Características epidemiológicas del síndrome febril inespecífico en Nueva Paz, Mayabeque / Epidemiological Characteristics of Nonspecific Febrile Syndrome in Nueva Paz Municipality, Mayabeque Province

Introducción: La vigilancia del síndrome febril inespecífico es una estrategia para la identificación temprana de enfermedades de interés en salud pública y de otras enfermedades no diagnosticadas usualmente. Objetivo: Determinar las características epidemiológicas del síndrome febril inespecífico. Métodos: Estudio descriptivo-transversal en pacientes con diagnóstico inicial de síndrome febril inespecífico en el municipio Nueva Paz, Mayabeque, en el período enero-diciembre, 2018. El universo estuvo constituido por 828 casos. Los datos obtenidos de la Unidad Municipal de Higiene y la base de datos de arbovirosis se vaciaron en una planilla creada al efecto. Las variables cuantitativas se resumieron mediante media aritmética y desviación estándar y las variables cualitativas mediante porcentajes. La comparación de proporciones se realizó a través de chi-cuadrado y dócima de Duncan, con un nivel de significación para p < 0,05. Resultados: Predominó el sexo femenino (55,08 por ciento) y la edad menor de 18 años (33,93 por ciento). Se encontró mayor número de focos en el área de salud de Los Palos (53,44 por ciento), donde se reportó más cantidad de síndrome febril inespecífico (50,60 por ciento). Los meses de mayo, julio y octubre notificaron mayor número de focos. La vigilancia se comportó en 61,7 por ciento con una reactividad en 56,50 por ciento. El 48,06 por ciento de los casos clasificaron dengue. Conclusiones: El incumplimiento de los programas de control del vector, la urbanización no planificada, el crecimiento acelerado de la población y la existencia de una infraestructura de salud deficiente ha permitido que proliferen las arbovirosis a gran escala en el municipio Nueva Paz(AU)

Introduction: Surveillance of nonspecific febrile syndrome is a strategy for early identification of public health concern diseases as well as other diseases not usually diagnosed. Objective: To determine the epidemiological characteristics of nonspecific febrile syndrome. Methods: Descriptive and cross-sectional study carried put, in the period January-December 2018, in patients with an initial diagnosis of nonspecific febrile syndrome from Nueva Paz Municipality, Mayabeque Province. The universe consisted of 828 cases. The data obtained from the Municipal Unit of Hygiene and Epidemiology as well as from the arbovirus diseases database were emptied into a form created for this purpose. Quantitative variables were summarized using arithmetic mean and standard deviation, while qualitative variables were summarized using percentages. The comparison of proportions was made through chi-square and Duncan's tests, with a level of significance P<0.05. Results: There was a predominance of the female sex (55.08 percent) and ages under eighteen years (33.93 percent). A greater number of focuses were found in the health area of Los Palos (53.44 percent), where a greater amount of nonspecific febrile syndrome was reported (50.60 percent). The months of May, July and October accounted for higher numbers of outbreaks. Surveillance was 61.7 percent with reactivity at 56.50 percent, 48.06 percent of the cases classified as dengue. Conclusions: Failure to comply with vector control programs, unplanned urban planning, accelerated population growth and the existence of a deficient health infrastructure have allowed great-scale arbovirus infections to proliferate in Nueva Paz Municipality(AU)

Valoración del niño con una primera crisis no provocada / Evaluation of a child with a first unprovoked seizure

Los episodios paroxísticos son uno de los trastornos neurológicos más frecuentes en niños. Es importante diferenciar entre los trastornos paroxísticos no epilépticos, las crisis sintomáticas agudas, las crisis febriles y las crisis no provocadas. La historia clínica permite, en la gran mayoría de los casos, poder llegar al diagnóstico. Las crisis no provocadas únicas son frecuentes en el niño. La tasa de recurrencia tras una primera crisis no provocada varía entre un 23-96% en los dos años siguientes a la primera crisis. El objetivo de este trabajo es describir cómo evaluar al paciente con una primera crisis no provocada y revisar el valor predictivo de los distintos factores de riesgo de recurrencia. Entre dichos factores de riesgo, se evalúan datos como la presencia de antecedentes familiares de epilepsia, historia previa de crisis febriles, edad de debut, tipo de crisis, presencia de crisis prolongadas o crisis agrupadas, crisis de presentación en sueño, anomalías neurológicas, evidencia de una etiología definida, y presencia de anomalías epileptiformes en el electroencefalograma. Los factores de riesgo de recurrencia más importantes son la etiología de las crisis y la presencia de anomalías epileptiformes en el electroencefalograma.

Paroxysmal episodes are one of the most common neurological disorders in children. It is important to distinguish between paroxysmal non-epileptic events, symptomatic seizures, febrile seizures, and unprovoked seizures. Patient's history is the key to proper diagnosis in most of the cases. A single unprovoked seizure is a frequent phenomenon in the pediatric population. Studies of recurrence after a first unprovoked seizure show percentages between 23% and 96% over a median follow-up of two years. The aim of this study is to define how to evaluate the first unprovoked epileptic seizure in a child and to review the weight of the different recurrence risk factors. Several factors enable us to predict the recurrence risk after a first unprovoked seizure including family history of epilepsy, prior history of febrile seizures, age at onset, type of seizure, prolonged seizures at onset, multiple seizures in a single day, sleep state, neurological abnormalities, etiology, and abnormalities in the electroencephalogram. The most important of these risk factors are the etiology of the seizures and the evidence of epileptiform abnormalities in the electroencephalogram.

Convulsão febril: estudo de base populacional / Febrile seizures: a population-based study

Resumo Objetivos Estabelecer a prevalência das crises febris e descrever o perfil clínico e epidemiológico dessa população. Métodos Estudo transversal de base populacional feito em Barra do Bugres (MT), de agosto de 2012 a agosto de 2013. Os dados foram coletados em duas etapas. Na primeira etapa usamos um questionário validado previamente em outro estudo brasileiro, para identificação de casos suspeitos de crises epilépticas. Na segunda etapa fizemos a avaliação neuroclínica para confirmação diagnóstica. Resultados A prevalência de crise febril foi de 6,4/1.000 habitantes (IC95% 3,8; 10,1). Não houve diferença entre os sexos. As crises febris simples foram encontradas em 88,8% dos casos. A história familiar de crise febril e epilepsia em parentes de primeiro grau esteve presente em 33,3% e 11,1% dos pacientes, respectivamente. Conclusões A prevalência da crise febril na Região Centro-Oeste foi menor do que a encontrada em outras regiões brasileiras, provavelmente relacionado à inclusão apenas das crises febris com manifestações motoras e as diferenças de fatores socioeconômicos entre as regiões pesquisadas.

Abstract Objectives To determine the prevalence of benign febrile seizures of childhood and describe the clinical and epidemiological profile of this population. Methods This was a population-based, cross-sectional study, carried out in the city of Barra do Bugres, MT, Brazil, from August 2012 to August 2013. Data were collected in two phases. In the first phase, a questionnaire that was previously validated in another Brazilian study was used to identify suspected cases of seizures. In the second phase, a neurological evaluation was performed to confirm diagnosis. Results The prevalence was 6.4/1000 inhabitants (95% CI: 3.8-10.1). There was no difference between genders. Simple febrile seizures were found in 88.8% of cases. A family history of febrile seizures in first-degree relatives and history of epilepsy was present in 33.3% and 11.1% of patients, respectively. Conclusions The prevalence of febrile seizures in Midwestern Brazil was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and differences in socioeconomic factors among the evaluated areas.

Convulsión febril / Febrile seizure

Febrile seizures are the most common seizure disorder in the pediatric population and represent a frequent cause of consultation in emergency departments, confirming its importance. We present an updated and practical review regarding this pathology, along with an operative definition that supports the application of a flowchart that integrates concepts and procedures that can be easily applied at any location nationwide. This review is designed to provide an analytic framework regarding pediatric febrile seizures, as well as present a guideline based on our experience in the emergency department by summarizing the main benzodiazepines in actual use that have been proved to be both safe and effective in treating this disorder, such as lorazepam and midazolam...

Neurological disorders in children and adolescents.

OBJECTIVE: To ascertain the prevalence of active epilepsy, febrile seizures (FS), cerebral palsy (CP) and tic disorders (TD) in aged 19 years or less. METHODS: This was a cross-sectional observational study conducted as a two-stage door-to-door survey of a stratified randomly selected population in 2003-04. Trained field workers screened the population followed by case examination by the field neurologist. RESULTS: A total of 16979 (male 8898, female 8081) subjects aged <or= 19 years were surveyed. The prevalence rates per 100,000 population of active epilepsy, FS, CP and TD with 95% confidence intervals are 700.87 (580.60-838.68), 1113.14 (960.07-1283.59), 282.70 (CI 208.43-374.82) and 35.34 (12.96-76.92) respectively. Active epilepsy prevalence shows a rising trend and that of other disorders a declining trend with age. Of the epileptics who had brain CT scans, 23.4% showed single or multiple lesions suggestive of neurocysticercosis. Regarding treatment, 23.5% of the epileptics never received any antiepileptic drugs. Among those with history of FS, 9.5% developed epilepsy later on. The prevalence of FS among slum dwellers is lower than in the non-slum population. Among CP cases, 39.6% gave history of birth anoxia, 16.7% kernicterus and 31.3% epilepsy. Prevalence of CP is significantly associated with lower education status. CONCLUSION: The prevalence of CP and TD is lower than reported from western countries. CP prevalence is also comparatively lower than in many community studies from India. Compared to western nations, higher proportion of FS cases develops epilepsy. A third of the CP cases have seizures which is higher than in many Indian studies. Birth anoxia is a common cause of CP and educational underachievement is frequent.

Recurrencia de crisis febriles en una población chilena / Febrile seizures recurrence in Chilean children

Objective: Evaluate the clinical presentation and risk factors for recurrence of first febrile seizure (FS) in patients at Pediatric Emergency Department or Neurology Units at Clinical Hospital Universidad Catolica (UC) and Hospital Herminda Martin from Chillan (HM). Method: Descriptive-observational study of children with age average of 2.9 years-old, with first febrile seizure between January 1, 2003 and December 31, 2005. Results: Total 158 patients; 76 percent presented a simple FS and 24 percent a complex FS as first episode, only 1 case with febrile epileptic status. In 22 percent and 18 percent respectively, there was a FS history and epilepsy in first degree relatives. 34 percent of patients presented a second episode; 36 percent of these cases present a third FS and 9 percent more than 3 episodes. The average time of recurrence was 6.9 months. The most important risk factors for recurrence were: epilepsy history in first degree relatives and type of febrile seizure, with hazard ratio of 2.5 (p = 0.001) and 1,8 (p = 0.03) respectively. When fitting both variables, only family history of epilepsy was significant. Conclusions: Most of FS episodes are simple and 34 percent present recurrence. Family history of epilepsy and type of febrile seizure are associated recurrence risk factors. The follow-up of these patients does not predict their future risk of epilepsy.

Objetivo: Evaluar la presentación clínica, recurrencia y factores de riesgo de recurrencia en un grupo de pacientes con primoconvulsión febril que consultaron en Urgencia pediátrica y/o consulta neurológica en los hospitales Clínico Universidad Católica (UC) y Herminda Martín de Chillan (HM). Método: Estudio observacional descriptivo de niños con primoconvulsión febril entre el Iº de Enero del 2003 y el 31° de Diciembre 2005 con seguimiento promedio de 2,92 años. Resultados: De 158 pacientes, el 76 por ciento debutó con una CF simple y el 24 por ciento con una CF compleja (1 status febril). En el 22 y 18 por ciento había antecedentes de CF y epilepsia en familiares de primer grado respectivamente. Recurrieron 34 por ciento de los pacientes y de ellos el 36 por ciento presento una tercera CF y el 9 por ciento más de tres episodios. El promedio de tiempo de recurrencia fue 6,9 meses. Los factores de riesgo más importantes de recurrencia fueron el antecedente de epilepsia en familiares de primer grado y tipo de crisis con un hazard ratio de 2,5 (p = 0,001) y 1,8 (p = 0,03) respectivamente. Al ajustar ambas variables sólo antecedentes familiares de epilepsia fue significativa. Conclusiones: La mayoría de las CF es simple y recurre un 34 por ciento. Los antecedentes familiares de epilepsia y tipo de crisis son factores de riesgo asociados a recurrencia). El seguimiento no permite evaluar el riesgo de epilepsia a futuro en estos pacientes.

Febrile seizures: Review article

Demographic, Genetic and clinical profiles Febrile seizures are broadly defined as seizures' occurring in the presence of fever, but in the absence of central nervous system infection. They occur in children aging from 6 months to 5 years with a mean age of onset of 18-24 months and they occur slightly more commonly in boys than in girls. 1 It is the most common reason for convulsions in children less than 6 years of age, and they occur in 2 to 5% of all children, although it has been reported to be more frequent in Asian countries. In Japan, the rate has been reported to be 7% and in Jordan 6.5%.2 It is thought that the rates in these areas are higher because some of the common infections of childhood may occur earlier in life when children are most susceptible to febrile seizures. 3 Febrile seizures can be divided into two types: simple and complex. Simple febrile seizures are characterized by the following: duration less than 15 minutes generally, and it occurs in normal children neurologically and developmentally. Complex febrile seizures have the following features: duration greater than 15 minutes, multiple within 24 hours, and/or focal. [2] The risk of recurrence after the first febrile seizure is about 33%. The risk factors for recurrence are: occurrence of the first febrile seizure at a young age; family history of febrile seizures; short duration of fever before the seizure; relatively low fever at the time of the initial seizure; and possibly a family history of an afebrile seizure. It has been observed that the time of recurrence is usually within the first year of onset. Although complex febrile seizures are not usually associated with an increased risk of recurrent febrile seizures, they may be a risk factor for epilepsy later in life. Febrile seizures seem to run in families, but their mode of inheritance is unknown. The risk for other siblings developing febrile seizures is about 10-20%, but may be higher if the parents also have a history of febrile seizures themselves. 4 In large families, the FS susceptibility trait is inherited by autosomal dominant pattern with a reduced penetrance. It has long been recognized that there is a significant genetic component for susceptibility to this type of seizure and this may be caused by a mutation in several genes.[2] In the presence of cases of FS and epilepsy in the same family one study the concept of a genetic epilepsy syndrome termed Generalized Epilepsy with FC plus [GEFS+]. GEFS has a spectrum of phenotypes including FC, and FC plus.[2]. Febrile seizures usually occur in the first 24 hours of the onset of fever. It has been suggested that it is the rapid rise in the child's temperature, which causes a febrile seizure rather than the actual height of the fever itself; however, there is no substantial proof to support this suggestion. The seizures are usually generalized and tonic-clonic, but other types may be present as well. There may be variations to this such as staring without stiffness, jerking movements without prior stiffening, and localized stiffness or jerking

Convulsiones febriles (CF) en el área occidente de Santiago / Febrile seizures (FS) in west area of Santiago

Objetivos: Describir las características epidemiológicas de pacientes con CF en el área occidente de Santiago. Pacientes y métodos: Se estudiaron en forma retrospectiva, 122 niños diagnosticados con CF desde enero 1996 a Diciembre 2000 que cumplían criterios de ingreso, evaluándose recurrencias con Tabla de Prosecución y variables asociadas a recurrencias. Resultados y Discusión por sexo, edad, temperatura y patología asociada a la primera crisis, fueron similares a lo descrito en la literatura. La primera CF ocurrió en promedio, a los 18 meses de edad (DE: 9,7), mediana de 15 meses y rango entre 4 meses y 4 años 6 meses. La temperatura asociada fue mayor a 38,5ºC en el 86,4 por ciento de los casos. La patología concomitante, en los casos en que se pudo establecer, fue de predominio respiratorio. Las crisis fueron simples en 71,3 por ciento y complejas en 28,7 por ciento incluidos 2 pacientes que debutaron con status convulsivo (1.6 por ciento). En 62,3 por ciento se registró antecedente familiar de epilepsia y/o CF. El número de crisis previas a control neurológico variaron entre 1 y 6. Un 22,1 por ciento consultó con historia de cuatro o más crisis. Se indicó profilaxis desde el primer evento en 9,8 por ciento, en la segunda crisis en el 40,2 por ciento y en el 50 por ciento restante después de tres o mas. El análisis de los distintos tratamientos se hizo en 122 pacientes: 76,2 por ciento inició profilaxis con Fenobarbital, 20,5 por ciento con Acido Valproico y 3,3 por ciento con Diazepam rectal intermitente. Se realizó electroencefalograma en 91 por ciento, normal en 85,6 por ciento. Se evaluaron las recurrencias mediante una Tabla de Prosecución, las cuales disminuyeron en los semestres sucesivos: 16,2 por ciento; 13,5 por ciento; 10 por ciento; 4,7 por ciento; 7 por ciento y 0 por ciento. Los pacientes que tuvieron recurrencias (CF simples o complejas), se compararon con el grupo sin recurrencias sin encontrar diferencias significativas en edad, sexo, temperatura, antecedentes familiares de CF y / o epilepsia sin anormalidades en el electroencefalograma.

Incidence of febrile seizures in thalassemic patients.

BACKGROUND: Febrile seizures are the most common seizures in children. Their incidence is 2-5% or 4.8/1000 person-years. To date, the pathophysiology of febrile seizures is unknown. But several hypotheses have been proposed that it may relate with plasma iron level. Such low incidence in thalassemic patients whose plasma iron level is high could give some clues to this hypothesis. PATIENTS AND METHOD: Four hundred and thirty thalassemic patients from the hematology clinic at two hospitals in Northeastern Thailand were consecutively enrolled between Febuary 2003 and January 2004. The authors reviewed all the medical records of the patients and interviewed their parents for occurrence of febrile seizures. RESULTS: The patients included 208 males and 222 females with an age ranged of 6 months to 10 years (mean = 6.36 years). Twenty patients (4.7%) had siblings who had febrile seizures. There were 3 episodes out of 2,734 person-years. The incidence was 1.10 per 1,000 person-years (95% CI: 0.23 to 3.20). This was statistically lower than that of the general population (p-value = 0.002). Therefore, the rate in thalassemic patients was 4.4 times less than that of the general population (95% confidence interval: 1.4 to 22.6). CONCLUSIONS: The incidence of febrile seizures in thalassemic patients was very low compared to that of the general children population. Thus, iron overload may be a major factor involving the brain metabolism that prevents febrile seizures.

Risk factors of febrile seizures among preschool children in Alexandria

The study design was a case control study to identify the risk factors of febrile seizures. Total sample of 28 children, their ages ranging from 12 to 60 months, with febrile seizure were matched with control group of 60 children of the same age group with fever without seizure. The peak age of first febrile seizure was between 6 and 12 months. The significant risk factors were upper respiratory tract infection [p<0.05], family history of febrile seizures [p<0.0001].Prematurity [p<0.005], problems during gestation [p<0.005], family history of epilepsy [p<0.005] and problem during labour [p<.0.005]

Knowledge, attitude and practices of parents of children with febrile convulsion.

CONTEXT: Parental anxiety and apprehension is related to inadequate knowledge of fever and febrile convulsion. AIMS: To study the knowledge, attitude, and practices of the parents of children with febrile convulsions. SETTINGS AND DESIGN: Prospective questionnaire based study in a tertiary care centre carried over a period of one year. SUBJECTS AND METHODS: 140 parents of consecutive children presenting with febrile convulsion were enrolled. STATISTICAL ANALYSIS USED: Chi-square test. RESULTS: 83 parents (59.3%) could not recognise the convulsion; 90.7% (127) did not carry out any intervention prior to getting the child to the hospital. The commonest immediate effect of the convulsion on the parents was fear of death (n= 126, 90%) followed by insomnia (n= 48, 34.3%), anorexia (n= 46, 32.9%), crying (n= 28, 20%) and fear of epilepsy (n= 28, 20%). Fear of brain damage, fear of recurrence and dyspepsia were voiced by the fathers alone (n= 20, cumulative incidence 14.3%). 109 (77.9%) parents did not know the fact that the convulsion can occur due to fever. The long-term concerns included fear of epilepsy (n= 64, 45.7%) and future recurrence (n= 27, 19.3%) in the affected child. For 56 (40%) of the parents every subsequent episode of fever was like a nightmare. Only 21 parents (15%) had thermometer at home and 28 (20%) knew the normal range of body temperature. Correct preventive measures were known only to 41 (29.2%). Awareness of febrile convulsion and the preventive measures was higher in socio-economic grade (P< 0.05). CONCLUSIONS: The parental fear of fever and febrile convulsion is a major problem with serious negative consequences affecting daily familial life.

Estudio de 60 pacientes pediátricos con convulsiones febriles / Study of 60 pediatric patients with febrile convulsions

Las crisis febriles son muy frecuentes en el paciente pediátrico afectando entre el 3 - 5 % de los niños entre los tres meses y los cinco años de edad. Se realizó un estudio descriptivo retrospectivo de 60 pacientes con el diagnóstico al egreso de crisis febriles pertenecientes al Hospital Pediátrico Docente de Sancti Spíritus en un período de un año con el objetivo de describir un grupo de características clínicas y electroencefalográficas. La edad de debut más frecuente fue la de 13 - 24 meses (58,34 %), la mayoría de los pacientes tenían temperatura entre 38 - 39,5 grados Celsius (60 %). Las crisis se presentaron en el 65 % de los casos en las primeras seis horas de la fiebre, la causa más común fueron las infecciones respiratorias altas (48,33 %) según las características de las crisis el 98,33 % fueron generalizadas, el 93,33 % duró menos de 15 minutos y el 95 % se presentaron en las primeras 24 horas de la fiebre. El 86,67 % de las crisis fueron simples y el 13,33 % complejas. Solamente el 36,67 % de los casos tuvo recurrencias, el EEG fue normal en el 93,33 % de los casos.

Prevalence of seizures and paralysis in a rural community.

A cross-sectional study covering four adjoining villages in Haryana during 1993 was carried out among 8595 subjects to find out cases having seizures or paralysis. The prevalence of seizures (n = 69) was found to be 8.03 per 1000 population. Out of 69 seizures, 48(69%) were true seizures and 21(31%) were febrile seizures. The prevalence of seizures was highest (14.05 per 1000) in the age group of > 1-4 years. Of 40 males with seizures, 22(55%) had epileptic seizures and 18(45%) had febrile seizures. Of the 29 females, 26(89%) had epileptic seizures and 3(11%) had febrile seizures. There were 25 cases of pseudoseizures. The prevalence of paralysis (n = 60) was 6.98 per 1000. Of these, 38 cases (63%) were due to poliomyelitis which is the highest so far the paralysis is concerned. Of 60 cases, 34 occurred among males and 26 among females. The prevalence of paralysis was highest (12.42 per 1000) among 0-1 year age group. As the prevalence of seizures is sufficiently high in rural areas, the primary health care doctors should be trained in counselling and therapy of seizures. As regarding paralysis due to poliomyelitis the recent success of pulse polio immunisations is commendable and which in near future is expected to eradicate poliomyelitis.