Search

Introduction Radiologically isolated syndrome (RIS) refers to the incidental discovery of white matter lesions suggestive of MS, on brain MRI, in asymptomatic patients. Recent studies suggest similar features of cognitive impairment between RIS and MS patients. Also, lower levels of health-related quality of life (QOL) and fatigue are reported in such patients. Aims characterize and compare the cognitive profile of a multicentric Portuguese cohort of RIS patients with a control group. Methods multicentric comparative study of a cohort of adult patients with RIS, and age and gender-matched controls followed in the headache outpatient clinic with prior MRI not fulfilling criteria for RIS diagnosis. We conducted interviews with participants, collected clinical data and applied the BICAMS battery and self-reported questionnaires (HADS, MFIS, MSQOL-54). Results we evaluated 31 patients with RIS (median age 46 years, IQR [( Dusankova et al., 2012 -52], 72% women) and 19 control individuals (median age 32 years, IQR [( O'Jile et al., 2005 -48], 71% women). Prevalence of cognitive impairment did not differ between groups (16% of the RIS and 10% of the controls, p=0.579). We found no differences between groups on the BICAMS tests, although the results of the California Verbal Learning Test (CVLT-II) score presented a trend to significance, with a lower value on the RIS group (53.9 vs. 59.3, p=0.066). There were no significant differences regarding fatigue, QOL, anxiety/depression scores. Conclusion this is the first study on a Portuguese cohort of RIS patients assessing cognitive profile with BICAMS. A non-neglectable part of our cohort presented cognitive impairment. Our findings add to previous studies in suggesting that a more pronounced impairment of verbal memory and learning, evaluated by CVLT-II, may be present in RIS patients compared to controls. BICAMS should be assessed on future studies with larger cohorts.

In this study, we evaluated the effects of organic matter in sediment on the aerenchyma development of the roots of Egeria najas (native to Brazil) and the exotic species Hydrilla verticillata. The questions of this study were: (i) can the structural development of roots be influenced by the substrate with different content in organic matter and (ii) do the quantity and perimeter of the cortex intercellular spaces of the roots increase with increases in sediment organic matter? To answer these questions, we conducted an experiment in a greenhouse. We manipulated E. najas and H. verticillata growing in sediment with different proportions of organic matter. The root cortex of E. najas had significantly greater numbers and perimeters of intercellular spaces compared with the exotic species. The interaction between species and sediment was significant for both response variables, which increased faster in E. najas than in H. verticillata with enhancing sediment organic matter. The superior plasticity of E. najas’ roots might be explained by its adaptation to this specific type of sediment in situ for a longer period of time given its native status. On the other hand, the low capacity to increase intercellular spaces in H. verticillata’s roots in organic sediment might be related to the species’ recent introduction to the area and be the main factor that inhibits its expansion into habitats with sediments containing high levels of organic matter. Our results suggest that the species-specific plasticity of roots in these Hydrocharitaceae may help explaining their distribution in the Upper Parana basin.

Background Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder, afflicting 1 in 2500–3000 individuals. These patients harbor cafe-au-lait macules, axillary and inguinal freckling, neurofibromas and optic pathway gliomas. Epilepsy, although not usual, is higher in these individuals than in the general population, occurring in 4–10%. Juvenile myoclonic epilepsy (JME) is a generalized, idiopathic epileptic syndrome characterized by myoclonic jerks, occurring mainly on awakening, often associated with generalized tonic-clonic seizures (GTCS). Material and methods A case report and literature review. Results A 19 yo woman was referred due to matinal myoclonic jerks and GTCS. The neurological examination was normal. The first EEG had generalized spikes, although without spike-and-wave pattern. The CT-scan was normal. She was diagnosed as having JME and was started on medication, remaining seizure-free from the age 24, with subsequent normal EEGs. At age 33, her daughter was referred due to learning disabilities and was diagnosed with NF1. Upon a more through physical examination, we also found discrete cafe-au-lait macules in our patients’ forearm, as well as axillar freckling. Genetic testing confirmed the diagnosis of NF1. Conclusions Generalized epilepsy (including JME) is described in 17% of the patients with NF1 and epilepsy. The literature is scarce on the association of JME and NF1, and a causal link cannot be established based on one case. However, this case highlights the relevance of a thorough physical examination in all patients with epilepsy, including a skin examination, as well as a proper imaging protocol in some generalized epilepsy cases.

The aim of this study was to determine the transmission paths of Neospora caninum in a dairy herd of crossbred cattle. Two hundred and ninety animals were grouped according to the year of their birth to verify the distribution of infection according to age. The blood of 196 cattle was collected thrice, with an average interval of 210 days, to evaluate the existence of horizontal transmission in the herd. To evaluate vertical transmission, the blood of 64 calves was collected prior to ingestion of colostrum and from their mothers at parturition. Moreover, 63 family trees were built. The presence of anti-N. caninum antibodies was detected using an indirect fluorescent antibody test. The chi-square test (χ(2)) with Yates' correction or Fisher's exact test was used to evaluate the relation between the serology and age groups and between the serostatus of cows and their progeny in different calvings. A higher seropositivity (p=0.035) was found in animals born in 2008 compared to those born in 1997-2007. The serological status of only 13 animals presented changes, of which six (3.1%) became seropositive, indicating a low proportion of horizontal transmission. All seropositive cows gave birth to seropositive calves, resulting in 100% vertical transmission. Sixty-three family trees were constructed. In 29 (46%) of these families, there were animals seropositive for N. caninum. Congenital infection in relation to the number of births was estimated from the relation of Mother+ and Daughter+, without significant differences (p=0.84) between the number of births and the transmission of the parasite from infected cows to their progeny. The low proportion of horizontal transmission combined with the high proportion of vertical transmission allowed us to conclude that transplacental transmission is the principal route of N. caninum infection in the herd.

The aim of this study was to characterize the role of quails (Coturnix coturnix japonica) as intermediate hosts for Neospora caninum. Fifty-eight 20-day old quails were individually identified with numbered rings and kept in cages adequate for the species. The birds were fed commercial feed and distilled water ad libitum. They were weighed daily during the first month and every seven days from then on. The birds were randomly distributed into 3 groups; 40 quails (group A) and 8 quails (group B) received 3.5 × 106 and 5 × 106N. caninum tachyzoites, respectively, and 10 quails (group C) received placebo. Four quails from group A and one from group C had their blood collected and were euthanized on the 1st, 3rd, 5th, 7th, 14th, 21th, 30th, 60th, 120th day after infection (DAI), and 4 quails from group B were euthanized on days 60th and 120th DAI. Following euthanasia, the birds were submitted to necropsy, the organs were weighed and fragments were collected for histopathology, immunohistochemistry (IHC) and PCR. On the 60th DAI, two dogs were fed tissue obtained from group A quails, and one dog was fed quail tissues from group B. The dogs’ blood was collected weekly for serology, and their feces were collected daily for 33 days for microscopy and molecular identification of oocysts. Student's t-test was used to compare the weights of the collected organs and the quail and cloacal temperature. No quail presented any clinical signs or died. Splenomegaly and hepatomegaly were the primary necropsy findings during the first week of infection (p

were decided by residents. The most diagnosed infections were urinary tract infection (UTI) (17.7%), community acquired pneumonia (CAP) (16.3%) and tonsillitis (11.5%). Antibiotics were prescribed in 6.2% of noninfectious diagnoses. Monotherapy prescriptions accounted for 81.3% of the cases: 41.7% of penicillins and 21.6% of quinolones. For UTI, the most frequently prescribed antibiotics were quinolones (37.5%), sulfonamides (22.2%) and penicillins (20.8%); regarding CAP, quinolones (28.1%) and penicillins (21.9%) were also the preferred options. For tonsillitis, prescribers chose mainly penicillins (76.1%) and macrolides (10.9%). Combined antibiotherapy represented 14.4% of the prescriptions and it was the option in almost half (42.6%) of CAP prescriptions: the most frequent association was penicillin/ cephalosporin and macrolide (23.5%). Most patients were discharged; however, 26.6% were admitted to internal medicine wards, 70.3% of them because of lower respiratory tract infections. The antibiotherapy prescribed at the EDwasmaintained in 80.2% until the discharge. There were 51.3% of appropriate prescriptions: 69.4% for UTI, 58.7% for tonsillitis and 45.3% for CAP. Conclusions: We concluded that almost half of the antibiotic prescriptions at the ED were inappropriate for the established diagnosis, according to the available guidelines. However, ED misdiagnosis was not possible to exclude. In patients admitted to the internal medicine ward, the nondescalation of the large spectrum antibiotherapy prescribed at the ED was an additional example of discordance between daily practices and national recommendations. We also unraveled some of the predictive factors for antibiotic prescription appropriateness. Improving appropriate antibiotic therapy at the emergency department reveals that it is an essential step towards healthcare quality.