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Destombes-Rosai-Dorfman’ disease (DRD) is an inflammatory non-langerhansian histiocytosis with adenomegaly. It is a rare histiocytic disorder worldwide, less than 1000 reported cases. It is of unknown etiology and is characterized in its classical form by multiple adenomegalia, especially localized at cervical area, but also at mediastinal, axillary and inguinal areas. It is a benign condition, even if it is deforming, with spontaneously resolving evolution. We report a case of DRD disease in a 13-year-old girl, hospitalized in the Department of Pediatrics of the Yalgado Ouedraogo University Hospital Center in Ouagadougou, in March 2015. She was admitted for a voluminous bilateral painless cervical swelling, with no sign of local compression, having been operating for about a year. Biological tests showed signs of chronic inflammation; the imagery specified the benign character of these formations: adenomegalia. Confirmation of the diagnosis was made by pathological examination, describing the aspect of emperipolesis to histology and, immunohistochemistry, polytypic plasmacytosis and PS100 positive/CD1a histiocytosis negative. The treatment could not be properly carried out, in view of the early discharge, against medical advice from the patient. The evolution would have been marked, according to the parents, by a slight involution of swelling.

Thoracic aortic aneurysm is a rather rare disorder in children and difficult to diagnose. It is generally linked to congenital heart defects or connective-tissue diseases. Our case is a 10-year-old girl admitted in the pediatric emergency care unit on January 19th, 2015 for massive haemoptysis and severe anaemia. Examination revealed severe anemia and a silent left lung. The Chest X-Ray revealed an abnormal mass on the upper left side of the mediastinum, and left lower lobe consolidation. The thoracic CT scan highlighted a 64 mm aneurysm of the subisthmic aorta with a thin 5 mm hole. It also showed pseudocoarctation of the aorta. Treatment in intensive care consisted of blood transfusion and iron supplement. She was due to travel abroad for cardio vascular surgery, but died on November 2016. Thoracic Aortic Aneurysm in our setting was discovered incidentally. In spite the fact that it is an extreme surgical emergency, in Burkina Faso, treatment can only be possible abroad upon medical evacuation.

Introduction: We are reporting a deadly case of massive bee stings observed in a 7-year-old child in Ouagadougou. Observation: The first symptoms, which appeared two hours after the stings of about 200 bees, motivated a consultation in a nearby dispensary in which the child received intravenous betamethasone before being referred to the University Hospital Center Yalgado Ouedraogo (CHUYO). Seven hours after the accident, a rapid deterioration in the general condition was noted with hemorrhage, respiratory distress, coma, and shock. A grade 3 anaphylaxis was diagnosed. The patient didn’t survive despite of the cardiopulmonary resuscitation using adrenaline in intensive care. Conclusion: The massive bee stings have caused a severe biphasic anaphylactic reaction which could not be reversed by the adrenaline administered in the second phase. The development of a protocol would contribute to a better management of the cases.

Ocular manifestations among HIV infected children are diverse and global incidence varies from 7% to 75%. At this age, eye lesions are often unnoticed because of the incapacity to express eye discomfort. The purpose of this study is to describe ocular manifestations among HIV-infected children and hence associated factors in the Department of Paediatrics at the Yalgado Ouedraogo Teaching Hospital. This was a cross-sectional descriptive and analytical study conducted between July 2014 and December 2014. A complete ophthalmic examination was systematically done to all HIV-positive children attending the clinic, as part of their routine medical visit. The most recent socio-demographic, clinical, biological and treatment data were registered. Seventy-nine children had an ocular examination and among them 92.4% were on ARV treatment. The incidence of ocular manifestations was 46.7%. Median age was 8 years old (interquartile 6 - 12 years old). Sex ratio was 1.3. The risk of ocular manifestations involvement among boys was twice than that of girls. More than half (59.5%) of children who had ocular problems had not expressed ocular discomfort. Ocular adnexal lesions were more common (35.4%) compared to eye segments (8.9%) lesions. Anterior segment and posterior segment lesions were statistically associated with immune system depression (p = 0.003 and 0.001). However, this relationship was not statistically significant (p = 0.15). Five out of seven children who had eye fundus lesions had CD4 count

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), characterized by acute exacerbations and remissions. We report the clinical case of an infant, an 8 months female baby. The time between disease onset and diagnosis of the disease was 6 months. It was from an unknown etiology. The main clinical picture was weight stagnation, mucoid bloody diarrhea, and rectal bleeding. The macroscopic aspect in anorectoscopy was an erythematous mucosa with healthy beaches intervals. The mucosa was bleeding easily on contact. Pathological examination realized within the various lesions of the association was highly suggestive. The suggested treatment was made of symptomatic, corticosteroids and immunosuppressant’s therapy. Conclusion: Ulcerative colitis is rare in infants and difficult to manage in our tropical context.

Background: Functional outcome scores are often used to measure results of Total Hip Replacement (THR). Most current scoring systems were designed for use in Europe or North America and seem not optimally suited for a general West African setting. We introduce a cross-cultural adaptation of the Lequesne index as a new score.Method: A new functional hip score, adapted to the West African setting and based on the Lequesne Index was introduced. To evaluate this score, the score questionnaire was completed by a group of patients in the Paul VI Hospital in Ouagadougou, Burkina Faso, who were possible candidates for hip replacement. Patients with hip fractures were excluded. Double scores acquired with a minimal interval of four weeks were analysed and test-retest reliability was assessed using intra-class correlation coefficient.Results: Mean patient age was 43,3 years. All patients were able to answer all questions. Double scores were available in 21 patients. Intra-class correlation coefficient was 0.896 indicating very good correlation.Conclusion: The current study has shown that the cross-cultural adaptation of the Lequesne Index, used as Ouaga Score. It can be obtained easily and is reliable in a general West African patient population. We recommend the use of the Ouaga Score for functional evaluation and follow-up of THR in West Africa.Keywords: THR, Hip, Africa, Functional score, Hip replacement, Arthroscopy

World Health Organization (WHO) places strong emphasis on exclusive breastfeeding of HIV exposed infants during the first 6 months, combined to antiretroviral treatment for mothers and prophylaxis for infants. However, adherence to safe breastfeeding among HIV infected mothers is still a major challenge in Burkina Faso. We conducted a cross sectional study in four hospitals in Ouagadougou, Burkina Faso in order to explore knowledge, attitudes and practices of HIV infected breastfeeding mothers attending selected clinics for Prevention of Mother to Child Transmission of HIV (PMTCT). Two hundred and one HIV infected mothers attended the clinics for their children’s routine medical visit, among them 162 (81%) had chosen breastfeeding. The majority of women (95%) were familiar with PMTCT measures required during pregnancy and childbirth, whereas prevention measures required during breastfeeding period were less mentioned: mothers strict adherence to antiretroviral treatment (48.1%), safe sexual practices (1.85%), cessation of breastfeeding in case of breast infection (6.2%), avoiding traditional enema (36.4%) and stopping breastfeeding at the age of 12 months after 6 months of exclusive breastfeeding along with the introduction of other foods and fluids (43.2%). Moreover, 52.2% of women did not practice exclusive breastfeeding during the first six months. Factors associated with poor breastfeeding practices were: infant feeding option decided solely by the mother, living in well serviced areas and having a low score (≤ 3) of knowledge on how to prevent HIV transmission during breastfeeding. There is a need for urgent interventions in support of safe breastfeeding in HIV exposed infants in Ouagadougou.

Au cours de l'infection à VIH, la fréquence élevée de l'anémie est fonction de l'évolution de la maladie. L'objectif de notre étude était de décrire l'évolution de l'anémie chez les enfants infectés par le VIH au cours du traitement antirétroviral dans le département de pédiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo. Il s'est agi d’une étude rétrospective, descriptive et analytique chez les enfants infectés par le VIH sous TARV de juin 2005 à juillet 2013. Tous les enfants infectés par le VIH, ayant bénéficié d'un hémogramme à l'initiation (M0) à 6 mois (M6) et à 12 mois (M12) du traitement antirétroviral ont été inclus. Pour l'analyse, nous avons utilisé le test de khi-deux ou le test de Fischer. En outre, le test de normalité de Kolmogorov-Smirnov a été utilisé pour vérifier la normalité des taux moyens d’hémoglobine. Le seuil de significativité retenu était de 5 %. Cent-huit patients ont été inclus. A l'inclusion, l’anémie était présente chez 94 enfants (87 %). Elle était modérée chez 65 %, normochrome normocytaire chez 56 % et hypochrome microcytaire chez 44 %. Sur le plan évolutif, à M6 et M12, l'anémie était présente respectivement chez 75 (69,4 %) et 66 (61 %) enfants. Notons qu'à M12, elle était modérée chez 57,6 % et normochrome normocytaire chez 85 % des enfants. En outre, le gain moyen d’hémoglobine était de 1,21 g/dl à 6 mois (p < 0,001) et de 1,57 g/dl à 12 mois (p < 0,001). La prescription du fer à l'initiation du traitement ARV n'était pas statistiquement associée à l'absence de l'anémie à M6. La fréquence de l'anémie diminuait chez les enfants sous traitement antirétroviral au cours de suivi. Devant une anémie chez un enfant infecté par le VIH, la prescription du fer ne doit pas être systématique mais doit être orientée par l'analyse de l'hémogramme et les autres examens complémentaires.Mots-clés : VIH, ARV, enfants, anémie, évolution, Burkina Faso.

La malnutrition aigüe sévère (MAS) est responsable de 30 % des décès infanto-juvénile dans le monde. Sa prise en charge reste une préoccupation de santé publique dans les pays en développement comme le Burkina Faso. L’objectif de cette étude était de mesurer le taux de mortalité des enfants malnutris sévères hospitalisés au département de pédiatrie du Centre Hospitalier Universitaire Yalgado Ouédraogo et d’identifier ses déterminants. Nous avons mené une étude de cohorte rétrospective des enfants âgés de 6 à 59 mois, hospitalisés pour malnutrition aiguë sévère au CHU-YO entre le 1er janvier 2010 et le 31 décembre 2013. Nous avons utilisé un modèle de risque proportionnel de Cox pour identifier les facteurs associés à la mortalité au cours de l’hospitalisation. Au total 506 enfants ont été inclus dans notre étude à un âge médian de 16 mois [Intervalle interquartile (IIQ) = 10-24], le sex-ratio était de 1,30. Le taux de mortalité était de 12,10 % soit 0,60 décès/100 personnes jour. La présence de MAS avec oedèmes (Hazard Ratio ajusté (HRa) 2,20 [1,25-3,89]) ; une sérologie VIH positive (HRa = 9,21 [4,85-17,49]), ou inconnue(HRa = 6,80 [3,44-13,46]) et le traitement systématique incomplet (HRa : 1,98 [1,11-3,54]) étaient significativement associés à la mortalité des enfants malnutris aigus sévères. Le dépistage et le traitement précoce de l’infection à VIH et la prise en charge suivant les recommandations restent une condition pour l'amélioration du pronostic de la malnutrition aiguë sévère dans notre contexte.Mots-clés : malnutrition, mortalité, traitement, enfant, Ouagadougou.

Le lymphoedème est l'accumulation de liquide lymphatique dans les espaces interstitiels, celui de l’enfant, la maladie de Milroy, est rare, héréditaire, autosomique dominante à pénétrance partielle. Nous rapportons un cas de maladie de Milroy chez une fillette de 7 ans vue, pour érysipèle sur grosse jambe droite congénitale. Des antécédents de gros membre congénital existent dans la famille maternelle. L’examen retrouvait une grosse jambe droite oedématiée et douloureuse à la palpation, avec une lichenification de la peau en regard et un érysipèle cutané. Le bilan paraclinique objectivait un lymphoedème cutané avec atteinte vasculaire à type d’ectasie de la saphène droite. Le caryotype de type féminin, était sans anomalie, n’excluant pas des remaniements chromosomiques de petite taille. Le traitement a constitué en une kinésithérapie, des bandages, le port de bas de compression et une psychothérapie. Ce premier cas décrit au Burkina Faso témoigne de la rareté de la pathologie mais surtout des difficultés diagnostiques liées à l’insuffisance des investigations paracliniques.Mots clés: Lymphoedème primaire, maladie de Milroy, diagnostic, traitement, OuagadougouEnglish Title: Primary congenital lymphedema: Milroy disease: the first case observed in the Department of Pediatrics at the University Hospital Yalgado Ouedraogo, OuagadougouEnglish AbstractCongenital lymphedema is the accumulation of lymphatic fluid in the child’s interstitial spaces. Milroy disease is a rare, hereditary, autosomal dominant condition showing incomplete penetrance. We report the case of a 7-year old little girl with Milroy disease examined for erysipelas on congenital big right leg. A family history of large congenital member existed. Physical examination showed big oedematous right leg painful to palpation, with skin lichenification and erysipelas. Paraclinical assessment objectified cutaneous lymphedema with vascular involvement suggestive of ectasia of the right saphenous vein. Female karyotype showed no abnormalities, despite the small chromosomal rearrangements. Treatment was based on physiotherapy, bandages, compression stockings and psychotherapy. This first case in Burkina Faso testifies to the rarity of the pathology but especially to the diagnostic difficulties related to the inadequacy of paraclinical investigations.Keywords: Primary lymphedema, Milroy disease, diagnosis, treatment, Ouagadougou

Le lymphœdeme est l'accumulation de liquide lymphatique dans les espaces interstitiels, celui de l’enfant, la maladie de Milroy, est rare, hereditaire, autosomique dominante a penetrance partielle. Nous rapportons un cas de maladie de Milroy chez une fillette de 7 ans vue, pour erysipele sur grosse jambe droite congenitale. Des antecedents de gros membre congenital existent dans la famille maternelle. L’examen retrouvait une grosse jambe droite oedematiee et douloureuse a la palpation, avec une lichenification de la peau en regard et un erysipele cutane. Le bilan paraclinique objectivait un lymphœdeme cutane avec atteinte vasculaire a type d’ectasie de la saphene droite. Le caryotype de type feminin, etait sans anomalie, n’excluant pas des remaniements chromosomiques de petite taille. Le traitement a constitue en une kinesitherapie, des bandages, le port de bas de compression et une psychotherapie. Ce premier cas decrit au Burkina Faso temoigne de la rarete de la pathologie mais surtout des difficultes diagnostiques liees a l’insuffisance des investigations paracliniques.

Background: The 2016 World Health Organization guidelines recommend all children, 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Engish Title: HIV infection in children at Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso: a retrospective study on 237 cases from 2005 to 2011 at the pediatric departmentEnglish AbstractThe management of HIV -infected children is still a challenge today in Burkina Faso. The purpose of this study is to describe the outcome of HIV-infected children treated and followed in the Pediatric Service of CHU-Yalgado Ouedraogo (CHUYO) from 2005 to 2011. This is a retrospective study based on records of children infected with HIV and enrolled for treatment from 2005 to 2011 in the Department of Pediatrics of the University Hospital Y algado Ouedraogo in Ouagadougou. During this period, 237 children were enrolled. The median age was three years. Global acute malnutrition, chronic gastroenteritis and respiratory infections were common at baseline with respectively 50.6% and 38.4%; 37, 6%. Over 80% of patients were at WHO stage III or IV. The mean CD4 count at initiation of treatment was 14.9 ± 9.4% and the average rate of hemoglobin 9.4 g/dl. Eleven patients (4.6%) had changed ART. The mortality rate was 17%. One out of 10 patients was lost to follow up.Innovative strategies are needed at this center to allow earlier identification of infected children, availability of biological tests and retention of patients in the center.Keywords: pediatric HIV, HAART, Burkina Faso

Definition of the ANRS 12206 MONOD Collaboration Study Group. (DOC 31 kb)

Background The paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children’s caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso. Methods We undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows: those who did not yet know their children’s HIV infection status, those who were waiting for their children’s HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment. Results A total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as “housewife”. Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers’ consent before carrying out any HIV-test for their child, and that caregivers’ consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done. Conclusions This study highlighted the low level of caregivers’ knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0569-y) contains supplementary material, which is available to authorized users.

Total hip replacement (THR) still is a rare intervention in many African countries. In Burkina Faso it is not performed on a regular basis. A visiting programme for THR was started in a district hospital with no previous relevant experience. In this paper we present an analysis of the surgical technical problems and peri-operative complications of 152 THRs in 136 patients and three bipolar hemiarthroplasties in three patients undertaken in this new programme with limited orthopaedic equipment. There were 86 male and 53 female patients with a mean age of 49 years (21 to 78). We identified 77 intra-operative technical problems in 51 operations. There were 24 peri-operative complications in 21 patients, 17 of which were bony in nature. So far, ten revision THRs have been performed in nine patients. Regular analysis of the technical problems and complications was used to improve quality, and we identified patient selection adapted to the local circumstances as important to avoid complications. Our reflections on the problems encountered in initiating such a programme may be of help to other teams planning similar projects. Cite this article: Bone Joint J 2014;96-B:177–80.