Aspect tdm d’une anomalie de l’arc aortique: variante de Nehausser?

Les malformations congénitales par anomalie de position et de développement des arcs brachiaux primitifs représentent 1% des anomalies congénitales cardio-vasculaires. Nous rapportons le cas rare d'un nourrisson de 22 mois, né par voie basse d'une grossesse menée à terme qui a présenté une dyspnée intermittente depuis la naissance associée à une toux. L'angio-scanner cervico-thoracique a permis d'objectiver un arc aortique droit et une artère sub-clavière gauche pré-trachéo-oesophagienne prenant en pince l'œsophage et la trachée à environ 15 mm au-dessus de la carène entrainant une sténose d'environ 70% de la trachée sur une hauteur de 16 mm. Cette malformation complexe représente un type rare d'anomalie de l'arc aortique avec une variante inhabituelle du trajet de l'artère sub-clavière gauche. Elle pose un problème diagnostique et de traitement dans notre contexte du fait des difficultés d'accessibilité au scanner et à la chirurgie

Effects of maternal multiple micronutrient supplementation on fetal growth: A double-blind randomized controlled trial in rural Burkina Faso

Background: Intrauterine growth retardation is a major predictor of child health in developing countries. Objective: We tested whether providing pregnant women with the UNICEF/WHO/UNU international multiple micronutrient preparation (UNIMMAP), rather than iron and folic acid alone, improved fetal growth and its correlates. Design: An intention-to-treat, double-blind, randomized controlled trial including 1426 pregnancies was carried out in rural Burkina Faso. Tablet intake was directly observed. Results: Pregnancy outcome was known in 96.3% of the participants. After adjustment for gestational age at delivery, both birth weight (52 g; 95% CI: 4, 100; P = 0.035) and birth length (3.6 mm; 95% CI: 0.8, 6.3; P = 0.012) were significantly higher in the UNIMMAP group. UNIMMAP had a differential effect by percentiles of birth weight and length distributions: the risk of large-forgestational-age infants was higher in the UNIMMAP group (OR: 1.58; 95% CI: 1.04, 2.38; P = 0.03), although the risk of low birth weight remained unchanged. The effect of UNIMMAP on birth size was modified by maternal body mass index at enrollment and could be more important in multiparous women and women taking sulfadoxine-pyrimethamine. Unexpectedly, the risk of perinatal death was marginally significantly increased in the UNIMMAP group (OR: 1.78; 95% CI: 0.95, 3.32; P = 0.07), and this seemed to affect mainly primiparous women (OR: 3.44; 95% CI: 1.1, 10.7; P for interaction = 0.11). Conclusions: Maternal UNIMMAP modestly but significantly increased fetal growth. The resulting benefit on infant growth and survival needs to be assessed. The possible lack of benefit and potential harm in primiparous women should be further investigated. This trial was registered at clinicaltrials.gov as NCT00642408. © 2008 American Society for Nutrition.SCOPUS: ar.jinfo:eu-repo/semantics/publishe