The clinico-radiological paradox of cognitive function and MRI burden of white matter lesions in people with multiple sclerosis: a systematic review and meta-analysis.

Moderate correlation exists between the imaging quantification of brain white matter lesions and cognitive performance in people with multiple sclerosis (MS). This may reflect the greater importance of other features, including subvisible pathology, or methodological limitations of the primary literature.To summarise the cognitive clinico-radiological paradox and explore the potential methodological factors that could influence the assessment of this relationship.Systematic review and meta-analysis of primary research relating cognitive function to white matter lesion burden.Fifty papers met eligibility criteria for review, and meta-analysis of overall results was possible in thirty-two (2050 participants). Aggregate correlation between cognition and T2 lesion burden was r = -0.30 (95% confidence interval: -0.34, -0.26). Wide methodological variability was seen, particularly related to key factors in the cognitive data capture and image analysis techniques.Resolving the persistent clinico-radiological paradox will likely require simultaneous evaluation of multiple components of the complex pathology using optimum measurement techniques for both cognitive and MRI feature quantification. We recommend a consensus initiative to support common standards for image analysis in MS, enabling benchmarking while also supporting ongoing innovation

Entomological investigation of a sylvatic yellow fever area in São Paulo State, Brazil Investigação entomológica em área de ocorrência de febre amarela silvestre no Estado de São Paulo, Brasil

Following reports of two autochthonous cases of sylvatic yellow fever in the State of São Paulo, Brazil, in 2000, entomological surveys were conducted with the objective of verifying the occurrence of vector species in forest environments close to or associated with riparian areas located in the western and northwestern regions of the State. Culicidae were captured in 39 sites distributed in four regions. Haemagogus leucocelaenus and Aedes albopictus were the most abundant species and were captured in all the regions studied. H. leucocelaenus was the most abundant species in the municipalities of Santa Albertina and Ouroeste, where the two cases of sylvatic yellow fever had been reported. Mosquitoes from the janthinomys/capricornii group were only found at eight sites in the São José do Rio Preto region, while Sabethes chloropterus was found at one site in Ribeirão Preto. H. leucocelaenus showed its capacity to adapt to a secondary and degraded environment. Our results indicate a wide receptive area for yellow fever transmission in the State of São Paulo, with particular emphasis on the possibility of H. leucocelaenus being involved in the maintenance of this sylvatic focus of the disease.<br>O registro de dois casos autóctones de febre amarela silvestre no Estado de São Paulo, Brasil, em 2000, desencadeou investigações entomológicas com o objetivo de verificar a ocorrência das espécies vetoras em ambientes florestais próximos ou associados às zonas ribeirinhas, situados nas regiões oeste e noroeste do Estado. As capturas foram realizadas em 39 localidades distribuídas por quatro regiões do Estado. Haemagogus leucocelaenus e Aedes albopictus foram as espécies mais abundantes e capturadas em todas as regiões. H. leucocelaenus foi a espécie mais abundante nos municípios de Santa Albertina e Ouroeste, onde os casos de febre amarela silvestre foram registrados. Mosquitos do grupo janthinomys/capricornii foram encontrados em oito localidades de São José do Rio Preto, enquanto Sabethes chloropterus uma única vez em localidade de Ribeirão Preto. Ficou evidenciada a aptidão de H. leucocelaenus para adaptar-se a ambiente secundário e degradado. Nossos resultados apontam para uma ampla área receptiva para a transmissão de febre amarela, com destaque para a possibilidade de H. leucocelaenus estar envolvido na manutenção deste foco silvestre da doença