Aim To describe the epidemiology and outcomes of convulsive status epilepticus (CSE) since the introduction of buccal midazolam and the change in International League Against Epilepsy definition of CSE to include seizures of at least 5 minutes. Method All children presenting to paediatric emergency departments with CSE (2011–2017) in Lothian, Scotland, were identified. Data, collated from electronic health records, included patient demographics, clinical characteristics, acute seizure management, and adverse outcomes (for example admission to intensive care). Results Six hundred and sixty‐five children were admitted with CSE who had 1228 seizure episodes (381 males, 284 females; median age 3y 8mo; age range 0–20y 11mo). CSE accounted for 0.38% (95% confidence interval 0.34–0.42) of annual attendances at emergency departments. Annual prevalence was 0.8 per 1000 children aged 0 to 14 years. Thirty‐four per cent of children had recurrent CSE. Sixty‐nine per cent of seizures lasted 5 to 29 minutes (median duration 10min). Buccal midazolam was given to 30% of children with CSE and had no effect on need for ventilatory support. Seventy per cent of children with CSE required hospital admission. Four per cent resulted in adverse outcome and there were only two deaths. Recurrent seizures, longer duration, and unprovoked seizures increased the odds of adverse outcome. Interpretation Adverse outcomes have decreased and the use of buccal midazolam is promising. Identifying high‐risk groups provides an opportunity for early intervention. These data form the basis for an extensive evaluation of acute seizure management and monitoring long‐term outcomes. The annual prevalence of convulsive status epilepticus in Lothian, Scotland, was 0.8 per 1000 children. There was a decrease in case‐fatality proportion from 3–9% to 0.2%. Use of buccal midazolam has increased, with no increase in adverse outcomes.
Aims The purpose of this work is to study features of physical development in children with cerebral palsy (CP) brought up in the different conditions. Methods Sixty children with CP participated in the research. Children were divided into 2 groups: the main group consisted of children brought up in children's community, and the comparison group consisted of children brought up in a family. Physical development of children was assessed using the WHO ANTHRO program, at the same time the body mass index (BMI) and indicators of Z-score BMI concerning age were calculated. Results When studying physical development of children it is established that at children of the main group average size BMI was 15.47±2.65, and the comparison group-16.21 ±2.89. Easy insufficiency of nutrition (Z-score from-2s to-1s) was observed at 26.7% of the examined children of the main group, and at 23.3% at the comparison group. Moderate nutritional deficiency (Z-score from-3s to-2s) it was diagnosed for 23.3% of children of the main group and for 16.7% at the comparison group, while the largest number of children with moderate nutritional deficiency was determined at the age of 3 to 4 years in both groups. Heavy degree of nutritional deficiency (Z-score <-3s) in the compared groups was noted equally (6.7%). Overweight corresponding to a moderate increase in nutrition (Z-score from +1s to +2s) was detected in 10% of children in the main group and in the 6.7% at the comparison group, increased moderate nutrition (Z-score from +2s to +3s) was determined in 3.3% of children of the main group and the comparison group. Studying of correlation dependence between indicators of BMI and weight at the birth did not reveal reliable communication between signs in the studied groups, at the same time the correlation coefficient in the main group was r=0.205, and in group comparison of r=-0.146 (p>0.05). Conclusion Assessment of physical development of children with use of the international standards allowed to establish existence of disharmonious development in most of the examined children.
Background In Scotland, childhood asthma hospitalisations fell in March 2006 following legislation to prohibit smoking in public places, and again in March 2014 following a massmedia campaign (Take It Right Outside TIRO). In December 2016, new Scottish legislation banned smoking in vehicles. It is unknown if this produced additional benefit. Objectives To use interrupted time series analysis to determine the presence of a change in trend for asthma admissions to hospital in Scotland after the 'car ban' smoking legislation was introduced. Methods Data were obtained on all asthma emergency hospitalisations in Scotland between 2000 and 2018 for individuals aged <16 years. Interrupted time series analyses studied changes in monthly incidence following the introduction of smoke-free vehicle legislation, taking account of TiRO (2014) and the smoke free public spaces legislation (2006). Sub-group analyses were undertaken by age and area-deprivation, and the analyses repeated for a control condition, gastroenteritis. Results Of the 32,342 hospitalisations, 13,954 related to children <5 years old. After the smoke-free vehicle legislation there was a fall in the slope of asthma hospitalisations (1.49%/month [95% CI 2.69, 0.27]) among children <5 years, but not older children. Hospitalisations fell significantly among children living in the most affluent areas (2.27%/ month [95% CI 4.41, 0.07]) but not those living in the most deprived areas. There was no change in gastroenteritis hospitalisations following the legislation. Conclusions Legislation banning smoking in vehicles was associated with reductions in severe asthma attacks requiring hospitalisations among pre-school children, over and above those already achieved through previous interventions. The legislation may have benefitted children in more affluent communities.
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