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Based on statistical analyses applied to official data from the Digital Atlas of Disasters in Brazil over the last 25 years, we evidenced a consistent intensification in the annual occurrence of natural disasters in the state of Pará, located in the eastern Brazilian Amazon. The quantitative comparison between the averages of the most intense period of disasters (2017 to 2023) and the earlier years (1999 to 2016) revealed a remarkable percentage increase of 473%. Approximately 81% of the state’s municipalities were affected, as indicated by disaster mapping. A clear seasonal pattern was observed, with Hydrological disasters (Inundations, Flash floods, and Heavy rainfall) peaking between February and May, while Climatological disasters (Droughts and Forest fires) were most frequent from August to October. The catastrophic impacts on people and the economy were documented, showing a significant rise in the number of homeless individuals and those directly affected, alongside considerable material damage and economic losses for both the public and private sectors. Furthermore, we conducted a comprehensive composite analysis on the tropical ocean–atmosphere dynamic structure that elucidated the various triggering mechanisms of disasters arising from Inundations, Droughts, and Forest fires (on seasonal scale), and Flash floods and Heavy rainfall (on sub-monthly scale) in Pará. The detailed characterization of disasters on a municipal scale is relevant in terms of the scientific contribution applied to the strategic decision-making, planning, and implementation of public policies aimed at early risk management (rather than post-disaster response), which is critical for safeguarding human well-being and strengthening the resilience of Amazonian communities vulnerable to climate change.

Based on statistical analyses applied to official data from the Digital Atlas of Disasters in Brazil over the last 25 years, we evidenced a consistent intensification in the annual occurrence of natural disasters in the state of Pará, located in the eastern Brazilian Amazon. The quantitative comparison between the averages of the most intense period of disasters (2017 to 2023) and the earlier years (1999 to 2016) revealed a remarkable percentage increase of 473%. Approximately 81% of the state's municipalities were affected, as indicated by disaster mapping. A clear seasonal pattern was observed, with Hydrological disasters (Inundations, Flash floods, and Heavy rainfall) peaking between February and May, while Climatological disasters (Droughts and Forest fires) were most frequent from August to October. The catastrophic impacts on people and the economy were documented, showing a significant rise in the number of homeless individuals and those directly affected, alongside considerable material damage and economic losses for both the public and private sectors. Furthermore, we conducted a comprehensive composite analysis on the tropical ocean–atmosphere dynamic structure that elucidated the various triggering mechanisms of disasters arising from Inundations, Droughts, and Forest fires (on seasonal scale), and Flash floods and Heavy rainfall (on sub-monthly scale) in Pará. The detailed characterization of disasters on a municipal scale is relevant in terms of the scientific contribution applied to the strategic decision-making, planning, and implementation of public policies aimed at early risk management (rather than post-disaster response), which is critical for safeguarding human well-being and strengthening the resilience of Amazonian communities vulnerable to climate change. [ABSTRACT FROM AUTHOR]

Precision medicine has revolutionized the field of neuroimmunology, with innovative approaches that characterize diseases based on their biology, deeper understanding of the factors leading to heterogeneity within the same disease, development of targeted therapies, and strategies to tailor therapies to each patient. This review explores the impact of precision medicine on various neuroimmunological conditions, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), optic neuritis, autoimmune encephalitis, and immune-mediated neuropathies. We discuss advances in disease subtyping, recognition of novel entities, promising biomarkers, and the development of more selective monoclonal antibodies and cutting-edge synthetic cell-based immunotherapies in neuroimmunological disorders. In addition, we analyze the challenges related to affordability and equity in the implementation of these emerging technologies, especially in situations with limited resources.

This research aimed to analyze the relationship between deforestation (DFT) and climatic variables during the rainy (CHU+) and less-rainy (CHU−) seasons in the Tapajós River basin. Data were sourced from multiple institutions, including the Climatic Research Unit (CRU), Center for Weather Forecasts and Climate Studies (CPTEC), PRODES Program (Monitoring of Brazilian Amazon Deforestation Project), National Water Agency (ANA) and National Centers for Environmental Prediction/National Oceanic and Atmospheric Administration (NCEP/NOAA). The study assessed anomalies (ANOM) in maximum temperature (TMAX), minimum temperature (TMIN) and precipitation (PREC) over three years without the occurrence of the El Niño–Southern Oscillation (ENSO) atmospheric–oceanic phenomenon. It also examined areas with higher DFT density using the Kernel methodology and analyzed the correlation between DFT and climatic variables. Additionally, it assessed trends using the Mann–Kendall technique for both climatic and environmental data. The results revealed significant ANOM in TEMP and PREC. In PREC, the highest values of ANOM were negative in CHU+. Regarding temperature, the most significant values were positive ANOM in the south, southwest and northwestern regions of the basin. Concerning DFT density, data showed that the highest concentration was of medium density, primarily along the highways. The most significant correlations were found between DFT and TEMP during the CHU− season in the Middle and Lower Tapajós sub-basins, regions where the forest still exhibits more preserved characteristics. Furthermore, the study identified a positive trend in TEMP and a negative trend in PREC.

The great current challenge for the conservation and use of natural resources refers to global climate change, because of its impacts felt in different intensities at global, regional, and local spatial scales. Within the system of environmental protection areas in Brazil, the extractive reserves ensure the sustainable use of natural resources by traditional populations, thus maintaining the cultural and biological aspects of a region. Such populations, being in close management of the surrounding environments, tend to perceive changes in ecological processes that many need for their livelihoods. The use of this perception of local populations in conjunction with academic research evidence has a high potential to allow a whole and systemic view of possible changes in natural phenomena. This study developed an integrated analysis of scientific evidence and local perceptions to understand the variation of precipitation in a community inserted in an extractive reserve in the eastern Amazon. We used 30 years of precipitation data from the Brazilian National Institute of Meteorology - INMET, the Southern Oscillation Index - SOI, and the Atlantic Meridional Mode Index - AMM. Furthermore, we applied a form to measure the population's perception of possible changes in rainfall cycles in the region. The meteorological data indicate that the region of the community has been presenting a rainfall reduction; however, people in the community do not perceive this trend. Although it is public knowledge that the global climate is undergoing changes, a fact noted after the integrating analysis of scientific evidence with local knowledge in Resexmar Soure is that the perceptions of traditional populations often focus on smaller temporal and spatial scale visions.

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.

ABSTRACT Background: To improve the comparability of multiple sclerosis (MS) prevalence across Brazilian regions, the Brazilian Committee for Treatment and Research in MS has implemented a standardized approach to assess the prevalence of the disease in five key cities, which were deemed representative of their regions in terms of socio-geographical features and where in-person revision of each case was feasible. Objective: To report the point-prevalence of MS in Passo Fundo, one of the key cities in Southern Brazil. Methods: We sought to identify all MS patients who were living in Passo Fundo on July 1st, 2015. The primary source for case ascertainment was records from the offices of neurologists and neurosurgeons practicing in the city. Multiple secondary sources were used to maximize identification of cases. All patients underwent in-person review of the diagnosis by a panel of neurologists with experience in MS. Results: We identified 52 MS patients living in Passo Fundo on July 1st, 2015. The point-prevalence rate for MS was 26.4/100,000 population (95% confidence interval, 19.7 to 34.6/100,000). Among the MS cases, 42 (80.8%) were female, for a sex ratio of 4.2:1. Forty-six cases (88.5%) were categorized as relapsing-remitting MS, and the remaining 6 cases, as secondary progressive MS (11.5%). Other epidemiological and clinical features were comparable to national and international MS populations. Conclusions: The prevalence of MS in Passo Fundo is one of the highest reported in Brazil so far. Studies in other key Brazilian cities, using the same methodology, are currently being carried out.

Abstract Improvements in assays for detecting serum antibodies against myelin oligodendrocyte glycoprotein (MOG) have led to the appreciation of MOG‐antibody‐associated disease (MOGAD) as a novel disorder. However, much remains unknown about its etiology. We performed human leukocyte antigen (HLA) analysis in 82 MOGAD patients of European ancestry in the UK population. No HLA class II associations were observed, thus questioning the mechanism of anti‐MOG antibody generation. A weak protective association of HLA‐C*03:04 was observed (OR = 0.26, 95% CI = 0.10‐0.71, pc = 0.013), suggesting a need for continued efforts to better understand MOGAD genetics and pathophysiology.

Rubia Carla Formighieri Giordani,1 Suely Ruiz Giolo,2 Camila Muhl,3 Arune João Estavela,4 Janete Ismael Mabuie Gove4 1Department of Nutrition, Federal University of Parana, Curitiba, Parana, Brazil; 2Department of Statistics, Federal University of Parana, Curitiba, Parana, Brazil; 3Department of Psychology, FAE University, Curitiba, Parana, Brazil; 4High Institute of Health Sciences, Maputo, MozambiqueCorrespondence: Rubia Carla Formighieri GiordaniDepartment of Nutrition, Federal University of Parana, Curitiba, Parana, 80210-170, BrazilTel +55 41 3360 4056Email rubia@ufpr.brPurpose: This study aimed to validate the Portuguese version of the Fear of COVID-19 Scale (FCV-19S) and investigate its association with sociodemographic and pandemic-related variables in the population of Mozambique.Participants and Methods: A cross-sectional online survey recruited 387 Mozambicans aged 18 to 70 years. The psychometric properties of the Portuguese version of the FCV-19S were evaluated using confirmatory factor analysis and Rash analysis. Additionally, the association of the FCV-19S with sociodemographic and pandemic-related variables was investigated using the two-sample t-test, one-way analysis of variance, and logistic regression.Results: The unidimensional factor structure of the Portuguese version of the FCV-19S was confirmed, and the scale showed good internal consistency reliability. The FCV-19S properties tested from the Rasch analysis were satisfactory. Women and those with lower education levels had higher scores of fear. Moreover, significantly higher levels of fear were observed among those being in an at-risk group for COVID-19, having family members or friends diagnosed or with death confirmed by COVID-19, and not being confident that they would receive adequate care from the public health services in case of COVID-19 infection.Conclusion: The Portuguese version of FCV-19S has strong psychometric properties and can be used to assess the fear of COVID-19 in the Portuguese-speaking population of Mozambique. As the adverse impacts of the COVID-19 pandemic on mental health represents a challenge to clinical psychiatry, and information on mental health in African countries is still scarce, our findings may assist in the planning of public mental health policies, aimed mainly at specific segments of the population, such as women and people in extreme poverty.Keywords: mental health, fear scale, infection, pandemic, psychometrics

Abstract Objective Fatigue is a common and disabling symptom amongst people with multiple sclerosis, however it has not been compared across the central nervous system (CNS) inflammatory diseases associated with aquaporin‐4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies (Ab). We explored the factors associated with fatigue within and across the two diseases, and compared fatigue levels between them. Methods We performed a cross‐sectional study of 90 AQP4‐Ab and 44 MOG‐Ab patients. Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS). Clinical, demographic, and psychometric (anxiety, depression, pain) data were used as independent variables. Multivariable linear regression was used to identify significant independent variables associated with fatigue within and across the two diseases. Results Within AQP4‐Ab patients, age (P = 0.002), disease duration (P = 0.004), number of clinical attacks (P = 0.001), disability (P = 0.007), pain interference (P

O sensoriamento remoto e o índice de risco de fogo são as formas de detecção e previsão de queimadas utilizadas pelo Instituto Nacional de Pesquisas Espaciais para monitorar a frequência de queimadas no Brasil, no entanto observa-se que a ocorrência de uma queimada nem sempre é prevista pelo índice do risco de fogo, particularmente na região da Amazônia oriental. Assim, esta pesquisa foi motivada pelo objetivo de analisar o padrão espaçotemporal das queimadas detectadas via satélite e a eficiência dos alertas de previsão de queimadas gerados pelo cálculo do risco de fogo, considerando a variabilidade dos fenômenos meteorológicos que podem influenciar o regime pluviométrico e alterar a ocorrência de focos de queimada na região da Amazônia oriental. As análises desta investigação consideraram as alterações das condições meteorológicas moduladas pela variabilidade interanual do fenômeno El Niño Oscilação Sul ocorridas entres os anos de 2000 e 2017. Os resultados mostraram que, em anos menos chuvosos, os focos de queimada apresentaram maior frequência ao longo do ano. Já nos mais chuvosos, tenderam a concentrar-se no segundo semestre em proporção superior à observada nos anos mais secos. A maior parte dos focos de queimada (80%) ocorreu em áreas alteradas pela atividade humana, resultado não captado pelo índice de risco de fogo, indicando que, por este levar em conta somente variáveis ambientais e não incluir a ação do homem como parâmetro, a eficiência em antecipar a ocorrência de uma queimada se torna limitada.

The antifungal effect of the essential oil from Satureja montana L., Lavandula angustifolia Mill., Lavandula hybrida Reverchon, Syzygium aromaticum (L.) Merril and Perry, Origanum vulgare L., Rosmarinus officinalis L. and six chemotypes of Thymus vulgaris L. on Candida albicans growth were studied. The most efficiency was obtained with the essential oil from Thymus vulgaris thymol chemotype (MIC 80% = 0.016 µL[sol ]mL and Kaff = 296 µL[sol ]mL). The presence in the culture medium of essential oil from Thymus vulgaris thymol chemotype (0.01, 0.1, 0.2, 0.3 µg[sol ]mL) and amphotericin B involved a decrease of the MIC 80% of amphotericin B. In contrast, the combination of amphotericin B and low concentrations (0.00031-0.0025 µg[sol ]mL) of essential oil was antagonistic. The strongest decrease (48%) of the MIC 80% was obtained with medium containing 0.2 µL[sol ]mL of essential oil. These results signify that the essential oil of Thymus vulgaris thymol chemotype potentiates the antifungal action of amphotericin B suggesting a possible utilization of this essential oil in addition to antifungal drugs for the treatment of mycoses. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary. Antifungal activity of latex from Hevea brasiliensis was observed with various fungi in macrobroth dilution assays. The strongest antifungal effect was obtained with Trichosporon cutaneum (MIC 80%=40.615 μ g protein ml-1 , K aff =0.075 μ g-1 protein ml) and Cryptococcus neoformans (MIC 80%=56.078 μ g protein ml-1 , K aff =0.059 μ g-1 protein ml). Amphotericin B was synergized with all H. brasiliensis latex concentrations tested. The rates of synergy were about 50, 44 and 55% with 15, 30 and 60 μ g protein ml-1 latex, respectively. The putative role of glycosidase activities measured in crude latex, especially α-d-mannosidase and N -acetyl-β-d-glucosaminidase activities which are potentially able to split off intraparietal linkages between glycosidic residues, is discussed. The possible role of another antifungal factor associated with rubber particles of latex is suggested. [ABSTRACT FROM AUTHOR]

Summary. In this paper a simplified modelling approach indicated that yeast growth was inhibited by an antifungal drug according to an exponential function. In addition, the corresponding inhibition rate followed a hyperbolic function the parameters of which permit us to determine the percentage of maximum inhibition and the minimum inhibitory concentration for 80%. From the equation of a hyperbola it was also possible to calculate an affinity constant K aff corresponding to the inverse of the concentration of antifungal drugs giving half the maximal inhibition. The affinity constant was demonstrated to be characteristic of the yeast strain and of the antifungal drug employed. Simulation of the mathematical modelling enabled determination of a theoretical inhibition level corresponding to strong concentrations of antifungal drugs which cannot be carried out for technical reasons (precipitates, opacity etc.). The interest of this mathematical modelling of growth and inhibition to predict the doses of antifungals which can act synergistically is discussed. [ABSTRACT FROM AUTHOR]

Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been found in some cases diagnosed as seronegative neuromyelitis optica spectrum disorder (NMOSD). MOG-IgG allowed the identification of a subgroup with a clinical course distinct from that of NMOSD patients who are seropositive for aquaporin-4-IgG antibodies. MOG-IgG is associated with a wider clinical phenotype, not limited to NMOSD, with the majority of cases presenting with optic neuritis (ON), encephalitis with brain demyelinating lesions, and/or myelitis. Therefore, we propose the term MOG-IgG-associated Optic Neuritis, Encephalitis, and Myelitis (MONEM). Depending on the clinical characteristics, these patients may currently be diagnosed with NMOSD, acute disseminated encephalomyelitis, pediatric multiple sclerosis, transverse myelitis, or ON. With specific cell-based assays, MOG-IgG is emerging as a potential biomarker of inflammatory disorders of the central nervous system. We review the growing body of evidence on MONEM, focusing on its clinical aspects.

Introduction: Studies indicate that war-affected and displaced groups, compared to local non-refugee populations, suffer variable but generally higher rates of stress-related somatic symptoms. The relation between traumatic events and somatization is poorly explored. Objectives: To assess the impact of trauma on somatic symptoms in forced migrants recently hosted in Italy. Methods: First generation asylum seekers/refugees of age over 18 referred to Umberto I Hospital, Rome, for a routine infectivologic screening were consecutively enrolled. The following tools were administered: Somatic Symptom Scale 8 (SSS-8), Life Events Check List (LEC-5), and Stress-related Vulnerability Scale (SVS). Results: Eighty-five subjects participated to the study (males=80 (94.1%); mean age= 28.3 SD=7.4). Fifty-eight (68%) participants reported at least one clinically significant somatic symptom and all reported at least one severe traumatic event in the LEC-5. Pearson Correlation Coefficients of SSS-8 total score with respect to LEC-5 and SVS lack of Social Support Subscale score were r=0,327 (p=0.003), r=0.529 (p=0.0001). A stepwise linear regression confirmed that LEC-5 total score (Beta standardized correlation coefficient = 0.151; p = 0.027) and SVS lack of Social Support Subscale (Beta standardized correlation coefficient = -0.309; p = 0.010) were significant predictors of SSS-8 total score. Conclusions: High levels of somatization were associated to the number of lifetime traumatic events and to perceived lack of social support in forced migrants. It is important to correctly recognize somatic symptoms in traumatized forced migrants. [ABSTRACT FROM AUTHOR]

Several animal and human studies have implicated CD4+ T helper 17 (Th17) cells and their downstream pathways in the pathogenesis of central nervous system (CNS) autoimmunity in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD), challenging the traditional Th1-Th2 paradigm. Th17 cells can efficiently cross the blood-brain barrier using alternate ways from Th1 cells, promote its disruption, and induce the activation of other inflammatory cells in the CNS. A number of environmental factors modulate the activity of Th17 pathways, so changes in the diet, exposure to infections, and other environmental factors can potentially change the risk of development of autoimmunity. Currently, new drugs targeting specific points of the Th17 pathways are already being tested in clinical trials and provide basis for the development of biomarkers to monitor disease activity. Herein, we review the key findings supporting the relevance of the Th17 pathways in the pathogenesis of MS and NMOSD, as well as their potential role as therapeutic targets in the treatment of immune-mediated CNS disorders.

A região de Carajás (constituída principalmente das cidades de Marabá, Parauapebas, Curionópolis, Canaã dos Carajás e Eldorado dos Carajás) no estado do Pará e a região de São Luís no estado do Maranhão são os polos mais importantes para a companhia Vale do Rio Doce. Assim, nesta pesquisa foi realizada uma análise das variáveis meteorológicas, temperatura (máxima, mínima e amplitude térmica) e precipitação para essas duas localidades. Foi calculada a correlação entre o gradiente térmico continental e o marítimo com a variabilidade pluviométrica sazonal da Amazônia oriental objetivando identificar o principal modulador da precipitação da região de estudo. Observou-se que a variabilidade climática da temperatura, tanto do ar como do oceano, nas duas regiões estudadas, apresentam um padrão semelhante de crescimento, resultado que produz resultados diferentes sobre a precipitação de cada localidade. Foi identificado que a intensidade da anomalia térmica no Nino 4, localizado a 5N-5S, 160E-150W no oceano atlântico, interfere diretamente sobre as variáveis meteorológicas no sudeste da Amazônia oriental e que a anomalia de TSM do oceano Pacífico possui maior correlação com a variabilidade pluviométrica da cidade de São Luís. .

This article presents the development of a system used by the Brazilian Network of Legal Metrology and Quality – INMETRO and its delegated public bodies to increase the coverage of mandatory periodic verification on measuring instruments in Brazil, especially non automatic weighing instruments. Based on a governmental database of active establishments that allowed the choice of an specific economic activity, the system provides a list of establishments where measuring instruments are used to commercial transitions and, therefore, subject to periodic mandatory verification. As a result, the use of system increased the number of measuring instruments controlled in Brazil, revealed areas for improvement and provided references to set goals.

Introduction: There was an increase in telemedicine during the COVID-19 pandemic to follow patients with multiple sclerosis (MS). However, there is scarce data if online evaluations can cover important information assessed during in-clinic appointments, especially the Expanded Disability Status Score (EDSS). This study aims to develop a remote evaluation tool for EDSS functional systems and compare the performance with face-to-face evaluations. Methods: This was a single-center study that included all MS patients followed up at outpatient clinics of Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, between April and August 2022. Initially, patients were routinely in-clinic evaluated by one trained neurologist for EDSS. After, patients were evaluated remotely without any information about the in-clinic EDSS results. We used a standardized interview with an interactive video platform to evaluate EDSS functional systems by telemedicine. Results: Forty-nine participants completed the two steps. Intra-class coefficient was 0.97 (95% CI: 0.95–0.98), concordance for EDSS below 4.0 was 0.87 (95% CI: 0.77–0.93) and ≥4.0 was 0.97 (95% CI: 0.89–0.99). There was perfect agreement in the final EDSS in 71.4% of the online and in-clinic evaluations. In the multivariate analysis, the visual (beta = 0.453; p = 0.003) and pyramidal (beta = 0.403; p = 0.009) systems contributed significantly to the difference in the final EDSS. Conclusion: The telemedicine tool created in this study can detect changes in functional systems with reliable results compared to in-clinic EDSS assessment. Telemedicine evaluations may reduce the number of in-clinic visits and the disease burden for patients with MS. [ABSTRACT FROM AUTHOR]

ABSTRACT Autoantibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been reported in patients with inflammatory central nervous system disorders including isolated optic neuritis (ON). We compared our MOG-IgG ON patients with multiple sclerosis (MS) patients presenting with ON. Methods and results: Among the total of 38 patients with optic neuropathies, six patients with isolated ON were MOG-IgG positive and eight patients with ON fulfilled the diagnostic criteria for MS. All MS patients were negative for MOG-IgG using a cell-based assay. When compared with the MS group, the MOG-IgG patients were older (mean 47 years), more frequently male (ratio 2:1) and had a higher frequency of bilateral and/or recurrent ON. The brain magnetic resonance imaging of all MOG-IgG positive patients was normal or had only unspecific white matter T2 lesions. Conclusion: These findings suggest that MOG-IgG is a biomarker of an inflammatory demyelinating CNS disease distinct from MS.

ABSTRACT The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.

ABSTRACT Familial cases of early-onset prominent frontal lobe dysfunction associated with epilepsy have not been reported to date. We report a mother and her only daughter with incapacitating behavioral manifestations of frontal lobe dysfunction and epilepsy of variable severity. The possibility of a hitherto undescribed genetic condition is discussed.

Resumo: A dinâmica de transmissão da dengue é multifatorial e envolve aspectos socioeconômicos, ecológicos e ambientais, sendo este último intimamente relacionado às condições climáticas locais que interferem no ciclo reprodutivo dos vetores da doença. Por sua vez, o clima é dependente dos mecanismos oceânicos tropicais, a exemplo das fases de El Niño/La Niña sobre o Pacífico. O presente trabalho contribui com esta temática e reporta as correlações entre o índice MEI (Multivariate ENOS Index) do Pacífico e o número de casos notificados de dengue em sete capitais da Amazônia brasileira, no período de 2001 a 2012. Além disso, investiga-se o padrão de sazonalidade (médias trimestrais) dos casos de dengue ao longo da região. As evidências de que o fenômeno El Niño/La Niña provoca redução/aumento no padrão pluviométrico local é consistente com o número menor/maior de casos notificados de dengue na maior parte das capitais amazônicas, cujo resultado foi comprovado pelas correlações negativas estatisticamente significantes encontradas para Manaus (Amazonas), São Luís (Maranhão), Belém (Pará) e Palmas (Tocantins). As médias dos 12 anos (2001/2012) revelaram a presença de sazonalidade pronunciada na incidência de dengue na maioria das capitais, com picos acentuados de janeiro a março [Rio Branco (Acre), Manaus, Belém e Palmas] e de abril a junho (São Luís), correspondendo em torno de 50% a 70% do total anual. As localidades mais ao norte [Boa Vista (Roraima) e Macapá (Amapá)] revelaram registro da dengue ao longo de todos os trimestres do ano, não apresentando sazonalidade acentuada.