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The present chapter focuses on the day fine model in Portugal. Based on an analysis of the historical development, the legal framework, the practical implementation and the public perception of the Portuguese day fines system, as well as of its constitutionality challenges, we conclude that, for the past two decades and although several other alternatives to imprisonment can be imposed, the day fine became the most frequently applied criminal sanction in Portugal, both as a primary and a substitutive penalty. We argue, however, that, in spite of the legal fairness of the adopted day fines regime and of the general level of acceptance of the day fine among the Portuguese courts and academic literature, the day fine has prima facie a retributive quality and, because of its maximum limits, hasn’t proved preventively adequate in the most economically lucrative offences (financial, environmental or political criminality), related to the offender’s cost-benefit equation. Furthermore, the subsidiary liability of corporate leaders for the fines imposed on legal persons raises difficult constitutionality issues.
Ectotherms are vulnerable to environmental changes and their parasites are biological health indicators. Thus, parasite load in ectotherms is expected to show a marked phenology. This study investigates temporal host–parasite dynamics in a lizard community in Eastern Spain during an entire annual activity period. The hosts investigated were Acanthodactylus erythrurus, Psammodromus algirus and Psammodromus edwardsianus, three lizard species coexisting in a mixed habitat of forests and dunes, providing a range of body sizes, ecological requirements and life history traits. Habitat and climate were considered as potential environmental predictors of parasite abundance, while size, body condition and sex as intrinsic predictors. Linear models based on robust estimates were fitted to analyse parasite abundance and prevalence. Ectoparasitic mites and blood parasites from two haemococcidian genera were found: Lankesterella spp. and Schellackia spp. Habitat type was the only predictor explaining the abundance of all parasites, being mostly higher in the forest than in the dunes. The results suggest that particularities in each host–parasite relationship should be accounted even when parasites infect close-related hosts under the same environmental pressures. They also support that lizard parasites can be biomarkers of environmental perturbation, but the relationships need to be carefully interpreted for each host–parasite assemblage.
Cardiovascular diseases are the main cause of mortality worldwide, and childhood excess weight/obesity are strong correlators of accumulated risk in later life. A relationship between maternal preeclampsia and offspring’s childhood obesity is recognized, but most studies fail to control for strong confounders. Our goal is to analyze the association between preeclampsia and childhood excess weight/obesity, after accounting for important confounders. We recruited 5133 women with singleton pregnancies during admission for delivery. Sixty-seven pregnancies were complicated by preeclampsia. Maternal and children outcomes were assessed at 10 years of age. We analyzed the association between preeclampsia and childhood excess weight/obesity by fitting a linear regression model (using offspring body mass index (BMI) z-score at 10 years of age) and a logistic regression model (using excess weight/obesity status). We then controlled both models for known confounders, namely maternal prepregnancy BMI, parity, and smoking during pregnancy. At 10 years of age, offspring of preeclamptic mothers had a higher BMI z-score and were more likely classified as overweight/obese, but these differences were not statistically significant. After controlling for maternal prepregnancy BMI, parity, and smoking during pregnancy, there was a high magnitude change in the beta coefficient of preeclampsia in the linear (0.175; −0.014) and the logistic regression models (1.48; 1.23) suggesting that the association between preeclampsia and childhood excess weigh/obesity is significantly confounded by these variables. These confounders also showed a significant association with childhood obesity. This finding suggests that in utero exposure to preeclampsia seems to have less impact in childhood obesity than the previously described confounders.
Ruptured sinus of Valsalva aneurysm is a rare entity in children. To our knowledge, this is the youngest child reported in the literature with a sinus of Valsalva ruptured aneurysm being successfully treated percutaneously using an AmplatzerTM Duct Occluder II Additional Sizes device.
The canopy-related terms in the transport equations for momentum, Reynolds stresses, turbulent kinetic energy and its dissipation rate were described by a perturbative expansion around a velocity scale based on the mean total kinetic energy. The quality of the series and the relative magnitude of the first orders were analysed through comparison with the results of large-eddy simulation of three canopy flows representative of real-life applications. The flows in question were those over a horizontally homogeneous forest, a sequence of forest stands and clearings, and a forested hill. The analysis gave both the highest order required for an accurate evaluation of the canopy effects and a mathematical formulation for the canopy-related terms in a Reynolds-averaged Navier–Stokes formulation. This offers a sounder basis and assured consistency for the turbulence modelling of canopy flows between Reynolds-averaged Navier–Stokes and large-eddy simulation frameworks.
We present the first results obtained from an extensive study of eclipsing binary (EB) system candidates recently detected in the VISTA Variables in the Vía Láctea (VVV) near-infrared (NIR) Survey. We analyse the VVV tile d040 in the southern part of the Galactic disc wherein the interstellar reddening is comparatively low, which makes it possible to detect hundreds of new EB candidates. We present here the light curves and the determination of the geometric and physical parameters of the best candidates found in this ‘NIR window’, including 37 contact, 50 detached, and 13 semi-detached EB systems. We infer that the studied systems have an average of the
mag and a median period of 1.22 days where, in general, contact binaries have shorter periods. Using the ‘Physics Of Eclipsing Binaries’ (PHOEBE) interactive interface, which is based on the Wilson and Devinney code, we find that the studied systems have low eccentricities. The studied EBs present mean values of about 5 700 and 4 900 K for the
components, respectively. The mean mass ratio (q) for the contact EB stars is
0.44. This new galactic disk sample is a first look at the massive study of NIR EB systems.
En las unidades domésticas de las comunidades chinamperas en Xochimilco del posclásico tardío, han sido localizadas un tipo de jarras que tienen como característica principal una aplicación en la parte frontal de la pieza que posiblemente representa una deidad. Con el propósito de entender su función y establecer elementos que permitan identificar estos objetos y su uso en otros contextos, proponemos estudiar estas piezas mediante métodos diferentes a los de los análisis formales tradicionales. Este trabajo expone los resultados de los estudios de residuos químicos impregnados en materiales porosos (spot test) y análisis de gránulos de almidón de 27 muestras obtenidas en 26 ejemplares de jarras efigie procedentes de tres sitios al sur de la cuenca de México. Los resultados indican que fueron enriquecidas con fosfatos, residuos proteicos, carbohidratos, y ácidos grasos, mientras que los almidones recuperados indican una presencia importante de maíz, y en menor medida, de camote, chile, y dioscórea. Basado en lo anterior, en sus contextos de procedencia y en la identificación de las deidades representadas, proponemos que estas jarras contenían bebidas de maíz y que fueron utilizadas en ceremonias domésticas dedicadas a la agricultura—como la fiesta de Huey Tozoztli, entre otras—del calendario mexica.
Superior–inferior ventricular arrangement with double-outlet left ventricle and malposition of the great arteries is an extremely rare congenital cardiac anomaly. The authors present the case of an infant who presented with cyanosis and respiratory distress. To the best of our knowledge, this is the first case reported.
Adults with CHD are known to greatly benefit from a prompt access to continuous expert care. On the other hand, coronavirus disease 2019 pandemic has determined a dramatic worldwide reconfiguration of the healthcare systems, with rapid redeployment of resources towards this emergency. Italy was the first Western country affected by a large-scale spread of coronavirus disease 2019. The aim of our study is to analyse the impact of the coronavirus disease 2019 outbreak on in-hospital care of patients with CHD in an Italian tertiary centre.
Methods and results:
We retrospectively reviewed data on CHD hospital admissions in our centre since 1 March, 2020, when the adoption of a strict infection containment policy throughout the country resulted in limited access of patients to routine hospital care and resources reallocation to the care of infected patients. Comparison with data from the previous year was performed in order to identify any relevant differences attributable to the outbreak. Despite cancellation of all elective procedures, the overall number of urgent hospital admission remained stable throughout the period of study. Patients admitted during the pandemic had greater disease complexity (p = 0.001) with longer length of in-hospital stay (p = 0.01). No adverse events or positive swabs were reported among CHD patients who were admitted to hospital or medical personnel caring for these patients.
Data from our early experience suggest that coronavirus disease 2019 pandemic did not impact significantly on the provision of urgent care to adult patients with CHD.
Correct stress assignment is a requirement for fluent reading in alphabetic languages. This study focuses on two nonlexical mechanisms at the core of stress assignment. In particular, the use of a default stress pattern (e.g., penultimate stress) and the Spanish stress mark. In Experiment 1, participants read aloud words and pseudowords with different stress types (on the antepenultimate or the penultimate syllable), and with or without a stress mark. Results showed longer reaction times (RTs) for words and pseudowords with antepenultimate stress. However, as words with antepenultimate stress always have a stress mark, it could be argued that stress type differences could be due to the presence of the stress mark. In Experiment 2, using a priming procedure participants read aloud words and pseudowords in pure versus mixed stress blocks. Again, words and pseudowords with antepenultimate stress were read slower (longer RTs), suggesting that previous differences were due to stress mark rather than stress type. These results indicate that processing stress marks is cognitively demanding when reading in Spanish.
Alveolar echinococcosis is a neglected parasitic zoonosis caused by Echinococcus multilocularis. The pharmacological treatment is based on albendazole (ABZ). However, the low water solubility of the drug produces a limited dissolution rate, with the consequent failure in the treatment of the disease. Solid dispersions are a successful pharmacotechnical strategy to improve the dissolution profile of poorly water-soluble drugs. The aim of this work was to determine the in vivo efficacy of ABZ solid dispersions using poloxamer 407 as a carrier (ABZ:P407 solid dispersions (SDs)) in the murine intraperitoneal infection model for secondary alveolar echinococcosis. In the chemoprophylactic efficacy study, the ABZ suspension, the ABZ:P407 SDs and the physical mixture of ABZ and poloxamer 407 showed a tendency to decrease the development of murine cysts, causing damage to the germinal layer. In the clinical efficacy study, the ABZ:P407 SDs produced a significant decrease in the weight of murine cysts. In addition, the SDs produced extensive damage to the germinal layer. The increase in the efficacy of ABZ could be due to the improvement of water solubility and wettability of the drug due to the surfactant nature of poloxamer 407. In conclusion, this study is the basis for further research. This pharmacotechnical strategy might in the future offer novel treatment alternatives for human alveolar echinococcosis.
The main objective of this study was to analyse the clinical and neuropsychological profile of a sample of Brazilian children with ADHD, in order to contribute for diagnostic procedures. Participants were 150 children aged 7 to 14 with complaints of attention difficulties and/or hyperactivity. They were assessed by a multidisciplinary team with a battery of neuropsychological tests.
75 children (55 male) fulfilled the criteria for ADHD: 35 of inattentive type, 28 of combined type and 12 hyperactive/impulsive. In addition, 33 (44%) of the children had comorbities. Children with higher scores for hyperactivity and impulsivity showed low performance in these working memory measures than those with other types. In the Conners’ Continuous Performance Test (CPT), a higher rate of omissions was found in the inattentive group. Children with comorbidity of oppositional desafiant disorder presented lower ISI and Hit RT scores in addition to higher rates of omission.
This study suggests that neuropsychological profile in children with ADHD is associated to specific differences in working memory performance and also in specific measures of the CPT. In addition, better defined tests, involving not only attention and motor planning may determine different neuropsychological profiles and, consequently, different approaches in cognitive rehabilitation.
Symptomatic neurosyphilis in immunocompetent patients is nowadays a rare diagnosis. Yet, if not properly diagnosed and treated, consequences for the patient's health are severe. Known as “the great imitator”, its detection involves both a high degree of suspicion and adequate diagnostic tests. Psychiatric symptoms are often the presenting symptoms of this illness.
The authors report four cases of neurosyphilis with psychiatric symptoms (general paresis) in immunocompetent patients. all four patients were initially referred for observation by a psychiatrist in the emergency room. Special diagnostic features of each case and potential diagnostic pitfalls are highlighted.
To raise awareness to the importance of this rare but highly disabling disease.
Review of clinical records and complementary exams.
All patients were male, two Caucasian and two African Black, with ages ranging from 41–56 years old. Clinical presentations were quite distinct, showing the symptomatic heterogeneity of paretic neurosyphilis. Blood VDRL test was negative in one case, CSF VDRL was negative in another case. TPHA was always positive in blood and CSF. White cell count and protein quantification in the CSF remains important to confirm diagnosis.
Current prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should undergo blood VDRL testing, and specific blood treponemal testing should be considered in specific situations. A high index of clinical suspicion is needed. Confirmation of diagnosis is only possible through further CSF analysis.
There is robust evidence recommending electroconvulsive therapy (ECT) in treating severe acute affective disorders. The clinical use of bitemporal electrode placement is still favoured to unilateral placement with just a relative disadvantage in cognitive side effects. Recently, bifrontal placement has gained popularity but there is still limited evidence on its relative benefits.
Compare bitemporal and bifrontal ECT efficacy in patients with pharmacologically resistant affective disorders, based on the number of acute phase treatments required to reach symptomatic remission.
Review of all patients' charts submitted to acute phase ECT, between June 2006 and June 2011. A total of 70 ECT treatment courses performed in a group of 67 patients met inclusion criteria. Thirty-eight of the total 70 courses received bitemporal ECT, and 32 received bifrontal ECT. A statistical analysis was performed. An attempt to use t-test was foiled due to breach of population variance homogeneity (p = 0,021). The non-parametric Mann-Whitney test was the alternative choice (M-W = 534;p = 0,377).
Bitemporal and bifrontal groups matched for age and sex. Bitemporal patients received on average five ECT treatments, while the average of bifrontal treatments to remission was six, but this difference was not statistically significant (p > 0.05).
Our results showed that bitemporal and bifrontal placements are equally effective. According to the largest randomised controlled trial conducted on ECT in depressive illness (Kellner et al,2010), bitemporal placement led to a faster rate of improvement. Additional studies and larger samples are required to understand if bifrontal placement's efficacy and cognitive advantages justify its popularity.
The co-occurrence of mania and delirium, named “delirious mania”, is an under-recognized entity not listed in major diagnostic classifications. Literature about this syndrome is still scarce and lacking evidence. Usually, reports of affective syndromes with delirium tend to be subdued in the manic descriptor
We report the case of a 44 year old female patient with a simultaneous affective episode and delirium.
To demonstrate the co-occurrence of depressive/mixed symptoms and delirium
Review of clinical records and complementary exams.
The patient was admitted after a three week long depressive syndrome with psychomotor agitation, followed by a week-long fluctuating pattern of delirious and mixed affective features. Shortly after admission the patient exhibited a stuporous state, with nocturnal agitation. A fluctuating pattern of symptoms ensued, with disorientation, disorganized behavior, cognitive impairment, anxiety and depressive features. the patient was put on mood stabilizers, antipsychotics and benzodiazepines. She was discharged symptom-free two months later and re-admitted 4 weeks later due to recurrence of symptoms. Electroconvulsive treatment was applied,with quick remission of affective symptoms. Yet, it took another two months until discharge, due to persistent cognitive symptoms. Medical conditions were excluded.
This case shows the simultaneous occurrence of an affective syndrome alongside delirium. the strongest treatment response occurred with ECT. the presence of depressed mood highlights the fact that this syndrome can begin without clear-cut manic symptoms. We suggest that its name should be changed to Delirious Affective Disorder, which might help to avoid misdiagnosis. Persistent cognitive deficits raise some questions in this case.
Bipolar mixed states were systematically described for the first time by Emil Kraepelin. Since then, their high prevalence has been repeatedly recognized, but they still remain poorly understood. These patients appear to be extremely difficult to treat, many being refractory to pharmacological approaches. Clinical experience supports the use of electroconvulsive therapy (ECT) in mixed states, but there is little information on its effectiveness in scientific literature.
Report our experience in using acute phase ECT (aECT) in mixed states.
The authors reviewed the clinical records of all patients submitted to aECT between June 2006 and June 2011. The inclusion criteria were: a) presence of a mixed state according to Akiskal's criteria (Akiskal et al,2005); b) completed treatment course with aECT. The following variables were collected: demographic characteristics, previous response to pharmacotherapy, presence of psychotic symptoms, number of aECT sessions, referral to continuation or maintenance ECT (c/mECT), number of readmissions. Relation between the diagnostics and the number of ECT sessions was validated with Eta-coefficient. Comparison between these two groups was carried out with One-Way-ANOVA.
Eighteen patients met inclusion criteria and were resistant to pharmacotherapy. Eight patients had psychotic features. All patients but one showed a positive clinical response, as documented on CGI. The average number of ECT sessions was five, while the mean of ECT treatments in manic and depressive patients was seven and six respectively. Thirteen patients were scheduled for c/mECT.
Our results confirm the effectiveness of ECT in medication nonresponsive patients experiencing a mixed state.
Cocaine dependence disorder has been widely described. However, differences due to gender remain unknown.
To compare clinical gender differences in a large sample of cocaine-dependent patients.
We performed a cross-sectional, observational study in 902 patients (35.47 yo, 21.3% women) with a cocaine dependence according DSM-IV criteria, seeking treatment during 2005 to 2013. Sociodemographic and clinical variables were collected The SCID-I, SCID–II, BIS and a structured interview about cocaine-induced psychosis were performed. Simple descriptive statistics were carried out for demographic and clinical data. Bivariate analysis was made to compare the main variables by sex using SPSSvs18.0.
No differences in age of dependence onset, other clinical variables or cocaine-induced psychosis were detected. However, less cocaine used in the last month (2.12 vs 3.37g) (p < 0.009), more impulsivity (67.2 vs 63.03) (p < 0.040), and more sedative dependence (21.2% % vs 8.3%)(p< 0.00) were detected in women than in men. Affective disorders lifetime were the most prevalent (57,4%) in women. More comorbidity with anxiety disorders (p< 0.025) eating disorders (p< 0.000) and personality disorders (p< 0.039) were detected in women than in men.
Sedative dependence and anxiety disorders should be investigated in cocaine-dependent women in order to treat these conditions. Surprisingly high impulsivity level was detected and could moderate cocaine consumption. However, no difference have been found previously in studies about gender differences in cocaine-dependent patients, so this finding should be confirm in new studies.
Elevation of prolactin level is a known adverse effect of antipsychotics. Long-standing hyperprolactinaemia may inhibit reproductive function by impairing gonadal steroidogenesis and is associated with a number of adverse effects such as galactorrhoea, amenorrhoea, gynecomastia, impotence and decreased bone mineral density. Lurasidone is a recently approved atypical antipsychotic agent for the treatment of schizophrenia.
To compare the incidence of treatment-emergent adverse events (TEAEs) related to hyperprolactinaemia in patients treated with lurasidone or active comparators.
Pooled data from two 52-week studies that evaluated the long-term safety and efficacy of lurasidone compared with quetiapine XR or risperidone in patients with schizophrenia were reviewed post-hoc for prolactin levels and TEAEs considered to be related to hyperprolactinaemia.
Prolactin levels decreased marginally in the lurasidone group (median -8.00 pmol/L, N=624) and quetiapine XR group (median -17.39 pmol/L, N=85), and increased in the risperidone group (median 385.00 pmol/L, N=199) (LOCF). The incidence of markedly abnormally high prolactin values (≥5× upper limit of normal) was 2.0%, 1.4% and 4.0% in the three groups, respectively. The hyperprolactinaemia-related TEAEs breast mass, gynecomastia, breast enlargement, breast tenderness, hypogonadism, infertility, pituitary tumors and mammary gland tumors were absent from all groups. Low rates (≤2.5%) of galactorrhoea, amenorrhoea and erectile dysfunction were seen in the lurasidone and risperidone groups, while no TEAEs were recorded in the quetiapine XR group.
This post-hoc review shows that long-term treatment with lurasidone was not associated with a clinically significant increase in prolactin levels and the incidence of associated TEAEs was low.