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A 71-year-old woman presented to the emergency room with dysphonia, diplopia, dysphagia and generalised weakness since that day. Neurological examination revealed eye adduction limitation, ptosis, hypoactive reflexes and gait ataxia. Blood and cerebrospinal fluid analysis and brain CT were normal. Electromyography revealed a sensory axonal polyneuropathy. She was diagnosed with Miller-Fisher syndrome (MFS) and started on intravenous immunoglobulin. Two days after intravenous immunoglobulin treatment was completed, she developed a sustained hypertensive profile and presented a generalised tonic-clonic seizure. Brain MRI was suggestive of posterior reversible encephalopathy syndrome (PRES) and supportive treatment was implemented with progressive improvement. PRES may be a possible complication of MFS not only due to autonomic and inflammatory dysfunctions, but also as a consequence of its treatment. Patients with MFS should be maintained under close surveillance, especially in the first days and preferably in intermediate care units.

The model presented in this work can be found in BioModels [26] with the identifier MODEL2205020002. To access the model: – Visit https://www.ebi.ac.uk/biomodels/login/auth. – Log in with the username reviewerForMODEL2205020002 and password DEMPB4. – Access https://www.ebi.ac.uk/biomodels/MODEL2205020002 to view the model., First Online: 20 October 2022, Xylella fastidiosa is a gram-negative phytopathogenic bacterium able to infect over 500 plant species, with devastating consequences for agricultural and forest-based economies. In the last decade, genome-scale metabolic (GSM) models have become important systems biology tools for studying the metabolic behaviour of different organisms. In this work, a GSM model of X. fastidiosa subsp. pauca De Donno is presented, comprising 1164 reactions, 1379 metabolites, and 508 genes. The model was validated by comparing in silico simulations with available experimental data. The GSM model allowed identifying potential drug targets using a pipeline based on a gene essentiality analysis of the model., This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/04469/2020 unit. A. Oliveira (DFA/BD/10205/2020), E. Cunha (DFA/BD/8076/2020) hold a doctoral fellowship provided by the FCT. Oscar Dias acknowledge FCT for the Assistant Research contract obtained under CEEC Individual 2018., info:eu-repo/semantics/publishedVersion

Journal of Statistics on Health Decision, vol. 4 n.º 1 (2022): Special Issue - Statistics on Health Decision Making: Real World Data

Enquadramento: a automedicação envolve o uso de medicamentos para tratar distúrbios ou sintomas autodiagnosticados, ou o uso intermitente ou continuado de medicação prescrita por um médico para tratamento crónico ou doenças ou sintomas recorrentes. Objetivos: caraterizar a prática da automedicação nos estudantes do ensino superior da saúde. Metodologia: estudo quantitativo e descritivo. Amostra constituída por 301 estudantes. Recolha de dados com recurso a questionário e análise de dados efetuada através do Statistical Package for the Social Sciences (SPSS). Resultados: verifica-se automedicação em 93,4% dos estudantes do ensino superior saúde. Os sinais e sintomas mais frequentes foram as cefaleias (29,8%), dismenorreia (13,5%) e febre (9,9%). Os medicamentos mais utilizados foram os analgésicos/antipiréticos (34,6%), os anti-inflamatórios (29,2%), vitaminas e sais minerais (7,4%). Conclusão: a automedicação entre os estudantes do ensino superior é elevada, pelo que é fulcral abordar esta problemática ao longo do curso de forma a minimizar os riscos associados a este consumo.

Imaging in the Intensive Care Unit (ICU) plays a crucial role in patient care, chest radiography is the most requested exam for COVID – 19 patients in ICU context. The high risk of exposure to the virus may influence the quality of the exams. The objective of this study is to compare the fulfillment of the criteria for good performance in chest radiography in the ICU, before and during the critical phase of the pandemic COVID – 19. Thirty-two images were evaluated, sixteen before the pandemic and sixteen to COVID –19 patients, according to a scale of 8 items, scored 8 to 25 points, inversely proportional to the degree of compliance. There were no significant differences in the mean values between the groups, except in the presence of artifacts, showing that the images performed on COVID - 19 patients met these criteria better/more effectively. The results suggest that, in spite of the increased stress resulting from exposure to the new virus, the quality standard in the ICU exams is maintained. A imagem nas Unidade de Cuidados Intensivos (UCI) desempenha um papel crucial na assistência ao paciente, sendo a radiografia ao tórax o exame mais requisitado aos pacientes COVID-19 em contexto de UCI. O elevado risco de exposição ao vírus poderá influenciar a qualidade de execução dos exames. O objetivo deste estudo é comparar o cumprimento dos critérios de boa realização em radiografia do tórax em UCI, antes e durante a fase crítica da pandemia COVID-19. Avaliaram-se 32 imagens, 16 realizadas antes da pandemia e 16 a doentes COVID-19, de acordo com uma escala de 8 itens, com pontuação entre 8 e 25 pontos, inversamente proporcional ao grau de cumprimento. Não se observaram diferenças significativas ao nível dos valores médios entre os grupos, exceto na presença de artefactos, constatando-se que os exames realizados a doentes COVID-19 cumpriram melhor/mais eficazmente este critério. Os resultados sugerem que, apesar do acréscimo de stress derivado à exposição ao novo vírus, se mantém o padrão de qualidade na realização de exames em UCI. info:eu-repo/semantics/publishedVersion

Background and Goal Curcumin is a polyphenolic compound found in Curcuma longa. This bioactive molecule has several reported health-benefit effects, being the anticarcinogenic activity among the most promising ones. However, curcumin extraction from natural sources is hampered by impure products obtained from harsh chemicals and limited by plant seasonality and high prices. Therefore, curcumin heterologous production emerged as an interesting alternative. Escherichia coli has been explored as chassis but the implementation of the pathway in Saccharomyces cerevisiae can have several advantages, including its generally regarded as safe status. Hence, S. cerevisiae was engineered for the first time to produce curcumin from its precursor ferulic acid. Methods and Results The enzymes 4-coumarate-CoA ligase (4CL1) from Arabidopsis thaliana or feruloyl-CoA synthetase (FerA) from Pseudomonas paucimobilis and type III polyketide synthases (PKSs) from Oryza sativa or C. longa were expressed in BY4741 strain. To avoid ferulic acid deviation, the gene FDC1 coding a ferulic acid decarboxylase was deleted. The maximum curcumin titer was obtained with FerA combined with C. longa PKSs (2.7 mg L1). Conclusions and Implications Up to our knowledge, this is the first work reporting the expression of a feruloyl-CoA synthase and also curcuminoid biosynthetic enzymes in S. cerevisiae, and consequently, curcumin production., This study was supported by the Portuguese Foundation for Science and Technology (FCT) under the scope of the strategic funding of UIDB/BIO/04469/2020 unit. J.R. is recipient of a fellowship supported by a doctoral advanced training (SFRH/BD/138325/2018) funded by FCT., info:eu-repo/semantics/publishedVersion

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business Intelligence Students’ academic achievement has been linked to a variety of personal and socioeconomic characteristics. The truth is, there is one field of study that has been showing promising results in terms of its effect on academic performance, which is the social relations. Social networks that are built within the students’ community can have a significant influence on students’ academic performance. Not only does a student’s position in a network might have an impact on academic success, but so does the influence that peers exert on one another. This dissertation aims to offer a more in-depth examination of these subjects, along with an analysis of the impact of the emergence of the pandemic (COVID-19) on the development of social ties. Bachelor’s degree students from a Portuguese university were asked about their grades, friends, study buddies and working group colleagues in order to explore multiple forms of social interactions and give a more robust analysis. The study was based on an online questionnaire aimed only at the desired target and data was analyzed using UCINET and SPSS. From the variety of centrality measures considered, findings suggest that students in high prestige positions within the friendship network present lower academic achievement, except for eigenvector (i.e., being connected to students who are themselves well connected). On advice and working group networks, there was minimal evidence of the relation between key positions and grades, however, when significant, the impact was either positive or negative depending on the centrality measure considered. Aside from social relations, the research also indicates that prior academic performance and being provided with a scholarship are the most dominant factors in the explanation of academic performance. Although there was not overall homophily towards grades – neither through selection nor influence mechanisms –, students with lower academic achievement tended to stablish friendship ties between themselves and to be influenced by them over time. No clear evidence was found regarding the emergence of the pandemic and its impact on the formation of personal ties since pre and post pandemic classes present very similar results, and both seem to have been significantly affected by the pandemic. These findings put in evidence the importance of studying personal relations in the educational realm and contribute to discussions on the spreading of knowledge in social networks.

We analyze mathematical models for COVID-19 with discrete time delays and vaccination. Sufficient conditions for the local stability of the endemic and disease-free equilibrium points are proved for any positive time delay. The stability results are illustrated through numerical simulations performed in MATLAB., Comment: This is a preprint of a paper whose final and definite form is published Open Access in 'Axioms' at [https://doi.org/10.3390/axioms11080400]

O artigo trata-se de um estudo baseado e fundamentado em uma revisaobibliografica com enfoque qualitativo e tem por objetivo relacionar os conhecimentosda Neurociencia com a Teoria da Aprendizagem Significativa como proposta teoricapara facilitar o processo de aprendizagem significativa de Fisica. Este trabalhotomou por base os resultados de pesquisas anteriores descritos em artigoscientificos, livros, e sites na internet, atraves de consultas a plataformas digitais.Entender como a neurociencia pode contribuir para a aprendizagem significativa noâmbito pedagogico e uma grande preocupacao, pois constantemente o docente sedepara com as questoes de dificuldades de aprendizagem do aluno. Diversosfatores podem estar envolvidos por tras desta problematica, por isso, o estudomostra a importância da relacao entre a neurociencia e a aprendizagem significativa,como mola propulsora do ensino no processo de aprendizagem. Espera-se com estapesquisa que as percepcoes entre Aprendizagem Significativa e a Neurociencia noensino de Fisica possibilitem reflexoes aos professores, buscando alternativas paramelhorar a qualidade e potencializar a aplicabilidade de tais teorias em sala de aula.

The staff of the XAFS beamline BM30B (FAME) at ESRF, France, and more particularly Dr. D. Testemale, are gratefully acknowledged for their help in performing the XAS experiments.; International audience; Application of anaerobically digested sludges and manure (digestates) to agricultural fields reduces the need for fertilizer application, but might also pose environmental risks due to the introduction of various pollutants –including metal trace elements and pharmaceuticals– to amended soils. The simultaneous presence of different contaminants can affect plant uptake, altering the performance of phytoremediation. This work aims to investigate and compare the single and combined effects of Enrofloxacin (Enro) and Cu on their plant uptake from digestate solutions. Plant uptake experiments were carried out by exposing, for 5 days, Phragmites australis to three different concentrations of a liquid digestate doped with Cu and/or Enro. Contaminant concentrations were afterward determined in both plant tissues and digestate solutions. Contaminant speciation in solution and Cu speciation in plant roots were also assessed. Cu plant uptake (mostly in plant roots, Cu concentration varied between 55 and 254 μg·g−1) was observed, especially at low concentration of digestate. At high digestate concentration, Cu uptake decreased due to the formation of Cu-DOC complexes rendering Cu less bioavailable. The presence of the antibiotic slightly further reduced Cu plant uptake due to the formation of Cu-Enro complexes. Plant roots also accumulated Enro, an accumulation also higher for the lowest concentration of digestate (an increase of 40%), and that slightly increased in the presence of Cu (up to 226 μg·g−1). However, proportion of free Enro in solution decreased (up to 70%) in the presence of Cu due to complexation. Cu speciation in plant roots confirmed the implication of the complexation in the uptake of Cu and Enro when they are simultaneously present in solution. Thus, the presence of amendments (such as digestates) increasing the DOC content, in addition to the interactions between contaminants, should be taken into account for field crop soils as well as for phytoremediation technologies.

Study ObjectivesTo describe the characteristics of stridor during sleep (SDS) in a series of adults identified by video-polysomnography (V-PSG).MethodsRetrospective clinical, V-PSG, laryngoscopic, and therapeutic data of patients diagnosed with SDS in a tertiary referral sleep disorders center between 1997 and 2017.ResultsA total of 81 patients were identified (56.8% males, age 61.8 ± 11.2 years). Related etiologies were multiple system atrophy (MSA), amyotrophic lateral sclerosis, spinocerebellar ataxia type 1, anti-IgLON5 disease, fatal familial insomnia, brainstem structural lesions, vagus nerve stimulation, recurrent laryngeal nerve injury, the effect of radiotherapy on the vocal cords, cervical osteophytes, and others. Stridor during wakefulness coexisted in 13 (16%) patients and in MSA was only seen in the parkinsonian form. Laryngoscopy during wakefulness in 72 (88.9%) subjects documented vocal cord abductor impairment in 65 (90.3%) and extrinsic lesions narrowing the glottis in 2 (2.4%). The mean apnea–hypopnea index (AHI) was 21.4 ± 18.6 and CT90 was 11.5 ± 19.1. Obstructive AHI > 10 occurred in 52 (64.2%) patients and central apnea index >10 in 2 (2.4%). CPAP abolished SDS, obstructive apneic events and oxyhemoglobin desaturations in 58 of 60 (96.7%) titrated patients with optimal pressure of 9.0 ± 2.3 cm H20. Tracheostomy in 19 (23.4%) and cordotomy in 3 (3.7%) subjects also eliminated SDS.ConclusionsSDS in adults is linked to conditions that damage the brainstem, recurrent laryngeal nerve, and vocal cords. V-PSG frequently detects obstructive sleep apnea and laryngoscopy usually shows vocal cord abductor dysfunction. CPAP, tracheostomy, and laryngeal surgery abolish SDS.

Obra coordenada por José Eduardo Franco e João Relvão Caetano Tem-se acentuado, nos últimos anos, o aparecimento, um pouco por todos os continentes, de novos estudos e programas de estudo sobre a globalização, especialmente nos países de língua e de influência anglo-saxónica. Ao mesmo tempo, assistimos à multiplicação de abordagens sobre temas e problemas do fenómeno desta nossa era de interconexão entre povos, culturas, religiões e territórios. Muito mais do que uma simples palavra, o termo e o conceito de «globalização» a ele associados afirmam um novo paradigma de conhecimento multidisciplinar, multidimensional, implicando a consideração de diferentes temporalidades e espacialidades e colocando em relação o que até hoje era estudado de forma compartimentada. O conceito de «aldeia global», cunhado pelo canadiano Marshall McLuhan nos anos 60 do século xx, é cada vez mais o conceito-chapéu para desconstruir e reconstruir o conhecimento sobre a realidade, seja ele material-palpável, seja imaterial-psicológico, cultural ou espiritual. Cada vez se abdica mais de ver o mundo a partir do umbigo nacional, o que configurou uma história do saber marcada por um reducionismo político e social, para se passar a olhá-lo com base numa metodologia heteronómica e, por vezes, mesmo heteróclita. info:eu-repo/semantics/publishedVersion

Patient global assessment (PGA) is included in almost all rheumatoid arthritis (RA) composite disease activity indices and definitions of remission. However, different PGA formulations exist and are used interchangeably in research and clinical practice. We investigated how five different PGA formulations used in four disease indices affect the remission rates. This was an ancillary analysis of data from a cross-sectional study in patients with RA. The data comprised the following: 28-joint counts, C-reactive protein, and five PGA formulations. Remission rate variation was assessed using five PGA formulations in each index (ACR/EULAR Boolean, CDAI, SDAI, and DAS28-CRP). PGA agreement was assessed by the following: Pearson's correlation; Bland-Altman plots; paired samples t test; and establishing the proportion of patients who scored (i) all formulations within an interval of 20 mm and (ii) each formulation ≤ 10 mm. This analysis included 191 patients. PGA formulations presented good correlations (≥ 0.65), but Bland-Altman plots showed clinically significant differences, which were statistically confirmed by comparison of means. Just over a half (51.8%) of patients scored all PGA formulations within a 20-mm interval. The proportion of those scoring ≤ 10 mm varied from 11.5 to 16.2%. When different formulations of PGA were used in each index, remission differences of up to 4.7, 4.7, 6.3, and 5.2% were observed. When formulations were used in their respective indices, as validated, the remission rates were similar (13.1, 13.6, 14.1, and 18.3%). Using PGA formulations interchangeably may have implications in the assessment of disease activity and in the attainment of remission, and this can impact upon management decisions.

Hyaluronic acid (HA)-based hydrogels have been widely used as cell culture substrates, adhesives and fillers for clinical therapeutics, and drug delivery vehicles, with promising results. Due to the limited mechanical properties, degradation rates, and biological activity of HA, it is important that HA be chemically modified, cross-linked or reinforced with specific components to confer a versatile range of viscoelastic and biophysical cues. Herein, we present a toolbox comprising of a class of in situ cross-linkable hydrogels encompassing a blend of three components: HA, cellulose nanocrystals (CNCs) and tropoelastin (TROPO). The resulting hydrogels confer tenable mechanical and biological properties which benefit from the merits of the individual components. Incorporation of CNCs enhanced the hydrogelâ s stability against hydrolytic and enzymatic degradation, due to the chemical integration of the nanoparticles within the HA mesh. Additionally, the incorporation of TROPO enhanced elasticity and resilience. Finally, the developed hydrogels demonstrated a positive in vitro biological response as they were able to support and promote the adhesion, viability and growth of the seeded fibroblasts. These results demonstrate a feasible approach for the production of hydrogels exhibiting key structural stability, biological response and improved elastic resilience that can be advantageously explored in acellular and cellular tissue engineering strategies for the regeneration of various tissues, such as the vocal fold., This work was supported by RECOGNIZE project(UTAP-ICDT/CTM-BIO/0023/2014), project NORTE-01–0145-FEDER-000021, and BEAM-Master Joint MobilityProject an EU Australian cooperation in BiomedicalEngineering Grant Agreement, 2014–1843/001 001-CPTEU-ICI-ECP. Pedro S Babo acknowledges his post-docgrant from project PTDC/CTM-BIO/4706/2014-POCI-01-0145-FEDER016716. Rui MA Domingues acknowledgesFCT for SFRH/BPD/112459/2015.

Breast Cancer is the most common invasive cancer in women worldwide. Indeed, it is imperative to investigate which factors influence the development of this disease in order to improve the efficiency of the treatment and to allow for a balanced follow-up. In fact, this article has in mind an original Case Based Reasoning (CBR) approach to problem solving, complemented with a novel approach to Knowledge Representation and Reasoning that takes into consideration the data items entropic states. It works towards cancer’s assessment after Neoadjuvant Chemotherapy in terms of its size, shape, and texture., This work has been supported by COMPETE: POCI-01-0145-FEDER-007043 and FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2013.

The audit expectation gap (AEG) is present in society and, while there, will encourage discrediting the auditors. Given the seriousness of this situation, several solutions have been pointed out, one of which is to promote audit education. The aim of this chapter is to verify if adult education, taught at the Polytechnic Institute of Cávado and Ave (IPCA), reduces the AEG, considering the perceptions of its students about the role assigned to the auditors and the degree of success of the auditors in certain situations. The application of a questionnaire allowed to conclude that, as the literature review showed, audit education changes the perceptions of IPCA students about the role and degree of success of the auditors, generally reducing the AEG.

Background/Aims: Previous studies demonstrated an alteration of diaphragmatic excursion on the paretic side after stroke; however, it is unclear if this change has clinical repercussions. We aimed to determine if there was an association between the paretic side and the laterality of pneumonia after stroke. Methods: A retrospective analysis of a consecutive cohort of patients admitted to a stroke unit from 2008 to May 2016 was performed. Patients with the diagnosis of acute stroke and pneumonia were included. The laterality of pneumonia was determined through the blinded observation of chest X-rays. Fisher's exact test was applied to study the association between the side of paresis and pneumonia. Results: One hundred and five patients were included. Sixty one percent (n = 64) had an ischemic stroke, 39% (n = 41) had brain hemorrhage, and 49.5% (n = 52) had right side paresis. We did not find in general an association between the side of paresis and the side of pneumonia (p = 1.00); however, we found a statistically significant association in patients with severe lower limb paresis (Medical Research Council, MRC ≤2; p = 0.035). Conclusion: We found an association between severe paresis of the lower limb (MRC ≤2) and ipsilateral pneumonia. We hypothesize that the proximity between the diaphragmatic and inferior limb corticospinal pathways could be the reason for this association.

Background Fatigue is one of the most prevalent and disabling symptoms among patients with Rheumatoid Arthritis (RA). However, it is also one of the most neglected by health professionals. Much of this problem is due to health professionals’ poor understanding of the etiology of fatigue and, also, the absence of effective strategies to prevent or treat it. Objectives This study aimed at developing a multidimensional explanatory model of fatigue in patients with RA as means to foster better understanding and care of this symptom. Methods This was an ancillary analysis of an observational, cross-sectional, single centre study. Patients completed a questionnaire that included demographic data and measures of sleep (0–10 Numeric Rating Scale (NRS)), pain (0–10 NRS), disability (HAQ), anxiety and depression (HADS), and personality (TIPI). Fatigue was assessed by the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F). Disease activity (DAS28-CRP3v) and haemoglobin levels were also assessed. Path analysis was performed to test and improve a hypothesised model for fatigue. Results In total, this analysis included 142 patients (83.1% females, mean (SD) age of 61.1 (11.7) years). The final path analysis model (figure 1) presented acceptable fit (Goodness of Fit Index, GFI=0.92; Comparative Fit Index, CFI=0.89; Root Mean Square Error of Approximation, RMSEA=0.10), and explained 60.0% of the variance of fatigue. Depression and disability had the greater direct influences upon fatigue (β=0.412; p Goodness of fit index=0.92; Comparative fit index=0.89; Root mean square error of approximation=0.10. All coefficients in the model presented p Conclusions Depression, disability and sleep disturbance appear to be the main factors explaining fatigue in patients with RA. Disease activity and pain seem to play only a secondary role. These findings foster a shift in the paradigm of patient care towards a more holistic management of fatigue, integrating adjunctive therapies in association with measures driven solely towards abrogation of the inflammatory process. References [1] van Steenbergen HW, et al. Fatigue in rheumatoid arthritis; A persistent problem: a large longitudinal study. RMD Open2015;1:e000041. [2] Nikolaus S, et al. Fatigue and factors related to fatigue in rheumatoid arthritis: A systematic review. Arthritis Care Res (Hoboken)2013;65:1128–46. Acknowledgements We thank study participants who gave their time to take part in this study. We thank the Rheumatology outpatient department medical staff for their assistance with gathering data for this study. We also thank Teresa Neves for statistical advice. Disclosure of Interest None declared

We prove a sufficient optimality condition for non-linear optimal control problems with delays in both state and control variables. Our result requires the verification of a Hamilton-Jacobi partial differential equation and is obtained through a transformation that allow us to rewrite a delayed optimal control problem as an equivalent non-delayed one., This is a preprint of a paper whose final and definite form is with 'Pure and Applied Functional Analysis', ISSN 2189-3756 (print), ISSN 2189-3764 (online). Submitted 10-Dec-2017; revised 18-April-2018; accepted for publication 18-April-2018