Cognitive impairment in amyotrophic lateral sclerosis : exploring its relationship with functional incapacity

Amyotrophic Lateral Sclerosis (ALS), traditionally associated with motor dysfunction, also presents cognitive impairments in approximately half of the patients. Significant cognitive and behavioural deficits in ALS affects executive functioning and could have critical implications for prognosis and disease management. Assessing these changes in ALS patients is challenging because their motor disabilities can mask the real extent of their ability to perform daily activities. This study aimed to explore the cognitive impairment in ALS and their relationship with functional incapacity in Activities of Daily Living (ADLs). In a comparative cross-sectional analysis, twenty-two ALS patients were divided into Low Severity and High Severity groups (n=11 each) based on their ALSFRS-R (Amyotrophic Lateral Sclerosis Functional Rating Scale Revised) scores and compared with twenty-two Healthy Controls. Cognitive, behavioural, emotional, and functional performance were assessed. The results revealed significant cognitive deficits in ALS patients, particularly with High Severity disease. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS), a multidomain evaluation specifically developed for ALS/Motor Neuron Disease, showed pronounced deficits including language, verbal fluency, executive function, and visuospatial abilities. The Mini Mental State Examination (MMSE) was more discriminative between levels of ALS severity, while the Frontal Assessment Battery (FAB) proved beneficial for comparisons with healthy individuals. Correlation analysis indicated a significant negative association between Executive Function and Advanced Instrumental Daily Living tasks. The results corroborate previous research and emphasize the importance of regular cognitive assessments in ALS patients, and also add value by assessing functional incapacity. Beyond the diagnostic cost, they pave the way for cognitive stimulation programs,, especially those targeting executive functions, which may delay cognitive decline and support complex daily living activities, essential for decision-making and developing coping strategies for the disease. Furthermore, the cognitive decline in a higher level of severity disease accentuates the need for early and comprehensive healthcare planning involving ALS patients and their families.A Esclerose Lateral Amiotrófica (ELA), tradicionalmente associada a disfunções motoras, também apresenta comprometimento a nível cognitivo em aproximadamente metade dos doentes. Os défices cognitivos e comportamentais na ELA afetam o funcionamento executivo e podem ter implicações críticas para o prognóstico e na gestão da doença. A sua avaliação é desafiadora, uma vez que os doentes apresentam limitações motoras que podem mascarar a verdadeira extensão da capacidade de realizar as atividades de vida diárias. Este estudo pretende explorar o comprometimento cognitivo na ELA e a sua relação com a incapacidade funcional nas Atividades da Vida Diária (AVDs). Numa análise transversal comparativa, vinte e dois pacientes com ELA foram divididos em grupos de Baixa Severidade e Alta Severidade (n=11 em cada) com base nos resultados na ALSFRS-R (Amyotrophic Lateral Sclerosis Functional Rating Scale Revised) e foram comparados com vinte e dois controlos saudáveis. O desempenho cognitivo, comportamental, emocional e funcional foram avaliados. Verificaram-se défices cognitivos significativos nos doentes com ELA, em particular de Alta Severidade. O ECAS (Edinburgh Cognitive and Behavioral ALS Screen), um instrumento de avaliação multidomínio desenvolvido para doentes com ELA/Doença do Neurónio Motor, revelou défices acentuados na linguagem, fluência verbal, função executiva e capacidade visuoespacial. O Exame Breve do Estado Mental (MMSE) foi mais discriminativo entre os níveis de severidade da ELA, enquanto que a Bateria de Avaliação Frontal (FAB) para comparações com indivíduos saudáveis. A análise de correlação indicou uma associação negativa significativa entre a Função Executiva e as Atividades Instrumentais Avançadas de Vida Diária. Os resultados corroboram pesquisas anteriores e enfatizam a importância de avaliações cognitivas regulares em doentes com ELA, acrescentando valor ao avaliar a incapacidade funcional. Para além do custo diagnóstico, abrem portas para programas de estimulação cognitiva, especialmente focados nas funções executivas, para retardar o declínio cognitivo e apoiar atividades diárias complexas, essenciais na tomada de decisões e desenvolvimento de estratégias de coping relativas à doença. Além disso, o declínio cognitivo no nível Alto de Severidade da doença acentua a necessidade de um precoce planeamento de cuidados de saúde envolvendo pacientes com ELA e suas famílias

Knowledge about COVID-19 among university students before the implementation of the enhanced community quarantine in Philippines

The purpose of this study was to determine the knowledge of the students about Coronavirus Disease-2019 (COVID-19) before the Philippines government implements the enhanced community quarantine in Luzon. A descriptive research design was conducted among the students of Nueva Ecija University of Science and Technology, San Isidro Campus. The sample size was computed by using the Epi-Info version 2000 Computer Programme. Questionnaire was used to collect data that was composed of the profile, questions regarding their knowledge about COVID-19 and their source of knowledge. Permission to conduct and informed consent was obtained before the respondent answer the questionnaire. Data were analyzed using various statistical tools. Majority of the respondents had an average and good knowledge while sex was the only variable that differs significantly in their knowledge about COVID-19. Social media and seminars in the school were among their primary source of knowledge. It is concluded that students‟ knowledge about COVID-19 was sufficient. However, the absence of vaccines against COVID-19, prevention and control of the disease was the only way to fight it which requires organizing health education campaigns in different communities to disseminate more information on how everybody can effectively deal with this pandemic

(RE)EXISTÊNCIAS E O DEVIR REVOLUCIONÁRIO NA LITERATURA NEGRO-FEMININA

      A produção literária de mulheres negras brasileiras apresenta, frequentemente, provocações e sinalizações de uma gramática literária atravessada por temas e propósitos que, a um só tempo, se ancoram entre sonhos por transformações e reinvenções de (re) existências, histórias e caminhos. Neste sentido, este texto aponta suas dicções literárias como práticas discursivas que transitam entre o devir revolucionário, elucidado por Gilles Deleuze (1990), e as travessias e pontes do (re) existir. Diante disso, este artigo faz leituras descritivo-interpretativas, pautada em poéticas e memórias de (re) existências e em algumas postulações do devir revolucionário, de algumas de suas tessituras poéticas. &nbsp

A AUTORIA NEGRO-FEMININA NO BRASIL E EM MOÇAMBIQUE: O ESCREVER ENTRE DOBRAS E INSURGÊNCIAS

A produção literária de escritoras negras no Brasil e africanas de Moçambique tem sido marcada por um árduo exercício de dessilenciamento de suas vozes autorais e visibilização de suas tessituras literárias. Diante disso, este artigo objetiva refletir sobre modos de (re) existências das autoras desses países. Propõe-se ainda discutir como em suas escritas elas (re) criam possibilidades de sentidos de vida, contrapondo-se às narratividades, demarcações, geografias e práticas que lhes fixam em “lugares” de subjugações e interdições. Apresentam-se, neste texto, leituras descritivo-interpretativas de algumas de suas dicções literárias para compreensão de como elas forjam os significados e dobras de (re) existir, criar mundos, caminhos e resistência

FIGURAÇÕES DE ÉTICA UBUNTU EM TRAJETÓRIAS DE INTELECTUAIS NEGRAS: MAIS UM DESAFIO À CRÍTICA CULTURAL

Resum

Vozes literárias de escritoras negras

Prefácio de Florentina SouzaO livro apresenta leituras descritivo-interpretativas de trajetórias, prosas e poéticas das autoras negras baianas Aline França, Angelita Passos, Elque Santos, Fátima Trinchão, Jocélia Fonseca, Mel Adún, Rita Santana, e Urânia Munzanzu. O texto enfatiza traços de identidades, memórias individuais e coletivas, autoria, escrita e cuidado de si/nós presentes em suas poéticas e narrativas, salientando suas formações discursivas como práticas de (des) silenciamento de suas vozes autorais, visibilização de africanidades, ressignificações de suas vidas, legados culturais negros e de estratégias de descolonização, descentramento e de desautomatização de sujeitos poéticos e ficcionais. A leitura de Vozes Literárias de Escritoras Negras possibilita aos/às leitores/as a compreensão de práticas discursivas e de assenhoramento da escrita de autoras negras baianas; suscita rasuras sobre ditos que subjugam sua produção literária, e, a um só tempo, faz provocações (contraditos) relacionadas às representações depreciativas e erotizadas de mulheres negras na literatura brasileira

Baladas e o Mar - Morada de Memórias - em O Canto dos Escravizados

Resumo: Este artigo advém de um mapeamento elaborado sobre autoras moçambicanas, entre 2015 e 2017, de estudos e pesquisas realizados sobre autoria feminina negra no Brasil e em países africanos em língua portuguesa e da experiência leitora de produções literárias de escritoras negras brasileiras e africanas de várias partes do continente africano. A contadora de histórias Paulina Chiziane, romancista moçambicana, destaca-se neste texto, o qual tem como objetivos expor alguns de seus dados (biblio)biográficos, bem como apresentar algumas leituras descritivo-interpretativas do livro O Canto dos escravizados (Nandyala, 2018), tendo como ênfase a compreensão dos cantos e do mar como residência e arquivo de memórias.   Abstract: This article comes from a mapping elaborated on mozambican authors between 2015 and 2017 of studies and researches on black female authorship in Brazil and in african countries in portuguese language and the literary experience of literary productions of brazilian and african black writers from various parts of the african continent. The storyteller, Paulina Chiziane, mozambican novelist, highlights in this text, which aims to expose some biographical of this author, as well as to present some descriptive-interpretative readings of the book The Song of the Slaves (Nandyala, 2018), with emphasis on understanding the songs and sea as a residence and archive of memories.   Resumen: Este artículo proviene de un mapeo en autores de Mozambique entre 2015 y 2017, de los estudios y la investigación sobre autoras negras en Brasil y los países africanos de lengua oficial portuguesa así como de la experiencia como lector de las producciones literarias de escritoras negras brasileñas y africanas de varios partes del continente africano. La contadora de historias Paulina Chiziane, novelista mozambiqueña, se destaca en este texto, el cual tiene como objetivos exponer algunos de sus datos (biblio)biográficos, así como presentar algunas lecturas descriptivas e interpretativas del libro El canto de los esclavizados (Nandyala, 2018), buscando analizar las canciones y la presencia del mar como residencia y archivo de memorias

Longitudinal qPCR study of the dynamics of L. crispatus, L. iners, A. vaginae, (sialidase positive) G. vaginalis, and P. bivia in the vagina

Background: To obtain more detailed understanding of the causes of disturbance of the vaginal microflora (VMF), a longitudinal study was carried out for 17 women during two menstrual cycles. Methods: Vaginal swabs were obtained daily from 17 non-pregnant, menarchal volunteers. For each woman, Gram stains were scored, the quantitative changes of 5 key vaginal species, i.e. Atopobium vaginae, Lactobacillus crispatus, L. iners, (sialidase positive) Gardnerella vaginalis and Prevotella bivia were quantified with qPCR and hydrogen-peroxide production was assessed on TMB+ agar. Results: Women could be divided in 9 subjects with predominantly normal VMF (grades Ia, Ib and Iab, group N) and 8 with predominantly disturbed VMF (grades I-like, II, III and IV, group D). VMF was variable between women, but overall stable for most of the women. Menses were the strongest disturbing factor of the VMF. L. crispatus was present at log7-9 cells/ml in grade Ia, Iab and II VMF, but concentrations declined 100-fold during menses. L. crispatus below log7 cells/ml corresponded with poor H2O2-production. L. iners was present at log 10 cells/ml in grade Ib, II and III VMF. Sialidase negative G. vaginalis strains (average log5 cells/ml) were detected in grade I, I-like and IV VMF. In grade II VMF, predominantly a mixture of both sialidase negative and positive G. vaginalis strains (average log9 cells/ml) were present, and predominantly sialidase positive strains in grade III VMF. The presence of A. vaginae (average log9 cells/ml) coincided with grade II and III VMF. P. bivia (log4-8 cells/ml) was mostly present in grade III vaginal microflora. L. iners, G. vaginalis, A. vaginae and P. bivia all increased around menses for group N women, and as such L. iners was considered a member of disturbed VMF. Conclusions: This qPCR-based study confirms largely the results of previous culture-based, microscopy-based and pyrosequencing-based studies

MMIST-ccRCC: A Real World Medical Dataset for the Development of Multi-Modal Systems

The acquisition of different data modalities can enhance our knowledge and understanding of various diseases, paving the way for a more personalized healthcare. Thus, medicine is progressively moving towards the generation of massive amounts of multi-modal data (\emph{e.g,} molecular, radiology, and histopathology). While this may seem like an ideal environment to capitalize data-centric machine learning approaches, most methods still focus on exploring a single or a pair of modalities due to a variety of reasons: i) lack of ready to use curated datasets; ii) difficulty in identifying the best multi-modal fusion strategy; and iii) missing modalities across patients. In this paper we introduce a real world multi-modal dataset called MMIST-CCRCC that comprises 2 radiology modalities (CT and MRI), histopathology, genomics, and clinical data from 618 patients with clear cell renal cell carcinoma (ccRCC). We provide single and multi-modal (early and late fusion) benchmarks in the task of 12-month survival prediction in the challenging scenario of one or more missing modalities for each patient, with missing rates that range from 26$\%$ for genomics data to more than 90$\%$ for MRI. We show that even with such severe missing rates the fusion of modalities leads to improvements in the survival forecasting. Additionally, incorporating a strategy to generate the latent representations of the missing modalities given the available ones further improves the performance, highlighting a potential complementarity across modalities. Our dataset and code are available here: https://multi-modal-ist.github.io/datasets/ccRCCComment: Accepted in DCA in MI Workshop@CVPR202

Consultation hold: interruptions during General Practice consultations

Introduction: The impact of interruptions (IR) in consultations is recognized. A study in Ireland identified IR in 53 of 212 consultations (25%) and the most common source was the phone. In Spain, 91% and 54% of consultations of two family doctors had an IR, with a mean duration of 35 and 16 seconds. Objective: To characterize the IR in consultations of the researchers’ Health Unit, in the centre of Portugal. Methods: Cross-sectional study. Authorization granted by Official Ethics Committee. General and Family Medicine consultations periods with at least 2 hours were randomized, by doctor in 2 weeks of evaluation. Informed consent was signed by patients. The researcher physician sat in the corner of the consulting room and recorded the information in a specifically designed data sheet. Significant IR was defined as the one lasting more than 5 seconds and/or changing the flow of the consultation. Inside and outside IR was defined according to origin in relation to consulting room. Data were analyzed by descriptive and nonparametric inferential statistics. Results: 37 of 63 consultations (58.7%) had at least one IR, with a mean duration of 42 seconds. No significant difference comparing weeks (p=0.440) or morning/afternoon periods (p=0.556). 19 consultations had 1 IR (51.4%), followed by 2 IR (10), 3 IR (6), 4 and 5 IR (1). In 34 consultations (91.9%) the IR were considered significant and in 30 consultations (83.3%) were considered unjustified. Of 66 IR, 57 (86.4%) were significant. The commonest source was the door [29 (43.9%) of the total and 27 (47.4%) of the significant IR], mainly caused by a physician [specialist (24%) and intern (21%)], followed by patient (21%), nurse (17%) and technical assistant (17%). Other sources were patient or doctor’s phone mobile (18.2%), lack of material (12.1%), consulting room telephone (10.6%), electronic problem (7.6%) and exit from office (7.6%). Lack of material and 3 cases of exit from office were considered justified. Outside factors had greater impact on consultations (p=0.041). Discussion: In this study at least half of the consultations had an IR. The door stands out as the main source and had a high impact. The IR by an intern may represent peculiarities of the formation. The inside factors, mainly the phone mobile and exit from office, are related to core doctor/patient and revealed to have a lesser impact. Correction measures can improve performance for even the justified IR can be avoided