Respiratory disease and acute respiratory difficulties are life threatening problems frequently m... more Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
C ette revue vise à proposer des recommandations permettant d'éviter les principaux risques encou... more C ette revue vise à proposer des recommandations permettant d'éviter les principaux risques encourus par les enfants lorsqu'ils voyagent hors d'Europe. Elle reflète un niveau d'évidence faible (= avis d'expert) dans la mesure où la littérature pédiatrique est extrêmement pauvre sur le sujet. De manière très sommaire, les affections potentielles relèvent soit d'une maladie «habituelle» ou cosmopolite, soit d'une maladie tropicale, soit d'un «traumatisme» (souvent en relation avec un accident de la circulation). 30 à 50 pour cent des voyageurs adultes seront malades au cours du voyage, 10 pour cent nécessitant une consultation médicale, 0,3 pour cent une hospitalisation, 0,05 pour cent une évacuation sanitaire et 0,01pour cent décéderont. Une consultation spécifique bien conduite avant le départ en voyage permet certainement de diminuer cette morbidité. Elle doit être structurée et prend du temps ... Recommandations générales: Puis-je voyager avec mon enfant? Cette question ne se pose pas pour un voyage dans le sud de l'Europe. Par contre, dès qu'une destination telle que l'Afrique ou l'Asie du Sud-Est est prévue, il faut s'interroger sur le bien-fondé d'un tel voyage, surtout pour les très jeunes enfants. Ce n'est pas tant la destination
Background: Children younger than 36 months with fever without a source (FWS) are at risk of seri... more Background: Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm. Methods: We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI. Results: Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for > 2 days (OR 29.1, 95% CI 3.5-243.5), and age < 9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively. Conclusions: In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.
QUESTIONS: Is the novel in-vitro diagnostic device U-Test ® reliable and secure for urine collect... more QUESTIONS: Is the novel in-vitro diagnostic device U-Test ® reliable and secure for urine collection in diaperwearing children and simultaneous evaluation of the urine collected for the presence of leucocytes and nitrite? METHODS: The qualitative and functional performance of U-Test ® was evaluated in a multicentre prospective clinical trial. The diagnostic performance of the novel in-vitro diagnostic device was determined in reference to the established procedure involving urine sampling by urine-bag, clean-catch, catheterisation and suprapubic aspiration followed by dipstick analysis and urine culture, and in an invitro study. RESULTS: U-Test ® proved to be comfortable and secure for the child and well accepted by the persons responsible for the participating children. No undesired side-effects were seen and in 75.8% (95% CI ± 10.5%; n = 66) of the tests used, enough urine was collected within the permitted time for immediate and successful urine analysis by the integrated test card. Diagnostic performance was found to be comparable to the established procedure using dipstick analysis (leucocytes: κ-coefficient 0.86; nitrite: κcoefficient 0.74; n = 150). Sensitivity of the U-Test ® for leucocyte detection was found to be 96.7% and specificity 100.0%. For nitrite detection sensitivity of 90.0% and specificity of 98.3% were found. CONCLUSIONS: The evaluation shows that U-Test ® is a safe and reliable device of high functionality and diagnostic performance for the detection of leucocytes and nitrite directly and without time delay in a child's diaper. This statement is based on a comprehensive comparison of the novel device with accepted diagnostic test systems and procedures based on the same dry chemistry technology. Due to its simplicity of use, U-Test ® can be considered an alternative to the cumbersome procedures of urine collection by the bag-method or clean-catch followed by dipstick analysis for the presence of leucocytes and nitrite.
The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatme... more The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatment of a critically ill or injured infant/young child. Now incorporated to the PALS course, it can be taught to all levels of health care providers in charge of severly-ill children. The PAT is a rapid and simple observational tool suitable for pediatric assessment regardless of complaint or underlying diagnosis. It can be introduced in every emergency department, especially those having relatively infrequent encounters with very sick children. Implementation of such a tool needs formal theoritical and practical education skills, rapid availability of experienced pediatric seniors and spaces specifically intented for children.
BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activit... more BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital. METHODS: Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects. RESULTS: A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010. CONCLUSION: This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited.
Objective: Malnutrition is responsible globally for 60% of deaths among children under 5 years an... more Objective: Malnutrition is responsible globally for 60% of deaths among children under 5 years and is often attributed to suboptimal feeding practices. In response, the World Health Organization recommends exclusive breast-feeding for the first 6 months of life. The objective of this study was to determine if an association exists between the early introduction of water and complementary foods (CFs) and the nutritional status of children in northern Senegal. Design/Setting/Subjects: A cross-sectional study of 374 children in the Podor Health District between the ages of 6 and 23 months was conducted. Knowledge and behaviours of mothers regarding introduction of water and CFs were assessed via individual interviews. Results: Water was introduced to about 85% of the children in the first 3 months of life and 62% were fed CFs before 6 months. Overall, 16% had clinically significant wasting (weight-for-length Z-score (WHZ) less than 22) and 20% had stunting (height-forage Z-score (HAZ) less than 2 2). There was no significant association between wasting or stunting and introduction of water before 3 months (WHZ: odds ratio ¼ 0.99, 95% confidence interval 0.46-2.14, P ¼ 0.97; HAZ: 0.68, 0.34-1.36, P ¼ 0.3) or introduction of CFs before 6 months (WHZ: 0.81, 0.46-1.42, P ¼ 0.5; HAZ: 0.79, 0.46-1.35, P ¼ 0.4). A significant association was found between wasting and male sex, age, living in Guede community, drinking river/pond water and large family size, while stunting was associated with age and drinking tap water. Conclusion: The results of the present study suggest that early introduction of water and CFs is frequent and is not associated with increased risk for malnutrition among children from this region of northern Senegal, but the possibility of reverse causality cannot be excluded. Keywords Malnutrition Infant food Breast-feeding Diarrhoea Western Africa Globally, malnutrition is responsible for 60% of the 10.9 million annual deaths among children under 5, with over two-thirds of these deaths occurring during the first year of life 1. Malnutrition is associated with 61% of deaths from diarrhoeal disease 2,3 and is a major prognostic indicator for diarrhoea-related mortality and convalescence 4. The World Health Organization (WHO) recommends exclusive breast-feeding for the first 6 months of life, with nutritionally adequate and safe complementary feeding while breast-feeding continues up to 2 years of life 1. Exclusive breast-feeding during the first 6 months of life is recommended to avoid exposure to contaminants and displacement of breast-feeding by water or other foods. Despite the well-known advantages of breast-feeding 5,6 and WHO recommendations, ,35% of infants worldwide are exclusively breast-fed for the first 4 months of life 1 , and many studies have demonstrated a high prevalence of early introduction of water and complementary foods (CFs) in the African setting 7,8. The objective of this study was to determine if an association exists between the early introduction of water (before 3 months) and CFs (before 6 months) and the nutritional status of infants and young children in northern Senegal, a region where early introduction of water and CFs is a frequent practice. This study additionally aimed to assess by qualitative analysis the underlying knowledge and behaviours regarding early introduction of water and CFs in this region.
For general practitioners, emergency assessment of a critically ill or injured child can be diffi... more For general practitioners, emergency assessment of a critically ill or injured child can be difficult, as history is usually given by caregivers, physical examination may be challenging due to lack of cooperation and vital signs are potentially difficult to interpret because of age-related variations. The Pediatric Assessment Triangle (PAT) is a rapid and simple observational tool to standardize the initial assessment of children regardless of complaint or underlying diagnosis. It only uses visual and auditory clues, requires no equipment, and takes only seconds to perform. It allows clinicians to assess whether an urgent intervention is necessary or whether a more detailed history and physical examination may be done. Respiratory distress, gastro-enteritis with dehydration, febrile convulsions and traumatic brain injury constitute four common pediatric complaints that are encountered in a general practitioners consultation and will be discussed in some detail.
La prise en charge des familles migrantes et de leurs enfants représente une part importante de l... more La prise en charge des familles migrantes et de leurs enfants représente une part importante de l'activité quotidienne d'un médecin, que ce soit en cabinet privé ou dans un centre d'urgences hospitalier. Le médecin de cabinet est la personne-clé pour ces familles.
Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the ab... more Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the absence of the clinical and laboratory findings typical of bacterial CAP, antibiotics are not required. However, the true value of the clinical and laboratory predictors of pediatric CAP still needs to be assessed. This prospective cohort study in three emergency departments enrolled 142 children with radiological pneumonia. Pneumonia with lung consolidation was the primary endpoint; complicated pneumonia (bacteremia, empyema, or pleural effusion) was the secondary endpoint. We showed that three clinical signs (unilateral hypoventilation, grunting, and absence of wheezing), elevated procalcitonin (PCT), C-reactive protein (CRP), negative nasopharyngeal viral PCR, or positive blood pneumococcal PCR (P-PCR) were significantly associated with both pneumonia with consolidation and complicated pneumonia. Children with negative clinical signs and low CRP values had a low probability of having pneumonia with consolidation (13%) or complicated pneumonia (6%). Associating the three clinical signs, CRP >80 mg/L and a positive P-PCR ruled in the diagnosis of complicated pneumonia with a positive predictive value of 75%. Conclusion: A model incorporating clinical signs and laboratory markers can effectively assess the risk of having pneumonia. Children with negative clinical signs and low CRP are at a low risk of having pneumonia. For children with positive clinical signs and high CRP, a positive blood pneumococcal Communicated by Communicated by Nicole Ritz
High-risk genital HPV types cause most high-grade precancerous lesions and > 99.7% of cervical ca... more High-risk genital HPV types cause most high-grade precancerous lesions and > 99.7% of cervical cancers (Frazer et al., 2006). Approximately 570,000 cervical cancers and 311,000 deaths occurred worldwide in 2018. HPV is also associated with other genital and oropharyngeal cancers and with anogenital warts.
Respiratory disease and acute respiratory difficulties are life threatening problems frequently m... more Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
The wave of migration that has hit Europe in recent years has led to several changes in the organ... more The wave of migration that has hit Europe in recent years has led to several changes in the organization of asylum systems and medical care provided to migrants. Previous studies indicate that asylum seekers and refugees face multiple barriers in accessing health care. For that reason, adapted structures are needed. In this context, a family consultation service was implemented in our medical center in Lausanne, Switzerland. It aimed at addressing the unique health care needs of recently resettled families from Syria, which has been the leading source country for refugees since 2014. This intervention, developed through collaboration between the University Center for Primary Care and Public Health (Unisanté) and the Children's Hospital of Lausanne (HEL) involved a multidisciplinary team comprising a pediatrician, a general practitioner and a pediatric nurse. Bringing together a multidisciplinary team optimized care coordination, facilitated communication between care providers and enabled a more global vision of the family system with the aim of enhancing quality of care.
Sedentary lifestyle in children is increasing at an alarming rate. Now, promotion of physical act... more Sedentary lifestyle in children is increasing at an alarming rate. Now, promotion of physical activity by health professionals is a promising way. To support childhood specialists in this role, a transdisciplinary training is being developped.
Schweizerische Medizinische Wochenschrift, Jun 4, 2020
AIMS: Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age fo... more AIMS: Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age for tuberculosis (TB) and to screen older children only if they have risk factors for tuberculosis. Our goals were to describe the epidemiology of latent tuberculosis in migrant children at the Lausanne University Hospital, to identify determinants of latent tuberculosis and tuberculosis disease, and to evaluate the risk of a false-positive tuberculin skin test when using a positivity limit of 5 mm. CONCLUSION: Screening migrant children ≥5 years of age for tuberculosis could confer a public health benefit even in the absence of other risk factors. The limit of tuberculin skin test positivity could be raised from ≥5 mm to ≥10 mm to decrease the rate of false-positive results. A national assessment of migrant children between the ages of 5 and 15 should be carried out to confirm our findings.
Background: Community-acquired pneumonia (CAP) is a serious cause of morbidity among children in ... more Background: Community-acquired pneumonia (CAP) is a serious cause of morbidity among children in developed countries. The real impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal pneumonia is difficult to assess accurately. Methods: Children aged ≤16 years with clinical and radiological pneumonia were enrolled in a multicenter prospective study. Children aged ≤16 years admitted for a minor elective surgery was recruited as controls. Nasopharyngeal samples for PCR serotyping of S. pneumoniae were obtained in both groups. Informations on age, gender, PCV7 vaccination status, day care/school attendance, siblings, tobacco exposure were collected. Results: In children with CAP (n=236), 54% of the nasopharyngeal swabs were PCR-positive for S. pneumoniae compared to 32% in controls (n=105) (p=0.003). Serotype 19A was the most common pneumococcal serotype carried in children with CAP (13%) and in controls (15%). Most common serotypes were non-vaccine types (39.4% for CAP and 47.1% for controls) and serotypes included only in PCV13 (32.3% for CAP and 23.5% for controls). There was no significant difference in vaccine serotype distribution between the two groups. In fully vaccinated children with CAP, the proportion of serotypes carried only in PCV13 was higher (51.4%) than in partially vaccinated or non vaccinated children (27.6% and 28.6% respectively, p=0.037). Conclusions: Two to 4 years following introduction of PCV7, predominant S. pneumoniae serotypes carried in children with CAP were non PCV7 serotypes, and the 6 new serotypes included in PCV13 accounted for 51.4% of carried serotypes in fully vaccinated children.
Respiratory disease and acute respiratory difficulties are life threatening problems frequently m... more Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
C ette revue vise à proposer des recommandations permettant d'éviter les principaux risques encou... more C ette revue vise à proposer des recommandations permettant d'éviter les principaux risques encourus par les enfants lorsqu'ils voyagent hors d'Europe. Elle reflète un niveau d'évidence faible (= avis d'expert) dans la mesure où la littérature pédiatrique est extrêmement pauvre sur le sujet. De manière très sommaire, les affections potentielles relèvent soit d'une maladie «habituelle» ou cosmopolite, soit d'une maladie tropicale, soit d'un «traumatisme» (souvent en relation avec un accident de la circulation). 30 à 50 pour cent des voyageurs adultes seront malades au cours du voyage, 10 pour cent nécessitant une consultation médicale, 0,3 pour cent une hospitalisation, 0,05 pour cent une évacuation sanitaire et 0,01pour cent décéderont. Une consultation spécifique bien conduite avant le départ en voyage permet certainement de diminuer cette morbidité. Elle doit être structurée et prend du temps ... Recommandations générales: Puis-je voyager avec mon enfant? Cette question ne se pose pas pour un voyage dans le sud de l'Europe. Par contre, dès qu'une destination telle que l'Afrique ou l'Asie du Sud-Est est prévue, il faut s'interroger sur le bien-fondé d'un tel voyage, surtout pour les très jeunes enfants. Ce n'est pas tant la destination
Background: Children younger than 36 months with fever without a source (FWS) are at risk of seri... more Background: Children younger than 36 months with fever without a source (FWS) are at risk of serious bacterial infections (SBI). The risk of occult bacteremia (OB) has been greatly reduced in vaccinated children. The aim of this study is to describe the epidemiology of SBI in children with FWS in our setting and to evaluate the performance of our management algorithm. Methods: We designed a prospective cohort study. We included children aged 0-36 months presenting with FWS in our emergency unit. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Information on clinical evolution, final diagnosis, and immunization history were obtained after 10 days. Potential predictors of SBI were compared between patients with and without SBI. Results: Between October 2015 and September 2017, 173 children were recruited, with a median age of 4.4 months (2.1-1). Of these children, 166 (96%) were up to date with their vaccinations. A total of 47 children (27%) had a final diagnosis of SBI, which were all urinary tract infections (UTI). Presence of chills (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.3-24.3), fever for > 2 days (OR 29.1, 95% CI 3.5-243.5), and age < 9 months (OR: 45.3, 95% CI: 4.9-415.7) were statistically significant predictors of UTI in a multivariate logistic regression. The sensitivity and specificity of our management algorithm were 100% (95% CI: 92.4-100%) and 21.4% (14.6-29.6%), respectively. Conclusions: In the setting of high vaccination coverage, we only identified SBI related to UTIs. We could not identify any OB. Our management algorithm was able to identify all SBI, but specificity was low. Refined criteria for screening of UTI could slightly increase this.
QUESTIONS: Is the novel in-vitro diagnostic device U-Test ® reliable and secure for urine collect... more QUESTIONS: Is the novel in-vitro diagnostic device U-Test ® reliable and secure for urine collection in diaperwearing children and simultaneous evaluation of the urine collected for the presence of leucocytes and nitrite? METHODS: The qualitative and functional performance of U-Test ® was evaluated in a multicentre prospective clinical trial. The diagnostic performance of the novel in-vitro diagnostic device was determined in reference to the established procedure involving urine sampling by urine-bag, clean-catch, catheterisation and suprapubic aspiration followed by dipstick analysis and urine culture, and in an invitro study. RESULTS: U-Test ® proved to be comfortable and secure for the child and well accepted by the persons responsible for the participating children. No undesired side-effects were seen and in 75.8% (95% CI ± 10.5%; n = 66) of the tests used, enough urine was collected within the permitted time for immediate and successful urine analysis by the integrated test card. Diagnostic performance was found to be comparable to the established procedure using dipstick analysis (leucocytes: κ-coefficient 0.86; nitrite: κcoefficient 0.74; n = 150). Sensitivity of the U-Test ® for leucocyte detection was found to be 96.7% and specificity 100.0%. For nitrite detection sensitivity of 90.0% and specificity of 98.3% were found. CONCLUSIONS: The evaluation shows that U-Test ® is a safe and reliable device of high functionality and diagnostic performance for the detection of leucocytes and nitrite directly and without time delay in a child's diaper. This statement is based on a comprehensive comparison of the novel device with accepted diagnostic test systems and procedures based on the same dry chemistry technology. Due to its simplicity of use, U-Test ® can be considered an alternative to the cumbersome procedures of urine collection by the bag-method or clean-catch followed by dipstick analysis for the presence of leucocytes and nitrite.
The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatme... more The Pediatric Assessment Triangle (PAT) has become the cornerstone for the assessment and treatment of a critically ill or injured infant/young child. Now incorporated to the PALS course, it can be taught to all levels of health care providers in charge of severly-ill children. The PAT is a rapid and simple observational tool suitable for pediatric assessment regardless of complaint or underlying diagnosis. It can be introduced in every emergency department, especially those having relatively infrequent encounters with very sick children. Implementation of such a tool needs formal theoritical and practical education skills, rapid availability of experienced pediatric seniors and spaces specifically intented for children.
BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activit... more BACKGROUND: The writing of prescriptions is an important aspect of medical practice. This activity presents some specific problems given a danger of misinterpretation and dispensing errors in community pharmacies. The objective of this study was to determine the evolution of the prescription practice and writing quality in the outpatient clinics of our paediatric university hospital. METHODS: Copies of prescriptions written by physicians were collected from community pharmacies in the region of our hospital for a two-month period in 2005 and 2010. They were analysed according to standard criteria, including both formal and pharmaceutical aspects. RESULTS: A total of 597 handwritten prescriptions were reviewed in 2005 and 633 in 2010. They contained 1,456 drug prescriptions in 2005 and 1,348 in 2010. Fifteen drugs accounted for 80% of all prescriptions and the most common drugs were paracetamol and ibuprofen. A higher proportion of drugs were prescribed as International Nonproprietary Names (INN) or generics in 2010 (24.7%) compared with 2005 (20.9%). Of the drug prescriptions examined, 55.5% were incomplete in 2005 and 69.2% in 2010. Moreover in 2005, 3.2% were legible only with difficulty, 22.9% were ambiguous, and 3.0% contained an error. These proportions rose respectively to 5.2%, 27.8%, and 6.8% in 2010. CONCLUSION: This study showed that fifteen different drugs represented the majority of prescriptions, and a quarter of them were prescribed as INN or generics in 2010; and that handwritten prescriptions contained numerous omissions and preventable errors. In our hospital computerised prescribing coupled with advanced decision support is eagerly awaited.
Objective: Malnutrition is responsible globally for 60% of deaths among children under 5 years an... more Objective: Malnutrition is responsible globally for 60% of deaths among children under 5 years and is often attributed to suboptimal feeding practices. In response, the World Health Organization recommends exclusive breast-feeding for the first 6 months of life. The objective of this study was to determine if an association exists between the early introduction of water and complementary foods (CFs) and the nutritional status of children in northern Senegal. Design/Setting/Subjects: A cross-sectional study of 374 children in the Podor Health District between the ages of 6 and 23 months was conducted. Knowledge and behaviours of mothers regarding introduction of water and CFs were assessed via individual interviews. Results: Water was introduced to about 85% of the children in the first 3 months of life and 62% were fed CFs before 6 months. Overall, 16% had clinically significant wasting (weight-for-length Z-score (WHZ) less than 22) and 20% had stunting (height-forage Z-score (HAZ) less than 2 2). There was no significant association between wasting or stunting and introduction of water before 3 months (WHZ: odds ratio ¼ 0.99, 95% confidence interval 0.46-2.14, P ¼ 0.97; HAZ: 0.68, 0.34-1.36, P ¼ 0.3) or introduction of CFs before 6 months (WHZ: 0.81, 0.46-1.42, P ¼ 0.5; HAZ: 0.79, 0.46-1.35, P ¼ 0.4). A significant association was found between wasting and male sex, age, living in Guede community, drinking river/pond water and large family size, while stunting was associated with age and drinking tap water. Conclusion: The results of the present study suggest that early introduction of water and CFs is frequent and is not associated with increased risk for malnutrition among children from this region of northern Senegal, but the possibility of reverse causality cannot be excluded. Keywords Malnutrition Infant food Breast-feeding Diarrhoea Western Africa Globally, malnutrition is responsible for 60% of the 10.9 million annual deaths among children under 5, with over two-thirds of these deaths occurring during the first year of life 1. Malnutrition is associated with 61% of deaths from diarrhoeal disease 2,3 and is a major prognostic indicator for diarrhoea-related mortality and convalescence 4. The World Health Organization (WHO) recommends exclusive breast-feeding for the first 6 months of life, with nutritionally adequate and safe complementary feeding while breast-feeding continues up to 2 years of life 1. Exclusive breast-feeding during the first 6 months of life is recommended to avoid exposure to contaminants and displacement of breast-feeding by water or other foods. Despite the well-known advantages of breast-feeding 5,6 and WHO recommendations, ,35% of infants worldwide are exclusively breast-fed for the first 4 months of life 1 , and many studies have demonstrated a high prevalence of early introduction of water and complementary foods (CFs) in the African setting 7,8. The objective of this study was to determine if an association exists between the early introduction of water (before 3 months) and CFs (before 6 months) and the nutritional status of infants and young children in northern Senegal, a region where early introduction of water and CFs is a frequent practice. This study additionally aimed to assess by qualitative analysis the underlying knowledge and behaviours regarding early introduction of water and CFs in this region.
For general practitioners, emergency assessment of a critically ill or injured child can be diffi... more For general practitioners, emergency assessment of a critically ill or injured child can be difficult, as history is usually given by caregivers, physical examination may be challenging due to lack of cooperation and vital signs are potentially difficult to interpret because of age-related variations. The Pediatric Assessment Triangle (PAT) is a rapid and simple observational tool to standardize the initial assessment of children regardless of complaint or underlying diagnosis. It only uses visual and auditory clues, requires no equipment, and takes only seconds to perform. It allows clinicians to assess whether an urgent intervention is necessary or whether a more detailed history and physical examination may be done. Respiratory distress, gastro-enteritis with dehydration, febrile convulsions and traumatic brain injury constitute four common pediatric complaints that are encountered in a general practitioners consultation and will be discussed in some detail.
La prise en charge des familles migrantes et de leurs enfants représente une part importante de l... more La prise en charge des familles migrantes et de leurs enfants représente une part importante de l'activité quotidienne d'un médecin, que ce soit en cabinet privé ou dans un centre d'urgences hospitalier. Le médecin de cabinet est la personne-clé pour ces familles.
Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the ab... more Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the absence of the clinical and laboratory findings typical of bacterial CAP, antibiotics are not required. However, the true value of the clinical and laboratory predictors of pediatric CAP still needs to be assessed. This prospective cohort study in three emergency departments enrolled 142 children with radiological pneumonia. Pneumonia with lung consolidation was the primary endpoint; complicated pneumonia (bacteremia, empyema, or pleural effusion) was the secondary endpoint. We showed that three clinical signs (unilateral hypoventilation, grunting, and absence of wheezing), elevated procalcitonin (PCT), C-reactive protein (CRP), negative nasopharyngeal viral PCR, or positive blood pneumococcal PCR (P-PCR) were significantly associated with both pneumonia with consolidation and complicated pneumonia. Children with negative clinical signs and low CRP values had a low probability of having pneumonia with consolidation (13%) or complicated pneumonia (6%). Associating the three clinical signs, CRP >80 mg/L and a positive P-PCR ruled in the diagnosis of complicated pneumonia with a positive predictive value of 75%. Conclusion: A model incorporating clinical signs and laboratory markers can effectively assess the risk of having pneumonia. Children with negative clinical signs and low CRP are at a low risk of having pneumonia. For children with positive clinical signs and high CRP, a positive blood pneumococcal Communicated by Communicated by Nicole Ritz
High-risk genital HPV types cause most high-grade precancerous lesions and > 99.7% of cervical ca... more High-risk genital HPV types cause most high-grade precancerous lesions and > 99.7% of cervical cancers (Frazer et al., 2006). Approximately 570,000 cervical cancers and 311,000 deaths occurred worldwide in 2018. HPV is also associated with other genital and oropharyngeal cancers and with anogenital warts.
Respiratory disease and acute respiratory difficulties are life threatening problems frequently m... more Respiratory disease and acute respiratory difficulties are life threatening problems frequently met in paediatric medicine. Since parents often call their doctor first, telephone triage is important in the correct management of children with respiratory distress. On arrival in the office or the emergency department, a child with dyspnea should rapidly be assessed for signs of severity and respiratory compromise. Oxygenation and early initiation of specific treatment are priorities in the management. Only a simple and rigorous clinical process, based on the essential, will reach all these objectives without delay. As soon as the child's situation is stabilised, the doctor decides what are the appropriate modalities for transfer. This article aims at reviewing these different issues.
The wave of migration that has hit Europe in recent years has led to several changes in the organ... more The wave of migration that has hit Europe in recent years has led to several changes in the organization of asylum systems and medical care provided to migrants. Previous studies indicate that asylum seekers and refugees face multiple barriers in accessing health care. For that reason, adapted structures are needed. In this context, a family consultation service was implemented in our medical center in Lausanne, Switzerland. It aimed at addressing the unique health care needs of recently resettled families from Syria, which has been the leading source country for refugees since 2014. This intervention, developed through collaboration between the University Center for Primary Care and Public Health (Unisanté) and the Children's Hospital of Lausanne (HEL) involved a multidisciplinary team comprising a pediatrician, a general practitioner and a pediatric nurse. Bringing together a multidisciplinary team optimized care coordination, facilitated communication between care providers and enabled a more global vision of the family system with the aim of enhancing quality of care.
Sedentary lifestyle in children is increasing at an alarming rate. Now, promotion of physical act... more Sedentary lifestyle in children is increasing at an alarming rate. Now, promotion of physical activity by health professionals is a promising way. To support childhood specialists in this role, a transdisciplinary training is being developped.
Schweizerische Medizinische Wochenschrift, Jun 4, 2020
AIMS: Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age fo... more AIMS: Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age for tuberculosis (TB) and to screen older children only if they have risk factors for tuberculosis. Our goals were to describe the epidemiology of latent tuberculosis in migrant children at the Lausanne University Hospital, to identify determinants of latent tuberculosis and tuberculosis disease, and to evaluate the risk of a false-positive tuberculin skin test when using a positivity limit of 5 mm. CONCLUSION: Screening migrant children ≥5 years of age for tuberculosis could confer a public health benefit even in the absence of other risk factors. The limit of tuberculin skin test positivity could be raised from ≥5 mm to ≥10 mm to decrease the rate of false-positive results. A national assessment of migrant children between the ages of 5 and 15 should be carried out to confirm our findings.
Background: Community-acquired pneumonia (CAP) is a serious cause of morbidity among children in ... more Background: Community-acquired pneumonia (CAP) is a serious cause of morbidity among children in developed countries. The real impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal pneumonia is difficult to assess accurately. Methods: Children aged ≤16 years with clinical and radiological pneumonia were enrolled in a multicenter prospective study. Children aged ≤16 years admitted for a minor elective surgery was recruited as controls. Nasopharyngeal samples for PCR serotyping of S. pneumoniae were obtained in both groups. Informations on age, gender, PCV7 vaccination status, day care/school attendance, siblings, tobacco exposure were collected. Results: In children with CAP (n=236), 54% of the nasopharyngeal swabs were PCR-positive for S. pneumoniae compared to 32% in controls (n=105) (p=0.003). Serotype 19A was the most common pneumococcal serotype carried in children with CAP (13%) and in controls (15%). Most common serotypes were non-vaccine types (39.4% for CAP and 47.1% for controls) and serotypes included only in PCV13 (32.3% for CAP and 23.5% for controls). There was no significant difference in vaccine serotype distribution between the two groups. In fully vaccinated children with CAP, the proportion of serotypes carried only in PCV13 was higher (51.4%) than in partially vaccinated or non vaccinated children (27.6% and 28.6% respectively, p=0.037). Conclusions: Two to 4 years following introduction of PCV7, predominant S. pneumoniae serotypes carried in children with CAP were non PCV7 serotypes, and the 6 new serotypes included in PCV13 accounted for 51.4% of carried serotypes in fully vaccinated children.
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Papers by mario Gehri