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A febrile seizure is a convulsion in a child that’s caused by a fever.

What is febrile seizures?

A febrile seizure is a convulsion in a child that’s caused by a fever. The fever is often from an infection. Febrile seizures occur in young, healthy children who have normal development and haven’t had any neurological symptoms before.

It can be frightening when your child has a febrile seizure. Fortunately, it is usually harmless, only last a few minutes, and typically don’t indicate a serious health problem.

You can help by keeping your child safe during a febrile seizure and by offering comfort afterward. Call your doctor to have your child evaluated as soon as possible after a febrile seizure.

What types of febrile seizures are there?

Febrile seizures have been divided two groups, simple or complex.

Febrile seizures are considered “simple” if they meet all of the following criteria:

Generalized full body convulsions

Last less than 15 minutes

No more than one in a 24-hour period

Febrile seizures are considered “complex or complicated” if any of the following features are present:

Start focally with one body part moving independently of others

Last more than 15 minutes

Occur more than once in a 24-hour period

Pathophysiology

Febrile seizures occur in young children at a time in their development when the seizure threshold is low. This is a time when young children are susceptible to frequent childhood infections such as upper respiratory infection, otitis media, viral syndrome, and they respond with comparably higher temperatures.

Febrile seizures are divided into 2 types: simple febrile seizures (which are generalized, last < 15 min and do not recur within 24 h) and complex febrile seizures (which are prolonged, recur more than once in 24 h, or are focal). Complex febrile seizures may indicate a more serious disease process, such as meningitis, abscess, or encephalitis. Febrile status epilepticus, a severe type of complex febrile seizure, is defined as single seizure or series of seizures without interim recovery lasting at least 30 minutes.

Viral illnesses are the predominant cause of febrile seizures. It tend to occur in families. In a child with febrile seizure, the risk is 10% for the sibling and almost 50% for the sibling if a parent has febrile seizures as well. Although clear evidence exists for a genetic basis of febrile seizures, the mode of inheritance is unclear.

While polygenic inheritance is likely, a small number of families are identified with an autosomal dominant pattern of inheritance of febrile seizures, leading to the description of a “febrile seizure susceptibility trait” with an autosomal dominant pattern of inheritance with reduced penetrance. Although the exact molecular mechanisms of febrile seizures are yet to be understood, underlying mutations have been found in genes encoding the sodium channel and the gamma amino-butyric acid A receptor.

What causes febrile seizures?

Fever causes febrile seizures. It is most common during the first day of an illness as a child’s temperature rises. They’re most likely with a fever of at least 100.4 degrees Fahrenheit (38 degrees Celsius). In some cases, children will sometimes have a seizure before developing a fever.

Fevers from viral infections usually trigger febrile seizures. But the fevers may be due to any type of infection, including:

Chickenpox.

Coronavirus (COVID-19).

Ear infections.

Encephalitis.

Influenza.

Malaria (in regions where this condition is possible).

Meningitis.

Stomach flu (gastroenteritis).

Strep throat.

Tonsillitis.

Upper respiratory infections.

(Note: Some childhood vaccinations may cause fever, and if a child has a febrile seizure after vaccination, it is the fever, not the vaccine itself, that causes the seizure.)

Risk factors

Factors that increase the risk of having a febrile seizure include:

Young age. Most febrile seizures occur in children between 6 months and 5 years of age, with the greatest risk between 12 and 18 months of age.

Family history. Some children inherit a family’s tendency to have seizures with a fever. Additionally, researchers have linked several genes to a susceptibility to febrile seizures.

Symptoms and signs

The symptoms of febrile seizures vary based on the two types:

Simple febrile seizures

Symptoms of simple febrile seizure are:

Loss of consciousness

Shaking limbs or convulsions (usually in a rhythmic pattern)

Confusion or tiredness after the seizure

No arm or leg weakness

It is the most common and last less than 2 minutes but can last as long as 15 minutes. It rarely happen more than once in a 24-hour period.

Complex febrile seizure

Symptoms of complex febrile seizure are:

loss of consciousness

shaking limbs or convulsions

temporary weakness usually in one arm or leg

It last for more than 15 minutes. Multiple seizures may happen over a 30-minute period. They may happen more than once during a 24-hour time frame as well.

When a simple or complex febrile seizure occurs repeatedly, it’s considered a recurrent febrile seizure. Symptoms of recurrent febrile seizures include the following:

Your child’s body temperature for the first seizure was lower.

The next seizure happens within a year of the initial seizure.

Your child has fevers frequently.

This type of seizure tends to occur in children under 15 months of age.

Complications of febrile seizures

Febrile seizures have been linked to an increased risk of epilepsy.

Many parents worry that if their child has one or more febrile seizures, they’ll develop epilepsy when they get older. Epilepsy is a condition where a person has repeated seizures without a fever.

While it’s true that children who have a history of febrile seizures have an increased risk of developing epilepsy, it should be stressed that the risk is still small.

It’s estimated that children with a history of simple febrile seizures have a 1 in 50 chance of developing epilepsy in later life.

Children with a history of complex febrile seizures have a 1 in 20 chance of developing epilepsy in later life.

People who have not had it have around a 1 to 2 in 100 chance of developing epilepsy.

Recurrence of febrile seizures

The most common complication is the possibility of more febrile seizures. The risk of recurrence is higher if:

Your child’s first seizure resulted from a low-grade fever.

The febrile seizure was the first sign of illness.

An immediate family member has a history of febrile seizures.

Your child was younger than 18 months at the time of the first febrile seizure.

Diagnosis of Febrile Seizures

A doctor’s evaluation

Sometimes a spinal tap, blood tests, or brain imaging

Because parents cannot tell whether children have a brain infection, children who have a fever and who have a seizure for the first time or are very sick should be taken to the emergency department immediately for evaluation.

Doctors examine the children and, depending on what they find, sometimes do tests to check for serious disorders that can cause seizures. These tests may include

A spinal tap (lumbar puncture) with analysis of fluid from around the spinal cord (cerebrospinal fluid) to check for meningitis and encephalitis

Blood tests to measure levels of sugar (glucose), calcium, magnesium, sodium, or other substances to check for metabolic disorders

Cultures of blood and urine to check for infections

Sometimes, imaging of the brain with magnetic resonance imaging (MRI) or computed tomography (CT) (if MRI is not available) may be done.

Electroencephalography (EEG), which is a test that checks for abnormal electrical activity in the brain, may be done for children who have certain symptoms or who have repeat seizures.

What is the medical treatment?

Should the child come to the hospital with persistent seizure activity (what is termed status epilepticus), the following interventions will be undertaken in the emergency department:

Emergency treatment is begun to make sure the airway is open and oxygen intake is adequate. A monitor called a pulse oximeter will be used to measure oxygen content in the bloodstream. If additional oxygen is needed, a mask may be used.

If necessary, the airway may be opened by means of a jaw thrust, chin lift, or a device known as an oral airway. In some cases, it may be necessary to breathe for the child, either with the use of a bag and mask or by placement of a tube in the trachea (windpipe).

Additional interventions may be needed as a physical examination is performed.

Placement of an IV line to obtain blood for testing and to administer medication to stop the seizure

A rapid bedside test for blood sugar (glucose) to determine if it is low and if glucose needs to be given through the IV (low blood sugar can cause seizures)

Measuring vital signs (temperature, pulse, respiratory rate, and blood pressure)

Treatment to lower body temperature, if fever is present

Benzodiazepines, such as lorazepam (Ativan) or diazepam (Valium). Sometimes more than one dose or more than one type of medication is needed.

The medications used often cause sedation. Combined with the natural drowsy state after a seizure, the child may remain sleepy for quite some time afterward.

What can I do at home to treat this symptom?

You shouldn’t try to treat a first-time febrile seizure at home. A first-time it needs immediate medical care to make sure that it isn’t another kind of seizure or that it isn’t happening because of a severe infection like meningitis or encephalitis (both of which can be life-threatening).

If your child has a history of febrile seizures, your healthcare provider can guide you on what to do to treat these at home. In general, you should do the following:

Stay calm. Seeing your child having a seizure can be very frightening, but it’s important for you to keep as calm as possible.

Track the time. Note how long your child’s seizure lasts. If the seizure lasts five minutes or more and isn’t slowing down or stopping, you should immediately call 911 (or your local emergency services number).

Slowly and gently set your child down on the floor. Don’t set a child on a table or bed (they could fall), and don’t try to hold them in your arms or hold them down (that increases the risk of an injury).

Place them in the rescue position. Lay your child on their left side with their lower arm stretched straight out, so it’s like a cushion for their head. This helps prevent choking from fluid (saliva or vomit) going into their lungs.

Don’t put anything in their mouth. That could result in an injury for your child or you.

Prevention

Most febrile seizures occur in the first few hours of a fever, during the initial rise in body temperature.

Giving your child medications

Giving your child infants’ or children’s acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) at the beginning of a fever may make your child more comfortable, but it won’t prevent a seizure.

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

Prescription prevention medications

Rarely, prescription anticonvulsant medications are used to try to prevent febrile seizures. However, these medications can have serious side effects that may outweigh any possible benefit.

Rectal diazepam (Diastat) or nasal midazolam might be prescribed to be used as needed for children who are prone to long febrile seizures.

These medications are typically used to treat seizures that last longer than five minutes or if the child has more than one seizure within 24 hours. They are not typically used to prevent febrile seizures.

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Ukrainian troops go offensive against invading Russian forces.

Ukrainian military footage supposedly shows Ukrainian troops attacking a Russian outpost established in a seized civilian residence.

According to the Ukrainian military, the incident occurred on a private property in the city of Sievierodonetsk in the territory of Luhansk Oblast in eastern Ukraine.

According to the 3rd Separate Special Forces Regiment, the attack destroyed the enemy stronghold and thwarts the Russian unit.

The 3rd Separate Special Forces Regiment stated on May 26: ” This video demonstrates that the Russian assassins will be punished regardless of how they attempt to conceal themselves.

Thanks to Ukrainian SSO (Special Operations Forces) troops, Russian occupants who attempted to fire a 120- mm mortar near Sievierodonetsk were eliminated.

The enemy established their position in the garden of a captured home.

This did not save them, however. According to verifiable reports, the attack by Ukrainian soldiers resulted in the death of the enemy.

In related developments, Ukrainian President Volodymyr Zelensky stated that the continuous assault could leave Donbas desolate and accused Russia of committing genocide in the region.

The city of Sievierodonetsk is currently being bombarded by Russian artillery, and three explosions were reported overnight in the city of Dnipro.

The death toll from shelling in the second- largest city in Ukraine, Kharkiv, on May 26 has risen to nine, including a baby.

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Putin won’t dictate peace terms in Ukraine says Germany Chancellor Scholz.

Blinken to China, we aren’t looking for conflict.

Many people have been feared dead and several houses were set ablaze in fresh violence that erupted in the Sakai and Kagadama areas of Bauchi Metropolis on Saturday.

The Nation gathered the violence erupted over the rivalry between youths of angular Taya and Taiwan took which extended to other parts of the area.

Security operatives, comprising tactical teams, Mobile Police Force, Rapid Response Squad(RRS), and Quick intervention Unit(QIU) of the Bauchi Police Command have swiftly responded to the distress calls by residents.

Details coming….

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Former US president Donald Trump react to $40 billion arm aide to Ukraine.

Former president of the United States (Donald Trumps), has said that if the United States Government could sent a whole $40billion to the war-torn country (Ukraine) without asking any question, the same United States Government can do whatever it takes to protect United States children at home, Newsmax reports.

According to Newsmax, Donald Trumps was reacting to the gunshots incident that happened at Texas school, where multiple children were shot dead.

He said that if the United States Government can send that huge amount of money to Ukraine in order to save lives there, it can also do likewise in the United States to keep the children safe from the constant gunshot encounters.This is not a matter of money. This is a matter of ‘will’. If United States has $40billion to send to Ukraine, we should be able to do whatever it takes to keep our children safe at home”, Newsmax reports.

This is not a matter of money. This is a matter of will.

If United States has $40billion to send to Ukraine, we should be able to do whatever it takes to keep our children safe at home, Newsmax reports.

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Atrial flutter is a type of heartbeat problem (arrhythmia) that usually causes a fast heart.

Definition

Atrial flutter is a type of heartbeat problem (arrhythmia) that usually causes a fast heart rate. This fast rate is caused by changes in the electrical system of your heart. Normally, the heart beats in a strong, steady rhythm.

In atrial flutter, a problem with the heart’s electrical system causes the two upper parts of the heart (the right atrium and the left atrium) to flutter, or beat very fast. Atrial flutter might be diagnosed using an electrocardiogram (EKG). An EKG translates the heart’s electrical activity into line tracings on paper.

This problem can be dangerous. If the heartbeat isn’t strong and steady, blood can collect, or pool, in the atria. And pooled blood is more likely to form clots. Clots can travel to the brain, block blood flow, and cause a stroke. Over time, atrial flutter can also lead to heart failure.

Types of atrial flutter

There are two types of atrial flutter: typical and atypical.

Typical atrial flutter is more common and usually responds better to treatment. The short-circuit is located in the right upper heart chamber around the heart’s tricuspid valve, which separates the atria and ventricle.

Atypical atrial flutter is caused by scarring on the left side of the heart from prior heart surgeries, previous procedures, or heart disease. The scarring can stretch and injure the upper heart chamber, leading to problems such as heart failure or valvular heart disease. During an RVR, the heart can beat 100-200 times a minute.

Both of these conditions can lead to a rapid ventricular response (RVR), causing the heart to beat 100-200 times a minute.

Epidemiology

Overall, the incidence of AFL in the United States is 88 per 100,000 person-years. 15% of supraventricular arrhythmias are AFL and usually coexist with AF. More than 80% of patients who undergo RFA of typical AFL will have AF within the following 5 years.

The incidence of AFL in men is more than twice that of women. Paroxysmal AFL can be seen in patients with no structural heart disease (SHD), whereas chronic AFL is frequently associated with underlying SHD, such as valvular disease or heart failure.

Acute AFL may happen secondary to acute disease process, such as pericarditis, pulmonary embolism, exacerbation of lung disease, following heart or lung surgery, or myocardial infarction.

ECG Waves

Pathophysiology of atrial flutter

Atrial flutter is a form of supraventricular tachycardia caused by a re-entry circuit within the right atrium. The length of the re-entry circuit corresponds to the size of the right atrium, resulting in a fairly predictable atrial rate of around 300 bpm (range 200-400)

Ventricular rate is determined by the AV conduction ratio (“degree of AV block”). The most common AV ratio is 2:1, resulting in a ventricular rate of ~150 bpm

Higher-degree blocks can occur — usually due to medications or underlying heart disease — resulting in lower rates of ventricular conduction, e.g. 3:1 or 4:1 block.

Atrial flutter with 1:1 conduction can occur due to sympathetic stimulation, or in the presence of an accessory pathway. The administration of AV-nodal blocking agents to a patient with Wolff-Parkinson-White syndrome can precipitate this

Atrial flutter with 1:1 conduction is associated with severe haemodynamic instability and progression to ventricular fibrillation

  1. The term “AV block” in the context of atrial flutter is something of a misnomer. AV block is a physiological response to rapid atrial rates and implies a normally functioning AV node.

Causes of atrial flutter

Doctors don’t always know. In some people, no root cause is ever found. But atrial flutter can result from:

Diseases or other problems in the heart

A disease elsewhere in your body that affects the heart

Substances that change the way your heart transmits electrical impulses

Heart diseases or problems that can cause atrial flutter include:

Ischemia: Lower blood flow to the heart due to coronary heart disease, hardening of the arteries, or a blood clot

Hypertension: High blood pressure

Cardiomyopathy: Disease of the heart muscle

Abnormal heart valves: Especially the mitral valve

Hypertrophy: An enlarged chamber of the heart

Open-heart surgery

Diseases elsewhere in your body that affect the heart include:

Hyperthyroidism: An overactive thyroid gland

Pulmonary embolism: A blood clot in a blood vessel in the lungs

Chronic obstructive pulmonary disease(COPD): A condition that lowers the amount of oxygen in your blood

Substances that may contribute to atrial flutter include:

Alcohol (wine, beer, or hard liquor)

Stimulants like cocaine, amphetamines, diet pills, cold medicines, and even caffeine

Symptoms of atrial flutter

The electrical signal that causes Atrial Flutter (AFL) circulates in an organized, predictable pattern. This means that people with AFL usually continue to have a steady heartbeat, even though it is faster than normal. It is possible that people with AFL may feel no symptoms at all. Others do experience symptoms, which may include:

Feeling tired and not have enough energy

Heart palpitations (feeling like your heart is racing, pounding, or fluttering)

Fast, steady pulse

Shortness of breath

Trouble with everyday exercises or activities

Pain, pressure, tightness, or discomfort in your chest

Dizziness, feeling lightheaded, or fainting

Risk factors

There are many risk factors for this type of flutter. The following is a list of some of the more common risk factors:

High blood pressure

Obesity

Diabetes

Heart failure

Ischemic heart disease and/or a previous heart attack

Serious acute illnesses

Heavy alcohol intake and/or binge drinking

Advanced age

Hyperthyroidism

Chronic lung disease

Recent surgery

Congenital heart disease

Complication

Heart failure; acute atrial flutter can impair cardiac function, lower blood pressure, and initiate myocardial ischaemia.

Thromboembolism (transient ischaemic attacks and stroke). Systemic embolism is less commonly associated with atrial flutter than with atrial fibrillation, but is still a significant risk. One study showed the annual incidence of ischaemic stroke to be 1.38%.

Tachycardia-induced cardiomyopathy.

Persistent untreated atrial flutter can become chronic atrial fibrillation.

Diagnosis

Doctors start to consider AFL if your heartbeat at rest goes above 120 bpm and if your ECG shows signs of atrial flutter.

Your family history may be important when your doctor is trying to diagnose AFL. A history of heart disease, anxiety, and high blood pressure can all affect your risk.

Your primary care doctor can make a preliminary diagnosis of AFL with an ECG. You may also be referred to a cardiologist for further testing.

Several tests are used to diagnose and confirm AFL:

Echocardiograms use ultrasound to show images of the heart. They can also measure the flow of blood through your heart and blood vessels and see if the heart has shown any signs of getting weak due to beating fast (tachycardia induced cardiomyopathy) or dilation of the atria (chambers of the heart where AFL originates).

Electrocardiograms record the electrical patterns of your heart.

Holter monitors allows a doctor to monitor the heart’s rhythm for at least a 24-hour period.

Electrophysiology (EP) studies are a more invasive way to record heart rhythm. A catheter is threaded from the veins of your groin into your heart. Electrodes are then inserted to monitor heart rhythm in different areas.

Atrial flutter treatment

The goal of treatment is to control the heart rate, prevent stroke, and maintain a normal heart rhythm.

To control heart rate, you may be given a prescription medicine that can slow down the heart rate.

To prevent stroke, your doctor may prescribe a blood thinner (anticoagulant) to prevent a blood clot in the heart. This clot can break free and travel to the brain

Rhythm control involves either medicine or a procedure.

Antiarrhythmics. These medicines can be taken as needed to stop an episode. Or you can take them every day to prevent future atrial flutter.

Electrical cardioversion. This is an outpatient procedure where large electrode patches are placed on your chest and back. Energy is sent through these patches as a shock that is synchronized with your heartbeat. In many cases, this restores normal rhythm. This is typically done with IV sedation so that the shock is not felt. Sometimes your doctor may start you on an antiarrhythmic medicine around the time of the cardioversion. This helps maintain a normal rhythm for a longer period of time after cardioversion. Or it may help the cardioversion to be a success.

Cardiac ablation. This is a non-surgical, catheter-based procedure that can often cure atrial flutter. It involves threading wires through a vein in your leg to the heart. Either heat energy or cold energy is used to destroy the abnormal circuit.

The success rate of each treatment varies. Discuss this with your doctor.

Prevention

Prevention of atrial flutter focuses on controlling or preventing the risk factors.

Stay at a healthy weight.

Drink alcohol only in moderation, if at all.

Stop tobacco use.

Control high blood pressure and diabetes.

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