In a prospective study conducted from January to December 2010 in the Teaching Hospital of Brazzaville (Congo), we compared the discharge of hospitalized children against medical advice at the parents' request (group 1 - cases) with those admitted during same period with routine discharge (group 2 - controls). Two hundred and seven (7.7%) hospitalized children, 117 boys and 90 girls, were discharged at the parents request. The mean age was 18.0 ± 13.5 months (range: 1 month-5 years). Among these patients, 150 (72.5%) children were from biparental families, and 30.9% of children were the first and/or only child of the household. Among the parents of Congolese nationality, 147 (71%) had a secondary school level education, including 66.7% of mothers and 58% of the fathers 59.9% of children were admitted between 15 and 7 hours, and 75.4% were hospitalized during working days. The duration of hospitalization did not exceed 3 days in 147 cases (71%). The main reasons for hospitalization were digestive disorders (27%), fever (16.4%), convulsions (11.1%) and anaemia (11.1%). Among patients discharged against medical advice, 34.8% left on the first day of hospitalization (72 cases), 36.7% before the start of treatment (76 cases of which 36 during check-up) and 63.3% during treatment (131 cases). The main reasons for discharge request were improvement in the clinical condition improvement (30.9% of cases), lack of money (28% of cases), supposed insufficient medical care (7.7% of cases), unsatisfactory hospitalization conditions (6.3% of cases), care of other children at home (6.3% of cases), traditional and/or religious beliefs (5.8% of cases) and disagreements with nurses (5.3%). Patients discharge against medical advice was correlated strongly with the educational level of parents, age of the child, delay of consultation, time of admission, rank of the child in family and nationality of parents. Discharge against medical advice is associated to the distrust between the patients and nurses. Improvement of hospitalization conditions in our hospitals, improvement of the socioeconomic status of Congolese and establishment of national social security seem to be the main determinants of reduction of discharge against medical advice.

Objectives: To describe the psychosocial functioning and assess the quality of life of children, adolescents and young adults with T1DM; and to identify the risk factors associated with the psychosocial experience and quality of life of these patients.Material and methods: A cross-sectional, descriptive study of children, adolescents and young adults with type 1 diabetes. Symptoms of anxiety and depression, and the quality of life were assessed using the Beck's Anxiety and Depression Scales and the pedsQL diabetes module score respectively.Results: A total of 74 patients were recruited. The mean age was 18 ± 4.1 years.Minimal symptoms of anxiety were noted in 51 (69%) patients, 23 (31%) had nonminimal symptoms of anxiety (mild:14, moderate: 5, severe: 4). Symptoms of depression were absent in 43 (58.1%) patients and present in 31 (41.9%) patients (mild: 19, moderate: 12). The patients total score of quality of life was 65.4. Higher socioeconomic status (p = 0.03) was a protective factor against Symptoms of anxiety, while the age above 14 years (p = 0.01) was a risk factor for symptoms of depression.The quality of life was lower in patients from low socio-economic status (p = 0.01), those with poor glycemic control (p = 0.03), and when symptoms of depression were present (p = 0.02).Conclusions: Patients with type 1 diabetes in Congo experienced a significant elevated symptoms of anxiety and depression, and a fairly good quality of life. These findings support recommendations for integrating psychosocial aspects in the management of these patients.

Ingestion of caustics by children is serious because of the increase in their frequency and the difficulties due to their management. Objective: To improve the management of caustic lesions in Pediatric Department at the University Hospital of Brazzaville. Patients and Methods: Prospective study was conducted from January 2014 to December 2015 in the Pediatric Departments of the UHB and centers of digestive endoscopy in Brazzaville. All children who ingested a caustic product and hospitalized were included after obtaining parental's consent. The studied parameters were: Age, sex, nature and quantity of the caustic, the family's attitude, clinical signs, endoscopic results according to Zagar's classification, therapeutic modalities and evolution. Results: 8292 children were hospitalized and 68 because of the ingestion of caustic, a frequency of 0.8%. The average age was 23.6 months [2 months-16 years]. The male sex was predominant (57.4%). Ingestion was accidental in 88.2% and voluntary in 11.8%. Factors favoring ingestion were storage methods (81.5%) and parental's inattention or negligence (10.8%). Bleach was the most incriminated caustic (54.4%) followed by caustic soda (29.4%). The estimated quantity ingested was assumed to be minimal in 61.7%. Unsuitable acts were practiced by the family before the medical consultation in 66.1%. The dominant symptoms were digestive (47%) and neurological (25%). The average time to perform endoscopy was 48 hours in 88.2%. Endoscopy revealed lesions in 51.7%, the different stages were I (12 cases), II (16 cases) and III (3 cases). The mains factors of gravity were inappropriate gestures (85%) and the non-respect of the fasting (9%). Proton pump inhibitors were used in 50%. The evolution was favorable for in 73.5%. Conclusion: Ingestion of caustics by children is most often accidental favored by the inadequate pack

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