Severe Plasmodium falciparum malaria remains a major cause of paediatric morbidity in sub-Saharan Africa. While mortality has declined in many settings, severe disease requiring escalation of care persists. Data on predictors of intensive care unit (ICU) transfer among children with severe malaria remain limited in Central Africa. This study aimed to describe the clinical and biological profiles of paediatric severe malaria in an urban Gabonese setting and to identify factors associated with ICU transfer as an early marker of clinical deterioration. A retrospective analytical study was conducted at the Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori (CHUMEFJE) in Libreville, Gabon. Medical records of children below 17 years and hospitalised between January 2021 and July 2022 with microscopically confirmed P. falciparum malaria were reviewed. Severe malaria was defined according to WHO 2014 criteria. ICU transfer among survivors was the primary adverse outcome. Clinical, laboratory, and demographic variables were analysed using univariate and multivariable logistic regression. A cumulative count of WHO severe malaria criteria was used as an indicator of disease severity. Among 3.009 hospitalised children, 480 (15.9
Introduction & Objectives Studies using ambulatory blood pressure measurement (ABPM) have highlighted a particular form of tensional abnormality: isolated nocturnal hypertension. Our study aims to estimate the prevalence of isolated nocturnal hypertension in hypertensive patients followed on outpatient basis. Methodology It is a cross-sectional descriptive study with prospective recruitment involving 227 hypertensive patients followed in consultation of internal medicine of the CHU Mustapha over a period of 2 years. Results The average age of our patients is 54.9±10.5years. The distribution of the population by sex shows a clear predominance of women (66.5%).Of the 227 hypertensive patients, 80.2% were on antihypertensive therapy at first consultation. Half of our treated patients were on monotherapy (52.2%). In our population, the number of known diabetic subjects is 71 patients (31.3%). Smoking was present in 26 patients (11.5%), sedentary in 19 patients (8.4%), obesity in 93 patients (41%) and dyslipidemia in 70 patients at the time of screening (30.8%). A quarter of our hypertensive patients treated had poor adherence and half of the patients did not follow the half-salt diet. Nocturnal hypertension is present in 65.2% of our population and in 62.6% of our hypertensive patients treated. The prevalence of isolated nocturnal hypertension is estimated at 25.5% of our general population. 18% of patients have masked hypertension. The majority of these patients have nocturnal hypertension (90%). In treated hypertensive patients, the prevalence of isolated nocturnal hypertension is estimated at 25.3% of cases and masked hypertension is estimated at 16.5%. Discussion Recently, studies have been published on the prognosis of a subcategory of masked hypertension (MHT), namely isolated nocturnal hypertension. It is defined as nocturnal hypertension (≥120/≥70mmHg) in the absence of daytime hypertension (<135/85mmHg). Its prevalence is estimated to range from 6% to 21%, depending on the cohorts studied. Numerous studies have shown that persistent nocturnal blood pressure elevation or the absence of a nighttime blood pressure dip is associated with an increased risk of developing target organ damage. Conclusion Using night values, a masked hypertension can be formally excluded and an isolated nocturnal hypertension diagnosed. The latter is considered a subcategory of the masked hypertension.
Nutrition during early childhood is essential for optimal growth, development and health. The first 1,000 days of life constitute a critical period requiring particular attention to nutritional intakes. Algerian experts have formulated clinical recom-mendations regarding the role of young child formulae (YCF) (12-36 months) within an optimized nutritional framework, providing a benchmark for both parents and childcare professionals. This multidisciplinary panel of paediatricians and nutritionists formulated priority questions related to optimal nutrition in toddlers and young children. A syste-matic literature review and evidence grading were conducted according to GRADE levels of evidence. Recommendations were adapted to local contexts and economic acces-sibility. Thirteen consensus statements were developed covering: consideration of micronutrient needs, impact of excess energy and protein, choice of milk type, recom-mended quantities, composition of YCF, alternative nutritional strategies, as well as educational needs of parents and professionals. YCF constitute a potential solution to improve the nutritional status of young Algerian children (12-36 months), particularly for those identified as being at nutritional risk during clinical evaluation.[La nutrition pendant la petite enfance est essentielle à une croissance, un développement et une santé optimaux. Les 1 000 premiers jours de vie constituent une période critique nécessitant une attention particulière aux apports nutritionnels. Des experts algériens ont établi des recommandations sur l’utilisation des préparations pour jeunes enfants (PEJ) (12-36 mois), afin de guider les parents et les professionnels de la petite enfance. Ce panel multidisciplinaire de pédiatres et de nutritionnistes a formulé des questions prioritaires concernant la nutrition optimale des jeunes enfants. Une revue systématique de la littérature et une hiérarchisation des preuves ont été réalisées selon les niveaux de preuve GRADE. Les recommandations ont été adaptées aux contextes locaux et à l'accessibilité économique. Treize déclarations de consensus ont été élaborées couvrant : la prise en compte des besoins en micronutriments, l'impact de l'excès énergétique et protéique, le choix du type de lait, les quantités recommandées, la composition des PJE, les stratégies nutritionnelles alternatives, ainsi que les besoins éducatifs des parents et des professionnels de la petite enfance. Les PJE constituent une solution potentielle pour améliorer le statut nutritionnel des jeunes enfants algériens (12-36 mois), particulièrement chez ceux identifiés comme étant à risque nutritionnel lors de l'évaluation clinique.]
RÉSUMÉ Introduction. Les manifestations neurologiques centrales sont une cause majeure de morbidité et de mortalité chez les personnes vivant avec le VIH, notamment en Afrique subsaharienne. Cette étude visait à décrire leur profil épidémiologique, clinique, radiologique et évolutif chez des patients hospitalisés à Libreville, Gabon. Matériels et méthodes. Nous avons mené une étude rétrospective, transversale et descriptive de janvier 2022 à décembre 2023 au service de médecine interne de l'Hôpital d'Instruction des Armées Omar Bongo Ondimba (Libreville), incluant les patients VIH confirmés présentant une atteinte neurologique centrale documentée par un examen paraclinique contributif(scanner cérébral ou analyse du liquide céphalo-rachidien). Résultats. Sur 243 patients VIH hospitalisés, 70 (28,8 %) ont été inclus : prédominance féminine (52,9 %), âge moyen 44,1 ± 13 ans. Le syndrome méningé prédominait sur le plan clinique (30,0 %). La toxoplasmose cérébrale (48,6 %) et la cryptococcose neuroméningée (17,1 %) étaient les principales étiologies. Une interruption antirétrovirale préexistait chez 72,8 % des patients. La mortalité hospitalière était de 8,6 %. Conclusion. Les atteintes neurologiques centrales concernent près d'un tiers des patients VIH hospitalisés, dominées par des infections opportunistes dans un contexte de rupture thérapeutique fréquente, soulignant l'importance du maintien dans les soins. ABSTRACT Introduction. Central neurological manifestations are a major cause of morbidity and mortality among people living with HIV, particularly in sub-Saharan Africa. This study aimed to describe their epidemiological, clinical, radiological, and evolutionary profile in patients hospitalized in Libreville, Gabon. Methods. We conducted a retrospective, cross-sectional, and descriptive study from January 2022 to December 2023 in the Department of Internal Medicine at the Omar Bongo Ondimba Military Teaching Hospital, Libreville, Gabon. The study, included patients with confirmed HIV infection presenting with documented central neurological involvement established by contributory paraclinical investigation. Results. Among 243 hospitalized HIV patients, 70 (28.8%) were included : predominantly female (52.9%), with a mean age of 44.1 ± 13 years. Meningeal syndrome was the most common clinical presentation (30.0%). Cerebral toxoplasmosis (48.6%) and cryptococcal meningoencephalitis (17.1%) were the leading etiologies. Antiretroviral therapy had been interrupted in 72.8% of patients. The in-hospital mortality rate was 8.6%. Conclusion. Central neurological disorders affected nearly one-third of hospitalized HIV patients, and were predominantly caused by opportunistic infections in the context of frequent treatment interruptions, highlighting the importance of maintaining treatment adherence.
