Dissimilar forests along the Rio Doce watershed call for multiple restoration references to avoid biotic homogenization.

An environmental disaster caused by the rupture of a mining tailings dam has impacted a large area of the Rio Doce watershed in the Brazilian Atlantic Forest, resulting in unprecedented damage at spatial and temporal scales. The Atlantic Forest is one of the world's most important biodiversity hotspots. A long history of land use conversion has resulted in a highly fragmented landscape. Despite numerous restoration initiatives, these efforts have often biased criteria and use limited species assemblages. We conducted a comprehensive synthesis of the plant community in riparian forests along the Rio Doce watershed. Our work detailed vegetation composition (tree and sapling strata) and examined its relationship with edaphic and landscape factors, aiming to inform restoration projects with scientifically robust knowledge. A total of 4906 individuals from the tree strata and 4565 individuals from the sapling strata were recorded, representing a total of 1192 species from 75 families. Only 0.8% of the tree species and 0.5% of the sapling species occurred in all sampled sectors, with over 84% of the species occurring in a single watershed sector for both strata. We observed a high species heterogeneity modulated by turnover (92.3% in the tree, and 92.7% in the sapling strata) among sites. Overall, our research revealed a gradient of soil fertility influencing species composition across different strata. Additionally, we discovered that preserved landscapes had a positive impact on species diversity within both strata. The species exclusivity in the sampled sites and the high turnover rate imply the need to consider multiple reference ecosystems when restoring the watershed to reduce the risk of biotic homogenization. Finally, the reference ecosystems defined here serve as a basis for the selection of locally particular species in the implementation of restoration projects that aim to improve biodiversity, ecosystem services, and water security.

Delusions and Hallucinations Are Associated With Greater Severity of Delirium.

BACKGROUND: The 3 core domains of delirium (cognitive, higher level thinking, circadian) do not include the less common noncore psychotic symptoms. However, psychosis might inform about perturbations of neural circuitry, outcomes, or suggest tailored clinical management. OBJECTIVE: We assessed relationships between psychosis and other characteristics of delirium in patients without dementia or antipsychotics treatment. METHODS: Cross-sectional analysis of 366 adults with delirium per the Delirium Rating Scale Revised-98, whose items distinguish hallucinations and delusions from other types of misperceptions and abnormal thought content, assessed during the preceding 24 hours to capture symptom severity fluctuation. The relationship of psychosis with other delirium characteristics was assessed using bivariate comparisons and analysis of variance as appropriate for groups with no psychosis and any psychosis (hallucinations and/or delusions), and subgroups with only hallucinations, only delusions, or both. A discriminant logistic model assessed variables associated with presence of any psychotic features versus none. RESULTS: Delirium with any psychotic features occurred in 44.5% (163 of 366). Of the 366, 119 (32.5%) had only hallucinations (Hall), 14 (3.8%) had only delusions (Del), and 30 (8.2%) had both (Both). In the psychotic group (n = 163), 73.0% were Hall, 8.6% Del, and 18.4% Both. All psychotic patient groupings had significantly greater delirium severity on the Delirium Rating Scale Revised-98. Delusions and hallucinations were discordant for occurring together. The discriminant model found increased odds of having psychosis as 3 symptom severities increased (visuospatial ability, thought process, and sleep-wake cycle) where these each represented a delirium core domain. The noncore symptom of lability of affect had high odds ratio for psychosis, while motor retardation reduced odds of psychosis in this model. CONCLUSIONS: Consistent with prior reports, psychosis occurred in less than half of delirious patients with delusions being infrequent, and an association with affective lability was found. Given that previous functional magnetic resonance imaging research found a correlation between neural network dysconnectivity with greater severity of delirium, psychotic symptoms might be a clinical marker for greater underlying cerebral cortical neural circuitry dysfunction.

Rock n' Seeds: A database of seed functional traits and germination experiments from Brazilian rock outcrop vegetation.

Advancing functional ecology depends fundamentally on the availability of data on reproductive traits, including those from tropical plants, which have been historically underrepresented in global trait databases. Although some valuable databases have been created recently, they are mainly restricted to temperate areas and vegetative traits such as leaf and wood traits. Here, we present Rock n' Seeds, a database of seed functional traits and germination experiments from Brazilian rock outcrop vegetation, recognized as outstanding centers of diversity and endemism. Data were compiled through a systematic literature search, resulting in 103 publications from which seed functional traits were extracted. The database includes information on 16 functional traits for 383 taxa from 148 genera, 50 families, and 25 orders. These 16 traits include two dispersal, six production, four morphological, two biophysical, and two germination traits-the major axes of the seed ecological spectrum. The database also provides raw data for 48 germination experiments, for a total of 10,187 records for 281 taxa. Germination experiments in the database assessed the effect of a wide range of abiotic and biotic factors on germination and different dormancy-breaking treatments. Notably, 8255 of these records include daily germination counts. This input will facilitate synthesizing germination data and using this database for a myriad of ecological questions. Given the variety of seed traits and the extensive germination information made available by this database, we expect it to be a valuable resource advancing comparative functional ecology and guiding seed-based restoration and biodiversity conservation in tropical megadiverse ecosystems. There are no copyright restrictions on the data; please cite this paper when using the current data in publications; also the authors would appreciate notification of how the data are used in publications.

O avanço da ecologia funcional depende fundamentalmente da disponibilidade de dados sobre traços reprodutivos, incluindo dados de plantas tropicais, que têm sido historicamente subrepresentados em bancos de dados de traços funcionais globais. Embora alguns bancos de dados valiosos tenham sido criados recentemente, eles são restritos principalmente a áreas temperadas e a traços vegetativos, como traços de folhas e madeira. Neste artigo apresentamos Rock n' Seeds, um banco de dados de traços funcionais de sementes e experimentos de germinação de vegetações associadas a afloramentos rochosos do Brasil, os quais são reconhecidos como centros notáveis de diversidade e endemismo. Os dados foram compilados através de uma revisão sistemática na literatura, resultando em 103 publicações das quais foram extraídos os traços funcionais das sementes. O banco de dados inclui informações de 16 traços funcionais para 383 taxa de 148 gêneros, 50 famílias e 25 ordens. Estes dezesseis traços incluem dois traços de dispersão, seis de produção, quatro morfológicos, dois biofísicos e dois germinativos; os eixos principais do espectro ecológico da semente. O banco de dados também fornece os dados brutos para 48 experimentos de germinação para um total de 10.187 registros para 281 taxa. Os experimentos de germinação no banco de dados avaliaram o efeito de uma ampla gama de fatores abióticos e bióticos sobre a germinação e diferentes tratamentos de quebra de dormência. Particularmente, 8.255 desses registros incluem a contagem diária da germinação. Estas informações facilitarão a síntese de dados de germinação e a utilização deste banco de dados para uma grande variedade de questões ecológicas. Dada a variedade de traços das sementes e as amplas informações sobre germinação disponibilizadas por este banco de dados, esperamos que ele seja um recurso valioso para o avanço da ecologia funcional comparativa e para orientar a restauração baseada em sementes e a conservação da biodiversidade em ecossistemas tropicais megadiversos. Não há restrições de direitos autorais sobre os dados; favor citar este artigo ao utilizar os dados nas publicações e os autores agradeceriam uma notificação de como os dados são utilizados nas publicações.

El avance de la ecología funcional depende fundamentalmente de la disponibilidad de datos sobre rasgos reproductivos-incluyendo los de las plantas tropicales-los cuales han estado poco representados en las bases de datos globales de rasgos. Aunque recientemente se han creado algunas bases de datos valiosas, estas se encuentran restringidas principalmente a las zonas templadas y a los rasgos vegetativos, como los de las hojas y la madera. En este artículo presentamos Rock n' Seeds, una base de datos de rasgos funcionales de semillas y experimentos de germinación de la vegetación asociada a afloramientos rocosos de Brasil, los cuales son destacados centros de diversidad y endemismo. Los datos se recopilaron mediante una búsqueda bibliográfica sistemática, que dio como resultado 103 publicaciones de las que se extrajeron los rasgos funcionales de las semillas. La base de datos incluye información de dieciséis rasgos funcionales para 383 taxones de 148 géneros, 50 familias y 25 órdenes. Estos rasgos incluyen dos rasgos de dispersión, seis de producción, cuatro morfológicos, dos biofísicos y dos de germinación; siendo estos los principales ejes del espectro ecológico de las semillas. La base de datos también proporciona los datos brutos de 48 experimentos de germinación, para un total de 10.187 registros de 281 taxones. Dichos experimentos de germinación evaluaron el efecto de una amplia gama de factores abióticos y bióticos sobre la germinación y de diferentes tratamientos para romper la dormancia. En particular, 8.255 de estos registros cuentan con conteos diarios de germinación. Esto facilitará la síntesis de los datos de germinación y el uso de esta base de datos para una gran diversidad de preguntas ecológicas. Dada la variedad de rasgos de las semillas y la amplia información sobre germinación que ofrece esta base de datos, esperamos que sea un recurso valioso para el avance de la ecología funcional comparativa y para orientar la restauración basada en semillas y la conservación de la biodiversidad en ecosistemas tropicales megadiversos. No hay restricciones de derechos de autor sobre los datos; se solicita citar este documento cuando se utilicen los datos en publicaciones y los autores agradecerán ser notificados sobre cómo se utilizan los datos en las publicaciones.

Aftershocks of the Samarco disaster: diminished growth and increased metal content of Raphanus sativuscultivated in soil with mining tailings

The collapse of the Fundão tailings dam of the Samarco mining complex in Mariana, Brazil, was the largest mining disaster in the world to date with many socio-economic and environmental impacts. Soil affected by mining tailings was severely altered with negative impacts for agriculture. We tested whether diluting mining tailings with organic soil would eliminate or at least attenuate the ecotoxic effects on plant development and performance. We cultivated radish, Raphanus sativus,in substrates containing different proportions of mining tailings and organic soil: pure tailings (T100%); 2) tailings75%+ soil25%(T75%); 3) tailings50%+ soil50%(T50%); 4) tailings25%+ soil75%(T25%), and 5) pure organic soil (Soil100%, control). There were large differences in soil quality parameters between the 100% tailings treatment (T100%) and the control (Soil100%), as well as for some parameters in the most diluted treatment -T25%(Ca2+, Fe, Mn) in relation to the controltreatment. Although dilution of the tailings soil improved radish development, there was lower radish productivity (leaf area, total biomass, and root/tuber biomass) than for pure soil (control). There were also significantly higher amounts of bioaccumulated metals in radish tubers grown with tailings, even when grown in T25%for Fe content and in T75%for Mn content. These results present a worrisome scenario for human communities in the region of the Doce river, as human consumption of crops produced in soil contaminated with tailingsis not recommended due to potential toxicological effects from high metal concentrations.(AU)

Subtle structures with not-so-subtle functions: A data set of arthropod constructs and their host plants.

The construction of shelters on plants by arthropods might influence other organisms via changes in colonization, community richness, species composition, and functionality. Arthropods, including beetles, caterpillars, sawflies, spiders, and wasps often interact with host plants via the construction of shelters, building a variety of structures such as leaf ties, tents, rolls, and bags; leaf and stem galls, and hollowed out stems. Such constructs might have both an adaptive value in terms of protection (i.e., serve as shelters) but may also exert a strong influence on terrestrial community diversity in the engineered and neighboring hosts via colonization by secondary occupants. Although different traits of the host plant (e.g., physical, chemical, and architectural features) may affect the potential for ecosystem engineering by insects, such effects have been, to a certain degree, overlooked. Further analyses of how plant traits affect the occurrence of shelters may therefore enrich our understanding of the organizing principles of plant-based communities. This data set includes more than 1000 unique records of ecosystem engineering by arthropods, in the form of structures built on plants. All records have been published in the literature, and span both natural structures (91% of the records) and structures artificially created by researchers (9% of the records). The data were gathered between 1932 and 2021, across more than 50 countries and several ecosystems, ranging from polar to tropical zones. In addition to data on host plants and engineers, we aggregated data on the type of constructs and the identity of inquilines using these structures. This data set highlights the importance of these subtle structures for the organization of terrestrial arthropod communities, enabling hypotheses testing in ecological studies addressing ecosystem engineering and facilitation mediated by constructs. There are no copyright restrictions and please cite this paper when using the data in publications.

Functional traits of three major invasive grasses in a threatened tropical mountain grassland.

The native flora of the Brazilian rupestrian grassland (campos rupestres) is threatened by the spread of invasive grasses. In this study, we evaluated the effect of habitat on the functional traits and CSR ecological strategies of three invasive alien grasses occurring both in the ironstone (IRG) and quartzitic (QRG) rupestrian grassland habitats. Although in both habitats the invasive species predominantly showed a stress-tolerant strategy, they exhibited distinct degrees of stress-tolerance and slightly differences in functional traits values in the IRG compared to the QRG. Habitat type distinctly influenced invasive grasses functional traits and ecological strategies, revealing a species-specific pattern.

Altitudinal variation in butterfly community associated with climate and vegetation.

Elevation creates a variety of physical conditions in a relatively short distance, which makes mountains suitable for studying the effects of climate change on biodiversity. We investigated the importance of climate and vegetation for the distribution of butterflies from 800 to 1400 m elevation. We sampled butterflies, and woody and rosette plants and measured air temperature and humidity, wind speed and gust, and solar radiation. We partitioned diversity to assess the processes underlying community shifts across altitudes - species loss versus replacement. We assessed the strength of the association among butterfly, vegetation, and climate. Butterfly richness and abundance decreased with altitude, and species composition changed along the elevation. Changes in butterfly composition with altitude were mainly through species replacement and by abundance increases in some species being compensated by decreases in others. Since the floristic diversity decreased with altitude due to soil conditions, and butterflies are closely related to their host plants, this could explain species replacement with altitude. Overall, we found a stronger association of butterfly community with vegetation than climate, but plant community and climate were also strongly associated between them. Butterfly richness was more strongly associated with plant richness than with temperature, while the reverse was true for butterfly abundance, which was more strongly associated with temperature than with plant richness. We must consider the complementary roles of resource and conditions in species distribution.

Delirium Phenotype by Age and Sex in a Pooled Data Set of Adult Patients.

The authors aimed to evaluate whether the clinical phenotype of delirium differs if dichotomized either by sex or age (cutoff age, 65 years old) in a pooled sample of 406 nondemented adult patients with delirium as defined by DSM-IV criteria. Delirium characteristics were measured with the Delirium Rating Scale-Revised-98 (DRS-R-98). DRS-R-98 items were subgrouped to represent subscores representing the three core domains of delirium (cognitive, higher-order thinking, and circadian), noncore accessory symptoms (psychotic and affective), and diagnostic characteristics (temporal onset, fluctuation, and physical disorder). The authors compared means of the DRS-R-98 subscores and medians of individual items. Exploratory factor analyses evaluated delirium characteristics for each subgroup for each of the four groups-male, female, nongeriatric, and geriatric-while taking into account active medical diagnoses. Males had higher scores on motor agitation and affective lability (behavioral), whereas females had a higher frequency of hypoactive delirium. Delirium had a two-factor structure that emerged in all four study groups, and all its core domains loaded (i.e., correlated together) onto some of these two factors and with circadian domain correlating with accessory symptoms. Although the influence of a variety of active diagnoses on delirium was small and complex, traumatic brain injury had a clear influence on cognitive domain and abrupt onset. Age had a mild influence over delirium characteristics for both males and females. In conclusion, the authors confirmed a two-factor structure for delirium phenomenology, regardless of age and sex, with few significant differences between etiological groups.

Formação x educação, Deontologia x ética: repensando conceitos, reposicionando docentes / Training x education, Deontology x ethics: rethinking concepts and repositioning professors

Partindo de inquietações e reflexões docentes, buscamos problematizar alguns conceitos frequentemente tomados como sinônimos no contexto da educação de profissionais de saúde, descortinando concepções alternativas para um fazer pedagógico eticamente comprometido. A análise se centra na ideia hegemônica da ética que conforma certo sentido para a expressão "ética na formação", em contraposição ao que se poderia denominar de uma "dimensão ética da educação". Por meio de uma escrita dialógica sobre temas comuns a todo (a) professor (a), quer-se provocar o (a) leitor (a) para o exame de sua práxis acadêmica e para o questionamento sobre o que temos realizado na universidade: formação profissional ou educação superior? Os argumentos expressos neste ensaio almejam fomentar o (auto)questionamento para que cada um(a) responda, a sua maneira, e depois coletivamente, à pergunta essencial que a ética nos faz: "que devo(devemos) fazer"? (AU).

Starting from teachers' concerns and reflections, we seek to problematize some concepts often taken as synonyms in the context of professionals' health education, revealing alternative conceptions of ethical and pedagogical doing. The analysis focuses on ethics hegemonic idea that forms a particular meaning for the expression "ethics in training," in opposition to what could be called an "ethical dimension of education." Through a dialogical writing about common topics to every professor, the rationale is to provoke the reader to his/her academic praxis examination and to question what are we doing in universities: developing vocational training or higher education? The arguments expressed in this essay seek to encourage the (self) questioning so that each one responds, in his or her way, and then collectively, to the essential question regarding ethics: "What should we do"? (AU).

Phylogeny strongly drives seed dormancy and quality in a climatically buffered hotspot for plant endemism.

BACKGROUND AND AIMS: Models of costs and benefits of dormancy (D) predict that the evolutionarily stable strategy in long-term stable environments is for non-dormancy (ND), but this prediction remains to be tested empirically. We reviewed seed traits of species in the climatically buffered, geologically stable and nutrient-impoverished campo rupestre grasslands in Brazil to test the hypothesis that ND is favoured over D. We examined the relative importance of life-history traits and phylogeny in driving the evolution of D and assessed seed viability at the community level. METHODS: Germination and viability data were retrieved from 67 publications and ND/D was determined for 168 species in 25 angiosperm families. We also obtained the percentage of embryoless, viable and dormant seeds for 74 species. Frequencies of species with dormant and non-dormant seeds were compared with global databases of dormancy distribution. KEY RESULTS: The majority of campo rupestre taxa (62·5 %) had non-dormant seeds, and the ND/D ratio was the highest for any vegetation type on Earth. Dormancy was unrelated to other species life-history traits, suggesting that contemporary factors are poor predictors of D. We found a significant phylogenetic structure in the dormancy categorical trait. Dormancy diversity was highly skewed towards the root of the phylogenetic tree and there was a strong phylogenetic signal in the data, suggesting a major role of phylogeny in determining the evolution of D versus ND and seed viability. Quantitative analysis of the data revealed that at least half of the seeds produced by 46 % of the surveyed populations were embryoless and/or otherwise non-viable. CONCLUSIONS: Our results support the view that long-term climatic and geological stability favour ND. Seed viability data show that campo rupestre species have a markedly low investment in regeneration from seeds, highlighting the need for specific in situ and ex situ conservation strategies to avoid loss of biodiversity.

Confirmatory Factor Analysis of the Delirium Rating Scale Revised-98 (DRS-R98).

Principal components analysis applied to the Delirium Rating Scale-Revised-98 contributes to understanding the delirium construct. Using a multisite pooled international delirium database, the authors applied confirmatory factor analysis to Delirium Rating Scale-Revised-98 scores from 859 adult patients evaluated by delirium experts (delirium, N=516; nondelirium, N=343). Confirmatory factor analysis found all diagnostic features and core symptoms (cognitive, language, thought process, sleep-wake cycle, motor retardation), except motor agitation, loaded onto factor 1. Motor agitation loaded onto factor 2 with noncore symptoms (delusions, affective lability, and perceptual disturbances). Factor 1 loading supports delirium as a single construct, but when accompanied by psychosis, motor agitation's role may not be solely as a circadian activity indicator.

Three core domains of delirium validated using exploratory and confirmatory factor analyses.

OBJECTIVE: To confirm the existence of the proposed three-core symptom domains in delirium by analyzing a dataset of nondemented adults using selected core symptoms as measured by the Delirium Rating Scale-Revised-98 (DRS-R98) scale. METHODS: Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of proposed delirium core symptoms were conducted in a pooled international dataset of 592 delirious and nondelirious patients using DSM-IV criteria from 14 studies with comparable methodologies. Using DRS-R98 categorization, 445 had either subsyndromal or full delirium and comprised the delirium group. The dataset was divided into three independent random subsamples to perform a stepwise analysis. First we performed EFA in 100 cases to delineate latent factor loadings of DRS-R98 items selected to represent the three-core domains (circadian, higher level thinking, and cognitive). These items were then assessed using CFA-modeling (n = 246) followed by a CFA-validation (n = 246). Reliability and goodness of fit of these two CFA were assessed statistically. RESULTS: DRS-R98 items representing the proposed delirium core symptoms loaded onto one factor in the EFA, supporting their core nature. The two CFA confirmed the nature of this core factor as comprising three core domains where DRS-R98 items each loaded with high values (>0.7) onto their corresponding core domain (circadian, higher level thinking, and cognitive) with good fit and reliability. Attention was DRS-R98 item with the highest loading in CFA, followed by thought process, and then by sleep-wake cycle and motor behavior. CONCLUSIONS: Our EFA and CFA confirm and validate the proposed three-core domains of delirium, where symptoms were highly related to the domain that they were hypothesized to represent. These domains are consistent with delirium being a state of impaired consciousness, and should be considered necessary to assess whether in clinical or research settings.

Phenotype of subsyndromal delirium using pooled multicultural Delirium Rating Scale--Revised-98 data.

OBJECTIVE: There is no consensus definition for the phenotype of subsyndromal delirium (SSD), a subthreshold state to full delirium. Without an a priori definition we applied advanced analytic techniques to discern SSD. METHOD: We pooled Delirium Rating Scale-Revised-98 (DRS-R98) data from 859 DSM-IV diagnosed nondemented delirious adults and nondelirious controls collected by investigators in 7 countries. Discriminant analyses defined an SSD group that was then compared to Nondelirium and Delirium groups. RESULTS: SSD (n=138) had intermediate DRS-R98 item severities between Delirium (n=497) and Nondelirium (n=224) groups, where groups significantly differed on all DRS-R98 items (ANOVA p<.001) except delusions. Discriminant analysis found SSD phenomenologically closer to Delirium than Nondelirium. Using full multinomial logistical regression, SSD was distinguished from Nondelirium by temporal onset, sleep-wake cycle, perceptual disturbances, motor retardation, delusion, affective lability, and all cognitive items; SSD was similar to Delirium in thought process, language, motor agitation or retardation, sleep-wake cycle, all cognitive items, fluctuation and physical disorder. The multivariate model correctly classified 94.2% of Nondelirium, 75.4% of SSD and 97.2% of Delirium subjects. Binary logistic regression of six core domain symptoms (sleep-wake cycle, thought process, language, attention, orientation, and visuospatial ability) together were found as highly differentiating of SSD from Nondelirium, which correctly classified almost 80% of SDD. CONCLUSIONS: SSD is intermediate in severity between nondelirious controls and full syndromal delirium, but its phenotype is more like delirium. Core domain delirium symptoms present at milder severity in SSD should be evaluated further for utility in detecting and managing SSD, preventing delirium, and possible inclusion in DSM-V.

A new genus and species of gall midge (Diptera, Cecidomyiidae) associated with Myrcia retorta (Myrtaceae) / Um novo gênero e espécie de mosquito galhador (Diptera, Cecidomyiidae) associados com Myrcia retorta (Myrtaceae)

Brethesia Maia, new genus and Brethesia myrciae Maia, new species of Cecidomyiidae are described and illustrated (male, female, pupa and gall) based on material collected in Minas Gerais (Brazil). This new species induces leaf galls on Myrcia retorta (Myrtaceae).

Brethesia myrciae, um novo gênero e espécie de Cecidomyiidae que induz galhas em Myrcia retorta (Myrtaceae) são descritos e ilustrados (macho, fêmea, pupa e galha) baseados em material coletado em Minas Gerais (Brazil).

Portuguese version of the Delirium Rating Scale-Revised-98: reliability and validity.

OBJECTIVE: To assess the validity and the reliability of the Portuguese version of the Delirium Rating Scale-Revised-98 (DRS-R-98). METHODS: The scale was translated into Portuguese and back-translated into English. After assessing its face validity, five diagnostic groups (n=64; delirium, depression, dementia, schizophrenia and others) were evaluated by two independent researchers blinded to the diagnosis. Diagnosis and severity of delirium as measured by the DRS-R-98 were compared to clinical diagnosis, Mini-Mental State Exam, Confusion Assessment Method, and Clinical Global Impressions scale (CGI). RESULTS: Mean and median DRS-R-98 total scores significantly distinguished delirium from the other groups (p<0.001). Inter-rater reliability (ICC between 0.9 and 1) and internal consistency (alpha=0.91) were very high. DRS-R-98 severity scores correlated highly with the CGI. Mean DRS-R-98 severity scores during delirium differed significantly (p<0.01) from the post-treatment values. The area under the curve established by ROC analysis was 0.99 and using the cut-off value of 20 the scale showed sensitivity and specificity of 92.6% and 94.6%, respectively. CONCLUSION: The Portuguese version of the DRS-R-98 is a valid and reliable measure of delirium that distinguishes delirium from other disorders and is sensitive to change in delirium severity, which may be of great value for longitudinal studies.

Afasia global sem hemiparesia: AVC ou transtorno conversivo? / Global aphasia without hemiparesis: stroke or conversion disorder?

CONTEXTO: A realização de diagnóstico neurológico e psiquiátrico em ambiente de emergência hospitalar com freqüência é uma tarefa complexa e exige colaboração interdisciplinar. Um dos diagnósticos diferenciais de doenças neurológicas é o transtorno conversivo, cuja característica principal é a presença de sintomas afetando funções motoras ou sensoriais, que sugerem desordem clínica ou neurológica, porém sem doença orgânica subjacente que explique o quadro. RELATO DE CASO: Os autores relatam o caso de uma paciente de 23 anos com apresentação clínica atípica de acidente vascular cerebral, afasia global sem hemiparesia, que foi inicialmente diagnosticada como transtorno psiquiátrico pelo serviço de clínica médica de emergência. CONCLUSÃO: Certas apresentações neurológicas podem ser interpretadas como transtorno conversivo pelas similaridades clínicas entre as duas desordens, raridade do quadro clínico, pela presença de sintomatologia psiquiátrica e fatores psicossociais nos pacientes neurológicos. Mesmo com apresentações neurológicas atípicas e sintomas psiquiátricos, pacientes com quadro sugestivo de transtorno conversivo devem ser sempre investigados de forma interdisciplinar.

BACKGROUND: The neurologic and psychiatric diagnosis in emergency settings are difficult tasks and require interdisciplinary effort. Conversion disorder is one of the differential diagnosis for certain neurologic disorders. The main characteristic is motor or sensory deficits suggesting neurologic or medical condition, but without organic disease that explains the symptoms. CASE REPORT: We present a 23 year-old-woman with an atypical clinical presentation of stroke: global aphasia without hemiparesis. This patient was initially diagnosed with conversion disorder by the internal medicine service in the emergency room. CONCLUSION: Some rare neurologic diseases can be interpreted as conversive disorders due to some reasons: clinical similarities between the two disorders, unusual clinical presentations, comorbidity of neurologic and psychiatric disorders and psychological features of the neurological patients. Patients presenting with atypical neurological or psychiatric symptoms, in which a diagnosis of conversion disorder is suspected, should always be investigated in an interdisciplinary setting.