Estado epiléptico en pacientes pediátricos: consecuencias evolutivas y actualización epidemiológica / Epileptic status in paediatric patients: its developmental consequences and an epidemiological update

INTRODUCCIÓN: El estado epiléptico representa la emergencia neurológica más frecuente en pediatría. Las convulsiones febriles prolongadas representan la etiología más frecuente. Nuestro objetivo es actualizar su epidemiología y analizar sus consecuencias evolutivas. PACIENTES Y MÉTODOS: Estudio observacional analítico de cohortes retrospectivas de niños atendidos en urgencias con estado epiléptico entre enero de 2014 y diciembre de 2018. Se recogieron las variables demográficas, los antecedentes personales, las características clínicas, las pruebas complementarias y la etiología de los estados epilépticos seguidos en nuestro hospital. Se analizaron las consecuencias evolutivas en cuanto a neurodesarrollo y epilepsia ulterior. RESULTADOS: De un total de 525.000 urgencias atendidas durante el estudio, los casos de estado epiléptico fueron 79 en 68 pacientes (16 casos/100.000 niños/año). La etiología sintomática fue la más frecuente (35,4%). El 20,6% de los pacientes presentaba antecedente de prematuridad; el 30,8%, un déficit del neurodesarrollo previo, más frecuente en caso de etiología sintomática, y el 44% estaba diagnosticado de epilepsia. La duración mediana de las crisis fue de 50 minutos. En siete pacientes se identificó un desencadenante cerebral agudo. El déficit del neurodesarrollo ulterior achacable al estado epiléptico fue del 9,1%, y se relacionó con la etiología sintomática o antecedentes de prematuridad. El desarrollo de epilepsia ocurrió en el 10,7%. CONCLUSIONES: La alteración del neurodesarrollo achacable al estado epiléptico afecta a uno de cada 11 casos. La prematuridad fue un factor de riesgo por sí misma. La epilepsia posterior a un estado epiléptico se desarrolló en uno de cada 10 casos

INTRODUCTION: Epileptic status represents the most frequent neurological emergency in pediatrics. Prolonged febrile seizures represent the most common etiology. Our objective is to update its epidemiology and analyze its evolutionary consequences. PATIENTS AND METHODS: Observational analytical study of retrospective cohorts of children seen in the emergency department with epileptic status between January-2014 and December-2018. Demographic variables, personal history, clinical characteristics, complementary tests and the etiology of the epileptic status followed in our hospital were collected. The evolutionary consequences in terms of neurodevelopment and subsequent epilepsy were analyzed. RESULTS: Of a total of 525,000 emergencies attended during the study, epileptic status cases were 79 in 68 patients (16 cases/100,000 children/year). The symptomatic etiology was the most frequent (35.4%). 20.6% of the patients had a history of prematurity, 30.8% had a deficit of previous neurodevelopment, this being more frequent in case of symptomatic etiology, and 44% were diagnosed with epilepsy. The median duration of seizures was 50 minutes. An acute brain trigger was identified in seven patients. The subsequent neurodevelopmental deficit attributable to epileptic status was 9.1% of patients related to symptomatic etiology and/or a history of prematurity. The development of epilepsy occurred in 10.7%. CONCLUSIONS: The neurodevelopmental disorder attributable to epileptic status affects one in 11 cases. Prematurity was a risk factor per se. Post-epileptic status epilepsy developed in one in 10 cases

Diffusion-barrier-free porous carbon monoliths as a new form of activated carbon.

For the practical use of activated carbon (AC) as an adsorbent of CH(4) , tightly packed monoliths with high microporosity are supposed to be one of the best morphologies in terms of storage capacity per apparent volume of the adsorbent material. However, monolith-type ACs may cause diffusion obstacles in adsorption processes owing to their necked pore structures among the densely packed particles, which result in a lower adsorption performance than that of the corresponding powder ACs. To clarify the relationship between the pore structure and CH4 adsorptivity, microscopic observations, structural studies on the nanoscale, and conductivity measurements (thermal and electrical) were performed on recently developed binder-free, self-sinterable ACs in both powder and monolithic forms. The monolith samples exhibited higher surface areas and electrical conductivities than the corresponding powder samples. Supercritical CH4 adsorption isotherms were measured for each powder and monolith sample at up to 7 MPa at 263, 273, and 303 K to elucidate their isosteric heats of adsorption and adsorption rate constants, which revealed that the morphologies of the monolith samples did not cause serious drawbacks for the adsorption and desorption processes. This will further facilitate the availability of diffusion-barrier-free microporous carbon monoliths as practical CH4 storage adsorbents.

High-surface-area carbon molecular sieves for selective CO(2) adsorption.

A series of carbon molecular sieves (CMSs) has been prepared, either as powders or monoliths, from petroleum pitch using potassium hydroxide as the activating agent. The CMS monoliths are prepared without the use of a binder based on the self-sintering ability of the mesophase pitch. Characterization results show that these CMSs combine a large apparent surface area (up to ca. 3100 m(2) g(-1)) together with a well-developed narrow microporosity (V(n) up to ca. 1.4 cm(3) g(-1)). The materials exhibit high adsorption capacities for CO(2) at 1 bar and 273 K (up to ca. 380 mg CO(2) g sorbent(-1)). To our knowledge, this is the best result obtained for CO(2) adsorption using carbon-based materials. Furthermore, although the CO(2) adsorption capacity for activated carbons has usually been considered lower than that of zeolites, the reported values exceed the total amount adsorbed on traditional 13X and 5A zeolites (ca. 230 mg and 180 mg CO(2) g sorbent(-1), respectively), under identical experimental conditions. Additionally, the narrow pore openings found in the CMS samples (ca. 0.4 nm) allows for the selective adsorption of CO(2) from molecules of similar dimensions (e.g., CH(4) and N(2)).