Selección del tratamiento farmacológico en el estado de mal epiléptico en niños

The status epilepticus (SE) is characterized by a series of crises which occur without recovery of consciousness or a single seizure lasting more than 30 minutes and can damage the central nervous system and systemic. The duration and frequency of attacks are directly related to patient prognosis. Whether seizures occur often and are longer, increase the risk of neurological and systemic complications. Child population has a higher frequency of seizures and it is associated with a lower threshold of immature brain to trigger these episodes. Aim: To determine the safest drugs prescribed for children in SE, their doses and schedules. A bibliographic survey was performed in electronic databases. Methods: The scientific health descriptors used for search was: “status epilecticus” and “anticonvulsivants” and “child”. Results: This strategy identified 396 manuscripts, of whom four were considered eligible for the study, after the assessment by floating reading and criteria. Of these, two were randomized trials and two descriptive. The studies address the use of oral midazolam, rectal diazepam and intravenous lorazepam. Conclusions: All investigated drugs were effective in treat in status epilepticus. Lorazepam is highlight, since it has fewer secondary effects and, as an alternative to the intravenous, oral midazolam. However, there is a need for further studies to demonstrate the efficacy and safety in the use of drugs in children.

A substituição do meio TCM pelo meio BARC, suplementado com SFB, BSA ou PVA, para maturação de oócitos bovinos in vitro, não incrementa a subsequente produção de blastocistos

This study was carried out to assess the influence of bovine embryo culture medium Beltsville Agriculture Research Center (BARC), supplemented with FCS, BSA or PVA, on the in vitro oocyte maturation, evidenced by cleavage rate and blastocysts production at different developmental stages. Three experiments were performed, as follows: exp.1: addition of FCS to BARC medium at concentrations of 0, 5 and 10%; exp. 2: addition of BSA to BARC medium at concentrations of 0, 4 and 8 mg/ml; exp. 3: addition of PVA to BARC medium at concentrations of 0, 0.5 and 1.0 mg/ml. TCM 199 supplemented with bicarbonate, pyruvate, gentamicin sulfate, FSH, LH and FCS was used as control group. Oocytes obtained from cow ovaries at slaughterhouse were selected in PBS, and then matured in BARC medium supplemented with FSH, LH and gentamicin sulfate, according to the experimental design. Percoll gradient was used for sperm selection and TALP medium for IVF. In vitro embryo culture was in SOF-m medium; a humidified atmosphere with 5% CO2, in air, at 38.7oC was used for all steps. The number of oocytes reaching blastocyst, expanded blastocyst, and hatched blastocyt stages was recorded, respectively at 72 and 168 h post-insemination. ANOVA and Bonferroni t test were used to determine differences among groups. Differences of P<0.05 were taken as significant. Higher percentage (P<0.05) of cleaved oocytes was observed in group TCM + FCS than for the other groups matured in BARC supplemented with FCS or BSA, regardless the concentration used. However, the cleavage rate was similar between groups BARC plus PVA with 1 mg/ml (85.7%) and TCM + FCS (90.8%). Significant difference was found among groups for the production of blastocysts, with the control group yielding a higher number of blastocysts (results ranging from 47.4 to 51.4%, in comparison with groups using BARC + FCS (4.1 to 19.7%), BSA (1.4 to 5.6%) and PVA (5.7 to 10.6%). In conclusion, BARC medium supplemented with different macromolecules did not promote a beneficial effect on in vitro oocyte maturation, resulting in lower rate of cleavage and blastocyst production when compared with TCM + FCS medium.