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Oxford Medical Case Reports, 2021

Oxford Medical Case Reports, 2020

In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize... more In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize, because it mimics or can be confused with other diseases even in cases of classic beriberi. Unsurprisingly, the likelihood of misdiagnosis of TD is even greater where beriberi has not been described. Critically ill patients have increased thiamine body consumption and dextrose-based IV fluid increases thiamine cellular demand even further. Consequently, severe acute conditions may result in TD, or trigger TD signs in patients with borderline thiamine status, with life-threatening consequences. Here, we describe the case of a young patient admitted to a West African hospital where TD is not well documented and diagnosed with severe pneumonia who responded dramatically to thiamine injection. The lack of rapid diagnostic capacity and the severe outcome of TD justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about TD and low thre...

The Pan African medical journal, 2018

Introduction: hypoxic-ischaemic encephalopathy (HIE) accounts for a significant proportion of neo... more Introduction: hypoxic-ischaemic encephalopathy (HIE) accounts for a significant proportion of neonatal deaths in resource limited settings (12% MSF-OCBA 2016). Moderate hypothermia started within the first 6 hours after birth is known to improve survival and outcome at 18 months. To date however, this is not feasible in MSF settings, where HIE continues to carry a poor prognosis with very high mortality rates and associated morbidities. While prevention is the goal, cases of HIE will always exist and, alternative treatments that could significantly improve outcome are nevertheless urgently needed.Method: pubmed search using the following key words: birth asphyxia, perinatal hypoxic ischaemic encephalopathy, neuroprotection, oxygen free radical inhibitors and scavengers. Results: we identified medications with high safety profiles which could be of potential interest for HIE management in MSF contexts: melatonin and vitamin k (VK). Melatonin preserves the developing brain from injury...

The Pan African medical journal, 2018

INTRODUCTION: acute thiamine deficiency (TD) in infancy is well described in Asia but poorly docu... more INTRODUCTION: acute thiamine deficiency (TD) in infancy is well described in Asia but poorly documented in Africa. Critically ill patients have increased thiamine body consumption (associated with hyper metabolism) and dextrose-based IV fluid increase thiamine cellular demand even further. Parenteral nutrition with vitamins is not a current practice in many resources limited settings. Consequently, severe acute conditions might result in TD or trigger TD signs in patients with borderline thiamine status, with life threatening consequences. METHODS: a critically ill 3-months old infant was admitted for acute respiratory distress with a working diagnosis of complicated pneumonia, fever, tachypnea with bilateral crackles, tachycardia, no edemas, poor feeding and hypotonia. Malaria rapid test was negative. He received IV ceftriaxone, IV fluids maintenance (RL/D5%) and O2 to maintain SpO2 > 92%. 8 hours later (H8), his condition worsened with hypoxia, lethargy and toxic appearance. An...

The Pan African medical journal, 2018

INTRODUCTION: selon la derniere enquete demographique et de sante du Mali (EDSM V 2012 - 2013) 39... more INTRODUCTION: selon la derniere enquete demographique et de sante du Mali (EDSM V 2012 - 2013) 39% des enfants de 12 - 24 mois etaient completement vaccines et 71% avaient recu la vaccination anti-rougeole. Depuis 2012, MSF apporte des soins gratuits, en appui au ministere de la sante au centre de sante communautaire et au centre de sante de reference d´Ansongo dans le nord du Mali (grande labilite securitaire). En 2015, nous avons mis en place un systeme de verification du statut vaccinal pour eviter les opportunites manquees au niveau des differents services. En parallele les vaccinations sont associees aux campagnes de chimio prevention du paludisme saisonnier (CPS) 4 mois/an. METHODES: etude retrospective sur les donnees des registres de patients de 0 - 23 mois admis au CESREF et en OPD du centre de sante d’Ansongo d’avril a decembre 2016 puis de janvier a avril 2017. RESULTATS: nombre d’enfants a jour de leurs vaccinations et rattrapes en 2016 - 2017 au sein du CESREF et du CES...

Introduction: according to WHO, worldwide 10 - 20% of children and adolescents experience mental ... more Introduction: according to WHO, worldwide 10 - 20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence children’s development and their educational attainments. Children with mental disorders face major challenges with stigma, lack of access to health care and education. In MSF Spain, it has been set as an operational priority to increase the access of adolescents to health programs, including MHPSS (Mental Health and Psychosocial Support) programs. Method: an analysis was done from HMIS (Health Management Information System) in order to identify the number of adolescents that were reached by MSF Spain MHPSS programs during 2015 and 2016. In 2016, some strategies were put in place to increase the number of adolescent’s beneficiaries: inclusion of adoles...

[This corrects the article DOI: 10.1371/journal.pone.0250933.].

Annals of the New York Academy of Sciences

PLOS ONE

Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrit... more Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrition (SAM) and TB diagnosis remains particularly challenging in the very young. We explored whether, in a low HIV-prevalence setting, the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine may assist TB diagnosis in SAM children, a pediatric population currently not included in LAM-testing recommendations. To that end, we assessed LAM test-positivity among SAM children with and without signs or symptoms of TB. Methods A cross-sectional assessment (February 2016-August 2017) included children <5 years with SAM from an Intensive-Therapeutic-Feeding-Centre in Madaoua, Niger. Group 1: children with signs or symptoms suggestive of TB. Group 2: children without any sign or symptom of TB. Urine-specimens were subjected to DetermineTM TB-LAM lateral-flow-test (using a 4-grade intensity scale for positives). LAM-results were used for study purposes and not for patient managemen...

SARS-Cov-2 is an RNA virus responsible for the Covid-19 pandemic which already claimed more than ... more SARS-Cov-2 is an RNA virus responsible for the Covid-19 pandemic which already claimed more than 215,000 lives worldwide as of April 28, 2020. Selenium has a key and complex role in the immune system. It is very clear that selenium deficiency is associated with higher susceptibility to RNA viral infections and more severe disease outcome. We present here how selenium deficiency promotes mutations, replication and virulence of RNA viruses. Selenium might be beneficial via various mechanisms including virus-host cell attachment interaction, restoration of host antioxidant capacity, anti-inflammatory and anti-clotting effects, to name a few. Selenium has been overlooked but probably has a significant place in Covid-19 management, especially in the elderly, and might represent a game changer in the global response to Covid-19.

BMJ Open

IntroductionDiagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the ... more IntroductionDiagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the non-specific, highly variable clinical presentation, often leading to misdiagnosis. Our primary objective is to develop a case definition for thiamine responsive disorders (TRD) to determine among hospitalised infants and young children, which clinical features and risk factors identify those who respond positively to thiamine administration.Methods and analysisThis prospective study will enrol 662 children (aged 21 days to <18 months) seeking treatment for TDD symptoms. Children will be treated with intravenous or intramuscular thiamine (100 mg daily for a minimum of 3 days) alongside other interventions deemed appropriate. Baseline assessments, prior to thiamine administration, include a physical examination, echocardiogram and venous blood draw for the determination of thiamine biomarkers. Follow-up assessments include physical examinations (after 4, 8, 12, 24, 36, 48 and 72 hours)...

Annals of the New York Academy of Sciences

Oxford Medical Case Reports

An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with sever... more An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with severe blistering dermatosis. He was treated with broad spectrum antibiotics and dressings, without improvement. After 2 weeks, linear IgA bullous dermatosis was suspected. Owing to lack of dapsone, the child was treated with prednisolone and improved. To avoid corticosteroids side effects, 2 months after starting prednisolone we switched to colchicine, but the boy's condition worsened for reasons of poor adherence, requiring intravenous corticosteroids and antibiotics. After complete resolution of the skin lesions, we continued with colchicine monotherapy, then changed to dapsone after 3 months. The child did not show any further signs of dermatosis, but his follow-up ended abruptly, because he did not return to the hospital. IgA bullous dermatosis is a challenging diagnosis in settings where pathological studies cannot be conducted. Multidisciplinary treatment is required and colchicine is a good option if dapsone is not available.

Oxford Medical Case Reports, 2021

Oxford Medical Case Reports, 2020

In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize... more In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize, because it mimics or can be confused with other diseases even in cases of classic beriberi. Unsurprisingly, the likelihood of misdiagnosis of TD is even greater where beriberi has not been described. Critically ill patients have increased thiamine body consumption and dextrose-based IV fluid increases thiamine cellular demand even further. Consequently, severe acute conditions may result in TD, or trigger TD signs in patients with borderline thiamine status, with life-threatening consequences. Here, we describe the case of a young patient admitted to a West African hospital where TD is not well documented and diagnosed with severe pneumonia who responded dramatically to thiamine injection. The lack of rapid diagnostic capacity and the severe outcome of TD justify the use of a therapeutic thiamine challenge in cases with high clinical suspicion. Increased awareness about TD and low thre...

The Pan African medical journal, 2018

Introduction: hypoxic-ischaemic encephalopathy (HIE) accounts for a significant proportion of neo... more Introduction: hypoxic-ischaemic encephalopathy (HIE) accounts for a significant proportion of neonatal deaths in resource limited settings (12% MSF-OCBA 2016). Moderate hypothermia started within the first 6 hours after birth is known to improve survival and outcome at 18 months. To date however, this is not feasible in MSF settings, where HIE continues to carry a poor prognosis with very high mortality rates and associated morbidities. While prevention is the goal, cases of HIE will always exist and, alternative treatments that could significantly improve outcome are nevertheless urgently needed.Method: pubmed search using the following key words: birth asphyxia, perinatal hypoxic ischaemic encephalopathy, neuroprotection, oxygen free radical inhibitors and scavengers. Results: we identified medications with high safety profiles which could be of potential interest for HIE management in MSF contexts: melatonin and vitamin k (VK). Melatonin preserves the developing brain from injury...

The Pan African medical journal, 2018

INTRODUCTION: acute thiamine deficiency (TD) in infancy is well described in Asia but poorly docu... more INTRODUCTION: acute thiamine deficiency (TD) in infancy is well described in Asia but poorly documented in Africa. Critically ill patients have increased thiamine body consumption (associated with hyper metabolism) and dextrose-based IV fluid increase thiamine cellular demand even further. Parenteral nutrition with vitamins is not a current practice in many resources limited settings. Consequently, severe acute conditions might result in TD or trigger TD signs in patients with borderline thiamine status, with life threatening consequences. METHODS: a critically ill 3-months old infant was admitted for acute respiratory distress with a working diagnosis of complicated pneumonia, fever, tachypnea with bilateral crackles, tachycardia, no edemas, poor feeding and hypotonia. Malaria rapid test was negative. He received IV ceftriaxone, IV fluids maintenance (RL/D5%) and O2 to maintain SpO2 > 92%. 8 hours later (H8), his condition worsened with hypoxia, lethargy and toxic appearance. An...

The Pan African medical journal, 2018

INTRODUCTION: selon la derniere enquete demographique et de sante du Mali (EDSM V 2012 - 2013) 39... more INTRODUCTION: selon la derniere enquete demographique et de sante du Mali (EDSM V 2012 - 2013) 39% des enfants de 12 - 24 mois etaient completement vaccines et 71% avaient recu la vaccination anti-rougeole. Depuis 2012, MSF apporte des soins gratuits, en appui au ministere de la sante au centre de sante communautaire et au centre de sante de reference d´Ansongo dans le nord du Mali (grande labilite securitaire). En 2015, nous avons mis en place un systeme de verification du statut vaccinal pour eviter les opportunites manquees au niveau des differents services. En parallele les vaccinations sont associees aux campagnes de chimio prevention du paludisme saisonnier (CPS) 4 mois/an. METHODES: etude retrospective sur les donnees des registres de patients de 0 - 23 mois admis au CESREF et en OPD du centre de sante d’Ansongo d’avril a decembre 2016 puis de janvier a avril 2017. RESULTATS: nombre d’enfants a jour de leurs vaccinations et rattrapes en 2016 - 2017 au sein du CESREF et du CES...

Introduction: according to WHO, worldwide 10 - 20% of children and adolescents experience mental ... more Introduction: according to WHO, worldwide 10 - 20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence children’s development and their educational attainments. Children with mental disorders face major challenges with stigma, lack of access to health care and education. In MSF Spain, it has been set as an operational priority to increase the access of adolescents to health programs, including MHPSS (Mental Health and Psychosocial Support) programs. Method: an analysis was done from HMIS (Health Management Information System) in order to identify the number of adolescents that were reached by MSF Spain MHPSS programs during 2015 and 2016. In 2016, some strategies were put in place to increase the number of adolescent’s beneficiaries: inclusion of adoles...

[This corrects the article DOI: 10.1371/journal.pone.0250933.].

Annals of the New York Academy of Sciences

PLOS ONE

Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrit... more Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrition (SAM) and TB diagnosis remains particularly challenging in the very young. We explored whether, in a low HIV-prevalence setting, the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine may assist TB diagnosis in SAM children, a pediatric population currently not included in LAM-testing recommendations. To that end, we assessed LAM test-positivity among SAM children with and without signs or symptoms of TB. Methods A cross-sectional assessment (February 2016-August 2017) included children <5 years with SAM from an Intensive-Therapeutic-Feeding-Centre in Madaoua, Niger. Group 1: children with signs or symptoms suggestive of TB. Group 2: children without any sign or symptom of TB. Urine-specimens were subjected to DetermineTM TB-LAM lateral-flow-test (using a 4-grade intensity scale for positives). LAM-results were used for study purposes and not for patient managemen...

SARS-Cov-2 is an RNA virus responsible for the Covid-19 pandemic which already claimed more than ... more SARS-Cov-2 is an RNA virus responsible for the Covid-19 pandemic which already claimed more than 215,000 lives worldwide as of April 28, 2020. Selenium has a key and complex role in the immune system. It is very clear that selenium deficiency is associated with higher susceptibility to RNA viral infections and more severe disease outcome. We present here how selenium deficiency promotes mutations, replication and virulence of RNA viruses. Selenium might be beneficial via various mechanisms including virus-host cell attachment interaction, restoration of host antioxidant capacity, anti-inflammatory and anti-clotting effects, to name a few. Selenium has been overlooked but probably has a significant place in Covid-19 management, especially in the elderly, and might represent a game changer in the global response to Covid-19.

BMJ Open

IntroductionDiagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the ... more IntroductionDiagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the non-specific, highly variable clinical presentation, often leading to misdiagnosis. Our primary objective is to develop a case definition for thiamine responsive disorders (TRD) to determine among hospitalised infants and young children, which clinical features and risk factors identify those who respond positively to thiamine administration.Methods and analysisThis prospective study will enrol 662 children (aged 21 days to <18 months) seeking treatment for TDD symptoms. Children will be treated with intravenous or intramuscular thiamine (100 mg daily for a minimum of 3 days) alongside other interventions deemed appropriate. Baseline assessments, prior to thiamine administration, include a physical examination, echocardiogram and venous blood draw for the determination of thiamine biomarkers. Follow-up assessments include physical examinations (after 4, 8, 12, 24, 36, 48 and 72 hours)...

Annals of the New York Academy of Sciences

Oxford Medical Case Reports

An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with sever... more An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with severe blistering dermatosis. He was treated with broad spectrum antibiotics and dressings, without improvement. After 2 weeks, linear IgA bullous dermatosis was suspected. Owing to lack of dapsone, the child was treated with prednisolone and improved. To avoid corticosteroids side effects, 2 months after starting prednisolone we switched to colchicine, but the boy's condition worsened for reasons of poor adherence, requiring intravenous corticosteroids and antibiotics. After complete resolution of the skin lesions, we continued with colchicine monotherapy, then changed to dapsone after 3 months. The child did not show any further signs of dermatosis, but his follow-up ended abruptly, because he did not return to the hospital. IgA bullous dermatosis is a challenging diagnosis in settings where pathological studies cannot be conducted. Multidisciplinary treatment is required and colchicine is a good option if dapsone is not available.