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Rhipicephalus microplus is an ixodid tick with a pantropical distribution that represents a serious threat to livestock. West Africa was free of this tick until 2007, when its introduction into Benin was reported. Shortly thereafter, further invasion of this tick species into other West African countries was identified. In this paper, we describe the first detection of R. microplus in Guinea and list the vector-borne haemoparasites that were detected in the invading and indigenous Boophilus species. In 2018, we conducted a small-scale survey of ticks infesting cattle in three administrative regions of Guinea: N`Zerekore, Faranah, and Kankan. The tick species were identified by examining their morphological characteristics and by sequencing their COI gene and ITS-2 gene fragments. R. microplus was found in each studied region. In the ticks, we found the DNA of Babesia bigemina, Anaplasma marginale, Anaplasma platys, and Ehrlichia sp. The results of this study indicate that R. microplus was introduced into Guinea in association with cows from Mali and/or the Ivory Coast.

The peri-urban area of Bamako contains many chicken breeding production farms. The conditions of these farms can constitute risk factors. The insufficiency of scientific data relating to the environment of those farms and to the various inputs makes it difficult to determine their real impact on the sanitary quality of food. Our study aimed to assess the microbiological quality of the food and water used in 15 farms in the peri-urban area of Bamako. The results showed that all of the analyzed water samples had more or less aflatoxin content with a maximum value of 12.2 ppb observed on the Bamako-Tienfala axis. The presence of mould was also detected in 46.6% of the water samples analyzed with a higher frequency in well water, i.e. 26.66%. Salmonella contamination of water has been observed in samples taken on all axes, with a strong dominance on the Bamako-Kati axis. For poultry foods the samples taken from farms on the Bamako-Kassela and Bamako-Siby axes were positive. Poultry food and water used in chicken breeding production are risk factors identified in the production system.

International audience; Objective: To investigate presence of and factors associated with self- and parent-reported fatigue 7 years after severe childhood traumatic brain injury (TBI) in the prospective longitudinal study TGE (Traumatisme Grave de l'Enfant-severe childhood trauma).Methods: Self-reports and/or parent reports on the Multidimensional Fatigue Scale were collected for 38 participants (aged 7-22 years) 7 years after severe childhood TBI, and 33 controls matched for age, gender, and parental educational level. The data collected included sociodemographic characteristics, age at injury and injury severity scores, overall disability (Glasgow Outcome Scale Extended), intellectual outcome (Wechsler scales), and questionnaires assessing executive functions, health-related quality of life, behavior, and participation.Results: Fatigue levels were significantly worse in the TBI than in the control group, especially for cognitive fatigue. Correlations of reported fatigue with age at injury, gender, TBI severity, and intellectual ability were moderate and often not significant. Fatigue was significantly associated with overall level of disability (Glasgow Outcome Scale Extended) and with all questionnaires completed by the same informant.Conclusion: High levels of fatigue were reported by 30% to 50% of patients 7 years after a severe childhood TBI. Reported fatigue explained more than 60% of the variance of reported health-related quality of life by the same informant (patient or parent).

International audience; Objective: To explore memory functioning 7 years after severe paediatric traumatic brain injury (TBI), associated factors, and relationships with other outcomes.Method: Children aged 0-15 years (n = 65), consecutively admitted over a 3-year period in a single trauma centre, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7 years post-injury using the Children's Memory Scale or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome.Results: Thirty-seven patients were available for assessment at 7 years post-injury. Mean GMS-7 was in the low average range (M = 84.9, SD = 12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome.Conclusions: Memory functioning is variable but often strongly impaired several years after severe paediatric TBI, and is mostly related to injury severity, functional outcomes measured 1 year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7 years than one year post-injury, supporting the importance of long term follow-up.

Rhipicephalus microplusis an ixodid tick with a pantropical distribution that represents a serious threat to livestock. West Africa was free of this tick until 2007, when its introduction into Benin was reported. Shortly thereafter, the further invasion of this tick into West African countries was demonstrated. In this paper, we describe the first detection ofR. microplusin Guinea and list the vector-borne haemoparasites that were detected in the invader and indigenousBoophilusspecies.In 2018, we conducted a small-scale survey of ticks infesting cattle in three administrative regions of Guinea: N`Zerekore, Faranah, and Kankan. The tick species were identified by examining their morphological characteristics and by sequencing their COI gene and ITS-2 gene fragments.R. micropluswas found in each studied region. In the ticks, we found DNA ofBabesia bigemina,Anaplasma marginale, Anaplasma platys, andEhrlichia spp. The results of this study indicate thatR. micropluswas introduced into Guinea with cows from Mali and/or Ivory Coast.

Rhipicephalus microplus is an ixodid tick with a pantropical distribution that represents a serious threat to livestock. West Africa was free of this tick until 2007, when its introduction into Benin was reported. Shortly thereafter, further invasion of this tick species into other West African countries was identified. In this paper, we describe the first detection of R. microplus in Guinea and list the vector-borne haemoparasites that were detected in the invading and indigenous Boophilus species. In 2018, we conducted a small-scale survey of ticks infesting cattle in three administrative regions of Guinea: N`Zerekore, Faranah, and Kankan. The tick species were identified by examining their morphological characteristics and by sequencing their COI gene and ITS-2 gene fragments. R. microplus was found in each studied region. In the ticks, we found the DNA of Babesia bigemina, Anaplasma marginale, Anaplasma platys, and Ehrlichia sp. The results of this study indicate that R. microplus was introduced into Guinea in association with cows from Mali and/or the Ivory Coast.

International audience; Objectives: Severe childhood traumatic brain injury (TBI) leads to long-standing executive function and attention deficits, with negative consequences for participation, academic outcome and independence. This study aimed to assess executive function and attention 7 years after severe childhood TBI in comparison with a matched control group and to investigate associated factors. Methods: Children (< 15 years) with severe accidental TBI consecutively admitted in a single trauma center over 3 years were included in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal study. Of the 81 children initially included, 65 survived. At 7 years post-TBI, executive functions and attention were assessed in 27 participants (42 % of the 65 survivors) by using a combination of computerized tasks from the Test of Attentional Performance (TAP) and the Behavioral Rating of Executive Functions (BRIEF) questionnaire. Patients were compared to a group of 27 typically developing controls who were matched for sex, age and parental education level. Results: Among the 27 participants, mean (SD) age at injury was 7.7 (4.6) years, and mean length of coma 5.6 (4.6) days. Regarding the TAP, the number of errors was significantly higher (P = 0.003) and reaction time marginally slower (P = 0.08) in the TBI than control group. The BRIEF questionnaire completed by parents indicated significantly more executive difficulties in the TBI than control group (Behavior Regulation Index, P = 0.005; Metacognitive index, P = 0.02; Global Executive Composite, P = 0.012). Correlations between BRIEF and TAP scores did not reach statistical significance. BRIEF total score was correlated moderately with length of coma (r = 0.40, P = 0.037), and TAP scores were correlated with the Full-Scale Intellectual Quotient (total number of errors: r = -0.48; P = 0.01; mean reaction time: r = −0.51; P = 0.009). Conclusions: Executive and attention deficits were evident 7 years after severe childhood TBI. Computerized tasks and questionnaires provide complementary and non-redundant information. Systematic long-term follow-up should be provided until the transition to adulthood, to assess ongoing development and to implement timely tailored interventions.

International audience; Purpose: To investigate self- and parent-reported Health-Related Quality-of-Life (HRQoL) and their associations after severe childhood traumatic brain injury (TBI) in the Traumatisme Grave de l'Enfant (TGE) cohort.Methods: Self- (n = 34) and/or parent-reports (n = 25) of HRQoL were collected for 38 participants (age 7-22 years) 7 years after severe childhood TBI. The collected data included sociodemographic characteristics, injury severity indices, and overall disability and functional outcome at 3-months, 1- and 2-years post-injury. At 7-years post-injury, data were collected in the TBI group and in a control group (n = 33): overall disability (Glasgow Outcome Scale Extended), intellectual ability (IQ), and questionnaires assessing HRQoL (Pediatric Quality of Life Inventory), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist), fatigue (Multidimensional Fatigue Scale) and participation (Child and Adolescent Scale of Participation).Results: Parent- and self-reports of HRQoL were significantly lower in the TBI group than in the control group. Parent-rated HRQoL was not associated with objectively assessed factors, whereas self-reported HRQoL was associated with gender (worse in females) and initial functional outcome. All questionnaire scores completed by the same informant (self or parent) were strongly inter-correlated.Conclusions: Reported HRQoL 7-years after severe childhood TBI is low compared to controls, weakly or not-related to objective factors, such as injury severity indices, clinically assessed functional outcomes, or IQ, but strongly related to reports by the same informant of executive deficits, behavior problems, fatigue, and participation.

International audience; Purpose: Participation in home, school and community activities is considered as the ultimate aim of rehabilitation. The aims of this study were to examine participation seven years post-severe childhood traumatic brain injury and factors associated with participation. Materials and methods: Participants were enrolled in the Traumatisme Grave de l’Enfant (Severe Childhood Injury) cohort study following severe accidental childhood traumatic brain injury. Participation seven years post-injury, was examined using parent- and self-report forms of the Child and Adolescent Scale of Participation among 37 patients [62% males, mean age 15.4 years (SD = 4.4), mean length of coma 6.68 days (SD = 4.96)] and 33 matched controls. Results: Parent reports indicated significantly lower participation among patients compared to controls, but the self-reports did not. In the traumatic brain injury group, parent-reported participation was variable, with 22% of the patients clearly showing greater restrictions than controls. Participation restrictions were significantly associated with injury severity, poor functional outcome one-year post-injury, executive and behavioral difficulties and higher fatigue levels seven years post-injury, but not with pre-injury nor family factors. Conclusions: Several years after severe childhood traumatic brain injury, participation appears to depend more on injury-related factors than on environmental factors. In self-reports assessments of participation, it could be difficult for children and adolescents to distinguish capacity from performance.

International audience; The aims of this study were (1) to prospectively measure memory functioning following severe childhood Traumatic Brain Injury (TBI), and its evolution over 2 years; (2) to assess demographic and medical factors associated with memory function and recovery; (3) to explore relations between memory and other TBI outcomes. Methods: Children (aged 0-15 years; n= 65) consecutively admitted in a single trauma center over a 3-year period, who survived severe non-inflicted TBI, were included in a prospective longitudinal study. Memory was assessed in 38 children aged 5-15 years at injury, using the Children's Memory Scale at 3, 12, and 24 months post-injury. Results: Mean general memory score was low at 3 months (M = 90.2, SD = 20.3) but within the normal range at 12 and 24 months (M = 100.6, SD = 23.1 and M = 108.6, SD = 24.1, respectively), with high variability. Improvement was stronger for immediate visual memory than for other memory indices. Lower general memory score was associated with higher injury severity, lower intellectual ability and functional status, higher overall disability, and ongoing education. Conclusion: Memory functioning is highly variable following severe childhood TBI, related to injury severity and functional, cognitive and educational outcomes; improvement is significant during the first-year post-injury, but varies according to the type of memory.

Background Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but little is known about functional outcome. Objective We aimed to 1) study clinical recovery and functional outcome over 24 months after severe childhood TBI, 2) identify early sociodemographic and severity factors influencing outcome, and 3) examine the clinical utility of the Pediatric Injury Functional Outcome Scale (PIFOS) to assess functional outcome. Methods Children (0-15 years) consecutively admitted in a trauma centre after accidental severe TBI over 3 years were included in a prospective longitudinal study (Traumatisme Grave de l’Enfant cohort). We measured clinical/neurological recovery, functional status (Pediatric Injury Functional Outcome Scale, [PIFOS]), overall disability (pediatric Glasgow Outcome Scale [GOS-Peds]) as well as intellectual ability (Wechsler scales) and educational outcome (mainstream school vs special education) of survivors at 1, 3, 12 and 24 months post-injury. Results For 45 children (aged 3 to 15 years at injury), functional impairments were severe within the first 3 months. Despite the initial rapid clinical recovery and significant improvement over the first year, substantial alterations persisted for most children at 12 months post-TBI, with no significant improvement up to 2 years. Up to 80% of children still had moderate or severe overall disability (GOS-Peds) at 24 months. The severity of functional impairments (PIFOS) at 12 and 24 months was mostly related to socio-emotional, cognitive and physical impairments, and was significantly correlated with clinical/neurological deficits and cognitive (intellectual, executive) and behavioural disorders. Initial TBI severity was the main prognostic factor associated with functional status over the first 2 years post-injury. Conclusions Our results confirm the significant impact of severe childhood TBI on short- and medium-term functional outcomes and overall disability. All patients should benefit from systematic follow-up. The PIFOS appeared to be an accurate and reliable tool to assess functional impairment evolution and clinically meaningful outcomes over the first 2 years post-injury.

Lassa virus is the causative agent of a dangerous zoonotic disease distributed in West Africa. A primary reservoir host of Lassa virus is Mastomys natalensis. These mice associate closely with humans and are commonly found in villages. Consequently, previous studies of Lassa virus have focused on rural areas. The prevalence of the virus in large cities has not been studied.We conducted a study in N’Zerekore city, which has a population of approximately 300,000 residents. Small mammals were captured during a pilot study in May, and the main study was performed in August 2018. Based on the pilot study, we designed and implemented a stratified random sample to investigate the prevalence of Lassa virus among M. natalensis in N’Zerekore. The total sampling efforts consisted of 45 and 985 trapping nights in May and August, respectively. Samples of rodent tissues were screened for Lassa virus by RT-PCR.In May, we trapped 20 rodents, including 19 M. natalensis. Viral RNA was detected in 18 M. natalensis. In August, 149 small mammals were captured, including 43 M. natalensis. The prevalence of Lassa virus among M. natalensis in N’Zerekore was 23.3% (CI 95%: 11.8–38.6%). Sequencing showed that the isolates belonged to lineage IV. We detected four Lassa virus hotspots located in different parts of the city. The largest Lassa virus hotspot was found in the neighborhood of the central market, which suggests that the virus was originally introduced into the city through the market.

Ngari virus is a mosquito-borne virus belonging to the genus Orthobunyavirus (Peribunyaviridae family). This virus is pathogenic to humans and causes severe illness. Ngari virus is present in several African countries, including Madagascar. Here, we report the detection of Ngari virus in ixodid ticks collected from cows in Guinea. A tick survey was conducted in March-November of 2018 in six regions of Guinea. The sample comprised 710 pools, with a total of 2067 ticks belonging to five species collected from 197 cows. At the initial stage, we screened a subsample of tick pools of vector-borne viruses with a multiplex genus-specific primer panel. In the second stage of the study, we narrowed the search and screened all the samples by qPCR for the detection of Ngari virus. All positive samples were sequenced with primers flanking Ngari virus-specific fragments on the S and M segments. We found Ngari virus in 12 pools that were formed from engorged ticks collected from livestock in three villages of the Kindia and Kankan regions. Sequencing of the S and M segments confirmed that the detected viruses belong to Ngari virus, and the viruses were most similar to the strain Adrar, which was isolated in Mauritania. We detected viral RNA in ticks of the following species: Amblyomma variegatum, Rhipicephalus geigyi, and Rh. (Boophilus) spp. There is no evidence that ixodid ticks are competent vectors of the Ngari virus. Most likely, the ticks obtained the virus through blood from an infected host. The study of engorged ticks can be recommended as a simpler approach for the wide screening of the Ngari virus and subsequent testing of cattle and mosquitos in those locations where the PCR-positive ticks were collected.

Suite à l"étude réalisée sur les ovins en 2007 dont les résultats du test ont montré que les cubes Jumbo n"ont eu aucun effet négatif sur la libido des moutons, le Comité Scientifique et Technique de l"ANSSA a recommandé de reprendre l"étude sur les bovins. La présente étude avait pour objectif de contribuer à une meilleure connaissance de l"effet des cubes alimentaires sur les bovins en embouche intensive. Pour cela une étude d"observation a été réalisée sur 20 taureaux zébu de race peuls du Macina âgés de 4-7 ans et 6 vaches maures vides de 4 à 7 ans. Les taureaux ont été répartis en 7 lots de 3 têtes chacun correspondant à 7 régimes alimentaires. Les taureaux de l"étude étaient de race peulh et les vaches de race maures. Les 6 vaches ont été utilisées pour inciter les mâles à la monte afin de mesurer la libido des taureaux et collecter leurs spermes pour analyse de sa qualité. Des prélèvements de sang sur la veine jugulaire ont été effectués pour une analyse de l"hormone sexuelle des animaux (la testostérone). Le lot I représentait le témoin sans cube alimentaire et les lots II, III et IV ont reçu respectivement 120 g de cubes alimentaires vedan, Magi poulet et Jumbo dissouts dans l"eau et administrés par voie orale aux taureaux une seule fois pendant toute la durée de l"étude. Les lots V, VI et VII ont reçu respectivement tous les jours 120 g de cubes alimentaires vedan, Magi poulet et Jumbo mis en poudre et mélangés aux 4 kg de concentré composé. Les animaux avaient libre accès à l"eau d"abreuvement. Le suivi sanitaire a eu lieu tous les jours. L"essai a duré 185 jours, il y a eu 30 jours de dressage des taureaux, 15 jours de mise en régime des taureaux et 140 jours de mesure de la libido. Pendant toute la durée de l"étude les taureaux des 7 lots ont tous gardé leur libido (moyenne inférieure à 15 mn). Elles ont varié entre 9,5 mn et 10 mn. Il n"y a pas eu de différence statistiquement significative au seuil des 5 % entre la moyenne de libido enregistrée par les lots II, III, IV et les lots V, VI et VII. Au départ de l"étude sans consommation des cubes alimentaires, les moyennes de libidos enregistrées au niveau des 7 lots n"ont pas été aussi statistiquement différentes au seuil des 5 %. Par la suite les moyennes de libido enregistrées au cours des périodes (P1 à P6 correspondant aux valeurs moyenne des libidos des lots pendant 6 répétitions) ont été statistiquement différentes à celles enregistrées à la fin de l"étude. Elles ont été de 5,6 et 6,0 mn contre 9,2 et 9,6 mn. Les résultats de la consommation des cubes alimentaires vedan, Magi poulet et Jumbo ont amélioré la libido et n"ont eu aucun effet négatif sur la libido des taureaux.

International audience; Objective: To investigate the long-term outcome in prospective memory (PM), seven years after childhood severe traumatic brain injury (TBI), in a prospective longitudinal cohort. Participants: 76 young individuals (aged 7–22 years): 39 patients with a severe accidental TBI included prospectively seven years earlier, aged 0–15 years at injury, and 37 controls individually matched on age, gender and parental education. Main outcome measures: Three novel short PM tasks varying in the delay, motivation and context (ecological versus paper and pencil task). Results: Individuals with severe TBI showed significantly poorer PM than matched controls in the two low-motivation PM tasks: (1) the ecological long-delay task consisting of sending a letter on a rainy day (p=0.047, odds ratio = 2.6); (2) the non-ecological short-delay task consisting of taking off post-its while identifying facial emotions (p=0.004, r=0.34). Differences in PM on the high motivation were not significant. PM is impaired several years post severe TBI.

Au Mali, Les hôpitaux sont des lieux privilégiés de ventes d"aliments de toutes sortes. C"est pour évaluer les pratiques d"hygiène alimentaire en milieu hospitalier que la présente étude a été réalisée. Une étude transversale par sondage raisonné à l"aide d"un échantillonnage par commodité a été réalisée auprès de 30 restaurateurs et 59 Consommateurs du 3 au 5 Décembre 2012. Les données avait été collecté auprès des restaurateurs publics et privés, des Consommateurs et des informateurs clés à l"aide d"un entretien directe semi- directif et d"une observation des pratiques au moyen d"une grille d"observation. Le test de chi2 de Pearson a été utilisé pour la comparaison des moyennes. Nos résultats ont montré que seuls 16,7% des restaurateurs observaient les règles d"hygiène alimentaire. Près de 63,3% d"entre eux ne désinfectaient pas les aliments préparés et les crudités ni à l"eau de javel ni au permanganate. Le lavage des mains au savon, était jugée acceptable chez 10% des enquêtés. Plus des deux tiers (70%) de restaurateurs n"avaient reçu aucune formation sur les bonnes pratiques d"hygiène alimentaire. Pour 40 % de consommateurs, l"environnement de préparation des aliments était sale et 66,7% des restaurateurs n"utilisaient pas de tenue de travail. Près de 28,8% des consommateurs avaient eu au moins une fois des malaises tels que diarrhée, douleurs abdominales et vomissements. L"hygiène alimentaire reste fortement influencée par le mode de préparation et le comportement des vendeurs qui devraient adopter de bonnes pratiques pour préserver la santé des consommateurs

Introduction/Background Severe Traumatic Brain Injury (TBI) is the main cause of children mortality and disability in developed countries. Among cognitive sequelae, memory impairment is frequent and impacts everyday functioning and academic achievement. The aims of this study were: (1) to measure memory functioning in children who sustained a severe TBI, and performance's evolution over time; (2) to assess factors associated to memory function and recovery. Material and method In the TGE (Traumatisme crânien grave de l’enfant) cohort, a prospective longitudinal study, 65 children aged 0 to 15 years old who sustained a severe TBI were included. Memory function was assessed using the Children's Memory Scale (CMS) at 3, 12 and 24 months post-injury. Results Memory was assessed in 46 children aged 5–15 years. Significant memory impairment was found at 3months post-injury (mean general memory (GENM) score = 89.1, SD = 20.5). Significant improvement was found at 24 months, but less so for verbal, learning and attention/concentration abilities. At 3 and 24 months post-injury, GENM score was significantly correlated to TBI severity indices (length of coma, Pediatric Traumatic Scale and Injury Severity Score). It was strongly correlated to full-scale intellectual quotient at each time point. Female gender was associated with worse memory impairment, whereas age at injury and socio-economic status were not. Furthermore, presence of motor impairment (MI) was correlated with worse memory recovery, probably as a marker of injury severity. Finally, the GENM score was significantly correlated with less favorable educational outcome. Conclusion Memory functioning is significantly impaired following severe TBI; it is mostly influenced by initial TBI severity and strongly impacts educational outcome. Those patients should benefit from long-term follow-up post injury.

Le traumatisme crânien (TC) est une des premieres causes de deces et de handicap durable chez l’enfant et demeure un important probleme de sante publique. Les troubles cognitifs et comportementaux lies au TC peuvent n’apparaitre ou ne devenir pleinement evidents qu’apres un long delai, lorsque les fonctions cerebrales concernees sont censees etre matures et fonctionnelles. Il est donc necessaire de prevoir un suivi organise et specifique sur le tres long terme des enfants traumatises crâniens. Des prises en charge reeducatives et des adaptations scolaires doivent etre mises en place, si necessaire, pour eviter une cascade d’echecs cognitif, scolaire et social.

UNLABELLED Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury. OBJECTIVE To assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury. METHODS We used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living. RESULTS The three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking. CONCLUSION Constraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury.

Les mecanismes sont domines par les chutes pour les plus jeunes et par les accidents de la voie publique pour les plus grands. Chez les plus jeunes, les lesions les plus graves entrent dans le cadre du syndrome du bebe secoue. Le pronostic en cas de lesions diffuses est moins bon que celui de l’adulte. Si la recuperation motrice est souvent satisfaisante et rapide, restent les atteintes cognitives et surtout comportementales, qui constituent le handicap « invisible » et determinent le pronostic. L’organisation des soins doit particulierement veiller a leur specificite et a leur continuite. La famille et l’ecole jouent un role privilegie. La reparation au sens juridique du terme, lorsqu’elle est possible, ne doit pas etre negligee.

IntroductionThe GOS-E Pediatric version allows measuring overall outcome in children and adolescents following ABI. Scores range from 1: upper good recovery, to 7: vegetative state.ObjectivesTo validate the French translation of the GOS-E Peds in children with (ABI) of various severity and stages post-injury.MethodsThe GOS-E Peds was used in a PMR department devoted to children with ABI, in three groups of patients: (1) patients shortly hospitalised post-ABI: GOS-E Peds was rated upon admission, at 3 and 6 months post-injury; (2) patients several years post-injury, requiring services of a multi-disciplinary outreach team; (3) patients followed-up on simple medical clinics. The type and severity of ABI were collected.Results398 patients were included [2/3 boys; mean age at injury 6 years (SD=4)]. In group 1 (n=124), mean (SD) GOS-E Peds scores were 5.9(.77) upon admission, 5.12(1.2) at 3 months (n=99) and 4.88(1.45) at 6 months (n=83); scores were significantly worse in case of hemiplegia (66%). GOS-E Peds improved over time (0–3 months P

Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD=3.2). After a median length of follow-up of 8 years (range 3.7-12), only seven children (15%) had "good outcome" (normal life - GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p=0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes.

Resume Le syndrome du bebe secoue (SBS) est un traumatisme crânioencephalique secondaire a un acte violent de secouement de la part d’un adulte envers un nourrisson. Les criteres diagnostiques du SBS ont ete recemment valides par la Haute Autorite de sante. La mortalite globale apres un SBS est en moyenne de 21,6 % et l’evolution a long terme n’est jugee favorable que pour 8 a 36 % des patients suivis plus de cinq ans en moyenne. Cet article decrit les sequelles, leurs mecanismes et les facteurs pronostiques ainsi que des pistes pour l’amelioration de la prise en charge des patients a long terme.

Objective Childhood traumatic brain injury (TBI) is a leading cause of death and lifelong acquired disability. The aim of this study was to prospectively study intellectual ability following childhood severe TBI over 7–8 years post-injury, and factors influencing outcome and change over time. Material/patients and methods Children (0–15 years) consecutively admitted in a single trauma center for severe non-inflicted TBI over a 3-year period were included in a prospective longitudinal study. Assessment was conducted at 3, 12 and 24 months, and at 7–8 years using age appropriate Wechsler Intelligence Scales. For the 7–8-year follow-up, one third of the group was aged 18 years or more, and a group of matched controls was included. SES was assessed by parents’ education. Results Sixty-five of the 81 included children survived (66% boys). After a mean delay post-injury of 7.6 years (SD = 1.5), 39 patients (60%) participated in the study [mean age at injury 7.6 years (SD = 4.72; n = 15; ≥ 6 years, n = 23); median initial Glasgow Coma Scale (GCS) score: 6; mean coma duration: 6 days (SD = 4.8)]. Participants and non-participants did not differ in terms of demographic and severity factors, or initial full scale IQ (FSIQ). For 36% of the sample, at least one parent had graduated from high school. At the 7–8 year follow-up, mean FSIQ in the TBI group was significantly lower than in the control group (86.4; SD = 18 versus 97.2; SD = 11.2; P = 0.016), with no significant change over time when compared with initial FSIQ (3 months post-injury; 85.2; SD = 18). In multivariate analysis, FSIQ was predicted mainly by parental SES ( P = 0.031), with a marginal effect of length of coma ( P = 0.079) and no effect of age at injury, initial GCS or intracranial hypertension. Discussion–conclusion Severe childhood TBI leads to severe and long-standing cognitive impairments, without significant improvement over time. Parental education appears to be the main predictor of cognitive outcome several years post-injury, consistent with previous studies in the literature.

Resume Le syndrome de SAPHO est evoque devant une patiente senegalaise, âgee de 47 ans, presentant une tumefaction du quart interne de la clavicule droite et des antecedents de pustulose palmaire. L’etat general est conserve, la biologie montre un syndrome inflammatoire non specifique (VS acceleree, CRP elevee) et une absence d’hyperleucocytose. L’examen anatomopathologique retrouve un granulome inflammatoire polymorphe avec des cellules mononucleees et des cellules geantes. La radiologie standard et le scanner ne decelent pas la lesion, alors que la scintigraphie montre dans la region sternoclaviculaire droite une image d’hyperfixation « en cornes de taureau » evocatrice d’un syndrome de SAPHO. Le frequent retard au diagnostic positif, habituellement lie a la meconnaissance du syndrome et a la crainte d’un processus tumoral osseux, est une source majeure de traitements antibiotiques abusifs et/ou de biopsies traumatisantes pour les patients. La scintigraphie osseuse a un role majeur a jouer en orientant le diagnostic lorsqu’elle decouvre des foyers claviculaires et du sternum, elle peut egalement etre utile pour faire le bilan des atteintes et apprecier leur evolutivite.

Introduction Childhood acquired brain injury (ABI) is responsible for severe cognitive and behavioural disorders, sometimes leading to violent and/or offending behaviours. The aim of this study was to review the cases of patients treated in a rehabilitation unit dedicated to children with ABI, who subsequently demonstrated behaviors leading to an intervention of the police and/or the justice, and identify any common characteristics. Methods Retrospective inventory of patients with ABI treated in a single rehabilitation department, who subsequently had contact with the police/justice following offenses. We collected demographic factors, type and severity of ABI, initial neurological examination, first and last neuropsychological assessment, type of schooling pre- and post-injury, and data from their offenses. Results Searches retrieved 40 patients (36 boys): 34 traumatic brain injury (TBI; 27 severe), 4 brain tumours, 1 frontal hemorrhagic stroke and 1 anoxia; mean age at injury was 9.7 years [SD = 4; (2.1–15.7)]. In 88% of cases, none of the parents had graduated from high school. Half of the children had previous school difficulties and 30% had repeated a grade. Overall, children sustained severe injuries, with impaired neurological function, major cognitive deficits [mean initial full-scale IQ 73.1 (SD = 12.8)] without significant improvement [77.4 (SD = 13.4) at the last assessment]. The processing speed index was particularly low [73.2 (±15.4)] and did not improve over time. 76% had behavioural disorders already evident during hospitalization. Upon discharge, 62% required adapted and/or specialized schooling. After an average follow-up of 8 and a half years, only 6 patients still followed an ordinary curriculum and 8 were not attending school anymore. Four girls were victims, and among 36 boys, all were perpetrators, but 3 had been victims previously. The offenses were mainly cases of violence (56%), but also entailed thefts, traffic offences, sexual assaults, drug use and vandalism. Discussion Children with ABI who suffer or commit offenses are mainly boys, from very low socioeconomic background, with pre-injury academic and social difficulties, who sustained severe TBI. They suffer very severe and disabling cognitive deficits and behavioral disorders. Multidisciplinary care and follow-up of those children more at risk is essential in the long-term.

Resume Propos - Reputee frequente chez le sujet âge, de symptomatologie pauvre et masquee, l'hyperthyroidie n'a pas ete etudiee dans la population Noire de plus de 50 ans en milieu africain. Methodes Notre etude a concerne 31 patients sur 300 cas hyperthyroidies repertories. Nous avons analyse la frequence de certains parametres, les caracteristiques demographiques, le motif de consultation, le syndrome de thyrotoxicose, les signes non thyrotoxiques, les manifestations cardiaques, les caracteristiques hormonales et scintigraphiques, l'etiologie de la maladie, les facteurs etiologiques et le traitement. Resultats La frequence de l'hyperthyroidie dans ce type de population etait de 10 %. Le plus grand nombre de cas (20 cas sur 31) a ete observe dans la population des femmes au foyer. Le groupe le plus important (13 cas sur 31) etait d'origine rurale. Trois signes predominaient dans les motifs de consultation : un amaigrissement (23 cas sur 31), une tumeur au niveau cervical (17 cas sur 31) et des palpitations (12 cas sur 31). Les trois signes majeurs suivants ont ete observes dans le syndrome de thyrocoxicose : un amaigrissement (29 cas sur 31), une tachycardie (27 cas sur 31) et des tremblements (22 cas sur 31). Le dosage des hormones thyroidiennes a montre une valeur de 265 ± 74 nmol/L en moyenne pour la thyroxine (T 4 ) et de 6 ± 2 nmol/L pour la tri-iodothyronine (T 3 ); le dosage radio-immunometrique a montre une valeur de la TSH ultrasensible de 0,17 ± 0,23 μlU/mL. Dans le syndrome non thyrotoxique, la protrusion du globe oculaire predominait (25 cas sur 31). Les formes etiologiques comprenaient 25 maladies de Basedow, dont 22 typiques. Les complications cardiaques comprenaient deux fibrillations auriculaires. Aucune forme iatrogene n'a ete constatee. La posologie initiale moyenne de carbimazole etait de 34 ± 8 mg/j. L'evolution s'est averee favorable dans 15 cas sur 23. Conclusion Dans cette serie africaine, l'originalite de nos resultats chez le sujet âge reside moins dans la preponderance du nombre de femmes au foyer de race noire presentant un hyperthyroidisme et dans l'origine rurale des patients que dans l'etiologie basedowienne. Cette derniere notion tient peut-etre a la jeunesse de la population etudiee, en fait reflet de la population generale.

OBJECTIVE: Childhood traumatic brain injury (TBI) is the first cause of death and acquired disability and it represents a major public health issue. Childhood severe TBI can lead to motor, cognitive, behavioural and social cognition deficits, which have consequences on academic achievement, social integration, participation and quality of life. Consequences may only appear after a delay, when the skills are supposed to be fully developed. The aim of this study was to prospectively assess academic outcome, health-related quality of life (HRQoL), amount of ongoing care and participation, following childhood severe traumatic brain injury (TBI) over 7-8years post-injury, in comparison with a matched uninjured control group. MATERIAL/PATIENTS AND METHODS: Sixty-five children, aged 0-15years, consecutively admitted in a single trauma center over a 3-year period for severe non-inflicted TBI were included in a prospective longitudinal study. At 7-8years, they were compared with a matched control group regarding schooling modalities, amount of ongoing care, and standardized questionnaires of HRQoL (PedsQL, including fatigue module), and participation (Child and Adolescent Scale of Participation - CASP). Family socio-economic status (SES) was assessed by parental education level. RESULTS: After a mean delay of 7.7years, 39 patients participated in the study (60% of the initial sample; 66% boys; mean coma duration: 6.6days; SD=4.83; mean age at injury: 7.6years, SD=4.72; mean age at assessment: 15.3years, SD=4.46, range 7.2-22.2), with no significant differences between participants and non-participants regarding demographic and severity factors, or initial intellectual ability). Only 62% of the TBI group was attending mainstream education (as opposed to 100% of controls). The amount of ongoing rehabilitation was high (35.3% speech-language therapy, 26.4% occupational therapy; 17.6% physiotherapy). Self-reported HRQoL was significantly lower in the TBI than in the control group [71.1; 95% IC 64.8-77.5 versus 83.9; 95% IC 79.3-88.4; P=0.0026], including the fatigue module [61.1; 95% IC 54.6-67.5 versus 77.4; 95% IC 71.9-82.8; P=0.0005]. Parent ratings of participation were relatively good but significantly lower than those of controls [86.4; 95% IC 81.4-91.3 versus 96.3; 95% IC 94.6-98.1; P=0.0002]. DISCUSSION-CONCLUSION: Severe childhood TBI leads to severe and long-standing impairments, evident several years post-injury, with consequences on school integration, independence, participation and HRQOL.Copyright © 2016. Published by Elsevier Masson SAS. Language: en

Objective Childhood acquired brain injury (ABI) is the leading cause of acquired disability in childhood, with significant consequences on independence, academic achievement and participation. The “Child and Adolescent Scale of Participation” (CASP; Bedell 2004) has been specifically developed to assess participation following childhood ABI. The aim of this study was to examine the psychometric properties of the French version of the Child and Adolescent Scale of Participation. Material/patients and methods Cross-sectional, monocentric study. The CASP questionnaire was given to 133 caregivers of children or adolescents (5 to 18 years) who were followed-up in a rehabilitation department following ABI. The CASP is comprised of 20 items in 4 subsections: (1) home participation; (2) neighborhood and community participation; (3) school participation; (4) home and community living activities. Parents are asked to rate the 20 items of the CASP using a four-point Likert scale: (4 = aged expected; 3 = somewhat limited; 2 = very limited; 1 = unable), or “not applicable”. Cronbach's alpha and factor analyses were performed to examine the psychometric properties of the French translation of the CASP and correlations of the CASP with demographic and clinical factors were explored. Results Eighty-five parents [(64%response rate; 61% boys; age at onset 5.66 years (SD = 3.9); age at assessment 10.51 years (SD = 3.4)] answered the questionnaire. There was no significant difference between respondents and non-respondents regarding demographic, medical, injury severity or level of neurological or cognitive impairment. Internal consistency was high (Cronbach alpha 0.84). Factor analysis yielded a five-factor structure explaining 88% of the variance. The total score of the CASP was correlated with the mother's education level (P = 0.04), but not with any of the other medical data, such as age at injury, age at assessment, injury severity, clinical condition (presence of hemiplegia, epilepsia, cerebellar signs), intellectual ability or number of ongoing rehabilitation types. Discussion - conclusion Our results confirm the cross-cultural psychometric properties of the French adaptation of the CASP. Interestingly, the CASP was not correlated with any of the clinical factors. Parental ratings of their child's participation probably rely on other factors such as emotional status, coping ability and environmental factors.

botulinum toxin (BT) appears to be a potentiel treatment of sialorrhea for children with CP (Jongerius et al., Eur J Pediatr 2001). Literature on this topic becomes richer but utilisation is not reached by consensus. Objective.– An exhaustive literature review has been realised in order to generate a situational awareness of conditions of use of BT in sialorrhea of children with CP. Method.– Explored databases were Medline, Embase and Cochrane Library. Utilized key words were: ‘‘sialorrhea’’, ‘‘drooling’’, ‘‘children’’ and ‘‘botulinum toxin’’. Only articles in English were selected. Age of children was to be more than 4. Type of BT had to be precised. Data looked for were: evaluation criteria, evaluation of efficacy, side effects and injection protocol. Results.– Thirty-two articles were selected in first reading out of which 9 were kept at last: three randomised controlled trials, four non controlled trials and two case reports. Several evaluation techniques of sialorrhea existed, both objective and subjective. BT was effective but conditions of use were not consensual. Discussion.– BT is effective in treatment of sialorrhea and its side effects are infrequent. It certainly has its place in arsenal armamentarium against sialorrhea. Literature proposes reflexions about some predictive factors of efficacy, in order to precise indications of treatment, but none can be admitted today. A work is currently carried out about french practices (enlarged former Botuloscope). After this and considering the literature, we would propose a utilisation and evalution protocole of BT for sialorrhea of children with CP.

The Shaken Baby Syndrome (SBS) is a severe inflicted brain injury due to an adult violently shaking an infant. Diagnostic guidelines have been recently published by the "Haute Autorité de santé". The mortality rate after SBS is 21.6 % and the long-term outcome is good for only 8 to 36 % patients followed over more than 5 years. The aim of this article is to describe sequelae after a SBS, their mechanisms, prognostic factors and recommendations for a better long-term care of the patients.

The complete analysis of the 1H and 13C NMR has been performed for four pentacyclic oxindole alkaloids: mitraphylline, isomitraphylline, speciophylline and pteropodine. The total assignment of the 1H NMR parameters was achieved from combined evaluation of homonuclear shift correlation and J-resolved diagrams, while DEPT spectra and selective decoupling experiments provided all carbon chemical shifts.

Background Acquired brain injury (ABI) is a leading cause of death and lifelong acquired disability in children and remains a significant public health issue. Deficits may only become fully apparent when developmental demands increase and once cognitive processes are expected to be fully developed. It is therefore necessary to provide organized long-term follow-up for children post ABI. Despite these recommendations, it has been shown that only a small proportion of children received specialized rehabilitation and adequate follow-up after ABI. Aims The aims are: (i) to describe a comprehensive model of care devoted to children with acquired brain injuries; and (ii) to provide descriptive data analysing the characteristics of children followed up, the type/amount of services provided and general outcomes. Programme description The programme features an in- and outpatient rehabilitation facility, where multidisciplinary rehabilitation and specialized schooling are provided. The ultimate goal of the programme is to promote each child's successful reintegration in school and in the community. Adequate preparation of discharge is essential, long-term follow-up is organized, and an outreach programme has been developed to deal with the complex delayed psychosocial issues. Results Overall outcome, as measured by the Glasgow Outcome Scale, improved dramatically between admission (3.3; SD = 0.45) and discharge (2.15; SD = 0.74). Most of the children were discharged home with an adequate personalized plan for ongoing rehabilitation and school adaptations. Analysis of the outreach programme underlines the more challenging issues arising in late adolescence-early adulthood. Conclusion Given the specificities of childhood ABI, long-term specific care must be organized and co-ordinated, regardless of injury severity.

Introduction Studies of long-term outcome of the shaken baby syndrome (SBS) are scarce, but they usually indicate poor outcome. Objectives To describe long-term outcome of a child having sustained a SBS, to ascertain possible delayed sequelae and to discuss medicolegal issues. Methods We report a single case study of a child having sustained a SBS, illustrating the initial clinical features, the neurological, cognitive and behavioural outcomes as well as her social integration. Results The child sustained diffuse brain injuries, responsible for spastic right hemiplegia leading to secondary orthopaedic consequences, as well as severe cognitive impairment, worsening over time: the developmental quotient measured at 15 months of age was 55 and worsened as age increased. At 6 years and 8 months, the child's IQ had fallen to 40. Behavioural disorders became apparent only after several months and precluded any social integration. The child eventually had to be placed in a specialised education centre at age 5. Discussion and conclusion The SBS has a very poor outcome and major long-standing sequelae are frequent. Cognitive or behavioural sequelae can become apparent only after a long sign-free interval, due to increasing demands placed on the child during development. This case report confirms severity of early brain lesions and necessity for an extended follow-up by a multi-disciplinary team. From a medicolegal point of view, signaling the child to legal authorities allows protection of the child, but also conditions later compensation if sequelae compromise autonomy.

Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury.To assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury.We used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living.The three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking.Constraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury.

This study is based on the livelihood used by street children for survival in Bamako, Mali. Two bus stations were selected for this study: Sogoniko bus station and Medina bus station. Most buses leave from these stations to the vicinity of the country. Data was collected through individual interviews (one by one), focus group discussions and interviews. A sample of one hundred and twenty street children aged between 8 and 17 years were selected for this study. Thirty people were also selected to give their opinions on street children. The results indicate that most of street children survive by selling small objects and through begging, 32.5% and 22.50% respectively. Our survey indicates that there are different factors pushing them to the streets, and as a way of survival on the streets, there is need to be organized, hence, they are organize themselves into groups for protection against violence and aggressions.

This work has been conducted on 162 subjects, aged over 60 years, living in Senegal, investigated in the Departement of Biophysics and Nuclear Medecine of Dakar for suspicion of dysthyroidism. The levels of T3, T4 and TSH US hormones were determined by a radio-immunological method. This technique, exhibiting good functionnal sensitivity and its high specificity, is likely to be beneficial to the diagnosis of dysthyroidisms. Besides, this experiment leads us to consider that the dosage of TSH remains an useful first intention examination for the old patients and could notably improve the screening of dysthyroidisms with a decrease in the cost of the investigation. However, because of the therapeutical implications, some biological profiles schould be interpreted cautiously. The equipment for the determination of the free fractions (T3 and T4) with the brought additional accuracy could allow to dismiss some diagnostci uncertainties.

The breakage of prosthesis constructed in polymethacrylate resin is a reality in daily practice. Several solutions have been proposed to overcome this problem. Thus, the reinforcement of resin with carbon fibre improved greatly the mechanical properties, notably the fatigue strength. The technique of elaboration of such prosthesis proposed in this study has little impact on aesthetic as well as on the final cost. This proposition could be a relevant solution for third world countries opposite to economical and technological problems generated by cast metallic framework.

According to the orthodontist supernumerary teeth on dental arches necessitate a special analysis of the occlusion to decide which to keep and which ones to pull out. Then he must solve the problem of the new occlusion to have. Thus in this study the authors, from their personal experiences of treatment of cases about supernumerary teeth go through the matter.

The face is the part of the human body that most reflects external marks of time. The change of this region concerns the body support as well as the musculo-cutaneous surface. In this survey, we have described its evolution during the life, in the Black African, particularly on the esthetical plane.