Qualité du suivi, en médecine de ville, de la croissance et de la corpulence des enfants prépubères habitant l agglomération lilloise

Contexte : Depuis 2011, il existe des recommandations de la HAS concernant la fréquence du suivi de la croissance et de la corpulence des enfants et des adolescents. Ce suivi est capital pour le dépistage et la prévention du surpoids, de la sous-nutrition et des troubles de la croissance staturale. A l heure actuelle, il y a peu d études disponibles sur la qualité du suivi de la croissance et de la corpulence chez les enfants français. Méthode : Notre objectif était d évaluer la qualité du suivi, en médecine de ville, chez les enfants prépubères selon les critères de la HAS. Nous avons réalisé une étude quantitative, rétrospective et monocentrique qui s est appuyée sur l analyse du carnet de santé de l enfant (CSE) et un questionnaire destiné aux parents. L informatisation des dossiers médicaux en cabinet de ville a été prise en compte selon la déclaration des parents. 301 enfants issus de l agglomération lilloise et pris en charge au CHRU de Lille pour une maladie chirurgicale aigüe ont été inclus dans cette étude. Résultats : 10% des enfants inclus ont eu un suivi de la croissance et de la corpulence conforme aux recommandations de la HAS. La qualité du suivi a été influencée par l âge de l enfant, la catégorie socioprofessionnelle des parents, le médecin réalisant le suivi (généraliste, pédiatre libéral et/ou médecin de PMI) . Ainsi, le suivi a été meilleur chez les enfants plus jeunes (moins de 7 ans), suivis par un pédiatre et dont les parents appartenaient à une catégorie socioprofessionnelle élevée. Sur la période des 12 derniers mois, les mesures ont été notées au minimum 2 fois sur le CSE pour respectivement 38% d enfants pour le poids, 29% pour la taille et 5% pour l IMC. Les courbes de poids et taille ont été réalisées selon les mêmes critères pour 12% d enfants et celles de l IMC pour 5%. Conclusion : La HAS recommande de réaliser les mesures du poids, de la taille, le calcul de l IMC et la réalisation de ces 3 courbes au minimum 2 fois par an (pour les enfants de plus de 2 ans). Nous avons constaté, sur un échantillon de 301 enfants prépubères vivant en milieu urbain à forte densité médicale, que le pourcentage ayant un bon suivi de la croissance et de la corpulence était très bas (seulement 10%), même si on prenait en compte l informatisation du dossier du patient au cabinet médical. Nous avons pour projet de diffuser ces résultats auprès de nos confrères de ville afin d améliorer le suivi de la croissance et de la corpulence des enfants.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Impact de la surveillance glycémique, des modalités du traitement et du vécu du diabète de type 1 sur l'équilibre de la maladie dans une population d'enfants pré-pubères

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

[Asthma and obesity in childhood: What is the link?]

International audienceAccording to the definition (body mass index>97 degrees percentile), overweight and obesity concern 15% of French children. The parallel trends in the increase in asthma and obesity may indicate a potential link between these two conditions. The purpose of this study was to review the epidemiological data indicating a relationship between asthma and obesity, to evaluate the consequences of obesity on asthma and to assess the mechanisms of this association. We conclude with the implications for treatment strategies

Current Use and Developments Needed for Optimal Design in Pharmacometrics: A Study Performed Among DDMoRe's European Federation of Pharmaceutical Industries and Associations Members

International audienceMethods and software tools for optimal design in nonlinear mixed effect models, based on the Fisher information matrix, have been developed for a decade. Academic groups regularly proposed new versions. Present tools do not incorporate adaptive designs for these models although prior information is needed and adaptive designs are increasingly used in drug development. We conducted a study among drug companies of the Drug and Disease Model Resources consortium to identify current practices and expectations

Growth Hormone Replacement Therapy Seems to Be Safe in Children with Low-Grade Midline Glioma: A Series of 124 Cases with Review of the Literature

There is little scientific evidence regarding the safety of GHRT in LGG, where GH deficiency is common. Purpose: to compare the recurrence rate in children with midline LGG, depending on whether or not they have received GHRT, in order to assess its impact on the risk of tumor recurrence. Methods: This bicentric retrospective study included 124 patients under the age of 18 who were diagnosed with a midline low-grade glial tumor between 1998 and 2016. We also reviewed literature on this subject. The main outcome measure was tumor relapse, demonstrated by brain MRI. Results: There were 17 patients in the GH-supplemented group (14%) and 107 patients in the non-supplemented group (86%). Relapse occurred in 65 patients (45.5%); 7 patients died (4.9%); no deaths occurred in patients receiving GHRT. Two patients developed a second tumor (1.4%), none of which had received GHRT. Relapse concerned 36.4% of patients without GHRT and 52.9% of patients with GHRT. The difference was not statistically significant between the two groups (p = 0.3). Conclusion: GHRT does not lead to a statistically significant increase in risk of relapse for pediatric midline low-grade pediatric glioma in our cohort. Although these results appear reassuring, future natural history or prospective studies should be done to ascertain these findings. Nevertheless, these reassuring data regarding GHRT are in agreement with the data in the current literature

Growth Hormone Replacement Therapy Seems to Be Safe in Children with Low-Grade Midline Glioma: A Series of 124 Cases with Review of the Literature

There is little scientific evidence regarding the safety of GHRT in LGG, where GH deficiency is common. Purpose: to compare the recurrence rate in children with midline LGG, depending on whether or not they have received GHRT, in order to assess its impact on the risk of tumor recurrence. Methods: This bicentric retrospective study included 124 patients under the age of 18 who were diagnosed with a midline low-grade glial tumor between 1998 and 2016. We also reviewed literature on this subject. The main outcome measure was tumor relapse, demonstrated by brain MRI. Results: There were 17 patients in the GH-supplemented group (14%) and 107 patients in the non-supplemented group (86%). Relapse occurred in 65 patients (45.5%); 7 patients died (4.9%); no deaths occurred in patients receiving GHRT. Two patients developed a second tumor (1.4%), none of which had received GHRT. Relapse concerned 36.4% of patients without GHRT and 52.9% of patients with GHRT. The difference was not statistically significant between the two groups (p = 0.3). Conclusion: GHRT does not lead to a statistically significant increase in risk of relapse for pediatric midline low-grade pediatric glioma in our cohort. Although these results appear reassuring, future natural history or prospective studies should be done to ascertain these findings. Nevertheless, these reassuring data regarding GHRT are in agreement with the data in the current literature

A novel <i>TBX19</i> gene mutation in patients with isolated ACTH deficiency from distinct families with a common geographical origin

International audienceIsolated ACTH deficiency (IAD) is a life-threatening condition, particularly in the neonatal period, while a main consequence of undiagnosed isolated ACTH deficiency in survivors is cognitive impairment. TBX19 is involved in the differentiation and proliferation of corticotropic cells and TBX19 mutations are responsible for more than 60% of neonatal cases of IAD. We describe a new variant of the main TBX19 transcript (NM 005149.3, c.840del (p.(Glu280Asp fs*27)), classified as pathogenic, whose pathogenicity is assumed to be due to nonsense mediated decay leading to non-expression of T-box transcription factor TBX19. Moreover we summarize the TBX19 mutations published as individual cases since our last large cohort. Interestingly, this pathogenic variant was identified in four patients from three apparently unrelated families. Two of these families were consanguineous, and after investigations all of three were discovered to have roots in the same mountainous region of northern Morocco, suggesting a founder effect. Early diagnosis, timely treatment (hydrocortisone therapy) and preventive education allowed normal development, growth and quality of life in all patients