philological jurists and legal theorists. Reality has come into conflict with idealism. It is inevitable, given this prescription, that these influences would be most evident in developments in the judicial philosophy of administrative adjudication, primarily because of its unique public role within the executive branch. While consistency, predictability and fairness of judicial administration are fundamental components of contemporary democratic practice, the neo-pragmatic judicial influence is clearly leading to a gradual, albeit distinct movement away from time-honored, common-law practices and natural law principles in the realm of constitutional administrative adjudication, all in a bid to maximize governmental power. The questions sought to be answered in this study thus was not whether there was any connection between the need for expeditious adjudication over an increasing number of administrative proceedings and the changes in judicial philosophy, but to what extent has it reshaped the underlying legal theories of administrative adjudication, and specifically how the understanding of administrative proceedings within the wider judicial context has been thereby affected. Towards this end, this study utilized the tools and perspectives of public administration to examine, from a historical, legal and philosophical basis, the consequences of the judicial rationalism in administrative law proceedings, both by the administrative judiciary, as well as Article III tribunals, and the socio-philosophical implications of these developments in public life.