Should We Assess Pituitary Function in Children After a Mild Traumatic Brain Injury? A Prospective Study

Objective: The aim of this study was to evaluate the frequency of hypopituitarism following TBI in a cohort of children who had been hospitalized for mild TBI and to identify the predictive factors for this deficiency.Design: A prospective study was conducted on children between 2 and 16 years of age who had been hospitalized for mild TBI according to the Glasgow Coma Scale between September 2009 and June 2013. Clinical parameters, basal pituitary hormone assessment at 0, 6, and 12 months, as well as a dynamic testing (insulin tolerance test) 12 months after TBI were performed.Results: The study included 109 children, the median age was 8.5 years. Patients were examined 6 months (n = 99) and 12 months (n = 96) after TBI. Somatotropic deficiency (defined by a GH peak <20 mUI/l in two tests, an IGF-1 <-1SDS and a delta height <0SDS) were confirmed in 2 cases. One case of gonadotrophic deficiency occurred 1 year after TBI among 13 pubertal children. No cases of precocious puberty, 5 cases of low prolactin level, no cases of corticotropic insufficiency (cortisol peak <500 nmol/l) and no cases diabetes insipidus were recorded.Conclusion: Pituitary insufficiency was present 1year after mild TBI in about 7% of children. Based on our results, we suggest testing children after mild TBI in case of clinical abnormalities. i.e., for GH axis, IGF-1, which should be assessed in children with a delta height <0 SDS, 6 to 12 months after TBI, and a dynamic GH testing (preferentially by an ITT) should be performed in case of IGF-1 <-1SDS, with a GH threshold at 20 mUI/L. However, if a systematic pituitary assessment is not required for mild TBI, physicians should monitor children 1 year after mild TBI with particular attention to growth and weight gain

Ivresse de l'adolescent (étude épidémiologique des adolescents de 12 à 16 ans hospitalisés pour intoxication alccolique aiguë de janvier à décembre 2008 au CHU d'Amiens)

Introduction: L'intoxication alcoolique aiguë des adolescents est un problème de santé publique. Matériel et méthodes: Cette étude descriptive, réalisée grâce à un questionnaire pré-établi, a pour but de comprendre qui sont les adolescents hospitalisés pour IAA, leurs motifs, la prise en charge et le devenir. Résultats: 51 adolescents dont 28 filles et 22 garçons ont été hospitalisés pour IAA, dont une majorité de collégiens. Pour la majorité il s'agissait d'une première hospitalisation pour alcoolisation mais pas d'une première prise de toxique. Tous types de milieux professionnels et tous milieux étaient représentés. Les IAA avaient lieu en majorité en journée et en période scolaire. Les alcoolémies étaient très élevées, supérieures à 1,5 à 2g/l. Un tiers des familles présentaient des difficultés à type de violences familiales ou d'alcoolisme. Les alcoolisations festives pures étaient rares. La prise en charge a été une hospitalisation et une prise en charge par un pédiatre et un pédopsychiatre, avec une bonne adhérence à la prise en charge proposée de la part des adolescents et de leur famille et peu de récidives. Discussion: Les IAA des adolescents sont multifactorielles et concernent tous types d'adolescents. Il est important de ne pas dramatiser ni banaliser, et de rechercher des facteurs de gravité et un contexte favorisant sous-jacent. L'hospitalisation permet à l'adolescent de trouver une explication à son acte et d'organiser le suivi s'il est nécessaire. Conclusion: Les IAA de l'adolescents sont potentiellement graves. La venue aux urgences copn,stitue en soi un facteur de risque de mésusage ou de troubles sous-jacents et doit alerter le praticien.Introduction: Acute alcohol intoxication adolescents is a public health problem. Materials and methods: This descriptive study, conducted through a set questionnaire, is intended to include adolescents who are hospitalized for AAI, their motives, the management and outcome. Results: 51 teenagers, including 28 girls and 22 boys were hospitalized for AAI, including a majority of college students. For most it was a first hospitalization for alcohol but not a first usage of toxics. All kinds of professional backgrounds and all walks of life were represented. AAIs were held mostly during the day and during school. The BACs were very high, greater than 1.5 to 2g / l. One third of families had difficulty type of domestic violence or alcoholism. The festive pure alcohol abuse were rare. Support has been hospitalized and is supported by a pediatrician and child psychiatrist, with good adhesion to the support given by the adolescents and their families and few recurrences. Discussion: AAI's adolescents are multifactorial and involve all types of teenagers. It is important not to trivialize or dramatize, and to search for factors favoring severity and context underlying. Hospitalization allows the teenager to find an explanation for his act and to organize follow-up if necessary. Conclusion: The AAI's adolescents are potentially serious. The arrival to the emergency constitutes in itself a risk factor for abuse or underlying disorders and should alert the practitioner.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Prise en charge du rachitisme vitamino-résistant hypophosphatémique héréditaire (difficultés et enjeux thérapeutiques)

Le rachitisme vitamino-résistant hypophosphatémique (RVR) héréditaire est une pathologie rare affectant l os en croissance, et responsable d un retard statural avec déminéralisation et déformations osseuses. Les énormes progrès qui ont été réalisés, ces quinze dernières années, sur le métabolisme du phosphore, ont permis de mieux appréhender cette pathologie. Lié à une anomalie génétique à l origine d une fuite urinaire de phosphates, le RVR hypophosphatémique héréditaire a pour corollaire une hypophosphatémie et des taux anormalement normaux de la forme active de la vitamine D. L adéquation entre les deux bras thérapeutiques que sont, la supplémentation phosphatée et la vitaminothérapie, est essentielle pour éviter les deux risques potentiels : néphrocalcinose et hyperparathyroïdie. Nous présentons dans ce travail les observations de 6 patients, suivis en Picardie depuis 1990, pour RVR hypophosphatémique héraditaire. La prise en charge s est compliquée pour la plupart de nos patients d hyperparathyroïdie avec chez l un d entre eux un processus d autonomisation de la glande. Dans notre série aucun cas de nephrocalcinose n a été mis en évidence. Nous avons été confronté dans 80% des cas à de réelles difficultés d observance chez ses patients, à différentes étapes de leur développement, entrainant parfois des conséquences dramatiques notamment sur les déformations osseuses et leurs répercussions d ordre esthétique. Le retard statural a concerné tous nos patients avec chez 2 frères, une puberté avancée, d évolution rapide, qui est venue compromettre le pronostic de taille finale. Ce travail souligne l importance d un accompagnement personnalisé, où l éducation thérapeutique y trouve une place centrale afin d optimiser l observance du patient atteint de maladie chronique, notamment à l adolescence, moment de tous les dangers. Certaines de nos questions restent en suspens (croissance, puberté, observance chez ces patients). Les difficultés liées aux traitements incitent à considérer de nouvelles voies thérapeutiques (calcimimétiques, anticorps anti FGF 23). Aussi, la transition est une période vulnérable: c est l heure pour le patient de prendre conscience des lésions mutilantes de cette pathologie, avec lesquelles il va falloir entamer irrémédiablement sa vie d adulte et où doivent collaborer Pédiatre et Médecins d adulte.Hypophosphatemic rickets is a rare hereditary disease affecting bone growth, and responsible for short stature with demineralization and bone deformities. The enormous progress that has been made, the last fifteen years, on the phosphate metbolism, have a better understanding of this disease. Linked to a genetic defect causing a leak urine phosphate, hypophosphatemic rickets is associated with hypophosphatemia and inapproprieted rates of the active form of vitamin D. The match between the two therapeutic arms (phosphate supplementation and vitamin D therapy), isessential to avoid two potential risks: nephrocalcinosis and hyperparathyroidism. We report our medical experience with 6 patient of six patients followed-up since 1990 in Picardie, to hypophosphatemic ricket. The management was complicated for most of our patients with hyperparathyroidism with one of them a process of empowerment of the gland. In our serie no case of nephrocalcinosis were identified. We have faced in 80% of the real difficulties of compliance in this patients at different stages of development, sometimes resulting in serious consequences including bone deformities and esthetic impacts. The stature is concerned with all of our patients in two brothers, an advanced puberty, rapid change, which came compromising the prognosis for final height. This work emphasizes the importance of a personalized, therapeutic education which finds a central place to optimize patient adherence to chronic disease, especially in adolescence, when all danger. Some of our questions remain unanswered (growth, puberty, compliance in these patients). The difficulties associated with treatment encourage to consider new therapeutic approaches (calcimimetics, anti FGF 23). Also, the transition is a vulnerable period: it's time for the patient to become aware of disfiguring lesions of this disease, with which it will take forever begin his adult life and which must work Pediatr Doctors and adult.AMIENS-BU Santé (800212102) / SudocSudocFranceF

PASSAGE DES ADOLESCENTS (12-19 ANS) AUX SERVICES D'ACCUEIL ET D'URGENCES D'UN CENTRE HOSPITALIER ET UNIVERSITAIRE (USAGE ET MESSAGES)

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude du status pondéral et des habitudes de vie dans une cohorte de 109 collégiens en classe de troisième (l'activité physique est-elle un élément déterminant ?)

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A qualitative study on the educational needs of young people with chronic conditions transitioning from pediatric to adult care

International audienc

Prévalence des marqueurs biologiques de la maladie cœliaque dans une cohorte d’enfants et d’adolescents diabétiques de type I

International audienceThe aim of this study was to determine the prevalence of celiac disease (CD) markers in a French cohort of 84 children type 1 diabetics. Detection of antitransglutaminase (AtTG), antiendomysium (AEA) and antigliadin (AGA) antibodies was performed. Group 1 included 81 (96.4%) diabetic patients with negative antibodies. Group 2 included 3 patients (3.6%) with positive serological markers: 1 AGA-AEA-AtTG and 1 AEA-AtTG with proved histological diagnosis and 1 AGA positive with negative histology. No statistically significant difference was observed between the groups with regard to age, duration of diabetes, familial target stature, and ratios Height/Age and Weight/Height. Presence of CD serological markers was related to a lower level of HbA1c. Prevalence of CD serological markers is important in this French cohort but lower than other countries

Isolated hypospadias: The impact of prenatal exposure to pesticides, as determined by meconium analysis

International audienceAlthough endocrine-disrupting chemicals (EDCs, including pesticides) are thought to increase the risk of hypospadias, no compounds have been formally identified in this context. Human studies may now be possible via the assessment of meconium as a marker of chronic prenatal exposure. The objective of the present study was to determine whether or not prenatal exposure to pesticides (as detected in meconium) constitutes a risk factor for isolated hypospadias. In a case-control study performed between 2011 and 2014 in northern France, male newborns with isolated hypospadias (n = 25) were matched at birth with controls (n = 58). Newborns with obvious genetic or hormonal anomalies, undescended testis, micropenis, a congenital syndrome or a family history of hypospadias were not included. Neonatal and parental data were collected. Foetal exposure was assessed by determining the meconium concentrations of the pesticides or metabolites (organophosphates, carbamates, phenylurea, and phenoxyherbicides) most commonly used in the region. Risk factors were assessed in a multivariate analysis. The pesticides most commonly detected in meconium were organophosphates (in up to 98.6% of samples, depending on the substance) and phenylurea (>85.5%). A multivariate analysis revealed an association between isolated hypospadias and the presence in meconium of the phenylurea herbicide isoproturon and of the phenoxyherbicide 2-methyl-4-chlorophenoxyacetic acid (odds ratio [95% confidence interval]: 5.94 [1.03-34.11] and 4.75 [1.20-18.76]) respectively). We conclude that prenatal exposure to these two herbicides (as assessed by meconium analysis) was correlated with the occurrence of isolated hypospadias. The results of our case-control study (i) suggest that prenatal exposure to pesticides interferes with the development of the male genitalia, and (ii) emphasize the importance of preventing pregnant women from being exposed to EDCs in general and pesticides in particular

Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring

International audiencePregnant women are exposed to various chemical products at home and at work. Some of these products contain endocrine-disrupting chemicals (EDCs) such as cosmetics, pesticides, industrial chemicals, heavy metals, plastics or medications that could alter sexual differentiation and increase the risk of hypospadias. We evaluated maternal occupational and household exposures that could constitute risk factors for hypospadias. From 2011 to 2014, we enrolled 57 full-term newborns with hypospadias and three randomly selected controls per case (162 control newborns), matched for gestational age, from 11 maternity units in Picardy, France. Neonatal and parental data were collected at birth (personal characteristics, maternal lifestyle, and medical history). Maternal occupational exposure was assessed by a job-exposure matrix for EDCs from a job history questionnaire completed by mothers. Odds ratios (OR) and 95% confidence intervals (CI) were calculated with univariate and multivariable logistic regression, and adjusted for relevant covariates. Multivariate analysis showed a strong association between hypospadias and potential maternal occupational exposure to EDCs and maternal household use of hair cosmetics (OR 6.1, 95% CI: 1.1-34.9; OR: 9.6, 95% CI: 1.4-66.1, respectively). Our results suggest that maternal occupational exposure to EDCs is a risk factor for hypospadias and suggests a possible influence of household use of hair cosmetics during early pregnancy on the incidence of hypospadias in the offspring. A larger study with more accurate exposure assessment should evaluate the impact of EDCs in hair cosmetics on the incidence of hypospadias

Response to Elwood, M. et al., Comment on: Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring. Int. J. Environ. Res. Public Health 2017, 14, 27

Dear Editor, Thank you for inviting us to reply to a “Comment” paper to our published paper “Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring” (Authors: Elodie Haraux, Karine Braun, Philippe Buisson, Erwan Stéphan-Blanchard, Jannick Ricard, Camille Devauchelle, Bernard Boudailliez, Pierre Tourneux, Richard Gouron, Karen Chardon).[...