Breast Cancer Presents With a Paraneoplastic Neurologic Syndrome

BACKGROUND: Paraneoplastic neurologic syndromes (PNS) pose quite an uncommon neurological complication, affecting less than 1% of patients with breast cancer. Nearly one third of these patients lack detectable onconeural antibodies (ONAs), and improvement in neurologic deficits with concomitant cancer treatments is achieved in less than 30% of cases. CASE PRESENTATION: A 42-year-old, premenopausal woman presented with facial paralysis on the central left side accompanied by a left tongue deviation, an upward vertical nystagmus, moderate spastic paraparesis, dystonic posturing of the left foot, lower limb hyperreflexia and bilateral extensor plantar reflex. After ruling out all other potential neurologic causes, PNS was suspected but no ONAs were found. A PET-CT scan detected increased metabolism in the right breast, as well as an ipsilateral thoracic interpectoral adenopathy. Core biopsy confirmed the presence of an infiltrating duct carcinoma. After breast surgery, the neurologic symptoms disappeared. One week later, the patient was readmitted to the hospital with a bilateral fatigable eyelid ptosis, and two weeks later, there was a noticeable improvement in eyelid ptosis, accompanied by a rapid and progressive development of lower spastic paraparesis. She started adjuvant treatment with chemotherapy with marked clinical and neurological improvement, and by the end of radiotherapy, there were no signs of neurologic impairment. CONCLUSION: This case study highlights the importance of a high level of vigilance for the detection of PNS, even when ONAs are not detected, as the rapid identification and treatment of the underlying tumor offers the best chance for a full recovery.

Relatório de estágio em ensino do 1.º ciclo do ensino básico

Relatório EPE - Relatório de estágio em Educação Pré-Escolar: O trabalho realizado no relatório de estágio tem como propósito a reflexão e análise crítica de todo o processo desenvolvido no contexto de educação pré-escolar, no âmbito da Unidade Curricular (UC) de Prática Pedagógica Supervisionada, Ao longo do presente relatório será mobilizado o quadro teórico e conceptual da formanda que sustentou e orientou as práticas desenvolvidas no decorrer do período de estágio, evocando autores conceituados como Piaget, Vygotsky, Oliveira-Formosinho, Zabalza, Roldão, entre muitos outros. Deste modo, será mencionado o papel da criança bem como a natureza do seu processo de desenvolvimento e de construção, evidenciando o seu papel ativo, participativo e construtivo. Também, será referida a importância do papel do Educador de infância, bem como os princípios deontológicos que o orientam na sua construção profissional e pessoal. Torna-se, também, fundamental referir os referenciais legais que norteiam a Educação Pré-Escolar referindo a sua importância no desenvolvimento das crianças, assim como os modelos curriculares e pedagógicos que orientam a práxis pedagógica, permitindo a construção de práticas fundamentadas e conscientes. Para isso é, também, imprescindível adotar uma atitude indagadora de caráter investigativo, crítico e reflexivo, permitindo responder de forma adequada às necessidades individuais de cada criança, numa perspetiva diferenciada e individualizada, mas também global. Neste sentido, ao longo de todo o período de estágio, foi adotada, a metodologia de investigação-ação, denotando a importância dos momentos de observação, planificação, ação e reflexão. Só desta forma foi possível compreender a realidade, de modo a transformá-la com o intuito de melhorar a qualidade da Educação

Tilt Training Increases Vasoconstrictor Reserve in Patients with Neurocardiogenic Syncope

Neurocardiogenic syncope (NCS) is a common clinical entity resulting from an excessive reflex autonomic response, particularly during orthostatism. Treatment options are controversial and of limited effectiveness. Tilt training (TT) is a promising option to treat these patients. However, its mechanism of action and clinical impact remain unclear. OBJECTIVE: To characterize hemodynamic and autonomic responses during a TT program in patients with NCS refractory to conventional measures. METHODS: We studied 28 patients (50% male, mean age 41±14 years) without structural heart disease, with NCS documented by tilt testing. The TT program included 9 tilt sessions (3 times a week, 30 min) (60° - 6 sessions, 70° - 3 sessions), under ECG and blood pressure monitoring combined with home orthostatic self-training and 10° head-up during sleep. Systolic volume, cardiac output, total peripheral resistance, baroreflex sensitivity and heart-rate variability were computed. Patients were reassessed at 1 month and every 6 months for a maximum of 36 months (24±12 months). RESULTS: Over the course of the TT program there was a significant increase in total peripheral resistance (1485±225 vs. 1591±187 dyn·s·cm(-5), p<0.05), with a decrease in standard deviation (206±60 vs. 150±42, p<0.05). During follow-up, syncope recurred in five patients (19%), with a significant reduction in the number of episodes (4.0±3.2/patient in the 12 months before TT vs. 1.4±0.8/patient post-TT, p<0.05). CONCLUSION: In refractory NCS, TT may be an effective therapeutic option, with long-term benefits. These results appear to be due to an increase in vasoconstrictor reserve combined with a reduction in its variance.

Internationalization strategy of Aveleda’s Wine in the Chinese market

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Fellini, a lenda : O sonho é a única realidade

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção do grau de Mestre na especialidade de Psicologia Clínica.

On the function of the floccular complex of the vertebrate cerebellum: implications in paleoneuroanatomy

The cerebellum floccular complex lobes (FCLs) are housed in the FCL fossa of the periotic complex. There is experimental evidence indicating that the FCLs integrate visual and vestibular information, responsible for the vestibulo-ocular reflex, vestibulo-collic reflex, smooth pursuit and gaze holding. Thus, the behavior of extinct animals has been correlated with FCLs dimension in multiple paleoneuroanatomy studies. Here I analyzed braincase endocasts of a representative sample of Mammalia (48 species) and Aves (59 species) rendered using tomography and image segmentation and tested statistical correlations between the floccular complex volume, ecological and behavioral traits to assess various previously formulated paleobiological speculations. My results demonstrate: 1) there is no significant correlation between relative FCL volume and body mass; 2) there is no significant correlation between relative FCL and optic lobes size in birds; 3) average relative FCL size is larger in diurnal than in nocturnal birds but there is no statistically significant difference in mammals; 4) feeding strategies are related with different FCL size patterns in birds, but not in mammals; 5) locomotion type is not related with relative FCL size in mammals; 6) agility is not significantly correlated with FCL size in mammals. I conclude that, despite the apparent relation between FCL size and ecology in birds, the cerebellum of tetrapods is a highly plastic structure and may be adapted to control different functions across different taxonomic levels. For example, the european mole (Talpa europaea) which is fossorial and practically blind, has a FCL fossae relative size larger than those of bats, which are highly maneuverable. Therefore, variation in FCL size may be better explained by a combination of multiple factors with relation to anatomical and phylogenetic evolutionary constraints.

O desafio da sustentabilidade e da solidariedade na prática dos profissionais de turismo. O turismo de voluntariado no Brasil

Tese de Doutoramento em Geografia - Geografia Humana

Lideranças curriculares intermédias no contexto da avaliação externa das escolas em Portugal

Tese de Doutoramento em Ciências da Educação (área de especialização em Desenvolvimento Curricular).

Significados dos episódios maníacos para pacientes com transtorno bipolar em remissão: um estudo qualitativo

Objetivo Discutir os significados da vivência de episódios maníacos para pacientes com transtorno bipolar (TAB). Métodos Trata-se de uma pesquisa qualitativa, feita por meio de entrevistas semidirigidas em profundidade, em uma amostra fechada pelo critério de saturação com oito pacientes com TAB em remissão. A técnica de tratamento de dados foi feita por meio da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Os resultados foram submetidos à validação externa, no Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da Unicamp, composto por 37 pesquisadores do método, entre eles mestrandos, doutorandos, pós-doutorados e pesquisadores seniores. Resultados Foram identificadas três categorias – Ambivalência e vergonha: pensar ou não pensar sobre os episódios maníacos; Organizando sentimentos pessoais: a remissão como um momento de autoconsciência; Episódios maníacos estruturando relações interpessoais versus projeções da angústia. Conclusão Os achados da presente pesquisa contribuem para a maior compreensão dos quadros maníacos no TAB, que podem auxiliar nas reflexões acerca da relação profissional-paciente, para elaborar estratégias para aderência e para as medidas terapêuticas e preventivas da recorrência dos episódios. Podem auxiliar a equipe de saúde envolvida no acompanhamento desses casos e também os pesquisadores na investigação da contribuição dos significados aqui discutidos nos fenômenos de aderência ao tratamento e de um melhor prognóstico.

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness

OBJECTIVE: This study was performed to observe the number of pacemakers that had never been reprogrammed after implantation, and the effect of optimised output programming on estimated longevity of pulse generators in patients with pacemaker METHODS: Sixty patients with Teletronics Reflex pacemakers were evaluated in a pacemaker clinic, from the time of the beginning of its activities, in June 1998, until March 1999. Telemetry was performed during the first clinic visit, and we observed how many pulse generators retained nominal output settings of the manufactures indicating the absence of reprogramming until that date. After evaluation of the capture threshold, reprogramming of pacemakers was performed with a safety margin of 2 to 2.5:1, and we compared the estimated longevity based on battery current at the manufacturer's settings with that based on settings achieved after reprogramming. RESULTS: In 95% of the cases, the original programmed setting was never reprogrammed before the patients attended the pacemaker clinic. Reprogramming the pacemaker prolonged estimated pulse generator life by 19.7±15.6 months (35.5%). CONCLUSION: The majority of the pacemakers evaluated had never been reprogrammed. Estimated pulse generator longevity can be prolonged significantly, using this simple, safe, efficacious, and cost-effective procedure.

Genetische und epigenetische Einflüsse auf die Entwicklung der Amygdala und des emotionalen Verhaltens - Untersuchungen an drei Mäusestämmen

Embryo transfer, amygdala, neuropeptide Y, parvalbumin, maternal effect, genetic background, open field, elevated plus maze, acoustic startle response, intrauterine influences

Alterações fisiológicas do sistema nervoso central de rã pelas toxinas de Cl. perfringens, Cl. oedematiens e Cl. septicum

The authors carried on experiences in order to confirm the neurotoxic theory of gas gangrene explained by Pacheco & Costa, uning preparations of isolated cord-posterior train of Leptodactylus ocellatus as described by OZORIO DE ALMEIDA & Cols. Frogs were intoxicated 3 days before the test with parcially purified toxins of Cl. perfringens, Cl. oedematiens and Cl. septicum. The intoxication produced a shortening of spinal reflexes duration time of such preparations, showing a typical alteration of the reflex activity of the spinal cord.

Dos modos de ver y sentir el Perú: las propuestas estéticas y culturales enfrentadas de José María Arguedas y Mario Vargas Llosa

: José María Arguedas y Mario Vargas Llosa, dos de los escritores más importantes del Perú del siglo XX, representan, a su vez, dos modos divergentes y contrapuestos de entender la realidad del país andino. Este estudio abordará las antagónicas propuestas estéticas y culturales de ambos autores a través del análisis de los principales ejes de la narrativa arguediana y del ensayo La utopía arcaica de Vargas Llosa y las planteará como una proyección de la conflictividad socio-cultural que inauguró la conquista y como un reflejo de las distintas respuestas que originó el movimiento indigenista en el Perú.

Indications à la stimulation cardiaque dans la syncope vasovagale [Pacing in vasovagal syncope].

This article presents a critical review of the literature about the potential benefit of cardiac pacing in patients suffering from vasovagal or neurocardiogenic syncope. The manifestation of vasovagal syncope comprises some reflex bradycardia and vasoplegia resulting in cerebral hypoperfusion that ultimately leads to a loss of consciousness. The literature reports conflicting results of the potential benefit of cardiac pacing on the prevention of recurrence of vasovagal events. A detailed analysis of the inclusion criteria of these studies permits to clarify the discrepancy. Only patients older than 50 years with prolonged sinus pause at time of syncope benefit of the implantation of a cardiac pacemaker.