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Background: Cognitive dysfunction as a predictor of clinical progression and mortality in multiple sclerosis (MS) is still a matter of debate. Objective: The aim of this study was to explore the long-term outcome associated with neuropsychological performance in a cohort of patients with MS. Methods: A series of 408 MS patients had previously undergone a comprehensive neuropsychological assessment and a contemporaneous neurological evaluation (T1). A retrospective review of the clinical records was conducted 102–192 months after T1. Demographic and clinical data regarding the last clinical appointment with EDSS measurement (T2) were collected and the date of the last clinical contact or death (TS) was recorded. Results: This review revealed that cognitive dysfunction (T1) was associated with higher odds of transitioning from relapsing–remitting course to a progressive disease course (adjusted odds ratio (OR) = 2.29, p = 0.043) and higher hazard of death in the total sample (adjusted hazard ratio (HR) = 3.07, p = 0.006) and the progressive disease course subgroup (adjusted HR = 3.68, p = 0.007), even when adjusting for other covariates. Discussion: The study results demonstrate that cognitive dysfunction in MS is predictive of poorer prognosis and mortality.

RESUMO Interesses e relações de poder ocorrem na avaliação de trabalhos, em processo editorial realizado em periódicos científicos. Tais processos tornam-se mais evidentes em meio a controvérsias científicas. Argumentamos que a atuação de editoras e editores de periódicos é fundamental para compreender como interesses e relações de poder interferem na política editorial, em disputas por estabelecimento ou encerramento de controvérsias. O artigo analisa como políticas editoriais influenciam controvérsias científicas. A controvérsia proposta é o debate sobre o papel do campesinato na questão agrária, disputa orientada por diferentes pressupostos, e localizada principalmente no programa de pesquisa marxista. O corpus de pesquisa é formado por artigos, editoriais, livros e resenhas publicados em três periódicos internacionais de Estudos Agrários: The Journal of Peasant Studies, Journal of Agrarian Change e Agrarian South: Journal of Political Economy, além de entrevistas semiestruturadas com editores. Analisaram-se os conteúdos, a recorrência de temas e a atuação de editoras e editores no fluxo editorial. Diferentes modos de atuação de editoras e editores operam para omitir ou evidenciar posições na controvérsia, direcionando-a para o encerramento ou a continuidade do debate.

The development and potential applications of telemedicine in neonatal resuscitation were reviewed by Donohue and colleagues in 2019, in a manuscript that compiled seminal references in the field [...]

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Em diferentes contextos, Aristides e Catão Censor são paradigmas de figuras históricas que se dedicaram à causa pública. Enfrentando obstáculos de diversa natureza, souberam, apesar dos oponentes à sua estratégia política, manter os seus valores. Por meio da arete e da dynamis distinguiram-se na politeia e atingir a doxa. No entanto, como é muitas vezes inerente à atividade política, isso contribuiu para o ostracismo de Aristides e também Catão Censor conseguiu suscitar a inimizade em vários sectores da sociedade romana. Plutarco, selecionando um conjunto de ações, evidencia um aspeto que é transversal na história do pensamento político: o coletivo e o privado. Aristides, mais do que Catão Censor, consegue valorizar o sentido coletivo da sua ação política em detrimento do bem-estar individual. O que para alguns pode ser falta de ambição, para Aristides é respeito pela justiça e pelo coletivo. Quanto a Catão Censor, distingue-se pelo sucesso com que gere o privado, o que pode ser um sinal de mesquinhez ou grandeza de espírito. No exercício das suas funções políticas, procuraram ambos manter uma conduta moral exemplar, ainda que condicionados por diferentes circunstâncias pessoais e também sociais

Copyright © Ordem dos Médicos 2020, Multiple sclerosis typically affects young women of reproductive age. Therefore, all healthcare professionals involved in the follow-up of multiple sclerosis patients must be prepared to discuss pregnancy and breastfeeding issues and provide the best possible counselling. However, there are still many doubts and heterogeneous clinical approaches partly due to the lack of consensus and guidelines. Concerning the handling of disease modifying therapies during pregnancy and postpartum, existing uncertainties have been complicated by the increase in the number of treatments available in recent years. This article aims to present the state-of-the-art and provide guidance based on the best level of available evidence and expert opinion regarding the management of multiple sclerosis patients at different stages: pregnancy planning, pregnancy, partum, and the postpartum period., Este trabalho teve o financiamento de uma bolsa de investigação da Roche Farmacêutica Química LDA: EPAM129844-G.

Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.

Therapeutic inertia (TI) is defined as a failure to initiate or intensify treatments despite evidence of disease activity. Its prevalence and determining factors in Relapsing-Remitting Multiple Sclerosis (RRMS) patients in Portugal are not known. The main objective of this work was to ascertain the prevalence of TI in RRMS and its determining factors.We conducted a multicentre retrospective observational study of RRMS patients followed in MS Clinics of six Portuguese hospitals with at least one medical appointment in 2018. TI was defined as the absence of treatment initiation or intensification when therapeutic goals were unmet, that is when there was evidence of disease activity based on the definition of "no evidence of disease activity" (NEDA) which refers to absence of clinical relapses, absence of disease progression measured by expanded disability status scale (EDSS) and absence of new disease activity (new T2 lesions/enhancing lesion) on magnetic resonance imaging (MRI) over the period of observation.We included 427 patients with RRMS meeting inclusion criteria, 69.6% females, with a mean age of 41.66 years old. The mean age at diagnosis was 33.17 years old and the average number of years since diagnosis was 8.72. MS relapses were reported on 54 patients. Moderate to severe relapses were reported in 59.3%. Median EDSS score was 1.5. Intention to get pregnant was explicit in 39 patients, representing 18.8% of the women at childbearing age. Among the 365 patients who had an MRI, 23.8% had new T2 lesions and 7.4% had enhancing lesions. Regarding DMT, 72.8% were treated with interferon, glatiramer acetate, teriflunomide, or dimethyl fumarate, 20.6% were under fingolimod, natalizumab, rituximab, and cladribine, and the remaining 6.6% were without treatment. Adverse events were reported in 12.9% of patients, and 10.1% mentioned preferences regarding the treatment. TI was present in 80 (18.7%) patients, representing 54.8% of those with potential to inertia. Patients with a radiologically less active disease, who were already on a DMT and who had no adverse events from their current treatment were more likely to have TI (p0,05). Also, patients followed in centers classified as higher level of care (level 1) had more TI compared with patients followed in centers of levels 2 and 3.TI was present in 1 in 5 patients, exceeding half of the sample with the potential to inertia, corroborating the high prevalence of TI in other studies. The determining factors of TI were the absence of relapses or the occurrence of mild relapses, being already on DMT, absence of adverse events, and follow-up in higher care level centers. TI is a topic rarely addressed in MS and this work highlights the importance of therapeutic optimization in these patients. Further studies should be held to explore the factors that influence TI once they have a great impact on therapeutic decisions.

Background Until recently, intravenous thrombolysis was the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, this treatment option has low recanalization rates in large-vessel occlusions. The search for additional treatments continued until 5 randomized trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT) revealed the superiority of mechanical thrombectomy for anterior circulation large-vessel occlusion. After 1 year of performing thrombectomy with stent retrievers in our tertiary hospital, we intended to answer the question: is it possible to achieve similar results in a "real-world" setting? Methods We analyzed data from our prospective observational registry, compared it with the trials aforementioned, and concluded that the answer is affirmative. Results Our study population of 77 patients, with a mean age of 68,2 years and 48,1% men, is comparable with these trials in much of selection criteria, baseline characteristics, and rate of previous intravenous thrombolysis (72,7%). Recovery of functional independence at 90 days was achieved in almost two thirds of patients, similarly to the referred trials. We devoted special emphasis on fast recanalization, keeping a simple image selection protocol (based on non-enhanced and computed tomography angiography) and not waiting for clinical response to thrombolysis in patients eligible for mechanical thrombectomy. We emphasize a successful recanalization rate of 87% and only 2,6% symptomatic intracranial hemorrhage. Conclusion In summary, mechanical thrombectomy seems to be a safe and effective treatment option in a " real-world " scenario, with results similar to those of the recent randomized controlled trials.

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.

O modelo homérico está muito presente no poema épico Posthomerica de Quinto de Esmirna, e, por isso mesmo, o poeta, durante o Renascimento, foi considerado homerikotatos. No entanto, a par da aemulatio, há vários elementos que denotam a intenção de transformar e reescrever alguns episódios mitológicos, numa construção poética que deixa transparecer características próprias da sua época. Nesse sentido, propomo-nos identificar e analisar alguns desses traços inventivos, seleccionando episódios suficientemente representativos da épica mitológica de Quinto de Esmirna. The homeric model is conspicuously evident in the epic Posthomerica by Quintus Smyrnaeus. For this reason, Quintus was considered as a homerikotatos in Renaissance. Nevertheless, alongside aemulatio, there are a series of topics that denote the intention of transforming and rewriting some mythological episodes, in a poetic construction that reveals some characteristics of Quintus’ times. As such it is the aim of this research to identify and analyse some of those inventive features by selecting some of the most representative episodes of Quintus’ poem. info:eu-repo/semantics/publishedVersion

Este trabalho destaca a relevância da investigação sobre controvérsias para a compreensão da produção e circulação do conhecimento científico. O objetivo é analisar como controvérsias científicas são permeadas por fatores extracientíficos que influenciam a validação e a circulação dos resultados de pesquisas pela comunidade acadêmica. O trabalho foi realizado pela reconstrução de controvérsias a partir da identificação de temas geradores e de diferentes participantes que convergiram ou divergiram em posições e argumentos. O corpus de pesquisa foi constituído de artigos científicos, capítulos de livros, artigos de jornais e revista de grande circulação que publicizaram as controvérsias. O estudo aponta que, por meio do estudo de controvérsias, é possível compreender que a atividade científica pode ser afetada por fatores sociais e os pressupostos de neutralidade e objetividade perdem poder explicativo diante de negociações sociais para aceitação do conhecimento científico.

O tratado De esu carnium (Sobre comer carne) chegou-nos na forma de dois logoi, com múltiplas lacunas, sobretudo o segundo logos. Recuperando temáticas já desenvolvidas pela doutrina pitagórica, por Xenócrates, por Teofrasto ou pelos Estóicos, Plutarco argumenta sobre a natureza dos seres vivos, no âmbito da relação entre homem e animal. À semelhança de outros tratados do corpus plutarcheum, como Bruta animalia ratione uti (Os animais são racionais), mais conhecido por Gryllus (Grilo), ou o De sollertia animalium (Sobre a inteligência dos animais), a narrativa desenvolve-se em torno de questões relacionadas com a natureza e a psicologia dos animais, como a possibilidade de existir virtude e razão entre os animais, defendendo Plutarco a philanthropia e a generosidade com que se deve tratar todos os seres vivos, opondo-se, dessa forma, ao simples utilitarismo ou ao problemático princípio da necessidade. Sendo um dos tratados zoológicos, o De esu carnium é também um texto de carácter retórico pelo facto de Plutarco construir, por oposição aos Estóicos, uma teoria argumentativa que sustenta a ideia de que comer carne é παρὰ φύσιν (‘contra a natureza’).

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