Abstract
Objective: To evaluate the impact of music on the level of anxiety in infants between 0-3 years during an ear examination. Study design: A randomized controlled trial between May 2012 and June 2013 at the Emek Medical Center, Afula, Israel. The study included 97 infants aged 0 to 3 years who were referred to the ear nose and throat (ENT) clinic. Infants in the interventional group listened to music during a standard ear examination, while infants in the non-interventional group did not. Following the examination, the investigator filled out a FLACC (Face, Legs, Activity, Cry, Consolability) scale questionnaire aimed at assessing the anxiety level of the infant during the examination. Results: The anxiety levels in the interventional group were statistically significantly lower than those in the non-interventional group. According to the FLACC values a statistically significant correlation was found between listening to music during the ear examination and low levels of anxiety in the girls sub-group (p<0.001); in the sub-group of infants aged 1-2 years only (p<0.001); and only in the group of children whose parents have attained higher education. Conclusions: Music was shown to reduce levels of anxiety in infants aged 0-3 years during an ear examination by an ENT physician. The sub-groups in which music was most effective were girls, infants aged 1-2 years, Hebrew speaking families and parents with a higher education. No correlation was found between the parental and child anxiety.
Highlights
We present a case of lamotrigine induced hypersensitivity reaction which was way more severe than the regular drug induced skin rash
Recent studies have suggested that the two entities are part of a spectrum based on the extent of end organ effect, with Anticonvulsant Hypersensitivity Syndrome (AHS) considered a more severe syndrome associated with hepatitis or acute renal failure
The case of Patient X is important for medical literature and physicians in general as we present the many possible side effects and hypersensitivity reactions that a medication may cause
Summary
We present a case of lamotrigine induced hypersensitivity reaction which was way more severe than the regular drug induced skin rash. The differential narrowed to a drug reaction, in regards to the lamotrigine Given her constellation of “allergic” type symptoms, and recent use of introduction of lamotrigine, the most logical diagnosis appeared to be related to side effect of lamotrigine including early stages of Steven Johnson’s/TEN, anticonvulsant hypersensitivity, and lastly, coagulopathy abnormalities with positive anticardiolipin antibody. All her symptoms resolved rapidly after discontinuation of lamotrigine with improvement of all her lab findings
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