Admissions to paediatric intensive care units (PICU) with refractory convulsive status epilepticus (RCSE): A two-year multi-centre study.

AIMS: To obtain national epidemiological data on the aetiology, management and outcome of refractory convulsive status epilepticus (RCSE) in children. METHODS: Data on children admitted with RCSE between 01.01.2008 and 31.12.2009, to eight paediatric intensive care units (PICUs) were retrospectively collected using a standard proforma designed with and co-ordinated by PICANet. RESULTS: Data were collected on 245 (male, 179) patients aged between <1 month and 16.5 years (median 2.8 years, IQR 1-7.43 years), of which: One hundred and fifty-one patients (male, 89) aged between <1 month and 16.5 years (median 2.3 years, IQR 1-7.17 years) met the study criteria for a diagnosis of RCSE. Causes included acute symptomatic (15.2%), remote symptomatic (29.0%), epilepsy-related (10.6%), progressive encephalopathy (10.6%) febrile seizures (18.2%); no cause was identified in 16.4%. First line treatments included lorazepam (118 patients, 78.1%), diazepam (72, 47.7%) and midazolam (37, 24.5%). Second-line treatments included phenytoin (125 patients, 82.8%) and phenobarbital (seven patients, 4.6%). Third-line treatments included a thiopentone bolus (99 patients, 65.6%), thiopentone infusion (20, 13.2%) midazolam infusion (56, 37.1%) phenobarbital (18, 11.9%), propofol (6, 4.0%) and clonazepam (2, 1.3%). Deviation from the national advanced paediatric life support (APLS) protocol was noted in approximately one quarter of all patients. Six patients died (4.0%). Seventeen patients (11.3%) developed a new neurological deficit on discharge from PICU, of which eight (5.3%) continued to show this deficit at a 30-day follow-up and 12 patients (7.9%) developed de novo epilepsy. CONCLUSIONS: Thiopentone was the most commonly used anticonvulsant to treat RCSE on admission to PICU. Mortality was low and approximately 1 in 25 showed a new neurological deficit at the 30-day follow-up.

Nutrient reduction evaluation of sewage effluent treatment options for small communities.

Small communities that are sewered by either package sewage treatment plants or on-site sewerage facilities are finding that the ground and surface waters are being contaminated. Nitrogen, which typically is not removed in these conventional systems, is a major concern. This project evaluated the capability of four sewage treatment technologies to reduce the amount of nitrogen being discharged in the effluent to the receiving environment. The four sewage treatment processes evaluated include a recirculating sand filter, biofilter, slow sand filter and constructed subsurface flow wetland. These processes were evaluated for their capability to reduce nitrogen, phosphorus, BOD5 and TSS. The primary objective of the project was to evaluate the capability of these treatment processes to reduce nitrogen using biological processes nitrification and denitrification. This paper reports on the performance of these processes to reduce nitrogen. The study demonstrated that the biofilter was capable of removing from a primary treated influent 40% of the total nitrogen. For the same quality influent the recirculating sand filter was capable of removing 35% of the total nitrogen. Secondary treated effluent was fed to the slow sand filter and the subsurface flow wetland. There was a 52% reduction in total nitrogen through the wetland however there was virtually no reduction in total nitrogen through the slow sand filter.