BACKGROUND Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families.Targeted emergency care and psychological nursing are widely applied in clin...BACKGROUND Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families.Targeted emergency care and psychological nursing are widely applied in clinical practice,but their value and impact on the management of pediatric febrile convulsions are unclear.AIM To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions.METHODS Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed.The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing.The time to fever resolution,time to resolution of convulsions,length of hospital stays,Pittsburgh Sleep Quality Index,patient compliance,nursing satisfaction of the parents,occurrence of complications during the nursing process,and parental anxiety and depression were compared between the control and research groups.Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression(HAMD)and the Hamilton Rating Scale for Anxiety(HAMA).RESULTS The fever resolution,convulsion disappearance,and hospitalization times were longer in the control group compared with the research group(P<0.0001).The time to falling asleep,sleep time,sleep quality,sleep disturbance,sleep efficiency,and daytime status scores were significantly better in the research group compared with the control group(P<0.0001).The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing(P<0.05).Compliance with treatment of children in the research group was higher than in the control group(P<0.05).Parental satisfaction with nursing in the research group was higher than in the control group(P<0.05).The total complication rate of children in the control group was higher than in the research group(P<0.05).CONCLUSION Combining psychological nursing with targeted emergency nursing improved the satisfaction of children’s families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.展开更多
Fructose-1,6-diphosphate is a metabolic intermediate that promotes cell metabolism. We hypothesize that fructose-1,6-diphosphate can protect against neuronal damage induced by febrile convulsions. Hot-water bathing wa...Fructose-1,6-diphosphate is a metabolic intermediate that promotes cell metabolism. We hypothesize that fructose-1,6-diphosphate can protect against neuronal damage induced by febrile convulsions. Hot-water bathing was used to establish a repetitive febrile convulsion model in rats aged 21 days, equivalent to 3–5 years in humans. Ninety minutes before each seizure induction, rats received an intraperitoneal injection of low- or high-dose fructose-1,6-diphosphate(500 or 1,000 mg/kg, respectively). Low- and high-dose fructose-1,6-diphosphate prolonged the latency and shortened the duration of seizures. Furthermore, high-dose fructose-1,6-diphosphate effectively reduced seizure severity. Transmission electron microscopy revealed that 24 hours after the last seizure, high-dose fructose-1,6-diphosphate reduced mitochondrial swelling, rough endoplasmic reticulum degranulation, Golgi dilation and synaptic cleft size, and increased synaptic active zone length, postsynaptic density thickness, and synaptic interface curvature in the hippocampal CA1 area. The present findings suggest that fructose-1,6-diphosphate is a neuroprotectant against hippocampal neuron and synapse damage induced by repeated febrile convulsion in immature rats.展开更多
Dissociative convulsions, a prominent form of dissociative (conversion) disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. However, the treatment of such patients is al...Dissociative convulsions, a prominent form of dissociative (conversion) disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. Here, we present a case with dissociative convulsions in order to catch the eye of the clinicians and researchers on the recognition of clinical manifestation and exploration of therapeutic strategies.展开更多
We observed for the first time the differences of immunoreactive β-endorphin(IR -β- EP) content in plasma, pituitary and hypothalamus of rats under various conditionsusing radioimmunoassay (RIA) and the effects of n...We observed for the first time the differences of immunoreactive β-endorphin(IR -β- EP) content in plasma, pituitary and hypothalamus of rats under various conditionsusing radioimmunoassay (RIA) and the effects of naloxone and β - endorphin (β- EP) antiserumon initial time of convulsions (ITC), severity of convulsions(SOC) and mortality on surface(MOS) of rats to hyperbaric oxygen(HBO). The results suggest thatβ- EP may partici-pate in the course of oxygen - induced convulsions and be one of endogenous convulsion - causingagents.展开更多
The purpose of this study was to limit intermittent diazcpam prophyiaxis of children with FC to the patients who haye the second recurrence.A series of 156 children with FC received prophylactic treatment.During 1 ̄5 ...The purpose of this study was to limit intermittent diazcpam prophyiaxis of children with FC to the patients who haye the second recurrence.A series of 156 children with FC received prophylactic treatment.During 1 ̄5 years for Follow-up (average,2 years and 10 months),28 cases of prophylactic group suffered recurrence of FC 48 times. 54 of 126 cases in control group suffered it 108 times. The difference in case number and recurrent rate between the prophylactic and control groups was highly significant (P<0. 01). Diazepam was found tO be considerably effective in reducing the risk of recurrence of FC.展开更多
Background: Since the isolation of HHV-6 in 1986, extensive investigation has revealed it to be ubiquitous and responsible for the majority of cases of a common febrile rash illness of infants known as roseola. Other ...Background: Since the isolation of HHV-6 in 1986, extensive investigation has revealed it to be ubiquitous and responsible for the majority of cases of a common febrile rash illness of infants known as roseola. Other clinical associations including seizure disorders, encephalitis and meningitis have also been stated in various publications. Objective: The aim of the study is to find out if there is any association between HHV-6 infection and the convulsions prevailing at the Child Health Department of the Korle-Bu Teaching Hospital, Accra-Ghana. Methods and Results: Children admitted into the Department of Child Health with episode of convulsions were recruited after informed consent had been sought from subjects. Cerebrospinal fluid (CSF) and Plasma were obtained from patients. PCR directed at the detection of the large tegument protein (LTP) gene in the SIE strain of the HHV-6 in Plasma and CSF from patients was done. The mean age of study subjects was 37.44 months with 53 (64.6%) being males. There was a significant relationship between the convulsions and fever (P < 0.05). Based on CSF characteristics gathered, viral infections may be the probable cause of the observed convulsions but not malaria or bacterial infections. None of the samples from the patients had evidence of HHV-6. Conclusion: The study was unable to establish HHV-6 infection in the CSF and Plasma of patients. What role if any HHV-6 has in convulsions seen in children or neurological diseases at large merits further studies. Other neurotropic viruses need to be investigated as possible causes for the convulsions.展开更多
BACKGROUND Primary intestinal lymphangiectasia(PIL)is a rare protein-losing enteropathy characterized by abnormally dilated lymphatic structures,resulting in leakage of lymph(rich in protein,lymphocytes,and fat)from t...BACKGROUND Primary intestinal lymphangiectasia(PIL)is a rare protein-losing enteropathy characterized by abnormally dilated lymphatic structures,resulting in leakage of lymph(rich in protein,lymphocytes,and fat)from the intestinal mucosal and submucosal layers and thus hypoproteinemia,lymphopenia,hypolipidemia,and pleural effusion.CASE SUMMARY A 19-year-old Chinese male patient complained of recurrent limb convulsions for the last 1 year.Laboratory investigations revealed low levels of calcium and magnesium along with hypoproteinemia and high parathyroid hormone levels,whereas gastroscopy exhibited chronic non-atrophic gastritis and duodenal lymphatic dilatation.Subsequent gastric biopsy showed moderate chronic inflammatory cell infiltration distributed around a small mucosal patch in the descending duodenum followed by lymphatic dilatation in the mucosal lamina propria,which was later diagnosed as PIL.The following appropriate mediumchain triglycerides nutritional support significantly improved the patient’s symptoms.CONCLUSION Since several diseases mimic the clinical symptoms displayed by PIL,like limb convulsions,low calcium and magnesium,and loss of plasma proteins,it is imperative to conduct a detailed analysis to avoid any misdiagnosis while pinpointing the correct clinical diagnosis and simultaneously ruling out other clinical aspects in the reported cases without any past disease history.A careful assessment should always be made to ensure an accurate diagnosis in a timely manner so that the patient can be delivered quality health services for a positive health outcome.展开更多
AIM:To determine the prevalence of recent immunisation amongst children under 7 years of age presenting for febrile convulsions.METHODS:This is a retrospective study of all children under the age of seven presenting w...AIM:To determine the prevalence of recent immunisation amongst children under 7 years of age presenting for febrile convulsions.METHODS:This is a retrospective study of all children under the age of seven presenting with febrile convulsions to a tertiary referral hospital in Sydney.A total of 78 cases occurred in the period January 2011 to July 2012 and were included in the study.Data was extracted from medical records to provide a retrospective review of the convulsions.RESULTS:Of the 78 total cases,there were five medical records which contained information on whether or not immunisation had been administered in the preceding 48 h to presentation to the emergency department.Of these five patients only one patient(1.28%of the study population) was confirmed to have received a vaccination with Infanrix,Prevnar and Rotavirus.The majority of cases reported a current infection as a likely precipitant to the febrile convulsion.CONCLUSION:This study found a very low prevalence of recent immunisation amongst children with febrile convulsions presenting to an emergency department at a tertiary referral hospital in Sydney.This finding,however,may have been distorted by underreporting of vaccination history.展开更多
Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of fe...Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of febrile convulsions is dominated by infections of the central nervous system. A detailed clinical examination and laboratory and imaging tests are carried out to identify the cause of the disease. Computed tomography is reserved for emergency situations or as a second line of defence, after Magnetic Resonance Imaging (MRI) to look for calcifications. Imaging thus helps to establish the nature of the epileptogenic lesion, specify its extent and guide its therapeutic management. The aim of this study is to clarify the contribution of MRI in the etiological investigation of convulsions in children at the paediatric university hospital, in addition to the usual means of exploration. Patient and Method: This was a cross-sectional, descriptive study from January 2022 to December 2023. We carried out an exhaustive sampling of all children aged between 1 and 59 months admitted for convulsion with fever or not who had undergone complementary examinations for aetiological purposes in relation to our technical platform during the study period. Results: Thirty patients were recruited. Children aged 12 to 59 months were the most represented (69.7%). The sex ratio was 1.30. The mean age was 36 months (range 30 days to 59 months). Of the 30 patients, 21.8% had a history of febrile convulsions. Most of our patients were from Bangui (73.3%). On admission, the majority of patients presented with an elevated temperature ranging from 38.5 degrees Celsius to 39.4 degrees Celsius in 33.1% of cases. The dominant clinical manifestations were tonic-clonic convulsions (53.2%), tonic convulsions (35.3%) and clonic convulsions (11.5%). According to their characteristics, convulsions were complex in 53.7% of cases and simple in 46.3%. Examinations for infectious diseases, tumors or malformation has been ruled out. The anticonvulsants most commonly used were diazepam, phenobarbital and phenytoin. We recorded a 73.3% cure rate and 4 (13.3%) cases of death. Conclusion: The investigation of seizures in search of aetiology outside the usual means in our context still presents difficulties. MRI is the examination of choice for exploring the posterior fossa and midline lesions. Combined with CT, it is better for exploring hemispheric tumours.展开更多
Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occ...Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occurs in various conditions such as collagenosis or vasculitis of the central nervous system, electrolytic disorders and the use of cytotoxics or immunosuppressive treatment. It is responsible for non-specific neurological manifestations such as confusion, coma, convulsions or visual disturbances. The diagnosis is suggested by brain magnetic resonance imaging (MRI). The lesions correspond to vasogenic edema and are therefore generally reversible after etiologic treatment and control of blood pressure. Aim: This clinical case aims to show the diagnostic complexity of rare pathologies in the intensive care unit. Case presentation: We present a case of a 14-year-old child received in the pediatrics department for generalized tonic-clonic convulsions with tongue biting in a febrile context. Malaria was negative, with hyperleukocytosis, slightly elevated C-reactive protein, anemia and hypokliemia, lumbar puncture was performed and all cerebrospinal fluid examinations revealed nothing. The seizures were controlled by titrated cumulative doses of diazepam with a total of 12mg, antibiotic therapy with ceftriaxone, corticotherapy with dexamethasone 12mg and blood transfusion without any improvement in his condition. He was then transferred to intensive care where the clinical and paraclinical assessment highlighted a neurological deficit Glasgow coma scale of 12/15 and biological hyponatremia. Brain CT-scan was normal. Hydroelectrolytic equilibration was undertaken, antibiotics continued, anti-comital prophylaxis and general resuscitation measures were provided. He regained consciousness on the 3rd day. On the 4th day, he presented high blood pressure and on the 5th, a resumption of convulsions without any obvious biological disorder, cerebrospinal fluid control was once more non-pathological. An MRI was performed and revealed Posterior-reversible encephalopathy syndrome. Conclusion: Posterior-reversible encephalopathy syndrome is a rare disease. It is necessary to keep rare diseases in mind.展开更多
Background SARS-CoV-2 continues to mutate over time,and reports on children infected with Omicron BA.5 are limited.We aimed to analyze the specific symptoms of Omicron-infected children and to improve patient care.Met...Background SARS-CoV-2 continues to mutate over time,and reports on children infected with Omicron BA.5 are limited.We aimed to analyze the specific symptoms of Omicron-infected children and to improve patient care.Methods We selected 315 consecutively hospitalized children with Omicron BA.5 and 16,744 non-Omicron-infected febrile children visiting the fever clinic at our hospital between December 8 and 30,2022.Specific convulsions and body temperatures were compared between the two cohorts.We analyzed potential associations between convulsions and vaccination,and additionally evaluated the brain damage among severe Omicron-infected children.Results Convulsion rates(97.5%vs.4.3%,P<0.001)and frequencies(median:2.0 vs.1.6,P<0.001)significantly differed between Omicron-infected and non-Omicron-infected febrile children.The body temperatures of Omicron-infected children were significantly higher during convulsions than when they were not convulsing and those of non-Omicron-infected febrile children during convulsions(median:39.5 vs.38.2 and 38.6℃,both P<0.001).In the three Omicron-subgroups,the temperature during convulsions was proportional to the percentage of patients and significantly differed(P<0.001),while not in the three non-Omicron-subgroups(P=0.244).The convulsion frequency was lower in the 55 vaccinated children compared to the 260 non-vaccinated children(average:1.8 vs.2.1,P<0.001).The vaccination dose and convulsion frequency in Omicron-infected children were significantly correlated(P<0.001).Fifteen of the 112 severe Omicron cases had brain damage.Conclusions Omicron-infected children experience higher body temperatures and frequencies during convulsions than those of non-Omicron-infected febrile children.We additionally found evidence of brain damage caused by infection with omicron BA.5.Vaccination and prompt fever reduction may relieve symptoms.展开更多
文摘BACKGROUND Febrile convulsions are a common pediatric emergency that imposes significant psychological stress on children and their families.Targeted emergency care and psychological nursing are widely applied in clinical practice,but their value and impact on the management of pediatric febrile convulsions are unclear.AIM To determine the impact of targeted emergency nursing combined with psychological nursing on satisfaction in children with febrile convulsions.METHODS Data from 111 children with febrile convulsions who received treatment at Nantong Maternal and Child Health Care Hospital between June 2021 and October 2022 were analyzed.The control group consisted of 44 children who received conventional nursing care and the research group consisted of 67 children who received targeted emergency and psychological nursing.The time to fever resolution,time to resolution of convulsions,length of hospital stays,Pittsburgh Sleep Quality Index,patient compliance,nursing satisfaction of the parents,occurrence of complications during the nursing process,and parental anxiety and depression were compared between the control and research groups.Parental anxiety and depression were assessed using the Hamilton Rating Scale for Depression(HAMD)and the Hamilton Rating Scale for Anxiety(HAMA).RESULTS The fever resolution,convulsion disappearance,and hospitalization times were longer in the control group compared with the research group(P<0.0001).The time to falling asleep,sleep time,sleep quality,sleep disturbance,sleep efficiency,and daytime status scores were significantly better in the research group compared with the control group(P<0.0001).The HAMD and HAMA scores for parents of children in the research group were lower than the scores in the control group after nursing(P<0.05).Compliance with treatment of children in the research group was higher than in the control group(P<0.05).Parental satisfaction with nursing in the research group was higher than in the control group(P<0.05).The total complication rate of children in the control group was higher than in the research group(P<0.05).CONCLUSION Combining psychological nursing with targeted emergency nursing improved the satisfaction of children’s families and compliance with treatment and promoted early recovery of clinical symptoms and improvement of sleep quality.
基金financially supported by the Medical Innovations Fund of Xi’an Jiaotong University,No.GH0203214Shaanxi Provincial People’s Hospital Incubator Fund Projects+1 种基金the National Natural Science Foundation of China,No.30901600Shaanxi Provincial Scientific and Technological Research Projects,No.2006K14-G12,2005K14-G7
文摘Fructose-1,6-diphosphate is a metabolic intermediate that promotes cell metabolism. We hypothesize that fructose-1,6-diphosphate can protect against neuronal damage induced by febrile convulsions. Hot-water bathing was used to establish a repetitive febrile convulsion model in rats aged 21 days, equivalent to 3–5 years in humans. Ninety minutes before each seizure induction, rats received an intraperitoneal injection of low- or high-dose fructose-1,6-diphosphate(500 or 1,000 mg/kg, respectively). Low- and high-dose fructose-1,6-diphosphate prolonged the latency and shortened the duration of seizures. Furthermore, high-dose fructose-1,6-diphosphate effectively reduced seizure severity. Transmission electron microscopy revealed that 24 hours after the last seizure, high-dose fructose-1,6-diphosphate reduced mitochondrial swelling, rough endoplasmic reticulum degranulation, Golgi dilation and synaptic cleft size, and increased synaptic active zone length, postsynaptic density thickness, and synaptic interface curvature in the hippocampal CA1 area. The present findings suggest that fructose-1,6-diphosphate is a neuroprotectant against hippocampal neuron and synapse damage induced by repeated febrile convulsion in immature rats.
文摘Dissociative convulsions, a prominent form of dissociative (conversion) disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. Here, we present a case with dissociative convulsions in order to catch the eye of the clinicians and researchers on the recognition of clinical manifestation and exploration of therapeutic strategies.
文摘We observed for the first time the differences of immunoreactive β-endorphin(IR -β- EP) content in plasma, pituitary and hypothalamus of rats under various conditionsusing radioimmunoassay (RIA) and the effects of naloxone and β - endorphin (β- EP) antiserumon initial time of convulsions (ITC), severity of convulsions(SOC) and mortality on surface(MOS) of rats to hyperbaric oxygen(HBO). The results suggest thatβ- EP may partici-pate in the course of oxygen - induced convulsions and be one of endogenous convulsion - causingagents.
文摘The purpose of this study was to limit intermittent diazcpam prophyiaxis of children with FC to the patients who haye the second recurrence.A series of 156 children with FC received prophylactic treatment.During 1 ̄5 years for Follow-up (average,2 years and 10 months),28 cases of prophylactic group suffered recurrence of FC 48 times. 54 of 126 cases in control group suffered it 108 times. The difference in case number and recurrent rate between the prophylactic and control groups was highly significant (P<0. 01). Diazepam was found tO be considerably effective in reducing the risk of recurrence of FC.
文摘Background: Since the isolation of HHV-6 in 1986, extensive investigation has revealed it to be ubiquitous and responsible for the majority of cases of a common febrile rash illness of infants known as roseola. Other clinical associations including seizure disorders, encephalitis and meningitis have also been stated in various publications. Objective: The aim of the study is to find out if there is any association between HHV-6 infection and the convulsions prevailing at the Child Health Department of the Korle-Bu Teaching Hospital, Accra-Ghana. Methods and Results: Children admitted into the Department of Child Health with episode of convulsions were recruited after informed consent had been sought from subjects. Cerebrospinal fluid (CSF) and Plasma were obtained from patients. PCR directed at the detection of the large tegument protein (LTP) gene in the SIE strain of the HHV-6 in Plasma and CSF from patients was done. The mean age of study subjects was 37.44 months with 53 (64.6%) being males. There was a significant relationship between the convulsions and fever (P < 0.05). Based on CSF characteristics gathered, viral infections may be the probable cause of the observed convulsions but not malaria or bacterial infections. None of the samples from the patients had evidence of HHV-6. Conclusion: The study was unable to establish HHV-6 infection in the CSF and Plasma of patients. What role if any HHV-6 has in convulsions seen in children or neurological diseases at large merits further studies. Other neurotropic viruses need to be investigated as possible causes for the convulsions.
文摘BACKGROUND Primary intestinal lymphangiectasia(PIL)is a rare protein-losing enteropathy characterized by abnormally dilated lymphatic structures,resulting in leakage of lymph(rich in protein,lymphocytes,and fat)from the intestinal mucosal and submucosal layers and thus hypoproteinemia,lymphopenia,hypolipidemia,and pleural effusion.CASE SUMMARY A 19-year-old Chinese male patient complained of recurrent limb convulsions for the last 1 year.Laboratory investigations revealed low levels of calcium and magnesium along with hypoproteinemia and high parathyroid hormone levels,whereas gastroscopy exhibited chronic non-atrophic gastritis and duodenal lymphatic dilatation.Subsequent gastric biopsy showed moderate chronic inflammatory cell infiltration distributed around a small mucosal patch in the descending duodenum followed by lymphatic dilatation in the mucosal lamina propria,which was later diagnosed as PIL.The following appropriate mediumchain triglycerides nutritional support significantly improved the patient’s symptoms.CONCLUSION Since several diseases mimic the clinical symptoms displayed by PIL,like limb convulsions,low calcium and magnesium,and loss of plasma proteins,it is imperative to conduct a detailed analysis to avoid any misdiagnosis while pinpointing the correct clinical diagnosis and simultaneously ruling out other clinical aspects in the reported cases without any past disease history.A careful assessment should always be made to ensure an accurate diagnosis in a timely manner so that the patient can be delivered quality health services for a positive health outcome.
文摘AIM:To determine the prevalence of recent immunisation amongst children under 7 years of age presenting for febrile convulsions.METHODS:This is a retrospective study of all children under the age of seven presenting with febrile convulsions to a tertiary referral hospital in Sydney.A total of 78 cases occurred in the period January 2011 to July 2012 and were included in the study.Data was extracted from medical records to provide a retrospective review of the convulsions.RESULTS:Of the 78 total cases,there were five medical records which contained information on whether or not immunisation had been administered in the preceding 48 h to presentation to the emergency department.Of these five patients only one patient(1.28%of the study population) was confirmed to have received a vaccination with Infanrix,Prevnar and Rotavirus.The majority of cases reported a current infection as a likely precipitant to the febrile convulsion.CONCLUSION:This study found a very low prevalence of recent immunisation amongst children with febrile convulsions presenting to an emergency department at a tertiary referral hospital in Sydney.This finding,however,may have been distorted by underreporting of vaccination history.
文摘Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of febrile convulsions is dominated by infections of the central nervous system. A detailed clinical examination and laboratory and imaging tests are carried out to identify the cause of the disease. Computed tomography is reserved for emergency situations or as a second line of defence, after Magnetic Resonance Imaging (MRI) to look for calcifications. Imaging thus helps to establish the nature of the epileptogenic lesion, specify its extent and guide its therapeutic management. The aim of this study is to clarify the contribution of MRI in the etiological investigation of convulsions in children at the paediatric university hospital, in addition to the usual means of exploration. Patient and Method: This was a cross-sectional, descriptive study from January 2022 to December 2023. We carried out an exhaustive sampling of all children aged between 1 and 59 months admitted for convulsion with fever or not who had undergone complementary examinations for aetiological purposes in relation to our technical platform during the study period. Results: Thirty patients were recruited. Children aged 12 to 59 months were the most represented (69.7%). The sex ratio was 1.30. The mean age was 36 months (range 30 days to 59 months). Of the 30 patients, 21.8% had a history of febrile convulsions. Most of our patients were from Bangui (73.3%). On admission, the majority of patients presented with an elevated temperature ranging from 38.5 degrees Celsius to 39.4 degrees Celsius in 33.1% of cases. The dominant clinical manifestations were tonic-clonic convulsions (53.2%), tonic convulsions (35.3%) and clonic convulsions (11.5%). According to their characteristics, convulsions were complex in 53.7% of cases and simple in 46.3%. Examinations for infectious diseases, tumors or malformation has been ruled out. The anticonvulsants most commonly used were diazepam, phenobarbital and phenytoin. We recorded a 73.3% cure rate and 4 (13.3%) cases of death. Conclusion: The investigation of seizures in search of aetiology outside the usual means in our context still presents difficulties. MRI is the examination of choice for exploring the posterior fossa and midline lesions. Combined with CT, it is better for exploring hemispheric tumours.
文摘Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occurs in various conditions such as collagenosis or vasculitis of the central nervous system, electrolytic disorders and the use of cytotoxics or immunosuppressive treatment. It is responsible for non-specific neurological manifestations such as confusion, coma, convulsions or visual disturbances. The diagnosis is suggested by brain magnetic resonance imaging (MRI). The lesions correspond to vasogenic edema and are therefore generally reversible after etiologic treatment and control of blood pressure. Aim: This clinical case aims to show the diagnostic complexity of rare pathologies in the intensive care unit. Case presentation: We present a case of a 14-year-old child received in the pediatrics department for generalized tonic-clonic convulsions with tongue biting in a febrile context. Malaria was negative, with hyperleukocytosis, slightly elevated C-reactive protein, anemia and hypokliemia, lumbar puncture was performed and all cerebrospinal fluid examinations revealed nothing. The seizures were controlled by titrated cumulative doses of diazepam with a total of 12mg, antibiotic therapy with ceftriaxone, corticotherapy with dexamethasone 12mg and blood transfusion without any improvement in his condition. He was then transferred to intensive care where the clinical and paraclinical assessment highlighted a neurological deficit Glasgow coma scale of 12/15 and biological hyponatremia. Brain CT-scan was normal. Hydroelectrolytic equilibration was undertaken, antibiotics continued, anti-comital prophylaxis and general resuscitation measures were provided. He regained consciousness on the 3rd day. On the 4th day, he presented high blood pressure and on the 5th, a resumption of convulsions without any obvious biological disorder, cerebrospinal fluid control was once more non-pathological. An MRI was performed and revealed Posterior-reversible encephalopathy syndrome. Conclusion: Posterior-reversible encephalopathy syndrome is a rare disease. It is necessary to keep rare diseases in mind.
基金supported by the Science and Technology Planning Project of Guangdong Province(No.2020B1111170001)The funder had no role in the study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Background SARS-CoV-2 continues to mutate over time,and reports on children infected with Omicron BA.5 are limited.We aimed to analyze the specific symptoms of Omicron-infected children and to improve patient care.Methods We selected 315 consecutively hospitalized children with Omicron BA.5 and 16,744 non-Omicron-infected febrile children visiting the fever clinic at our hospital between December 8 and 30,2022.Specific convulsions and body temperatures were compared between the two cohorts.We analyzed potential associations between convulsions and vaccination,and additionally evaluated the brain damage among severe Omicron-infected children.Results Convulsion rates(97.5%vs.4.3%,P<0.001)and frequencies(median:2.0 vs.1.6,P<0.001)significantly differed between Omicron-infected and non-Omicron-infected febrile children.The body temperatures of Omicron-infected children were significantly higher during convulsions than when they were not convulsing and those of non-Omicron-infected febrile children during convulsions(median:39.5 vs.38.2 and 38.6℃,both P<0.001).In the three Omicron-subgroups,the temperature during convulsions was proportional to the percentage of patients and significantly differed(P<0.001),while not in the three non-Omicron-subgroups(P=0.244).The convulsion frequency was lower in the 55 vaccinated children compared to the 260 non-vaccinated children(average:1.8 vs.2.1,P<0.001).The vaccination dose and convulsion frequency in Omicron-infected children were significantly correlated(P<0.001).Fifteen of the 112 severe Omicron cases had brain damage.Conclusions Omicron-infected children experience higher body temperatures and frequencies during convulsions than those of non-Omicron-infected febrile children.We additionally found evidence of brain damage caused by infection with omicron BA.5.Vaccination and prompt fever reduction may relieve symptoms.