Características clínicas del estado epiléptico en niños de un hospital de tercer nivel de Lima / Clinical characteristics of status epilepticus in children in a third level hospital of Lima

RESUMEN El estado epiléptico (EE) en niños exhibe altos niveles de morbi-mortalidad y ha sido poco estudiado en el Perú. Objetivo: Describir la frecuencia y características clínicas de niños con estado epiléptico, atendidos en el Hospital Cayetano Heredia de Lima. Material y métodos: Estudio retrospectivo y observacional, tipo serie de casos de niños menores de 14 años con diagnóstico de estado epiléptico, atendidos entre enero y diciembre de 2021. Resultados: Se registró EE en un 28,8% de todos los niños atendidos por crisis epilépticas durante el año 2021. Se incluyeron 23 niños que presentaron 46 EE, varones (73,9%), con una mediana de la edad de 2 años, diagnóstico subyacente de epilepsia o malformación cerebral (21,7%), atendidos en emergencia pediátrica (91%). El tipo semiológico predominante fue el EE motor generalizado (52,2%), con etiología sintomática remota (87%) y EEG registrado en un 63% de los casos, predominantemente de tipo normal (75,9%). La mediana de duración fue de 22 minutos, de resolución total, 7 minutos y resolución parcial, 2 minutos. Se empleó midazolam (78%) como primera línea de tratamiento y fenitoína (85%), como segunda línea. Conclusiones: El EE en niños fue una emergencia prevalente durante el año 2021. La mayoría fueron varones, cuya etiología predominante fue sintomática remota y el tipo semiológico más común fue el motor generalizado. Los niños fueron atendidos de acuerdo con las guías internacionales de manejo. Se insiste en la necesidad de un sistemático afronte de vigilancia epidemiológica.

SUMMARY Status Epilepticus (SE) in children exhibits high levels of morbidity and mortality and has been poorly studied in Perú. Objective: To describe the frequency and clinical characteristics of children with Status Epilepticus treated at Cayetano Heredia Hospital in Lima. Material and Methods: Retrospective and observational study, case series type, in children under 14 years of age, with Status Epilepticus treated between January and December of 2021. Results: SE was recorded in 28.8% of children with epileptic seizures seen during 2021. Twenty-three children presenting 46 SEs were included. The median age was 2 years, the majority (73,9%) being males, with diagnosis of epilepsy or brain malformation (21.7%) and treated in the pediatric emergency (91%). The predominant semiological pattern was of generalized motor type (52.2%), with remote symptomatic etiology (73.9%), and EEG recorded in a 63% of all cases, mainly reported as normal (75,9%). The median duration was 22 minutes of total resolution, 7 minutes, and of partial resolution, 2 minutes. Midazolam was used as the first line of treatment (78%), and phenytoin as the second line (85%). Conclusions: SE was a frequent condition observed in children throughout the year 2021. Most affected children were male, the predominant etiology was remote symptomatic, and the most common semiological type was the generalized motor. The children were treated according to international management guidelines. Asystematic epidemiological surveillance approach is highly encouraged.

Electrical Power Diversification: An Approach Based on the Method of Maximum Entropy in the Mean.

Electrical energy is generated in different ways, each located at some specific geographical area, and with different impact on the environment. Different sectors require heterogeneous rates of energy delivery, due to economic requirements. An important problem to solve is to determine how much energy must be sent from each supplier to satisfy each demand. Besides, the energy distribution process may have to satisfy ecological, technological, or economic cost constraints.

Synthesis of exo-Imidazolidin-2-one Dienes, Their Isomerization, and Selectivity in Diels-Alder Cycloadditions.

An efficient and alternative synthesis of exo-imidazolidin-2-one dienes is described. A condensation reaction was carried out with bis-imino derivatives, diacetyl, and triphosgene, affording symmetrically N, N-disubstituted dienes. The use of alkyl methyl α-diketones led to the formation of nonsymmetrical dienes, which underwent isomerization to provide more stable inner-outer-ring dienes under Lewis acid conditions. Evaluation was made of the reactivity as well as regio- and stereoselectivity of these dienes in Diels-Alder reactions. They proved to be highly reactive and selective. DFT calculations of the transition states accounted for their behavior.

Condensation of Diacetyl with Alkyl Amines: Synthesis and Reactivity of p-Iminobenzoquinones and p-Diiminobenzoquinones.

Condensation reactions between diacetyl and α-branched primary alkylamines under mild and neutral conditions provided a mixture of 2,5-dimethylbenzoquinone(alkylimines), 2,5-dimethylbenzoquinone(bis-alkyldiimines), and N,N'-dialkyl-2,5-dimethylbenzene-1,4-diamines, which were efficiently separated as pure products by column chromatography. Both 2,5-dimethylbenzoquinone(alkylimines) and 2,5-dimethylbenzoquinone(bis-alkyldiimines) underwent an interchange of the alkylimino group when treated with anilines, followed by reductive aromatization, to provide diarylamines and 1,4-dianilinobenzenes, respectively. Evaluation was also made of the reactivity and selectivity of these compounds in the presence of anilines, thiophenols and alkylhalides.

Palladium-catalyzed synthesis of natural and unnatural 2-, 5-, and 7-oxygenated carbazole alkaloids from N-arylcyclohexane enaminones.

A palladium-catalyzed synthesis of the carbazole framework is described, including the preparation of 2-, 5-, and 7-oxygenated natural and unnatural carbazole alkaloids. A series of N-arylcyclohexane enaminones, generated by condensation of cyclohexane-1,3-dione with diverse anilines, were aromatized by a Pd(0)-catalyzed thermal treatment to afford the corresponding diarylamines. The latter were submitted to a Pd(II)-catalyzed cyclization and methylation processes to provide the desired carbazoles, including clausine V. Following an inverse strategy, a new and short total synthesis of glycoborine is also reported.

Regioselective synthesis of 1,2-dihydroquinolines by a solvent-free MgBr2-catalyzed multicomponent reaction.

A highly efficient and regioselective synthesis of 1,2-dihydroquinolines via a multicomponent reaction between an aniline and two ketones is described. This reaction was catalyzed by magnesium bromide and carried out under solvent-free conditions. When the reaction was performed by using 3-substituted anilines and nonsymmetrically substituted ketones, principally a single product was found among the four expected regioisomers. A variety of anilines and ketones, including cyclic ketones, were evaluated providing a series of 1,2-dihydroquinolines with diverse substitution patterns. A study of the mechanism is discussed. There is evidence of the in situ formation of the imine as a result of the reaction between the aniline and one of the ketones, before annulation to the heterocyclic ring.