Repositório RCAAP

Cardiac rhythm abnormalities are a possibly serious manifestation of epilepsy and seizures. We present a 36-year-old woman with episodes of altered mental status and loss of muscle tone for 20-30 seconds, preceded by déjà vu, bilateral tinnitus and generalized coldness.

Objective: Electroencephalography (EEG) can identify biomarkers of epileptogenesis and ictogenesis. However, few studies have used EEG in the prediction of poststroke seizures. Our primary aim was to evaluate whether early EEG abnormalities can predict poststroke epilepsy. Methods: A prospective study of consecutive acute anterior circulation ischemic stroke patients, without previous epileptic seizures, who were admitted to a stroke unit over 24 months and followed for 1 year. All patients underwent standardized clinical and diagnostic assessment during the hospital stay and after discharge. Video-EEG was performed in the first 72 h (first EEG), daily for the first 7 days, in case of neurological deterioration, at discharge, and at 12 months after stroke. The occurrence of epileptic seizures in the first year after stroke (primary outcome) was evaluated clinically and neurophysiologically during the hospital stay and at 12 months. A telephone interview was also performed at 6 months. The primary outcome was the occurrence of at least one unprovoked seizure (poststroke epilepsy). Secondary outcomes were the occurrence of at least one acute symptomatic seizure and (interictal and/or ictal) epileptiform activity on at least one EEG during the hospital stay for acute stroke. The first EEG variables were defined using international criteria/terminology. Bivariate and multivariate analyses with adjustment for age, admission National Institutes of Health Stroke Scale (NIHSS) score, and Alberta Stroke Program Early CT Score (ASPECTS) were performed. Results: A total of 151 patients were included; 38 patients (25.2%) had an acute symptomatic seizure and 23 (16%) had an unprovoked seizure.The first EEG background activity asymmetry and first EEG with interictal epileptiform activity were independent predictors of poststroke epilepsy during the first year after stroke (P = 0.043 and P = 0.043, respectively). No EEG abnormality independently predicted acute symptomatic seizures. However, the presence of periodic discharges on the first EEG was an independent predictor of epileptiform activity (p = 0.009) during the hospital stay. Significance: An early poststroke EEG can predict epilepsy in the first year after stroke, independently from clinical and imaging-based infarct severity.

This study aimed to characterize, clinically and neurophysiologically, a series of patients with gelastic seizures (GS), including both adults and children. We retrospectively collected patients with GS from epilepsy clinics of five tertiary hospital centres within a single country. Patients were selected through relatives'/caregivers' descriptions, home video and/or video-EEG monitoring. GS were identified through ictal semiology. Thirty-five patients were enrolled; 62.9% had initial GS in infancy, 14.3% in adolescence and 22.8% at adult age. Twenty-six had abnormal MRI: eight presented with hypothalamic hamartoma (HH) and 16 non-HH lesions that included different structural aetiologies and genetic, metabolic and immune aetiologies. All patients with HH had their first GS in infancy or adolescence. For the remaining aetiologies, GS started in infancy in 59.3%, in adolescence in 11.1% and at adult age in 29.6%. Video-EEG data was available for analysis in 11 patients, including seven patients with a non-HH MRI lesion. The ictal onset topography on scalp video-EEG was usually concordant with the MRI lesion (in 6/7 patients) and the most frequent ictal onset was fronto-temporal. In two patients, both video-EEG and MRI suggested a parietal and occipital epileptogenic zone. Aetiologies and patterns of affected topography unrelated to HH are common in patients with GS, and all age groups may manifest with this type of ictal semiology. This ictal manifestation has no lateralizing value and, despite a clear preponderance for hypothalamic, frontal and temporal lobe origins, other brain areas, namely the parietal and occipital lobes, should be considered.

O mundo contemporâneo da comunicação massiva traduz a necessidade de compreender os meios de comunicação e as suas imagens. Aliada à televisão, a publicidade comunica com um grande número de pessoas, procura conhecer os seus estilos de vida, sonhos, desejos e cativa-as para uma identificação pessoal e social. Os mais jovens reconhecem na publicidade televisiva formas de ser, aprender e estar em cidadania, que se reflectem nas suas atitudes perante o consumo. À luz da educação do consumidor e do cidadão, a finalidade deste estudo procura compreender a relação entre o grupo de alunos investigado e a recepção da imagem publicitária televisiva, enquanto representação da realidade. Como objectivos, importa entender o modo como a publicidade é entendida e recebida pelos sujeitos de investigação, como interpretam as suas alterações e os desejos que lhes provoca. Para atingir esses objectivos, instituíram-se como instrumentos de investigação o registo de observação da sessão de visionamento de uma compilação de anúncios publicitários televisivos, o texto livre, escrito pelos alunos, e a entrevista semi-estruturada. O grupo de alunos investigado é composto por 20 elementos do 2º ciclo do ensino básico, na faixa etária entre os 9 e 13 anos, residentes na cidade de Sines. Estes dados foram compreendidos através de uma análise qualitativa de conteúdo e orientados pelos objectivos inerentes às questões das entrevistas, em esquemas interpretativos. O grupo de alunos investigado, na relação com a imagem de publicidade televisiva, revelou três atitudes-padrão: de participação no seu pensamento e comportamento; de consciência sócio-moral e afectiva e de poder sobre as escolhas de compra. As conclusões do presente estudo são ambivalentes. O grupo de investigação considera a publicidade televisiva e valoriza as suas imagens, sem lhes atribuir relevância perante o consumo massivo. Reconhece-a como humorística, descontraída e criativa, embora lhe atribua um teor persuasivo e, em certos casos, fraudulento. Para a construção dos conhecimentos e interpretação das experiências dos mais jovens, considera-se importante o papel dos adultos na sua vida cívica e a ajuda na análise crítica do mundo visual em que vive.

Purpose: Periodic discharges (PDs) are common in acute structural or metabolic brain lesions, but their occurrence during follow-up of epileptic patients in an outpatient setting is rare. Aim of this article was to study whether PDs on the routine outpatient scalp EEG of patients with epilepsy, as compared with nonperiodic epileptiform discharges, are associated with drug refractoriness and the decompensation of epilepsy and particular etiologies. Methods: A retrospective case–control study. EEG reports were screened for PDs and their variants. The inclusion criteria were as follows: a diagnosis of epilepsy, epileptogenic lesion on imaging, or a normal 3-T MRI. Inpatient EEGs or EEGs performed in patients with acute cerebral lesions were excluded. Age- and sex-matched controls presenting with other epileptiform EEG abnormalities were selected, and similar selection criteria were applied. Results: Forty-one patients with PDs and 82 controls were selected. There were no significant differences between the cases and controls in the rates of epilepsy decompensation at the time of EEG collection or drug refractoriness. Stroke, hippocampal sclerosis, and malformations of cortical development were the most frequent etiologies, without significant differences between the groups. Conclusions: By performing a case–control study, the authors have shown that PDs are not a marker of epilepsy decompensation and drug refractoriness and that the finding of PDs is not suggestive of particular epilepsy etiologies, when compared with other epileptiform abnormalities.

This study concerns the use of concepts by children and their thinking strategies playing educational games involving the number concepts of factor, prime, negative number, order relation and approximation. The games were found to constitute a stimulating learning environment and to provide observers a window on students' thinking.

Objective: To evaluate the response to CPAP in patients with chronic insomnia disorder (CID) with OSAS in an unselected patient population including all OSAS severity groups. As a secondary objective, we also wanted to evaluate the differences between patients that improve insomnia symptoms with CPAP and patients that do not improve, specifically evaluating possible gender differences. Methods: Retrospective study of patients with a diagnosis of OSAS treated with CPAP and CID at the first clinical visit, selected from a database of an outpatient sleep clinic of University Hospital. Results: From a database of total of 827 patient, 90 patients were identified with OSAS and CID (53.3% women). Middle / moderate OSAS was diagnosed in 68.9% and severe OSA in 31.1%. Most patients (61.1%) improved insomnia symptoms after CPAP therapy. In the responders group, 58.2% had initial insomnia, 63.6% middle insomnia and 12.7% late insomnia. Responders to CPAP were more frequently women (women 61.8%, men 38.2%, p = 0.035) and there was no other difference between responders and non-responders. On subgroup analysis, this difference was significant only in severe OSAS (women 88.9%, men 31.6%, p = 0.013). Conclusion: In most patients with CID and OSA, there is a consistent reduction of insomnia symptoms with the CPAP use. This factor emphasizes the importance of performing PSG in CID. Insomnia in men with severe OSAS responds less frequently to CPAP suggesting that in these cases the insomnia phenotype is less dependent on the respiratory symptoms.

The Mediterranean aquaculture has been developed mostly in brackish environment in inactive coastal salt production areas. This study aims to utilise Technosols made with aquaculture sediments for Limonium algarvense Erben cultivation. This species that has nutraceutical potential thrives in halophilic environments in the southwest of the Iberian Peninsula and in Morocco. A microcosm assay was set up with plants grown in bottom sediments (C+), commercial substrate (C-), and Technosols with amendments mixture application at 180 g/kg (Tec180) or at 360 g/kg (Tec360). These plants were irrigated with saline (assay 1) and/or with deionised water (assay 2). The bottom pond sediments, coffee wastes and the estuarine water were evaluated for diverse physicochemical parameters. Plant growth was characterised through a combined methodology using morphometric, SEM and physiological analysis. The Technosols were constructed with bottom sediments and a mixture of organic wastes used as amendments. Results revealed that the bottom sediments had low pH 3.2, Corg and extractable P and K contents, and high electroconductivity (EC) and N-NH4 concentration. The estuarine water had a neutral pH, high EC and high Cl-, HCO3-, Na+, Mg2+ and Ca2+ but low N-NO3- content. The Technosols showed a significant increase of pH, Corg, K and P and a decrease in N-NH4 and EC in comparison with sediments. Principal component analysis separated the different experiments in three groups: C-, A1 and A2 assays. The C- was highly correlated with Corg, P, K, N-NO3 parameters and total ascorbate. The A1 assay showed a strong association with Na, Ca and EC parameters, whereas the A2 assay presented a strongly correlation with plant growth. Plants from Technosols had greater development when irrigated with deionised water than under salty irrigation as opposed to plants cultivated in unamend sediments. In conclusion, these results support that highly saline sediments could be valorised through Technosols construction to cultivate plants with saline water, with potential application in the agro-food and pharmaceutical industry.

Glutamic acid decarboxylase (GAD) antibodies (ab) have been associated with rare disorders, such as Stiff-person syndrome, limbic encephalitis, cerebellar ataxia, and temporal lobe epilepsy. Other systemic autoimmune disorders have been linked to antiGAD ab, among them, diabetes mellitus (DM).

Objective: EEG value in possible transient ischemic attacks (TIA) is unknown. We aim to quantify focal slow wave activity (FSWA) and epileptiform activity (EA) frequency in possible TIA, and to analyse its contribution to the final diagnosis of seizures and/or definitive TIA. Methods: Prospective longitudinal study of possible TIA patients evaluated at a tertiary centre during 36 months and with 1-3 months follow-up. EEG was performed as soon as possible (early EEG) and one month later (late EEG). A stroke neurologist established final diagnosis after reassessing all clinical and diagnostic tests. Results: 80 patients underwent an early EEG (45.8 h after possible TIA): 52 had FSWA and 6 of them also EA. Early FSWA was associated with epileptic seizure or definitive TIA final diagnosis (p = .041). Patients with these diagnoses had more frequently early FSWA (19/23; 82.6%) than EA (6/23; 26.1%). 6/13 (46.2%) patients with epileptic seizure final diagnosis had EA.In the late EEG, 43 (58.1%) patients demonstrated persistent FSWA and 3 of them also EA. Persistent FSWA in the late EEG was more frequent in seizures than in TIA patients (91.7% vs. 45.5%). FSWA disappearance was associated with acute vascular lesion on neuroimage. Conclusions: FSWA was the commonest EEG abnormality found in the early EEG of patients with possible TIA, but did not distinguish between TIA and seizure patients. In patients with seizures, FSWA was more common than EA and its presence in the late EEG was more likely in patients with epileptic seizures than with TIA. Significance: The majority of possible TIA patients with the final diagnosis of epileptic seizures do not have EA in the early or late EEG.

A 41-year-old woman with congenital Holt-Oram syndrome, permanent pacemaker, neurogenic bladder with recurrent urinary infections, type 2 diabetes mellitus, and dyslipidemia developed recurrent episodes of somnolence, transient anterograde amnesia, irritability, anorexia, occasional changes in the eating habits (craving for French fries) and subtle derealization feelings (she felt her house and bedroom were different and strange). Her family history was positive for bipolar disorder in a first-degree relative.

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The Mediterranean diet is promoted as one of the healthiest and closely linked to socioecological practices, knowledge and traditions, promoting sustainable food production, and linking geographical origin with food quality and ecosystem services. Consumer adherence to this dietary pattern drives increased consumption of authentic “premium” foods, such as Iberian pig meat and dry-cured ham from Portugal and Spain, argan oil from Morocco, “Djebel” lamb from Tunisia and truffles from Italy and Slovenia, i.e., food products that respond to current ethical, environmental and socially sustainable demands. Geographical indication and appellation of origin can increase traditional food products competitiveness, but the high-value recognition of these products can also lead to economically motivated product adulteration. It is therefore imperative to protect the high added value of these unique food products by ensuring their quality, authenticity, provenance and sustainable production systems. In this review, we provide a critical evaluation of the analytical methods that are currently used for the determination of provenance and authenticity of these Mediterranean products as well as possible strategies for improving the throughput and affordability of the methods discussed.

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This paper describes a qualitative case study dealing with the views about mathematics teaching and learning held by students of a school involved in a experience of new curricula, stressing active methodologies and groupwork. At grade 7, the students noticed important differences in the mathematics classes and welcomed them. At grade 10, students had a general positive attitude towards mathematics but did not perceive major chnages. However, they were very concerned with the implications of this experience for their academic progression.

In heterogeneous environments, dispersal may be hampered not only by direct costs, but also because immigrants may be locally maladapted. While maladaptation affects both sexes, this cost may be modulated in females if they express mate preferences that are either adaptive or maladaptive in the new local population. Dispersal costs under local adaptation may be mitigated if it is possible to switch to expressing traits of locally adapted residents. In a sexual selection context, immigrant females may learn to mate with locally favoured males. Mate‐choice copying is a type of social learning, where individuals, usually females, update their mating preferences after observing others mate. If it allows immigrant females to switch from maladapted to locally adapted preferences, their dispersal costs are mitigated as mate choice helps them create locally adapted offspring. To study if copying can promote the evolution of dispersal, we created an individual‐based model to simulate the coevolution of four traits: copying, dispersal, a trait relevant for local adaptation, and female preference. We contrast two scenarios with copying—either unconditional or conditional such that only dispersers copy—with a control scenario that lacks any copying. We show copying to lead to higher dispersal, especially if copying is conditionally expressed. This leads to an increase in gene flow between patches and, consequently, a decrease in local adaptation and trait‐preference correlations. While our study is phrased with female preference as the learned trait, one may generally expect social learning to mitigate dispersal costs, with consequent feedback effects on the spatial dynamics of adaptation.

Home respiratory care (HRC) is the provision of healthcare services at the place of residence of patients or their families, with the aim of meeting needs mainly resulting from chronic respiratory conditions, permanent disability, or terminal illness. In 2016, an innovative electronic prescription system, PEM-CRD, was fully implemented for HRC services in Portugal. To date, no study has addressed the impact of the execution of this digital innovation. For this purpose, we carried out an analysis of the prevalence and number of prescriptions for people with chronic respiratory diseases receiving HRC in the Lisbon metropolitan area, during 2014–2018, using the information obtained from the PEM-CRD database. The data analysis shows that while the number of patients receiving HRC treatment with a prescription has remained stable over the last four years, the number of prescriptions has significantly dropped since 2016 (2016–2018), with consequent paper and processes efficiency. The implementation of the digital Medical Electronic Prescription for Home Respiratory Care tool (PEM-CRD) and consequent dematerialization of these processes has increased the efficiency of prescribing in HRC. Additionally, the possibility of obtaining data through the PEM-CRD allows the monitoring of the evolving prevalence of therapies, improving the health services optimization and allowing reporting on data other than medicines.

Background: There is increasing evidence for the role of inflammation in clinical outcome after subarachnoid hemorrhage (SAH). Specifically, the TNF-alfa(α) pathway seems to be relevant after SAH. Although the TNF-α main receptor, TNF-R1 is associated with aneurysm growth and rupture, its relation to prognosis is unknown. We sought to compare TNF-R1 levels in peripheral venous blood and arterial blood closer to the ruptured aneurysm to study the association of TNF-R1 blood levels with poor prognosis (modified Rankin Scale > 2 at discharge, 3 and 6 months) and complications (hydrocephalus or delayed cerebral ischemia/DCI) following SAH. Methods: We included consecutive SAH patients admitted in the first 72 h of symptoms. Blood samples were simultaneously collected from a peripheral vein and from the main parent artery of the aneurysm. Levels of TNF-R1 were measured using enzyme-linked immunosorbent assays. Results: We analyzed 58 patients. Arterial and venous levels of TNF-R1 were correlated (R = 0.706, p < 0.001). In multivariate regression analysis, venous TNF-R1 was an independent predictor of poor outcome at 6 months after adjusting by age and sex [odds ratio (OR) 11.63; 95% CI 2.09-64.7, p = 0.005] and after adjusting by Glasgow Coma Scale and Fisher scales (OR 8.74; 95% CI 1.45-52.7, p = 0.018). There was no association of TNF-R1 with DCI. A cut-off for arterial TNF-R1 of 1523.7 pg/mL had 75% sensitivity/66% specificity for the prediction of hydrocephalus. Conclusion: Levels of venous TNF-R1 are associated with poor outcome in SAH. A specific association was found between levels of arterial TNF-R1 and hydrocephalus. These results are consistent with the role of TNF-α pathway in SAH and need to be validated in larger cohorts.