Distinguishing features of COVID-19 and non-COVID-19 febrile seizures in hospitalised children.

INTRODUCTION: Febrile seizures in children can be associated with various underlying conditions, including COVID-19. Differentiating COVID-19 and non-COVID-19 related febrile seizures is crucial for tailored patient management and for implementing appropriate infection control measures to prevent nosocomial transmission. This study aimed to describe the clinical features of children hospitalised for COVID-19 and non-COVID-19 febrile seizures and to identify factors that differentiate between the two groups. MATERIALS AND METHODS: This retrospective cross-sectional study involved children aged 6 months to 6 years who were hospitalised for febrile seizures in Hospital Tuanku Ja'afar Seremban (HTJS) from January 2021 to June 2022. Descriptive statistics were used to summarise the differences in demographics and clinical presentations. Logistic regression analyses were performed to identify factors associated with COVID-19 and non-COVID-19 febrile seizures. RESULTS: Of the 345 patients (median age 22 months, IQR 15- 32; 59.7% were males) included in the study, 130 (37.7%) tested positive for COVID-19, while 215 (62.3%) tested negative. There were no significant differences between both groups based on age, comorbidities, history of febrile seizures, seizure types, temperature on arrival, cough and rhinorrhoea. Multivariate analysis revealed that a family history of febrile seizures and leucocytosis were associated with increased odds of non-COVID-19 febrile seizures. In contrast, lymphopenia was associated with decreased odds. CONCLUSION: The clinical presentation of COVID-19 and non- COVID-19 febrile seizures are remarkably similar, highlighting the importance of including COVID-19 screening in febrile seizures workup. Full blood count readings may be potentially useful for differentiating between these conditions.

A survey of calf management practices and farmer perceptions of calf housing in UK dairy herds.

Adoption of optimal management techniques for rearing dairy calves has significant effects on their health, welfare, and productivity. Despite much published literature on best practice, calf morbidity and mortality rates remain high. This survey aimed to establish current calf management practices in the United Kingdom, along with farmer perceptions surrounding different housing types. A survey containing 48 questions was distributed online to UK farmers via social media, online forums, and a convenience sample of veterinary practices and was completed by 216 participants. A descriptive analysis with frequency distributions was calculated, with chi-squared tests, linear regression and multinomial regression performed to assess associations between variables. There was a low level of regular veterinary involvement in day-to-day health decision making for calves (3/216, 1.4%), highlighting the need for appropriate staff training and standard operating procedures to ensure prudent antimicrobial usage. Restricted calf milk feeding remains highly prevalent in the United Kingdom, with most calves fed milk replacer (114/216, 52.8%), twice daily (189/216, 87.5%), initially given milk at 4 L/d (66/216, 30.6%) or 6 L/d (47/216, 21.8%). There was, however, a small number of farmers initially feeding only 2 to 3 L/d (28/216, 13.0%). Euthanasia of bull calves (5/216, 2.3%) and feeding antimicrobial waste milk to calves (8/216, 3.7%) both occurred on some farms. With regard to housing, use of individual calf pens has reduced from around 60% in 2010 to 38.4% in this study (83/216), with this reduction being partly driven by the policy of UK milk buyers. Farmer perceptions indicated that individual housing was thought to help to improve calf health and feed monitoring of calves, suggesting that successful use of group housing requires a higher level of stockmanship. The majority of farmers did not provide fresh bedding to calves on a daily basis (141/216, 65.3%), and relatively few disinfected both the calf housing (38.0%) and ground (47.7%) between calves, suggesting that hygiene practices may require additional attention in farm management protocols.

The epidemiology of multiple sclerosis in the Isle of Man: 2006-2011.

BACKGROUND: We sought to determine the prevalence of MS on the Isle of Man in 2006 and 2011, and the incidence and mortality rates over this interval. METHODS: Cases were identified by hospital medical record review, General Practitioners and the local MS Society. The significance of the change in prevalence over time and the significance of differences in frequencies by sex and place of birth were assessed by Poisson regression. RESULTS: The 2006 prevalence was 153.64 per 100,000 persons and the 2011 prevalence was 179.89. The prevalence was higher among females and persons born in the Isle of Man at both time points. The 2006-2011 incidence rate was 6.86 per 100,000 person-years, much higher among females and persons born in the Isle of Man. The prevalence sex ratios in 2006 and 2011, 2.77 and 2.59, respectively, and the incidence sex ratio, 2.19, are similar to others found in the region. The mortality rate over the study period was 2.84 per 100,000 person-years, this solely among persons born overseas. CONCLUSIONS: This is the first study of MS epidemiology in the Isle of Man, finding this area to be of high prevalence and to have one of the highest incidence rates in the UK region.

Bilateral synchronous tonsillar carcinoma: a case series and review of the literature.

We present the first dedicated case series of bilateral synchronous tonsillar carcinoma and discuss the role of bilateral tonsillectomy as a diagnostic tool. The occurrence of multiple head and neck tumours is well recognised; however, reports of bilateral synchronous tonsillar carcinoma are rare. A literature review reveals only 12 cases of bilateral synchronous tonsillar carcinoma described in the international literature in the past 15 years. We present a further three cases confirmed following bilateral tonsillectomy. In conclusion, bilateral tonsillectomy has in many centres been established as a standard diagnostic and therapeutic procedure for patients who have cervical metastases from a head and neck cancer of unknown primary site. It is likely the true incidence of bilateral synchronous tonsillar carcinoma is underestimated and under-reported. We recommend bilateral tonsillectomy for patients with suspected or proven unilateral tonsillar carcinoma as well as those with cervical metastases from unknown primary site.

A comparison of Thiel and formalin embalmed cadavers for thyroid surgery training.

BACKGROUND: The European Working Time Directive has increased the need for surgical skills training which does not involve patients. Recent changes in the anatomy legislation now make it possible to perform surgical procedures on human cadavers. Standard formalin embalming, however does not provide a very realistic model and alternative approaches, such as Thiel soft-fix embalmed cadavers, should be explored and evaluated. METHODS: Two formalin and 3 Thiel embalmed cadavers were used at a senior trainee and consultant course in thyroid surgery. The 12 participants (8 trainees and 4 consultants) were asked to score 15 aspects, such as quality of different tissues, for each type of cadaver. Some of these aspects were specific to thyroid surgery, however many are equally applicable to other specialties. RESULTS: All participants rated the Thiel embalmed cadavers better or equal for all aspects. Of the 180 pairs of scores 33 were excluded, 10 were equal for formalin and Thiel, while in the remaining 137 Thiel scored better. The preference was particularly pronounced in aspects that require flexibility of tissues such as flap raising. CONCLUSIONS: Thiel embalmed cadavers provide a more realistic model for training of thyroid surgical skills; this is expected to be similar for many other types of surgery.

Human auditory nerve compound action potentials and long latency responses.

CONCLUSION: The compound action potential (CAP) is followed by a long latency response (LLR), attributable to the post-auricular musculature. The LLR to one pulse may overlap with the CAP to a subsequent one, contributing to the clinically observed reduction in CAP at high pulse rates. OBJECTIVES: To measure refractory and other influences on CAPs in humans and guinea pigs. MATERIALS AND METHODS: CAPs were obtained from humans using trans-tympanic and extra-tympanic electrocochleography and from anaesthetized guinea pigs. Stimuli were single pulses presented at a slow rate, pairs of pulses, and 100 ms pulse trains where the inter-pulse interval alternated between 4 and 6 ms. RESULTS: For single pulses, the CAP shape was similar across species. For pairs of pulses, the CAP to the second pulse was smaller than that to the first, and decreased with increasing inter-pulse interval in a way that was similar across species. For pulse trains, CAPs were observed in response to each pulse in the train for the guinea pigs, but not for humans. For both filtered and unfiltered single pulses, there was a large LLR in humans, but not in guinea pigs, with peaks at latencies of 10-12 and 20-25 ms. Posture affected the LLR in a way consistent with the post-auricular response.

Randomised positive control trial of NSAID and antimicrobial treatment for calf fever caused by pneumonia.

One hundred and fifty-four preweaning calves were followed between May and October 2015. Calves were fitted with continuous monitoring temperature probes (TempVerified FeverTag), programmed so a flashing light emitting diode (LED) light was triggered following six hours of a sustained ear canal temperature of ≥39.7°C. A total of 83 calves (61.9 per cent) developed undifferentiated fever, with a presumptive diagnosis of pneumonia through exclusion of other calf diseases. Once fever was detected, calves were randomly allocated to treatment groups. Calves in group 1 (NSAID) received 2 mg/kg flunixin meglumine (Allevinix, Merial) for three consecutive days and group 2 (antimicrobial) received 6 mg/kg gamithromycin (Zactran, Merial). If fever persisted for 72 hours after the initial treatment, calves were given further treatment (group 1 received antimicrobial and group 2 received NSAID). Calves in group 1 (NSAID) were five times more likely (P=0.002) to require a second treatment (the antimicrobial) after 72 hours to resolve the fever compared with the need to give group 2 (antimicrobial) calves a second treatment (NSAID). This demonstrates the importance of ongoing monitoring and follow-up of calves with respiratory disease. However, of calves with fever in group 1 (NSAID), 25.7 per cent showed resolution following NSAID-only treatment with no detrimental effect on the development of repeated fever or daily live weight gain. This suggests that NSAID alone may be a useful first-line treatment, provided adequate attention is given to ongoing monitoring to identify those cases that require additional antimicrobial treatment.

Randomised controlled trial to evaluate the effect of foot trimming before and after first calving on subsequent lameness episodes and productivity in dairy heifers.

The objective of this study was to assess both independent and combined effects of routine foot trimming of heifers at 3 weeks pre-calving and 100 days post calving on the first lactation lameness and lactation productivity. A total of 419 pre-calving dairy heifers were recruited from one heifer rearing operation over a 10-month period. Heifers were randomly allocated into one of four foot trimming regimens; pre-calving foot trim and post-calving lameness score (Group TL), pre-calving lameness score and post-calving foot trim (Group LT), pre-calving foot trim and post-calving foot trim (Group TT), and pre-calving lameness score and post-calving lameness score (Group LL, control group). All heifers were scored for lameness at 24 biweekly time points for 1 year following calving, and first lactation milk production data were collected. Following calving, 172/419 (41.1%) of heifers became lame during the study (period prevalence), with lameness prevalence at each time-point following calving ranging from 48/392 (12.2%) at 29-42 days post-calving to 4/379 (1.1%) between 295 and 383 days after calving. The effects of the four treatment groups were not significantly different from each other for overall lameness period prevalence, biweekly lameness point prevalence, time to first lameness event, type of foot lesion identified at dry off claw trimming, or the 4% fat corrected 305-day milk yield. However, increased odds lameness was significantly associated with a pre-calving trim alone (P = 0.044) compared to the reference group LL. The odds of heifer lameness were highest between 0 and 6 weeks post-partum, and heifer farm destination was significantly associated with lameness (OR 2.24), suggesting that even at high standard facilities, environment and management systems have more effect on heifer foot health than trimming.

Audit of specialist registrar training in tympanomastoid surgery for chronic otitis media.

BACKGROUND: A prospective audit of specialist registrars' (SRs') training in tympanomastoid surgery for chronic otitis media within the Anglia Regional Training Scheme is described. This audit recorded the surgical activity of the trainees and their contribution to operative procedures, and assessed the results of the procedures. This type of systematic approach to the audit of surgical training is important in light of the current shortened training programmes and increased accountability of trainers. OBJECTIVES: The study aimed to establish the levels of exposure to, supervision of and outcome of ear operations for chronic otitis media performed by ENT trainees in the East Anglia region. METHOD: A prospective, region-wide, minimum otology dataset-based proforma audit was undertaken, with compulsory SR participation. Proformas were completed at the time of operation (form one) and at a minimum interval of nine months post-operatively (form two). Data on form one included hospital, supervising consultant, name and training year of SR, contribution of SR (based on England Royal College of Surgeons guidelines interpreted by the SR), pre-operative audiology average (air conduction/bone conduction over 0.5, 1, 2 and 4 kHz), the pathology and the state of the ear at the time of surgery, and a breakdown of the procedure(s) undertaken. Form two recorded data relevant to form one as well as information regarding patient satisfaction and the operative result obtained, graded as 'gold' (no disease, dry ear and hearing average < 25 dB), 'silver' (two of these three) and 'bronze' (one of these three). All completed forms were analysed using Microsoft Access software. RESULTS: Completed copies of 409 form ones and 156 form twos were analysed. With advancing years, SRs' contributions to procedures increased without significant effect on the graded outcome, which appeared to be independent of SR year of training. Different regional hospitals were compared. Data collected also provided an otology training portfolio for SRs, forming part of their registrar in-training assessment (RITA). CONCLUSION: The East Anglia SR audit of SRs' training in tympanomastoid surgery for chronic otitis media was a powerful training tool. It demonstrated the safe progression of SR training in supervised ear surgery, with SRs' results being comparable to those for consultant-performed procedures.

Cutaneous metastases from a hypopharyngeal malignancy.

We present an unusual case of carcinoma of the piriform fossa, presenting with cutaneous metastases. These metastases are very rare, present in the late stages of disease, and are usually associated with distant metastases and poor prognosis. They often suggest aggressive disease. We believe that cutaneous metastases from a malignancy in the piriform fossa are more unusual than those from other sites of the head and neck.

Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy.

OBJECTIVE: This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy. METHODS: Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves' disease and non-Graves' groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed. RESULTS: A total of 225 patients met the inclusion criteria. Graves' disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves' disease patients (p < 0.05). CONCLUSION: Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.

p16 status and interval neck dissection findings after a 'clinically complete response' to chemoradiotherapy in oropharyngeal squamous cell carcinoma.

OBJECTIVES: To evaluate the histopathological findings from post-treatment neck dissection of p16 positive and negative oropharyngeal carcinoma cases, after completion of chemoradiotherapy, and to question the role of neck dissection after a 'clinically complete response' to chemoradiotherapy. METHODS: Data were collected retrospectively from a cohort of patients treated with curative intent using chemoradiotherapy and post-treatment neck dissection. Primary tumours underwent p16 immunohistochemistry. Neck dissection specimens were examined for viable cancer cells. RESULTS: A total of 76 cases were assessed. Viable cancer cells were detected from neck dissection in 29 per cent of p16 negative cases. Locoregional recurrence occurred in 12.9 per cent of p16 negative cases. The association between p16 positivity in the primary tumour and histopathologically negative neck dissection was significant (p < 0.05). CONCLUSION: p16 status appeared to be an independent marker of disease control for the cohort in this study. The data raise questions about the role of post-treatment neck dissection in p16 positive cases with a 'clinically complete response' to chemoradiotherapy.

Interventions for acute auricular haematoma.

BACKGROUND: Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity. OBJECTIVES: To assess the effectiveness of treatment options in acute auricular haematoma. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003. SELECTION CRITERIA: Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma. DATA COLLECTION AND ANALYSIS: Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria. MAIN RESULTS: Due to the lack of data from trials fulfilling selection criteria no results could be presented. REVIEWERS' CONCLUSIONS: There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.

Mastoid obliteration with hydroxyapatite cement: the Ipswich experience.

OBJECTIVE: This article reports the outcomes of a series of patients who underwent obliteration of the mastoid cavity using hydroxyapatite cement. A comparison is made with a group of patients who underwent similar surgery in the same period using hydroxyapatite granules. STUDY DESIGN: Nonrandomized observational analysis. SETTING: Tertiary otology unit. PATIENTS AND INTERVENTIONS: All patients requiring mastoid surgery and primary obliteration or revision mastoid surgery and obliteration. MAIN OUTCOME MEASURES: Dry cavity with full epithelialization and good tolerance to swimming at 1 year postoperatively. RESULTS: In four of eight patients who had obliteration using hydroxyapatite cement, there was infection of the obliteration site, requiring revision. All of the patients who had obliteration with hydroxyapatite granules had dry and well-epithelialized mastoid cavities at 1-year follow-up, with ears that tolerated swimming. CONCLUSION: The use of hydroxyapatite cement is not recommended in mastoid obliteration surgery.

Survival after cardiopulmonary resuscitation in an urban Indian hospital.

BACKGROUND: Survival after cardiopulmonary resuscitation depends upon the quality of pre-hospital support, availability of resuscitation equipment and the competence of the resuscitator. There are few data on the prognosis of patients undergoing such resuscitation in India. METHODS: In a retrospective analysis of 215 resuscitations done in a 125-bed community hospital between January 1995 and November 1997, return of spontaneous circulation and survival to discharge were evaluated. Multivariate methods were used to identify the predictors of successful outcome. RESULTS: Of all the patients, 14.4% were alive at discharge. Survival after a cardiorespiratory arrest in the hospital was 18.4%, which was significantly better than survival after pre-hospital events (5.9%; p = 0.027). Multivariate predictors of survival at discharge were resuscitation duration of less than 20 minutes [odds ratio (95% confidence limit): 32.6 (6.5-164.3)], presentation with ventricular tachycardia or fibrillation [odds ratio: 18.5 (4.4-77.9)], in-hospital cardiorespiratory arrest [odds ratio: 5.2 (1.2-21.6)] and female sex [odds ratio: 3.2 (1.1-9.6)]. Bystander resuscitation, though rarely provided, increased survival at discharge (p = 0.026). CONCLUSIONS: With 5.5 resuscitation attempts needed for one live discharge after in-hospital cardiorespiratory arrest and 17 attempts to save a life after pre-hospital events, our outcomes are comparable to those reported from developed nations. A return of pulse after shorter durations of cardiopulmonary resuscitation, ventricular fibrillation or tachycardia as the abnormal presenting rhythm, in-hospital location of cardiorespiratory (CR) arrest and female sex were independent predictors of live discharge. Age and aetiology of CR arrest did not influence the outcome.

Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: a prospective study.

BACKGROUND: Successful treatment of acute myocardial infarction is dependent on early presentation of the patient to the hospital. The factors that contribute to delay in seeking treatment have not been systematically evaluated in the Indian milieu. METHODS: Patients admitted with acute myocardial infarction to a 125-bed urban community hospital were evaluated prospectively. A record of admission characteristics, prior medical history, pre-hospital symptoms and treatment patterns was completed within 48 hours of each admission. Independent predictors of delayed admission were identified by logistic regression. RESULTS: Of 144 consecutive admissions with myocardial infarction, 133 had completed data as per the protocol [mean (SD) age 59 (12.7) years; 79.6% men]. The distribution of presentation times was skewed, with the mode, median and mean being 1, 3 (interquartile range 1.25-11) and 10.9 (SD 20.5) hours, respectively. Seventy-nine patients (59.4%) consulted a general practitioner prior to hospital referral and 48 patients (36.1%) delayed admission to hospital by more than 6 hours from the onset of symptoms. On multivariate analysis, individuals who were initially seen by a general practitioner (OR 5.57; 95% CI 1.84-16.8) and those over the age of 65 years (OR 3.24; 95% CI 1.06-9.89) were identified as 'delayers', while patients with severe symptoms (OR 0.32; 95% CI 0.12-0.87) or prodromal angina (OR 0.25; 95% CI 0.08-0.82) minimized delay. CONCLUSION: Though 50% of patients with acute myocardial infarction present to hospital within 3 hours, about 36% delay seeking treatment by more than 6 hours. Besides age and the pattern and severity of symptoms, visits to the general practitioner were found to be an independent correlate of delay.

Post-tonsillectomy bleed: a delayed diagnosis of duodenal ulceration.

Post-operative haemorrhage is one of the commonest complications of tonsillectomy. We report a case of a 36-year-old lady who presented with three haemorrhagic episodes following tonsillectomy. Although initially treated as secondary tonsillar haemorrhage, the actual cause of the bleeding was later identified to be a duodenal ulcer. The case is presented with a review of the literature.

Familial vocal fold paralysis.

Familial clustering of congenital bilateral abductor vocal fold paralysis has been reported very rarely. So far, only a handful of cases have been reported, mostly with the autosomal dominant of X-linked recessive mode of inheritance. We describe the cases of a brother and sister, who presented with neonatal stridor due to bilateral abductor vocal fold paralysis. First-degree parental consanguinity suggests an autosomal recessive mode of inheritance. Karyotype analysis revealed a paracentric balanced inversion of chromosome 13 in both cases, that was also present in the unaffected mother. An updated review of the literature on this interesting but rare condition is also presented.