Evaluación, Cuidado y Registro Sistemático del Dolor

Artigo resultante de uma comunicação oral no I Congreso Iberoamericano sobre Dolor y Sufrimiento del Niño y su Familia, em que obteve o primeiro prémio.Evaluar el dolor es un desafío para los profesionales de salud. En Portugal, el dolor, fue elevado a la categoría de 5ª constante vital en 2003. En el Hospital Mª Pia estamos implementando un proyecto de mejoría continua de la calidad sobre evaluación, cuidado y registro del dolor. En la fase conceptual escogemos diversas escalas ya validadas para pediatria, definimos objetivos, indicadores de calidad y actividades para el desarrollo del proyecto. Como estrategia de base se proponen oportunidades de participación para todos los enfermeros. La fase de implementación empezó con un cuestionario diagnostico que permitió sensibilizar los enfermeros para la temática del dolor, auscultar conocimientos y servir de referencia para programar la formación. Se ha hecho formación de soporte al desenvolvimiento del proyecto: escalas escogidas, elaboración de procedimientos técnicos de enfermería y dossier. La evaluación sistematizada del dolor a los niños ingresados en el hospital empezó, oficialmente, el día 6 de Setiembre de 2007. Las dificultades notadas pasan por la necesidad de motivar continuamente a los enfermeros a una participación activa e reflejada; objetivar la evaluación del dolor en las situaciones más difíciles: niños/recién nacidos con ventilación mecánica y sedación bien como adolescentes emocionalmente inestables, ingresados en la pedopsiquiatria. Estamos ahora en fase de auditorías y reformulación del proyecto para el prójimo año. Esperamos entrar en una fase de consolidación por lo que invertiremos en la formación específica del dolor y seguiremos creando oportunidades de participación. Esperamos que en un futuro prójimo, el hospital tenga todos sus niños sin dolor

Nutritional assessment of fresh, salted and soaked European catfish

The European catfish (Silurus glanis Linnaeus, 1758) is an invasive fish species in Portugal and it is the largest-bodied European freshwater fish.CERNAS-IPCB [UIDB/00681/2020] funding by the Portuguese National Funding Agency for Science, Research and Technology (FCT).info:eu-repo/semantics/publishedVersio

Nocturnal Blood Pressure Dipping in Acute Ischemic Stroke

OBJECTIVES: We aim to assess the impact of early nocturnal blood pressure (BP) variation in the functional outcome of patients after an acute ischemic stroke. MATERIALS AND METHODS: We included consecutive stroke patients treated with intravenous thrombolysis (IVrtPA) in a tertiary stroke center. BP measurements were performed at regular intervals throughout day and night during the first 48 h after stroke onset, and subjects were divided into four dipping categories (extreme dippers, dippers, non-dippers, and reverse dippers). Recanalization was assessed by transcranial color-coded Doppler and/or angiographic CT. Hemorrhagic transformation was evaluated at 24 h follow-up CT scan. Functional outcome was evaluated at 3 months after stroke using the modified Rankin Scale. RESULTS: A total of 304 patients were included, mean age 72.80 ± 11.10 years. After 24 h of systolic BP monitoring, 30.59% were classified as reverse dippers, 39.14% as non-dippers, 19.10% as dippers, and 11.18% as extreme dippers. Multivariate analysis did not show an independent association of any dipping class with 3-month functional outcome. Hemorrhagic transformation was not uniform between dipping classes: 25.81% for reverse dippers, 14.29% for non-dippers, 15.52% for dippers, and 5.88% for extreme dippers, P = 0.033. CONCLUSIONS: Nocturnal BP dipping pattern is not associated with functional outcome at 3 months in acute stroke patients treated with IVrtPA. Hemorrhagic transformation was more frequent in reverse dippers.info:eu-repo/semantics/publishedVersio

Collateral pial circulation relates to the degree of brain edema on CT 24 hours after ischemic stroke

Background Cerebral edema is frequent in patients with acute ischemic stroke (AIS) who undergo reperfusion therapy and is associated with high mortality. The impact of collateral pial circulation (CPC) status on the development of edema has not yet been determined. Methods We studied consecutive patients with AIS and documented M1-middle cerebral artery (MCA) and/or distal internal carotid artery (ICA) occlusion who underwent reperfusion treatment. Edema was graded on the 24-hour non-contrast computed tomography (NCCT) scan. CPC was evaluated at the acute phase (≤6 hours) by transcranial color-coded Doppler, angiography and/or CT angiography. We performed an ordinal regression model for the effect of CPC on cerebral edema, adjusting for age, baseline National Institutes of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on admission, NCCT, parenchymal hemorrhagic transformation at 24 hours and complete recanalization at six hours. Results Among the 108 patients included, 49.1% were male and mean age was 74.2 ± 11.6 years. Multivariable analysis showed a significant association between cerebral edema and CPC status (OR 0.22, 95% CI 0.08-0.59, p = 0.003), initial ASPECTS (OR 0.72, 95% CI 0.57-0.92, p = 0.007) and parenchymal hemorrhagic transformation (OR 23.67, 95% CI 4.56-122.8, p < 0.001). Conclusions Poor CPC is independently associated with greater cerebral edema 24 hours after AIS in patients who undergo reperfusion treatment.info:eu-repo/semantics/publishedVersio

Blood Pressure Variability in Acute Ischemic Stroke: The Role of Early Recanalization

We performed a retrospective study with the aim of investigating the association between blood pressure (BP) variability in the first 24 h after ischemic stroke and functional outcome, regarding arterial recanalization status. A total of 674 patients diagnosed with acute stroke and treated with revascularization therapies were enrolled. Systolic and diastolic BP values of the first 24 h after stroke were collected and their variation quantified through standard deviation. Recanalization state was evaluated at 6 h and clinical outcome at 3 months was assessed by modified Rankin Scale. In multivariate analyses systolic BP variability in the first 24 h post-stroke showed an association with 3 months clinical outcome in the whole population and non-recanalyzed patients. In recanalyzed patients, BP variability did not show a significant association with functional outcome.info:eu-repo/semantics/publishedVersio

A 68 ka precipitation record from the hyperarid core of the Atacama Desert in northern Chile

[Abstract] The Atacama Desert in northern Chile is one of the driest deserts on Earth. Hyperaridity persists at least since the Miocene and was punctuated by pluvial phases. However, very little is known about the timing, regional spread and intensities of precipitation changes. Here, we present a new precipitation record from a sedimentary sequence recovered in a tectonically blocked endorheic basin that is located in the hyperarid core of the Atacama Desert. The chronostratigraphic framework of the record is given by a multi-disciplinary dating approach, suggesting an age of ca. 68 ka BP for the core base. The sequence consists of three sediment types, whose sedimentological and geochemical characteristics suggest different depositional processes that reflect different degrees in humidity. First, particularly fine-grained sediments with high clastic but low calcium sulfate and carbonate contents reflect a particularly dry climate with only sporadic precipitation events and fluvial supply via channel systems. Second, more coarse-grained sediments with lower clastic and higher calcium sulfate and carbonate contents reflect more moist conditions with stronger precipitation events that lead to fluvial activity not restricted to the channels but involving the slopes and plains in the catchment. Third, normally graded layers with an equally high proportion of calcium sulfate and carbonate reflect occasional high-precipitation events that caused sediment supply also from most distant parts of the catchment via severe flash floods. The sedimentary succession suggests that precipitation changes took place on orbital but also on millennial time scales. Rather moist periods occurred during most of MIS 2, several shorter periods within MIS 3 and parts of MIS 4. Comparison of the findings from the Huara record with selected climate records from continental and marine sites in South America suggests a strong precipitation heterogeneity across the Atacama. This heterogeneity is caused by pronounced differences in the dominating climate patterns and a shift from predominant summer rain in the north to winter rain in the south. Precipitation supply to the Huara clay plan is controlled by the atmospheric circulation rather than the surface temperature of the adjacent ocean

Cognitive impairment and magnetic resonance imaging correlates in primary progressive multiple sclerosis

Objectives: To characterize cognitive impairment in primary progressive multiple sclerosis (PPMS) and to correlate the pattern of cognitive deficits with brain magnetic resonance imaging (MRI) volumetric data. Materials and methods: In a multicenter cross-sectional study, we recruited consecutive patients with PPMS as well as age, sex, and education level-matched healthy controls (HC). All participants underwent neuropsychological (NP) assessment, and brain MRI was performed in patients with PPMS for analysis of lesion load, subcortical GM volumes, and regional cortical volumes. Results: We recruited 55 patients with PPMS and 36 HC. Thirty-six patients were included in the MRI analysis. Patients with PPMS performed significantly worse than HC in all NP tests. Subcortical GM volume was significantly correlated with all NP tests, except for Stroop Test, with the largest effect for the thalamus (r=−.516 [BVMT-R DR, P=.016 FDR-corrected] to r=.664 [SDMT, P<.001 FDR-corrected]). In the stepwise linear regression model, thalamic volume was the only predictor of performance in all NP tests. Conclusion: Cognitive impairment is common in PPMS and affects all evaluated cognitive domains. Subcortical GM volume, particularly of the thalamus, is a strong predictor of cognitive performance, suggesting it has a central role in the pathophysiology of PPMS-related cognitive dysfunction

Quantitative Control of Organ Shape by Combinatorial Gene Activity

A novel combination of molecular genetics, shape analysis, and computational modelling shows how the complex three-dimensional shape of the Snapdragon flower can arise through local gene activity

Just use it! Linguistic conversion and identities of resistance amongst Galician new speakers

In recent years there has been a focus in language policy research on understanding how national policies are interpreted and negotiated by social actors on the ground. This paper looks at the interplay between government and grassroots initiatives to create Galician-speaking spaces in predominantly Spanish-speaking urban settings. While official language policies in Galicia since the 1980s have increased the potential for language use through bilingual educational policies, these policies have failed to convert the large pool of potential speakers amongst a younger generation of Galicians into active language users. Drawing on ethnographic fieldwork and in-depth interviews with Galician neofalantes (new speakers) this paper looks at instances where such policies seem to have worked and where the linguistic capacity created through the education system has been converted into active language use. The article examines how such speakers rationalise their practice of linguistic conversion not as success stories of language policy but as reactions to and dissatisfaction with what is perceived as ‘top-down’ governmentality through a reflexive process in which existing power structures are brought into question. The article looks specifically as the ideologies underpinning their decisions to become active speakers and the role they play as language planners in contemporary Galicia