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Acta médica portuguesa 35(2), 127-134 (2022). doi:10.20344/amp.15031, Published by Ordem dos Médicos, Lisboa

Contrary to anterior circulation, the legitimacy of endovascular treatment in posterior circulation stroke is still being questioned. Finding reliable prognostic factors and determining how patient selection should be done has become top priority.Observational and retrospective study from two Portuguese hospitals, including all consecutive patients with posterior circulation occlusions who underwent thrombectomy between January 1st 2015 and December 31st 2019.Out of a total of 126 patients, the median age was 74 (IQR 61-80) and 39.7% were female. A good clinical outcome (mRS ≤2) was associated with a lower incidence of coma (24,2% vs 66,7%, p 0,001) and of sudden onset coma (3% vs 18%,=0,04), a lower NIHSS at admission (14 vs 19, p 0,001), a higher pc-ASPECTS at admission (10 vs 9, p 0,001) and at 24 h (8 vs 6, p 0,001) and a higher BATMAN score (7 vs 6, p = 0,017). Differences in the times of symptom-onset-to-recanalization (496 vs 536, p = 0,19) and symptom-onset-to-coma (130 vs 195, p = 0,52) were not remarkable. When excluding NIHSS and pc-ASPECTS at 24 h, coma (p = 0,003; OR=0,22; 95% CI: 0,08-0,59) and the pc-ASPECTS at admission (p = 0,037; OR=1,63; 95% CI: 1,03-2,57) become independent predictors of good outcome.In strokes from the posterior circulation, coma, more than time, appears to be an important prognostic factor. The BATMAN and the pc-ASPECTS scores were also associated with clinical outcome and coma.

Multiple sclerosis (MS) is an inflammatory disease that may also be associated with vascular dysfunction. One master component of vascular regulation is cerebral autoregulation (CA). We aimed to investigate the integrity of CA in MS patients and study its relationship with autonomic dysfunction (AD), magnetic-resonance-imaging (MRI) lesion load and hemodynamic parameters. We enrolled 20 relapsing-remitting MS and 20 healthy subjects. CA was assessed by transfer function analysis parameters (coherence, gain and phase), as obtained in the very low, low and high-frequency domains (VLF, LF, HF, respectively). We evaluated the autonomic parameters heart rate variability and spontaneous baroreflex sensitivity (BRS). There were no significant differences in CA parameters between MS and controls (p > 0.05). Lesion load was not correlated with any CA parameter. LF gain was positively correlated with BRS in both groups (MS: p = 0.017; controls: p = 0.025). Brainstem lesion load in MS was associated with higher systolic blood pressure (SBP; p = 0.009). Our findings suggest that CA is preserved in our MS cohort. On the other hand, AD in MS patients with brainstem lesions could contribute to the increase of supine SBP. Whether this systemic deregulation could contribute to disease burden remains to be investigated.

This project is composed by a strategic analysis of the business ecosystem and value creation for the implementation of a touristic route. The main purpose was to construct theoretical frameworks for the analysis of the networks and value creation in tile tourism, enabling the analysis of a possible “Rota do Azulejo”. The project states that relations inside the network are crucial and underlines the importance of stakeholders in the creation of value. This thesis constitutes a theoretical and critical analysis of the strategic viability of a touristic route, laying the foundations for the development of further analysis and projects

MS-associated autonomic dysfunction (AD) in multiple sclerosis (MS) is poorly understood and the best method for its detection unestablished. We compared classical Ewing battery and newer methods as heart rate variability (HRV) and spontaneous baroreflex sensibility (BRS) to detect AD in MS and related them to central autonomic network (CAN) lesions.We enrolled 20 relapsing-remitting MS patients, median age of 36 (interquartile range 32-46) years, disease duration of 5.5 (2.2-6.8) years, Expanded Disability Status Scale (EDSS) score of 1.0 (1.0-1.5) and 20 age- and gender-matched healthy controls. We assessed Ewing battery and spontaneous HRV and BRS. CAN involvement was evaluated by magnetic resonance imaging.HRV showed both parasympathetic and sympathetic significant impairment in MS (p0.05). From Ewing battery only isometric test was significantly decreased in MS (p=0.006). Disease duration and severity, lesion burden and CAN involvement were not correlated with laboratorial parameters.Our MS cohort had both sympathetic and parasympathetic dysfunction independently from disease duration, neurological deficits and lesion burden or CAN involvement. HRV analysis maybe more useful than classical Ewing battery to screen AD.

No seguimento do estágio curricular realizado no Centro Ciência Viva do Alviela – Carsoscópio (CCVAlv), no âmbito do mestrado em Comunicação de Ciência da Faculdade de Ciências Sociais e Humanas da Universidade Nova de Lisboa (FCSH-UNL) e do Instituto de Tecnologia Química e Biológica (ITQB), surge o presente relatório de estágio. O objectivo deste relatório é criar uma ferramenta de trabalho útil e fundamentada para que futuramente o CCVAlv possa planear, desenvolver e executar um plano estratégico de comunicação de forma a captar e filiar novos públicos, na qual resultará uma maior afluência ao centro, assim como uma maior relevância junto da sociedade. Assim o CCVAlv será capaz de cumprir os seus propósitos de divulgar a ciência e a tecnologia junto de diferentes públicos, fomentando o interesse por estas temáticas, principalmente dos mais jovens. Inicialmente o objectivo do estágio e, consequentemente, deste relatório foi o de ajudar na criação e/ou implementação de um plano estratégico de comunicação no CCVAlv. Contudo, o centro deverá cumprir diferentes pré-requisitos para conseguir criar um plano de sucesso. A desorganização e falta de planeamento, juntamente com dificuldades económicas resultantes em parte da quebra de visitas, torna difícil a definição de um plano de comunicação. O presente relatório contém uma profunda análise ao CCVAlv, desde a sua origem até à actualidade, abordando as diferentes e diversificadas valências que possui e que o tornam num local com potencial para se tornar num centro de ciência de referência. Com base nessa análise surge um diagnóstico de comunicação que contempla diferentes métodos, técnicas e ferramentas que o CCVAlv poderá seguir para criar um plano de comunicação estratégico de sucesso. Durante o relatório é possível encontrar diversas referências ao trabalho desenvolvido durante o estágio curricular e que contribuiram para a percepção de como o CCVAlv actualmente desenvolve o seu trabalho e que ajudaram a redefinir os objectivos do relatório. Após a análise e diagnóstico ao CCVAlv, conclui-se que, apesar das enormes potencialidades que este tem, necessita traçar um rumo bem definido para o seu futuro de forma a captar e filiar novos públicos.

By measuring the apparent diffusion coefficient (ADC) of liver parenchyma and focal hepatic lesions (FHL) we proposed to investigate the utility of ADC in the differential diagnosis of hepatic disease and to determine the influence of region of interest (ROI) characteristics in those measurements.Ninety-three patients with at least one supracentimetric FHL, or parenchymal abnormality, were retrospectively evaluated. Diagnosis was based on histopathologic data or, alternatively, on a combination of consensus between imaging methods and 24 months of follow-up. Ninety lesions were evaluated with respiratory-triggered diffusion-weighted imaging (b values: 50 and 700 s/mm(2)): 14 hepatocellular carcinomas, 18 metastases, 10 focal nodular hyperplasias, four adenomas, 30 hemangiomas and 14 cysts. ADC of hepatic parenchyma was measured by placing ROIs in four different segments, and in FHLs by using three circular 1 cm(2) ROIs and one ROI encompassing the full lesion. Data was statistically analyzed (p 0.05 considered significant), and a receiver operating characteristic curve was assessed to evaluate the accuracy for the diagnosis of malignancy.Our measurements showed that parenchyma ADC was significantly higher in segment II and that ADCs of malignant lesions were significantly lower than those of benign lesions (p 0.001). There was significant overlap between benign solid lesions and malignant lesions and the area under the curve for malignancy was 0.939 (sensitivity 89.7 %, specificity 90.6 %), using a cutoff of 1.43 × 10(-3) mm(2)/s. No significant difference was found between ROIs of different characteristics.ADC measurements can help to characterize FHLs and differentiate normal from pathological parenchyma. Any ROI above 1 cm(2) can provide accurate ADC measurements in homogenous lesions.

A 62-year-old man presented with subacute horizontal binocular diplopia and slight gait imbalance, preceded by frequent episodes of vomiting. The patient had undergone two gastric surgeries for gastric ulcer in the past (in 1988 and 2002). Bilateral internuclear ophthalmoplaegia, conjugate vertical gaze palsy and mild tandem gait abnormalities were observed (video 1, part 1; figure 1). Upper gastrointestinal endoscopy and gastric emptying scintigraphy suggested a delay in gastric emptying. Brain MRI demonstrated hyperintense symmetric areas in the thalami, midbrain tegmentum, quadrigeminal plate and floor of the fourth ventricle, suggesting Wernicke encephalopathy (figure …