• Newsletter
  • Search
  • Contacto
  • Home (next newsletter)
  • Home
  • News # 80 | Jun. 2018
  • News # 81 | Jul. 2018
  • News # 82 | Set. 2018
  • News # 83 | Oct. 2018
  • News # 84 | Nov. 2018
  • News # 85 | Dec. 2018
  • News # 86 | Jan. 2019
  • News # 87 | Feb. 2019
  • News # 88 | Mar. 2019
  • News # 89 | Apr. 2019
  • News # 90 | May. 2019
  • News # 91 | Jun. 2019
  • News # 92 | Jul. 2019
  • News # 93 | sep. 2019
  • Newsletters
    • 2008 – 2009
      • News # 1 | nov. 2008
      • News # 10 | nov/dez. 2009
      • News # 2 | dec. 2008
      • News # 3 | jan/fev. 2009
      • News # 4 | mar. 2009
      • News # 5 | abr. 2009
      • News # 6 | mai/jun. 2009
      • News # 7 | jul. 2009
      • News # 8 | ago/set. 2009
      • News # 9 | out. 2009
    • 2010 – 2011
      • News # 11 | jan/fev. 2010
      • News # 12 | mar. 2010
      • News # 13 | abr. 2010
      • News # 14 | mai. 2010
      • News # 15 | jun/jul. 2010
      • News # 16 | ago/set. 2010
      • News # 17 | out/nov. 2010
      • News # 18 | dez. 2010
      • News # 19 | jan/fev. 2011
      • News # 20 | mar/abr. 2011
      • News # 21 | mai/jun. 2011
      • News # 22 | jul/ago. 2011
      • News # 23 | set/out. 2011
      • News # 24 | nov/dez. 2011
    • 2012 – 2013
      • News # 25 | jan. 2012
      • News # 26 | fev/mar. 2012
      • News # 27 | jun. 2012
      • News # 28 | ago. 2012
      • News # 29 | set/out. 2012
      • News # 30 | nov/dez. 2012
      • News # 31 | jan. 2013
      • News # 32 | mar. 2013
      • News # 33 | abr. 2013
      • News # 34 | mai. 2013
      • News # 35 | jun. 2013
      • News # 36 | set. 2013
      •  News # 37 | out. 2013
      • News # 38 | nov/dez. 2013
    • 2014 – 2015
      • News # 39 | jan/fev. 2014
      • News # 40 | mar. 2014
      • News # 41 | abr/mai. 2014
      • News # 42 | jun/jul. 2014
      • News # 43 | set. 2014
      • News # 44 | out/nov. 2014
      • News # 45 | dez. 2014
      • News # 46 | jan. 2015
      • News # 47 | fev. 2015
      • News # 48 | abr. 2015
      • News # 49 | mai. 2015
      • News # 50 | jun. 2015
      • News # 51 | set. 2015
      • News # 52 | out. 2015
      • News # 53 | dez. 2015
    • 2016 – 2017
      • News # 54 | jan. 2016
      • News # 55 | fev. 2016
      • News # 56 | mar. 2016
      • News # 57 | abr. 2016
      • News nº 58 | may 2016
      • News # 59 | jun. 2016
      • News # 60 | jul. 2016
      • News # 61 | set. 2016
      • News # 62 | out. 2016
      • News # 63 | nov/dez. 2016
      • News # 64 | jan. 2017
      • News # 65 | fev. 2017
      • News # 66 | mar. 2017
      • News # 67 | apr. 2017
      • News # 68 | may 2017
      • News # 69 | jun. 2017
      • News # 70 | jul. 2017
      • News # 71 | set. 2017
      • News # 72 | out. 2017
      • News # 73 | nov. 2017
      • News # 74 | dez. 2017
    • 2018
      • News # 75 | jan. 2018
      • News # 76 | fev. 2018
      • News # 77 | mar. 2018
      • News # 78 | abr. 2018
      • News #79 | May 2018
  • Subscribe Newsletter
My Company
  • Home
  • Newsletters
    • 2018 – 2019
      • News nº 92 | jul. 2019
      • News nº 91 | jun. 2019
      • News nº 90 | Mai. 2019
      • News nº 89 | Abr. 2019
      • News nº 88 | Mar. 2019
      • News nº 87 | Fev. 2019
      • News nº 86 | Jan. 2019
      • News nº 85 | Dez. 2018
      • News nº 84 | Nov. 2018
      • News nº 83 | Out. 2018
      • News nº 82 | Set. 2018
      • News nº 81 | Jul. 2018
      • News nº 80 | Jun. 2018
      • News Nº 79 | Mai. 2018
      • News nº 78 | abr. 2018
      • News nº 77 | mar. 2018
      • News nº 76 | fev. 2018
      • News nº 75 | jan. 2018
    • 2016 – 2017
      • News nº 74 | dez. 2017
      • News # 73 | nov. 2017
      • News # 72 | out. 2017
      • News # 70 | set. 2017
      • News nº 70 | jul. 2017
      • News nº 69 | jun. 2017
      • News nº 68 | mai. 2017
      • News nº 67 | abr. 2017
      • News nº 66 | mar. 2017
      • News nº 65 | fev. 2017
      • News nº 64 | jan. 2017
      • News nº 63 | nov/dez. 2016
      • News nº 62 | out. 2016
      • News nº 61 | set. 2016
      • News nº 60 | jul. 2016
      • News nº 59 | jun. 2016
      • News nº 58 | mai. 2016
      • News nº 57 | abr. 2016
      • News nº 56 | mar. 2016
      • News nº 55 | fev. 2016
      • News nº 54 | jan. 2016
    • 2014 – 2015
      • News nº 53 | dez. 2015
      • News nº 52 | out. 2015
      • News nº 51 | set. 2015
      • News nº 50 | jun. 2015
      • News nº 49 | mai. 2015
      • News nº 48 | abr. 2015
      • News nº 47 | fev. 2015
      • News nº 46 | jan. 2015
      • News nº 45 | dez. 2014
      • News nº 44 | out/nov. 2014
      • News nº 43 | set. 2014
      • News nº 42 | jun/jul. 2014
      • News nº 41 | abr/mai. 2014
      • News nº 40 | mar. 2014
      • News nº 39 | jan/fev. 2014
    • 2012 – 2013
      • News nº 38 | nov/dez. 2013
      • News nº 37 | out. 2013
      • News nº 36 | set. 2013
      • News nº 35 | jun. 2013
      • News nº 34 | mai. 2013
      • News nº 33 | abr. 2013
      • News nº 32 | mar. 2013
      • News nº 31 | jan. 2013
      • News nº 30 | nov/dez. 2012
      • News nº 29 | set/out. 2012
      • News nº 28 | ago. 2012
      • News nº 27 | jun. 2012
      • News nº 26 | fev/mar. 2012
      • News nº 25 | jan. 2012
    • 2010 – 2011
      • News nº 24 | nov/dez. 2011
      • News nº 23 | set/out. 2011
      • News nº 22 | jul/ago. 2011
      • News nº 21 | mai/jun. 2011
      • News nº 20 | mar/abr. 2011
      • News nº 19 | jan/fev. 2011
      • News nº 18 | dez. 2010
      • News nº 17 | out/nov. 2010
      • News nº 16 | ago/set. 2010
      • News nº 15 | jun/jul. 2010
      • News nº 14 | mai. 2010
      • News nº 13 | abr. 2010
      • News nº 12 | mar. 2010
      • News nº 11 | jan/fev. 2010
    • 2008 – 2009
      • News nº 10 | nov/dez. 2009
      • News nº 9 | out. 2009
      • News nº 8 | ago/set. 2009
      • News nº 7 | jul. 2009
      • News nº 6 | mai/jun. 2009
      • News nº 5 | abr. 2009
      • News nº 4 | mar. 2009
      • News nº 3 | jan/fev. 2009
      • News nº 2 | dez. 2008
      • News nº 1 | nov. 2008
  • Subscrever Newsletter
  • Contacto
Main Menu
  • Home
  • Newsletters
    • 2018 – 2019
      • News nº 92 | jul. 2019
      • News nº 91 | jun. 2019
      • News nº 90 | Mai. 2019
      • News nº 89 | Abr. 2019
      • News nº 88 | Mar. 2019
      • News nº 87 | Fev. 2019
      • News nº 86 | Jan. 2019
      • News nº 85 | Dez. 2018
      • News nº 84 | Nov. 2018
      • News nº 83 | Out. 2018
      • News nº 82 | Set. 2018
      • News nº 81 | Jul. 2018
      • News nº 80 | Jun. 2018
      • News Nº 79 | Mai. 2018
      • News nº 78 | abr. 2018
      • News nº 77 | mar. 2018
      • News nº 76 | fev. 2018
      • News nº 75 | jan. 2018
    • 2016 – 2017
      • News nº 74 | dez. 2017
      • News # 73 | nov. 2017
      • News # 72 | out. 2017
      • News # 70 | set. 2017
      • News nº 70 | jul. 2017
      • News nº 69 | jun. 2017
      • News nº 68 | mai. 2017
      • News nº 67 | abr. 2017
      • News nº 66 | mar. 2017
      • News nº 65 | fev. 2017
      • News nº 64 | jan. 2017
      • News nº 63 | nov/dez. 2016
      • News nº 62 | out. 2016
      • News nº 61 | set. 2016
      • News nº 60 | jul. 2016
      • News nº 59 | jun. 2016
      • News nº 58 | mai. 2016
      • News nº 57 | abr. 2016
      • News nº 56 | mar. 2016
      • News nº 55 | fev. 2016
      • News nº 54 | jan. 2016
    • 2014 – 2015
      • News nº 53 | dez. 2015
      • News nº 52 | out. 2015
      • News nº 51 | set. 2015
      • News nº 50 | jun. 2015
      • News nº 49 | mai. 2015
      • News nº 48 | abr. 2015
      • News nº 47 | fev. 2015
      • News nº 46 | jan. 2015
      • News nº 45 | dez. 2014
      • News nº 44 | out/nov. 2014
      • News nº 43 | set. 2014
      • News nº 42 | jun/jul. 2014
      • News nº 41 | abr/mai. 2014
      • News nº 40 | mar. 2014
      • News nº 39 | jan/fev. 2014
    • 2012 – 2013
      • News nº 38 | nov/dez. 2013
      • News nº 37 | out. 2013
      • News nº 36 | set. 2013
      • News nº 35 | jun. 2013
      • News nº 34 | mai. 2013
      • News nº 33 | abr. 2013
      • News nº 32 | mar. 2013
      • News nº 31 | jan. 2013
      • News nº 30 | nov/dez. 2012
      • News nº 29 | set/out. 2012
      • News nº 28 | ago. 2012
      • News nº 27 | jun. 2012
      • News nº 26 | fev/mar. 2012
      • News nº 25 | jan. 2012
    • 2010 – 2011
      • News nº 24 | nov/dez. 2011
      • News nº 23 | set/out. 2011
      • News nº 22 | jul/ago. 2011
      • News nº 21 | mai/jun. 2011
      • News nº 20 | mar/abr. 2011
      • News nº 19 | jan/fev. 2011
      • News nº 18 | dez. 2010
      • News nº 17 | out/nov. 2010
      • News nº 16 | ago/set. 2010
      • News nº 15 | jun/jul. 2010
      • News nº 14 | mai. 2010
      • News nº 13 | abr. 2010
      • News nº 12 | mar. 2010
      • News nº 11 | jan/fev. 2010
    • 2008 – 2009
      • News nº 10 | nov/dez. 2009
      • News nº 9 | out. 2009
      • News nº 8 | ago/set. 2009
      • News nº 7 | jul. 2009
      • News nº 6 | mai/jun. 2009
      • News nº 5 | abr. 2009
      • News nº 4 | mar. 2009
      • News nº 3 | jan/fev. 2009
      • News nº 2 | dez. 2008
      • News nº 1 | nov. 2008
  • Subscrever Newsletter
  • Contacto

Apathy in Acute Stroke and Personality Disturbance Secondary to Stroke

By etavares On 31 December, 2010 Open Space | 2010 Comments Off on Apathy in Acute Stroke and Personality Disturbance Secondary to Stroke No tags

INTRODUCTION 
Mental health care and the prevention of mental disease secondary to stroke constitute important areas for research and applied medicine. Stroke itself, and handicaps and dependence after stroke are causes for depression and for loss of motivation or apathy [1].

Apathy appears following uni or bilateral brain lesions involving the caudate, nternal globus pallidus or putamen, or parts of a circuit that includes the medial nucleus of the thalamus and certain frontal regions connected with the limbic system. Lesions or malfunctions in the cortico-subcortical circuit of the anterior cingulate lead to apathy in patients affected by neurological diseases. [2-6]

Recent studies have indicated post-stroke apathy rates of 19-71%, and it was associated with age, low educational levels, right brain lesion, and physical, cognitive and emotional impairments [3, 5, 7-14].

The objective of the present study was to ascertain if apathy in the the acute stage of stroke was a risk factor for Personality Disturbance Secondary to stroke –Apathy Type (Post-stroke apathy), and if post-stroke apathy was related with depression, cognitive impairment, executive and perceptive dysfunctions, or temperament.

METHODS AND PATIENTS 
We have systematically evaluated stroke patients (hemorrhagic or ischemic) admitted to the Stroke Unit, Department of Neuroscience, Santa Maria Hospital, up to 7 days following stroke, and re-evaluated at 6 months and 1 year follow-up. All patients gave their informed consent.

Acute evaluation included demographic recordings, and collecting neurological, neuroradiological, neuropsychiatric, and neuropsychological data. Patients with severe communication disturbances based on NIH Stroke Scale [15], and patients with a score of 5-9 in the Glasgow Coma Scale [16] were excluded. They were all subject to a CT or MR scan. Lesions were categorized as: 1) brainstem/cerebellum or hemispheric, 2) hemispheric left or right, 3) hemispheric cortical or subcortical, 4) hemispheric cortical anterior or cortical posterior [17].

The factors deemed to be of risk for apathy were: 1) mild cognitive impairment/dementia (Clinical diagnostic [18] or cognitive subjective complaints) confirmed by a relative; 2) alcohol abuse (=5 drinks per day); 3) previous mood disturbance [18].

At outcome we evaluated the patients’ functional status using the modified Rankin Scale (mRS) [19], post-stroke functional dependence using the Barthel Index [20], and their post-stroke Quality of Life using the EuroQol [21].

The neuropsychiatric and neuropsychological evaluation included apathy assessment using the Apathy Evaluation Scale [1], depression (Montgomery Asberg Depression Rating Scale) [22-23], general cognition (MMSE) [24-25], executive functions (BLAD) [26], emotional perception (Comprehensive Affective Testing System) [27], and temperament (TEMPS) [28].

We used the chi-square to assess bivariate associations between apathy and the remaining variables. We compared the frequencies of neuropsychiatric and neuropsychological disturbances between 2 (McNemar’s test) or 3 (Cochran’s Q test) evaluations (acute and at 6 months and/or 1 year). The Independent T-test and the Paired-Samples T-test were used to compare continuous variables with categorical variables. Pearson’s and Spearman’s tests were used to study the correlations. The value of p=0.05 was statistically significant.

RESULTS
We included 98 patients (61.5±11.4 years old) in the study with a mean of 6.9±4.5 yeas of school,, 67% male, 82% had ischemic lesions, 75% had hemispheric lesions, 49% had right hemispheric lesions and 66% had subcortical lesions. Twenty six patients had a previous mood disorder and eighteen had previous cognitive impairment/mild cognitive impairment.

In acute stage apathy was frequent in 21.4% (21/98) of patients, in 19.4% (14/72) at 6 months, and in 23% (17/76) at 1 year. Apathy in the acute stage was associated with apathy at 6 months (x=5.1; p=.02) and at 1 year (x=3.7; p=.05). At 6 months and 1 year, 40% and 41% of patients suffering from apathy at acute stage remained apathetic, and 57% and 60% new cases of apathy were detected. There was no association between apathy and post-stroke depression, the two coexisting in 8% of patients. No cerebrovascular lesion was associated with post-stroke apathy. Post-stroke apathy was correlated with age and inversely correlated with educational level, functional dependence and quality of life.

Previous mild cognitive impairment/dementia was associated with post-stroke apathy. At 6 months, apathy was associated with emotional perception, and at 1 year it was associated with verbal reasoning disturbances.

Cyclothymic temperament previous to the stroke was associated with apathy at 1 year. No other significant associations were found.

CONCLUSIONS 
Post-stroke apathy was frequent in 1/5 of the patients. Apathy at the acute stage of stroke was the strongest indicator of post-stroke apathy, as 40% of patients denoted post-stroke apathy. Age, low educational levels and previous cognitive impairment/dementia were associated with post-stroke apathy. Changes in emotional perception and verbal reasoning were associated with post-stroke apathy. Post-stroke apathy is an indicator of functional dependence and of low quality of life following a stroke..

Lara Caeiro PsyD,
Psychologist, Master Neurosciences,
Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon
laracaeiro@fm.ul.pt

José M. Ferro MD PhD,
Medical Doctor, PhD,
Neurology Service, Department of Neurosciences,
Hospital de Santa Maria, and Faculty of Medicine, University of Lisbon

M. Luísa Figueira MD, PhD
Medical Doctor, PhD,
Psychiatry Service, Department of Neurosciences,
Hospital de Santa Maria, and Faculty of Medicine, University of Lisbon
___________________________

BIBLIOGRAPHIC REFERENCES 
1. Marin RS, Biedrzycki RC, Firinciogullari S (1991). Reliability and validity of the apathy evaluation scale. Psychiatry Research 38:143-162.
2. Ghika-Schmid FS e Bogousslavsky J (2000). Emotional behaviours in acute brain lesions In Behaviour and mood disorders in focal brain lesions, Ed. J Bogousslavsky & J L Cummings. Cambridge: University Press; pp: 65-94.
3. Habib M (2000). Disorders of motivation. In: Bogousslavsky J, Cummings JL, editors. Behaviour and mood disorders in focal brain lesions. Cambridge: Cambridge University Press. pp: 261-684.
4. Habib M (1995). Activity and motivational disorders in neurology: proposal for an evaluation scale. Encephale 21:563-70.
5. Bhatia KP and Marsden CD (1994). The behavioural and motor consequences of focal lesions of the basal ganglia in man. Brain 117: 859-876.
6. Marin RS (1990). Differential diagnosis and classification of apathy. Am J Psychiatry 147:22-30.
7. Santa N, Sugimori H, Kusuda K, Yamashita Y, Ibayashi S, Iida M (2008). Apathy and functional recovery following first-ever stroke.Int J Rehabil Res 31:321-326.
8. Jarzebska E (2007). [Stroke patient’s apathy]. Pol Merkur Lekarski 22: 280-2.
9. Hama S, Yamashita H, Shigenobu M, Watanabe A, Kurisu K, Yamawaki S, Kitaoka T (2007). Post-stroke affective or apathetic depression and lesion location: left frontal lobe and bilateral basal ganglia Eur Arch Psychiatry Clin Neurosci 257:149–152
10. Hama S, Yamashita H, Shigenobu M, Watanabe A, Hiramoto K, Kurisu K, Yamawaki S, Kitaoka T (2007). Depression or apathy and functional recovery after stroke. Int J Geriatr Psychiatry 22:1046-51.9.
11. Brodaty H, Sachdev PS, Withall A, Altendorf A, Valenzuela MJ, Lorentz L (2005). Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke-the Sydney Stroke Study. Psychol Med35:1707-16.
12. Caeiro L (2004). Tese de mestrado. Faculdade de Medicina da Universidade de Lisboa. (Master thesis) Caeiro L, Ferro JM, Figueira ML. Apathy in acute stroke.
13. Hommel M, Trabucco-Miguel S, Joray S, Naegele B, Gonnet N, Jaillard A (2009). Social dysfunctioning after mild to moderate first-ever stroke at vocational age. J Neurol Neurosurg Psychiatry 80:371-5.
14. Feil D, Razani J, Boone K, Lesser I (2003). Apathy and cognitive performance in older adults with depression. Int J Geriatr Psychiatry 18:479-85.
15. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw CJ, Walker M (1989). Measurements of acute cerebral infarction: A clinical examination scale. Stroke 20:864-870.
16. Jennett B e Teasdale G (1977). Aspects of coma after severe head injury. The Lancet 23: 878-881.
17. Tatemichi TK, Foulkes MA, Mohr JP, Hewitt JR, Hier DB, Price TR, Wolf PA (1990). Dementia in stroke survivors in the Stroke Data Bank Cohort. Prevalence, incidence, risk factors and computed tomographic findings. Stroke 21:858-66.
18. American Psychiatric Association (APA) (2002). Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Review. DSM IV-TR. American Psychiatric Association: Washington.
19. Bamford JM, Sandercock PAG, Warlow CP, Slattery J (1989). Interobserver agreement for the assessment of handicap in stroke patients. Stroke 20:828.
20. Collin C, Wade DT, Davis S, Horne V (1988). The Barthel index: a reliability study, Int. Disabil. Stud 10: 61–63.
21. Rabin R e De Charro F (2001). EQ-5D: a measure of health status from the Euroqol group, Ann Med 33: 337–343.
22. Caeiro L, Ferro JM, Santos CO, Figueira L (2006). Depression in acute stroke. J Psychiatry Neurosci 31: 377-383.
23. Montgomery S e Asberg M (1979). A new depression rating scale designed to be sensitive to change. Brit J Psychiatry 134: 382-389.
24. Guerreiro M, Botelho MA, Leitão O, Castro-Caldas A, Garcia C (1994). Adaptação à população portuguesa do Mini Mental State Examination (MMSE). Revista Portuguesa de Neurologia: 9-10.
25. Folstein M, Folstein S, Mc Hush P (1975). Mini Mental State, a pratical method for grading the cognitive status of patients for the clinician. J Psychiatr Res 12:189-198.
26. Garcia C (1984). Alzheimer’s disease: difficulties in clinical diagnosis, PhD dissertation, University of Lisbon, Lisbon.
27. Fernandes S (2005). Emotional perception and emotional memory in health subjects. Master thesis presented to the Faculty of Medicine in the Lisbon University.
28. Figueira ML, Caeiro L, Ferro A, Severino L, Duarte PM, Abreu M, Akiskal HS, Akiskal KK (2008). Validation of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A): Portuguese-Lisbon version. J. Affect. Disord 111,193-203.

Share

Search

Index - News # 18 | dez. 2010
 Editorial Note
 Pessoa Prize awarded to Professor Maria do Carmo Fonseca
 Five prizes awarded to IMM researchers in one month
 Interview with Professor José Ferro – Full Professor in Neurology and Head of the Neurology Unit
 Interview with Professor Isabel Pavão Martins – President of the Portuguese Society of Neurology
 Debate about Oncology at the Second International Symposium of the Harvard Medical School Program – Portugal
 Education for Science” brings together Students, Lecturers and Researchers
 8th IST / FMUL Biomedical Engineering Meeting 2010-2011
 Interview with Professor José Pedro Sousa Dias
 Campaign “Small and Ecological”
 Egas Moniz Museum
 Um pouco de História e bibliografia selectiva de Egas Moniz (1874-1955)
 Conferência “Universidade Verde”Carla Reis
 Communication inside the Organisation
 Resultados da Campanha do Banco Alimentar Contra a Fome SPUL/FMUL
 Livro do Mês
 7th AstraZeneca Foundation /Faculty of Medicine of the University of Lisbon Research Scholarship
 21st European Students’ Conference
 Scientific Research Projects 2009/2010 – Neurology Area
 Lecturers’ Participation in Academic Examination Panels in other institutions (by 9 December 2010)
 Academic examinations at the Faculty of Medicine of the University of Lisbon
 Publications FMUL/HSM/IMM
 Bags and Rucksacks: “weights” today and “burdens” tomorrow (PART II)
 Efficacy of intensive speech therapy in aphasic patients due to vascular causes
 Cerebral venous and sinus thrombosis
 The research project LADIS – LeukoAraisosis and DISability
 Role of the B-type natriuretic peptide in the classification of ischemic Cerebrovascular Accidents
 Apathy in Acute Stroke and Personality Disturbance Secondary to Stroke
 Acute Brain Ischemia, Hypothermia and Hybernation: The Role of Oxidative Fosforilation Inhibitors
 Science and Health Research
 Indicators of the University Clinic of Neurology
My Company

100 AnosPropriedade e Edição: Faculdade de Medicina da Universidade de Lisboa NIPC: 502662875  Periodicidade: Mensal  Diretor: Prof. Doutor Fausto J. Pinto Conselho Editorial: Prof. Doutor Fausto J. Pinto, Profª. Doutora Ana Sebastião, Prof. Doutor Mamede de Carvalho, Prof. Doutor António Vaz Carneiro, Prof. Doutor Miguel Castanho, Dr. Luís Pereira  Equipa Editorial:  Ana Raquel Moreira, Cristina Bastos, Isabel Varela, Joana Sousa, Maria de Lurdes Barata, Rui Gomes, Sónia Teixeira  Colaboração:  Gabinete de Relações Públicas, Internacionais e Comunicação  Versão Inglesa: AP|PORTUGAL- Language Services  Conceção: Metatexto, Lda. e-mail: news@medicina.ulisboa.pt  Sede do Editor e Sede da Redação: Avenida Prof. Egas Moniz, 1649-028 Lisboa Estatuto Editorial Anotado na ERC 

  • Increase Font
  • Decrease Font
  • Black & White
  • Inverse Colors
  • Highlight Links
  • Regular Font
  • Reset
Real Accessability