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ObjectivesThis study aimed to systematically appraise risk factors associated with SARS-CoV-2 infection in high-income countries during the period of predominance of the Alpha variant (January 2020 to April 2021).MethodsFour electronic databases were used to search observational studies. Literature search, study screening, data extraction and quality assessment were conducted by two authors independently. Meta-analyses were conducted for each risk factor, when appropriate.ResultsFrom 12,094 studies, 27 were included. The larger sample size was 17,288,532 participants, more women were included, and the age range was 18–117 years old. Meta-analyses identified men [Odds Ratio (OR): 1.23, 95% Confidence Interval (CI): 1.97–1.42], non-white ethnicity (OR: 1.63, 95% CI: 1.39–1.91), household number (OR: 1.08, 95% CI: 1.06–1.10), diabetes (OR: 1.22, 95% CI: 1.08–1.37), cancer (OR: 0.82, 95% CI: 0.68–0.98), cardiovascular diseases (OR: 0.92, 95% CI: 0.84–1.00), asthma (OR: 0.83, 95% CI: 0.75–0.92) and ischemic heart disease (OR: 0.82, 95% CI: 0.74–0.91) as associated with SARS-CoV-2 infection.ConclusionThis study indicated several risk factors for SARS-CoV-2 infection. Due to the heterogeneity of the studies included, more studies are needed to understand the factors that increase the risk for SARS-CoV-2 infection.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244148, PROSPERO registration number, CRD42021244148.

Las personas utilizamos vestuarios en diferentes espacios y contextos deportivos. Por lo general, estos espacios son altamente sexuados y están pensados para que mujeres y hombres cisexuales los utilicen de forma separada. Por su fuerte carácter sexuado, los vestuarios generan incomodidad y conflicto en aquellas personas en las que su identidad de género no corresponde con su sexo asignado al nacer. De hecho, diversos estudios han considerado éstos como uno de los espacios más problemáticos para las personas trans. En concreto, los vestuarios que no cuentan con mecanismos que velen por la privacidad de los cuerpos, exigen su exposición pública, control y vigilancia. Las reacciones sociales que suscita dicha exposición en las personas que ocupan estos espacios son clave para comprender cómo estos espacios afectan especialmente a la autoestima y autoconcepto de las personas trans así como su vinculación con el deporte y la actividad física. Para conocer las experiencias y situaciones que tienen lugar en los vestuarios deportivos, en este estudio analizamos 43 entrevistas semidirigidas realizadas a personas trans. Los resultados muestran que estos espacios son relevantes para la construcción de la identidad de género de las personas trans y que el malestar e incomodidad que sienten en ellos afecta a su grado de compromiso y disfrute con las prácticas físico-deportivas. Las instituciones deportivas y lxs trabajadorxs sociales deben tener en consideración estas experiencias si desean promocionar el deporte y la actividad física en las personas trans. Los vestuarios se convierten pues en espacios de intervención social para mejorar el acceso y disfrute de las personas trans en estos espacios deportivos.

Se presenta una nueva localidad paleontológica del Ordovícico del noroeste de España, ubicada en el flanco meridional del sinclinorio de Vega de Espinareda, al norte de Ponferrada (provincia de León). Se trata de la octava localidad con fósiles esqueléticos encontrada en la Formación Agüeira (Ordovícico Superior) del Dominio del Navia-Alto Sil de la Zona Asturoccidental-leonesa, y la primera ubicada en la mitad inferior de la formación. El nuevo yacimiento se sitúa muy próximo a su sección de referencia de la garganta fluvial entre las localidades de Congosto y Santa Marina del Sil, donde estos niveles eran interpretados como facies distales de un abanico submarino, en una sedimentación predominantemente turbidítica. Pero los trilobites, moluscos y braquiópodos encontrados, que por su escasa a nula desarticulación no parecen transportados, revelan una asociación propia de ambientes de plataforma mucho más someros, con fondos oxigenados como revela la alta concentración de galerías horizontales. La presencia de los trilobites Colpocoryphe grandis (Šnajdr) y Dalmanitina n. sp. (D. rabanoae Pereira, n. n.) indica una edad Berouniense temprano (= Sandbiense temprano), lo que abre la posibilidad de que el límite Ordovícico Medio/Superior se sitúe en los 400-450 m basales de la Fm. Agüeira en el sector estudiado.

Abstract Immunological memory is critical for immune protection, particularly at epithelial sites, which are under constant risk of pathogen invasions. To counter invading pathogens, CD8+ memory T cells develop at the location of infection: tissue-resident memory T cells (TRM). CD8+ T-cell responses are associated with type-1 infections and type-1 regulatory T cells (TREG) are important for CD8+ T-cell development, however, if CD8+ TRM cells develop under other infection types and require immune type-specific TREG cells is unknown. We used three distinct lung infection models, to show that type-2 helminth infection does not establish CD8+ TRM cells. Intracellular (type-1) and extracellular (type-3) infections do and rely on the recruitment of response type-matching TREG population contributing transforming growth factor-β. Nevertheless, type-1 TREG cells remain the most important population for TRM cell development. Once established, TRM cells maintain their immune type profile. These results may have implications in the development of vaccines inducing CD8+ TRM cells.

IntroductionHeart failure (HF) is the leading cause of hospitalization in the elderly in developed countries and significantly impacts public health expenditures. Patients with HF usually have associated comorbidities that require multidisciplinary management. This study aims to demonstrate the benefits of a multidisciplinary clinic in reducing all-cause hospitalizations and HF events (HF hospitalizations and urgent HF visits) in a real-world setting. Finally, the study evaluates the associated costs of HF events.MethodsThis observational study included patients admitted to GEstIC, a multidisciplinary Portuguese HF clinic, from January 2013 to February 2019, who had one-year follow-up. Hospitalizations and HF events, total days spent in the hospital during HF hospitalizations, and HF events-related costs, in the year before and the year after GEstIC admission, were compared.ResultsOf the 487 patients admitted to the GEstIC, 287 were eligible for the study sample. After one year of HF patients' multidisciplinary management at GEstIC, there was a 53.7% reduction in all-cause hospitalizations (462 vs. 214), a 71.7% reduction in HF hospitalizations (392 vs. 111), and a 39.1% reduction in urgent HF visits (87 vs. 53). As a result, there was a significant decrease of 12.6 days in the length of hospital stay due to HF per patient (15.6 vs. 3.0, p 40%. Before GEstIC, there was no medical intervention to improve the prognosis of these patients. The reduction of over one million euros in health-related costs after only one year of person-centered multidisciplinary management highlights the need to replicate this approach in other national healthcare institutions.

Green algae, phylum Chlorophyta, due to their green appearance as higher plants, are seen as one of the raw materials to be widely used by humanity for different purposes. How can these different purposes achieve ONU Sustainable Development Goals? The genus Ulva sp. is widely distributed through all continents, tolerating different ecosystems (freshwater and marine), different intensities of light, temperature, and salinity. The Ulva sp. life cycle is isomorphic and biphasic type, also affected by biotic factors such as thallus age, phytohormones, microbiome, sporulation inhibitors and metabolomic. Due to that, types of farming can be implemented depending on the cultivation method and it is final biomass exploitation. Thus, this critical review analyzes the laminar Ulva species from the ecology and demonstrates that the seaweed biomass application, may make significant contributions to marine ecosystems, humans, aquaculture, and biotechnological innovation, indicating its importance in both environmental and socioeconomic contexts based on experiments across the world, time and critical thinking. This means that explaining the actual road and future roads of laminar Ulva into a multi-tool development from humankind welfare. With right management of resources and human empowerment, Ulva sp. products can be produced facing climate change and support different industries. However, responsible management of Ulva populations and farming is essential to prevent overgrowth, green floods, and maintain environmental equilibrium.

Introduction: Platypnea-orthodeoxia syndrome (POS) is a rare disorder characterized by dyspnoea and oxygen desaturation in the upright position which improves in the supine position. Clinical case: 84 years old woman with hypertension and Parkinson disease. She came to the emergency department complaining of dyspnoea. At admission she was polypneic (35 bpm), spO2 80%, 157/108mmHg, 115bpm, apyretic, normal pulmonary auscultation and without peripheral oedema. Oxygen supplementation was started with lack of response. The patient, which at first was lying in the bed with the headboard at 45º, recovered the peripheral oxygen saturation to 96-97% when the bed was placed at 0º. Diagnostic tests were performed, excluding cardiac myocardial infarction, pulmonary embolism and pneumonia. Transthoracic echocardiogram revealed an aneurysmatic interauricular septum with transoesophageal echocardiogram showing an interauricular communication ostium secundum type with a septal aneurysm that led to a right to left shut. The anatomical and clinical features did not allowed percutaneous or surgical closure. After a group discussion we decided for palliative care. Discussion: POS due to a septal aneurysm with right-to-left shunt is a rare and difficult diagnose because it requires a detailed medical examination and exclusion of any other possible diseases. Besides that, it is a very rare presentation in such an old person.

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that presents a largely unknown etiopathology. The presence of reactive astrocytes in MS lesions has been described for a long time; however, the role that these cells play in the pathophysiology of MS is still not fully understood. Recently, we used an MS animal model to perform high-throughput sequencing of astrocytes’ transcriptome during disease progression. Our data show that astrocytes isolated from the cerebellum (a brain region typically affected in MS) showed a strong alteration in the genes that encode for proteins related to several metabolic pathways. Specifically, we found a significant increase in glycogen degradation, glycolytic, and TCA cycle enzymes. Together with these alterations, we detected an upregulation of genes that characterize “astrocyte reactivity”. Additionally, at each disease time point we also reconstructed the morphology of cerebellum astrocytes in non-induced controls and in EAE animals, near lesion regions and in the normal-appearing white mater (NAWM). We found that near lesions, astrocytes presented increased length and complexity compared to control astrocytes, while no significant alterations were observed in the NAWM. How these metabolic alterations are linked with disease progression is yet to be uncovered. Herein, we bring to the literature the hypothesis of performing metabolic reprogramming as a novel therapeutic approach in MS.

Middle Ordovician successions occur at Naturtejo UNESCO Global Geopark in five Variscan-folded, kilometer- to tens of kilometer-long structures. Four of them revealed to be fossiliferous in the different recognized lithostratigraphic units, middle-to-uppermost Darriwilian in age, with particular emphasis for Brejo Fundeiro (Oretanian regional chronostratigraphic stage) and Fonte da Horta (Dobrotivian regional stage) formations. Recent paleontological and biostratigraphic works have detected most of the previously recorded and new fossil sites, improving the Middle Ordovician biostratigraphy of this region and updating the knowledge of its fossil assemblages, which are fairly more diverse than previously considered. The good preservation of the fossils and their relevance to understanding the climax of the Global Ordovician Diversification Event at high paleolatitude shallow marine environments, as well as the protection or identification of some of the fossil sites as UNESCO Geopark’ geosites, make certain their interpretation and use in already existing geotrails and new interpretation centers and school programs.

Naturtejo UNESCO Global Geopark (Portugal) area includes deposits from the Neoproterozoic to the Quaternary. Despite its limited exposure area in major Variscan folded structures, the Ordovician series hosts some of its most famous geological heritage features, such as the Penha Garcia Ichnological Park. The Upper Ordovician of the Central Iberian Zone is still far from being as well-understood as it is in other areas. Extensional tectonics, magmatism, global eustatic and climatic changes generated a great variability of sequences in a reduced geographical area. The Upper Ordovician of the Naturtejo region, often considered poorly represented, is here demonstrated to have a great potential and to be more complete than previously assumed. New stratigraphic and paleontologic data are presented for the three Upper Ordovician-bearing structures within Naturtejo: Fajão-Muradal, Vila Velha de Ródão and Penha Garcia synclines. Remobilized upper Katian fossiliferous clasts were found for the first time within the Hirnantian Casal Carvalhal from the Fajão-Muradal Syncline and a new fossil site is added to the Orvalho GeoTrail. In the Vila Velha de Ródão Syncline, the Barroca da Senhora stream fossil site constitutes a new geosite within the protected area of Portas de Ródão Natural Monument, presenting the most complete Upper Ordovician sequence of this structure. Finally, the stratigraphic and paleontologic record of the Vale Feitoso estate offers all the conditions to propose a new theme geotrail, diversifying the tourism in the Monfortinho village (Penha Garcia Syncline).

The giant Ordovician trilobites from the Canelas quarry constitute the most iconic sign of identity of the Arouca UNESCO Global Geopark at an international level. Palaeontological studies determined the importance of this fossil locality for studying aspects of the social behavior of these marine arthropods and their interactions with other represented invertebrate fossil groups. Although part of the famous ‘gigantism’ of the fossils represented in the slate quarry is due to tectonic expansion, which is responsible for one-third of the outstanding size of the fossils, there is no doubt that this locality, sometimes considered as a fossil lagerstätte, has a great scientific interest and represents a unique international reference among the geological heritage of Portugal. The construction of an on-site museum and the establishment of a geotrail around the quarry have turned this geosite into an example of cooperation between extractive industry, education, science and sustainable development. The formal partnership established with the AGA – Arouca Geopark Association reinforces the projection of this geosite, allowing its disclosure in exhibitions and educational programs, as well as the collaboration with the scientific community.

The superior vena cava syndrome refers to a medical emergency resulting from superior vena cava compression, which develops in 2%-4% of non-Hodgkin lymphomas. Primary mediastinal (thymic) large B-cell lymphoma is an unusual and aggressive non-Hodgkin lymphoma that can present with superior vena cava syndrome.We report the case of a Caucasian 21-year-old female, who presented with acute superior vena cava syndrome, having started 2 weeks before. Chest computerized tomography disclosed an anterior mediastinal mass (18 × 14 cm). Thoraco-abdominopelvic magnetic resonance imaging was performed in order to differentiate compression versus mass invasion. A gross anterior mediastinal mass (109 × 60 × 105 mm) occupying the totality of the prevascular space was found, extending from the sternal furcula to the pericardium, fully embedding the superior vena cava. A computerized tomography guided biopsy was performed. Histopathological and immunohistochemical analysis was consistent with Primary mediastinal (thymic) large B-cell lymphoma.Primary mediastinal (thymic) large B-cell lymphoma has unique clinicopathologic aspects and it should be considered in a young patient with Superior vena cava syndrome. Prompt recognition, a timely diagnosis and appropriate treatment are crucial for prognosis.

(1) Background: Acetaminophen (APAP), an active component of many analgesic and antipyretic drugs, is one of the most concerning trace contaminants in the environment and is considered as an emergent pollutant of marine and aquatic ecosystems. Despite its biodegradability, APAP has become a recalcitrant compound due to the growth of the global population, the ease of availability, and the inefficient wastewater treatment applied. (2) Methods: In this study, we used a transcriptomic approach to obtain functional and metabolic insights about the metabolization of APAP by a phenol-degrading fungal strain, Penicillium chrysogenum var. halophenolicum. (3) Results: We determined that the transcriptomic profile exhibited by the fungal strain during APAP degradation was very dynamic, being characterized by an abundance of dysregulated transcripts which were proportional to the drug metabolization. Using a systems biology approach, we also inferred the protein functional interaction networks that could be related to APAP degradation. We proposed the involvement of intracellular and extracellular enzymes, such as amidases, cytochrome P450, laccases, and extradiol-dioxygenases, among others. (4) Conclusions: Our data suggested that the fungus could metabolize APAP via a complex metabolic pathway, generating nontoxic metabolites, which demonstrated its potential in the bioremediation of this drug.

Decision support visualization tools provide insights for solving problems by displaying data in an interactive, graphical format. Such tools can be effective for supporting decision-makers in finding new opportunities and in measuring decision outcomes. In this study, was used a visualization tool capable of handling multivariate time series for studying a problem of operational control in a textile manufacturing plant; the main goal was to identify sources of inefficiency in the daily production data of three machines. A concise rule-based model of the inefficiency measures (i.e. quantitative measures were transformed into categorical variables) was developed and then performed an in-depth visual analysis using a particular technique, the categorical time series plots stacked vertically. With this approach were identified a wide array of production inefficiency patterns, which were difficult to identify using standard quantitative reporting - temporal pattern of best and worst performing machines - and critically, along with most important sources of inefficiency and some interactions between them were revealed. The case study underlying this work was further contextualized within the state of the art, and demonstrates the effectiveness of adequate visual analysis as a decision support tool for operational control in manufacturing.

Background: Multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region. The aim of this work is to present a patient that lacks the three classic orofacial manifestations but has other less common clinical alterations. Case presentation: A 49-year-old female patient diagnosed with long-term relapsing–remitting multiple sclerosis visited the dentist complaining of mild but persistent orofacial pain including the temporomandibular joint and pain not specific to any tooth. She presented mucosal irritation, xerostomia, halitosis, and localized gingivitis. There was excessive wear of the upper and lower incisal edges and the occlusal faces of the upper canines and loss of six teeth due to caries. After a clinical oral examination, the diagnosis was temporomandibular joint disorder, gingivitis, dental hypersensitivity, bruxism, hyposalivation, xerostomia, and halitosis. Conclusions: Patients with multiple sclerosis present classic orofacial manifestations. Although these were not observed in this patient, she had others, such as gingivitis, tooth hypersensitivity, and bruxism. In addition, despite few studies associating a higher prevalence of caries with these patients, the number of carious and missing teeth in this patient highlight the evidence that multiple sclerosis has had a significant impact on the patient’s dental status over the years.

A worldwide increase in longevity is bringing novel challenges to public health and health care professionals. Cognitive impairment in the elderly may compromise living conditions and precede Alzheimer’s disease (AD), the most prevalent form of dementia. Therefore, finding molecular markers associated with cognitive impairment is of crucial importance. Lipocalin 2 (LCN2), an iron-related protein, has been suggested as a potential marker for mild cognitive impairment (MCI) and AD. This study aimed at investigating the association between LCN2 measured in serum and cerebrospinal fluid (CSF) with cognitive impairment. A cross-sectional design based on two aging cohorts was used: individuals diagnosed with subjective cognitive complaints (SCC), MCI, and AD from a Swedish memory clinic-based cohort, and individuals diagnosed with SCC and AD from a Portuguese cohort. Binary logistic [for the outcome cognitive impairment (MCI + AD) in the Swedish cohort and AD in the Portuguese cohort] and multinomial logistic (for the outcomes MCI and AD) regression analyses were used. No associations were found in both cohorts when controlling for sex, education, and age. This explanatory study suggests that the association between serum and CSF LCN2 concentrations with cognitive impairment reported in the literature must be further analyzed for confounders.

A genuine and functional lymphatic vascular system is found in the meninges that sheath the central nervous system (CNS). This unexpected (re)discovery led to a reevaluation of CNS fluid and solute drainage mechanisms, neuroimmune interactions and the involvement of meningeal lymphatics in the initiation and progression of neurological disorders. In this manuscript, we provide an overview of the development, morphology and unique functional features of meningeal lymphatics. An outline of the different factors that affect meningeal lymphatic function, such as growth factor signaling and aging, and their impact on the continuous drainage of brain-derived molecules and meningeal immune cells into the cervical lymph nodes is also provided. We also highlight the most recent discoveries about the roles of the CNS-draining lymphatic vasculature in different pathologies that have a strong neuroinflammatory component, including brain trauma, tumors, and aging-associated neurodegenerative diseases like Alzheimer’s and Parkinson’s. Lastly, we provide a critical appraisal of the conundrums, challenges and exciting questions involving the meningeal lymphatic system that ought to be investigated in years to come.

Microglia have been increasingly implicated in neurodegenerative diseases (NDs), and specific disease associated microglia (DAM) profiles have been defined for several of these NDs. Yet, the microglial profile in Machado–Joseph disease (MJD) remains unexplored. Here, we characterized the profile of microglia in the CMVMJD135 mouse model of MJD. This characterization was performed using primary microglial cultures and microglial cells obtained from disease-relevant brain regions of neonatal and adult CMVMJD135 mice, respectively. Machine learning models were implemented to identify potential clusters of microglia based on their morphological features, and an RNA-sequencing analysis was performed to identify molecular perturbations and potential therapeutic targets. Our findings reveal morphological alterations that point to an increased activation state of microglia in CMVMJD135 mice and a disease-specific transcriptional profile of MJD microglia, encompassing a total of 101 differentially expressed genes, with enrichment in molecular pathways related to oxidative stress, immune response, cell proliferation, cell death, and lipid metabolism. Overall, these results allowed us to define the cellular and molecular profile of MJD-associated microglia and to identify genes and pathways that might represent potential therapeutic targets for this disorder.

Muscle invasive bladder cancer (MIBC, stage ≥T2) is generally associated with poor prognosis, constituting the second most common cause of death among genitourinary tumours. Due to high molecular heterogeneity significant variations in the natural history and disease outcome have been observed. This has also delayed the introduction of personalized therapeutics, making advanced stage bladder cancer almost an orphan disease in terms of treatment. Altered protein glycosylation translated by the expression of the sialyl-Tn antigen (STn) and its precursor Tn as well as the activation of the PI3K/Akt/mTOR pathway are cancer-associated events that may hold potential for patient stratification and guided therapy. Therefore, a retrospective design, 96 bladder tumours of different stages (Ta, T1-T4) was screened for STn and phosphorylated forms of Akt (pAkt), mTOR (pmTOR), S6 (pS6) and PTEN, related with the activation of the PI3K/Akt/mTOR pathway. In our series the expression of Tn was residual and was not linked to stage or outcome, while STn was statically higher in MIBC when compared to non-muscle invasive tumours (p = 0.001) and associated decreased cancer-specific survival (log rank p = 0.024). Conversely, PI3K/Akt/mTOR pathway intermediates showed an equal distribution between non-muscle invasive bladder cancer (NMIBC) and MIBC and did not associate with cancer-specif survival (CSS) in any of these groups. However, the overexpression of pAKT, pmTOR and/or pS6 allowed discriminating STn-positive advanced stage bladder tumours facing worst CSS (p = 0.027). Furthermore, multivariate Cox regression analysis revealed that overexpression of PI3K/Akt/mTOR pathway proteins in STn+ MIBC was independently associated with approximately 6-fold risk of death by cancer (p = 0.039). Mice bearing advanced stage chemically-induced bladder tumours mimicking the histological and molecular nature of human tumours were then administrated with mTOR-pathway inhibitor sirolimus (rapamycin). This decreased the number of invasive lesions and, concomitantly, the expression of STn and also pS6, the downstream effector of the PI3K/Akt/mTOR pathway. In conclusion, STn was found to be marker of poor prognosis in bladder cancer and, in combination with PI3K/Akt/mTOR pathway evaluation, holds potential to improve the stratification of stage disease. Animal experiments suggest that mTOR pathway inhibition could be a potential therapeutic approach for this specific subtype of MIBC.

Due to their toxicity, especially their carcinogenic potential, polycyclic aromatic hydrocarbons (PAHs) are considered priority in biomonitoring programmes. Many of these compounds are listed through the European Water Framework Directive as priority pollutants. Benzo(b)fluoranthene (B[b]F), considered potentially carcinogenic, and phenanthrene (Phe), non-carcinogenic, are two common PAHs in coastal waters and own distinct proprieties that are reflected in their mechanisms of toxicity. Still, their interaction effects onto the aquatic biota remain largely unknown. This work aimed to analyze the genotoxic effects caused by the interaction of B[b]F and Phe and their relation to histopathological alterations in the liver. The model organism was the seabass Dicentrarchus labrax, an important coastal species for fisheries and aquaculture. For the purpose, fish were injected with the two compounds (5 µg/g fish ww), isolated or in mixture, and incubated for 24h. The results only revealed minor clastogenic and aneugenic alterations, determined through erythrocytic nuclear abnormalities. On the other hand, the Comet assay showed significant DNA strand breakage in the individuals injected with B[b]F and the combination of the two compounds. On the contrary, Phe failed to cause significant genotoxic effects. Significant hepatic histopathological alterations were also found in animals injected with B[b]F, relating especially to inflammation-related responses. Overall, the results indicate no significant additive effect between B[b]F and Phe, under the current experimental conditions. Nonetheless, the seabass revealed to be sensitive to exposure to B[b]F (a higher molecular weight PAH), likely due to more efficient bioactivation of the pollutant (yielded genotoxic metabolites and reactive oxygen species), when compared to Phe. It is of paramount importance to understand the long-term interaction effects between PAHs under ecologically-relevant scenarios, since PAHs, like many other toxicants, are usually present in the aquatic environment as a complex mixture of xenobiotics.

Because the metabolic syndrome (MS) poses a growing public health problem, it is crucial to identify related modifiable risk factors. The MS is a multifaceted syndrome, however, physical activity (PA) is thought to be one of the protective factors in MS occurrence. The purpose of this study is to analyse recent literature on the association between PA and MS. Studies seem to agree in the protective effect of PA in MS occurrence, but associations are only seen in moderate or high PA levels. Differences observed in studies are probably related to different study methods. According to recent literature adequate PA levels can help to lower the risk of developing MS; PA can decrease body weight, visceral fat accumulation, improve insulin sensitivity, decrease plasma level of triglycerides, increase plasma levels of HDL cholesterol and decrease blood pressure.

Hypertension is a major cardiovascular risk factor. The treatment of the individual with hypertension is aimed to reduce cardiovascular mortality and morbidity. With such aim the management of hypertension goes beyond arterial pressure lowering and involves the treatment of thrombotic risk with antiplatelet therapy, treatment of hyperlipidemia with lifestyle measures and statins, and diabetes prevention with lifestyle measures. For the hypertensive patient with concomitant cardiovascular disease or diabetes, pharmacological treatment is consensual. However, in primary prevention the institution of drug therapy must be judicious to guarantee that benefit surpass costs.

Stroke remains an important cause of death, hospitalisation and chronic disability in developed populations. This study aimed to evaluate patients characteristics at admission that relate to length of hospital stay, mortality and destination of stroke patients. We studied 255 consecutive stroke patients admitted to internal medicine wards of Hospital São João, Porto. In-hospital mortality was 5.5%. In a multivariate analysis, we found male sex, paralysis in affected limb and intracerebral haemorrhage as significantly associated with longer hospitalisation. None of the studied characteristics was found to be independently associated with mortality. Previously living at an institution was significantly associated with discharge to an institution. This study showed that admission characteristics may provide relevant information to assess short term prognosis and to identify patients with special difficulties and needs.