Human health and well-being have advanced substantially during the past two centuries, mainly due to improvements in nutrition, hygiene, and clinical medicine. During this period, a close interrelationship has been established among nutrition, infection, and hygiene. In fact, nutritional status greatly influences infectious disease morbidity and mortality. In most developed countries, improvements in diet have resulted in the virtual disappearance of nearly all nutritional deficiency disorders. However, there is now a transition from nutritional deficiency-related disorders to health problems associated with excessive caloric intake, such as obesity, diabetes, and cardiovascular disease.

Abstract In 2013, children living with human immunodeficiency virus (HIV)(CLHIV) and on antiretroviral therapy (ART) in Togo accounted for 7.6% of people living with HIV on ART. Management faces many challenges due to insufficient qualified human resources. This study aimed to assess the availability of care offered to these children in health facilities. This was a retrospective descriptive study on 244 CLHIV (under 15 years) who were on ART and randomly selected in 26 sites providing HIV medical care in Togo from July 22 to September 06 2014. Evaluation forms on children's clinical, biological, and therapeutic parameters were analyzed. Forty percent of CLHIV were between the ages of 5 and 9 years. The average age was 5 years at testing for diagnosis; 49% of children were in the World Health Organization (WHO) stage III–IV. The sex ratio (male/female [M/F]) was 1:1. Almost 71% of CLHIV were underweight (weight-for-age < − 2 Z scores Severely underweight : weight-for-age < − 3 Z scores). The patient height was not recorded in 81.6% of the cases. According to the guidelines, the criteria to be on ART were met for 90.2% of children. The average delay (from diagnosis) to be on ART was 216 days. First-line regimens were mostly zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) (47.0%) and stavudine/lamivudine/nevirapine (d4T/3TC/NVP) (38.7%). Follow-up was characterized by a low rate of achievement of the biological semi-annual evaluation (19.8%), child compliance for 62.7%, a cotrimoxazole prophylaxis for 70.2%, and tuberculosis screening for 64.8%. The lost-to-follow-up (LFU) proportion was 8.9%. HIV pediatric diagnosis is still an issue in Togo. Early maternal and child healthcare and HIV care are not optimal. Recruitment and capacity building of health professionals, delegation of tasks to paramedics, and innovative motivation processes could improve care for HIV-infected children.

The mucopolysaccharidoses (MPS) are well known to present a high risk of anesthesia. Predominantly, this risk is not only related to upper airway issues but also to multilevel airway obstruction, respiratory morbidity, and cardiac issues. Before disease-specific treatment became available, the management of the untreated patients with MPS was regarded as the worst airway problem in pediatric anesthetic practice. The last 20 to 30 years have seen great advances in the treatment of the different types of MPS with hematopoietic stem cell transplantation (HSCT) being offered to children with MPS I Hurler sundrome since the 1980s, and more recently enzyme replacement therapy (ERT) becoming available for many MPS subtypes.These treatments have undoubtedly affected the relative risk involved with an anesthetic. HSCT improves markedly the upper airway and cardiac myocardial function and there is evidence that airway management is much more straightforward. ERT, on the other hand, improves obstructive sleep apnea and exercise tolerance, but the overall effect on the risk of anesthesia is less obvious and airway complications during anesthesia remain at a high level. The impact of improved anesthetic management in the same time frame is borne out by a reduced failed intubation rate in the literature.The management of the MPS patients necessitates a multidisciplinary approach presently widely practiced in pediatric centers, but successful modes of therapy increasing their life span have pushed many of the extreme anesthetic challenges into adult practice where most anesthetists will be unfamiliar with the problem. This is a problem that needs to be addressed, and solutions to this issue could be collaborative working between pediatric and adult practitioners or an international network of experts available for advice.

Abstract Gnathostomiasis is a common parasitic infection in Southeast Asia, involving many organs in infected human hosts. Common neurological manifestations of Gnathostoma infection include radiculomyelitis, eosinophilic meningitis, and nontraumatic subarachnoid hemorrhage, leading to a high mortality and morbidity. This study first reported transient cerebral vasculopathy, an atypical neurological manifestation, in an 11-year-old Thai girl. The patient was diagnosed with intracerebral and intraventricular hemorrhage, and meningitis with atypical cerebrospinal fluid (CSF) profile. The imaging study of the brain revealed the abnormal white matter lesion and transient cerebral vasculopathy with the cerebral hemorrhage showing a track-like appearance (at the level of the corpus callosum). The serological testing in CSF and serum using the enzyme-linked immunosorbent assay (ELISA) technique was positive for Gnathostoma spinigerum. The patient spontaneously recovered within 3 months without albendazole or corticosteroid treatments.

Abstract Mucopolysaccharidoses (MPSs) are multisystemic, chronic progressive, heterogeneous, and life-threatening diseases, involving severely the musculoskeletal system, in particular in MPS I, II, IV, VI, VII, and less prevalent in MPS III. Accumulation of glycosaminoglycans (GAGs) in soft tissues, such as ligaments, tendons, and joint capsules, as well as in cartilage, and bone lead to orthopedic complications: joint stiffness, contractures, and skeletal deformities, resulting in hip dysplasia, genua valga, feet deformities, kyphoscoliosis, narrowing of the spinal canal, atlantoaxial instability, carpal tunnel syndrome, trigger finger, and growth retardation. These complications significantly reduce the quality of life due to impaired mobility, loss of independency, and pain. Compression of the cervical spinal cord is also life threatening. According to the progressive nature of MPSs, musculoskeletal symptoms worsen over time and surgical intervention may be inevitable. However, due to the increased anesthesia risk of MPSs, surgical intervention has to be evaluated carefully by a multidisciplinary team. Additionally, due to the rarity of the diseases, not many standards or recommendations are available to determine the indication of a surgical intervention, so each intervention must be decided individually, based on the few data available. In addition, conservative treatment should be taken into consideration. Physiotherapy, pain medication, insoles, orthosis, braces, corsets, and special footwear play a pivotal role. Unfortunately, the skeletal tissues are poorly vascularized and enzyme replacement therapy does not have much effect on them. It is important to detect and observe musculoskeletal complications in the regular follow-up visits, in particular the life-threatening compression of the cervical spinal cord.

Abstract Diaper dermatitis is defined as an inflammatory reaction localized on the skin that is usually covered by the diaper (genitals, buttocks, and anus). The aim of this study was to determine the prevalence of diaper dermatitis and to describe the clinical presentation and practices related to hygiene in infants with diaper rash at the Yaounde Gynaeco-Obstetric and Pediatric hospital. It was a descriptive cross-sectional study undertaken in 1,004 mother–children pairs. Data were collected using structured questionnaires during face-to-face interviews with the parents. The prevalence of diaper dermatitis was 18.4%, and infants were aged 7 days to 24 months with a mean age of 5.91 months. The most represented age group was 0 to 6 months (67.6%). Infants living in urban areas (59.5%), of unemployed mothers or guardians (30.3%), and those of mothers living as a couple (75.1%) were most represented in our study sample. The majority of infants used both disposable and reusable diapers (48.6%). In addition, 72.7% mothers used palm kernel oil, and 27.3% rubbed other ointments before changing the baby's diapers. The most frequent clinical form was the chaffing form (48.1%). Healthcare personnel should inform, educate, and communicate with mothers on body hygiene of their babies to avoid this disorder, which can cause severe discomfort and sometimes lead to complications.

Abstract The diagnosis of neonatal sepsis is usually difficult because the sign and symptoms are nonspecific. Although C-reactive protein (CRP) and procalcitonin (PCT) are the most commonly used auxiliary tests, they are not reliable enough markers to be used for diagnosis of neonatal sepsis. This study aimed to evaluate the efficacy of resistin in diagnosing early onset neonatal sepsis and to compare its effectiveness to CRP and PCT. This prospective study was performed in the neonatal intensive care unit of Medicine Hospital between June and September 2016. Twenty-nine infants in the sepsis group and 33 infants in the control group were recruited. The Töllner scoring system was used for clinical signs. The hematologic parameters were evaluated using the Manroe and Rodwell scoring systems. The blood samples for CRP, PCT, and resistin were collected at admission (T0), and at 72 hours (T3). Mean plasma resistin level at T0 was 54.20 ± 39.3 ng/mL in the sepsis group and 34.92 ± 6.9 ng/mL in the control group. The sensitivity at T0 for resistin was 76%, and the specificity was 67%. The values of area under the curve (AUC) for CRP, PCT, and resistin were 0.84, 0.66, and 0.72, respectively. We found the diagnostic value of resistin to be lower than CRP, although its plasma levels were elevated. Therefore, we propose that resistin has limited value in diagnosis and follow-up of early-onset neonatal sepsis.

Abstract Cytokines are a very important part in the regulation of immune response in sepsis. They are cellular signaling proteins whose production is a result of activation of specific receptors. Variations in the genes encoding cytokines have a significant role in interindividual susceptibility to sepsis and its severity, and their function may be modulated by age, gender, and some environmental factors. Cytokines are classified into the subsets of proinflammatory, anti-inflammatory, and multiple function cytokines. Regulated balance between proinflammatory cytokines, anti-inflammatory cytokines, and soluble inhibitors of proinflammatory cytokines is important for eliminating pathogens and reducing inflammation. High levels of some cytokines, such as tumor necrosis factor-α, interleukin (IL)-1, and IL-6, determine the course of disease and outcome in sepsis. Likewise, numerous other biomarkers may be potential indicators of sepsis, but none has been routinely used. The best approach to the diagnosis of sepsis is the combination of different biomarkers.

Abstract Counterclockwise barber pole sign (also known as reverse barber pole sign) is an angiographic sign described in patients with small bowel volvulus due to counterclockwise twisting of mesenteric vessels around the superior mesenteric artery (SMA). The sign was first described in a catheter angiographic examination; however, the concept can be translated to the display methods of computed tomography (CT). This sign can be depicted clearly on multiplanar and three-dimensionally rendered images of multidetector computed tomography (MDCT) examination. In the current report, the reverse barber pole sign is illustrated in a child with partial small bowel volvulus secondary to mesenteric lymphatic malformation. The clinical course, management, and imaging appearances are presented, highlighting the observation of counterclockwise barber pole sign on MDCT imaging. The importance of the sign in identification of volvulus and implications for patient management are emphasized.

Abstract Developmental dysplasia of the hip (DDH) is an important cause of childhood disability. Subluxation or dislocation can be diagnosed through pediatric physical examination; nevertheless, the ultrasonographic examination is necessary in diagnosing certain borderline cases. It has been evaluated routine sonographic examination of 2,444 hips of 1,222 babies to determine differences in both, developmental dysplasia and types of hips, and evaluated their development on the 3-month follow-up. Evaluating the pathologic “α” angles under 59, there was no statistically significant differences between girls and boys in both right (55.57 ± 3.73) (56.20 ± 4.01), (p = 0.480), and left (55.79 ± 3.96) (57.00 ± 3.84), (p = 0.160) hips on the 45th day of life. Routine sonographic examinations on the 45th day of life revealed that 51 of (66.2%) 77 type 2a right hips were girls and 26 (33.8%) were boys. The number of the right hips that develop into type 1 was 38 (74.5%) for girls and 26 (100%) for boys on the 90th day of life (p = 0.005). A total of 87 type 2a left hips included 64 girls (73.6%) and 23 boys (26.4%). In the 90th day control, 49 right hip of girls (76.6%) and 21 right hip of boys (91.3%) developed into type 1 (p = 0.126). In the assessment of both left and right hips, girls showed a significantly higher frequency in latency and boys showed significantly higher development in the control sonography. A total of 31 girls (2.5%) and 11 boys (0.9%) accounted for a total of 42 (3.4%) cases who showed bilateral type 2a hips in 1,222 infants. On the 90th day control, 26 girls (83.9%) and all 11 boys (100%) developed into type 1 (p = 0.156). The study emphasizes the importance of the sonographic examination on the 90th day of life. Results of the investigation include the data of sonographic screening of DDH on the 45th day, and also stress the importance of the 90th-day control sonography after a close follow-up with physical examination between 45th and 90th days of life.