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Telemedicine in Developing Countries: Knowledge, Attitudes, and Practices of Caregivers of Children with Epilepsy Regarding Telemedicine at the Philippine Children’s Medical Center 发展中国家的远程医疗:菲律宾儿童医疗中心癫痫儿童护理人员关于远程医疗的知识、态度和实践
Q4 Medicine Pub Date : 2023-08-24 DOI: 10.26815/acn.2023.00108
Grael M. Dumallay, L. K. Banta-Banzali
Purpose: The coronavirus disease 2019 pandemic has prompted the use of telemedicine as an alternative method for providing continuous epilepsy care. This study was conducted to validate and administer a web-based questionnaire to assess the knowledge, attitudes, and practices (KAP) regarding telemedicine among caregivers of children with epilepsy at the Philippine Children’s Medical Center (PCMC). Methods: This cross-sectional study was conducted by a primary investigator from the child neurology section of PCMC between July 2022 and October 2022 and consisted of two phases. In phase 1, content validation and pre-testing of the Filipino version of the questionnaire were conducted with 29 caregivers. Phase 2 involved the web-based administration of the final version of the questionnaire to 89 caregivers. Results: The resulting questionnaire comprised four main sections: demographics, KAP. Regarding caregivers’ knowledge, 70.8% had not heard of telemedicine before participating in teleconsulta-tions at PCMC. However, most participants were able to correctly identify its purposes (86.4%), benefits (87.6%), and barriers (78.7%). All aspects of the caregivers’ attitudes demonstrated positive agreement with the Likert scale of attitudes, with P values of <0.01, which indicated statistical significance. The most common device used was a cellular phone, and most caregivers identified Facebook Messenger, Viber, and Zoom as the most useful platforms. Conclusion: Our study revealed low awareness of the availability of telemedicine services but good knowledge of its purposes, benefits, and barriers. Caregivers exhibited positive attitudes toward telemedicine, with Facebook Messenger identified as the most useful platform.
目的:2019年冠状病毒病大流行促使人们将远程医疗作为提供持续癫痫治疗的替代方法。本研究旨在验证和管理一份基于网络的问卷,以评估菲律宾儿童医疗中心(PCMC)癫痫儿童护理人员关于远程医疗的知识、态度和实践(KAP)。方法:横断面研究由一名来自PCMC儿童神经内科的主要研究者于2022年7月至2022年10月进行,包括两个阶段。在第一阶段,对29名护理人员进行了菲律宾版问卷的内容验证和预测试。第二阶段是对89名护理人员进行最终版问卷的网络管理。结果:所得问卷包括四个主要部分:人口统计,KAP。在护理人员的知识方面,70.8%的人在参加PCMC远程会诊之前没有听说过远程医疗。然而,大多数参与者能够正确识别其目的(86.4%),好处(87.6%)和障碍(78.7%)。照顾者态度各方面均与李克特态度量表正一致,P值<0.01,具有统计学意义。最常用的设备是手机,大多数护理人员认为Facebook Messenger、Viber和Zoom是最有用的平台。结论:我们的研究表明,人们对远程医疗服务的可用性认识较低,但对其目的、好处和障碍有很好的了解。护理人员对远程医疗表现出积极的态度,Facebook Messenger被认为是最有用的平台。
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引用次数: 0
Sporadic Hemiplegic Migraine: Hypoperfusion Demonstrated by Susceptibility-Weighted Magnetic Resonance Imaging and Computed Tomography Perfusion Study 散发性偏瘫偏头痛:敏感性加权磁共振成像和计算机断层扫描灌注研究显示的灌注不足
Q4 Medicine Pub Date : 2023-08-23 DOI: 10.26815/acn.2023.00178
Yae Kyung Kim, Yoo Jung Lee, Yoon Hee Jo, Young Mi Kim
Hemiplegic migraine (HM) is a rare subtype of migraine with aura, characterized by the gradual progression of varying degrees of hemiparesis (motor aura) or other neurological deficits. HM has two forms: familial and sporadic. Sporadic HM (SHM) is defined as HM without a family history of similar episodes. Abnormalities in cerebral perfusion have been suggested as a potential cause of encephalopathy and hemiplegia in both SHM and familial HM (FHM).
偏瘫性偏头痛(HM)是一种罕见的先兆偏头痛亚型,其特征是不同程度的偏瘫(运动先兆)或其他神经功能缺陷逐渐发展。HM有两种形式:家族性和散发性。散发性HM(SHM)被定义为没有类似发作家族史的HM。脑灌注异常被认为是SHM和家族性HM(FHM)脑病和偏瘫的潜在原因。
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引用次数: 0
Effect of Tizanidine on Spasticity in Pediatric Patients with Cerebral Palsy: A Systematic Review 替扎尼定对小儿脑瘫痉挛的影响:一项系统综述
Q4 Medicine Pub Date : 2023-08-08 DOI: 10.26815/acn.2023.00101
Anna Dominique Py Castro, M. A. A. Valencia
Purpose: Cerebral palsy (CP) is a permanent, non-progressive disorder of the developing brain. Ti-zanidine is an effective treatment for spastic CP; however, insufficient evidence exists regarding its effect on motor function and side-effect profile. This review explored the effects and safety of tizanidine in treating spasticity among pediatric patients with CP. Methods: Two reviewers conducted a literature search. The Cochrane risk of bias tool and the 14-item National Institutes of Health Quality Assessment Tool were used to evaluate the risk of bias. A systematic review was performed for relevant studies. Results: Five studies were included: three randomized controlled trials (RCTs) and two observational studies. The control group received a placebo in two RCTs, while baclofen was used in the remaining studies. Tizanidine dosage and duration varied across reports, except for the two observational studies. Excepting one observational study, tizanidine was associated with a greater improvement on the modified Ashworth scale. Pain reduction was also greater with tizanidine treatment compared to the placebo, as evidenced by one RCT. Three studies evaluating gross motor function reported superior results with tizanidine compared to baclofen. Two RCTs indicated similar safety profiles between tizanidine and the placebo. The remaining studies reported a more favorable safety profile for tizanidine than baclofen. Conclusion: The studies examined in this review reported beneficial effects of tizanidine on spasticity, pain, and gross motor function. Tizanidine usage was associated with no serious adverse events, reflecting a better safety profile than baclofen. Nevertheless, high-quality RCTs are recommended to support tizanidine administration in pediatric patients.
目的:脑瘫(CP)是一种永久性的、非进行性的大脑发育障碍。替扎尼定是治疗痉挛性脑瘫的有效药物;然而,关于其对运动功能的影响和副作用的证据不足。本综述探讨替扎尼定治疗小儿CP患者痉挛的疗效和安全性。方法:两位审稿人进行文献检索。采用Cochrane偏倚风险评估工具和14项美国国立卫生研究院质量评估工具评估偏倚风险。对相关研究进行系统综述。结果:纳入5项研究:3项随机对照试验(rct)和2项观察性研究。在两项随机对照试验中,对照组接受安慰剂治疗,其余研究使用巴氯芬。除两项观察性研究外,替扎尼定的剂量和持续时间在各报告中有所不同。除一项观察性研究外,替扎尼定与改良Ashworth量表的更大改善相关。一项随机对照试验证明,与安慰剂相比,替扎尼定治疗减轻疼痛的效果也更大。三项评估大运动功能的研究报告了替扎尼定与巴氯芬相比有更好的结果。两项随机对照试验显示替扎尼定和安慰剂的安全性相似。其余的研究报告了替扎尼定比巴氯芬更有利的安全性。结论:本综述中研究报告了替扎尼定对痉挛、疼痛和大运动功能的有益作用。Tizanidine的使用与严重不良事件无关,反映了其安全性优于巴氯芬。然而,推荐高质量的随机对照试验来支持替扎尼定在儿科患者中的应用。
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引用次数: 0
Acute Necrotizing Encephalopathy in Children with COVID-19 Accompanied by Multisystem Inflammatory Syndrome 新冠肺炎并发多系统炎症综合征患儿急性坏死性脑病
Q4 Medicine Pub Date : 2023-08-08 DOI: 10.26815/acn.2023.00129
Dahlgaard Park, S. Yoon, Dong Hyun Kim, Y. Kwon
ganglia
神经节
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引用次数: 0
Diagnosis of Neuralgic Amyotrophy in an Adolescent Girl Using Magnetic Resonance Neurography: A Case Study 用磁共振神经造影诊断少女神经痛性肌萎缩症:个案研究
Q4 Medicine Pub Date : 2023-08-08 DOI: 10.26815/acn.2023.00122
S. Yang, Y. H. Kim, Kye Hyang Lee
Neuralgic amyotrophy (NA) is characterized by severe acute pain around the shoulder, followed by upper extremity weakness and muscle atrophy. NA often occurs after triggering events, such as viral or bacterial infection, vaccination, or surgery. Although rare in children, it has been reported in individuals as young as 7 weeks old [1-3]. NA is not well-known among pediatricians and has seldom been reported in the pediatric population.
神经痛性肌萎缩症(NA)的特征是肩部周围严重的急性疼痛,随后是上肢无力和肌肉萎缩。NA通常发生在触发事件后,如病毒或细菌感染、接种疫苗或手术。虽然在儿童中罕见,但有报道称在7周大的个体中也有[1-3]。NA在儿科医生中并不为人所知,在儿科人群中也很少有报道。
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引用次数: 0
Limbic System and Optic Nerve Diffusion Restriction in a Child with Biotinidase Deficiency 生物素酶缺乏症儿童的边缘系统和视神经扩散受限
Q4 Medicine Pub Date : 2023-07-21 DOI: 10.26815/acn.2023.00115
Gvn Pradeep, C. Prasad, J. Saini, Karthik Kulanthaivelu, Sabhan Ahmed
Congenital biotinidase deficiency (CBD) is a rare, autosomal recessive, reversible metabolic encephalopathy caused by pathogenic variants in the biotinidase ( BTD ) gene (Online Mendelian Inheritance in Man 609019). Biotin serves as a cofactor for four carboxylase enzymes (pyruvate carboxylase, propionyl CoA carboxylase, 3-meth-ylcrotonyl CoA carboxylase, and acetyl CoA carboxylase) required for fatty acid synthesis, amino acid metabolism, and gluconeogenesis. A deficiency in biotinidase disrupts biotin recycling and the release of biotin bound to dietary proteins, leading to reduced biotin availability for carboxylase enzymes. This results in energy depletion and metabolic acidosis [1].
先天性生物素酶缺乏症(CBD)是一种罕见的常染色体隐性可逆代谢性脑病,由生物素酶(BTD)基因的致病变异引起(在线孟德尔遗传609019)。生物素是脂肪酸合成、氨基酸代谢和糖异生所必需的四种羧化酶(丙酮酸羧化酶、丙酰辅酶a羧化酶、3-甲基酰基辅酶a羧化酶和乙酰辅酶a羧化酶)的辅助因子。缺乏生物素酶会破坏生物素的循环和与膳食蛋白质结合的生物素的释放,导致羧化酶的生物素可用性降低。这导致能量消耗和代谢性酸中毒。
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引用次数: 0
A Case of Status Epilepticus Caused by Intravenous Tramadol 曲马多静脉注射致癫痫状态1例
Q4 Medicine Pub Date : 2023-07-01 DOI: 10.26815/acn.2023.00052
S. Y. Kim, Young Eun Kim, Kook Won Kim, Sungwon Byun
Tramadol is a recently developed, centrally acting synthetic analgesic agent. The pharmacological mechanism of tramadol has not yet been fully elucidated, but unlike standard opioid analgesics, tramadol alleviates pain by modulating norepinephrine secretion and inhibiting serotonin reuptake [1]. The potency of tramadol is between 10% and 25% of that of morphine at the μ-opioid receptor, so it is considered a “weak opioid.” For this reason, it is regarded as relatively safe. Tramadol has been commonly used for postoperative pain treatment in children who have mild to moderate pain. The recommended dose for the intravenous (IV) route for children is 2 mg/kg every 4 to 6 hours, which is best for analgesic action with minimal side effects [2]. However, tramadol has some unique properties compared to other standard opioid medications that are attributable to its mechanism of inhibiting monoamine reuptake. Examples of the adverse effects of tramadol include respiratory depression, seizure, tachycardia, hypertension, serotonin syndrome, and manic syndrome [3]. Seizures have been noted as a concerning side effect of tramadol since its market approval in the United States in 1995, based on post-marketing reports to the U.S. Food and Drug Administration (FDA). Between 1997 and 2017, 30,730 tramadol-related cases had been reported to the FDA's Adverse Event Reporting System, and seizures accounted for 7% of the cases [4]. The FDA issued a black-box warning in 2017, banning the use of tramadol in children and adolescents under the age of 12, and in those aged 12 to 18 with underlying diseases, due to its potential to cause serious respiratory side effects and death [5]. Despite the FDA’s warning, tramadol continues to be given, which is worrisome. Here, we present a case of tramadol-induced status epilepticus in a 15-year-old girl with no past history of seizures. A 15-year-old girl (height, 159 cm; weight, 47 kg) presented to the emergency department due to abdominal pain. She had normal developmental milestones and her past medical history was unremarkable. She had undergone laparoscopic left ovarian cystectomy (pathology: functional cyst) 23 days earlier. A clinical examination revealed normal hemodynamic variables, and there was no sign of dehydration, or fever. On physical examination, widespread abdominal tenderness without rebound tenderness was found, while other physical examination and lab test results were normal. Abdominopelvic computed tomography (CT) showed paralytic small bowel ileus. She was referred to the gynecology department for conservative management. The patient was given 30 mg of IV ketorolac tromethamine (Trolac, Whanin Pharm Co., Seoul, Korea) and 100 mg of IV tramadol (Tandol, AJU Pharm Co., Seoul, Korea). Since the pain persisted, IV tramadol was
曲马多是最近开发的一种集中作用的合成镇痛剂。曲马多的药理机制尚未完全阐明,但与标准的阿片类止痛药不同,曲马多通过调节去甲肾上腺素分泌和抑制血清素再摄取来减轻疼痛[1]。曲马多在μ-阿片受体上的效力是吗啡的10%至25%,因此被认为是“弱阿片”。因此,它被认为是相对安全的。曲马多通常用于轻度至中度疼痛儿童的术后疼痛治疗。儿童静脉注射(IV)途径的推荐剂量为每4至6小时2 mg/kg,这对镇痛作用最好,副作用最小[2]。然而,与其他标准阿片类药物相比,曲马多具有一些独特的特性,这归因于其抑制单胺再摄取的机制。曲马多的不良反应包括呼吸抑制、癫痫发作、心动过速、高血压、血清素综合征和躁狂综合征[3]。根据提交给美国食品药品监督管理局(FDA)的上市后报告,曲马多自1995年在美国上市以来,缉获一直被认为是一种令人担忧的副作用。1997年至2017年间,美国食品药品监督管理局的不良事件报告系统报告了30730例曲马多相关病例,癫痫发作占病例的7%[4]。美国食品药品监督管理局在2017年发布了一项黑匣子警告,禁止12岁以下的儿童和青少年以及12至18岁患有潜在疾病的人使用曲马多,因为它可能会导致严重的呼吸道副作用和死亡[5]。尽管美国食品药品监督管理局发出警告,曲马多仍在继续使用,这令人担忧。在此,我们报告一例曲马多诱导的15岁女孩癫痫持续状态,该女孩既往无癫痫病史。一名15岁女孩(身高159厘米,体重47公斤)因腹痛被送往急诊科。她有正常的发育里程碑,过去的病史并不明显。23天前,她接受了腹腔镜左卵巢囊肿切除术(病理学:功能性囊肿)。临床检查显示血流动力学变量正常,没有脱水或发烧的迹象。体格检查发现腹部广泛压痛,无反弹性压痛,其他体格检查和实验室检查结果正常。腹部计算机断层扫描(CT)显示麻痹性小肠梗阻。她被转诊到妇科进行保守治疗。给患者静脉注射30 mg酮咯酸氨丁三醇(Trolac,Whanin Pharm Co.,Seoul,Korea)和100 mg曲马多(Tandol,AJU Pharm Co.)。由于疼痛持续,静脉注射曲马多
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引用次数: 1
Real-Life Efficacy and Tolerability of Lacosamide in Pediatric Patients Aged 4 Years or Older with Drug-Resistant Epilepsy Lacosamide在4岁及以上儿童耐药癫痫患者中的实际疗效和耐受性
Q4 Medicine Pub Date : 2023-07-01 DOI: 10.26815/acn.2023.00073
S. Byun, J. Kong, S. Y. Lyu, S. Nam, Young Mi Kim, G. Yeon, Yun-Jin Lee
Purpose: The aim of this study was to evaluate the efficacy and safety of adjunctive lacosamide therapy in pediatric patients aged ≥4 years with drug-resistant epilepsy (DRE).Methods: Medical records of children aged 4 to 19 years treated with lacosamide as adjunctive therapy for DRE were retrospectively reviewed. The patients were divided into two groups according to their age at the start of lacosamide treatment: group A (aged 4–15 years) and group B (aged 16–19 years). Changes in seizure frequency from baseline, adverse events, and the retention rate were evaluated at each follow-up visit.Results: Sixty-two patients (33 males and 29 females) with a mean age of 11.4 years (range, 4 to 19) were included. The mean duration of follow-up was 20.1±12.9 months. The mean maintenance dose of lacosamide was 6.7±4.8 mg/kg/day. Forty-two patients (67.7%) were responders (≥50% reduction in seizures) with 19.4% (12/62) achieving freedom from seizures. The response rate did not differ significantly between groups A and B (67.6% vs. 68.0%, P=0.795) and was not affected by the concomitant use of sodium channel blockers. Significant independent factors associated with a good response to lacosamide treatment were a shorter duration of epilepsy (P=0.035) and fewer concomitant anti-seizure medications (P=0.002). Mild transient adverse events were observed in 20 patients (32.3%).Conclusion: Lacosamide adjunctive therapy was efficacious and tolerated in children aged ≥4 years with DRE. Early use of lacosamide may be helpful for a good response to drug-resistant seizures.
目的:本研究旨在评估拉沙酰胺辅助治疗年龄≥4岁的儿童耐药癫痫(DRE)的疗效和安全性。根据患者开始接受拉沙酰胺治疗时的年龄,将其分为两组:A组(4-15岁)和B组(16-19岁)。在每次随访中评估基线发作频率、不良事件和保留率的变化。结果:包括62名患者(33名男性和29名女性),平均年龄11.4岁(4至19岁)。平均随访时间20.1±12.9个月。lacosamide的平均维持剂量为6.7±4.8 mg/kg/天。42名患者(67.7%)有反应(癫痫发作减少≥50%),19.4%(12/62)无癫痫发作。A组和B组的有效率没有显著差异(67.6%对68.0%,P=0.795),并且不受同时使用钠通道阻滞剂的影响。与拉沙酰胺治疗效果良好相关的重要独立因素是癫痫持续时间较短(P=0.035)和伴随的抗癫痫药物较少(P=0.002)。20名患者(32.3%)出现轻度短暂性不良事件。结论:拉沙酰胺辅助治疗对≥4岁DRE儿童有效且耐受。早期使用拉沙酰胺可能有助于对耐药性癫痫发作做出良好反应。
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引用次数: 0
Sphenoid Sinus Mucocele Causing Orbital Apex Syndrome, Methicillin-Susceptible Staphylococcus aureus Bacteremia, and Hypopituitarism 蝶窦粘液囊肿引起眶尖综合征,甲氧西林敏感金黄色葡萄球菌菌血症和垂体功能减退
Q4 Medicine Pub Date : 2023-06-23 DOI: 10.26815/acn.2023.00080
So Eun Park, You Jeong Lee, Yoon Hee Jo, Soo-Han Choi, Young Mi Kim
Sphenoid sinus mucocele (SSM) is a rare disease, accounting for only 1% to 2% of all paranasal sinus mucoceles [1]. Typically, paranasal sinus mucoceles develop after radiotherapy or in patients with cystic fibrosis; however, some studies have reported SSM with no specific underlying cause other than chronic rhinitis [2]. Although SSM is benign, it tends to expand, leading to severe complications such as optic nerve palsy, ocular motor nerve palsy
蝶窦黏液囊肿(SSM)是一种罕见的疾病,仅占所有鼻窦黏液囊肿的1%-2%[1]。通常,放疗后或囊性纤维化患者出现鼻窦黏液囊肿;然而,一些研究报道了除了慢性鼻炎之外没有特定潜在原因的SSM[2]。虽然SSM是良性的,但它往往会扩大,导致严重的并发症,如视神经麻痹、眼运动神经麻痹
{"title":"Sphenoid Sinus Mucocele Causing Orbital Apex Syndrome, Methicillin-Susceptible Staphylococcus aureus Bacteremia, and Hypopituitarism","authors":"So Eun Park, You Jeong Lee, Yoon Hee Jo, Soo-Han Choi, Young Mi Kim","doi":"10.26815/acn.2023.00080","DOIUrl":"https://doi.org/10.26815/acn.2023.00080","url":null,"abstract":"Sphenoid sinus mucocele (SSM) is a rare disease, accounting for only 1% to 2% of all paranasal sinus mucoceles [1]. Typically, paranasal sinus mucoceles develop after radiotherapy or in patients with cystic fibrosis; however, some studies have reported SSM with no specific underlying cause other than chronic rhinitis [2]. Although SSM is benign, it tends to expand, leading to severe complications such as optic nerve palsy, ocular motor nerve palsy","PeriodicalId":33305,"journal":{"name":"Annals of Child Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42927712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurofibromatosis Type 1 with Arnold Chiari Type 1 Malformation in A Child 儿童1型神经纤维瘤病伴Arnold Chiari 1型畸形
Q4 Medicine Pub Date : 2023-06-09 DOI: 10.26815/acn.2023.00087
Hae Young Ro, S. Yoon, Woo Ri Jang, Y. Kwon
Neurocutaneous disorders primarily affect the central and peripheral nervous systems, as well as the skin, and can ultimately lead to the development of tumors in these organs. Neurofibromatosis type 1 (NF1) is one of the most common neurocutaneous syndromes, with a reported incidence of approximately 1 in 2,600 to 1 in 3,000 individuals [1]. It is an autosomal dominant genetic disorder caused by pathogenic variants of the NF1 tumor suppressor gene located on chro-mosome 17q11.2
神经皮肤疾病主要影响中枢和外周神经系统以及皮肤,并最终导致这些器官中肿瘤的发展。1型神经纤维瘤病(NF1)是最常见的神经皮肤综合征之一,据报道其发病率约为2600至3000人中的1人[1]。它是一种常染色体显性遗传病,由位于chromosome 17q11.2的NF1肿瘤抑制基因的致病性变体引起
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引用次数: 0
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Annals of Child Neurology
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