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Background: The death of a child at the emergency ward is one of the most difficult problems that the clinicians of these wards have to deal with. In our country the published data concerning the causes and the factors related to pediatric mortality especially in the pediatric emergency wards is very rare. This study aimed to study the epidemiology of the pediatric mortality in the pediatric emergency department (PED), to determine its rate and identify its most frequent causes.Methods: It is a retrospective and descriptive study, over five years (1st January 2012 and 31st December 2016) including all children aged from 0 to 15 years old who died at the PED in the Mohamed VI Hospital in Marrakech.Results: During the period of the study a total of 172.691 patients presented to the PED, among which 628 died (pediatric mortality rate: 3.63%). The masculine gender was predominant (n = 383) with a gender ratio of 1.59. Two-thirds of the patients died in the first 24 h (n = 421). The median of time from admission to death was around 12 h. Majority of the deceased children (n = 471, 75%) were from a low socioeconomic status. The most frequent cause of admissions for deceased patients in the PED was respiratory distress (n = 296, 47%) followed by neurological disorders (n = 70, 11%). Neonatal mortality (≤ 1 month of age) was predominant (n = 472, 75.1%), followed by postnatal mortality (1 month to 1 year old) (n = 73, 11.6%). The most frequent causes of pediatric mortality, whatever the age range, were dominated by neonatal pathologies (n = 391, 62.3%), followed by infecious causes bronchopulmonary infections included (n = 49, 7.7%), birth deformities (n = 46, 7.3%) while traumas were merely at 0.9% (n = 6). The most frequent causes of neonatal mortality were neonatal infections (n = 152, 32.2%) and prematurity (n = 115, 24.4%).Conclusion: Our data once again underline the crucial importance of prevention. This requires correct follow-up of the pregnancies, an adequate assistance of births, and perfecting healthcare provision to newborns in order to attain proper assistance. [ABSTRACT FROM AUTHOR]

Vaginal bleeding in girls is an alarming symptom for both parents and pediatricians. Serious underlying causes should be always evoked. Case Report. We describe here a 9-year-old girl who was admitted at our emergency department for vaginal bleeding and severe anemia. No history of trauma and no evidence of prior abuse were reported by the parents. Full Blood Count showed profound anemia (hemoglobin at 4 g/dl). The child was managed as a hypovolemic shock and resuscitated with intravenous fluids and urgent blood transfusion. Gynecologic examination found a live leech at the vulva and the extraction was facilitated by applying a saline solution. The child was clinically stable and discharged home the next day with ambulatory treatment. Conclusion. This case emphasizes that a through external genital exam with possible exam under anesthesia should be undertaken in all girls with unexplained vaginal bleeding and that in those living in rural areas without potable water, leech infection should be considered. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les méningites du nourrisson et de l’enfant demeurent une affection préoccupante en pédiatrie tant par sa fréquence que par sa gravité. Objectif Rapporter notre expérience dans les méningites du nourrisson et de l’enfant. Matériels et méthodes Il s’agissait d’une étude rétrospective portant sur 150 patients atteints de méningite colligés dans le service de pédiatrie A du CHU Mohamed VI de Marrakech du 1 er janvier 2009 au 31 décembre 2012. Résultats L’âge moyen a été de 60 mois et la prédominance a été masculine avec un sex-ratio de 2/2. Une otite a été la principale porte d’entrée dans 10 % et une antibiothérapie préalable a été administrée dans 26 % des cas. Les principaux signes cliniques ont été dominés par une fièvre (95 %), des vomissements (82 %) et des céphalées (68 %). Une ponction lombaire a été effectuée chez tous nos patients. Elle a montré une méningite virale (52 %), une méningite purulente (47 %) et une méningite tuberculeuse dans 2 cas. Les germes isolés ont été le pneumocoque (51 %) puis le méningocoque (40 %) et l’Haemophilus dans un cas. Le traitement instauré a été la céftriaxone (70 %) et l’association ceftriaxone et vancomycine dans 6 cas. L’évolution a été marquée par la survenue de séquelles dans 13 % et une létalité dans 1 % des cas. Conclusion Les méningites du nourrisson et de l’enfant posent encore un problème dans notre contexte car les méningites purulentes à pneumocoque les plus redoutables ont été retrouvées dans presque la moitié des cas dans notre étude. Summary Introduction Meningitis in infants and children remains a worrying condition in pediatrics as its frequency by severity. Objective To report our experience in meningitis in infants and children. Materials and methods This was a retrospective study of 150 patients with meningitis collected in the pediatric ward A CHU Mohamed VI of Marrakech from 1 January 2009 to 31 December 2012. Results The average age was 60 months and the dominance was male with a sex ratio of 2/2. Otitis was the main gateway to 10% and prior antibiotic therapy was administered in 26% of cases. The main clinical signs were dominated by fever (95%), vomiting (82%) and headache (68%). A lumbar puncture was performed in all patients. It showed viral meningitis (52%), purulent meningitis (47%) and tuberculous meningitis in 2 cases. The bacteria isolated were pneumococcus (51%) and meningococcal (40%) and Haemophilus in one case. The established treatment was ceftriaxone (70%) and ceftriaxone and vancomycin combination in 6 cases. The evolution was marked by the occurrence of sequelae in 13% and lethality in 1% of cases. Conclusion Meningitis in infants and children still pose a problem in our context as purulent meningitis in most formidable pneumococcus were found in almost half of cases in our study. [ABSTRACT FROM AUTHOR]

Summary: Acute media otitis (AMO) is a common infection in children. Actually, it raises three major problems: difficulties of diagnosis, exaggerated prescription of antibiotics, and the increasing prevalence of bacterial resistance. Objective: Our aim is the study of the general doctors’ habits in diagnosing and their therapeutic preferences in their prescriptions for sick children in the Wilaya of Agadir concerning this disease (the AOM). Methodology: We conducted a descriptive and transversal study on a group of 155 general doctors practicing in both health sectors: the private and the public during the year 2008. Data were collected through a questionnaire. Results: The participation rate was 91.1%. The main risk factors considered by doctors were: the hypertrophy of the adenoids (76.1%), and the viral infections of upper airways (70.9%). The clinical signs required for diagnosis were mainly fever (91.6%) and the appearance of otoscopy (71.6%). Only 42.5% of these doctors considered the association of inflammation of the tympanic membrane and effusion of the middle ear as a diagnostic criterion. The systematic antibiotic was prescribed by 35.5% of physicians. 70.3% of these practitioners opted first for amoxicillin-clavulanic acid and 14.2% for amoxicillin. In their second choice, 25.2% prescribed cephalosporins antibiotic of the third generation. If the first treatment fails, 42% of the practitioners opt for sending the child to the ORL specialist. Conclusion: It appears from this study that the recommendations on AMO are weakly used by the general doctors, especially in the diagnostics and in the therapeutic. It seems necessary to maintain continuous efforts on proper education and prevention. The aim in the coming years is to curb the increase in bacterial resistance. [ABSTRACT FROM AUTHOR]

Summary: The hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome takes part of the partial epilepsies. It is an unfavourable evolution of the complex seizures crises. This syndrome has become rare in medical practice because of the preventive treatment of the febrile seizures. Objectives: To put forward the profile epidemiological, clinical, paraclinical, therapeutic and evolutionary of this syndrome. Patients and methods: A retrospective study of 22 cases followed for HHE syndrome conducted in the pediatry “A” service in the Mohammed VI CHU in Marrakech over one period from August2003 till September2008. The patients included in this study answered the criteria of definition of the syndrome. Results: The HHE syndrome represented 4% of epileptic patients. The age of beginning of the seizures was less than 4years in 95% of the cases. The hemiplegia was objectified for all our patients. All our patients presented epilepsy. The backwardness was objectified for four patients (18.20%). The cerebral imagery for 14 patients revealed: a cerebral atrophy (27%) and a porencephalic cavity (9%). The antiepileptic treatment rested primarily on the carbamazepine (73.6%). The majority of the patients (90%) continued to have residual crises. Two patients had a total disappearance of their hemiparesy; the remaining children always showed a light deficit. Conclusion: Under HHE syndrome, epilepsy remains a good forecast inspite of the cases of pharmacoresistance which remain rare. Finally, the key treatment of HHE syndrome basically remains prophylactic. [ABSTRACT FROM AUTHOR]

Summary: Introduction: The viral hepatitis A infection represents a real public health problem in Morocco, always stated with other countries of Africa as an endemic country. Objectives: To assess prevalence of the viral hepatitis A infection in febrile icteric children and to examine the main risk factors of transmission. Patients and methods: A cross-sectional study was conducted in a sample of 129 acute infantile febrile icteric cases between October 2006 and September 2008 in the paediatric department of the University Hospital of Marrakech. Baseline data included demographic and socio-economic information, conditions of living, dietary habits and conditions of hygiene. The serology of the viral hepatitis A (anti-VHA IgM) used the standard test ELISA immunocapture. Results: From the 129 cases of acute icteric hepatitis, 118 (91.5%) were positive for IgM anti-VHA. Among positive children, age ranged from one to 15 years, with an average of 6.1±3.1 years, and a middle age of 5.5 years. The prevalence was highest (51.7%) among children aged less than six years and declined progressively thereafter. The sex-ratio M/F was of 1.4. Most cases was diagnosed between July and October, had a low socioeconomic level (60.2%), were living in the urban area (72%) and had a crowding households (51.7%). Conclusion: This study points out the high prevalence of hepatitis A in Marrakech; it suggests that this infection is still endemic in this region. More studies are required to establish the epidemiological profile of hepatitis A in this context in order to appreciate the most appropriate preventive approach. [Copyright &y& Elsevier]

Summary: Enuresis is a frequent manifestation with important psychological and social consequences. In order to help the public authorities to plan monitoring actions and better-targeted health interventions, the authors carried out this study; the aim was to describe and analyze enuretic children and teenagers profile from 5 to 16 years old, and their parents attitude toward the disorder. This transverse study was conducted among 952 children and teenagers of this age group. Those children and teenagers were chosen from an accidental random sample of 500 households. Enuresis was present in 165 (17.33%). Among them 95.76% had primary enuresis, It was mostly nocturnal (72.12%) and isolated (87.27%). Family history of enuresis was present in parents (49%) and phratry (47%). Enuretic children were not treated in 81.8%; and punished by their parents in 22.4% of the cases. Sociodemocraphic characteristics of our sample were similar to those in the literature, however, the parents in our study rarely used treatment and had inappropriate attitudes toward the disorder. The authors recommend that the most important factors to be taken in the secondary prevention of enuresis are the parent''s ignorance and for their scepticism toward the therapeutic possibilities. [Copyright &y& Elsevier]

Summary: We report a case of acrocallosal syndrome in a 7-month-old female patient born to consanguineous parents, who presented with agenesis of the corpus callosum, polydactyly, and minor craniofacial dysmorphism. This case is similar to two other occurrences described in the literature, with no psychomotor development delay and hypotonia. [Copyright &y& Elsevier]

Le syndrome de Guillain-Barré est une polyneuropathie aigue, d’évolution habituellement bénigne, mais, peut engager le pronostic vital à sa phase aigue ou bien laisser des séquelles à long terme. Objectif évaluer la prise en charge et l’évolution des enfants hospitalisés au service de pédiatrie A de l’hôpital mère-enfant de Marrakech. Patients et méthodes de juillet 2008 à décembre 2013, 35 enfants ont été hospitalisés et étudiés rétrospectivement. Résultats la moyenne d’âge des malades était de 8,5 ans. 48% des malades avaient une tétraplégie, Les troubles sensitifs étaient constatés dans 32% des cas. La ponction lombaire pratiquée chez 09 malades, a montré la dissociation albumino-cytologique chez 03 enfants. L’électromyogramme réalisé chez 40% des malades était typique d’un syndrome de Guillain-barré. Six enfants ont nécessité une prise en charge en réanimation. Les immunoglobulines ont été employées chez 41% des malades, les boulus de corticoïdes chez deux malades et les échanges plasmatiques chez un malade. La récupération était complète chez 53,7% des malades. Conclusion le syndrome de Guillain-barré est une urgence pédiatrique. La plasmaphérèse et les immunoglobulines constituent les traitements de choix mais de coût non négligeable. [ABSTRACT FROM AUTHOR]

Summary: Objective: To determine the prevalence of anti-hepatitis A virus (HAV) antibodies among Moroccan children and to examine some of the factors influencing its transmission. Methods: 150 children, aged six months to 14 years, were tested for anti-HAV IgG (indicating past infection). A questionnaire concerning personal and epidemiological data relating to hepatitis A was completed. Results: The overall prevalence of anti-HAV antibodies was 51 %. There was no significant difference between male and female children. The proportions of children positive for HAV-IgG varied significantly with age : 70.3 % in the 7-14 age range were positive compared with 45.2 % aged 6 years and less. Urban inhabitants did not have a higher prevalence than rural residents did. Socioeconomic factors were significantly correlated with the prevalence of anti-HAV-IgG, the father''s level of education having the strongest influence. Conclusion: The high overall HAV prevalence in children confirms that Morocco is an intermediately endemic area for HAV infection. Morocco is entering a transitional phase and the introduction of hepatitis A vaccination in early childhood may reduce the prevalence of this infection and prevent outbreaks. [Copyright &y& Elsevier]

Résumé Introduction Aux urgences pédiatriques, La pathologie infectieuse représente un motif d’admission fréquent, et par conséquent les antibiotiques sont fréquemment prescrits, ceci le plus souvent pour des infections respiratoires aiguës. Ces prescriptions ne sont pas sans conséquences cliniques et épidémiologiques, car même bien tolérés, les antibiotiques peuvent sur le plan individuel provoquer des effets secondaires indésirables et sur le plan collectif, Ils participent à la pression de sélection induisant l’augmentation de la résistance des bactéries aux antibiotiques les plus utilisées. Conscients de la problématique alarmante de l’antibiorésistance, ce travail a pour objectif d’évaluer la prescription d’antibiotiques aux urgences pédiatriques du CHU Mohamed VI de Marrakech. Matériel et méthodes Il s’agit d’une étude prospective réalisée au service des urgences pédiatriques du CHU Mohamed VI de Marrakech sur une durée de 6 mois (juillet 2016–décembre 2016), incluant toutes les consultations pédiatriques qui ont amené à une prescription d’antibiotique. L’antibiothérapie a été considérée comme justifiée si le diagnostic établi avait une cause bactérienne ou le risque de surinfection était important en l’absence d’antibiothérapie. Une antibiothérapie était considérée abusive devant l’absence d’une infection ou quand elle est présumée non bactérienne ou devant l’absence de risque d’infection. La collecte des données a été faite à l’aide de fiches d’exploitation préétablies comportant des renseignements épidémiologiques, cliniques et microbiologiques. Résultats Durant la période de l’étude, 112 fiches ont été remplies. L’âge moyen était de 2 ans (1 j–15 ans), le sex-ratio F/M était de 1,07, un bon niveau socio-économique était retrouvé dans 65 % des cas. Le prescripteur était un résidant dans 76 % des cas. Parmi les consultants, 87,5 % n’avaient pas d’antécédents pathologiques particuliers. Le motif de consultation a été dominé par la fièvre (86 %) suivie par la gêne respiratoire (39 %). L’infection néonatale a représenté le motif le plus fréquent de prescription d’une antibiothérapie dans 34 cas (C3G + gentamicine) suivi par les infections respiratoires dans 20 cas (amoxicilline [ n = 12], amoxicilline acide clavulanique [ n = 6] macrolide [ n = 2]), les méningites dans 19 cas (C3G dose méningée) et l’infection urinaire dans 14 cas (C3G + gentamycine [ n = 10], C3G seul [ n = 3], ciprofloxacine [ n = 1]). Les C3G ont été prescrites dans 69 % des cas. La base de la prescription de l’antibiothérapie était dans 92 cas en suivant les recommandations et les protocoles du service, dans 16 cas en suivant l’avis d’un senior et dans 4 cas en suivant les résultats de l’antibiogramme. La ponction lombaire a été faite dans 23 cas, l’ECBU dans 41 cas, la numération formule sanguine et la CRP dans 104 cas, l’étude cytobactériologique d’un liquide de ponction dans 6 cas, et dans 8 cas aucun bilan n’a été demandé. Discussion/Conclusion Le choix de la molécule d’antibiotique a reposé le plus souvent sur une logique probabiliste car les éventuels résultats bactériologiques n’étaient pas encore disponibles au moment de la prescription. Cette étude a montré que la prescription des antibiotiques aux urgences pédiatriques était généralement bien cadrée vue que l’établissement de l’étude est d’ordre universitaire où les bonnes démarches sont exigées, d’autre part, les prescripteurs se sont référés à des protocoles bien codifiés reposant pour la plupart sur des conférences de consensus ou en cas de difficulté après l’avis d’un senior. En effet, la population pédiatrique comme conséquence de la prématurité du système immunitaire constitue un lit adéquat pour l’implantation des infections bactériennes souvent d’évolution sévère en l’absence d’une antibiothérapie précoce et bien adaptée. La prescription d’une antibiothérapie aux urgences pédiatrique doit résulter d’un raisonnement médical qui doit être très rigoureux du fait des implications pronostiques potentielles ou immédiates et devant conduire à une forte suspicion clinique d’infection bactérienne. Summary Introduction In pediatric emergencies, infectious pathology is a frequent reason for admission. Consequently, antibiotics are frequently prescribed, most often for acute respiratory infections. However, these prescriptions are not without clinical and epidemiological consequences, because even well tolerated, antibiotics on an individual level can cause unwanted side effects, and on the collective level that may exert a selective pressure leading to an increase in the prevalence of resistance. The aim of this study was to evaluate antibiotic prescription practices in the pediatric emergency department at the university hospital of Marrakech. Material and methods This was a prospective study carried out in the pediatric emergency department at the university hospital of Marrakech for a period of 6 months (July 2016–December 2016), including all pediatric consultations leading to an antibiotic prescription. Antibiotic therapy was considered to be justified if the established diagnosis had a bacterial cause or if the risk of bacterial superinfection was high. Antibiotic therapy was considered inappropriate in the absence of bacterial infection or when it is presumed to be not bacterial or if there is no risk of bacterial superinfection. Epidemiologic, microbiologic and clinical data were collected using pre-structured questionnaire. Results A total of 112 questionnaires were completed during the study period. The mean age was 2 years (1 day–15 years), the sex ratio F/M was 1.07, a good socioeconomic status was found in 65% of cases. The prescriber was a resident physician in 76% of cases. Among the consultants, 87.5% have no medical history. The reason of consultation was dominated by fever (86%) followed by respiratory problems (39%). The neonatal infection was the most common reason for prescribing antibiotic therapy in 34 cases (third-generation-cephalosporin + gentamicin) followed by respiratory tract infection in 20 cases [amoxicillin ( n = 12), amoxicillin/clavulanic acid ( n = 6), macrolide ( n = 2)], meningitis in 19 cases (third-generation-cephalosporin) and urinary tract infection in 14 cases [third-generation-cephalosporin + gentamycin ( n = 10), third-generation-cephalosporin alone ( n = 3), ciprofloxacin ( n = 1)]. The third-generation-cephalosporin was prescribed in 69% of cases. The antibiotic prescription was based on the recommendations and protocols of the service in 92 cases, acting on the advice of an expert in 16 cases, and on the antibiogram results in 4 cases. The lumbar puncture was performed in 23 cases, Bacteriological examination of urine BEU in 41 cases, blood count and CRP in 104 cases, cytobacteriological study of a puncture fluid in 6 cases, and in 8 cases no biological check-up was requested. Discussion/Conclusion The choice of the antibiotic molecule was based mostly on a probabilistic logic because the bacteriological results were not yet available at the time of the prescription. This study showed that the antibiotic prescription practice in the pediatric emergency department was generally well structured, probably because the establishment studied was a university hospital where good procedures are required and controlled. On the other hand, prescribers referred mostly on well-defined protocols based on consensus conferences or after consulting an expert in event difficulty. In fact, the pediatric population as a consequence of the prematurity of the immune system is a target of bacterial infections with a severe evolution in the absence of an early and well adapted antibiotherapy. The prescription of antibiotic therapy in pediatric emergencies must result from a medical reasoning, which must be very rigorous and must lead to a strong clinical suspicion of bacterial infection. [ABSTRACT FROM AUTHOR]

Summary: Moyamoya is an angiogenic disorder and a rare cause of stroke. It is a progressive narrowing of cerebral arteries at the base of the brain involving the intracerebral portion of the internal carotid arteries, where it leads to development of collateral arteries, causing a “cigarette smoke” aspect. Ischemic events are more frequent in pediatric pathology, where hemorrhagic manifestations account for only 10%. The prognosis is severe, even worse than when onset of symptoms is earlier. We present the case of an 8-year-old child, who had presented recurrent hemiparesis since the age of 3years; the brain CT scan and magnetic resonance imaging objectified injury sequelae. The MRA revealed stenosis of the internal carotid artery consistent with Moyamoya. In conclusion, the diagnosis of Moyamoya disease is now accessible to modern brain imaging techniques (MRI and MRA), easily achievable in children. The natural course of the disease involves the neurological and vital prognosis in young children, due to repeated ischemic attacks. Their identification would facilitate early diagnosis in order to treat neurosurgically, leading to a better neurological and cognitive prognosis. [Copyright &y& Elsevier]