RESUMO
INTRODUCTION: The improvement in understanding the process that determines the death of an individual and his or her evolution toward brain death allows organization and planning of health policies, optimization of clinical activity and management of organ and tissue procurement processes for transplantation. OBJECTIVE: This study sought to analyze the epidemiological and evolutionary profile of patients with spontaneous subarachnoid hemorrhage (SAH) with a Glasgow Coma Scale score (GCS) ≤8 who entered follow-up in the Neurocritical Patient Monitoring Program (SPN) of Instituto Nacional de Donación y Trasplante (INDT), Uruguay. MATERIALS AND METHODS: SPN, a monitoring and follow-up program for neurocritical patients with GCS ≤ 8, prospectively collected data from 5 public and private intensive care units. A total of 160 patients with SAH with GCS ≤8 in 10 years were identified and analyzed using a 2-step nested model. Firstly, independent risk factors for mortality were identified, tested in different combinations, and one of them was selected using the best correct classification rate. In the second step, risk factors for evolution to brain death were investigated. RESULTS: The mortality of patients with SAH with GCS ≤8 was 68%. Mortality for GCS 3 was 82%, significantly higher than for other values on the scale (P = .0025). Female sex (P = .011) and arterial hypertension (P = .017) were associated with higher mortality. There was no significant association between mortality and age, Acute Physiology and Chronic Health Evaluation score, and Simplified Acute Physiologic Score II. Administration of analgesia and/or sedation was a protective factor (P < .0001). Of the patients who died, 50% were in brain death. We did not find clinical elements capable of identifying an increased probability of developing brain death. CONCLUSIONS: Based on epidemiological data, models capable of improving the understanding of the complex process of death and particularly brain death can be generated. More studies are needed to explore the differential evolutionary behavior of critical neurological illness.
Assuntos
Morte Encefálica/patologia , Escala de Coma de Glasgow/estatística & dados numéricos , Hemorragia Subaracnóidea/mortalidade , Adulto , Morte Encefálica/diagnóstico , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos Prospectivos , Fatores de Risco , Hemorragia Subaracnóidea/patologia , Obtenção de Tecidos e Órgãos , UruguaiRESUMO
The aim of this study was to analyse the reproductive biology of Echinopsis terscheckii, a species endemic to northwest Argentina that has nocturnal flowers. We expected that this species had a generalised pollination system, with moths and diurnal visitors as the primary pollinators. To test this, we studied the floral biology, breeding system and floral visitors of this species and the effectiveness of nocturnal and diurnal visitors. Floral biology was defined based on floral morphology, floral cycle and nectar production of the flowers. The breeding system and relative contributions of diurnal and nocturnal visitors to fruit and seed set were analysed through field experiments. E. terscheckii flowers opened at sunset and closed the following day. The peak of nectar production occurred at midnight. Flowers were determined to be self-incompatible. Moths, bees and birds were identified as floral visitors. Moths were the most frequent visitors at night, whereas bees were the most frequent visitors during the day. Fruit production by diurnal pollinators was less than that by nocturnal pollinators; among all floral visitors, moths were the most effective pollinators. We have demonstrated for the first time that moths are the primary pollinators of columnar cacti of the genus Echinopsis. Our results suggest that moths might be important pollinators of columnar cactus species with nocturnal flowers in the extra-tropical deserts of South America.
Assuntos
Cactaceae/fisiologia , Ritmo Circadiano , Flores/fisiologia , Pólen/fisiologia , Animais , Argentina , Abelhas , Cruzamento , Ritmo Circadiano/fisiologia , Flores/anatomia & histologia , Frutas/fisiologia , Mariposas , Néctar de Plantas , Polinização , Reprodução , Sementes , Fatores de TempoRESUMO
AIMS: To study the effects of intravitreal bevacizumab (Avastin) on retinal neovascularization (RN) in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective study of patients with RN due to PDR who were treated with at least one intravitreal injection of 1.25 or 2.5 mg of bevacizumab. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. RESULTS: Forty-four eyes of 33 patients with PDR and a mean age of 57.2-years (range: 23-82 years) participated in the study. Thirty-three eyes (75%) had previous panretinal photocoagulation (PRP). Twenty-seven eyes (61.4%) showed total regression of RN on fundus examination with absence of fluorescein leakage, 15 eyes (34.1%) demonstrated partial regression of RN on fundus examination and FA. Follow-up had a mean of 28.4 weeks (range from 24 to 40 weeks). BCVA and OCT demonstrated improvement (P<0.0001). Three eyes without previous PRP ('naive' eyes) and with vitreous haemorrhage have avoided vitreo-retinal surgery. One eye (2.2%) had PDR progression to tractional retinal detachment requiring vitrectomy, and one eye (2.2%) had vitreous haemorrhage with increased intraocular pressure (ghost cell glaucoma). No systemic adverse events were observed. CONCLUSIONS: Intravitreal bevacizumab resulted in marked regression of RN in patients with PDR and previous PRP, and rapid resolution of vitreous haemorrhage in three naive eyes. Six-months results of intravitreal bevacizumab at doses of 1.25 or 2.5 mg in patients with PDR do not reveal any safety concerns.
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Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Retinopatia Diabética/tratamento farmacológico , Neovascularização Retiniana/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados , Bevacizumab , Feminino , Angiofluoresceinografia , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To compare the prevalence of age-related maculopathy (ARM) in a sample of diabetic patients with the general population. METHODS: Binocular indirect ophthalmoscopy, biomicroscopy, and fluorescein angiography. Retrospective prevalence study; descriptive-observational case-control type. Two different groups were analyzed from a sample of 1000 consecutive files of diabetic patients: 1) 65 to 74 years old (n = 263) and 2) 75 years and older (n = 199). Prevalence was compared to that of the general population in a control group and the following epidemiologic studies: Beaver Dam Eye Study, Framingham Eye Study, Blue Mountains Study, and Rotterdam Eye Study. RESULTS: In diabetic patients aged 75 or older, prevalence of ARM was as follows: early lesions 2.51% (5/199), late lesions (ARMD) 2.51% (5/199). In comparison, the risk in patients 75 or older is as follows: control group (ARMD): OR 4.79, 95% CI 1.778-12.033, p (Fisher) 0.0005; Beaver Dam Eye Study (ARMD): OR 2.93, 95% CI 1.152-7.450, p (Fisher): 0; Blue Mountains Eye Study (ARMD): OR 3.06, 95% CI 1.208-7.754, p (Fisher): 0; Framingham Eye Study (ARM): OR 6.73, 95% CI 3.041-14.880, p (Fisher): 0; Rotterdam Eye Study: p (Fisher) 0.133. CONCLUSIONS: 1) A lower prevalence of ARM was found in the sample of diabetic patients aged 75 or older than in the general population (with the exception of the Rotterdam study). 2) Prevalence of ARM was even lower in diabetic patients presenting diabetic retinopathy, whether or not they had been treated with photocoagulation. 3) In diabetic patients, the exudative form was more frequent than the atrophic form, in an inverse ratio to that of the general population.
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Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Degeneração Macular/epidemiologia , Idoso , Argentina/epidemiologia , Austrália/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Angiofluoresceinografia , Humanos , Fotocoagulação a Laser , Degeneração Macular/diagnóstico , Degeneração Macular/cirurgia , Masculino , Microscopia Acústica , Países Baixos/epidemiologia , Oftalmoscopia , Prevalência , Estudos Retrospectivos , Reino Unido/epidemiologia , Estados Unidos/epidemiologiaRESUMO
AIMS: The aim of this study was to report the development or progression of tractional retinal detachment (TRD) after the injection of intravitreal bevacizumab (Avastin) used as an adjuvant to vitrectomy for the management of severe proliferative diabetic retinopathy (PDR). METHODS: The clinical charts of patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 mg bevacizumab before vitrectomy for the management of PDR were reviewed. RESULTS: Eleven eyes (patients) out of 211 intravitreal injections (5.2%) that developed or had progression of TRD were identified. All eyes had PDR refractory to panretinal photocoagulation (PRP). Nine patients had type 1 diabetes mellitus (DM), and two patients had type 2 DM. Patients had a mean age of 39.5 years (range 22-62 years). In the current study, all patients used insulin administration and had poor glycaemic control (mean HbA(1c) 10.6%). Time from injection to TRD was a mean of 13 days (range 3-31 days). Mean best correct visual acuity (BCVA) at TRD development or progression was logarithm of the minimal angle of resolution (LogMAR) 2.2 (range 1.0-2.6) (mean Snellen equivalent hand motions; range 20/200 to light perception), a statistically significant worsening compared with baseline BCVA (p<0.0001). Eight eyes underwent vitrectomy and three patients refused or were unable to undergo surgery. The final mean BCVA after surgery was LogMAR 0.9 (range 0.2-2.0) (mean Snellen equivalent 20/160; range 20/32 to counting fingers), a statistically significant improvement compared with TRD BCVA (p = 0.002). CONCLUSIONS: TRD may occur or progress shortly following administration of intravitreal bevacizumab in patients with severe PDR.
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Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Retinopatia Diabética/tratamento farmacológico , Descolamento Retiniano/induzido quimicamente , Adulto , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Bevacizumab , Quimioterapia Adjuvante/efeitos adversos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/cirurgia , Progressão da Doença , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Vitrectomia , Corpo VítreoRESUMO
Many columnar cacti are bat pollinated. It has been suggested that this kind of pollination would be more important in tropical than in temperate regions where flowers are open only one night. Thrichocereus pasacana produces big and resistant white flowers. We analyzed flower characteristics, floral cycle, stigmatic receptivity, nectar production, pollen presence and floral visitors in a T. pasacana population at National Park Los Cardones (Salta, Argentina) in November 1997. Flower features were constant between individuals of the population. Flowers start opening at evening and anthesis time is from 18 to 40 hs. The estigma was receptive throughout the floral cycle. Anther dehiscence occurs with flower opening. Nectar production was highest between 18 to 24 hs. Although T. pasacana are open during the night, floral visitors are diurnal. The most frequent was Xylocopa sp. In the study area, nectarivorous bats were not detected. The morphological features of T. pasacana flowers were similar but bigger compared to other columnar cacti. Anthesis time was also longer while nectar production was lower. T. pasacana pollination at National Park Los Cardones is done by bees.
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Fenômenos Fisiológicos Vegetais , Pólen/fisiologia , Animais , Argentina , Abelhas , Plantas/anatomia & histologia , Fatores de TempoRESUMO
The tree Caesalpinia paraguariensis grows in the Chaco region, Argentina. Fruits are indehiscent with many seeds. This species is an important source of wood and the fruits are consumed by cattle in Salta province. We studied seed germination under chemical, mechanical and biological scarification. Seeds from controls (without scarification) and those with biological scarification had a smaller (and similar) germination rate. The non-germinated seeds from biological treatments were mechanically scarified and their germination rate was similar to others under the mechanical treatment. Passage by digestive tracts would not enhance germination because viable seeds are still dormant due to their hard coats.