Conception and first results of a cross-sectional national study on the demography, disease characteristics and socioeconomics status of the Portuguese patients with multiple sclerosis : the PORT-MS study

RESUMO: Introdução e objetivos: Não existia um estudo multicêntrico que descrevesse as características dos doentes com EM, da doença em si, ou do seu tratamento, em Portugal.Métodos: Doentes McDonald 2010 positivos foram sequencialmente recrutados em 7 centros entre Maio e Novembro 2014. Aplicou-se um Caderno de Recolha de Dados incidindo na demografia, doença, educação e emprego (estudo PORT-MS). Resultados: 561 doentes incluídos. Primeiros sintomas aos 30,2±10,5 anos (RRMS 29,2±10, PPMS 39,4±11,7, p<0,001); diagnóstico 3,2±5,3 anos depois (RRMS 3,0±5,1, PPMS 4,9±2,5, p=0,002); tempo de doença após diagnóstico 9,4±7,2 anos (semelhante RRMS no diagnóstico e PPMS); idade atual 42,9±12,4 anos (grupo RRMS no diagnóstico 42,0±12,1, PPMS 52,5±11,3, p<0,001); EDSS atual 2,5 (RRMS 2.0, PPMS 6.0); proporção feminino:masculino é 2,5:1 (RRMS semelhante, PPMS 1,1:1, p<0,05); no diagnóstico RRMS 90,6%, SPMS 0,9%, PPMS 8,6%; 9,5% dos RRMS encontravam-se em SP na inclusão (nomeadamente os com mais idade no diagnóstico e/ou atualidade ou tempo de doença mais prolongado). PPMS mais frequente em doentes diagnosticados mais tardiamente (p<0,001), onde aumenta também ligeiramente a proporção de mulheres na PPMS. Nas últimas décadas: novos casos mostram estabilidade na proporção de géneros e tipos de doença; idade nos primeiros sintomas e no diagnóstico aumentou ligeiramente, tempo entre eles diminuiu ligeiramente. Proporção sob DMT (Maio 2014): global 84,5%; atualmente RRMS 90,4%; SPMS 70,8%; PPMS 36,8%; progressivas agregadas 48%. Tipo de DMT, amostra global: interferões 56,5%, GA 18,4%, Natalizumab 11,6%, Fingolimod 9,7%. Global: economicamente ativos 61,5%, desemprego 13,5%, 74,1% dos não activos estão reformados por doença. Gravidezes após diagnóstico em 15% mulheres. Casos com história familiar positiva 7,8%. Discussão e conclusões: Incluída cerca de 10% da população portuguesa. Resultados congruentes com dados internacionais. Elevada proporção sob DMT, mesmo EDSS alto e formas progressivas. Terapêuticas de segunda linha sub representadas. Doentes jovens e com doença ligeira com vida económica ativa; restantes essencialmente reformados por doença.---------------- ABSTRACT : Background/aims: In Portugal, there wasn’t a multicentric study on the general characteristics (demography, disease milestones, DMT, socioeconomic status) of Multiple Sclerosis patients. Methods: Patients fulfilling McDonald 2010 criteria were sequentially recruited from May to November 2014 in 7 centers and data was systematically collected. Results: 561 patients included. First symptoms occurred at 30,2±10,5 years-old (RRMS 29,2±10, PPMS 39,4±11,7, p<0,001); diagnosis 3,2±5,3 years later (RRMS 3,0±5,1, PPMS 4,9±2,5, p=0,002); 9,4±7,2 years elapsed since diagnosis (similar for those is RRMS at diagnosis and PPMS); current age 42,9±12,4 years-old (group RRMS at diagnosis 42,0±12,1, PPMS 52,5±11,3, p<0,001); current EDSS 2,5 (RRMS 2.0, PPMS 6.0); females to males 2,5:1 (RRMS similar, PPMS 1,1:1, p<0,05); at diagnosis RRMS 90,6%, SPMS 0,9%, PPMS 8,6%; 9,5% of RRMS reached SP at inclusion (those older at diagnosis, in actuality, or with longer follow-up). PPMS more frequente in patients diagnosed at older ages (p<0,001), also slight increase in females. Along the last decades: new cases have showed stable proportions of gender and disease types; age at first symptoms and diagnosis slightly increased, time between them slightly decreased. Proportion on DMT (May 2014): 84,5% of all; 90,4% of currently in RRMS; 70,8% of SPMS; 36,8% of PPMS; 48% of progressive forms together. Type of DMT, all patients: interferons 56,5%, Glatiramer Acetate 18,4%, Natalizumab 11,6%, Fingolimod 9,7%. Economically active 61,5% of all, unemployment 13,5%, 74,1% of non-active are retired due to disease. Females pregnant after diagnosis 15%. Positive family cases in 7,8%. Discussion/Conclusions: 10% of the national MS population collected. Data generally consistente with international reports. Proportion under DMT relatively high in all disease types, but second line therapies underrepresented. Young patients with mild disease have an active economic life. Those not active are essentially retired due to disease.

Skin lesions simulating blue toe syndrome caused by prolonged contact with a millipede

Venomous animals are those that, by means of a hunting and defense mechanism, are able to inject their prey with a toxic substance produced in their bodies, directly from specialized glands (e.g., tooth, sting, spur) through which the poison passes. Millipedes are poisonous animals; they can be harmful to humans, and their effects usually manifest as erythematous, purpuric, and cyanotic lesions; local pain; and paresthesia. Here, we report a case of skin contact with a millipede for 6h resulting in skin lesions similar to blue toe syndrome.

Blue rubber bleb nevus syndrome

The blue rubber nevus syndrome consists of multiple venous malformations in the skin and gastrointestinal tract associated with intestinal hemorrhage and iron deficiency anemia. Other organs may be involved. The causes of this syndrome are unknown. Its most common presentation is in the form of sporadic cases, but dominant autosomal inheritance has been described. It is a condition that affects both sexes equally, and its occurrence is rare in the black race. We present a case of this syndrome diagnosed in a 11-year-old patient. He had severe anemia and a venous swelling on the trunk. Similar lesions were found in the stomach, bowel, and on his foot. We emphasize the main clinical aspects: intestine, eyes, nasopharynx, parotids, lungs, liver, spleen, heart, brain, pleura, peritoneum, pericardium, skeletal muscles, bladder, and penis lesions, systemic complications that may occur to these patients which are thrombosis and calcification, as well as consumptive coagulopathy and thrombocytopenia that may occur within the nevi.

Historical reconstructions of raw materials based on a blue smalt coating applied to a seventeenth-century altarpiece

Based on samples cross-sections from the Main Altarpiece of the Coimbra Old Cathedral, where a blue coating performed in 1685 is observed (that was partly covered with a Prussian blue-containing overpaint), the raw materials present in this coating were reproduced and studied. Blue areas were painted with smalt in oil, according to the contract signed by Manoel da Costa Pereira in 1684 and the analysis by Le Gac in 2009. Based on these, three batches of cobalt-based glasses (S1, S2 and S3) were heated and melted in alumina crucibles in the kiln. S1 contained 6.03 % of cobalt oxide, S2 contained 2.10 %, with the addition of 1.49 % of magnesium oxide, and S3 contained 6.82 % of cobalt oxide, with the addition of 4.63% of antimony trioxide. These batches were ground mechanically with water and manually with different vehicles stated in recipes. The results were studied by means of OM, SEM-EDS, X-Ray CT, Colorimetry and Vickers HT. Different binders were also produced and analyzed by means of μ-FTIR, in order to perform their characterization and obtain Standard Spectra. Since anhydrite was identified in the ground layers, gypsum from Óbidos was also characterized by XRD. The main goal of this thesis was to study all the raw materials present in the 1685-blue coating, in order to allow the historically accurate reconstruction of the layers build-up in the next future.

Blue rubber bleb nevus syndrome: case report

The case of a patient with blue rubber bleb nevus syndrome who is infected by acquired immunodeficiency syndrome virus due to multiple blood transfusions is presented. This case shows that although it is a rare systemic disorder, blue rubber bleb nevus syndrome has to be considered in the differential diagnosis of chronic anemia or gastrointestinal bleeding. Patients should be investigated by endoscopy, which is the most reliable method for detecting these lesions. The patient underwent gastroscopy and enteroscopy via enterotomy with identification of all lesions. Minimal resection of the larger lesions and string-purse suture of the smaller ones involving all the layers of the intestine were performed. The string-purse suture of the lesions detected by enteroscopy proved to be an effective technique for handling these lesions, avoiding extensive intestinal resection and stopping the bleeding. Effective management of these patients demands aggressive treatment and should be initiated as soon as possible to avoid risks involved in blood transfusions, as occurred in this case.

60,000 years of interactions between Central and Eastern Africa documented by major African mitochondrial haplogroup L2

Mitochondrial DNA (mtDNA) haplogroup L2 originated in Western Africa but is nowadays spread across the entire continent. L2 movements were previously postulated to be related to the Bantu expansion, but L2 expansions eastwards probably occurred much earlier. By reconstructing the phylogeny of L2 (44 new complete sequences) we provide insights on the complex net of within-African migrations in the last 60 thousand years (ka). Results show that lineages in Southern Africa cluster with Western/Central African lineages at a recent time scale, whereas, eastern lineages seem to be substantially more ancient. Three moments of expansion from a Central African source are associated to L2: (1) one migration at 70-50 ka into Eastern or Southern Africa, (2) postglacial movements (15-10 ka) into Eastern Africa; and (3) the southward Bantu Expansion in the last 5 ka. The complementary population and L0a phylogeography analyses indicate no strong evidence of mtDNA gene flow between eastern and southern populations during the later movement, suggesting low admixture between Eastern African populations and the Bantu migrants. This implies that, at least in the early stages, the Bantu expansion was mainly a demic diffusion with little incorporation of local populations.

A genetic perspective on African prehistory

The various genetic systems (mitochondrial DNA, the Y-chromosome and the genome-wide autosomes) indicate that Africa is the most genetically diverse continent in the world and the most likely place of origin for anatomically modern humans. However, where in Africa modern humans arose and how the current genetic makeup within the continent was shaped is still open to debate. Here, we summarize the debate and focus especially on the maternally inherited mitochondrial DNA (mtDNA) and a recently revised chronology for the African mtDNA tree. We discuss the possible origin of modern humans in southern, eastern or Central Africa; the possibility of a migration from southern to eastern Africa more than 100 ka, carrying lineages within mtDNA haplogroup L0; the evidence for a climate-change-mediated population expansion in eastern Africa involving mtDNA haplogroup L3, leading to the “out-of-Africa” migration around 70–60 ka; the re-population of North Africa from the Near East around 40–30 ka suggested by mtDNA haplogroups U6 and M1; the evidence for population expansions and dispersals across the continent at the onset of the Holocene ; and the impact of the Bantu dispersals in Central, eastern and southern Africa within the last few millennia.

Transnational identities in the fiction of Monica Ali: In the Kitchen and Alentejo Blue

Monica Ali’s In the Kitchen shows London as a cosmopolitan and postmodern city, a locus of transnational identities. Although this is not a new theme in contemporary English writing, in this novel the topic of migration is detached from the usual postcolonial loci that feature in “immigrant” or “diasporic” literature. In the novel Alentejo Blue, set in the South of Portugal, Monica Ali had already approached the question of migration from the point of view of the exiled citizen, whose situation is part of globalization processes outside of the normal push/pull (centre/periphery, east/west, north/south) conceptions of migration. The focus in the article is, thus, on the ways the new world order of economic globalization relates to the processes of immigration and the dispersal of a stable sense of individual and national identity.

Synchronous reproduction may facilitate introgression in a hybrid mussel (Mytilus) population

Mussel populations on the Irish Atlantic coast comprise an interbreeding mixture of the blue mussel, Mytilus edulis (L.) and the Mediterranean mussel, Mytilus galloprovincialis (Lmk.). The occurrence of hybrid genotypes varies between sites but can be as high 80%. This study compares the reproductive cycle of M. edulis, M. galloprovincialis and their hybrids to determine if the extensive hybridisation observed at Irish Atlantic coast sites is linked to spawning synchrony between the two taxa. Mussels (40-45 mm size class) were collected monthly from a sheltered shore in Galway Bay from January to December 2005. Two major spawning events (March- June and September-October) were observed and gametogenesis took place throughout the year. The spawning cycles of the three taxa were largely overlapping. Small differences were observed in the timing of peak spawning which occurred in March and October in M. galloprovincialis and in May-June and September in M.edulis. Spawning of hybrid individuals was intermediate between the parental genotypes. Fecundity was slightly higher in M. galloprovincialis females compared to the other taxa (up to 30% difference, p<0.05). This apparent advantage is not shared by the sexes and is likely being offset by high numbers of hybrid genotypes releasing gametes during peak spawning of M. galloprovincialis. There was no evidence for increased mortality in hybrid males; sex ratios did not deviate from the 1:1 ratio. The results show that in this region of the hybrid zone the timing of reproduction does not present a barrier to gene flow between M. edulis and M. galloprovincialis. Nonetheless, small differences in the timing of peak spawning may increase the likelihood of conspecific fertilisation at certain times of the year. Hybrids outnumber the parental genotypes, undergo complete gametogenesis and show no evidence of depressed fitness (i.e. hybrids are reproductively competent suggesting a high degree of introgression.

The distribution, size, and reproduction of the pedunculate barnacle, Octolasmis mülleri (Coker, 1902), on the blue crab, Callinectes sapidus (Rathburn, 1896) / William B. Jeffries, Harold K. Voris.

n.s. no.16(1983)

Abundance, breeding and food of the Little Blue Heron Egretta caerulea (Aves, Ardeidae) in the Patos Lagoon estuary, a recently colonized area in southern Brazil

We document the expansion of the breeding distribution of the Little Blue Heron Egretta caerulea (Linnaeus, 1758) to 850 km beyond its previous southern limit in South America. In addition we present data on abundance, breeding biology and food of the species in the Patos Lagoon estuary, the area which the species recently colonized. The maximum abundance recorded in the breeding colony and in a nocturnal roosting site was 53 and 49 individuals respectively. Nesting occurred from September to March. Birds nested in a mixed breeding colony together with about 3,000 breeding pairs of seven other species of Pelecaniformes, in a swampy forest near the margin of the estuary. Five nests were between 1.5 and 4.3 m from the ground, on the shrub Daphnopsis racemosa (Thymelaeaceae), on the trees Sebastiana brasiliensis (Euphorbiaceae) and Mimosa bimucronata (Leguminosae), or on the bamboo Bambusa sp. (Poaceae). Four nests produced two fledglings each, while one nest was abandoned. Of 13 grouped samples of food regurgitated by five nestlings, Pink Shrimp Farfantepenaeus paulensis (Perez-Farfante, 1967) constituted 70% in mass, while total length of ingested fishes and shrimps varied mostly between 20 and 50 mm. Estuarine prey items represented 99% of the total food mass. The recent southward expansion of the breeding range of the Little Blue Heron in South America may be a response to climate warming of the Patos Lagoon estuary. Degradation of estuaries in the southwestern Atlantic may also be forcing the birds to breed in areas outside previous geographical range.

Dietary modulation of plasma antioxidant deficiencies: effect of mediterranean diet

Estudi elaborat a partir d’una estada al National Research Institute for Food and Nutrition, Itàlia, des de novembre del 2006 fins a febrer del 2007. La capacitat antioxidant total (TAC) en plasma pot ser un bon biomarcador del estat antioxidant dels humans. Prenent les mostres de dos projectes diferents de recerca s’ha mesurat la TAC mitjançant el FRAP (ferric reductant antioxidant potencial) i el TRAP (total radical-trapping antioxidant parameter ). D’una banda el PREDIMED, és un estudi prospectiu aleatoritzat i controlat, amb una cohort d’ individus sense patología vascular coneguda, però amb un alt risc de patir-la. En aquest es valora la utilitat d’una intervenció dietética del tipus mediterrània en la prevenció primària de la malaltia cardiovascular. L’altre és el de biodisponibilitat en humans dels metabòlits dels polifenols presents en els solubles de cacau, un estudi crònic (28 dies) on es vol mesurar la influència de la llet en l’absorció dels polifenols del cacau, en voluntaris amb elevat risc de sofrir patologia cardiovascular.

Blue Lingo

Combined media on photographic paper. 55½" x 86" Private Collection