Psychosocial well-being in children with epilepsy.

Objective: To examine the aptitude, school performance and parent satisfaction (psychosocial wellbeing) of epileptic children in comparison to a control group Method: A prospective study was conducted from 30th May to 8th August 2005 at the Lady Ridgeway Hospital for Children, Colombo. Data was collected by a trained investigator. All children between the ages of 6 and 10 years, diagnosed with epilepsy for a period extending 2 years, and attending the hospital during the study period, were included as cases. Only children who were attending school (mainstream or special needs) were included. 102 questionnaires were administered and none were discarded. The controls were identified from 3 primary schools in the same district. Each epileptic child was matched by age and sex with a non-epileptic child. The social class profiles of the 2 groups did not differ significantly. Each participating parent completed a pre-tested questionnaire to assess the psychosocial well-being of the epileptic children and their parents. This was followed by a standardized aptitude test which was completed by both cases and controls. The data was entered into the Statistical Package for Social Sciences (SPSS) Version 12 for Windows to examine the differences between the groups via frequency distributions. Results: When compared with the non-epilepsy sample, the epilepsy sample was characterised by low academic achievement, extra-curricular participation, self and life skills, dependency, lethargy, restricted independence and less equal opportunity towards success. On the other hand, on items relating to aggressive behaviour and family relationships no significant differences were found between the two groups. On the Aptitude test the average score by an epileptic child was 4.12/10 whereas it was 8.42/10 in the control group. Conclusion: The psychosocial wellbeing of epileptic children is poor in comparison to the control group.

Management of acute paracetamol poisoning in a tertiary care hospital.

OBJECTIVES: To compare the management of acute paracetamol poisoning with the best evidence available, and to determine the effect of plasma paracetamol level estimation on the management. DESIGN: Descriptive study with an intervention. SETTING: Medical wards of the National Hospital of Sri Lanka, Colombo. PATIENTS: Patients admitted with a history of acute paracetamol poisoning. INTERVENTION: Measurement of plasma paracetamol. METHODS: Data were obtained from the patients, medical staff and medical records. Plasma paracetamol was estimated between 4-24 hours of paracetamol ingestion. The current management practices were compared with the best evidence on acute paracetamol poisoning management. RESULTS: 157 patients were included. The mean ingested dose of paracetamol was 333 mg/kg body weight. Majority of the patients (84%) were transfers. Induced emesis and activated charcoal were given to 91% of patients. N-acetylcysteine was given to 66, methionine to 55, and both to 2. Aclinically important delay in the administration of antidotes was noted; 68% of patients received antidotes after 8 hours of the acute ingestion. Only 31 (26%) had paracetamol levels above the Rumack-Matthew normogram. 74 patients received an antidote despite having a plasma paracetamol level below the toxic level according to the normogram. INTERPRETATION: Management of acute paracetamol poisoning could be improved by following best available evidence and adapting cheaper methods for plasma paracetamol estimation.

Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children.

OBJECTIVE: To evaluate the risk of fulminant hepatic failure in relation to paracetamol overuse with therapeutic intent in febrile children. METHODS: It was a case control study. Paracetamol ingestion for the current febrile illness was compared between 25 cases of fulminant hepatic failure and 33 hospital age matched controls. RESULTS: Supra-therapeutic doses of paracetamol (mean 145 mg/kg/day) were consumed by all 25 cases compared to none in the control group. Mean paracetamol level in the cases and controls were, respectively, 26.84 mg /dl and 0.051 mg /dl (p< 0.001). The mean duration of paracetamol intake prior to admission in cases was 3. 45 days compared to 1.85 days in the control group. Nineteen, 5 and 3 were, respectively, graded as hepatic encephalopathy grade 1, 2 and 3. All six patients in grade 2 and 3 had hepatomegaly compared to 78% in the grade 1. Four had jaundice and all were in grade 2 or 3. Mean alanine aminotransferase was 2781 U/L None of the randomly selected cases (6) had serological evidence of Hepatitis A, Hepatitis B or Dengue. Three cases died. CONCLUSION: Exposure to multiple supratherapeutic doses of paracetamol is a risk factor to develop fulminant hepatic failure in children with an acute viral like febrile illness.