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Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder associated with Epstein-Barr virus (EBV) infection and is frequently associated with immunodeficiency. Pulmonary involvement with angiocentric distribution is the most common clinical manifestation. Diagnosis is confirmed by tissue biopsy, usually from lung lesions. Due to the paucity of reported cases, there is no validated treatment for LYG. Therapeutic options include interferon-alpha, systemic corticosteroids, rituximab, chemotherapy, and autologous hematopoietic stem cell transplantation. We report a case of a 49-year-old man, with human immunodeficiency virus type 2 (HIV-2) infection, who was diagnosed with LYG with lung involvement and had a full remission after treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone).

The present work intends to approach the EKUI methodology as a literacy strategy. Through a brief exploratory qualitative study, which despite being insipient, intends to give clues of the usefulness of the resource for future research. The EKUI methodology is designed to help identify, assess, and intervene in the skills necessary for learning to read, write, and communicate. The study has methodological options for the application of questionnaires to professionals who are applying the EKUI methodology in the current year. Furthermore, the methodology aims to applicate a semi-structured interview to professionals who have already applied the methodology in their pedagogical intervention, in order to validate its contributions. The results obtained show the importance of the EKUI methodology as a strategy of Universal Learning Design and, consequently, as a promoter of a reflective attitude in teachers. On the other hand, it also contributes to the identification and intervention in necessary skills for learning to read, write and communicate.

Logging companies are extremely important in the economy of the country, but the large number of occupational accidents is of concern in this sector. It is therefore essential to act preventively in the cause of these accidents by identifying and controlling hazards. Thus, the objective of this work was to elaborate an Occupational Health and Safety Risk Matrix in a logging plant in Criciúma - SC. To this end, the applied matrix is based on the requirements set forth in BS OHSAS 18001: 2007. As a result it was observed that the greatest risk is incorrect posture and intense physical effort, as well as noise and projection of wood residues in the eyes and skin. It was inferred that with the matrix it was possible to identify the points in which a company should seek quick solutions to minimize the risks to which its employees are subjected daily.

Background Currently, we live in a society that is too competitive and with aggressive physical and social environments, which triggers profound changes in work conditions and requirements. Pressures are constantly being felt that foster the increase in psychosocial risks, altering the psychological, physical and social balance of the human being with serious implications for the health of the worker. Methods The present study aimed to understand whether the ability of professionals in a Higher Education Institution to work is influenced by sociodemographic variables (age, gender, marital status, educational qualifications, function); whether psychosocial factors are influenced by sociodemographic variables (age, gender, marital status, educational qualifications, function) and whether the ability to work varies depending on psychosocial factors. For data collection, a two parts questionnaire was applied. The first part of the questionnaire was dedicated to collecting sociodemographic data and assessing the perception of workers' ability to work, through the Work Ability Index (WAI). The second part concerned the Copenhagen Psychosocial Questionnaire (COPSOQ), to identify factors of exposure to psychosocial risk factors. Results The average work capacity was 41.07 points, which corresponded to a ‘good’ work capacity. In the COPSOQ results, no critical values were identified in the subscales. We found that the ability to work varies according to psychosocial risk factors. Conclusions We conclude that the variable age influences the ability to work. As for the remaining sociodemographic variables, although this study did not show statistically significant differences, they also seem to influence the WAI.

In European forests, extreme wind events associated with severe extratropical cyclones are considered the main abiotic agent of forest vulnerability, leading to high economic losses in forests due to damage caused by the uprooting of trees and trunk breaks. Despite the importance recognized to severe cyclones and associated extreme phenomena, the impact on forest stocks is not always properly reported, leading to underestimation in the perception of losses, with direct consequences on forest governance decisions. This is particularly true in countries where other agents traditionally have a high impact, such as the countries under the influence of the Mediterranean, where wildfire is a recurrent menace with devastating effects. This work characterizes the situation observed in Portugal and presents the methodology followed to obtain information about forest damages and the procedure to identify the extreme extratropical cyclones responsible for those damages. As an example, available information and the recording of damage occurring in the Portuguese forest in winter 2017–2018 are presented and discussed. The study shows how difficult and demanding it is to obtain past information about the damage. In addition, there is high uncertainty about the precise identification of the event that caused the damage, as field records often occur several days or even weeks after the storm. To reduce the constraints, it is proposed to use a model whose skeleton of information has been designed to obtain useful information from traditional registries. The proposed model is useful for the characterization of losses and to support national policies to reduce the impact of damage associated with extreme wind events. The design of the catalogue can be used for recording information at the stand scale level by stakeholders and ensure compatibility with international databases for updating information purposes.

Resumo Os principais sinais e sintomas da insuficiência venosa crônica são dor, edema, varizes e alterações teciduais, condições que comprometem a funcionalidade e qualidade de vida. Visando amenizar esses prejuízos, o manejo da doença envolve uma ampla modalidade de intervenções; entre elas, o exercício terapêutico. Esta pesquisa apresenta as evidências existentes sobre a efetividade dos exercícios terapêuticos na qualidade de vida, dor e funcionalidade da insuficiência venosa crônica. Efetuou-se uma busca nas bases de dados CENTRAL, CINAHL, LILACS, MEDLINE, PEDro, SciELO, Science Direct, Scopus e Web of Science. Dos 2.961 resultados, quatro atenderam aos critérios de elegibilidade. Desses, apenas um estudo mostrou benefícios dos exercícios para melhora da qualidade de vida e redução da dor. Os demais apresentaram baixa qualidade metodológica. Portanto, as evidências existentes são insuficientes para indicar ou contraindicar os exercícios terapêuticos para melhoria da qualidade de vida, dor e funcionalidade em pacientes com insuficiência venosa crônica. Abstract The main signs and symptoms of chronic venous insufficiency are pain, edema, varicose veins, and tissue changes; conditions that compromise functionality and quality of life. Management of the disease aims to mitigate these losses and involves a wide range of interventions, one of which is therapeutic exercise. This article presents the existing evidence on the effectiveness of therapeutic exercises for quality of life, pain, and functionality in chronic venous insufficiency. Searches were run on the databases CENTRAL, CINAHL, LILACS, MEDLINE, PEDro, SciELO, Science Direct, Scopus, and Web of Science. Four of the 2,961 results met the eligibility criteria. Only one of these studies showed benefits of exercise for improving quality of life and reducing pain. The others had low methodological quality. The existing evidence is therefore insufficient to indicate or contraindicate therapeutic exercises for improvement of quality of life, pain, and functionality in patients with chronic venous insufficiency.

Renewable resources are dependent on the variability of weather conditions and thus on the availability of the resource as it is the case of wind energy. The huge expansion of the worldwide wind power capacity to produce electricity makes this technology vulnerable to extreme weather conditions such as those associated with extratropical cyclones and extreme weather events (Gonçalves et al., 2020). This work aims to assess the wind resources available and the wind energy potential (WEP) during recent December months (the years 2017 to 2020) in the southwestern Europe. These winter months were characterized by high impact storms with strong winds associated which caused extensive damage. In this region, a total of 10 intense named storms occurred in December: 2017 (Ana, Bruno, and Carmen); 2018 (Etienne and Flora); 2019 (Daniel, Elsa, and Fabien); 2020 (Dora and Ernest) (IPMA; AEMet; Météo France; 2021). To understand the effect of the strong winds associated with the passage of the storms during these months, the ERA5 Reanalysis 10m wind components (10-meter U and V wind components) are retrieved from the European Centre for Medium Range Weather Forecasts (ECMWF) (Hersbach et al., 2019). The fields were extracted at 00, 06, 12 and 18 UTC (6-hourly data), for the 2017, 2018, 2019 and 2020 December months over a geographical sector that covers the southwestern Europe region (30°N–65°N; 40°W–25°E) and compared to climatological values for the 1981-2010 period. Moreover, the wind energy potential was calculated for the respective December months and the values compared and associated with the values of renewable energy reports available for the Iberian Peninsula and the countries of southwestern Europe. Obtained results show an increase of wind intensity of up to 2 m.s-1 in southwestern Europe during December 2017 and 2019 and a decrease of 2 m.s-1 in December 2018, when compared with the respective climatology for the 1981-2010 period. In December 2020, a significant increase of wind intensity reaching up to 2.8 m.s-1 in the Bay of Biscay region, affecting the Iberian Peninsula and the west coast of France. The increase in wind resource resulted in an increase in wind potential in the months under study. These values are in line with the values of wind energy produced during the months analyzed for the EU-28 countries. Finally, it is shown that the highest values of wind production occurred during the days when the storms hit southwestern Europe.AcknowledgementsThis work is supported by Fundação para a Ciência e a Tecnologia – FCT through the projects PTDC/CTA-MET/29233/2017 (WEx-Atlantic) and UID/GEO/50019/2020. Partial support was also obtained from the Xunta de Galicia under the Project ED431C 2017/64-GRC Programa de Consolidación e Estructuración de Unidades de Investigación Competitivas (Grupos de Referencia Competitiva) and Consellería de Educación e Ordenación Universitaria, cofunding from the ERDF, in the framework of the Operational Program Galicia 2014–2020. ReferencesAgencia Estatal Meteorología, 2021. Online: http://www.aemet.es/es/conocermas/borrascas Gonçalves et al., 2020. ECAS 2020, doi:10.3390/ecas2020-08132Hersbach et al., 2019. ECMWF Newsletter, Vol 159, pp. 17–24, doi: 10.21957/vf291hehd7Instituto Português do Mar e da Atmosfera, 2021. Online: https://www.ipma.pt/en/index.html Météo France, 2021. Online: http://www.meteofrance.com/accueil

Electricity production through renewable energy sources, such as wind energy, is dependent of the variability of weather conditions. Thus, this work aims to assess the wind resource available and the wind energy potential during recent December months (the three years 2017, 2018, 2019). These winters were characterized by the occurrence of high impact storms. To understand the effect of the strong winds associated with the passage of the storms during these months, 10m wind components (10-meter U and V wind components) are used. The fields were extracted at 00, 06, 12 and 18 UTC ( 6-hourly data), for the 2017, 2018 and 2019 December months over a geographical sector that covers the Iberian Peninsula (IP) region (35°N–45°N;10°W–4°E) and compared to climatological values for the 1981-2010 period. The obtained results show an increase of wind intensity of up to 1.5 m.s-1 in IP during December 2017 and 2019, and a decrease of 1.5m.s-1 in December 2018, when compared with the respective climatology for the 1981-2010 period. This increase corresponds to an increase in the corresponding wind energy potential. Therefore, our results agree with the values of the wind energy produced during the analyzed months for the two countries, Portugal and Spain. Finally, it is notably that the highest values of wind energy production occurred on the days of the storms passage through the IP.

Acromegaly is a rare disease characterized by a chronic exposition to growth hormone (GH) and insulin-like growth factor-1 (IGF-1), caused in most cases by a pituitary GH-secreting adenoma. Chronic GH excess induces systemic complications (metabolic, cardiovascular, respiratory, neoplastic, and musculoskeletal) and increased mortality if not appropriately treated. Recent epidemiological data report an improved life span of patients with acromegaly probably due to better acromegaly management; additionally, the number of pituitary incidentaloma in general population also increased over time due to more frequent imaging. Therefore, the number of elderly patients, newly diagnosed with acromegaly or in follow-up, is expected to grow in the coming years and clinicians will need to be aware of particularities in managing these patients. This review aims to explore different aspects of acromegaly of the elderly patients, focusing on epidemiology, diagnosis, clinical presentation, complications, and management options. Available literature has been assessed through PubMed (data until August 2019) by specific keywords. Available data on acromegaly in the elderly patient are sparse, but point to important differences. Further studies are needed comparing elderly with younger patients with acromegaly to better define a tailored diagnostic and therapeutic management.

The electricity produced through renewable resources is dependent on the variability of weather conditions and, thus, on the availability of the resource, as is the case with wind energy. This study aims to assess the wind resource available and the wind energy potential (WEP) during the December months for the three years 2017, 2018, and 2019, in southwestern Europe, when several high-impact storms affected the region. Additionally, a comparison of Prandtl’s logarithmic law and Power-law equations for extrapolation of the vertical wind profile is performed for onshore conditions, to evaluate the differences in terms of energy production, with the use of different equations. To assess the effect of the strong winds associated with the storms, 10 m wind components are used, with a 6-hourly temporal resolution, for the December months over the southwestern Europe region (30° N–65° N, 40° W–25° E). Results are compared to the climatology (1981–2010) and show an increase of wind intensity of 1.86 m·s−1 in southwestern Europe during December 2019, and a decrease up to 2.72 m·s−1 in December 2018. WEP is calculated for the selected wind turbine, 4 MW E-126 EP3—ENERCON, as well as the values following the wind resource record, that is, (i) higher values in December 2019 in the offshore and onshore regions, reaching 35 MWh and 20 MWh per day, respectively, and (ii) lower values in December 2018, with 35 MWh and 15 MWh per day for offshore and onshore. Differences in WEP when using the two equations for extrapolation of wind vertical profile reached 60% (40%) in offshore (onshore) regions, except for the Alps, where differences of up to 80% were reached. An additional analysis was made to understand the influence of the coefficients of soil roughness and friction used in each equation (Prandtl’s logarithmic law and Power-law), for the different conditions of onshore and offshore. Finally, it is notable that the highest values of wind energy production occurred on the stormy days affecting southwestern Europe. Therefore, we conclude that these high-impact storms had a positive effect on the wind energy production in this region.

Background Although the incidence rates of non-tuberculous mycobacteria (NTM) have been increasing in many countries, the basic epidemiology of NTM remains to be fully understood. Objective To assess the incidence, clinical relevance and geographical distribution of NTM disease in Portugal and to identify demographic and clinical characteristics associated with Mycobacterium avium complex (MAC) disease. Methods Information stored in an electronic database of all NTM cases reported over an 11-year period was retrospectively reviewed. Significant demographic and clinical characteristics of MAC disease (vs. having any other NTM disease) were determined using multiple logistic regression models. Results We identified 632 patients, mostly male, native Portuguese, with pulmonary disease, predominantly from Lisbon and Porto. The annual incidence of NTM disease was 0.54 per 100 000 population. The annual number of NTM cases increased throughout the study period. MAC was most frequently isolated. MAC disease was positively (and significantly) associated with being female, age >45 years and human immunodeficiency virus infection. Conclusions The increasing incidence of NTM over the study period emphasises the importance of NTM as a public health issue. This study provides important information for health care professionals and a basis for further study of NTM in Portugal.

La sindrome di Pendred è, in ordine di frequenza, la seconda causa di ipoacusia su base genetica autosomica recessiva. Si manifesta con un ipoacusia accompagnata dalla presenza di un gozzo tiroideo con eventuale ipotiroidismo. Tali caratteristiche si accompagnano a malformazioni dell’orecchio interno, quali l’acquedotto vestibolare largo. Nel 50% dei casi vi è una mutazione del gene SLC26A4. Riportiamo nel presente lavoro il caso di una paziente portoghese di 47 anni affetta da ipoacusia di grado severo/profondo e ipotiroidismo. La madre e la sorella della paziente, entrambe decedute, erano a loro volta affette da ipoacusia associata a gozzo tiroideo. La risonanza magnetica e la TC hanno entrambe evidenziato un allargamento dell’acquedotto vestibolare e del sacco endolinfatico. La paziente è stata sottoposta a uno studio di GJB2 e GJB6 seguiti da uno screening di tutti gli esoni di SLC26A4 e delle regioni introniche 8 e 14. È stata rilevata, per la prima volta in omozigosi, una mutazione c.918 + 2T>C nella regione intronica 7 del gene SLC26A4. Sequenziando i campioni di controllo è stata rilevata una nuova mutazione c.821C>G presente in eterozigosi nell’estone 7 del gene SLC26A4, per la quale si è ipotizzato un ruolo dannoso. Il presente studio ha condotto alla scoperta di due nuovi genotipi di SLC26A4, e alla miglior definizione degli aspetti fenotipici associati alla sindrome di Pendred.

In order to contribute to the knowledge about the influence of several factors on the in-service performance of renders, as well as about the applicability of in-situ testing techniques in the evaluation of their performance, an experimental work was carried. In this work, the influence of some factors (type of substrate, number and thickness of mortar layers) on the mechanical and physical performance of two mortars (site-made and industrial) was evaluated, using the following in-situ testing techniques: pendulum rebound hammer test (with two types of rebound hammer), ultrasonic pulse velocity test (with two types of device) and water absorption under low pressure test (with Karsten tubes). It was possible to verify that the above-mentioned factors influence the performance of the mortars. The in-situ testing techniques were, in general, able to identify differences in the behaviour of renders due to these factors. However, for the same technique, different devices sometimes led to distinct results. Nevertheless, the combination of the results of different techniques helped to reduce the uncertainty of the analysis.

Background Fructose is a hexose sugar found naturally in our diet and excessive fructose consumption has been documented in humans over the last decades. Fructose absorption in the small intestine is a highly regulated process and GLUT5 plays an essential role in this process, but GLUT2 is also involved. Methods In this review, we will describe the multiple mechanisms involved in the regulation of intestinal fructose absorption and the effects of excessive consumption of this sugar on human health. Results Excessive fructose intake is associated with a growing incidence of certain diseases, including obesity, type 2 diabetes, non-alcoholic fatty liver disease, cardiac disease, gastrointestinal disorders, and cancer. It is also associated with changes in gut integrity and microbiota. Conclusions High fructose consumption is associated with the development of characteristics of metabolic syndrome and of other diseases such as cardiomyopathies, kidney disease and tumor growth, in both humans and rodents So, modulation of GLUT5- and/or GLUT2-mediated intestinal fructose absorption might provide a novel pharmacologic strategy for the treatment of these diseases. However, most of the data on high fructose consumption has been obtained in rodent models, and so more studies are needed in order to fully confirm these observations in humans.

This chapter takes as its research starting point a critical and convergent review and reexamination of existing theory and knowledge about entrepreneurship and sustainability. We question whether smart cities provide the ideal context for sustainability entrepreneurship (SE) to emerge and how sustainability-driven entrepreneurs can contribute to the development of smarter and more sustainable tourism destinations. Hence, we examine SE tourism and hospitality businesses implemented by these so-called ‘smart citizens' in Lisbon (Portugal), a city that arguably provides the necessary context for smart decisions to flourish. This chapter thus aims at opening up new modes of inquiry and questioning existing epistemologies on the study of smart cities and entrepreneurship that help breaking new ground about the role of entrepreneurs in the tourism activity.

The aim of the paper is to present the battery equivalent circuit for electric vehicle application. Moreover, the model described below is dedicated to lithium-ion types of batteries. The purpose of this paper is to introduce an efficient and transparent method to develop a battery equivalent circuit model. Battery modeling requires, depending on the chosen method, either significant calculations or a highly developed mathematical model for optimization. The model is evaluated in comparison to the real data measurements, to present the performance of the method. Battery measurements based on charge/discharge tests at a fixed C-rate are presented to show the relation of the output voltage profiles with the battery state of charge. The pulse discharge test is presented to obtain the electric parameters of the battery equivalent circuit model, using a Thévenin circuit. According to the Reverse Trike Ecologic Electric Vehicle (VEECO RT) characteristics used as a case study in this work, new values for vehicle autonomy and battery pack volume based on lithium nickel manganese cobalt oxide cells are evaluated.

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ResumoO desenvolvimento de uma fístula entre uma grande artéria e o intestino é incomum, constituindo normalmente um evento catastrófico. Os autores descrevem um caso de um homem de 78 anos, com história prévia de stenting ilíaco. O doente recorre ao SU por hematoquézia, em choque hipovolémico e séptico com dor à palpação dos quadrantes inferiores do abdómen. Realizou TC sugerindo hematoma com bolhas aéreas a envolver artéria ilíaca externa (AIE) direita e isquemia do cólon. Submetido a cirurgia, constatando‐se hemorragia arterial abundante da AIE, exteriorização do stent e fístula da artéria ilíaca para o cego (ílio‐cecal). Procedeu‐se a laqueação da AIE, colectomia total e bypass femoro‐femoral. Evolução em choque séptico com falência multiorgânica e óbito ao 15.° dia pós-operatório. A propósito deste caso clínico, não havendo outros descritos na literatura, os autores discutem a terapêutica das fístulas ílio‐cecais.AbstractThe development of a fistula between a major artery and the bowel is infrequent, but usually catastrophic. The authors describe the case of a 78 year old man, with a previous history of iliac stenting. He presented to the emergency department with hematochezias, in hypovolemic and septic shock, with tenderness in the lower abdomen. CT was performed suggesting hematoma with air surrounding the right EIA and colonic ischemia. Surgery was performed, finding abundant arterial hemorrhage originating from the EIA, exteriorization of the stent and iliac‐cecal fistula. Ligation of the EIA, total colectomy and femoral‐femoral bypass were performed. Evolution to septic shock and multi-organic failure resulted in the patient‘s death at 15th post-operative day. Regarding this case and without similar cases described in literature, the authors discuss the therapeutic approach to iliac‐cecal fistula.

This study aimed to validate the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for obstructive pulmonary diseases (OPDs) from the perspective of patients with chronic obstructive pulmonary disease. A cross-sectional qualitative study was carried out with outpatients with chronic obstructive pulmonary disease using focus groups with an ICF-based approach. Qualitative data were analysed using the meaning condensation procedure by two researchers with expertise in the ICF. Thirty-two participants (37.5% women; 63.8 ± 11.3 years old) were included in six focus groups. A total of 61 (86%) ICF categories of the Comprehensive ICF Core Set for OPD were confirmed. Thirty-nine additional second-level categories not included in the Core Set were identified: 15 from the body functions component, four from the body structures, nine from the activities and participation and 11 from the environmental factors. The majority of the categories included in the Comprehensive ICF Core Set for OPD were confirmed from the patients' perspective. However, additional categories, not included in the Core Set, were also reported. The categories included in the Core Set were not confirmed and the additional categories need to be investigated further to develop an instrument tailored to patients' needs. This will promote patient-centred assessments and rehabilitation interventions.

ResumoAs malformações arteriovenosas (MAVs) congénitas podem ocorrer em qualquer território vascular mas a sua localização pélvica no sexo masculino é rara, e representam um desafio terapêutico difícil.Os autores descrevem um caso clínico de um doente do sexo masculino de 72 anos, com quadro clinico de disúria, hematúria e desconforto pélvico. O estudo por tomografia computorizada (TC) detetou a presença de uma MAV pélvica com origem na artéria hipogástrica esquerda. O doente foi submetido a tratamento endovascular com embolização seletiva e, por recorrência dos sintomas, o procedimento percutâneo foi repetido ao final de um ano. Doente atualmente em follow-up anual, permanecendo assintomático e, na Angio-TC de controlo, verificou-se diminuição das dimensões da MAV.A propósito do caso clínico, discute-se a abordagem terapêutica das malformações pélvicas congénitas.AbstractCongenital arteriovenous malformations (AVMs) can occur in any vascular territory but their pelvic location is rare in male patients, and presents a difficult therapeutic challenge.The authors present a case report of a 72 year old man, who presented with symptoms of dysuria, hematuria, and pelvic discomfort. The study by computed tomography (CT) detected the presence of a pelvic AVM with feeding vessels from the left hypogastric artery. The patient underwent transcatheter selective embolization and, due to recurrent symptoms, percutaneous procedure was repeated one year after. Patient has been followed anually and remains asymptomatic and the CT demonstrated reduction in AVM size.In this report, we will discuss the therapeutic approach to congenital pelvic malformations.

Introduction: Portuguese recommendations propose universal screening for TB before starting biologics and then annually if screened negative. Aim: To characterize i)biologics candidates9 baseline screening (BS) results ii)conversions of immunodiagnostic tests iii)development of active TB during follow-up iv)compliance with screening recommendations. Methods: Patients screened for TB at a reference centre before starting biologics between 2008-2012 were identified. Medical files were retrospectively reviewed. Demographic data, screening and follow-up results and information on biological therapy were collected. Exclusion criteria: unavailable data on biologics9 initiation. Results: 183 patients were included in the study, with 115 starting biologics - 45(39,1%) had Psoriasis, 21(18,3%) Crohn9s Disease, 21(18,3%) Multiple Sclerosis, 12(10,4%) Ankylosing spondylitis, 8(7%) Rheumatoid Arthritis and 8(7%) had other pathologies. The BS was positive in 52(45,2%) patients. Patients with positive BS did not develop active TB during follow-up. Of the 63(54,8%) patients who screened negative, 2(3,17%) developed active TB (under anti-TNFα) more than 1 year after starting biologics. 26 patients were re-screened at the TB centre. 5(19,23%) had TST conversion and one concomitantly undetermined IGRA. No IGRA conversions were observed. Conclusion: The rate of latent TB at BS was higher than expected. No patients with positive BS developed active TB. The rate of re-screening suggests a low awareness to recommendations. Efforts should be made to raise awareness to the risk of TB exposure, since the active TB cases suggested new infection. Nationwide studies are necessary to evaluate the efficacy of the re-screening strategy.

Background: Hospital-acquired infections (HAI) can be defined as those occurring after 48 hours of hospital admission, 30 days of discharge or 30 days of an operation without prosthesis and 1 year if placement of prosthesis. They affect 1 in 10 patients admitted to hospital. Purpose: The aim of this study was to characterize, find predictors and evaluate the impact of HAI. Methods: We carried out an observational prospective study that included all patients admitted in the Pulmonology Department of a portuguese central hospital between October and December 2014. Socio-demographic variables, comorbidities, cause of admission, presence of infection and its nature (HAI or community acquired-CAI), microbiologic findings and mortality were recorded. Results: There were 235 patients included: mean age 63±1.7 years, 59.6% men. Infection prevalence was 81%: 11.1% HAI and 87.4% CAI. An aetiological agent was found in 15.3% of all infections, 52.3% of HAI, and 11% of CAI. The most frequent agents were Haemophilus influenzae and Legionella pneumophila in CAI and Staphylococcus aureus , Pseudomonas aeruginosa and Acinetobacter baumann ii in HAI. Predictors of HAI were reduced mobility (p=0.032), malnutrition (OR 5.37; p=0.047), neoplastic disease (OR 5.65; p=0.001) and immunosuppression (OR 5.65; p=0.005). Comparing with CAI HAI was associated with higher mortality (OR 4.65; p=0.032) and length of hospitalization (p=0.004). Conclusions: HAI is associated with a higher mortality and increased hospitalization duration. Risk factors for HAI such as malnutrition, immunosuppression, and presence of neoplastic disease should be evaluated at admission and infection control measures should be taken.

Objective: To evaluate differences in the follow-up of recurrent unintended pregnancy (UP) between a former and a posterior episode. Methods: Retrospective study of women with recurrent UP comparing contraception and methods of abortion between the first and second episode. Results: Ninety-one women fulfilled the study criteria. The prevalence of UP was 13.7%. The mean time between abortions was 21 months (2-57). Before the first episode, most women were not using any contraceptive method (39.3%), while before the second episode most were using oral contraception (OC) (48.8%). In both groups, OC was the most frequent method chosen after the abortion, with a higher prevalence after the first episode (82.1% vs 42.1%) (p=0.001); the number of subcutaneous implants inserted was higher after the second abortion (10.2% vs 39.6%) as well as intrauterine devices (1.4% vs 9.8%) (p=0.001). While after the first abortion no women chose sterilization, after the second eight women had their tube ligated (p=0.039). In both episodes most women started a new contraceptive method after the abortion (77%; 75%). In the first UP only 9.1% (n=26) of the abortions were surgical while in the second episode, surgical abortions had a higher prevalence (n=99; 34.7%) (p=0.001). Conclusions: Past history of abortion changes the clinical management of UP in what concerns abortion methods and contraceptive choice.

Knockout mice for CXC receptor 2 (CXCR2) chemokine receptor were used to study the recruitment of neutrophils during acute and chronic inflammatory responses. When treated with lipopolysaccharide (LPS), either intraperitoneally or intratracheally, these animals had a significant reduction in the neutrophil recruitment in the first 24-48 h as compared with control mice. During 15 days of intraperitoneal infection by Mycobacterium avium, the knockout mice showed significantly reduced numbers of neutrophils in the peritoneal cavity as compared with the control mice. In contrast, the recruitment of neutrophils to the lungs during an aerogenic M. avium infection was not affected by the CXCR2 mutation throughout the 60 days of the study. Finally, we could not find any impact of the mutation on the mycobacterial growth of the infected animals. These findings indicate that CXCR2 may be essentially involved in acute inflammatory responses where an early and rapid recruitment of neutrophils is observed.

Objectives: Haematidrosis, also known as haematohidrosis, is a very rare condition where blood is excreted with sweat. As only a few cases have been described in the literature, we present guidelines on management of this rare phenomenon. Case: A 44-year-old man presented with self-limited and spontaneous bleeding episodes from different parts of his body. This had started 2 weeks before admission after an episode of extreme emotional stress. Medical history and laboratory tests were normal. The microscopic examination of a sample of the fluid excreted confirmed all blood elements. Conclusion: The disorder is thought to be related to activation of the sympathetic nervous system. The use of benzodiazepines and beta blockers may be helpful in controlling the bleeding episodes and give some comfort to the patient.

Objectivo: Pretende-se caraterizar os doentes com úlcera crónica ativa, seguidos em Consulta de Cirurgia Vascular, identificando a patologia vascular envolvida e as modalidades terapêuticas instituídas e seus resultados. Pretendemos ainda identificar alguns fatores preditores de atraso de cicatrização. Material e métodos: Estudo retrospectivo, descritivo, de uma população de 50 doentes consecutivos com úlcera crónica ativa, seguidos em Consulta de Cirurgia Vascular entre 2000-2010. Foram recolhidos dados do processo clínico que incluíram: idade, sexo, presença de comorbilidades como a diabetes, hipertensão, obesidade, antecedentes de úlcera. Foi defi nida a etiologia vascular através do exame físico, complementando com eco-doppler. Foi registado o tipo de terapêutica efetuada e resultados da mesma. Resultados: A média de idade foi de 69 anos, com uma ligeira prevalência do sexo masculino. A insuficiência venosa esteve presente em 56% dos doentes, predominando a insufi ciência venosa superficial em 71,4% dos doentes. A insuficiência arterial esteve presente em 44% da amostra, e responsável isoladamente pela úlcera em 18%. 53% dos doentes com úlcera de etiologia venosa foram abordados por cirurgia e 47% por tratamento compressivo. A taxa de cicatrização foi semelhante nos dois grupos. A infeção esteve presente em 30% das mesmas. Conclusões: Nas úlceras de perna estão envolvidos múltiplos fatores que dificultam a abordagem terapêutica. Nas úlceras de etiologia venosa, a terapêutica cirúrgica e compressiva oferecem excelentes resultados, sobretudo se envolver isoladamente o sistema venoso superficial. O envolvimento arterial e a infeção podem estar associados e devem ser despistadas, pois contribuem para um pior prognóstico. Objective: To characterize patients with chronic active ulcer, by identifying the vascular pathology involved and therapeutic modalities used and their results. We also want to identify some predictors of delayed healing. Material and methods: A retrospective, descriptive study form data collected between 2000 and 2012, from 50 patients attending a Vascular Surgery. The Data was collected from the clinical file process which included age, sex, presence of comorbidities such as diabetes, hypertension, obesity, previous history of ulcer. It was also defined the etiology through physical examination, complemented with Doppler ultrasound. It as recorded the type of treatment carried out and their results. Results: The average age of patients studied was 69 years, with a slight prevalence of males. Venous insufficiency was present in 56% of patients, predominantly superficial venous insufficiency in 71.4% of patients. Arterial insufficiency was present in 44% of the sample, accounting alone for 18% ulcer 53% of patients with venous ulcer underwent surgery and 47% were treated with compression treatment. The healing rate was similar in both groups, with 60% improvement / ulcer healing. The infection was present in 30% of the patients. Conclusions: Multiple factors are involved in leg ulcers that make the therapeutic approach difficult. In venous ulcers, surgical therapy and compression offer great results, especially if they involve the superficial venous system alone. The arterial involvement and the infection should be excluded as it contributes to a worse prognosis.

Objective: To assess the spectrum and prevalence of mutations in the GJB2 gene in Portuguese nonsyndromic sensorineural hearing loss (NSSHL) patients. Design: Sequencing of the coding region, basal promoter, exon 1 and donor splice site of the GJB2 gene; screening for the presence of the two common GJB6 deletions. Study sample: A cohort of 264 Portuguese NSSHL patients. Results: At least one out of 21 different GJB2 variants was identified in 80 (30.2%) of the 264 patients analysed. Two mutant alleles were found in 53 (20%) of these probands, of which 83% (44/53) harboured at least one c.35delG allele. Twenty-seven (10.2%) of the probands harboured only one mutant allele. Subsequent analysis revealed that the GJB6 deletion del(GJB6-D13S1854) was present in at least 7.4% (2/27) of the patients carrying only one mutant GJB2 allele. Overall, one in five (55/264) of the patients were diagnosed as having DFNB1-related NSSHL, of which the vast majority (53/55) harboured only GJB2 mutations. Conclusions: This study provides clear demonstration that mutations in the GJB2 gene are an important cause of NSSHL in Portugal, thus representing a valuable indicator as regards therapeutical and rehabilitation options, as well as genetic counseling of these patients and their families. info:eu-repo/semantics/publishedVersion

1.1 Bone mass acquisition in normal teenagers The first three years of life seem to be very important in the skeleton bone mass apposition. The bone mineral density (BMD) increases during childhood, but the maximum increment occurs in the critical phase of growth, reaching a plateau at the end or after the puberty in girls as well as in boys (Theintz et al., 1992; Bachrach, 2001; Schoenau et al., 2001). Bone mass increases as the bone size increase. In females, BMD is increased rapidly after 11 years of age and reaches maximum at around the age of 13-14 years or quickly after menarche. Until the age of 18 years, about 90% of the peak bone mass has been acquired. At puberty, there is an acceleration of bone mineralization, especially of the trabecular bone and by the end of sex maturation it is more than twice as compared with that at the pubertal onset (Theintz et al., 1992; Bailey, 1999). In general, the girls have a greater BMD than boys in the first half of the second decade of life. During the intermediate stage of puberty (Martin et al., 1997), the bone mineral content (BMC) and the bone thickness are lower in girls, thus predisposing women to a higher complication risk of reduced BMD (Baroncelli & Saggese, 2000). Nutrition, body weight and total body lean mass are determinants of the bone mass in adolescent girls. Calcium intake is essential for optimization of the bone mass acquisition in healthy pubertal adolescents (Garcia e Costa et al., 1995). The accumulation of calcium in the skeleton varies with the daily intake and 1200