The weight of MMRV-related febrile convulsions among other clinical factors contributing to febrile convulsions in children

Background

It was previously demonstrated that MMRV vaccine causes a higher rate of febrile convulsions (FC) compared to the MMR vaccine. Additional risk factors for FC include age, familial tendency, day care attendance, viral diseases, complications at birth and developmental delay.

Objective

We evaluated the relative and attributable risk of FC for vaccinees’ age, ethnicity, low birth weight, preterm birth and MMRV vaccination in 10–24 months old children.

Methods

Data on medical history and vaccination were extracted from data warehouses of Clalit Health Services and Israel's Ministry of Health and linked on an individual record level for 90,294 MMR- and 8344 MMRV-vaccinees. A retrospective study design was used to reveal the risk factors associated with FC in study participants.

Results

During the second week after immunization, an elevated relative risk of FC was demonstrated in MMRV-recipients (adjusted RR = 2.16 (95%CI: 1.01; 4.64)). However, the cumulative incidence of FC during the entire 40-day observation period did not differ between the MMR and MMRV vaccinees. The MMRV-specific attributable risk of FC was not statistically significant at any point of observation period and was exceedingly low compared to other risk factors, equaling 5.3 FC cases per 10,000 vaccinees (95%CI: −1.4; 12.2).

Discussion

Our findings demonstrate that MMRV-associated FC in 10–24 months old contributes very marginally to the overall rate of FC in this population.

Conclusion

Given the low number of MMRV-specific FC cases, their transient nature and the benefit of vaccination, the overall benefit-risk of the vaccine can be considered favourable. Nonetheless, the option of separate immunization with MMR + V should be offered to parents, in order to maintain sufficient vaccine uptake in the population.     

Les complications respiratoires de la transfusion

Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20 % of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records.     

轻度胃肠炎伴婴幼儿良性惊厥患儿血清硫化氢水平变化的研究

目的 研究轻度胃肠炎伴婴幼儿良性惊厥(BICE)患儿血清硫化氢(H2S)水平的变化及意义.方法 选择住院治疗的42 例BICE 患儿为观察组,同期因单纯急性胃肠炎入院治疗的46 例患儿为对照组.使用分光光度计法检测其血清H2S 水平.结果 观察组患儿血清H2S 水平显著低于对照组(28±12 μmol/L vs45±10 μmol/L,P<0.O1).惊厥发作次数≥ 2 次患儿血清H2S 水平显著低于发作次数<2 次患儿(P<0.O5).BICE 患儿惊厥发作次数与血清H2S 水平呈负相关(r=-0.485,P=0.001);惊厥持续时间≥ 5 min 组患儿的发作时间与血清H2S 水平呈负相关(r=-0.736,P=0.004).结论 内源性H2S 水平的降低可能是BICE 患儿发病原因之一;血清H2S 水平下降程度与惊厥发生的次数及发作超过5 min 的持续时间有关,其临床意义有待于更多的研究证实.     

Unusual variability of PRRT2 linked phenotypes within a family

BackgroundMutations in the proline-rich transmembrane protein 2 (PRRT2) gene on chromosome 16p11.2 have recently been identified as a cause of paroxysmal kinesigenic dyskinesias (PKD), infantile convulsions and choreoathetosis (ICCA) syndrome or infantile convulsions (IC).AimsHere, we describe a family with four affected members. They all suffer from different diseases: febrile convulsion, epileptic seizures, PKD or headache.MethodsThe whole coding region of PRRT2 gene has been analyzed.ResultsMolecular testing revealed the PRRT2 gene mutation c649.delC in exon 2 for all three sibs as well as for the mother.ConclusionOur presented family case shows the great variability within PRRT2 linked phenotypes even within the same family. Further and more detailed studies will be needed before genetic findings enter into the daily diagnostic and the daily genetic counseling with all its consequences.     

三色预警分级护理对小儿高热惊厥疾病治疗与降温效果的影响

目的探讨三色预警分级护理对小儿高热惊厥治疗效果及降温效果的影响。方法选择我院2018年1月至2019年6月收治的高热惊厥患儿120例,将其随机等分为对照组与观察组,对照组实施常规护理,观察组实施三色预警分级护理,比较两组治疗与降温效果。结果观察组体温恢复时间、惊厥持续时间均短于对照组(P<0.05);观察组复发次数及复发体温均低于对照组(P<0.05),复发间隔时间长于对照组(P<0.05)。结论三色预警分级护理在小儿高热惊厥中的应用,能显著改善治疗效果,有助于防控疾病复发。     

羟基积雪草苷与积雪草苷对LPS诱导大鼠发热模型的影响

目的观察积雪草苷和羟基积雪草苷的解热作用,并比较两者在解热作用上的差异。方法将80只SD大鼠随机分为空白组、模型组(LPS 100μg/kg)、溶酶对照组(羧甲基纤维素钠)、积雪草苷5,15,45 mg/kg、羟基积雪草苷10,20,40mg/kg、对乙酰氨基酚50 mg/kg组。腹腔注射LPS(100μg/kg)建立SD大鼠发热模型,绘制各组平均体温变化曲线,比较测量体温与基础体温差值ΔT。结果羟基积雪草苷(10,20,40 mg/kg)与积雪草苷(5,15,45 mg/kg)对LPS诱导的SD大鼠发热模型体温有显著的降温作用(P<0.05)。结论羟基积雪草苷和积雪草苷对LPS诱导的SD大鼠发热模型的体温均有降温作用,积雪草苷在某些时间点(如LPS注射5 h后)降温效应优于羟基积雪草苷。     

掌叶半夏超临界CO_2乙醇萃取物的抗惊厥作用(英文)

目的研究掌叶半夏超临界CO2乙醇萃取物(SEE-CO2 PP)对青霉素诱发惊厥的对抗作用。方法采用大鼠皮质局部定位注射青霉素诱发惊厥模型,研究SEE-CO2 PP对惊厥发作的潜伏期以及惊厥行为变化的影响,并用RM6240C型多道生理信号采集处理仪记录皮质和海马痫性放电的潜伏期、频率和痫波最高发放波幅,同时应用高效液相色谱法测定海马谷氨酸(Glu)、天冬氨酸(Asp)、甘氨酸(Gly)和γ-氨基丁酸(GABA)递质的含量。结果 SEE-CO2 PP 15和30 g·kg-1(ig)可延长青霉素诱发惊厥的潜伏期,并减弱发作强度。SEE-CO2PP能够延长痫性放电的潜伏期,减少痫性放电的频率,减小皮质和海马发放痫波的最高波幅,同时,SEE-CO2PP可以增加海马GABA的水平,对Gly,Asp和Glu水平无明显影响。结论 SEE-CO2PP可对抗青霉素诱发的惊厥行为和痫样放电,具有抗惊厥作用。     

《伤寒论》多媒体视频案例教学问卷调查与分析

《伤寒论》作为中医临床经典著作,是中医学习的重点与难点。创建多媒体视频案例库,并运用于课堂教学,体现了理论与临床、经典与现代、继承与创新三结合。通过56份教学问卷分析,从视频印象、拍摄元素、运用设计、改进建议等进行探讨,具有积极示范与指导意义。