Laurent Hiffler

• MD, Paediatrician with special interest in Micronutrition
• Paediatrician - Micronutrition at Cellular Nutrition Resarch Group

Background Lactate is a by-product of thiamine-deficient cellular metabolism, and hyperlactataemia can indicate severe illness. However, little is known about the clinical significance of hyperlactataemia in thiamine deficiency disorders (TDDs). Aim To describe the relationship between whole blood lactate level and thiamine-responsive disorders (T...

Background There is limited information on relationships among biomarkers of thiamine status (whole blood thiamine diphosphate [ThDP], erythrocyte transketolase activity coefficient [ETKac], and human milk thiamine [MTh]) and clinical manifestations of thiamine deficiency. Objectives This study aimed to explore correlations among these biomarkers...

Objective: To develop a predictive model for thiamine responsive disorders (TRDs) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDDs) based on response to therapeutic thiamine in a high-risk setting. Study design: Children aged 21 days to <18 months hospitalized with signs or symp...

This research topic is in the straight line of our thoughts about of micronutrients scope including vitamins and trace elements on host defense during viral infection. It addresses the mechanisms of the host fight against viruses facing the effect of viral attack and hijacking in cellular and molecular environment. It is also intended to explore th...

[This corrects the article DOI: 10.1371/journal.pone.0250933.].

Often thought to be a nutritional issue limited to low‐ and middle‐income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high‐income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine‐deficient mothers living in disadvantaged socioeconomic conditions are though...

Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrition (SAM) and TB diagnosis remains particularly challenging in the very young. We explored whether, in a low HIV-prevalence setting, the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine may assist TB diagnosis in SAM children, a pedia...

[This corrects the article DOI: 10.1093/omcr/omz004.].

Benjamin Rakotoambinina, Laurent Hiffler. Aspectos atuais da deficiência de tiamina em pediatria September 2020 chapter 4, 57-103 [Current aspects of thiamine deficiency in pediatrics] Benjamin Rakotoambinina, MD,PhD, paediatrician, professor of physiology , University Antananarivo, Madagascar Laurent Hiffler, MD, paediatrician (micronutrition), Fr...

SARS-CoV-2 is an RNA virus responsible for the COVID-19 pandemic that already claimed more than 340,000 lives worldwide as of May 23, 2020, the majority of which are elderly. Selenium (Se), a natural trace element, has a key and complex role in the immune system. It is well-documented that Se deficiency is associated with higher susceptibility to R...

SARS-CoV-2 is an RNA virus responsible for the COVID-19 pandemic that already claimed more than 340,000 lives worldwide as of May 23, 2020, the majority of which are elderly. Selenium (Se), a natural trace element, has a key and complex role in the immune system. It is well-documented that Se deficiency is associated with higher susceptibility to R...

In paediatrics, the overall clinical picture of thiamine deficiency (TD) is not easy to recognize, because it mimics or can be confused with other diseases even in cases of classic beriberi. Unsurprisingly, the likelihood of misdiagnosis of TD is even greater where beriberi has not been described. Critically ill patients have increased thiamine bod...

31 mars 2020 Le SARS-Cov-2 est responsable de la pandémie de Covid19 qui a déjà fait plus de 35000 victimes dans le monde au 31 mars 2020. Il s'agit d'un virus ARN dont le métabolisme complexe reste comparable aux virus ARN responsables d'épidémies tels que influenza, certains virus de fièvres hémorragiques (comme virus Ebola Ebov ou le virus Hanta...

Introduction Diagnosis of infantile thiamine deficiency disorders (TDD) is challenging due to the non-specific, highly variable clinical presentation, often leading to misdiagnosis. Our primary objective is to develop a case definition for thiamine responsive disorders (TRD) to determine among hospitalised infants and young children, which clinical...

During 2018, there has been a phenobarbital and phenytoin worldwide supply shortage, which are two of the principal drugs for seizure management in neonates and children in resource limited settings. In June 2018, the Intersectional Paediatric Working Group of MSF had to develop an “Interim paediatric seizure management protocol” (graphic below)....

Immunobullous diseases are rare skin conditions involving the skin and mucosa. They are characterized by skin fragility, bullae, erosions, pain and scarring. Their management in Resource Limited Settings (RLS) is challenging.

MSF implemented a neonatal area in the general paediatric ward of Bafatá Hospital in 2015. Despite increased number of staff, trainings, technical support with paediatricians and free care, mortality failed to reduce. Consequently, new strategies were developed, including having dedicated neonatal staff and eventually, creating a Neonatal Unit (NNU...

Supplemental oxygen (O2) therapy via nasal cannula (NC) for improving oxygenation during acute respiratory illness may be necessary, especially in cases of severe pneumonia. However, at the start of supportive treatment we may not know whether NC-O2 will be required for longer-term management since there are many other conditions that result in hyp...

- OCBA runs its largest malnutrition treatment centre and supports paediatric services at Madaoua District Hospital, Niger (bed capacity - 400). - The remote and insecure setting, large numbers of complicated malnutrition cases, seasonal peaks of malaria and frequent meningitis outbreaks are some of the challenges faced. - OCBA and MSF Canada start...

MSF is working since 2017 in Pediatric and Neonatal Intensive Care Units (PICU/NICU) at Hospital Nacional Simão Mendes in Guinea Bissau. Both services work as a tertiary level of care with its expectable mortality due to severe and complex pathologies. Several barriers are perceived when approaching Pediatric Palliative Care (PPC). Perception of de...

Chaque année, près de 300.000 enfants naissent avec la drépanocytose en Afrique et l’OMS indique qu’environ 80 % d’entre eux meurent avant l'âge de 5 ans faute de diagnostic et prise en charge adaptée. Dans les pays de l’Afrique de l’Ouest tels que le Ghana et le Nigeria, la fréquence du gène drépanocytaire atteint 15 à 30%, alors qu’en Ouganda où...

La schistosomiase est une parasitose qui touche environ 240 millions de personnes et est considérée comme la troisième maladie tropicale la plus dévastatrice. Chez l’enfant, elle peut causer une anémie, un retard de croissance, une diminution des capacités d’apprentissage mais, avec le traitement, ces effets sont en général réversibles. Dans sa fo...

Status epilepticus (SE) is a life-threatening neurological emergency. The international rupture of intravenous phenobarbital and phenytoin has made impossible to manage cases of convulsive status that do not respond to diazepam in MSF projects. Levetiracetam was recently introduced but has not made his way to many projects yet. The literature conta...

An 8-month-old child was admitted to a paediatric intensive care unit in Guinea-Bissau with severe blistering dermatosis. He was treated with broad spectrum antibiotics and dressings, without improvement. After 2 weeks, linear IgA bullous dermatosis was suspected. Owing to lack of dapsone, the child was treated with prednisolone and improved. To av...

This chapter outlines the fundamentals of providing care in humanitarian settings, including overall guidance to clinical care, key aspects of patient triage, and approaches for paediatrics. This chapter on the approach to paediatric care in humanitarian, conflict, or disaster setting, aims to assist the non-paediatrician presented with paediatric...

In resource-limited settings with high burdens of preventable illness and poor access to preventative and curative health care,1–5 many children become critically ill, requiring immediate lifesaving interventions. These needs increase rapidly during humanitarian emergencies—whether natural or man-made disasters, conflict, epidemics, or the collapse...

Thiamine is an essential micronutrient that plays a key role in energy metabolism. Many populations worldwide may be at risk of clinical or subclinical thiamine deficiencies, due to famine, reliance on staple crops with low thiamine content, or food preparation practices, such as milling grains and washing milled rice. Clinical manifestations of th...

BACKGROUND: Background: Sub-Saharan Africa has one of the highest burdens of deaths caused by infectious diseases. Indeed it is one of the 7 countries with the worst under 5 mortality rate in the world. Inappropriate use of antibiotics (ABTs) has been identified as one of the multiple causes of antimicrobial resistance. Since 2012 MSF is working w...

Hypoxic-Ischaemic Encephalopathy (HIE) accounts for a significant proportion of neonatal deaths in resource limited settings. Moderate hypothermia started within the first 6 hours after birth is known to improve survival and outcome at 18 months. Although now considered standard care in developed countries, controlled therapeutic hypothermia requir...

Case report presentation: an eight month old child, without relevant past personal or familiar medical history, was admitted presenting a severe and disseminated blistering dermatosis, of 1 month of evolution...

According to WHO, worldwide 10-20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions. If untreated, these conditions severely influence children’s development and th...

Acute Thiamine deficiency (TD) in infancy is well described in Asia but poorly documented in Africa. Critically ill patients have increased thiamine body consumption (associated with hypermetabolism) and dextrose-based IV fluid increase thiamine cellular demand even further...

Selon la dernière enquête démographique et de sante du Mali (EDSM V 2012-13) 39 % des enfants de 12-24 mois étaient complètement vaccinés et 71 % avaient recu la vaccination anti-rougeole. Depuis 2012, MSF apporte des soins gratuits, en appui au ministère de la Santé au centre de santé communautaire et au centre de santé de référence d'Ansongo dans...

Staple diets that are deficient in thiamine can result in low body thiamine levels, which may be subclinical or may manifest as a thiamine-deficiency syndrome. In many communities in the developing countries of Africa, the staple diets of polished rice or processed cassava are deficient in thiamine, and thus the communities are at high risk for mar...

Since community-based management of severe acute malnutrition has become the standard of care, the clinical profile of severe acutely malnourished patients admitted to hospitals or inpatient therapeutic feeding centers has changed significantly. These patients are usually very ill and often present with several comorbidities, such as shock, sepsis,...

Study/Objective N/A Background Medecins Sans Frontieres (MSF) aka Doctors Without Borders, Madaoua Project supports the paediatric services of a remote and insecure district hospital integrating Inpatient Therapeutic Feeding Center (ITFC). MSF is implementing a telemedicine pilot project tailored to ensure continuity of expert care in case foreign...

Aluminium is widely used for cookware due to its low cost, high resistance and good heat conduction. Local factories of developing countries often use recycled materials to make cookware utensils that potentially contain other heavy metals such as lead. High aluminium intakes has shown neurological and renal disorders and minimal quantity of lead o...

Traditional medicines are widely used in Madaoua, Niger. Many children admitted at the District Hospital, supported by MSF, have received oral infusions from plants or mineral salts yet no accurate data on the amount of cases is available. ¨Natron¨  natural sodium carbonate decahydrate -Na2CO3•10(H2O), is one of the most popular ones and it is mos...

In Niger roughly 18000 children are born annually with the disease (estimated 2 % out of 900,000 live births). 50 to 90 % of them will die before age 5...

Complicated severe acute malnutrition (SAM) remains a major challenge in MSF programmes and carries significant mortality. As the body has a very limited, diet-dependent store of thiamine (vitamin B1), deficiency is common in malnourished children. Thiamine has many functions, and is an essential component of key metabolic pathways involving glucos...

Background and aims: Refeeding syndrome is characterized by electrolytes imbalances including hypomagnesemia and is associated with thiamine deficiency. It leads to congestive heart failure, neurological and hematological complications. Signs are often misinterpreted as sepsis, cardiac failure, pneumonia and sudden death. Diagnosis is rarely made a...

In humans, thiamine is a micronutrient prone to depletion that may result in severe clinical abnormalities. This narrative review summarizes current knowledge on thiamine deficiency (TD) and bridges the gap between pathophysiology and clinical presentation by integrating thiamine metabolism at subcellular level with its function to vital organs. Th...

Metabolic acidosis tied to increased lactate level is a common feature of critical illness. The lactate acidosis proceeds from hypoxia (type A) and hypo perfusion or pseudo hypoxia without evidence of actual hypoxia (type B). In the later form, lactic acidosis is secondary to the metabolic shift of glycolysis at the pyruvate level towards the lacta...

Thiamine plays a critical role in cellular energy metabolism with a well described neuronal tropism. The active form, thiamine pyrophosphate, is an important co-factor in carbohydrates metabolism, in pentose phosphate pathway, and in mitochondrial enzyme complexes for energy production. Clinically neurological presentations of thiamine deficiency (...

Problem Statement: Shock and severe acute illnesses are among the major causes of death of children living in resource-limited settings. Improving the outcome for such patients remains a major challenge without increasing significantly the access to proper intensive care units. Thiamin (vitamin B1) role for children has been historically limited to...

Providing adequate food to meet the nutritional needs of growing children is critical to prevent an increase in malnutrition prevalence, which would lead to excess mortality during the recovery phase of a disaster. Nutritional status directly impacts the vulnerability for and the severity of infectious diseases that affect children in emergency set...

Mémoire de Diplôme Universitaire "Alimentation Santé et Micronutrition" Université de Bourgogne (Fr) 2011.

Management of children and adolescents with HIV infection in Africa. A practical guide written for "Grandir" program. Second edition 2014 downloadable (free) www.grandir.sidaction.org . 3 chapters: Follow-up of children born from HIV infected mothers; nutritional aspects; psychological support. These are practical approach based management based on...

The purpose of this book is to provide information on the care and management of paediatric AIDS, offering guidelines for nurses, medical practitioners and carers on how to care for children with HIV and AIDS in resource limited settings. Part One provides information about the care of the child living with and/or affected by HIV and AIDS in the co...

Clostridium perfringens meningitis is a rare condition usually associated to skull injuries, surgery or gastro-intestinal disorders. A 21 day-old infant was admitted for the sudden worsening of a neonatal post-hemorrhagic hydrocephalus. Eighteen hours after admission, she developed a septic status with acute meningitis. A CT scan revealed the prese...

Background. — Clostridium perfringens meningitis is a rare condition usually associated to skull injuries, surgery or gastro-intestinal disorders.Case report. — A 21 day-old infant was admitted for the sudden worsening of a neonatal post-hemorrhagic hydrocephalus. Eighteen hours after admission, she developed a septic status with acute meningitis....