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1.
Semina cienc. biol. saude ; 42(2): 201-220, jun./dez. 2021. Tab, Ilus
Article in English | LILACS | ID: biblio-1293130

ABSTRACT

Studies of the diversity and natural history of amphibians are extremely important and contribute with the knowledge about the patterns of geographical distribution and biology of the species, outlining the factors that influence this distribution, and contributing to the development of conservation projects of them. This study aimed to identify the richness, abundance, spatial and temporal distribution of amphibians in the Bauru region, state of São Paulo, Brazil, and compare the species composition with others regions in the São Paulo state located in the Cerrado and Atlantic Forest. Eight locations were sampled between the years 2009 and 2012. Thirty-seven amphibian species were recorded, which represents 15.61% of the species in the state of São Paulo. In comparison to other regions of the state, Bauru resemble with the north-western region of the state and with the Assis Ecological Station in species composition. The community of amphibians in the studied region is regulated to morphoclimatic conditions, environmental heterogeneity and the conservation of natural resources, which directly reflect on the composition, abundance and species' spatial and temporal distribution of the amphibians in this region. The richness of amphibians of the Bauru region is significant for the state of São Paulo and contributes with the maintenance of environments with conditions for the occurrence of Proceratophrys moratoi, which is considered in threat of extinction. This study contributed with the filling gap on the amphibian knowledge of the state of São Paulo.


Estudos sobre diversidade e história natural de anfíbios são de extrema importância para o conhecimento sobre os padrões de distribuição geográfica e biologia das espécies delineando os fatores que influenciam nessa distribuição, o que contribui para a elaboração de projetos de conservação mais realistas e efetivos. Este estudo visou identificar a riqueza, abundância, distribuição espacial e temporal das espécies de anfíbios da região de Bauru, estado de São Paulo, Brasil, e comparar a composição de espécies com outras regiões de Cerrado e Mata Atlântica do estado de São Paulo. Oito localidades foram amostradas entre os anos de 2009 e 2012. Foram registradas 37 espécies de anfíbios, as quais representam 15,61% das espécies do estado de São Paulo. Em comparação com outras regiões do estado, Bauru se assemelha à Região Noroeste do estado e à Estação Ecológica de Assis na composição de espécies. A comunidade de anfíbios da região estudada é regulada pelas condições morfoclimáticas, heterogeneidade ambiental e estado de conservação dos recursos naturais, que refletem diretamente na composição, na abundância e nos padrões de distribuição espacial e temporal das espécies de anfíbios presentes na região. A riqueza de anfíbios da região de Bauru é significativa para o estado de São Paulo e contribui com a manutenção de ambientes com condições para a ocorrência de Proceratophrys moratoi, considerada em risco de extinção. Este estudo contribui com o preenchimento de lacunas no conhecimento de anfíbios do estado de São Paulo.


Subject(s)
Animals , Anura , Natural History , Amphibians
2.
Rev. Eugenio Espejo ; 15(2): 98-114, 20210516.
Article in Spanish | LILACS | ID: biblio-1252498

ABSTRACT

SARS CoV-2 se transmite principalmente a través de la vía aérea. La media del tiempo desde la exposición hasta la presentación de la sintomatología es de 5 días. Los pacientes infectados pueden permanecer asintomáticos o tener un amplio espectro de manifestaciones como: fiebre, tos seca y malestar general. Aproximadamente, el 20% de pacientes con la COVID-19 requiere hospitalización (10% en área general, el 5% requiere cuidados intermedios y el 5% restante ingresa a cuidados intensivos debido a su estado de gravedad). Los exámenes de laboratorio y radiológicos muestran anomalías de común presentación, pero inespecíficas. El diagnóstico es a través de la prueba de reacción en cadena de polimerasa de transcripción inversa cuando detecta SARS CoV-2. El objetivo de la revisión que se presenta es sintetizar elementos importantes relacionados con la fisiolopatología, manifestaciones clínicas y diagnóstico de la COVID-19.


SARS CoV-2 is transmitted primarily through the airway. The mean time from exposure to presentation of symptoms is 5 days. Infected patients can remain asymptomatic or have a wide spectrum of manifestations such as: fever, dry cough, and general malaise. Approximately 20% of patients with COVID-19 require hospitalization (10% in the general area, 5% require inter-mediate care, and the remaining 5% enter intensive care due to their serious condition). Labora-tory and radiological examinations show common but nonspecific abnormalities. Diagnosis is through the reverse transcription polymerase chain reaction test when it detects SARS CoV-2. This systematic review aimed to synthesize important elements related to the physiopathology, clinical manifestations, and diagnosis of COVID-19.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pathology , Coronavirus Infections , Natural History , Patients , Signs and Symptoms , Diagnosis
3.
Hist. ciênc. saúde-Manguinhos ; 28(1): 15-37, mar. 2021. graf
Article in Portuguese | LILACS | ID: biblio-1154322

ABSTRACT

Resumo O artigo pretende contribuir com a história das ciências, a história indígena e a história da América portuguesa. Parte-se dos pressupostos metodológicos de Dominique Pestre e da historiografia sobre a América portuguesa para interrogar a existência de uma rede de aldeamentos indígenas, a atuação de funcionários com saberes naturalistas, o envio de espécies botânicas para análise em Portugal e, por fim, a fundação de um horto botânico na capitania de Guayases (Goiás) entre 1772 e 1806. Apresenta-se a contribuição indígena na construção dos conhecimentos da história natural e discutem-se as influências de concepções da Ilustração na reforma do sistema colonial português na capitania a partir de documentação administrativa portuguesa, cartas e do estudo da aplicação de leis e instruções.


Abstract The article intends to contribute to the history of science, indigenous history and the history of Portuguese America. We begin with the methodological assumptions of Dominique Pestre and the historiography on Portuguese America to investigate a network of indigenous settlements, the work of civil servants with naturalist knowledge, the shipment of botanical species for analysis in Portugal and, finally, the foundation of a botanical garden in the captaincy of Guayases (Goiás) from 1772 to 1806. We describe the indigenous contribution to the construction of natural history knowledge, and discuss the influence of Enlightenment concepts on the reform of the Portuguese colonial system in the captaincy based on Portuguese administrative documentation, letters and study of the application of laws and instructions.


Subject(s)
History, 18th Century , History, 19th Century , Botany/history , Colonialism/history , Natural History/history , Indigenous Peoples/history , Portugal , Brazil , Gardens/history
4.
Neotrop. ichthyol ; 19(4): e200105, 2021. graf, mapas, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1351159

ABSTRACT

The semi-anadromous sea catfish species Cathorops tuyra (Ariidae, Besudo sea catfish) from the Tropical Eastern Pacific has been found reproductively active in the freshwater rivers and lakes of the Panama Canal. Despite growing concerns for biodiversity, reports on natural history are lacking for many Neotropical sea catfishes. We aimed to provide data on the diet and seasonal timing of spawning of C. tuyra for an autochthonous, semi-anadromous, brackish water population from Rio Santa Maria and an allochthonous freshwater non-migrating population from Rio Chagres, an affluent to the Panama Canal, to understand how changing from semi-anadromous to residential lifestyle affects the natural history of a species. Fish from both sampling sites were dissected and information on stomach content, size, weight, parasitic load, sex, maturity, and number of eggs were recorded. In Rio Chagres, there was a female bias and individuals were larger and in pre-spawning mode compared to Rio Santa Maria. Parasite prevalence was low in Rio Chagres and zero in Rio Santa Maria. The diets were very similar between populations: gastropods, bivalves, and insects were the most important prey items in both rivers representing a diverse omnivorous diet that is similar to that of other catfishes.(AU)


El bagre de mar semi-anádromo Cathorops tuyra (Ariidae, Bagre besudo) del Pacífico Oriental Tropical se encuentra reproductivamente activa en los ríos y lagos del Canal de Panamá. A pesar de la creciente preocupación por la biodiversidad, faltan informes sobre la historia natural de muchos de los bagres Neotropicales. Nuestro objetivo es proporcionar datos básicos sobre la dieta y el momento del desove estacional de C. tuyra para una población autóctona semi-anádroma de agua salobre de Río Santa María y una población alóctona residente de agua dulce de Río Chagres para comprender cómo el cambio de un estilo de vida semi-anádromo a residencial afecta la historia natural de una especie. Se disecaron peces de ambos sitios de muestreo y se registró la información de contenido del estómago, tamaño, peso, carga parasitaria, sexo, madurez y número de huevos. En Río Chagres hubo un sesgo femenino y los individuos eran más grandes y estaban en modo pre-desove que en Río Santa María. La prevalencia de parásitos fue baja en el Río Chagres y cero en Río Santa María. Las dietas fueron muy similares entre poblaciones: gasterópodos, bivalvos e insectos fueron las presas más importantes en ambos ríos, lo que representa una dieta omnívora diversa, que es similar a la de otros bagres.(AU)


Subject(s)
Animals , Catfishes/classification , Natural History/education , Biodiversity , Dams , Research Report
5.
J. venom. anim. toxins incl. trop. dis ; 27: e20210051, 2021. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1356458

ABSTRACT

King Cobra (Ophiophagus hannah) has a significant place in many cultures, and is a medically important venomous snake in the world. Envenomation by this snake is highly lethal, manifested mainly by neurotoxicity and local tissue damage. King Cobra may be part of a larger species complex, and is widely distributed across Southeast Asia, southern China, northern and eastern regions as well as the Western Ghats of India, indicating potential geographical variation in venom composition. There is, however, only one species-specific King Cobra antivenom available worldwide that is produced in Thailand, using venom from the snake of Thai origin. Issues relating to the management of King Cobra envenomation (e.g., variation in the composition and toxicity of the venom, limited availability and efficacy of antivenom), and challenges faced in the research of venom (in particular proteomics), are rarely addressed. This article reviews the natural history and sociocultural importance of King Cobra, cases of snakebite envenomation caused by this species, current practice of management (preclinical and clinical), and major toxinological studies of the venom with a focus on venom proteomics, toxicity and neutralization. Unfortunately, epidemiological data of King Cobra bite is scarce, and venom proteomes reported in various studies revealed marked discrepancies in details. Challenges, such as inconsistency in snake venom sampling, varying methodology of proteomic analysis, lack of mechanistic and antivenomic studies, and controversy surrounding antivenom use in treating King Cobra envenomation are herein discussed. Future directions are proposed, including the effort to establish a standard, comprehensive Pan-Asian proteomic database of King Cobra venom, from which the venom variation can be determined. Research should be undertaken to characterize the toxin antigenicity, and to develop an antivenom with improved efficacy and wider geographical utility. The endeavors are aligned with the WHO´s roadmap that aims to reduce the disease burden of snakebite by 50% before 2030.(AU)


Subject(s)
Animals , Poisoning , Snake Bites , Snakes , Antivenins , Proteome , Elapid Venoms , Natural History
6.
Coluna/Columna ; 19(2): 116-119, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1133569

ABSTRACT

ABSTRACT Objective This study aims to analyze the characteristics of patients with acute lumbar/sciatic disc herniation who underwent conservative, pain block procedures and surgical treatment, in order to better understand the natural history of herniations and their surgical indications, as well as the impact of hernia volume. Methods We analyzed 150 patients with a diagnosis of acute lumbar disc herniation. The treatments considered were: conservative, infiltration/pain block procedures and microdiscectomy. For seven patients who were surgically treated, the lumbar sequestrectomy volume was submitted to pathological analysis. Results Of the 150 patients, 80% were treated conservatively; 15.31% were treated with pain block procedures and 4.66% underwent microdiscectomy. The mean age of the surgical group was 42.5 years, and 57.1% of the patients were men. Most of the hernias were at L5-S1 (55.5%), and 77.7% were on the left side. All patients had presented significant lumbar pain or sciatica for a long period prior to the surgery. The Lasègue sign was present in all patients. Of the total number of patients, 85.7% presented hypoesthesia and 42.8% presented focal motor deficits, among other findings. The mean hernia volume was 9.6 cm3. Conclusions Unresponsiveness to conservative treatment is an important indication for surgery. The clinical manifestations in patients with a lumbar/sciatic hernia can be very diverse, as can the disc herniation volume, so these are not good indicators for surgery. Level of evidence IV; Case series


RESUMO Objetivo O presente estudo tem como objetivo analisar as características dos pacientes com hérnia de disco lombar/ciática aguda que passaram por procedimentos conservadores, procedimentos de bloqueio de dor e tratamento cirúrgico, a fim de melhor entender a história natural das hérnias e suas indicações cirúrgicas, assim como o impacto do volume da hérnia. Métodos Analisamos 150 pacientes diagnosticados com hérnia de disco lombar aguda. Os tratamentos considerados foram: tratamento conservador, procedimentos para bloqueio da dor/infiltração e microdiscectomia. Para sete pacientes tratados cirurgicamente, o volume de sequestrectomia lombar foi enviado para análise patológica. Resultados Dos 150 pacientes analisados, 80% foram tratados de modo conservador, 15,31% com procedimentos de bloqueio da dor e 4,66% com microdiscectomia. A idade média do grupo submetido à cirurgia foi 42,5 anos, sendo que 57,1% dos pacientes eram homens. A maior parte das hérnias estavam localizadas em L5-S1 (55,5%) e 77,7% das hérnias estavam no lado esquerdo. Todos os pacientes apresentaram significativa dor lombar ou ciática por um longo período antes da cirurgia. O sinal de Lasègue estava presente em todos pacientes. Do número total de pacientes, 85,7% apresentaram hipoestesia e 42,8% apresentaram déficits motores focais, entre outros achados. O volume médio das hérnias foi 9,6 cm3. Conclusões A falta de resposta ao tratamento conservador é uma importante indicação para cirurgia. As manifestações clínicas dos pacientes com hérnia lombar/ciática podem ser muito diversas, assim como o volume da hérnia de disco, portanto, esses não são bons indicadores para cirurgia. Nível de evidência IV; Série de casos.


RESUMEN Objetivo El presente estudio tiene como objetivo analizar las características de los pacientes con hernia de disco lumbar/ciática aguda que pasaron por procedimientos conservadores, procedimientos de bloqueo de dolor y tratamiento quirúrgico, a fin de entender mejor la historia natural de las hernias y sus indicaciones quirúrgicas, así como el impacto del volumen de la hernia. Métodos Analizamos a 150 pacientes diagnosticados con hernia de disco lumbar aguda. Los tratamientos considerados fueron: conservador, procedimientos para bloqueo de dolor/infiltraci ón y microdiscectom ía . Para siete pacientes tratados quirúrgicamente, el volumen de secuestrectomía lumbar fue enviado para análisis patológico. Resultados De los 150 pacientes analizados, 80% fue tratado de modo conservador, 15,31% con procedimientos de bloqueo de dolor y 4,66% con microdiscectomía. La edad promedio del grupo sometido a cirugía fue de 42,5 años, siendo que 57,1% de los pacientes eran hombres. La mayor parte de las hernias estaban localizadas en L5-S1 (55,5%) y 77,7% de las hernias estaban en el lado izquierdo. Todos los pacientes presentaron dolor lumbar o ciático significativo por un largo período antes de la cirugía. La señal de Lasègue estaba presente en todos los pacientes. Del número total de pacientes, 85,7% de los pacientes present ó hipostesia y 42,8% present ó déficit s motores focales, entre otros hallazgos. El volumen promedio de las hernias fue de 9,6 cm3. Conclusiones La falta de respuesta al tratamiento conservador es una importante indicación para la cirugía. Las manifestaciones clínicas de los pacientes con hernia lumbar/ciática pueden ser muy diversas, así como el volumen de la hernia de disco, por lo tanto, é stos no son buenos indicadores para cirugía. Nivel de evidencia IV; Serie de casos.


Subject(s)
Humans , Intervertebral Disc , Epidemiology , Natural History , Hernia , Lumbosacral Region
8.
Coluna/Columna ; 18(3): 209-213, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019785

ABSTRACT

ABSTRACT Objective To compare the sagittal alignment (SA) parameters in individuals with LCS and surgical indication with a control group and to study the correlations between SA parameters and ODI, VAS and EQ-5D in individuals with LCS and surgical indication. Methods In this multicenter cross-sectional case-control study, the individuals were allocated as follows. A stenosis group (SG) composed by patients with LCS confirmed by magnetic resonance imaging with surgical indication, treated between July 2010 and August 2016 and a control group (CG), without LCS. All subjects underwent anamnesis, completed the Health-related Quality of Life (HRQoL) and total spine radiographs were taken. Clinical data, HRQoL and radiographic parameters were correlated. Results Sixty-four individuals formed the SG and 14 the CG. The SG had higher values of mean age, coronal imbalance, sagittal vertical axis (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), PI-LL mismatch, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain and smaller thoracic kyphosis (TK), total (TLPL) and regional lumbopelvic lordosis (RLPL) in all vertebrae, sagittal offset (SO) in all evaluated vertebrae and EuroQol-5D (EQ-5D) with p <0.05. In the SG, the only significant correlations (p <0.05) were between TK and ODI and EQ-5D; all the other sagittal parameters did not correlated with VAS, ODI or EQ-5D. Conclusion SG had SA parameters altered in relation to CG. There was a direct correlation between decrease in TK and worsening of ODI and EQ-5D in SG. Level of evidence: III; Case Control Study.


RESUMO Objetivo Comparar parâmetros do AS em indivíduos portadores de EDL com indicação cirúrgica aos de uma população controle; estudar a correlação entre os questionários ODI, VAS e EQ-5D a parâmetros do AS nos portadores de EDL com indicação cirúrgica. Métodos Estudo transversal multicêntrico tipo caso-controle. Grupo estenose (GE) composto por portadores de EDL, confirmada por Ressonância Nuclear Magnética, com indicação cirúrgica, atendidos entre Julho de 2010 a agosto de 2016. Grupo controle (GC) sem EDL. Todos os indivíduos realizaram anamnese, responderam questionários de qualidade de vida e realizaram radiografias de coluna total. Dados clínicos, questionários e parâmetros radiográficos foram correlacionados. Resultados 64 indivíduos formaram o GE e 14 o GC. GE apresentou valores maiores de idade média, desequilíbrio coronal, sagital vertical index (SVA), pelvic tilt (PT), sacrofemoral distance (SFD), overhang (OH), missmatch PI - LL, Owestry Disability Index (ODI), Visual Analogic Scale (VAS) e valores menores de cifose torácica, lordose lombopélvica total e regional em todas as vértebras, offset sagital em todas as vértebras avaliadas e EuroQol-5D (EQ-5D), com p < 0,05. No GE, houve correlações significativas (p < 0,05) apenas entre TK e ODI e EQ-5D, sendo que todos os outros parâmetros sagitais não apresentaram correlação significativa com os questionários de qualidade de vida. Conclusão GE apresentou perda dos parâmetros de AS em relação ao GC. Houve correlação direta entre diminuição da TK e piora do ODI e EQ-5D no GE. Nível de Evidência III; Estudo de Caso Controle.


RESUMEN Objetivo Comparar los parámetros del alineamiento sagital (AS) en individuos con ECL e indicación quirúrgica con un grupo control y estudiar las correlaciones entre los parámetros de SA y ODI, EVA y EQ-5D en pacientes con ECL e indicación quirúrgica. Métodos En este estudio multicéntrico de casos y controles, los individuos fueron asignados como sigue. Un grupo estenosis (GE) compuesto por pacientes con ECL confirmada por imágenes de resonancia magnética con indicación quirúrgica, tratados entre julio de 2010 y agosto de 2016 y un grupo control (GC) sin ECL. Todos los individuos se sometieron a una anamnesis, respondieron el cuestionario de Calidad de Vida Relacionada con la Salud (HRQoL) y se tomaran radiografías totales de la columna. Se relacionaron datos clínicos, HRQoL y parámetros radiográficos. Resultados Sesenta y cuatro individuos formaron el GE y 14 el GC. El GE tenía valores más altos de edad promedio, desequilibrio coronal, eje sagital vertical (ESV), inclinación pélvica (IP), distancia sacrofemoral (DSF), protuberancia (P), falta de emparejamiento IP -LL, Índice de Discapacidad de Oswestry (ODI), Escala Visual Analógica (VAS) para el dolor y menos cifosis torácica (CT), lordosis lumbopélvica total (LLPT) y regional (LLPR) en todas las vértebras, offset sagital (OS) en todas las vértebras evaluadas y EuroQol-5D (EQ-5D), con p < 0,05. En el GE, las únicas correlaciones significativas (p < 0,05) fueron entre TC y ODI y EQ-5D; todos los demás parámetros sagitales no se correlacionaron con EVA, ODI o EQ-5D. Conclusión El GE tuvo parámetros de AS alterados en relación con el GC. Hubo correlación directa entre la disminución de TC y el agravamiento del ODI y EQ-5D en el GE. Nivel de evidencia III; Estudio de Caso Controle.


Subject(s)
Humans , Quality of Life , Spinal Stenosis , Spine , Radiography , Natural History
9.
Acta amaz ; 49(2): 105-113, abr. - jun. 2019.
Article in English | LILACS | ID: biblio-1119151

ABSTRACT

The pitviper Bothrops atrox is a widely distributed and medically important snake in Amazonia. Given that the reproductive and feeding biology of snakes varies geographically, we aimed to characterize the natural history of individuals from the central and southwestern portions of the biome. We analyzed museum-preserved specimens collected in the region between the metropolitan areas of the Brazilian cities of Manaus and Porto Velho. We took morphometric measurements and performed the analysis of gonads and digestive tracts of 109 individuals. Females attain sexual maturity with larger body sizes. Adults of the species show pronounced sexual dimorphism in body size, with females being larger. The reproductive cycle, especially in males, appears to be synchronized with regional rainfall, which markedly differed across the biome. The pitvipers had a generalist diet, consuming a wide range of prey such as centipedes, frogs, lizards, snakes and mammals. We provide the first record of predation of the snake Imantodes cenchoa (Dipsadidae) by B. atrox. There was an ontogenetic shift in the diet: smaller individuals fed mainly on ectothermic prey (centipedes, frogs, lizards and snakes), while adults tended to incorporate endothermic prey (mammals) to their food repertoire. (AU)


Subject(s)
Reproduction , Bothrops , Natural History , Diet
10.
Korean Journal of Radiology ; : 1491-1497, 2019.
Article in English | WPRIM | ID: wpr-760260

ABSTRACT

OBJECTIVE: To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies. MATERIALS AND METHODS: In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging. RESULTS: The median age of the study population was 63.0 years (range, 57.0–72.0 years), and the median FU period was 5.72 years (range, 4.08–6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups (p = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, p = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging. CONCLUSION: Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.


Subject(s)
Adult , Aneurysm , Angiography , Arteries , Coronary Artery Disease , Coronary Vessels , Diagnosis , Fistula , Follow-Up Studies , Humans , Methods , Natural History , Prognosis , Pulmonary Artery , Retrospective Studies , Vascular Fistula
11.
Article in English | WPRIM | ID: wpr-760238

ABSTRACT

Kawasaki disease (KD) is a systemic vasculitis in infants and young children. However, its natural history has not been fully elucidated because the first case was reported in the late 1960s and patients who have recovered are just now entering middle age. Nevertheless, much evidence has raised concerns regarding the subclinical vascular changes that occur in post-KD patients. KD research has focused on coronary artery aneurysms because they are directly associated with fatality. However, aneurysms have been reported in other extracardiac muscular arteries and their fate seems to resemble that of coronary artery aneurysms. Arterial strokes in KD cases are rarely reported. Asymptomatic ischemic lesions were observed in a prospective study of brain vascular lesions in KD patients with coronary artery aneurysms. The findings of a study of single-photon emission computed tomography suggested that asymptomatic cerebral vasculitis is more common than we believed. Some authors assumed that the need to consider the possibility of brain vascular lesions in severe cases of KD regardless of presence or absence of neurological symptoms. These findings suggest that KD is related with cerebrovascular lesions in children and young adults. Considering the fatal consequences of cerebral vascular involvement in KD patients, increased attention is required. Here we review our understanding of brain vascular involvement in KD.


Subject(s)
Aneurysm , Arteries , Brain , Central Nervous System , Child , Coronary Vessels , Humans , Infant , Middle Aged , Mucocutaneous Lymph Node Syndrome , Natural History , Prospective Studies , Stroke , Systemic Vasculitis , Tomography, Emission-Computed , Vasculitis , Vasculitis, Central Nervous System , Young Adult
12.
Asia Pacific Allergy ; (4): e35-2019.
Article in English | WPRIM | ID: wpr-762874

ABSTRACT

BACKGROUND: Epidemic thunderstorm asthma (ETSA) severely affected Melbourne, Australia in November 2016. There is scant literature on the natural history of individuals affected by ETSA. OBJECTIVE: A multicentre 12-month prospective observational study was conducted assessing symptomatology and behaviors of ETSA-affected individuals. METHODS: We used a structured phone questionnaire to assess asthma symptom frequency, inhaled preventer use, asthma action plan ownership and healthcare utilization over 12 months since the ETSA. Analysis of results included subgroup analyses of the “current,” “past,” “probable,“ and “no asthma” subgroups defined according to their original 2016 survey responses. RESULTS: Four hundred forty-two questionnaires were analyzed. Eighty percent of individuals reported ongoing asthma symptoms at follow-up, of which 28% were affected by asthma symptoms at least once a week. Risk of persistent asthma symptoms was significantly higher in those with prior asthma diagnosis, current asthma, and probable undiagnosed asthma (all p < 0.01). Of 442 respondents, 53% were prescribed inhaled preventers, of which 51% were adherent at least 5 days a week. Forty-two percent had a written asthma action plan and 16% had sought urgent medical attention for asthma in the preceding year. CONCLUSIONS: Following an episode of ETSA, patients experience a pivotal change in asthma trajectory with both loss of asthma control and persistence of de novo asthma. Suboptimal rates of inhaled preventer adherence and asthma action plan ownership may contribute to asthma exacerbation risk and susceptibility to future ETSA episodes. Longer-term follow-up is needed to determine the extent and severity of this apparent change.


Subject(s)
Asthma , Australia , Delivery of Health Care , Diagnosis , Environmental Exposure , Follow-Up Studies , Humans , Natural History , Observational Study , Ownership , Prospective Studies , Public Health , Surveys and Questionnaires , Weather
13.
Article in English | WPRIM | ID: wpr-762290

ABSTRACT

PURPOSE: Perianal adenocarcinoma arising from a chronic anorectal fistula is a rare condition for which the natural history and optimal management are not well established. For that reason, we conducted a retrospective analysis of 5 consecutive patients with a perianal adenocarcinoma arising from a chronic anorectal fistula managed at our institution from January 2014 to December 2015. METHODS: The patients were identified from a prospectively collected colorectal cancer database that included all patients managed for colorectal cancer at our institution. RESULTS: The median age at diagnosis was 64 years (range, 55–72 years). Magnetic resonance imaging (MRI) was the initial investigation for all patients and showed a hyperintense T2-weighted image. One patient underwent an abdominoperineal resection following neoadjuvant chemoradiotherapy and remained disease free during the 12-month follow-up. Three patients received neoadjuvant therapy with intent for surgery, but did not undergo surgery due to either worsening health or metastatic spread. One patient declined intervention. The median overall survival was 10.5 months (range, 2–19 months). CONCLUSION: A high index of suspicion is required to make a clinical diagnosis of an anal adenocarcinoma arising from a chronic fistula. Histologic diagnosis must be achieved to confirm the diagnosis. Multimodal therapy with neoadjuvant chemoradiotherapy followed by abdominoperineal resection is the treatment of choice.


Subject(s)
Adenocarcinoma , Asian Continental Ancestry Group , Chemoradiotherapy , Colorectal Neoplasms , Diagnosis , Fistula , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Natural History , Neoadjuvant Therapy , Prospective Studies , Rectal Fistula , Retrospective Studies
14.
Article in Korean | WPRIM | ID: wpr-761570

ABSTRACT

HBV is the most common etiology of both liver cirrhosis and hepatocellular carcinoma in Korea. Despite much progress made, the currently available antiviral therapies cannot eradicate or eliminate this virus. Hence, the benefits and risks of antiviral therapy should be carefully evaluated on an individual basis and within the context of the clinical situation. The ultimate goals of treatment are to decrease the mortality from liver disease. The benefits of antiviral therapy come from prevention of progression of liver disease. Understanding the natural history of chronic HBV infection is a key step in the decision making process to treat patients with chronic HBV infection. Generally, chronic hepatitis B patients in the immune tolerant phase and immune inactive phase are not recommended to undergo antiviral treatment, except for those patients in special conditions (e.g., immunosuppression or anticancer chemotherapy). Chronic hepatitis B patients in the immune active phase are recommended for antiviral therapy. For patients with liver cirrhosis, treatment should be considered when serum HBV DNA is detectable regardless of the serum level of ALT.


Subject(s)
Carcinoma, Hepatocellular , Decision Making , DNA , Hepatitis B virus , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Immunosuppression , Korea , Liver Cirrhosis , Liver Diseases , Mortality , Natural History , Risk Assessment
15.
Article in Korean | WPRIM | ID: wpr-761569

ABSTRACT

Multiple studies have shown that oral antiviral therapies reduced the incidence of hepatocellular carcinoma (HCC) and improved the survival of patients with chronic hepatitis B when compared with that of untreated patients. In particular, entecavir and tenofovir share the qualities of high efficacy in reducing the HBV DNA levels, and they have excellent tolerability and safety. These drugs modified the natural history of liver fibrosis, improve liver function, decrease the incidence of HCC, decrease the need for liver transplantation, and improve survival. Many studies have suggested that long-term antiviral therapy reduces the risk of HCC and liver cirrhosis in patients with chronic hepatitis. The mechanism of these drugs in reducing the risk of HCC is not clear. This article reviews the mechanisms of carcinogenic HBV by conducting a review of the literature on the efficacy of therapy for reducing the risk of HCC. A few recent articles have suggested that tenofovir offers advantages over entecavir in terms of HCC prevention, but these articles have the inherent limitations of observational data. No other head-to-head randomized trials exist. Further randomized studies would help provide stronger evidence of the association between the type of antiviral agent and the HCC outcomes. Only achieving complete viral eradication from the liver will truly decrease the mortality and incidence of HCC.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , DNA , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Incidence , Liver , Liver Cirrhosis , Liver Transplantation , Mortality , Natural History , Tenofovir
16.
Article in Korean | WPRIM | ID: wpr-761389

ABSTRACT

With increasing sensitivity, availability, and use of magnetic resonance imaging (MRI) in the past three decades, there is also an increase in incidental abnormal findings. The most common findings of these incidental abnormalities are white matter lesions that are interpreted as demyelinating based on radiological criteria. MRI findings suggestive of multiple sclerosis (MS) in patients without typical MS symptoms and with normal neurologic findings are now defined as a radiologically isolated syndrome (RIS) which reported relatively low incidence, especially hard to find case report in Korea. The natural history and pathophysiologic processes of RIS remain largely unknown. The nature, prevalence, and long-term prognosis of RIS, as well as the role of disease-modifying therapy should be established in the future.


Subject(s)
Demyelinating Diseases , Humans , Incidence , Korea , Magnetic Resonance Imaging , Multiple Sclerosis , Natural History , Neurologic Manifestations , Prevalence , Prognosis , White Matter
17.
Article in English | WPRIM | ID: wpr-788821

ABSTRACT

OBJECTIVE: To analyze the angiographic features and clinical course, including treatment outcomes and the natural course, of fusiform middle cerebral artery aneurysms (FMCAAs) according to their location, size, and configuration.METHODS: We reviewed the literature on adult cases of FMCAAs published from 1980 to 2018; from 25 papers, 112 FMCAA cases, for which the location, size, and configuration could be identified, were included in this study. Additionally, 33 FMCAA cases in our hospital were included, from which 16 were assigned to the observation group. Thus, a total of 145 adult FMCAA cases were included. We classified the FMCAAs according to their location (l-type 1, beginning from prebifurcation; l-type 2, beginning from bifurcation; l-type 3, beginning from postbifurcation), size (small, <10 mm; large, ≥10 mm; giant, ≥25 mm), and configuration (c-type 1, classic dissecting aneurysm; c-type 2, segmental ectasia; c-type 3, dolichoectatic dissecting aneurysm).RESULTS: The c-type 3 was more commonly diagnosed with ischemic symptoms (31.8%) than hemorrhage (13.6%), while 40.9% were found accidentally. In contrast, c-type 2 was more commonly diagnosed with hemorrhagic symptoms (14.9%) than ischemic symptoms (10.6%), and 72.3% were accidentally discovered. According to location, ischemic symptoms and hemorrhage were the most frequent symptoms in l-type 1 (28.6%) and l-type 3 (34.6%), respectively. Most of l-type 2 FMCAAs were found incidentally (68.4%). Based on the size of FMCAAs, only 11.1% of small aneurysms were found to be hemorrhagic, while 18.9% and 26.0% of large and giant aneurysms were hemorrhagic, respectively. Although four aneurysms of the 16 FMCAAs in the observation group increased in size and one aneurysm decreased in size during the observation period, no rupture was seen in any case and there were no significant predictors of aneurysm enlargement. Of 104 FMCAAs treated, 14 cases (13.5%) were aggravated than before surgery and all the aggravated cases were l-type 1.CONCLUSION: While ischemic symptoms occurred more frequently in l-type 1 and c-type 3, hemorrhagic rather than ischemic symptoms occurred more frequently in l-type 3 and c-type 2. In case of l-type 1 FMCAAs, more caution is required in determining the treatment due to the relatively high complication rate.


Subject(s)
Adult , Aneurysm , Aneurysm, Dissecting , Dilatation, Pathologic , Hemorrhage , Humans , Intracranial Aneurysm , Middle Cerebral Artery , Natural History , Rupture
18.
Article in English | WPRIM | ID: wpr-788756

ABSTRACT

OBJECTIVE: Pituitary adenomas (PAs) are often detected as incidental findings. However, the natural history remains unclear. The objective of this study was to evaluate the natural history and growth pattern of untreated PAs.METHODS: Between 2003 and 2014, 59 PAs were managed with clinico-radiological follow up for longer than 12 months without any kind of therapeutic intervention. Tumor volumes were calculated at initial and last follow-up visit, and tumor growth during the observation period was determined. Data were analyzed according to clinical and imaging characteristics.RESULTS: The mean initial and last tumor volume and diameter were 1.83±2.97 mL and 13.77±6.45 mm, 2.85±4.47 mL and 15.75±8.08 mm, respectively. The mean annual tumor growth rate was 0.33±0.68 mL/year during a mean observation period of 46.8±32.1 months. Sixteen (27%) PAs showed tumor growth. The initial tumor size (HR, 1.140; 95% confidence interval, 1.003–1.295; p=0.045) was the independent predictive factor that determined the tumor growth. Six patients (11%) of 56 conservatively managed non-symptomatic PAs underwent resection for aggravating visual symptoms with mean interval of 34.5 months from diagnosis. By Cox regression analysis, PAs of last longest diameter over 21.75 mm were a significant prognostic factor for eventual treatment.CONCLUSION: The initial tumor size of PAs was independently associated with the tumor growth. Six patients (11%) of conservatively managed PAs were likely to be treated eventually. PAs of last follow-up longest diameter over 21.75 mm were a significant prognostic factor for treatment. Further studies with a large series are required to determine treatment strategy.


Subject(s)
Diagnosis , Follow-Up Studies , Humans , Incidental Findings , Natural History , Pituitary Neoplasms , Prognosis , Tumor Burden
19.
Article in Korean | WPRIM | ID: wpr-787218

ABSTRACT

HBV is the most common etiology of both liver cirrhosis and hepatocellular carcinoma in Korea. Despite much progress made, the currently available antiviral therapies cannot eradicate or eliminate this virus. Hence, the benefits and risks of antiviral therapy should be carefully evaluated on an individual basis and within the context of the clinical situation. The ultimate goals of treatment are to decrease the mortality from liver disease. The benefits of antiviral therapy come from prevention of progression of liver disease. Understanding the natural history of chronic HBV infection is a key step in the decision making process to treat patients with chronic HBV infection. Generally, chronic hepatitis B patients in the immune tolerant phase and immune inactive phase are not recommended to undergo antiviral treatment, except for those patients in special conditions (e.g., immunosuppression or anticancer chemotherapy). Chronic hepatitis B patients in the immune active phase are recommended for antiviral therapy. For patients with liver cirrhosis, treatment should be considered when serum HBV DNA is detectable regardless of the serum level of ALT.


Subject(s)
Carcinoma, Hepatocellular , Decision Making , DNA , Hepatitis B virus , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Immunosuppression , Korea , Liver Cirrhosis , Liver Diseases , Mortality , Natural History , Risk Assessment
20.
Article in Korean | WPRIM | ID: wpr-787217

ABSTRACT

Multiple studies have shown that oral antiviral therapies reduced the incidence of hepatocellular carcinoma (HCC) and improved the survival of patients with chronic hepatitis B when compared with that of untreated patients. In particular, entecavir and tenofovir share the qualities of high efficacy in reducing the HBV DNA levels, and they have excellent tolerability and safety. These drugs modified the natural history of liver fibrosis, improve liver function, decrease the incidence of HCC, decrease the need for liver transplantation, and improve survival. Many studies have suggested that long-term antiviral therapy reduces the risk of HCC and liver cirrhosis in patients with chronic hepatitis. The mechanism of these drugs in reducing the risk of HCC is not clear. This article reviews the mechanisms of carcinogenic HBV by conducting a review of the literature on the efficacy of therapy for reducing the risk of HCC. A few recent articles have suggested that tenofovir offers advantages over entecavir in terms of HCC prevention, but these articles have the inherent limitations of observational data. No other head-to-head randomized trials exist. Further randomized studies would help provide stronger evidence of the association between the type of antiviral agent and the HCC outcomes. Only achieving complete viral eradication from the liver will truly decrease the mortality and incidence of HCC.


Subject(s)
Antiviral Agents , Carcinoma, Hepatocellular , DNA , Hepatitis B, Chronic , Hepatitis, Chronic , Humans , Incidence , Liver , Liver Cirrhosis , Liver Transplantation , Mortality , Natural History , Tenofovir
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