The document summarizes information on seizures in children, including prevalence, classification, etiology, assessment, and management. It discusses the pathophysiology, types like febrile seizures and absence epilepsy. Evaluation involves detailed history, examination, EEG, and imaging in some cases. Management includes emergency treatment with diazepam or lorazepam for acute seizures. Long-term treatment primarily involves antiepileptic drugs like carbamazepine, valproate, and phenobarbitone.
the causes, pathophysiology, clinical manifestations, diagnosis and treatment of epilepsy has been discussed in detail with the perspective of a subject called pathophysiology in both medical sciences as well as the pharmaceutical sciences
Epilepsy in children is common clinical problem encountered in practice both by general practitioners and paediatricians. so knowledge about different types of epilepsies is mandatory in diagnosis the disease early and instituting appropriate treatment
the causes, pathophysiology, clinical manifestations, diagnosis and treatment of epilepsy has been discussed in detail with the perspective of a subject called pathophysiology in both medical sciences as well as the pharmaceutical sciences
Epilepsy in children is common clinical problem encountered in practice both by general practitioners and paediatricians. so knowledge about different types of epilepsies is mandatory in diagnosis the disease early and instituting appropriate treatment
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. SEIZURES
• One of the most common life threatening events in
childhood, more than adults
• Paroxysmal electrical activity in brain -->
motor/sensory/autonomic disturbance with
/without alteration of consciousness
• Convulsion – seizure with motor activity 5%
• Epilepsy – recurrent (2 or more) unprovoked
seizures beyond newborn period 0.5%
4. Seizures: DDx
Tremors –distal, rhythmic, equal amplitude, no loss of
consciousness
Jitteriness
Breath holding spells –always after crying, sequence of
events important
Syncope – after prolonged standing/emotional upset,
gradual loss of consciousness, slow pulse,
pallor, sweating, improves in supine/head down position
Pseudoseizures – older girl, never hurts herself, bizarre
movements, normal s Prolactin
Detailed sequence of events necessary – HISTORY, HISTORY,
HISTORY
5. Seizures: Pathophysiology:
Sustained partial depolarisation in a group of
neurons -->excitability --> sudden
depolarisation in response to stimuli --
>conduction to surrounding cells, distant
synaptically connected cells & subcortical
neurons -->dissemination -->loss of
consciousness
8. CLASSIFICATION OF EPILEPTIC
SEIZURES: ILAE 1981
• I Partial 54%
– Simple - motor/sensory/autonomic 7.7%
– Complex 35.5%
– Partial with secondary generalization 56.4%
• II Generalised 40.4%
– Tonic clonic 69%
– Absence 3%
– Myoclonic 20.5%
– Tonic 4.1%
– Atonic 3.1%
• III Unclassifiable 6% (hospital based study in Mumbai)
• However, same patient can have more than 1 type
• Many patients show a distinct evolution of disease
9. CLASSIFICATION OF EPILEPTIC
SYNDROMES : ILAE 1989
I Localisation related
• Symptomatic
• Cryptogenic
• Idiopathic
II Generalised
• Idiopathic
• Cryptogenic
– West syndrome
– Lennox Gastaut syndrome
– epilepsy with myoclonic astatic seizures
– epilepsy with myoclonic absences
• Symptomatic
– Non specific
– specific
III Epilepsies undetermined whether focal or generalised
IV Special syndromes
CLASSIFICATION
OF EPILEPSY
STILL EVOLVING
10. EPILEPSY - SPECIAL TYPES:
GTCS: v common
• Aura tonic spasm loss of consciousness fall clonic
movements
• Rolling of eyeballs/Frothing at mouth/Distortion of face
• Incontinence/ Jerky breathing
• Post ictal sleep
11. Absence epilepsy
• 2-4% of childhood idiopathic epilepsy
• Girls 3-7 yrs, normal IQ
• Transient loss of consciousness for few secs
• No loss of tone
• Ppted by hyperventilation -
• Treatment – Ethosuximide, valproate
• May develop GTCS
• EEG - 3/sec spike & wave activity
12.
13. EPILEPSY - SPECIAL TYPES:
Infantile spasms: Onset in 1st year
• Sudden flexion/extension in series esp on awakening
• Upto 100 times /day
• 60% secondary, 30% cryptogenic
• Treatment - ACTH/steroids/ vigabatrin
• Associated with mental regression
• EEG - hypsarrhythmic
• May develop GTCS
Lennox Gastaut:
• 1-8 yrs,
• tonic/atonic/absence type
• EEG - diffuse 2 Hz spike-waves
• Very difficult to control
14.
15. EPILEPSY - SPECIAL TYPES:
Psychomotor (Temporal lobe) seizures: Complex partial seizures
with origin in temporal lobe.
• Purposeful but inappropriate acts 'automatisms'
• Associated with behavioral problems
• Difficult to diagnose or treat.
Benign epilepsy with centrotemporal spikes: Partial, idiopathic,
• orofacial/hemifacial, 3-13 yrs, often during sleep. Easy to
control
Myoclonic: heterogenous, multiple causes
Juvenile myoclonic: myoclonic jerks esp after awakening
• EEG - 4-6 Hz polyspike, photosensitivity, GTCS may occur
• Good response to Valproate
16. FEBRILE SEIZURES:
• 2-4% of children
• 3m - 5 yr age
• Assn with fever due to extracranial infection
• Generalised, Short lasting, only one sz per illness
• No mental/neurological/EEG abnormality
• Typical vs Atypical (complex)
• Focal
• Prolonged
• >1 seizure during illness
• 1/3 have at least 1 recurrence
• 1/6 have multiple recurrences
• Risk of epilepsy:
– Fh/o epilepsy
– Atypical
– Abnormal neurologic/mental status
17. Febrile Seizures: Management
• Exclude CNS infection
• Control fever
• Look for & treat cause of fever
• Rectal diazepam
• Explain to parents, reassure
• If multiple - intermittent oral diazepam by
80%
• If high risk for epilepsy long term
phenobarb/valproate.
18. Seizures: ASSESSMENT
History:
• 1st seizure/ recurrent seizures
• Fever
• Precipitating factors – diarrhea/ vomiting/ drug/ toxin/ metabolic
• Headache/vomiting/visual loss
• Duration
• Age at onset
• No of attacks
• Frequency /, change in seizure type, last seizure when?
• Exact description
– Aura
– partial/generalised onset
– Loss of consciousness
– Tonic/clonic phase
– Associated events - bed wetting/fall/tongue bite
– Duration
– Post ictal
• Precipitating factors
• Diurnal
• Family history
• Antecedant events - trauma/CNS infection/asphyxia
• Personality change/intellectual deterioration
• Failure to thrive
• Developmental milestones
• Treatment
19. Seizures: ASSESSMENT
Examination:
• BP
• Head circumference
• Skin lesions
• Facial features
• Organomegaly
• Fundus
• Meningeal signs
• Neurological deficit
• Development
20. Seizures: Investigations
• If features of CNS infection - CSF examination
• Glucose, Ca, Mg - low yield
• Skull Xray - calcification/ ICT - low yield
• EEG: Always diagnostic during a seizure
• Interictal record : normal in 40-50% of epileptics (spikes/sharp
waves & spikes –slow wave complexes)
• yield with sleep, sleep deprivation, hyperventilation, photic
stimulation
• 2-10% normal population may have epileptic changes
• EEG indicated in all cases of epilepsy for:
• -confirmation of diagnosis & syndrome
• -type of seizures - absence vs temporal lobe,
• primary generalised vs secondarily generalised
• -presence of underlying lesion/ idiopathic vs symptomatic
• -follow up
• -before withdrawal of AEDs
• -localisation of focus before surgery
• Video EEG
21. Seizures: Imaging - CT/MRI
Has revolutionised the management of epilepsy
Indications: focal features on exam, EEG
Features of ICT
Intractable
However, now indicated in every case with unknown cause
Not necessary in febrile/absence/BETS/ JME etc.
Western studies - 30% abnormal (30-50% of focal)
-only 3% treatable
Indian studies:
Very high prevalence of granuloma like lesions –recent onset
partial seizures in child/young adult
40% abn even after 1st seizure
indicated in every case
22.
23.
24. MCQ
• The following are features of benign
(typical) febrile seizures except:
• They are short lasting
• They are always generalised
• They only occur within 4 hours of fever
onset
• They do not recur in the same febrile
illness
25. The typical EEG pattern in absence epilepsy
is:
• Intermittent spike and slow waves
• Hypsarrythmia
• Burst suppression
• 3 per second spike and waves
26. The following is true about absence
epilepsy
• It occurs more commonly in boys
• There is loss of tone
• It is precipitated by hyperventilation
• Imaging is usually abnormal
27. Definition of epilepsy includes:
• At least 3 seizures
• EEG is abnormal
• Imaging is abnormal
• Beyond neonatal period
28. The following is true about breath holding
spells:
• It is usually preceded by crying
• Child is always blue
• There is no loss of consciousness
• EEG may show spikes
29. The following is true about infantile spasms
except:
• They occur in clusters
• They may appear like ‘startling’
• They usually occur during sleep
• They are also called ‘salaam attacks’
30. West syndrome usually has the following
features except:
• Infantile spasms
• Onset in newborn period
• Hypsarrythmia on EEG
• Psychomotor retardation or regression
31. Imaging in seizures is not indicated in:
• Generalised tonic clonic seizures
• Absence seizures
• Temporal lobe seizures
• Infantile spasms
32. Prevention of febrile seizures can be
achieved by:
• Intermittent phenobarb
• Long term phenytoin
• Intermittent diazepam
• Long term carbamazepine
33. Emergency dose of IV diazepam for seizure
control is:
• 1 mg/kg
• 0.5 mg/kg
• 0.1 mg/kg
• 0.3 mg/kg
34. Seizures - Management
• I Management of acute attack:
• Calm down
• Head down lateral position
• Prevent hurt
• If does'nt stop convulsing in 3-5 min,
• Inj Diazepam 0.3 mg/kg slow iv bolus
• Maybe repeated after 20 min
• Effect lasts 0.5-3 hrs
• SE- hypotension, respiratory depression,
secretions
• or
• Rectal diazepam 0.5 mg/kg dose/ nasal midzolam 0.2
mg/kg/dose
36. Seizures: Status epilepticus:
• Prolonged seizure for >20 min or repeated
seizures without regaining consciousness
• Persistent seizure activity hypoxia,
hypoglycemia, hyperthermia, cerebral
edema & vasomotor instability
• Life threatening
• Risk of permanent brain damage
Medical emergency
37. Mx of Status epilepticus
ICU, monitoring
IV dextrose drip
Oxygen
IV Inj Diazepam 0.3 mg/kg or Lorazepam 0.1 mg/kg (longer action)
or Midzolam (lesser respiratory depression)
Inj phenytoin 15-20 mg/kg iv at a rate of <1mk/kg/min
Inj Phenobarbitone 20 mg/kg iv at a rate of 1 mg/kg/min or
IV Valproate 20 mg/kg as infusion in 50 ml NS over 30 min
Ventilatory support + diazepam/midzolam infusion
`` Thiopental infusion
38. LONG TERM MANAGEMENT OF
EPILEPSY:
I General advice:
• As normal a life style as possible
• No swimming/cycling on road/driving
• Inform teacher
• First aid
• Seizure dairy
• Regularity
39. LONG TERM MANAGEMENT OF
EPILEPSY:
Drugs:
• When to start? If 2 or more seizures within a 12 month
period
• Monotherapy:
• Start at lower limit & build up gradually till toxicity/control
• If no effect at maximum dose, taper off while introducing
2nd drug
• 4 first line drugs - Carbamazepine, phenytoin, valproate
and phenobarbitone
• No drug completely safe
• 70% can be controlled
40. First line AEDs
Carbamazepine:
• Ind: Partial, tonic clonic
• Dose: 10-30 mg/kg/d in 2-3 doses13-18 hrs,
• Adv: Relatively safe, improves cognitive fn.
• SE: Diplopia,drowsiness, giddiness
initially.Hepatitis, skin rash, BM depression, drug
interactions, dystonia, can aggravate minor motor
seizures
41. First line AEDs
Sodium valproate:
Ind: Broad spectrum
Dose: 20-30 mg/kg/d (upto 80) in 2-3 doses
Half Life; 7-10 hrs
SE: Nausea, vomiting, wt gain, hair loss,
hepatic failure, tremors, platelets, s
ammonia, s carnitine, no correlation
between drug levels & toxicity, levels of
other AEDs
42. First line AEDs
Phenobarbitone
Ind: Tonic-clonic, partial, febrile
Dose: 3-6 mg/kg/d as single doses
level:10-15 g/ml20-80 hrs
Adv: Cheap, once daily dose
SE: Drowsiness, hyperkinesia, cognitive
impairment ??, rash, rickets
43. First line AEDs
Diphenylhydantoin:
Ind: Tonic-clonic, atonic, partia
Dose: l4-8 mg/kg/d in 2 doses
level: 10-20 g/ml
Half Life: Upto 20 hrs
SE: Hirsutism, gum hyperplasia, rickets,
ataxia, lymphoma like syndrome, Sle like
illness, megaloblastic anemia, rash, low
margin of safety