Value of combining targeted emergency nursing with psychological nursing in children with febrile convulsions

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.

Clinical analysis between serum 25-hydroxyvitamin D3, interleukin-6 levels and febrile convulsion in children

Objective:To investigate the relation between febrile convulsions and 25hydroxy-vitamin D_(3)[25-(OH)D_(3)]and interleukin-6(IL-6)levels in children.Methods:241 children(divided into simple febrile convulsions and complex febrile convulsions),who were diagnosed with febrile convulsions at the Women and Children's Medical Center of Hainan Province from January 2017 to October 2022,were selected into the febrile convulsions group;100 healthy children,who had no uncomfortable symptoms and attended the outpatient clinic of the Women and Children's Medical Center of Hainan Province for physical examination,for the control group.All the subjects measured the serum 25-(OH)D_(3) and IL-6 levels,and clinical information,such as age,gender and season,was recorded.Results:1)Serum 25-(OH)D_(3) levels in the febrile convulsion group were significantly lower than in the healthy control group(78.77±20.37 nmol/L versus 96.55±29.74 nmol/L,respectively),and there was a statistically significant between the two groups(t value-6.359,P<0.001).Serum IL-6 levels in the febrile convulsion group were significantly higher than in the healthy control group,and there was a statistically significant between the two groups(Z value of-14.291,P<0.001).2)Serum 25-(OH)D_(3) levels in children with complex febrile convulsions were significantly lower than those in children with simple febrile convulsions,and the difference between the two groups was statistically significant(t-value of 6.612,P<0.05).IL-6 levels were higher in children with complex febrile convulsions than in children with simple febrile convulsions,and the difference between the two groups was statistically significant(Z value-10.151,P<0.001).The difference in the severity of febrile convulsions was statistically significant in serum 25-(OH)D_(3) levels(x^(2)=29.83,P<0.001).3)The results of correlation analysis showed that serum 25-(OH)D_(3) level was negatively correlated with febrile convulsion(γ=-0.393,P<0.05);serum 25-(OH)D_(3) level was positively correlated with that(γs=0.328,P<0.05).4)The correlation analysis results showed that the serum 25-(OH)D_(3) level was negatively correlated with the clinical characteristics of febrile convulsion(γ=-0.393,P<0.05).However,serum IL-6 water is positively correlated with it(γs=0.328,P<0.05).4)In contrast,there was no statistically significant difference in serum 25-(OH)D_(3) levels among children with febrile convulsions in different seasons(P>0.05).Conclusions:There is a correlation between febrile convulsion and serum levels of 25-(OH)D_(3) and IL-6.25-(OH)D_(3) and IL-6 may participate in the pathogenesis of febrile convulsion.

Repeated febrile convulsions impair hippocampal neurons and cause synaptic damage in immature rats: neuroprotective effect of fructose-1,6-diphosphate

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.

Effect of zinc protoporphyrin on carbon monoxide/heme oxygenase-1 system in rats subjected to recurrent febrile convulsion

BACKGROUND： Studies on febrile convulsion （FC）-caused brain injury are disputed in many aspects. How FC cause nervous system injury in the developmental period and what are the characteristics of these pathological injury are unknown. The current studies have demonstrated that berne oxygenase-1 （HO-1） exerts effects on brain injury mainly by catalyzing hemoglobin to produce degradation products, and HO-1 not only has neuroprotective effects, but also has neurotoxic effects during the FC-caused brain injury. Study on the effect of zinc protoporphyrin （ZnPP） on brain injury is still in the stage of animal experiment. OBJECTIVE： To observe the effects of ZnPP on carbon monoxide （CO）/HO-1 system of rats subjected to FC, and to analyze the action pathway of ZnPP in brain protective effect. DESIGN： A randomized controlled animal experiment. SETTING： Department of Pediatrics, First Hospital Affiliated to Jiamusi University. MATERIALS： Sixty-five Wistar rats, of either gender, were involved in this study. They were randomized into normal control group（ n =14, 37℃ water bath） and febrile treatment group （n =51, 44.5℃ hot water bath）. Febrile treatment group was sub-divided into febrile non-convulsion group （FNC group, n =16） and FC group （n =35）. FC group was further sub-divided into simple convulsion group （n =20） and ZnPP treatment group （n =15）. HO-1 mRNA in situ hybridization kit was provided by Boster Bioengineering Co.,Ltd. ZnPP（dark brown powder） was the product of Jingmei Bioengineering Company. METHODS： This study was carried out in the postgraduate laboratory of Jiamusi University between January 2004 and January 2007. Rats in the febrile treatment group were placed in the 44.5℃ hot water bath box. If rats did not convulse in the water within 5 minutes, they were taken out, namely FNC group （n = 16）, and those, which were convulsed within 5 minutes, were taken out immediately when they presented such a phenomenon, namely FC group （n =35）. Convulsion induction was conducted once every other day, totally 10 times. Rats were euthanized for analysis at 24 hours after the last induction. Rats in the control group were placed in the 37℃ water. Rats in the ZnPP treatment group were intraperitoneally injected with ZnPP at 45 μ mol/kg before FC attack. Rats in the simple convulsion group were only induced to be convulsed but not administrated. MAIN OUTCOME MEASURES： CO level in the brain tissue homogenate and plasma of rats in each group was detected with a spectrophotometer. HO-1 mRNA expression in the hippocampal CAI region, CA3 region and dentate gyrus of rats was observed by in situ hybridization technique. RESULTS： Sixty-five Wistar rats were involved in the study. Two rats died respectively due to drowning and convulsion in the FC group. One rat died due to convulsion drowning in the ZnPP treatment group. ①Plasma CO concentration of control group and ZnPP treatment group was significantly lower than that of the FC group （P 〈 0.01）, and was significantly higher in the ZnPP treatment group than in the FNC group （P 〈 0.05）. ②CO level in the brain tissue homogenate was significantly lower in the control group and ZnPP treatment group than in the FC group （P 〈 0.01）, and was very significantly higher in the ZnPP treatment group than in the control group （P 〈 0.01）. ③HO-1 mRNA expressions in the neuron of hippocampal CAl region, CA3 region and dentate gyrus of the control group were the lowerest, and those in the FC group were the highest. HO-1 mRNA expression in the neuron of dentate gyrus in the FC group was significantly higher than that in the ZnPP treatment group （P 〈 0.01）, and those in the FNC group and control group was significantly lower than that in the ZnPP treatment group （P 〈 0.01）. CONCLUSION： FC can cause brain injury. Over-expression of HO-I mRNA and the increase of CO are involved in the patho-physiological process of FC. ZnPP can inhibit HO-lmRNA activity and decrease CO level, which is one of pathways for protecting brain.

Gentianine protects hippocampal neurons in a rat model of recurrent febrile convulsion

Gentianine has been shown to have a protective effect on hippocampal CA1 neurons in rats subjected to recurrent febrile convulsion（FC）.The present study sought to explore the possible mechanism of gentianine by intraperitoneally injecting gentianine into rats with warm water-induced FC.The results revealed that neuronal organelle injury was slightly ameliorated in the hippocampal CA1 region.The level of glutamate was decreased,but the level of γ-aminobutyric acid was increased,as detected by ninhydrin staining.In addition,glutamate acid decarboxylase expression in hippocampal CA1 was increased,as determined by immunohistochemistry.The results demonstrated that gentianine can ameliorate FC-induced neuronal injury by enhancing glutamate acid decarboxylase activity,decreasing glutamate levels and increasing γ-aminobutyric acid levels.

Changes of somatostatin content in some brain areas of rats during oxygen－induced convulsion

The content of somatostatin(SS) in hippocampus,striatum and frontal cortex tissues of rats exposed to 600 kpa hyperbaric oxygen was determined by means of radioimmunoassay. Initial time of convulsion, severity of convulsion and survival time of rats with convulsion exposed to 700 kPa hyperbaric oxygen after intraperitoneal injection of cysteamine (CSH) or intracerebroventricular injection of anti-somatostatin serum(ASS) were also observed. The results showed that the content of SS in hippocampus and striatum tissues increased remarkably when rats were at near-convulsion ; by the time the rats developed convulsion,it had a significant increase in all brain areas observed. Intraperitoneal injection of CSH or intracerebroventricular injection of ASS could delay initial time of convulsion (ITC),prolong survival time (ST) and reduce severity of convulsion (SOC). These results suggest that SS might play a role in oxygen-induced convulsion and be one of the endogenous agents which caused oxygeninduced convulsion.

Prevalence of recent immunisation in children with febrile convulsions

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.

Etiology and Short Term Outcome of Neonatal Convulsion in NICU at Benghazi Children Hospital

Background: Neonatal seizures are the most prominent feature of neurological dysfunction during neonatal period, which are abnormal electrical discharges in the central nervous system of neonates, usually manifest as stereotyped muscular activity or autonomic changes, occurring in approximately 1.8 - 3.5/1000 live birth. Objective: The aims of study are to determine prevalence rate, natural history, time of onset, etiological factors, clinical types and the short term outcome of neonatal convulsion. Settings: This study conducted in Neonatal Department at Benghazi Children Hospital—Libya. Patients and Methods: Descriptive cross sectional study, included all neonates who developing clinically identifiable seizures, admitted from 1st of March 2013 to 1st of March 2014. The data collected by using a designed perform including;gender, nationality, residence, place of transfer, gestational age, time of onset, mode of delivery, and history of maternal diseases, family history of neonatal seizures in previous siblings or death, jaundice and exchange transfusion were taken. Details examination include dysmorphic features, weight, head circumference were recorded. Types of seizures were diagnosed by clinical observations, and the etiology of neonatal seizures had been identified from imaging study and from initial relevant investigations which include blood glucose levels, arterial blood gases, serum calcium, electrolytes, phosphate and cerebrospinal fluid examination for evidence of infection. In addition to treatments received, as well as causes of deaths. Results: A total of 2842 neonates were admitted to NNW, out of which 150 had seizures. 86 (57%) were male with M:F ratio of 1.3:1. (97%) were Libyan and (76%) from Benghazi, (42%) admitted directly from home. 131 (87%) were term and 15 (10%) preterm. Most of neonatal seizures (76%) were seen in the 1st week of life, and during initial 72 hours of life (63%), with 24% presented in 1st 24 hours of life. Vaginal delivery conducted in 101 (67%), C/S 49 (33%). Among babies with birth asphyxia, 76% delivered vaginally. 43/150 mothers presented with different medical problems, 32% of them had preeclampsia followed by diabetes in 28%. 127 (85%) babies had normal birth weight and 128 (86%) lie within normal range of head circumference. The most common type of seizure was subtle (48%) followed by clonic (36%). Cranial ultrasound performed to 110 (73%), among them, 16 babies MRI or CT scan were done. The most common cause of seizure was birth asphyxia (30%) followed by infection (16%), hypocalcemia (14%). Phenobarbitone was the most common drug used in treatment (60%), followed by phenytoin (40%) and resistant cases for treatment received pyridoxine (2%). 77 (52%) improved and discharged home without treatment. Mortality rate was 15%;among them 44% from IEM, followed by birth asphyxia 22%. There is strong association between main causes and the outcome with p = 0.005. Conclusion: The majority of neonates in our study were full term and male. The most common etiology of seizures is birth asphyxia. Hypocalcemia is the most common biochemical abnormality. Subtle represents the commonest type of seizure. Phenobarbitone is still the most commonly prescribed anticonvulsant. Inborn error of metabolism carries a higher mortality rate. Statically analysis showed there is significant association between main causes of neonatal convulsions and the outcome with p = 0.005.

A case of dissociative convulsions presented as frequent epilepsylike seizures

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.

Evaluation of the anticonvulsant activity of the essential oil of Myrothamnus moschatus in convulsion induced by pentylenetetrazole and picrotoxin

Objective: To evaluate the anticonvulsant effect of the essential oil of Myrothamnus moschatus(M. moschatus) in convulsion induced by pentylenetetrazole and picrotoxin in rodent models.Methods: The essential oil of the aerial parts of M. moschatus was extracted by steam distillation. Thereafter, it was injected subcutaneously to rats and mice at escalating doses(0.1–0.8 m L/kg). Ten minutes after drug injection, pentylenetetrazole was injected intraperitoneally to rats and picrotoxin was administered to mice by the same route.Diazepam served as the positive control. Every single animal was placed into transparent cage and observed for convulsive behavior for 30 min by using ordinary security cameras connected to a video recorder. Death occurring for a period of 24 h was also recorded.Results: The essential oil at 0.8 m L/kg completely arrested the pentylenetetrazole-induced convulsion without any sedative effect and delayed its appearance at lower doses, but showed moderate activities on picrotoxin-induced convulsion. For the rats treated with pentylenetetrazole alone, the mortality was 100% within 1 h, but for the rats pre-treated with the essential oil, the mortality was 0%. For the mice treated with picrotoxin, the mortality rate was also 100%, while 20%–100% died in those that had been pre-treated with the oil.Conclusions: The results confirmed at least partly the traditional uses of the smoke of M. moschatus for the management of convulsion, and implied that the essential oil may inhibit the convulsion by GABAergic neuromodulation.

Changes of Immunoreactive β-Endorphin in Plasma, Pituitary and Hypothalamus of Rats during Oxygen-Induced Convulsions

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.

Influence of nitric oxide synthase inhibitor on gerbil behavior after hyperbaric oxygen-induced convulsion

BACKGROUND：Studies have reported that nitric oxide synthase （NOS） inhibitor can prolong the latency of hyperbaric oxygen-induced convulsion （HBOC）. However, there are very few reports addressing the influence of NOS inhibitor on mental behavior. OBJECTIVE： To investigate behavioral changes after HBOC in gerbils, as well as the influence of NOS inhibitor. DESIGN, TIME AND SETTING： Randomized experiments were performed in the Laboratory of Hyperbaric Pressure and Diving Physiology, Naval Medical Research Institute of Chinese PLA （Shanghai, China） from March 2005 to June 2007. MATERIALS： Forty male gerbils were randomly divided into five groups： HBOC, saline control, NOS inhibitor, pressure control, and normal control. Each group contained eight animals. METHODS： In the HBOC group, once depression induction ended, animals were removed from the chamber five minutes after the first appearance of generalized convulsion induced by 0.5 MPa hyperbaric oxygen. Ten minutes before entering the chamber, saline control and NOS inhibitor animals were intraperitoneally injected with 1 mL saline and 20 mg/kg NG-nitro-L-arginine, respectively. The pressure control group was only exposed to 0.5 MPa. The remaining procedures in these three groups were identical to the HBOC group. The normal control group received no intervention. MAIN OUTCOME MEASURES： Open field test scores in gerbils prior to HBOC, as well as immediately, 24 hours, and 72 hours after decompression ended. RESULTS： HBOC was not detected in either the normal control or the pressure control group, and there were no significant differences in open field test scores prior to and after HBOC （P 〉 0.05）. HBOC occurred in the HBOC, saline control, and NOS inhibitor groups, with significant differences in open field test scores after decompression ended compared to normal control and pressure control groups （P 〈 0.05–0.01）. Compared to the HBOC and saline control groups, the NOS inhibitor group exhibited a significantly lower score in the open field test immediately after decompression, and a higher score at 24 and 72 hours （P 〈 0.05–0.01）. CONCLUSION： NOS inhibitor can regulate behavioral changes in gerbils after HBOC.

Clinical Analysis of the Relationship between Convulsion and Blood Electrolyte in Children

Objective: Febrile convulsion in children is age-dependent and genetic predisposition. However, mild electrolyte disturbances are not uncommon in such children. This study was to investigate the effect of electrolyte disturbance on febrile convulsion and to screen for febrile convulsion-related genes. Methods: This retrospective cohort study included children who admitted to the Pediatric Emergency Department of Guangzhou Women and Children’s Medical Center due to fever and febrile convulsion between May to December 2020. Clinical manifestations and serum electrolyte levels were recorded and analyzed by binary logistic regression on risk factors of convulsion, and children with family histories were screened for febrile convulsion-related genes. Results: This study included 322 children with fever: 161 in the febrile convulsion group (FC Group) including 71 in the single convulsion group (SC Group) and 90 in the multiple convulsion group (MC Group), and the control group consisted of 161 children with fever without convulsion and nervous system disease. Serum sodium, potassium and calcium in FC Group were lower than those in the control group (p Conclusion: Hyponatremia may be a relative risk factor in febrile convulsion, and for children with a family history of febrile convulsion and serum sodium lower than 133 mmol/L, related gene analysis can be performed.

PROPHYLAXIS OF INTERMITTENT DIAZEPAM IN CHILDREN WITH FEBRILE CONVULSIONS（FC）

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.

The Role of Human Herpesvirus Type-6 (HHV-6) in Convulsions Seen in Children at Korle-Bu Teaching Hospital, Accra

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.

Vancomycin-related convulsion in a pediatric patient with neuroblastoma:A case report and review of the literature

BACKGROUND Vancomycin is often used as an anti-infective drug in patients receiving antitumor chemotherapy.There are concerns about its adverse drug reactions during treatment,such as nephrotoxicity,ototoxicity,hypersensitivity reactions,etc.However,potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported.CASE SUMMARY A 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion.No other potential disease conditions could explain the occurrence of the convulsion.The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion.The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L,respectively,which were much higher than the safe range.Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg·h/L.Therefore,vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy.CONCLUSION Unexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin.Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.

Primary intestinal lymphangiectasia presenting as limb convulsions:A case report

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.

Possible convulsion and electroencephalographic abnormality in a patient taking long-term oral clarithromycin:A case report

BACKGROUND Clarithromycin is a macrolide antibiotic commonly prescribed to patients with upper respiratory and otolaryngological infections.Neuropsychiatric adverse effects of clarithromycin include agitation,insomnia,delirium,psychosis,and seizure.CASE SUMMARY A 52-year-old man was admitted to our hospital with a convulsion.He had>10-year history of clarithromycin intake for chronic sinusitis.One week before admission,he started to take diltiazem for angina pectoris.On admission,his convulsion subsided.His electroencephalography showed frontal intermittent rhythmic delta activity.One week after he ceased clarithromycin,his electroencephalographic abnormalities disappeared.We suggested that the patient developed convulsions due to increased blood levels of clarithromycin caused by oral administration of diltiazem,which is involved in CYP3A metabolism.CONCLUSION Clarithromycin has a relatively high safety profile and is a frequently prescribed drug.However,there are a few previous reports of clarithromycin-related convulsive disorders.Clinicians should be aware of the drug interaction and rare side effects of seizures.

Relationship between serum Ca2+ level and nerve injury as well as myocardial injury in children with febrile convulsion

Objective:To study the relationship between serum Ca2+ level and nerve injury as well as myocardial injury in children with febrile convulsion.Methods: A total of 32 children with febrile convulsion treated in our hospital between May 2011 and September 2015 were selected as observation group and 30 healthy children receiving vaccination in our hospital during the same period were selected as normal control group. Blood calcium levels of two groups of children were detected, and the median blood calcium level was referred to further divide the observation group into high blood Ca2+ group (n=16) and low blood Ca2+ group (n=16). The differences in nerve injury and myocardial injury were compared between children with blood calcium levels within observation group.Results: Serum Ca2+ level of observation group was lower than that of normal control group;excitatory amino acids Glu, Asp, Lys and Ser contents in peripheral blood of low blood Ca2+ group were higher than those of high blood Ca2+ group while inhibitory amino acids Gly and GABA contents were lower than those of high blood Ca2+ group;cardiac function parameters SV, CI and Vpk levels of low blood Ca2+ group were lower than those of high blood Ca2+ group while SVR level was higher than that of high blood Ca2+ group;myocardial enzyme spectrum indexes CK-MB, LDH andα-HBDH contents in peripheral blood of low blood Ca2+ group were higher than those of high blood Ca2+ group.Conclusion: Serum Ca2+ level is low in children with febrile convulsion and Ca2+ level is negatively correlated with nerve injury and myocardial injury.

HMGB1及血清炎性因子与轻度胃肠炎伴良性惊厥发病机制的关系

目的 探讨高迁移率族蛋白B1(HMGB1)及白介素(IL)-1β、IL-2R、IL-6、IL-8及肿瘤坏死因子α(TNF-α)与轻度胃肠炎伴良性惊厥(CwG)发病机制的关系。方法 选取2022年1月至2023年11月期间在江西省儿童医院就诊的CwG患儿30例(CwG组)和同期轻度急性胃肠炎(AGE)不伴有惊厥的患儿30例(对照组)。采集2组急性期和恢复期的静脉血,采用酶联免疫吸附法(ELISA)检测血清HMGB1水平;采用化学发光法检测血清IL1β、IL2R、IL6、IL8、TNF-α水平。结果 在急性期,CwG组的血清HMGB1、IL-6、IL-8、TNF-α水平均显著高于对照组(P<0.001),而血清IL-1β、IL-2R水平与对照组比较差异无统计学意义(P>0.05)。CwG组的惊厥发作次数、惊厥发作总时间、病程均与血清HMGB1、IL-6、IL-8、TNF-α水平成正相关(P<0.05或P<0.001),且血清HMGB1、IL-6、IL-8、TNF-α水平之间相互呈正相关(P<0.05或P<0.001)。CwG组恢复期HMGB1、IL-6、IL-8、TNF-α水平均较急性期下降(P<0.05);2组在恢复期时HMGB1、IL-1β、IL-2R、IL-6、IL-8、TNF-α水平比较差异无统计学意义(P>0.05)。结论 HMGB1介导的免疫炎症网络与CwG的发病过程密切相关,血清HMGB1、IL-6、IL-8、TNF-α水平与CwG急性期的惊厥严重程度及病程转归显著相关。