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BACKGROUND AND AIMS: There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. RESULTS: Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon. CONCLUSION: COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

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INTRODUCTION: no one can deny that vaccination against several serious diseases in the world, and particularly in Morocco, has given very satisfactory protective results. The extension of the COVID-19 pandemic in our country has led to a significant decline in childhood immunization, which could have severe repercussions increasing the risk of future outbreaks. Hence, the measures of the Ministry of Health to correct the situation. The purpose of this study was to highlight the extent of vaccine release during COVID-19 pandemic and to make recommendations to restore vaccination programmes. METHODS: we conducted a cross-sectional study of the effect of containment measures during this pandemic on the monitoring of children´s vaccinations. We conducted a national survey of pediatricians using an electronic questionnaire administered via Google Forms. We collected, analyzed and interpreted the results. RESULTS: one hundred and three Moroccan pediatricians answered the questionnaire. More than 2-thirds (78.6%) of pediatricians practiced in the private sector and delivered vaccines in the immunization schedule. The majority of pediatricians (95%) were asked about parental vaccine concerns. We noted that 82.5% of parents were reluctant to go to the local health department and 5.8% refused to take vaccination during COVID-19 pandemic. About 22% of pediatricians completely stopped immunization services and 72.8% delayed immunizations from 3 to 4 weeks. Vaccination stoppage involved older children in two thirds of cases. CONCLUSION: it is essential to maintain public confidence in vaccination. Ongoing and timely assessment of vaccine coverage as well as clear recommendations and broad public awareness are essential to respond to vaccine changes during the COVID-19 pandemic.

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INTRODUCTION: COVID-19 is an infectious disease caused by a new coronavirus. The first cases were identified in Wuhan. It rapidly spread causing a pandemic worldwide. The incidence and severity of this disease are likely to be different in children compared with adults. Few publications of COVID-19 in children have been published. Our Moroccan paediatric series is among the first studies on this disease in Africa. METHODS: We included all children with COVID-19 who were admitted and treated at the hospital from March 25 to April 26, 2020. We have collected information, including demographic data, symptoms, imaging data, laboratory results, treatments and clinical progress from patients with COVID-19. RESULTS: Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Morocco, a total of 145 COVID-19 confirmed cases have been reported in the Cheikh Khalifa's Hospital. Among this cases, 15 children were registered. The median age of patients was 13 years. There were 7 boys and 8 girls. Five children are asymptomatic, 8 have mild symptoms and 2 have a moderate respiratory difficulty. The RT-PCR test results were positive in all patients. Radiologically, we found in 2 cases, multiple nodules with ground-glass opacities on the chest scan. The treatment was based on the combination of hydroxychloroquine and azithromycin. Evolution under treatment was good for all patients. CONCLUSION: This study describes the profile of COVID-19 in child in a Moroccan hospital and confirms that the severity of illness in children with COVID-19 to be far less than adults.

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Introduction: COVID-19 is an infectious disease caused by a new coronavirus. The first cases were identified in Wuhan. It rapidly spread causing a pandemic worldwide. The incidence and severity of this disease are likely to be different in children compared with adults. Few publications of COVID-19 in children have been published. Our Moroccan paediatric series is among the first studies on this disease in Africa. Methods: we included all children with COVID-19 who were admitted and treated at the hospital from March 25 to April 26, 2020. We have collected information, including demographic data, symptoms, imaging data, laboratory results, treatments and clinical progress from patients with COVID-19. Results: since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Morocco, a total of 145 COVID-19 confirmed cases have been reported in the Cheikh Khalifa's Hospital. Among this cases, 15 children were registered. The median age of patients was 13 years. There were 7 boys and 8 girls. Five children are asymptomatic, 8 have mild symptoms and 2 have a moderate respiratory difficulty. The RT-PCR test results were positive in all patients. Radiologically, we found in 2 cases, multiple nodules with ground-glass opacities on the chest scan. The treatment was based on the combination of hydroxychloroquine and azithromycin. Evolution under treatment was good for all patients. Conclusion: this study describes the profile of COVID-19 in child in a Moroccan hospital and confirms that the severity of illness in children with COVID-19 to be far less than adults

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Weber christian's disease or idiopathic panniculitis is a rare condition characterized by an inflammation of the subcutaneous adipose tissue; it is a non-specific pathological condition that remains a central issue of debate and whose outcome is unpredictable. We here report the case of a 9-month-old female infant admitted in the hospital with sepsis preceded by respiratory symptoms and followed by the occurrence of small, hard, susceptible, asymmetrical erythematous subcutaneous nodes located in the arms and lower limbs. Cutaneous biopsy showed lobular hypodermitis with polymorphonuclear neutrophil infiltrations. The diagnosis of Weber Christian's disease was retained after eliminating other differential diagnoses. The patient was treated with prednisone with good outcome; during the follow-up period and during disease regression the diagnosis of B-cell acute lymphoblastic leukemia was made; this uncommon outcome has never been described in the literature. The aim of this study is to discuss any similar situation where another diagnosis was made in patients initially treated for idiopathic lobular panniculitis. This highlights the need for exhaustive etiological investigations and prolonged monitoring in order to search for a possible associated disorder.

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INTRODUCTION: This study aimed to evaluate the daily consumption of milk products in a population of Moroccan children and to determine the factors influencing this consumption. METHODS: We conducted a prospective study from 1 October 2013 to 31 April 2014. Children aged between 2 and 16 years were included in the study. The participants were recruited in the city of Fez. Data were collected using a frequency questionnaire. Enrolled parents and children were interviewed on their consumption of milk products and on sociodemographic factors. Children underwent anthropometric examination. The association between variables in milk products consumption was analyzed using univariate and multivariate analysis with logistic regression model. RESULTS: Food survey involved 286 children: 151 girls (52.8%) and 131 boys (45.8%). Children aged 2 to 3 years accounted for 26.4%, those aged 4 to 7 years accounted for 28.9%, those aged 7 to 9 years accounted for 18.3% and adolescents aged 10 to 16 years accounted for 26.4%. Children consumed on average 2.5±1 milk products per day. 57.8% of children aged 2 to 3 years, 53.6% of children aged 4 to 6 years, 40% of children aged 7 to 9 years and 41.2% of children aged 10 to 16 years consumed at least 3 milk products per day. The factors associated with the consumption of at least three milk products per day in univariate analysis were an illiterate maternal education level p < 0.001 OR= 0.1 and an elementary maternal education level p = 0.002 OR = 0.1, a medium familial socio-economic status p < 0.001 OR = 3, age p = 0.01 OR = 0.9 and a normal body mass index p = 0.01 OR = 2.5 and > 90° percentiles p < 0.001 OR= 6. There was a positive correlation between a body mass index > 90° percentiles p= 0.01 OR = 3.9 and the quantity of consumed milk products while there was a negative correlation between a body mass index > 90° percentiles p = 0.01 OR = 3.9 and a low maternal schooling: illiterate p = 0.008 OR= 0.1 elementary p = 0.009 OR = 0.1. CONCLUSION: The consumption of milk and of other milk products was inappropriate in particular among children aged 7 to 9 years and adolescents aged 10 to 16 years. Low maternal schooling and a body mass index higher than 90° percentiles were factors independently associated with the consumption of less than 3 milk products per day. The awareness of parents and children about the role of the milk and its derivatives in children diet is essential.

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Gaucher's disease (GD) is a lysosomal storage disorder due to glucocerebrosidase deficiency; it's one of the rare genetic diseases for which therapy is now available. The purpose of this work is to study the epidemiological features of the disease and to highlight the diagnostic difficulties. We performed an 11-year retrospective study of 11 patients with GD followed-up in the department of paediatric hepatology gastroenterology and nutrition of Rabat children's Hospital. We observed 11 patients with GD: 6 males and 5 females. Age at onset ranged from 3 months to 10 years with an average of 3.41 years. Mean age at diagnosis was 4 years (range 3 months-14 years). Parental consanguinity was noted in 85% cases. According to the clinical presentation, we classified our patients into: 9 cases of type 1 (81%) and two cases of type 2 (19%), none of the patients presented GD type 3. GD type 1: The age at diagnosis ranged from 2 years to 14 year with an average of 6 years. Main symptoms were: splenomegaly, hepatomegaly, pallor, haemorrhagic appearance (40%), bone pain (40%). The diagnosis was based on histology showing the Gaucher's cells in various tissues (100%). Enzymatic activity dosage confirmed the diagnosis of GD for 4 patients (44.5%). The treatment was always symptomatic (analgesics, transfusion). A splenectomy was performed in one case presenting with multiple splenic abscesses and high transfusion requirements. None of the patients received a specific treatment (substitutive enzymotherapy). The follow-up period ranged from 3 months to 6 years with an average follow-up of 4 years. We noticed stability in 4 cases, 2 worsening cases with bone and spleen complications. Three patients were lost to follow-up. GD type 2: we observed two cases of GD type 2 diagnosed at 3 and 18 months. The visceral symptoms were serious and the neurological features included seizures, hypertony, squint, physical developmental milestones delay. Both of them died. Gaucher's disease is not exceptional in Morocco. Type 1 is the most common type. We noted through this study some diagnostic difficulties as the diagnosis was delayed and the enzymatic dosage was performed in only 42% of the cases as well as therapeutic difficulty with no prescription of the specific treatment given the high cost of the enzyme.

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Malignant Infantile Osteopetrosis (MIOP) is a rare genetic disorder due to osteoclast abnormal activity. We report a thirteen month-old male patient, diagnosed as MIOP while investigating the cause of hepatosplenomegaly associated with hydrocephalus. His medical history revealed non consanguineous parents and one brother's death at the same age of unknown etiology (similar symptoms). Systemic examination showed hepatosplenomegaly, growth failure, developmental milestones delay, and rickets features. Ophthalmic exam yielded bilateral optic atrophy. Skeleton radiographs detected generalized dense bone and rickets. Cerebral CT scan revealed hydrocephalus. Histological examination showed hypoplastic bone marrow and extra-medullary hematopoeisis. Diagnosis was confirmed by genetic testing that showed two heterozygote mutations within the TCIRG1 gene. The patient received supportive treatment. He died from an acute respiratory distress. MIOP should be kept in mind as a rare cause of hepatosplenomegaly. Early diagnosis and timely Hematopoietic stem cell transplantation are the only curative approach for an otherwise fatal disease.

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INTRODUCTION: To determine the metabolic profile in a group of obese children in Morocco. METHODS: The BMI, the waist circumference, the blood pressure and metabolic parameters in 73 children (37 obese and 36 normal) were compared. RESULTS: 80% of obese children had abdominal obesity (p <0.0001). For systolic blood pressure among children who have a higher value than the 95th percentile, 85.7% were obese and 14.3% children are normal children. For diastolic blood pressure, 83.34% of obese children had higher diastolic blood pressure values in the 95th percentile and 16.6% of normal children have a higher value than the 95th percentile (p=0.013). No obese child had hyperglycemia. The prevalence of metabolic syndrome was 21.6%. CONCLUSION: Obesity is number one risk of cardiovascular disease for children. Early detection can help for an appropriate care.

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OBJECTIVES: The aim of this study was to assess the prevalence of underweight, stunting, and the socioeconomic risk factors among children enrolled in primary public schools in Rabat, Morocco. METHODS: Twenty-three schools were randomly selected. A cross-sectional study was conducted between April and June 2010. The survey was conducted on the basis of two questionnaires for both parents and children. The references used were from the World Health Organization, 2007. RESULTS: Our study focused on a sample of 1569 children whose average age was 9.7 ± 0.95 years. The prevalence of underweight among girls and boys was 43.1%, while that of stunting was 18.2%. The majority of the children in our population come from a low socioeconomic level. While 59% of fathers are laborers, 85% of mothers are unemployed. CONCLUSION: In our study, we demonstrated that child malnutrition is strongly linked to a low socioeconomic level. These observations suggest that besides income, schooling and food quality may also be important factors that can affect growth. Educational programs, whether held in schools or informally, such as literacy or parenting classes, are valuable complements to other nutrition sustaining activities.

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BACKGROUND AND AIMS: We undertook this study to assess the prevalence of obesity and overweight in children enrolled in government primary schools in the city of Rabat, Morocco. METHODS: Twenty three schools were randomly selected. A cross-sectional study was conducted between April 2010 and June 2010. The survey was conducted on the basis of two questionnaires for both parents and children. The references used are those of the WHO (2007). RESULTS: Our study involved a sample of 1570 children with an average age of 9.7 ± 0.95 years. The prevalence of overweight and obesity was 8.7%. Overweight affected 5.1% and obesity affected 3.6%. The majority of our population consisted of children of low socioeconomic status where 59% of fathers are laborers and 85% of mothers are unemployed. CONCLUSION: Overweight and obesity do not spare the most underprivileged social strata of our country. Therefore, prevention strategies and programs to raise awareness of risks and threats involved must be a public health priority.

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