Bathing, make-up, and sunscreen: which products do children use? / Banho, maquiagem e protetor solar: o que as crianças usam?

ABSTRACT Objective: To evaluate the hygiene practices and frequency of use of personal hygiene products, cosmetics, and sunscreen among children and adolescents. Methods: Cross-sectional study with interviews about skincare conducted with caregivers through closed-ended questions. We included patients up to 14 years of age waiting for consultation in pediatric outpatient clinics of a tertiary hospital. We performed a descriptive statistical analysis and applied the Kruskal-Wallis test and Fisher's exact test to compare the practices according to maternal schooling. Results: We conducted 276 interviews. The median age of the participants was age four, and 150 (54.3%) were males. A total of 143 (51.8%) participants bathed once a day and 128 (46.3%) bathed two or more times a day, lasting up to ten minutes in 132 (47.8%) cases. Adult soap was used by 103 (37.3%) children and bar soap by 220 (79.7%). Fifty-three (19.2%) participants used sunscreen daily. Perfume was used by 182 (65.9%) children, hair gel by 98 (35.5%), nail polish by 62 (22.4%), and some type of make-up by 71 (25.7%) - eyeshadow by 30 (10.8%), lipstick by 52 (18.8%), face powder and mascara by 13 (4.7%). Make-up use started at a median age of 4 years. Henna tattoo was done in eight children. Conclusions: The children studied used unsuitable products for their skin, such as those intended for adults, used sunscreen inadequately, and started wearing make-up early, evidencing the need for medical orientation.

RESUMO Objetivo: Avaliar os hábitos de higiene e a frequência do uso de produtos de higiene pessoal, cosméticos e protetor solar nas crianças e adolescentes. Métodos: Estudo transversal com entrevistas para cuidadores sobre cuidados com a pele, por meio de perguntas fechadas. Incluídos pacientes de até 14 anos que consultavam nos ambulatórios pediátricos de um hospital terciário. Realizada estatística descritiva e aplicados os testes de Kruskal-Wallis e exato de Fisher para comparar os hábitos conforme a escolaridade materna. Resultados: Foram realizadas 276 entrevistas. A mediana de idade foi de 4 anos, sendo 150 (54,3%) crianças do sexo masculino. O número de banhos por dia foi de um em 143 (51,8%) casos e dois ou mais por parte de 128 (46,3%) indivíduos, com duração de até dez minutos em 132 (47,8%) dos participantes. O sabonete destinado a adultos era utilizado por 103 (37,3%) crianças e o sabonete em barra por 220 (79,7%) delas. Protetor solar era utilizado diariamente por 53 (19,2%) participantes. Perfume foi utilizado por 182 (65,9%) integrantes da amostra, gel de cabelo por 98 (35,5%), esmalte por 62 (22,4%) e algum tipo de maquiagem por 71 (25,7%) - sombra em 30 (10,8%), batom em 52 (18,8%), pó facial e rímel em 13 (4,7%). A mediana de idade de início do uso de maquiagem foi de 4 anos. Tatuagem de hena foi realizada em oito crianças. Conclusões: As crianças estudadas utilizavam produtos inadequados para a sua pele, como os destinados à pele do adulto, e faziam uso incorreto do protetor solar e uso precoce de maquiagem, mostrando a importância da orientação médica.

Brazilian version of the shriners hospital upper extremity evaluation (shuee): translation, cultural adaptation, and evaluation of psychometric properties / Versão brasileira do shriners hospital upper extremity evaluation: tradução, adaptação cultural e validação das propriedades psicométricas

ABSTRACT Objective: To validate the upper limb assessments tool, Shriners Hospital Upper Extremity Evaluation (SHUEE), for individuals with hemiplegic cerebral palsy in the Brazilian population. Methods: Validation study to translate and culturally adapt the Manual and the instrument. The psychometric properties evaluated were reliability and convergent validity. Reliability was determined by internal consistency (Cronbach's α coefficient), ceiling and floor effect, sensitivity to changes, and intra- and interobserver agreement. Convergent validity was performed using the Pediatric Motor Activity Log, the self-care scale of the Pediatric Evaluation of Disability Inventory, and the Manual Ability Classification System. Results: We evaluated 21 individuals with hemiplegic cerebral palsy, with a mean age of 8.7±4.0 years. After the instrument was translated, there was no need for cultural adaptation. The total Cronbach's α coefficient was 0.887 (95% confidence interval [95%CI] 0.745-0.970). We calculated sensitivity to changes in five subjects who underwent treatment with Botulinum Toxin Type A and physical therapy, with a significant difference between pre- and post-treatment evaluations in the Spontaneous Functional Analysis and Dynamic Positional Analysis. Convergent validity showed a significant correlation of the Spontaneous Functional Analysis and Dynamic Positional Analysis with the scales evaluated. All items of SHUEE presented high intra- and interobserver agreement. Conclusions: The results revealed that the Brazilian version of the SHUEE demonstrated good reliability and convergent validity, suggesting that it is an adequate and reliable tool for individuals with hemiplegic cerebral palsy in the Brazilian population.

RESUMO Objetivo: Validar o instrumento de avaliação do membro superior, Shriners Hospital Upper Extremity Evaluation (SHUEE), para indivíduos com paralisia cerebral hemiplégica da população brasileira. Métodos: Estudo de validação no qual foi realizada tradução e adaptação cultural do manual e do instrumento. As propriedades psicométricas avaliadas foram confiabilidade e validade convergente. A confiabilidade foi determinada através da consistência interna (coeficiente α de Cronbach), efeito teto e chão, sensibilidade à mudança e concordância intra e interobservador. A validade convergente foi realizada utilizando-se o Pediatric Motor Activity Log, a escala de autocuidados do Pediatric Evaluation of Disability Inventory e o Manual Ability Classification System. Resultados: Foram avaliados 21 indivíduos com paralisia cerebral hemiplégica com idade média de 8,7±4,0 anos. Após a tradução do instrumento, não houve necessidade de adaptação cultural. O coeficiente α de Cronbach total foi de 0,887 (intervalo de confiança de 95% [IC95%] 0,745-0,970). A sensibilidade à mudança foi calculada em cinco indivíduos que realizaram aplicação de Toxina Botulínica tipo A e fisioterapia, apresentando diferença significativa entre a avaliação pré e pós-tratamento na Análise Funcional Espontânea e Análise Posicional Dinâmica. A validade convergente mostrou correlação significativa da Análise Funcional Espontânea e Análise Posicional Dinâmica com as escalas avaliadas. Todos os itens do SHUEE apresentaram concordâncias fortes, tanto na avaliação intra quanto na interobservador. Conclusões: A versão brasileira do SHUEE demonstrou um bom desempenho em relação à confiabilidade e validade convergente, sugerindo ser uma ferramenta adequada e confiável para os indivíduos com paralisia cerebral hemiplégica na população brasileira.

Water protection in patients with tympanostomy tubes in tympanic membrane: a randomized clinical trial / Proteção auricular da água em pacientes com tubo de ventilação em membrana timpânica: ensaio clínico randomizado

ABSTRACT Objective To analyze the incidence of otorrhea in the postoperative period of patients submitted to tympanotomy to place ventilation tube, and who did not protect the ear when exposed to water. Methods Open, randomized-controlled trial. Eighty patients submitted to unilateral or bilateral ear grommet tympanostomy were included and divided into two groups: Auricular Protection and Non-Protection to water during bathing and activities in water. Results In the first postoperative month, the Non-Protection Group presented a significant increase in the number of patients with otorrhea and in the incidence. Four patients of the Protection Group (11%) presented at least one episode of otorrhea in this period, representing an incidence of 0.11 (standard deviation ±0.32) episode/month, whereas in the Non-Protection Group there were 12 episodes (33%; p=0.045) and incidence of 0.33 (±0.48; p=0.02). Between the 2nd and the 13th postoperative months, there was no difference between groups. Seven patients in the Protection Group (20%) had at least one episode of otorrhea, representing an incidence of 0.04 (±0.09) episodes/month, while in the Non-Protection Group there were seven episodes (22%; p=0.8) and incidence of 0.05 (±0.1; p=0.8). Conclusion Patients who underwent ear protection when exposed to water had a lower incidence of otorrhea in the first postoperative month than those who did not undergo protection. From the second month, there was no difference between groups.

RESUMO Objetivo Avaliar a incidência de otorreia no período pós-operatório em pacientes submetidos à timpanotomia para colocação de tubo de ventilação e que não realizaram proteção auricular quando expostos à água. Métodos Ensaio clínico controlado, aberto e randomizado. Foram incluídos 80 pacientes submetidos à timpanotomia para colocação de tubo de ventilação unilateral ou bilateral, divididos em dois grupos: Grupo Proteção e Grupo Não Proteção auricular da água durante o banho e as atividades aquáticas. Resultados No primeiro mês pós-operatório, o Grupo Não Proteção apresentou aumento significativo tanto no número de pacientes com otorreia quanto na incidência. Quatro pacientes do Grupo Proteção (11%) apresentaram ao menos um episódio de otorreia neste período, representando incidência de 0,11 (desvio padrão ±0,32) episódio/mês, enquanto no Grupo Não Proteção ocorreram 12 episódios (33%; p=0,045) e incidência de 0,33 (±0,48; p=0,02). Entre o 2º e o 13º meses pós-operatórios, não houve diferença entre os grupos. Sete pacientes do Grupo Proteção (20%) apresentaram ao menos um episódio de otorreia, representando incidência de 0,04 (±0,09) episódios/mês, enquanto no Grupo Não Proteção foram registrados sete episódios (22%; p=0,8) e incidência de 0,05 (±0,1; p=0,8). Conclusão Pacientes que realizaram a proteção auricular quando expostos à água apresentaram menor incidência de otorreia no primeiro mês pós-operatório do que aqueles que não a realizaram. A partir do segundo mês, não houve diferença entre os grupos.

Banho no leito: colonização e infecções relacionadas aos cuidados em saúde em paciente crítico / Bed baths: colonization and healthcare-associated infections and in critical patients

As infecções relacionadas aos cuidados de saúde, principalmente as causadas por microrganismos multirresistentes, contribuem para o aumento da morbidade, mortalidade, acréscimo de custos e tempo prolongado de internação. As enterobactérias produtoras de Klebsiella pneumoniae carbapenemase têm sido encontradas com frequência cada vez maior nos estabelecimentos de saúde, com taxas de colonização gradativamente mais elevadas, sobretudo em pacientes críticos, internados por longos períodos. Na tentativa de diminuir as taxas de colonização e, consequentemente, as infecções relacionadas à Klebsiella pneumoniae carbapenemase, tendo como princípio a colonização de pele, o presente estudo visa analisar o efeito da implementação de um protocolo assistencial de banho no leito na ocorrência de colonização da pele por enterobactérias resistentes a carbapenêmicos, assim como as infecções relacionadas aos cuidados de saúde em pacientes adultos críticos e as culturas positivas para microrganismos gram-negativos e positivos resistentes, respectivamente, a carbapenêmicos e à vancomicina. Trata-se de um estudo quase experimental, desenvolvido na unidade de terapia intensiva geral adulto de um hospital de ensino. Participaram do grupo comparação pacientes submetidos ao banho no leito antes da implementação do procedimento operacional padrão, neste caso com dados coletados retrospectivamente. No grupo intervenção, foram avaliados os pacientes submetidos ao banho no leito conforme procedimento operacional padrão. O desfecho primário foi a colonização da pele por enterobactérias resistentes a carbapenêmicos e os secundários, as infecções relacionadas aos cuidados de saúde e as culturas positivas para gram-negativos resistentes a carbapenêmicos e gram-positivos com resistência à vancomicina. No total, foram avaliados 488 pacientes: 226 do grupo comparação e 262 do grupo intervenção. Para a coleta de dados, elaborou-se um instrumento com dados sociodemográficos e clínicos, testado e adaptado após estudo-piloto, e implementou-se o procedimento operacional padrão de banho após treinamento prévio da equipe de enfermagem. As variáveis qualitativas foram descritas por meio de frequências absolutas e percentuais e as quantitativas, por medidas como média, desvio-padrão, mínimo, máximo e mediana. Fez-se a comparação dos grupos quanto a idade, dias de internação hospitalar antes da admissão na UTI e dias de internação na UTI mediante a realização do teste de Mann-Whitney, e analisou-se a associação entre grupos e sexo pelo teste qui-quadrado. Os resultados não demonstraram evidência estatística entre a colonização da pele nos dois grupos (p = 0,69) para culturas positivas para microrganismos gram-negativos resistentes a carbapenêmicos e gram-positivos resistentes à vancomicina. Em relação às infecções hospitalares na UTI, houve evidência somente quando não considerada a variável tempo de internação na UTI (p = 0.03). Observou-se que microrganismos gram-positivos resistentes à vancomicina não foram isolados nas culturas do grupo intervenção e, no grupo comparação, foram identificadas duas uroculturas e duas hemoculturas positivas para esse perfil de microrganismo. Os resultados do presente estudo são úteis e podem subsidiar as escolhas da equipe nas unidades de saúde no que se refere ao tipo de banho utilizado com base nas necessidades institucionais e no desenvolvimento de protocolos que incluam medidas de cuidados e higienização de pele, bem como ações educativas permanentes

Healthcare-associated infections, mainly those caused by multidrug-resistant microorganisms, contribute to increased morbidity, mortality, costs and length of hospital stay. Klebsiella pneumoniae carbapenemase-producing enterobacteria have been increasingly found in healthcare facilities, with gradually higher rates of colonization, especially in critical patients, who are hospitalized for longer periods. In an attempt to reduce colonization rates and, consequently, infections related to Klebsiella pneumoniae carbapenemase, starting at skin colonization, the present study aims at analyzing the effect of implementing a bed bath protocol at the occurrence of skin colonization by carbapenem-resistant Enterobacteriaceae, as well as healthcare-associated infections in adult critical patients and positive cultures for gram-negative and positive microorganisms resistant to, respectively, carbapenem and vancomycin. A quasi-experimental study, was developed at the adult general intensive care unit of a teaching hospital. The comparison group was made up of patients submitted to bed baths before the implementation of the standard operating procedure, in this case, with data collected retrospectively. In the intervention group, patients submitted to bed baths following the standard operating procedure were assessed. The primary outcome was skin colonization by carbapenem-resistant Enterobacteriaceae, and the secondary outcomes were healthcare-associated infections and positive cultures for gram-negative carbapenem-resistant microorganisms and gram-positive vancomycin-resistant microorganisms. A total of 488 patients were evaluated: 226 in the comparison group and 262 in the intervention group. An instrument with sociodemographic and clinical information was created for data collection. This instrument was tested and adapted after a pilot study, and the standard operating procedure was implemented following the nursing staff training. Qualitative variables were described by means of absolute and percentage frequencies, and the quantitative variables were presented using means, standard deviation, minimum, maximum and median values. Groups were compared as regards age, length of hospital stay before ICU admission and ICU length of stay using Mann-Whitney's test. The chi-square test was used to analyze the association between the groups and genders. The results did not demonstrate statistical evidence between skin colonization in both groups (p = 0.69) for positive cultures for carbapenem-resistant gram-negative or vancomycin-resistant gram-positive microorganisms. Regarding hospital infections in the ICU, there was evidence only when the ICU length of stay variable was not considered (p = 0.03). Vancomycin-resistant gram-positive microorganisms were not isolated in the intervention group cultures and, in the comparison group, two positive urine cultures and two positive blood cultures were identified for this microorganism profile. The results of this study are useful and can support the decision of health professionals at healthcare facilities as regards the type of bath used based on institutional needs and the development of protocols including skin hygiene and care measures, as well as permanent educational actions

A review of 50 cases of bath-related headache: clinical features and possible diagnostic criteria / Uma revisão de 50 casos de cefaleia relacionada ao banho: características clínicas e possíveis critérios diagnósticos

ABSTRACT Objective: To describe clinical features and possible diagnostic criteria of the 50 bath-related headache (BRH) cases that have been published in the literature to date. Methods: Based on a literature search in the major medical databases, we analyzed all case reports or case series on BRH that were published between 2000 and 2017. Results: We describe 48 women and two men diagnosed with BRH. Of these 50 patients, 90% were from Asian countries. The average age was 49.3 years. There was an association of BRH with migraine (28%), tension-type headache (12%) and cold stimulus headache (4%). Headache was bilaterally localized, had an explosive or pulsating quality and a severe intensity. The pain lasted from five minutes to four days. Associated manifestations were nausea, vomiting, photophobia or phonophobia. There was a good therapeutic response with nimodipine and when avoiding a hot bath. Conclusions: Bath-related headache is a benign headache that is not associated with a structural lesion.

RESUMO Objetivo: Descrever as características clínicas e possíveis critérios diagnósticos dos 50 casos de cefaleia relacionada ao banho (CRB) que foram publicados na literatura até agora. Métodos: Com base em uma pesquisa de literatura nas principais bases de dados médicos, analisamos todos os relatos de casos ou séries de casos sobre BRH que foram publicados entre 2000 e 2017. Resultados: Descrevemos 48 mulheres e 2 homens diagnosticados com CRB. Destes 50 pacientes, 90,0% eram asiáticos. A média de idade foi 49,3 anos. Houve associação com migrânea (28,0%), cefaleia do tipo tensional (12,0%) e cefaleia por estímulo frio (4,0%). A cefaleia foi localizada bilateralmente, explosiva ou pulsátil e de forte intensidade. A dor durou de 5 minutos a 4 dias.As manifestações associadas foram náuseas, vômitos, fotofobia ou fonofobia. Houve uma boa resposta terapêutica com nimodipina e evitando-se banho quente. Conclusões: CRB é uma cefaleia benigna não associada com lesão estrutural.

Alteraciones hemodinámicas del paciente crítico cardiovascular durante la realización del baño diario / Hemodynamic changes of patients with cardiovascular diseases during the daily bath

Objetivo: evaluar las alteraciones hemodinámicas que se presentan durante la realización del baño en pacientes críticos en post-operatorio de cirugía cardiovascular. Metodología: estudio cuasi-experimental (pre–post) en el que se incluyeron 36 pacientes de la Unidad de Cuidado Intensivo y Cuidado Especial de la Clínica El Rosario, sede El Tesoro, de la ciudad de Medellín entre abril y julio de 2009. Se determinaron los cambios hemodinámicos durante el baño a través de pruebas paramétricas o no paramétricas y se consideró la distribución de las variables. Resultados: el 64% de los pacientes está compuesto por el sexo masculino, la edad promedio fue 59.7 ± 11.2 años. A la mayoría se le realizó baño de esponja (94.3%). El 78% de los pacientes estaba extubado. El diagnóstico post-operatorio más frecuente fue la revascularización coronaria (70%). Se observaron alteraciones en los valores de presión arterial sistólica y frecuencia respiratoria, de acuerdo con el tiempo de evaluación (p = 0.017 y p<0.0001, respectivamente); se observó un aumento de la presión arterial sistólica durante el baño (p = 0.010) y un aumento de la frecuencia respiratoria después del baño (p = 0.008). Conclusiones: aunque se advirtieron cambios en la presión arterial sistólica y la frecuencia respiratoria, éstos no representaron una alteración clínica significativa.

Objective: to evaluate the hemodynamic changes that occur during the performance of bath on a cardiovascular post-operatory patient.Methods: a quasi-experimental study (pre and post) in which 36 patients were included from the Intensive Care Unit and Special Care Unit of La Clinica del Rosario, Medellin, between April and July 2009. Hemodynamic changes were determined during the bath through parametric or nonparametric tests, according to the distribution of variables.Results: 64% of patients were male, mean age was 59.7 ± 11.2 years. Most of the patients underwent sponge bath (94.3%). 78% of patients were extubated. The most frequent postoperative diagnosis was coronary revascularization (70%). Abnormalities were observed in systolic blood pressure values and respiratory rate, according to the evaluation period (p value= 0.017 and p value <0.0001, respectively), an increase of systolic blood pressure during the bath (p value= 0.010), and an increased respiratory rate after the bath (p value= 0.008).Conclusions: although there were changes in systolic blood pressure and respiratory rate, these did not represent any important clinical disorder

Epilepsia de água quente numa mulher grávida: relato de caso / Hot water epilepsy in a pregnant woman: case report

A epilepsia de água quente é uma forma singular de epilepsia reflexa desencadeada por se banhar e jorrar água quente na cabeça. Embora seja mais frequente em crianças e predomine no sexo masculino, o presente artigo discute o caso de uma mulher grávida de 28 anos de idade que apresentava convulsões reflexas ao jorrar água na cabeça ao tomar banho. O tratamento homeopático constitucional teve sucesso terapêutico.

Hot water epilepsy is a unique form of reflex epilepsy triggered by bathing and pouring hot water over the head. Although it is mostly seen in infants and children, with predominance in males, the present article discusses the case of a 28-year-old pregnant woman with reflex seizures triggered by pouring hot water over the head while having a bath during pregnancy and successfully treated with constitutional homeopathic medication.

Hammam an ancient principle of health

The baths or 'hammams' as they are named, are for many, aspects of health not just for external cleanliness. Hammam [bath] is being used as a method of Ilaj-bil-tadbeer [Regimental therapy] advocated in Unani system of medicine since ages. Hammam refers to bath. Hammam refreshes body by dispersing the superfluities and preparing body for assimilation of food. Moreover it guards against discomfort. Unani physicians have mentioned various types of Hammam for different ailments and plays important role in prevention and promotion of health like Wajaul Mafasil [Arthritis], skin diseases, menorrhagia, liver disease etc. This paper is a review of the history, benefits, therapeutic effects and different types of Hammam used and mentioned by old Unani physicians in classical Unani literature. Hammam will also be discussed in the light of modern medicine

Tepid sponging plus dipyrone versus dipyrone alone for reducing body temperature in febrile children / Banho tépido e dipirona versus dipirona isolada no tratamento de crianças com febre

CONTEXT AND OBJECTIVE: The role of tepid sponging to promote fever control in children is controversial. We did not find any studies reporting on the effectiveness of tepid sponging in addition to dipyrone. The aim of this study was to compare the effects of tepid sponging plus dipyrone with dipyrone alone for reducing fever. DESIGN AND SETTING: A randomized clinical trial was undertaken at Instituto Materno-Infantil Professor Fernando Figueira, Recife, Pernambuco. METHODS: Children from six months to five years old with axillary temperature greater than 38 ºC in the emergency ward between January and July 2006 were eligible. One hundred and twenty children were randomly assigned to receive oral dipyrone (20 mg/kg) or oral dipyrone and tepid sponging for 15 minutes. The primary outcome was mean temperature reduction after 15, 30, 60, 90 and 120 minutes. Secondary outcomes were crying and irritability. RESULTS: 106 children finished the study. After the first 15 minutes, the fall in axillary temperature was significantly greater in the sponged group than in the control group (p < 0.001). From 30 to 120 minutes, better fever control was observed in the control group. Crying and irritability were observed respectively in 52 percent and 36 percent of the sponged children and in none and only two of the controls. CONCLUSIONS: Tepid sponging plus dipyrone cooled faster during the first 15 minutes, but dipyrone alone presented better fever control over the two-hour period. Tepid sponging caused mild discomfort, crying and irritability for most of the children.

CONTEXTO E OBJETIVO: O papel do banho tépido no controle da febre em crianças é controverso. Não encontramos estudos verificando a eficácia do banho tépido associado à dipirona. O objetivo deste estudo foi comparar a eficácia da dipirona associado com banho tépido, com a dipirona isolada no tratamento da febre. TIPO DE ESTUDO E LOCAL: Foi realizado um ensaio clínico randomizado no hospital de ensino Instituto Materno-Infantil Professor Fernando Figueira, Pernambuco. METODOS: Foram elegíveis crianças com idade entre 6 a 60 meses, atendidas no setor de emergência com temperatura axilar acima de 38 ºC, entre janeiro a julho de 2006. Cento e vinte crianças receberam de forma randomizada, dipirona (20 mg/kg), associada ou não com banho tépido durante 15 minutos. O desfecho primário foi a redução da temperatura axilar, mensurada após 15, 30, 60, 90 e 120 minutos da intervenção; desfechos secundários foram choro e irritabilidade. RESULTADOS: 106 crianças finalizaram o estudo. Nos primeiros 15 minutos, a temperatura diminuiu de forma mais significativa no grupo do banho tépido (p < 0.001). No período de 30 a 120 minutos foi observada maior redução da temperatura no grupo controle. Choro e irritabilidade foram mais observados no grupo estudo, respectivamente, 52 por cento e 36 por cento versus nenhuma e duas no grupo controle. CONCLUSÕES: Banho tépido associado com dipirona baixou de forma mais rápida a temperatura nos primeiros 15 minutos. Ao final dos 120 minutos, observou-se um melhor controle da temperatura com a dipirona isoladamente. Banho tépido provocou moderado desconforto, choro e irritabilidade na maioria das crianças.

Self abortion of attacks in patients with Hot Water Epilepsy.

A cross sectional hospital based study was undertaken to find out the various clinical aspects and management of Hot Water Epilepsy (HWE) in children. Of the 71 cases analysed, 67.6% had onset of seizures in the first decade of life. Seizures occurred frequently towards the end of head bath (71.8%). In 14.1% cases, seizures were precipitated with cold-water head bath also. Complex partial seizures (60.6%) and generalized atonic seizures (21.1%) were common. Spontaneous non-reflex epilepsy was seen in 47.9% cases. Self-induction and self-abortion of seizures were seen in 16.9% and 12.7% patients respectively. Family history was available in 32.4% of cases. Majority had good response to continuous prophylactic treatment with antiepileptic drugs. We conclude that high incidence of spontaneous seizures and generalized atonic seizures seem to be peculiar to our geographical area. "Self abortion of attacks"may be of immense help in controlling the attacks.

Wet heat exposure: a potentially reversible cause of low semen quality in infertile men

OBJECTIVE: To evaluate the recovery of semen quality in a cohort of infertile men after known hyperthermic exposure to hot tubs, hot baths or whirlpool baths. MATERIALS AND METHODS: A consecutive cohort of infertile men had a history remarkable for wet heat exposure in the forms of hot tubs, Jacuzzi or hot baths. Clinical characteristics and exposure parameters were assessed before exposure was discontinued, and semen parameters analyzed before and after discontinuation of hyperthermic exposure. A significant seminal response to withdrawal of hyperthermia was defined as > 200 percent increase in the total motile sperm count (TMC = volume x concentration x motile fraction) during follow-up after cessation of wet heat exposure. RESULTS: Eleven infertile men (mean age 36.5 years, range 31-44) exposed to hyperthermia were evaluated pre and post-exposure. Five patients (45 percent) responded favorably to cessation of heat exposure and had a mean increase in total motile sperm counts of 491 percent. This increase was largely the result of a statistically significant increase in sperm motility from a mean of 12 percent at baseline to 34 percent post-intervention (p = 0.02). Among non-responders, a smoking history revealed a mean of 5.6 pack-years, compared to 0.11 pack-years among responders. The prevalence of varicoceles was similar in both cohorts. CONCLUSIONS: The toxic effect of hyperthermia on semen quality may be reversible in some infertile men. We observed that the seminal response to exposure elimination varies biologically among individuals and can be profound in magnitude. Among non-responders, other risk factors that could explain a lack of response to elimination of hyperthermia should be considered.

Kindling & mossy fibre sprouting in the rat hippocampus following hot water induced hyperthermic seizures.

BACKGROUND & OBJECTIVES: Hot water epilepsy (HWE) is well recognized reflex epilepsy with possible genetic susceptibility. Rat model and human experimentation had proven that HWE is a type of hyperthermic seizure with possible kindling on repeated stimulation in animals. The present study was undertaken to investigate kindling associated with hyperthermic seizures induced by repeated hot water stimulation in the rat model and to prove hyperthermic kindling. METHODS: Epileptic seizures were induced in 36 male Wistar albino rats by means of hot water sprays at 48 h time intervals. Progression of seizure activity was investigated by studying the behaviour, severity and duration of the seizure. Threshold of rectal temperatures and timed latency for seizure induction were studied. Seizure discharges (EEG) were recorded from ventral hippocampus in six of these rats. Timm's staining was used to study the neuronal sprouting as a consequence of kindling. Studying the seizure threshold, latency, duration of seizure discharge and behavioural seizure following a stimulus-free interval of 30 days tested permanence of kindling. RESULTS: Following 8-12 episodes of hot water stimulations there was progressive epileptic activity manifested in the form of lowering of rectal temperature thresholds from 41.5 to 40.0 degrees C, drop in latency for developing seizures from 185 to 118 sec, increase in duration of hippocampal seizure discharge from 15 to 140 sec, along with progressive increase in complexity of EEG after discharges, increase in behavioural seizure severity from Grade 1 to 5 in all the rats, and neuronal sprouting observed in supragranular molecular layer and in stratum lacunosum. INTERPRETATION & CONCLUSION: Our study covered all aspects of kindling and provided a useful animal model for human hot water epilepsy. Hyperthermic seizures induced by hot water in the rat model kindle as demonstrated by Timm's staining.

A Case of Multiple Organ Failure due to Heat Stoke Following a Warm Bath

Heat stroke is a potentially fatal disorder that's caused by an extreme elevation in body temperature. We report here an unusual case of multiple organ failure that was caused by classical, nonexertional heat stroke due to taking a warm bath at home. A 68 year old diabetic man was hospitalized for loss of consciousness. He was presumed to have been in a warm bath for 3 hrs and his body temperature was 41 degrees C. Despite cooling and supportive care, he developed acute renal failure, disseminated intravascular coagulation (DIC) and fulminant liver failure. Continuous venovenous hemofiltration was started on day 3 because of the progressive oligouria and severe metabolic acidosis. On day 15, septic ascites was developed and Acinetobacter baumanii and Enterococcus faecium were isolated on the blood cultures. In spite of the best supportive care, the hepatic failure and DIC combined with septic peritonitis progressed; the patient succumbed on day 25.

"Hot-water epilepsy ", "warm-water epilepsy", or bathing epilepsy? Report of three cases and considerations regarding an old theme

Crises reflexas a banhos quentes, tônicas-clônicas parciais e generalizadas foram descritas como relacionadas à temperatura. Descrevemos três casos de epilepsia do banho quente: um homem de 28 anos e uma mulher de 30 anos com crises provocadas por contato com água morna ou quente e uma mulher de 32 anos com crises ao contato com água quente. Os últimos dois casos apresentaram epilepsia localizada e um histórico familiar de epilepsia. Nesta forma de epilepsia, um estímulo táctil complexo parece ter o papel mais relevante na precipitação das crises, sendo potencializado pela temperatura da água.

Hot water epilepsy - a report of three cases.

Hot water epilepsy (HWE) is a rare form of reflex epilepsy caused by bathing with hot water. In this paper, we describe three cases with hot water epilepsy.It occurs generally in children with normal psychomotor development and children continue to develop normally after seizure. HWE has usually a favorable prognosis by first avoiding lukewarm water and secondly using either intermittent oral prophylaxis with benzodiazepines or conventional AEDs.