The distribution and conservation of areas with microendemic species in a biodiversity hotspot: a multi-taxa approach.

Background: Microendemic species are species with very small geographic distributions (ranges). Their presence delimitates areas with microendemic species (AMs), denoting a spatial unit comprising at least one population of at least one microendemic species. AMs are assumed to be distributed distinctively and associated with specific ecological, historical, and anthropogenic attributes. However, the level of influence of these factors remains unclear. Thus, we studied the distribution patterns of microendemic species within the Brazilian Atlantic Forest to (a) identify the region's AMs; (b) evaluate whether ecological (latitude, altitude, distance from the coastline), historical (climate stability), and anthropogenic (ecological integrity) attributes distinguish AMs from non-AMs; and (c) assess the conservation status of the Atlantic Forest's AMs. Methods: We mapped the ranges of 1,362 microendemic species of angiosperms, freshwater fishes, and terrestrial vertebrates (snakes, passerine birds, and small mammals) to identify the region's AMs. Further, spatial autoregressive logit regression models were used to evaluate whether latitude, altitude, distance from the coastline, Climate Stability Index, and ecological integrity can be used to discern AMs from non-AMs. Moreover, the AMs' conservation status was assessed by evaluating the region's ecological integrity and conservation efforts (measured as the proportion of AMs in protected areas). Results: We identified 261 AMs for angiosperm, 205 AMs for freshwater fishes, and 102 AMs for terrestrial vertebrates in the Brazilian Atlantic Forest, totaling 474 AMs covering 23.8% of the region. The Brazilian Atlantic Forest is a large and complex biogeographic mosaic where AMs represent islands or archipelagoes surrounded by transition areas with no microendemic species. All local attributes help to distinguish AMs from non-AMs, but their impacts vary across taxonomic groups. Around 69% of AMs have low ecological integrity and poor conservation efforts, indicating that most microendemic species are under threat. This study provides insights into the biogeography of one of the most important global biodiversity hotspots, creating a foundation for comparative studies using other tropical forest regions.

Human disturbance is the major driver of vegetation changes in the Caatinga dry forest region.

Drastic changes in vegetation structure caused by exceeding ecological thresholds have fueled the interest in tropical forest responses to climate and land-use changes. Here, we examine the potential successional trajectories experienced by the largest dry tropical forest region in South America, driven by climate conditions and human disturbance. We built potential distribution models for vertebrate taxa associated with forest or shrub habitats to estimate natural vegetation cover. Distribution patterns were compared to current vegetation across the entire region to identify distinct forest degradation levels. Our results indicate the region has climatic and soil conditions suitable for more forest cover than is currently found, even in some areas with limited precipitation. However, 11.04% of natural cover persists across such an immense region, with only 4.34% consisting of forest cover. Forest degradation is characterized by the dramatic expansion of shrubland (390%), farming, and non-vegetation cover due to changes in land-use, rather than climatic conditions. Although different climate conditions have been the principal drivers for natural forest distribution in the region, the forest seems unable to resist the consequences of land-use changes, particularly in lower precipitation areas. Therefore, land-use change has exceeded the ecological thresholds for the persistence of forests, while climate change may exacerbate vegetation-type transitions.

Cerebral Venous Thrombosis Due to Overdrainage in a Patient With Normal Pressure Hydrocephalus: A Case Report.

Mechanical shunting of cerebrospinal fluid (CSF) is an effective treatment for hydrocephalus but is not exempt from complications. A 67-year-old male with a history of normal pressure hydrocephalus (NPH) and ventriculoperitoneal shunting (VPS) one year ago presented with gait disturbance and memory impairment. His head computed tomography (CT) was normal, and the shunting pressure was reduced from 110 to 70 mmH20 with gait and memory improvement. One week later, he reported persistent pressure headaches, which worsen when lying down, accompanied by nausea and vomiting. His neurological examination was notable for a short-stepped wide-based gait. Two generalized seizures were observed. CT cerebral venography revealed sinus venous thrombosis (SVT). After two days, a new CT was performed, and bilateral subdural hygromas were found. The shunting pressure was readjusted to 110 mmH20, and symptom improvement was noted. One week later, CT showed enlargement and bleeding of subdural collections. The drainage system was closed, and the patient continue to recover. The temporal association between pressure adjustment and symptom onset and the evidence of progressive subdural effusions suggest that the decrease of CSF volume by overdrainage led to an increase in cerebral blood volume and the dilatation of the venous sinus, which precipitated thrombus formation.

Occurrence of contaminants of emerging concern in surface waters from Paraopeba River Basin in Brazil: seasonal changes and risk assessment.

This study describes the application of gas chromatography coupled to mass spectrometry (GC-MS) to evaluate the occurrence of 12 CECs-contaminants of emerging concern (bisphenol A, diclofenac, 17ß-estradiol, estriol, estrone, 17α-ethinylestradiol, gemfibrozil, ibuprofen, naproxen, 4-nonylphenol, 4-octylphenol, and acetaminophen) in surface waters from Paraopeba River Basin, Minas Gerais State, Brazil. The analytical procedure was validated and applied to 60 surface water samples collected across four sampling campaigns along the upper and middle watershed. Methods for CECs determination involved sample filtration, and solid-phase extraction (SPE) with subsequent derivatization of the target compounds prior to their analysis by GC-MS. The LOQ varied from 3.6 to 14.4 ng/L and extraction recoveries ranged from 46.1 to 107.1% for the lowest spiked concentration level (10 ng/L). The results showed a profile of spatial distribution of compounds, as well as the influence of rainfall. Ibuprofen (1683.9 ng/L), bisphenol (1587.7 ng/L), and naproxen (938.4 ng/L) occurred in higher concentrations during the rainy season, whereas during the dry season, the concentrations of bisphenol (1057.7 ng/L), estriol (991.0 ng/L), and estrone (978.4 ng/L) were highlighted. The risk assessment of human exposure shows that for most contaminants, the concentration is well below the estimated thresholds for chronic toxicity from water intake. However, estradiol and 17α-ethinylestradiol showed concentrations in the same order of magnitude as the guide values estimated for babies.

Data of plant diversity, spectral reflectance at specie level and satellite spectral variables from the largest dry forest nucleus in South America.

The use of satellite remote sensing makes it possible to acquire useful information about the environment, since it presents tools capable of assisting the practical search of information related to species richness. Here we present data on richness and Shannon index from phytosociological researches, vegetation indices and individual bands spectral reflectance from satellite images and leaf-level spectral reflectance from eight Caatinga species. For further interpretation of the data presented in this article, please see the research article "Predicting plant species richness with satellite images in the largest dry forest nucleus in South America" [1].

Diagnostic Delay of Multiple Sclerosis in a Portuguese Population.

INTRODUCTION: Multiple sclerosis is a chronic inflammatory disease, in which a diagnostic delay could reduce the available therapeutic options. Therefore, it is important to monitor the time to diagnosis and understand factors that may potentially reduce it. The objective of this study was to determine the time between the first symptoms and the diagnosis of multiple sclerosis and which factors may contribute to a diagnostic delay. MATERIAL AND METHODS: Cross-sectional multicenter study, with retrospective data analysis, conducted in five tertiary Portuguese hospitals. Patients were consecutively selected from each local multiple sclerosis patients´ database. Sociodemographic and initial clinical data were collected through a questionnaire. Date of final diagnosis and multiple sclerosis classification was obtained from clinical files. RESULTS: A total of 285 patients were included with mean age at diagnosis of 36 years. The median time between first clinical manifestation and multiple sclerosis diagnosis was nine months (IQR 2 - 38). Diagnostic delay was associated with an older age (p < 0.001; r = 0.35), motor deficit at onset [26.5 months (IQR 4.5 - 56.5); p = 0.0005], higher number of relapses before diagnosis (p < 0.001; r = 0,626), first observation by other medical specialty [11 months (IQR 2 - 48); p < 0.001], prior alternative diagnosis [20 months (IQR 4 - 67.5); p < 0.001] and primary progressive subtype [37 months (IQR 25 - 64.5); p < 0.001]. The most significant delay occurred between the initial symptom and neurological observation. DISCUSSION: A significant delay occurred between initial symptoms and the diagnosis of multiple sclerosis, reflecting the need toincrease awareness of this entity and its diverse symptom presentation.

Introdução: A esclerose múltipla é uma doença inflamatória crónica na qual um atraso no diagnóstico poderá reduzir as opções terapêuticas, sendo importante monitorizar o tempo até ao diagnóstico e compreender os fatores que potencialmente o reduzam. Foi objetivo deste estudo determinar o tempo entre os primeiros sintomas e o diagnóstico de esclerose múltipla e quais os fatores que podem contribuir para o atraso no diagnóstico. Material e Métodos: Estudo multicêntrico transversal retrospetivo, realizado em cinco hospitais portugueses. Os doentes foram selecionados, consecutivamente, a partir de bases de dados locais. Os dados sociodemográficos e clínicos iniciais foram adquiridos através de questionário individual. A data do diagnóstico final e a classificação da esclerose múltipla foram obtidas por consulta do processo clínico. Resultados: Foram incluídos 285 doentes com média de idade ao diagnóstico de 36 anos. A mediana do tempo entre a primeira manifestação clínica e o diagnóstico foi de nove meses (IQR 2 - 38). O atraso no diagnóstico foi associado a idade avançada (p < 0,001; r = 0,35), défice motor inicial [26,5 meses (IQR 4,5 - 56,5), p = 0,0005], maior número de surtos previamente ao diagnóstico (p < 0,001; r = 0,626), primeira observação por outra especialidade médica [11 meses (IQR 2 - 48); p < 0,001], diagnóstico prévio alternativo [20 meses (IQR 4 - 67,5); p < 0,001] e esclerose múltipla primária progressiva [37 meses (IQR 25 - 64,5), p < 0,001]. O atraso mais significativo ocorreu entre o primeiro sintoma e a observação por neurologista. Discussão: Ocorreu um atraso significativo entre o primeiro sintoma e o diagnóstico de esclerose múltipla, refletindo uma necessidade de maior acuidade na identificação dos seus principais sintomas.

Dr. Miguel Ángel Moreno Rodríguez. Modelo clínico de la Medicina Interna

El profesor Miguel Ángel Moreno Rodríguez fue un clínico ejemplar, dedicado a la asistencia y docencia en la especialidad de Medicina Interna. Su curriculum Vitae refleja su destacada labor como profesional, internista y revolucionario. Paradigma para las nuevas generaciones de médicos amantes de la clínica médica.

Professor Miguel Ángel Moreno Rodríguez was a model of clinician, devoted to medical care and teaching in the Internal Medicine specialty. His Curriculum Vitae shows his outstanding work as a professional, internist and revolutionary. He was a paradigm for the new generations of doctors who love the Medical Clinics.

Neuropsychiatric Profile in Early Versus Late Onset Alzheimer's Disease.

BACKGROUND: The aim of this study was to investigate the frequency and severity of neuropsychiatric symptoms (NPS) in patients with early onset Alzheimer's disease (EAOD) and late onset AD (LOAD). METHODS: Patients were selected from a specialized memory outpatient clinic. The Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), and the Global Deterioration Scale results were analyzed. RESULTS: By comparing EOAD (n = 35) and LOAD (n = 35) patients, no significant differences were found in clinical or demographic variables, matched for sex, education, and disease severity. There were no differences between groups in total NPI frequency or severity scores. The most common NPS were irritability, apathy, anxiety, and depression. We found an association of NPI scores with disease severity and duration, which was more specific in patients with LOAD and was also associated with the presence of delusions and hallucinations. CONCLUSION: Despite subtle differences, NPS is considered important in the assessment of patients with AD, regardless of the age of onset.

Post-stroke psychosis: how long should we treat?

OBJECTIVE:: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. CASE DESCRIPTION:: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. COMMENTS:: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Post-stroke psychosis: how long should we treat? / Psicose após acidente vascular cerebral: até quando devemos tratar?

Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Resumo Objetivo: Descrever o caso raro de um paciente que desenvolveu sintomas psicóticos após um acidente vascular cerebral (AVC) no nível do hemisfério direito que remitiram com tratamento antipsicótico, mas parece precisar de uma terapêutica de manutenção com antipsicótico em baixa dosagem. Descrição de caso: Um homem de 65 anos apresentou-se no serviço de urgência psiquiátrica por um quadro persistente de delírio de ciúmes, ilusões visuais e agitação com início cerca de 1 mês após AVC isquêmico no nível da artéria cerebral posterior direita. Esses sintomas só desapareceram com doses terapêuticas de antipsicótico (risperidona 3 mg/dia). Após 2 anos de seguimento, o paciente não mais apresentava atividade delirante, e o tratamento antipsicótico foi progressivamente descontinuado durante o ano seguinte. No entanto, 1 semana após a suspensão total, o paciente começou a ficar agitado e desconfiado, tendo-se reiniciado a risperidona 0,25 mg/dia, com rápida remissão clínica. O paciente está medicado com esta baixa dose de antipsicótico há um ano, permanecendo psicopatologicamente compensado e sem sintomas psicóticos. Comentários: A psicose é uma complicação relativamente rara após AVC. Segundo nosso conhecimento, não há casos descritos até ao momento de psicose após AVC que, aparentemente, requerem uma dose baixa contínua de antipsicótico. Nosso caso sugere que uma terapêutica de manutenção com antipsicótico em baixa dosagem pode ser necessária para determinados pacientes com psicose após AVC, especialmente para aqueles com fatores de risco e início não agudo dos sintomas.

Orolingual angioedema after thrombolysis is not associated with insular cortex ischemia on pre-thrombolysis CT.

OBJECTIVE: Orolingual angioedema (OA) is a well known early complication of treatment with alteplase in ischemic stroke patients. Our aim was to study risk factors for OA in these patients, namely insular cortex ischemia. METHODS: Retrospective case-cohort study using the prospective registry of all consecutive ischemic stroke patients submitted to intravenous thrombolysis with alteplase. Clinical data was retrieved from the registry and medical records. Two independent observers evaluated early signs of insular cortex ischemia on pre-thrombolysis computed tomography (CT) and of insular cortex infarct on early follow-up imaging. Univariate and multivariate analysis were performed to identify predictors of OA. RESULTS: Of the 659 patients with acute ischemic stroke treated with alteplase, 32 developed OA (4.9%, 95%CI=3.3-6.6). Frequency of early signs of insular cortex ischemia on pre-thrombolysis CT and of insular cortex infarct on follow-up imaging was similar in patients with and without OA (p=0.241 and p=0.145, respectively). The only independent predictors of OA occurrence were female sex (OR=5.47, 95%CI=1.98-15.10) and angiotensin-converting enzyme inhibitor (ACE-I) use (OR=3.87, 95%CI=1.71-8.75). CONCLUSIONS: Female sex and ACE-I use are independent risk factors for OA occurrence in ischemic stroke patients treated with alteplase. Early signs of insular cortex ischemia on pre-thrombolysis CT were not significantly associated with OA.

Characterization of metformin by-products under photolysis, photocatalysis, ozonation and chlorination by high-performance liquid chromatography coupled to high-resolution mass spectrometry.

RATIONALE: Metformin (MTF) is the most widely prescribed drug for the treatment of patients with type 2 diabetes. Studies involving the removal of MTF from aqueous solutions and detailed information regarding the overall degradation process are scarce. METHODS: The degradation of MTF in aqueous solution induced by direct photolysis, photocatalysis, ozonation and chlorination was evaluated. The process was continuously monitored focusing on the identification and monitoring of the by-products formed by applying high-performance liquid chromatography coupled to high-resolution mass spectrometry in positive ion mode. The cytotoxicity of metformin by-products was evaluated with an MTT assay. RESULTS: The results from the chlorination and ozonation tests indicate metformin removal efficiencies of 60% after 30 min of exposure. On the other hand, direct photolysis (UV-C) and heterogeneous photocatalysis (TiO2 /UV-C) led to a lower degree of metformin degradation, with removal efficiencies of 9.2% and 31%, respectively, after 30 min of exposure. The mineralization rates varied from 20% for ozonation to 0.72% for photolysis, thereby indicating there was accumulation of degradation by-products in all experiments. Mass spectrometric analysis indicated the presence of five metformin by-products. It was not possible to identify any by-product generated in the photolysis, and, in all oxidative assays, the treated samples were nontoxic to HepG2 cells. CONCLUSIONS: It is also observed that all systems exhibited low mineralization rates, with the chlorination process being slightly more efficient in promoting the degradation, whereas the ozonation was more efficient in promoting the mineralization of metformin. Based on these results a route for the chlorination, photodegradation and ozonation of MTF, which comprised of its successive oxidation in the aqueous medium, could be proposed. It could also be concluded that the treated samples were not cytotoxic to HepG2 cells in a MTT assay. Copyright © 2016 John Wiley & Sons, Ltd.

Five-Year Outcome in Stroke Patients Submitted to Thrombolysis.

BACKGROUND AND PURPOSE: Little is known on long-term follow-up after thrombolysis in ischemic stroke patients because the majority of studies evaluated outcome at 3 to 12 months. We aimed to assess 5-year outcome after intravenous thrombolysis (IVT). METHODS: Cohort study based on the prospective registry of all consecutive ischemic stroke patients submitted to IVT in our Stroke Unit. Five-year outcome, including living settings, functional outcome, stroke recurrence, and mortality, was ascertained by telephonic interviews and additional review of clinical records. Multivariate analyses were performed to identify predictors of outcome and mortality. Excellent outcome was defined as modified Rankin scale 0 to 1. RESULTS: Five-year outcome was available for 155/164 patients submitted to IVT. At 5 years, 32.9% of patients had an excellent outcome (95% confidence interval (CI) =25.5-43.3) and mortality was 43.9% (95%CI=36.1-51.7). Increasing age (odds ratio =0.93, 95% CI =0.90-0.97) and increasing National Institute of Health Stroke Scale (NIHSS) 24 h after thrombolysis (odds ratio =0.81, 95% CI =0.74-0.90) were independently associated with a lower likelihood of an excellent 5-year outcome. Age (hazards ratio =1.07, 95% CI =1.03-1.11) and excellent functional outcome 3 months after thrombolysis (hazards ratio =0.28, 95%CI=0.12-0.66) were independently associated with mortality during follow-up. CONCLUSIONS: One third of ischemic stroke patients have excellent 5-year outcome after IVT. Younger age, lower NIHSS 24 h after IVT, and excellent 3-month functional outcome are independent predictors of excellent 5-year outcome.

Paroxysmal dystonia as a manifestation of multiple sclerosis.

INTRODUCTION: Paroxysmal dystonia is a rare manifestation of multiple sclerosis (MS). CASE REPORT: A 41-year-old man presented to our Emergency Department with sudden and repeated episodes of left upper limb flexion and lower limb extension. His medical history included an episode of left facial palsy a year earlier. Neurological examination demonstrated only brisk deep tendon reflexes on the left upper limb. Routine blood and urine analyses were normal. Computed tomography of the brain and cervical Doppler were normal. Aspirin and sodium valproate were started, without improvement. Video-EEG monitoring revealed no electrographic abnormality synchronous with these paroxysmal events, excluding epileptic nature. Cerebral magnetic resonance imaging showed multiple T2 white matter lesions at the midbrain, right diencephalon, corpus callosum, cervical, and thoracic spinal cord. The right diencephalic lesion enhanced with gadolinium. Complete basic and immunologic analysis and serological studies were normal or negative. Oligoclonal bands were positive in cerebrospinal fluid (negative in serum). Methylprednisolone (1 g/d for 5 d) was started without clinical improvement. Carbamazepine (400 mg/d) was promptly effective, and discontinued after 1 month without recurrence. DISCUSSION: The patient met the criteria for the diagnosis of MS according to the 2010 McDonald criteria. The timely and accurate diagnosis of MS requires the recognition of its varied and atypical clinical manifestations.