Complicaciones neurológicas y extra neurológicas en pacientes con ACV internados en el Hospital de Clínicas de Montevideo durante un período de 2 años / Neurological and extra-neurological complications in stroke patients treated at Hospital de Clinicas during a 2 years period / Complicações neurológicas e extraneurológicas em pacientes com AVC internados no Hospital de Clínicas de Montevidéu por um período de 2 anos

Introducción: Los pacientes con Ataque Cerebrovascular (ACV) presentan un elevado riesgo de complicaciones durante la internación, que pueden condicionar su pronóstico. Objetivos: Describir las complicaciones neurológicas y extra neurológicas durante la internación. Evaluar sus características y diferencias de acuerdo al tipo de ACV. Identificar factores predictores de complicaciones y de mortalidad intrahospitalaria. Pacientes y métodos: Fueron incluidos en el estudio los pacientes atendidos en el Hospital de Clínicas (HC) de Montevideo con diagnóstico de ACV entre 1/1/14 y 31/12/15. Se analizaron las principales características clínico-epidemiológicas de los pacientes, se pesquisó la presencia o no de complicaciones según el subtipo y se clasificaron en Neurológicas y Extra Neurológicas (Sistémicas y Cardiovasculares). Resultados: Se analizaron 206 pacientes, 57 % de los cuales presentaron complicaciones, indistintamente del subtipo de ACV. Las más habituales fueron las sistémicas, en 49 % de los casos. La edad, diabetes, NIHSS al ingreso, cardiopatía previa y trombólisis se asociaron en forma significativa e independiente a complicaciones. La mortalidad intrahospitalaria fue 11 %, siendo significativamente menor en los pacientes que ingresaron a la Unidad de ACV del centro. Conclusiones: Las complicaciones fueron muy frecuentes y la principal causa de muerte, siendo las sistémicas las más prevalentes. Ciertas variables se asociaron a un mayor riesgo de complicaciones: edad, diabetes, cardiopatía previa, NIHSS al ingreso, y la trombolisis. La Unidad de ACV descendió la mortalidad en forma significativa.

Introduction: Stroke patients present high risk of complications conditioning its prognosis. Objectives: To describe neurological and extra-neurological complications during admission. To evaluate complications according with stroke subtype, identifying morbidity and mortality predictive factors. Patients and methods : All patients treated at the Hospital de Clínicas (HC) with a diagnosis of stroke between 01/01/14 and 12/31/15 were analyzed. The presence or absence of complications was also analyzed according to stroke subtype during the hospital stay and were classified into three groups: neurological and extra-neurological, the last ones subdivided into systemic and cardiovascular diseases. Results: Sample of 206 patients. 57 % of them presented complications, regardless to the stroke subtype. The most common complications were the systemic ones (49 %). Age, diabetes, NIHSS at admission, previous cardiac disease and thrombolysis were significantly associated with complications. Overall mortality was 11 %. Mortality was significantly lower for patients admitted to the institutional Stroke Unit. Conclusions : Stroke complications were very frequent and are the main cause of mortality, with systemic complications being the most common. Furthermore, there are other variables which are associated with a greater risk of complications such as older age, diabetes, previous heart disease, NIHSS at admission, and thrombolysis. Admission to stroke unit resulted in a significant decrease in the mortality rate.

Introdução: Pacientes com Ataque Cerebrovascular (AVC) apresentam alto risco de complicações durante a hospitalização, o que pode condicionar seu prognóstico. Objetivos: Descrever as complicações neurológicas e extra neurológicas durante a hospitalização. Avalie suas características e diferenças de acordo com o tipo de ACV. Identifique fatores que predizem complicações e mortalidade hospitalar. Pacientes e métodos: Os pacientes atendidos no Hospital de Clínicas (HC) de Montevidéu com diagnóstico de acidente vascular cerebral entre 1/1/14 e 31/12/15 foram incluídos no estudo. As principais características clínico-epidemiológicas dos pacientes foram analisadas e a presença ou ausência de complicações de acordo com o subtipo foi investigada e classificada em Neurológica e Extra Neurológica (Sistêmica e Cardiovascular). Resultados: foram analisados 206 pacientes, 57 % dos quais apresentaram complicações, independentemente do subtipo ACV. Os mais comuns foram sistêmicos, em 49 % dos casos. Idade , diabetes, NIHSS na admissão, Trombólise foram significativamente associados a complicações. A mortalidade intra-hospitalar foi de 11 %, sendo significativamente menor nos pacientes internados na Unidade de ACV do centro. Conclusões: As complicações foram muito freqüentes e a principal causa de morte, sendo as sistêmicas as mais prevalentes. Certas variáveis foram associadas a um risco aumentado de complicações: idade, diabetes, doença cardíaca prévia, NIHSS na admissão e trombólise. A Unidade de ACV diminuiu significativamente a mortalidade.

Changes in structure and composition of evergreen forests on an altitudinal gradient in the Venezuelan Guayana Shield

There have been several ecological studies in forests of the Guayana Shield, but so far none had examined the changes in structure and composition of evergreen forests with altitude. This study describes and analyzes the structure, species composition and soil characteristics of forest stands at different altitudinal zones in Southeastern Venezuelan Guayana, in order to explain the patterns and the main factors that determine the structure and composition of evergreen forests along the altitudinal gradient. Inventories of 3 948 big (>10cm DBH) and 1 328 small (5-10cm DBH) woody stems were carried out in eleven plots, ranging from 0.1 to 1.0ha, along a 188km long transect with elevations between 290 and 1 395masl. It has been found that 1) hemiepihytes become more dominant and lianas reduce their dominance with increasing altitude and 2) the forest structure in the study area is size-dependent. Five families and 12 genera represented only 9% of the total number of families and genera, respectively, recorded troughout the gradient, but the two groups of taxa comprised more than 50% of the Importance Value (the sum of the relative density and the relative dominance) of all measured stems. Moreover, the results suggest that low species richness seems to be associated with the dominance of one or few species. Stand-level wood density (WD) of trees decreased significantly with increasing elevation. WD is an indicator of trees’life history strategy. Its decline suggests a change in the functional composition of the forest with increasing altitude. The Canonical Correspondence Analysis (CCA) indicated a distinction of the studied forests on the basis of their altitudinal levels and geographic location, and revealed different ecological responses by the forests, to environmental variables along the altitudinal gradient. The variation in species composition, in terms of basal area among stands, was controlled primarily by elevation and secondarily ...

A pesar de los diversos estudios ecológicos realizados en los bosques del Escudo de Guayana, ninguno de ellos había analizado hasta ahora los cambios en la composición y estructura de bosques siempreverdes que ocurren al incrementar la altitud. Con el fin de identificar patrones y factores determinantes de la estructura y la composición de bosques en un gradiente altitudinal (290-1 395msnm) en el sudeste de Venezuela se realizaron inventarios de 3 948 fustes grandes (>10cm DAP) y 1 328 pequeños (5-10cm DAP) en once parcelas a lo largo de un transecto de 188km. Con el incremento de la altitud, el área basal aumenta en las hemiepífitas y disminuye en las lianas. Las familias y los géneros más importantes representaron una reducida proporción del total de taxones, pero abarcaron más del 50% del Valor de Importancia. Bajos valores de riqueza se asocian con la dominancia de pocas especies. La densidad de madera decrece significativamente a mayor altitud, y sugiere un cambio en la composición funcional. Existen diferentes respuestas ecológicas de los rodales ante cambios físico-ambientales. La variación de la composición de especies en el gradiente fue controlada por altitud, lluvia y condiciones edáficas; pero se desconoce el efecto de otros factores no considerados como régimen de perturbaciones, interacciones biológicas, productividad e historia de dispersión. La variabilidad observada en la estructura y la composición de bosques en el gradiente parece ser un resultado del efecto combinado de diferentes climas y procesos locales aleatorios que interactúan en un complejo paisaje.