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IntroductionFew data are available about pediatric cardiovascular disease (CVD) in the Horn of Africa. The objective of this study was to describe the spectrum of CVD in children in Djibouti.MethodsClinical features and management of Djiboutian children between 1 month-old and 15 year-old with CVD were prospectively recorded over a two-year period in Bouffard Military Hospital in Djibouti (January 2009- December 2010).ResultsClinical examination and echocardiography were performed on 156 patients: 32 of them (20%) had CVD. Three (10%) of them had Down's syndrome. The median age was 5 years (male 53%). Congenital heart disease was observed in 27 (84%) patients and dilated cardiomyopathy (DCM) in 5 (16%) patients including 2 patients with rheumatic valvular disease. Ventricular septal defect was frequent (28%). Other abnormalities were atrial septal defect (13%), Tetralogy of Fallot (9%), pulmonary stenosis (6%) and 3 other patients had multiple congenital anomalies condition. Surgical management was required in 22 (69%) patients and was performed on 15 (47%) cases. During follow up (mean 11.3 ± 6.8 months), 5 (16%) patients died. Absence of surgery was associated with significant mortality (p > 0.05) but age, sex and mean follow up were not.ConclusionPediatric CVD is at least as common in this Djiboutian community as in other African cohorts. The absence of surgery was a major mortality risk factor. DCM was frequent in this study. Much work remains to be done to discover the size and nature of genetic and environmental contributions to these various forms of heart diseases in the Horn of Africa.

Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported.

Commonly used biochemical parameters correctly predict CBDS when they are analysed in a dynamic setting rather than at discrete time points. The proposed model constitutes a reliable tool to decrease unnecessary ERCP and perioperative discovery rates of CBDS.

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