Does the degree of smoking effect the severity of tardive dyskinesia? A longitudinal clinical trial

Background. - Tardive dyskinesia (TD) is a movement disorder observed after chronic neuroleptic treatment. Smoking is presumed to increase the prevalence of TD. The question of a cause-effect-relationship between smoking and TD, however, remains to be answered. Purpose of this study was to examine the correlation between the degree of smoking and the severity of TD with respect to differences caused by medication. Method. - We examined 60 patients suffering from schizophrenia and TD, We compared a clozapine-treated group With a group treated with typical neuroleptics. Movement disorders were assessed using the Abnormal-Involuntary-Movement-Scale and the technical device digital image processing, providing rater independent information on perioral movements. Results. - We found a strong correlation (.80 < r < .90, always p < .0001) between the degree of smoking and severity of TD. Repeated measurements revealed a positive correlation between changes in cigarette consumption and changes of the severity of TD (p < .0001). Analyses of covariance indicated a significant group-effect with a lower severity of TD in the clozapine-group compared to the typical-neuroleptics-group (p = .010). Interaction-analyses indicated a higher impact of smoking oil the severity of TD in the typical-neuroleptics-group compared to the clozapine-group (p = .033). Conclusion. - Concerning a possible cause-effect-relationship between smoking and TD, smoking is more of a general health hazard than neuroleptic exposure in terms of TD. (C) 2008 Elsevier Masson SAS. All rights reserved.

Browlifting as an Alternative Procedure for Apraxia of Eyelid Opening

Essential blepharospasm is an idiopathic disorder that consists of spontaneous, spasmodic, and involuntary eyelid closure in the absence of ocular disease. Some patients develop an inability to open their eyelids in the absence of orbicularis spasms. These patients have essential blepharospasm combined with apraxia of eyelid opening. Botulinum toxin injections are the treatment of choice for blepharospasm but results may be insufficient, especially in cases associated with apraxia. Apraxia can be treated surgically by levator aponeurosis advancement, frontalis suspension, and upper myectomy. The authors report the first browlift using polypropylene suture to manage eyelid apraxia associated with blepharospasm as an alternative and minimally invasive procedure.

Spinal Myoclonus after Subarachnoid Anesthesia with Bupivacaine

Abrao J, Bianco MP, Roma W, Krippa JAS, Hallak JE - Spinal Myoclonus after Subarachnoid Anesthesia with Bupivacaine. Background and objectives: It is presented in this case report a very rare complication after spinal anesthesia to provide subsidies to the management and therapeutic conduct. Case report: This is a 63-year old African-Brazilian patient, ASA I, scheduled for transurethral resection of the prostate (TURP). He underwent subarachnoid anesthesia with bupivacaine (15 mg) without adrenaline. Intercurrences were not observed during puncture, and the patient was positioned for surgery. Soon after positioning the patient, he complained of severe pain in the perineum region followed by involuntary tonic-clonic movements of the lower limbs. The patient was treated with a benzodiazepine to control the myoclonus without response. This episode was followed by significant agitation and the patient was intubated. He was maintained in controlled ventilation and transferred to the Intensive Care Unit. Despite all biochemical and imaging tests performed, an apparent cause was not detected. The medication was not changed and the same batch of anesthetic had been used in other patients that same day without intercurrences. Conclusions: After ruling out all possible causes, the diagnosis of spinal myoclonus after spinal anesthesia with bupivacaine was made by exclusion.

Kallmann syndrome and mirror movements: White matter quantitative evaluation with magnetic resonance imaging

Kallmann syndrome (KS), characterized by the association of hypogonadotropic hypogonadism and anosmia, may present many other phenotypic abnormalities, including neurologic features as involuntary movements, called mirror movements (MM). MM etiology probably involves a complex mechanism comprising corticospinal tract abnormal development associated with deficient contralateral motor cortex inhibitory system. In this study, in order to address previous hypotheses concerning MM etiology, we identified and quantified white matter (WM) alterations in 21 KS patients, comparing subjects with and without MM and 16 control subjects, using magnetization transfer ratio (MTR) and T2 relaxometry (R2). Magnetization transfer and 12 double-echo images were acquired in a 1.5 T system. MTR and R2 were calculated pixel by pixel to initially create individual maps, and then, group average maps, co-registered with MNI305 stereotaxic coordinate system. After analysis of selected regions of interest, we demonstrated areas with higher 12 relaxation time and lower MTR values in KS patients, with and without MM, differently involving corticospinal tract projection, frontal lobes and corpus callosum. Higher MTR was observed only in pyramidal decussation when compared in both groups of patients with controls. In conclusion, we demonstrated that patients with KS have altered WM areas, presenting in a different manner in patients with and without MM. These data suggest axonal loss or disorganization involving abnormal pyramidal tracts and other associative/connective areas, relating to the presence or absence of MM. We also found a different pattern of alteration in pyramidal decussation, which can represent the primary area of neuronal disarrangement. (C) 2010 Elsevier B.V. All rights reserved.

Cannibal rights: Intertextuality and postcolonial discourse in the Caribbean region

"The history of the Caribbean," says Roberto Gonzalez Echevarria in his book on Alejo Carpentier, "is one of beginnings or foundations" (252). The Caribbean, in thi'i sense, sets the scene for Latin American history. Caribbean writers' attempts to retrieve or, better, refashion their cultural origins prefigure the collective struggle of a New World continent to imagine itself into the future. Imagination clashes here with memory; for like many of their Latin American counterparts, Anglo-Caribbean writers are often torn between an almost involuntary desire to remember and an urgent need to reinvent. [Extract]

NITRIC OXIDE SYNTHASE INHIBITION ATTENUATES L-DOPA-INDUCED DYSKINESIAS IN A RODENT MODEL OF PARKINSON`S DISEASE

Chronic L-DOPA pharmacotherapy in Parkinson`s disease is often, accompanied by the development of abnormal and excessive movements known as L-DOPA-induced dyskinesia. Rats with 6-hydroxydopamine lesion of dopaminergic neurons chronically treated with L-DOPA develop a rodent analog of this dyskinesia characterized by severe axial, limb, locomotor and orofacial abnormal involuntary movements. While the mechanisms by which these effects occur are not clear, they may involve the nitric oxide system. In the present study we investigate if nitric oxide synthase inhibitors can prevent dyskinesias induced by repeated administration Of L-DOPA in rats with unilateral 6-hydroxydopamine lesion. Chronic L-DOPA (high fixed dose, 100 mg/kg; low escalating dose, 10-30 mg/kg) treatment induced progressive dyskinesia changes. Two nitric oxide synthase inhibitors, 7-nitroindazole (1-30 mg/kg) and NG-nitro-L-arginine (50 mg/kg), given 30 min before L-DOPA, attenuate dyskinesia. 7-Nitroindazolee also improved motor performance of these animals in the rota-rod test. These results suggest the possibility that nitric oxide synthase inhibitors may be useful to treat L-DOPA.-Induced dyskinesia. (C) 2009 IBRO. Published by Elsevier Ltd. All rights reserved.

Clinically significant drug interactions with agents specific for migraine attacks

The drugs which provide specific relief from migraine attacks, the ergopeptides (ergotamine and dihydroergotamine) and the various 'triptans' (notably sumatriptan), are often prescribed for persons already taking various migraine preventative agents, and sometimes drugs for other indications. As a result, migraine-specific drugs may become involved in drug-drug interactions. The migraine-specific drugs all act as agonists at certain subclasses of serotonin (5-hydroxytryptamine; 5-MT) receptor, particularly those of the 5-HT1D subtype, and produce vasoconstriction through these receptor-mediated mechanisms. The oral bioavailabilities of these drugs, particularly those of the ergopeptides, are often incomplete, due to extensive presystemic metabolism. As a result, if migraine-specific agents are coadministered with drugs with vasoconstrictive properties, or with drugs which inhibit the metabolism of the migraine-specific agents, there is a risk of interactions occurring which produce manifestations of excessive vasoconstriction. This can also occur through pharmacodynamic mechanisms, as when ergopeptides or triptans are coadministered with methysergide or propranolol (although a pharmacokinetic element may apply in relation to the latter interaction), or if one migraine-specific agent is used shortly after another. When egopeptide metabolism is inhibited by the presence of macrolide antibacterials, particularly troleandomycin and erythromycin, the resultant interaction can produce ergotism, sometimes leading to gangrene. Similar pharmacokinetic mechanisms, with their vasoconstrictive consequences, probably apply to combination of the ergopeptides with HIV protease inhibitors (indinavir and ritonavir), heparin, cyclosporin or tacrolimus. Inhibition of triptan metabolism by monoamine oxidase A inhibitors, e.g. moclobemide, may raise circulating triptan concentrations, although this does not yet seem to have led to reported clinical problems. Caffeine may cause increased plasma ergotamine concentrations through an as yet inadequately defined pharmacokinetic interaction. However, a direct antimigraine effect of caffeine may contribute to the claimed increased efficacy of ergotamine-caffeine combinations in relieving migraine attacks. Serotonin syndromes have been reported as probable pharmacodynamic consequences of the use of ergots or triptans in persons taking serotonin reuptake inhibitors. There have been two reports of involuntary movement disorders when sumatriptan has been used by patients already taking loxapine. Nearly all the clinically important interactions between the ergopeptide antimigraine agents and currently marketed drugs are likely to have already come to notice. In contrast, new interactions involving the triptans are likely to be recognised as additional members of this family of drugs, with their different patterns of metabolism and pharmacokinetics, are marketed.

Contingent attentional capture or delayed allocation of attention?

Under certain circumstances, external stimuli will elicit an involuntary shift of spatial attention, referred to as attentional capture. According to the contingent involuntary orienting account (Folk, Remington, & Johnston, 1992), capture is conditioned by top-down factors that set attention to respond involuntarily to stimulus properties relevant to one's behavioral goals. Evidence for this comes from spatial cuing studies showing that a spatial cuing effect is observed only when cues have goal-relevant properties. Here, we examine alternative, decision-level explanations of the spatial cuing effect that attribute evidence of capture to postpresentation delays in the voluntary allocation of attention, rather than to on-line involuntary shifts in direct response to the cue. In three spatial cuing experiments, delayed-allocation accounts were tested by examining whether items at the cued location were preferentially processed. The experiments provide evidence that costs and benefits in spatial cuing experiments do reflect the on-line capture of attention. The implications of these results for models of attentional control are discussed.

Overcrowding and Infant Mortality: A Tale of Two Cities

Using detailed historical data for the cities of Glasgow and Edinhurgh, evidence is found in support of the hypothesis that overcrowding is a significant cause of infant mortality. We distinguish between voluntary overcrowding (due to the budgetary choices of poor families) and involuntary overcrowding (due to market failure in the provision of an adequate supply of appropriate housing). We found that, over the fifty year period, 1911-1961, Glasgow's infant mortality rate was significantly higher than that of Edinburgh, despite their close geographical proximity, and that a large part of the difference can he attributed to involuntary overcrowding in the first half of the twentieth century. We argue that this was due to the distinctly different housing policies adopted by the two cities, with important lessons for present day public authorities.

Um corpo-dissertação em movimento : uma questão de aprendizagem

Este trabalho ganha corpo a partir das experiências do antropólogo Carlos Castaneda. Além de ponto de partida para pensar as questões relativas ao corpo, o movimento e aprendizagem, as obras A Erva do diabo, Uma estranha realidade e Porta para o infinito, do autor mencionado, comparecem aqui para 1) investigarmos os relatos de experiência; 2) apresentarmos alguns conceitos-chaves, relativos a aprendizagem da “feitiçaria”, tal como a vontade. Vale frisar que nosso interesse na obra de Castaneda, não está nas questões místicas do xamanismo, nem mesmo nos pontos relativos ao campo da antropologia, mas na questão da aprendizagem. Para Dom Juan, o vellho índio feiticeiro e principal mestre de Carlos Castaneda, o propósito final do aprendizado da feitiçaria é justamente tornar-se um homem de conhecimento. Com o objetivo de analisar o lugar do movimento e do corpo no processo de aprendizagem, faremos o seguinte percurso analítico: de Skinner e Piaget abordaremos respectivamente a aprendizagem do comportamento operante e a aprendizagem em sentido amplo. Em seguida, apresentamos o pensamento de Francisco Varela e Bruno Latour, principalmente os conceitos de enação, corpos articulados e aprendizagem por afetação. Com Vincianne Despret discutiremos o aspecto afectivo, corporal e involuntário da aprendizagem. Com este apanhado conceitual, visamos então colocar em análise os efeitos ético-políticos dos modos de produção de conhecimento, efeitos irremediavelmente neste corpo-dissertação, e mais ainda efeitos na vida. Por fim, ao que parece, as modulações nos conceitos de corpo, movimento/ação, ao longo da exposição dos autores indicaram, por vezes, a participação de outros elementos, tais como a vontade e a percepção-atenção, implicando variações na forma de conceber a aprendizagem. Percebemos que de acordo com a formulação de aprendizagem e as nuances do movimento/ação e do corpo, isto implica produções diferenciadas de conhecimento e de realidade.

Moravia : das lógicas da informalidade às lógicas da formalidade

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Arquitetura e Urbanismo, Programa de Pós-Graduação em Arquitetura e Urbanismo, 2016.

Occupational exposure to environmental tobacco smoke in hospitality venues: are genetic- or proteomics-based biomarkers predictive of respiratory diseases?

Environmental tobacco smoke (ETS) is recognized as an occupational hazard in the hospitality industry. Although Portuguese legislation banned smoking in most indoor public spaces, it is still allowed in some restaurants/bars, representing a potential risk to the workers’ health, particularly for chronic respiratory diseases. The aims of this work were to characterize biomarkers of early genetic effects and to disclose proteomic signatures associated to occupational exposure to ETS and with potential to predict respiratory diseases development. A detailed lifestyle survey and clinical evaluation (including spirometry) were performed in 81 workers from Lisbon restaurants. ETS exposure was assessed through the level of PM 2.5 in indoor air and the urinary level of cotinine. The plasma samples were immunodepleted and analysed by 2D-SDSPAGE followed by in-gel digestion and LC-MS/MS. DNA lesions and chromosome damage were analysed innlymphocytes and in exfoliated buccal cells from 19 cigarette smokers, 29 involuntary smokers, and 33 non-smokers not exposed to tobacco smoke. Also, the DNA repair capacity was evaluated using an ex vivo challenge comet assay with an alkylating agent (EMS). All workers were considered healthy and recorded normal lung function. Interestingly, following 2D-DIGE-MS (MALDI-TOF/TOF), 61 plasma proteins were found differentially expressed in ETS-exposed subjects, including 38 involved in metabolism, acute-phase respiratory inflammation, and immune or vascular functions. On the other hand, the involuntary smokers showed neither an increased level of DNA/chromosome damage on lymphocytes nor an increased number of micronuclei in buccal cells, when compared to non-exposed non-smokers. Noteworthy, lymphocytes challenge with EMS resulted in a significantly lower level of DNA breaks in ETS-exposed as compared to non-exposed workers (P<0.0001) suggestive of an adaptive response elicited by the previous exposure to low levels of ETS. Overall, changes in proteome may be promising early biomarkers of exposure to ETS. Likewise, alterations of the DNA repair competence observed upon ETS exposure deserves to be further understood. Work supported by Fundação Calouste Gulbenkian, ACSS and FCT/Polyannual Funding Program.

O impacto da Lei nº 37/2007 (Lei do Tabaco) no consumo de tabaco em ambiente profissional na ilha Terceira e a sua influência na produtividade e absentismo laboral

Dissertação de Mestrado, Ambiente, Saúde e Segurança, 19 de Julho de 2013, Universidade dos Açores.

A ingerência do conhecimento explícito no conhecimento tácito: a técnica Alexander e a prática e ensino da flauta

Doutoramento em Música

Value of a lower limb immobilization device for SPECT/CT image fusion optimization

The foot and the ankle are small structures commonly affected by disorders, and their complex anatomy represent significant diagnostic challenges. SPECT/CT Image fusion can provide missing anatomical and bone structure information to functional imaging, which is particularly useful to increase diagnosis certainty of bone pathology. However, due to SPECT acquisition duration, patient’s involuntary movements may lead to misalignment between SPECT and CT images. Patient motion can be reduced using a dedicated patient support. We aimed at designing an ankle and foot immobilizing device and measuring its efficacy at improving image fusion. Methods: We enrolled 20 patients undergoing distal lower-limb SPECT/CT of the ankle and the foot with and without a foot holder. The misalignment between SPECT and CT images was computed by manually measuring 14 fiducial markers chosen among anatomical landmarks also visible on bone scintigraphy. Analysis of variance was performed for statistical analysis. Results: The obtained absolute average difference without and with support was 5.1±5.2 mm (mean±SD) and 3.1±2.7 mm, respectively, which is significant (p<0.001). Conclusion: The introduction of the foot holder significantly decreases misalignment between SPECT and CT images, which may have clinical influence in the precise localization of foot and ankle pathology.