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A living donor (LD) kidney transplant is the best treatment for kidney failure, but LDs safety is paramount. We sought to evaluate our LDs cohort’s longitudinal changes in estimated glomerular filtration rate (eGFR). We retrospectively studied 320 LDs submitted to nephrectomy between 1998 and 2020. The primary outcome was the eGFR change until 15 years (y) post-donation. Subgroup analysis considered distinct donor characteristics and kidney function reduction rate (%KFRR) post-donation [−(eGFR6 months(M)–eGFRpre-donation)/eGFRpre-donation*100]. Donors had a mean age of 47.3 ± 10.5 years, 71% female. Overall, LDs presented an average eGFR change 6 M onward of +0.35 mL/min/1.73 m2/year. The period with the highest increase was 6 M–2 Y, with a mean eGFR change of +0.85L/min/1.73 m2/year. Recovery plateaued at 10 years. Normal weight donors presented significantly better recovery of eGFR +0.59 mL/min/1.73 m2/year, compared to obese donors −0.18L/min/1.73 m2/year (p = 0.020). Noteworthy, these results only hold for the first 5 years. The subgroup with a lower KFRR (

The quest for improving energy efficiency is transversal to all areas of society. Higher education institutions represent an important sector in this quest due to their high demand, but also for the role model that they can play in educating energy-efficient citizens and piloting new approaches and experiences. Thus, decreasing energy consumption in higher education institutions, in addition to reducing the carbon footprint, contributes to ameliorating countries' energy bills, and, most importantly, contributes to a more sustainable society. The purpose of the paper, based on the energy consumption of the University of Minho, Portugal, between 2007 and 2022, is threefold: first, to evaluate how energy consumption and associated carbon footprint indicators have performed under a sustainable strategy program, second to reflect on total energy and specific energy indicators, and lastly to emphasize the need to improve energy metering and planning systems to account for the distinctive needs of the different scientific area buildings. This is not only relevant but also rare to find in scientific literature. Findings suggest that UMinho's energy consumption is in line with the numbers reported in the literature. Moreover, detailed indicators, specified by scientific area building, show diverse patterns in energy use, demonstrating the limitations of an overall analysis of buildings in the university campi. The results show that energy efficiency improved as a result of the implemented action plan, and demonstrate the need for detailed and specific indicators that reflect the different needs of each scientific area. The results provided by this refinement call for the design of tailored initiatives to decrease energy consumption, since they allow the planning of specific measures and programs for different energy use patterns, and therefore improve their efficiency. Finally, the preliminary results of the analysis of building specific energy use point to the need for more detailed data on hourly and daily consumption and academic term given the relative contribution of users' behaviour.

Objetives: The incidence of posttransplant diabetes and the elevated cardiovascular (CV) risk among transplant recipients are on the rise. Glucagon-like peptide agonists have the potential to mitigate the effects of immunosuppressive drugs, addressing both hyperglycemia and weight gain. This makes them appealing for use in this population, given their CV and renoprotective benefits. Nevertheless, there is insufficient substantial evidence regarding their efficacy in diabetic kidney transplant recipients (KTR). Methods: The objective of this retrospective study was to assess the effectiveness and safety of glucagon-like peptide agonists in KTR. The primary focus was to evaluate their impact on various parameters, such as hemoglobin A1c levels, body mass index (BMI), lipid panel, hemoglobin levels, renal allograft function (estimated glomerular filtration rate [eGFR]), and urinary protein-to-creatinine ratio. Results: During a median observation period of 18 months, this investigation included 64 renal transplant patients. Median eGFR at baseline was 61.9 mL/min/1.73 m2 and remained stable throughout the follow-up. Median HbA1c decreased from 7.5 to 7% (95%CI; p < 0.002). A significant improvement in BMI and lipid panel were also observed. We did not observed significant changes regarding median creatinine and urinary protein:creatinine ratio levels. No side effects justified discontinuation of the drug. Conclusion: This study shows that the use of glucagon-like peptide agonists is feasible and well-tolerated in KTR, with no significant side effects observed. Subsequent studies are needed to explore whether glucagonlike peptide agonists can effectively improve allograft survival in these patients.

Introduction: Considering the rising occurrence of posttranplant diabetes and the elevated cardiovascular burden among transplant recipients, the utilization of SGLT2 inhibitors (SGLT2i) in this group is appealing because of their cardiovascular and renoprotective benefits. Nevertheless, there is a scarcity of evidence for diabetic kidney transplant recipients (DKTRs) owing to concerns about potential renal graft damage and adverse effects. Methods: This retrospective study was devised to assess the effectiveness and safety of SGLT2i in kidney transplant recipients (KTRs). The main focus was on evaluating their impact on parameters such as haemoglobin A1c levels, body mass index (BMI), lipid panel, haemoglobin levels, renal allograft function (estimated glomerular filtration rate) and urirnary protein-to-creatinine ratio. Results: A total of 75 renal transplant patients were included in this investigation. The study spanned a median observation period of 18 (2.0–71.0) months. Median estimated glomerular filtration rate at baseline was 61,9 (26–120) mL/min/1.73 m2 and remained stable throughout the follow-up. Median HbA1c decreased from 7.5 to 7.0% (95% CI; p

Introduction: Kidney transplantation is the preferred treatment for end-stage renal disease, but organ scarcity can result in longwaiting times. Living-donor kidney transplantation offers an alternative to deceased donation, but HLA or AB0 incompatibility can pose a significant obstacle. This study aimed to show the results achieved by a portuguese hospital since its integration into an international cross-over program, the South Alliance for Transplants (SAT). Methods: The SAT program was founded in 2017 and is composed of ten Spanish hospitals, three Italian hospitals and one Portuguese hospital. The program runs every 4 monthsand enrolled only pairs that were incompatible. Organ transportation is carried out in partnership with the Portuguese Air Force. Results: Three distinct cross-over kidney transplants were performed in partnership with three Spanish hospitals, culminating in the transplantation of three Portuguese patients out of a total of seven patients. The first swap was performed in March 2020, at the beginning of the COVID-19 pandemic, in partnership with two Portuguese and one Spanish hospital. It involved one donor/recipient pair from each country, with AB0 incompatibility between the Portuguese donor and recipient, and no complications were reported. The second swap occurred in December 2021, with three donor/recipient pairs (one Portuguese, where the recipient presented anti- donor antibodies and positive crossmatch with the potential donor, and two from two Spanish hospitals). It was complicated by type-IB cellular rejection in the Portuguese recipient, one week after transplantation, which was treated with corticosteroid therapy. The third swap, also in December 2021, involved two donor/recipient pairs (one Portuguese and one Spanish). It was complicated by delayed renal function due to acute tubular necrosis (histological diagnosis) in the Portuguese recipient. At follow-up, the patients‘serum creatinine levels were within normal limits, and no other unexpected outcomes were recorded. Conclusion: SAT program has allowed some successful cross-over kidney transplants, probably improving the outcomes of kidney transplantation in Portugal. The expansion of such programs may contribute to a more efficient use of the available resources, increasing the number of transplants performed and reducing waiting times.

The COVID-19 pandemic increased morbidity and mortality worldwide, particularly in the Kidney and Kidney-Pancreas Transplant Recipient (KTR/KPTR) population. Aiming at assessing the absolute and relative excess mortality (EM) in a Portuguese KTR/KPTR cohort, we conducted a retrospective observational study of two KTR/KPTRs cohorts: cohort 1 (P1; n = 2,179) between September/2012 and March/2020; cohort 2 (P2; n = 2067) between March/2020, and August/2022. A correlation between relative and absolute EM and age, sex, time from transplantation and cause of death was explored. A total of 145 and 84 deaths by all causes were observed in P1 and P2, respectively. The absolute EM in P2 versus P1 was 19.2 deaths (observed/expected mortality ratio 1.30, p = 0.006), and the relative EM was 1.47/1,000 person-months (95% CI 1.11–1.93, p = 0.006). Compared to the same period in the general population, the standardized mortality rate by age in P2 was 3.86 (95% CI 2.40–5.31), with a peak at 9.00 (95% CI 4.84–13.16) in P2C. The higher EM identified in this population was associated, mainly, with COVID-19 infection, with much higher values during the second seasonal COVID-19 peak when compared to the general population, despite generalized vaccination. These highlight the need for further preventive measures and improved therapies in these patients.

Pneumocystis jirovecii (PJ) opportunistic infections occur in immunocompromised patients impacting significantly hospitalizations and mortality. Trimethoprim-sulfamethoxazole (TMP-SMX) is universally used as prophylaxis of Pneumocystis jirovecii pneumonia (PJP) and therefore, this infection is rare condition in solid organ transplant (SOT) recipients. We present a case of a 46-years-old male, who received an ABO-incompatible transplant with prior desensitization protocol with plasmapheresis, rituximab, and anti-CMV immunoglobulin. IgG anti-B title pre-desensitization was 1:128. The patient had 6 ABDR mismatches, without HLA antibodies, and the CDC crossmatch for T and B cells was negative. Both recipient and donor were CMV positive (D+/R+). The patient received induction immunosuppression with corticosteroids, basiliximab, calcineurin inhibitor, and mycophenolate mofetil. Immediate kidney function was verified, and three additional plasmapheresis sessions were performed. At discharge serum creatinine (sCr) was 1.38 mg/dL, but kidney function declined during the first 6 months (sCr 2.5 mg/dL). Urinalysis was unremarkable. A kidney biopsy was declined by the patient. Unit protocol maintained the prophylaxis for PJP and cytomegalovirus (CMV) infection with TMP-SMX and valganciclovir. The patient was admitted to the emergency department 20 months after the transplant with respiratory symptoms and was diagnosed with PJP. Bronchoalveolar lavage fluid was also positive for CMV. Intensive care unit (ICU) admission was necessary due to clinical deterioration, with subsequent good evolution without mechanical ventilation. At discharge, prophylaxis with TMP-SMX and valganciclovir was maintained for more than six months. Here we discuss the late onset of PJP, and the main risk factors related to severe infection. Transplant subgroups in which longer PJP prophylaxis could be beneficial and the indication to re-start PJP prophylaxis is still under discussion.

Abstract It is a type of quantitative documentary research of descriptive and exploratory content in which studied the profile of adolescents with self-injurious behavior and the variables of risk and protection regarding the suicidal intent, reported in a Children and Youth Psychosocial Care Center (CAPS IJ) from a metropolitan region in the south of Brazil. Data from 139 assisted adolescents, admitted for self-injury, reported that self-injuries occurred predominantly at home (M=14,36 years; SD=1,63), with multiple episodes, using sharp objects with suicidal intent. The hierarchical binary logistic regression results point out that experiencing abuse in the present -using non-sharps objects- having severe injuries and practicing them in different places are risk variables. Whereas the existence of community and school social support networks are protective factors. There is a necessity of investment in the studies that explore the etiology of self-injuries and that provide support for cases of prevention, detection, and treatment.

Older to older living kidney transplantation is an acceptable alternative to avoid dialysis, improve quality of life and maintain favorable long-term outcomes of patients with end-stage kidney disease. However, the management of these patients is complex and the acceptance of older donors and recipients to kidney transplantation remains controversial. The older recipients usually have several comorbidities that may complicate the postoperative course and increase the risk of end-stage kidney disease. We present a clinical case of living kidney transplantation between an older donor and recipient, both over 70 years old, who evolved to a stage 3 chronic kidney disease, without proteinuria, hypertension, or other complications, three years after transplantation. Our case reinforces favorable outcomes in older living transplantation, both for recipient and donor, as has been demonstrated in several published studies.

Background: Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease (ESRD). General organ donor shortage remains an important limitation on KT, given the increasing number of patients waiting for transplantation. This has led to the adoption of different strategies to increase the pool of donors, such as ABO incompatible (ABOi) living KT. In this single center study, we retrospectively evaluated all donor/recipient pairs proposed for ABOi KT since the beginning of this transplantation program in our hospital in 2014. Methods: Between November 2014 and March 2022, 609 deceased donor and 223 living donor KT were performed in our center. Seventy-one donor/recipient pairs were proposed for ABOi KT and were evaluated for ABO/Rh group, Coombs tests, human leukocyte antigen (HLA) type I (A, B, C) and II (DR) high resolution genotyping and receptor to donor isoagglutinin titers and HLA antibodies. Recipients with immunoglobulins G (IgG) and/or M (IgM) isoagglutinin titers > 1:512 and/or with HLA donor specific alloantibodies (DSAs) were excluded from the ABOi transplantation program. Isoagglutinins removal was performed recurring to therapeutic plasma exchange (TPE) and/or immunoadsorption techniques. Transplanted patients were evaluated for demographic data, diagnosis, relationship with donor, sessions of antibodies removal, pre- and post-KT isoagglutinin titers, graft function, transfusion support, significant complications and overall patient survival. Results: Eighteen patients (14 males and 4 females) were transplanted with an ABOi graft out of 71 ABOi studied pairs. Median baseline IgG and IgM isoagglutinin titers were 1:32 (min 1:2, max 1:256) and 1:8 (min 1:2, max 1:32), respectively. Fifteen patients (83.3%) had pre-KT TPE and/or immunoadsorption sessions for isoagglutinin removal (mean 2.4 ± 1.8 session per patient). Seven patients (36.8%) were submitted to post-KT TPE (mean 1.9 ± 3.2 session per patient). No acute antibody mediated rejection was observed and overall graft survival was 100% on a follow-up period between 3 and 92 months (47.6 ± 25.2 months). All patients were dialysis-free with serum creatinine steady levels (median 1.4 mg/dL) at 47.6 ± 25.2 months of follow up. Conclusion: These results confirm that ABOi KT is a viable treatment for patients with ESRD, thus expanding living donor pool and reducing access time to transplantation.

BackgroundThe worldwide increase in pediatric overweight and obesity, in parallel with the global increase in the consumption of sucrose and fructose, is associated with non-alcoholic fatty liver disease (NAFLD). Elevated branched-chain amino acids (BCAAs) are a metabolic feature related to obesity and an early risk factor for insulin resistance and NAFLD. However, few studies have assessed metabolic risk factors and nutritional status in maple syrup urine disease (MSUD) patients under restricted BCAA and high carbohydrate diets.Methods and resultsHerein, we present a pilot report of a 17-year-old boy with classic MSUD with poor diet compliance and high fructose consumption, mainly during early adolescence. At that time, he was overweight and developed features of metabolic syndrome, including persistently elevated liver enzymes and hepatic steatosis. He underwent liver transplantation at the age of 13 years to prevent the risk of progressive cognitive impairment. Two months later, NAFLD relapsed in the graft, despite a better BCAA balance and weight loss. Nevertheless, 6 months after dietary restriction of fructose consumption, NAFLD had sustainably improved.ConclusionChildhood overweight and fructose overconsumption are wellestablished driving forces in the development of pediatric NAFLD. However, their role in the early onset and progression of NAFLD in the allograft remains to be established. Furthermore, it is not known whether the dysmetabolic state associated with elevated BCAAs may be contributory. Further studies are required with a cohort of MSUD subjects to validate our findings and to ascertain the possible interaction between a BCAA imbalance and dietary intake in the development of NAFLD.

End stage kidney disease (ESKD) is a prevalent health issue across the world and it is well established that kidney transplantation (KT), specifically from a living donor, is currently the best value-based treatment method. Ergo, it is crucial to invest heavily in making this care strategy the best possible option for the majority of eligible patients. Barriers to the kidney transplant process are mainly related to education and accessibility: awareness of the clinical and societal relevance of the therapy must be promoted at the level of patients, clinicians and health providers. A health-literacy-focused website has been developed as part of this, aiming to provide the general population, particularly potential organ receptors and donors, with better access to trustworthy information and data. This was meant to be the effective expression of knowledge diffusion and innovation as a result of an academic master thesis. This communication-focused digital resource is designed to combat these obstacles and to create a long-lasting, positive and significant impact.

Abstract Introduction: Kidney transplant (KT) recipients have a high risk for adverse outcomes from infections, such as COVID-19. Methods: We have retrospectively reviewed all KT recipients with documented COVID-19 between March 1, 2020, and March 15, 2021, and analyzed patients’ characteristics, clinical course, treatment, and outcomes. Results: We identified 123 patients, 72% were male, with a mean age of 54.5±13.0 years. Twenty percent were asymptomatic, 7% had a nosocomial transmission, and 36% of the remainder required hospitalization. Almost all admitted patients received oxygen, 30% required invasive mechanical ventilation (IMV), more than a half had acute kidney injury, with 10% requiring dialysis, and 20% died. Incidence was comparable to that of the Portuguese population, but the mortality rate was almost four times higher (SMR of 3.768 (95% CI:1.723-7.154). Higher body mass index (OR 1.275, P=0.001), lower baseline graft function (OR 0.968, P=0.015), and nosocomial transmission (OR 13.836, P=0.019) were associated with oxygen demand, whereas female gender (OR 3.801, P=0.031) and lower baseline kidney graft function (OR 0.955, P=0.005), but not body mass index, were associated with IMV and/or death. Conclusion: Mortality rate in KT patients was higher than in the general population and lower baseline kidney function was the most consistent marker for adverse outcomes.

Transtornos mentais estão entre as principais causas de adoecimento no mundo. Essas questões se agravam principalmente em momentos de grande instabilidade, como no caso da pandemia de COVID-19, justificando ainda mais o uso de estratégias de divulgação e disseminação de cuidados em Saúde Mental. O objetivo desse artigo é apresentar um método de estruturação de equipe e comunicação em saúde (CS) acessível, prático e com potencial de impacto sobre o comportamento dos indivíduos. Foram produzidos cards com informações sobre cuidados com a saúde mental durante a pandemia para serem divulgados em redes sociais a partir do método SAM (Suitability Assessment of Materials) e da literatura em CS. Concluiu-se que proporcionar à população informações sobre cuidados em saúde pode ter um impacto positivo, alinhando-se com os pressupostos da Atenção Primária em Saúde (APS). Tanto cidadãos quanto o poder público, ao investir em APS, podem economizar recursos a médio e longo prazo.

This study aims to evaluate the thermal and mechanical performances of PET-G thermoplastics with different 3D microstructure patterns and infill densities. The production costs were also estimated to identify the most cost-effective solution. A total of 12 infill patterns were analysed, including Gyroid, Grid, Hilbert curve, Line, Rectilinear, Stars, Triangles, 3D Honeycomb, Honeycomb, Concentric, Cubic, and Octagram spiral with a fixed infill density of 25%. Different infill densities ranging from 5% to 20% were also tested to determine the best geometries. Thermal tests were conducted in a hotbox test chamber and mechanical properties were evaluated using a series of three-point bending tests. The study used printing parameters to meet the construction sector’s specific needs, including a larger nozzle diameter and printing speed. The internal microstructures led to variations of up to 70% in thermal performance and up to 300% in mechanical performance. For each geometry, the mechanical and thermal performance was highly correlated with the infill pattern, where higher infill improved thermal and mechanical performances. The economic performance showed that, in most cases, except for the Honeycomb and 3D Honeycomb, there were no significant cost differences between infill geometries. These findings can provide valuable insights for selecting the optimal 3D printing parameters in the construction industry.

RESUMO As anomalias craniofaciais constituem um grupo diverso e complexo de defeitos congênitos impondo um significativo impacto sobre a qualidade de vida do indivíduo e de toda a sua família. Nesta realidade, o fonoaudiólogo apresenta-se como profissional indispensável no processo de reabilitação, todavia, a formação do mesmo não predispõe dos conhecimentos necessários para uma visão integral do portador da anomalia. Este estudo tem por objetivo, portanto, discutir a utilização das Tecnologias Digitais como instrumentos mediadores da aprendizagem de estudantes e profissionais, levando-se em consideração as mudanças nas interações sociais na sociedade contemporânea que contribuem para a constituição da subjetividade. Palavras-chave: Anomalia Craniofacial. Educação Permanente. Educação em Saúde. Tecnologia em Saúde. ABSTRACT Craniofacial anomalies constitute a diverse and complex group of birth defects that have a significant impact on the quality of life of individuals and their families. In this reality the speech therapist is presented as an indispensable professional in the rehabilitation process, however, the training of the same do not predispose the knowledge necessary for an integral view of the patient with the anomaly. Therefore, this study aims to discuss the use of Digital Technologies as mediators in the learning of students and professionals, taking into account the changes in social interactions in contemporary society that contribute to the constitution of subjectivity. Keywords: Craniofacial Abnormalities. Education Continuing. Health Education. Biomedical Technology.

Daylight illuminance levels and their spatial distribution are important design elements to achieve indoor visual comfort conditions and sustainability in buildings during the operation stage. While a proper daylighting scheme increases the efficiency of the building, the excessive use of glazed surfaces can contribute to thermal and visual discomfort, hence increasing the cooling demand and use of artificial lighting. Solar control film (SCF) is a self-adhesive thin film that can be applied on glazing systems of existing buildings for retrofitting purposes to modify thermal and optical properties of the glass substrate. This paper analyses experimentally the impact of single glazing with different SCFs on the indoor illuminance levels and respective distribution on horizontal work plane by comparing the measured absolute values and the useful daylight illuminance metric. Field experiments using a small scale model with the glazing oriented to the south, in Lisbon, were performed for a 6 mm clear glass and four different SCFs applied on the external surface of the glass, under clear sky conditions during summer and winter solstice at 9h00, 12h00, and 15h00. The results show that all SCFs reduced the indoor illuminance, which demonstrate their potential for glazing refurbishment when indoor visual discomfort occurs in buildings.

Spontaneous rupture of the uterine artery is a rare cause of hemoperitoneum during pregnancy. This is a life-threatening condition associated with maternal and fetal mortality. We describe a case of spontaneous rupture of the left uterine artery in a 32-year-old healthy pregnant woman with an uneventful pregnancy.

Buildings are responsible for several negative impacts on the environment, most of them related to nonrenewable energy consumption, increasing the concern regarding buildings energy efficiency. In this context, computer software has been used to estimate the energy needs of the built environment, and the Building Information Modelling (BIM) methodology can be used to simplify this process. This study aims to validate a BIM-based framework to streamline the energy analysis of Portuguese buildings, based on the method of the national regulation for the thermal performance of residential buildings. Currently, designers need to spend considerable time assessing all the building characteristics and performing the mandatory calculations for energy performance analysis. It is also intended to link the results of the energy simulation with a Building Sustainability Assessment method—SBToolPT-H. The purpose is to demonstrate how it is possible to benefit from this approach to simultaneously improve building sustainability during the design stage. To do so, different case studies were modelled in Autodesk Revit and exported to a BIM energy tool to perform energy simulation analysis. The results were validated against the official assessment method of the Portuguese thermal regulation and were successfully used to assess the SBToolPT-H energy efficiency category. The research outcomes provide design teams with a reliable BIM-based framework to improve building energy performance and to develop thermal projects while enhancing building sustainability. It also increases the knowledge about the integration of sustainability assessment in the BIM environment, providing new insights for complete integration.

Patients who are candidates for a second kidney transplant (SKT) frequently have a higher level of panel reactive antibodies (PRA). We assessed the allosensitisation change after a first graft failure (GF), its predictors and impact on retransplantat outcomes. We retrospectively selected 140 adult patients who received a SKT. Recipient and donor characteristics were analyzed. We defined the delta PRA (dPRA) as the difference between peak PRA before the SKT and first one (cohort median value = +10%). Logistic regression analysis was used to determine risk factors for dPRA ≥ 10% and acute rejection (AR) in the SKT. Univariable and multivariable Cox analysis was applied to assess independent predictors of second GF. Risk factors for dPRA ≥ 10% at SKT were AR (OR = 2.57; P = 0.022), first graft survival

Abstract The occurrence of ascites after Renal Transplant (RT) is infrequent, and may be a consequence of surgical or medical complications. Case report: 61 year-old, male, history of arterial hypertension, tongue carcinoma and alcoholic habits 12-20g/day. He had chronic kidney disease secondary to autosomal dominant polycystic kidney disease, without hepatic polycystic disease. He underwent cadaver donor RT in September 2017. He had delayed graft function by surgically corrected renal artery stenosis. He was admitted in January 2018 for ascites de novo, with no response to diuretics. HE had visible abdominal collateral circulation. Graft dysfunction, adequate tacrolinemia, Innocent urinary sediment, mild anemia, without thrombocytopenia. Serum albumin 4.0g / dL. Normal hepatic biochemistry. Peritoneal fluid with transudate characteristics and serum albumin gradient > 1.1. Ultrasound showed hepatomegaly, permeable vascular axes, without splenomegaly. Mycophenolate mofetil was suspended, with reduced remaining immunosuppression. He maintained refractory ascites: excluded infectious, metabolic, autoimmune and neoplastic etiologies. No nephrotic proteinuria and no heart failure. MRI: micronodules compatible with bile cysts. Upper Digestive Tract Endoscopy did not show gastroesophageal varicose veins. Normal abdominal lymphoscintigraphy. He underwent exploratory laparoscopy with liver biopsy: incomplete septal cirrhosis of probable vascular etiology some dilated bile ducts. He maintained progressive RT dysfunction and restarted hemodialysis. The proposed direct measurement of portal pressure was delayed by ascites resolution. There was further recovery of the graft function. Discussion: Incomplete septal cirrhosis is an uncommon cause of non-cirrhotic portal hypertension. Its definition is not well known, morphological and pathophysiological. We have not found published cases of post-RT ascites secondary to this pathology, described as possibly associated with drugs, immune alterations, infections, hypercoagulability and genetic predisposition.

Até 30% dos pares de dador vivo não são transplantados por incompatibilidade do grupo ABO e/ou do sistema Human Leukocyte Antigen (HLA). Os programas de doação renal cruzada surgiram como uma estratégia para tentar ultrapassar estas barreiras. Em Portugal o Programa Nacional de Doação Renal Cruzada (PNDRC) foi legislado em 2010 e o primeiro transplante renal cruzado ocorreu em 2013. Até ao momento foram efetuados 22 transplantes deste tipo. Objetivo: O presente trabalho visa avaliar as caraterísticas e perfil evolutivo dos doentes submetidos a transplante renal cruzado em Portugal. Métodos: Os autores apresentam um estudo observacional retrospetcivo com análise dos respetivos doentes. Resultados: Da amostra total, a maioria dos recetores era do sexo masculino (55%), com idade mediana 53 anos. A poliquistose renal foi a etiologia da doença renal mais comum (18%) e a maioria dos doentes encontrava-se previamente em programa crónico de hemodiálise (68%). Três doentes apresentaram Calculated Panel Reactive Antibody (PRAc) superior a 98% e 10 PRAc superior a 80%. Foi realizada indução de imunossupressão com Anti-Thymocyte Globulin (ATG) em 50% dos doentes e imunomodulação com Rituximab e/ou plasmaferese em 15%. Todos os recetores evoluíram com função imediata do enxerto. Não se registaram complicaçães major, com eventos minor em 15%. Num tempo mediano de follow-up de 2 7 [ 2-46] meses, não se verificou nenhum caso de rejeição celular aguda e a penas um de rejeição humoral. As sobrevidas do dador e recetor foram ambas 100%. Conclusão: A apresentação destes resultados preliminares excelentes visa estimular o aumento do número de pares a incluir no PNDRC e um maior número de transplantes efetuados no programa. Tal como uma parte significativa desta amostra, o transplante renal cruzado pode constituir uma possibilidade para doentes com incompatibilidade do sistema HLA e/ou do grupo ABO. A doação renal cruzada em muito engrandece a doação em vida, oferecendo a pares incompatíveis e selecionados, uma oportunidade de transplantação renal com sucesso.

An ecological mortar is designed from industrial sub-products, with the objective of utilizing both the slag residues, generated during steel manufacturing processes, and the waste from Polyurethane Foam (PF) panels, generated during refrigerator chamber manufacturing processes. The ecological mortar design involves the dosing of Electric Arc Furnace (EAF) slag, together with finely ground Polyurethane Foam, cement, and additives. An energy efficient prefabricated block is designed with the mortar, for use in construction, and its energy performance is assessed as a material inserted within the envelope of a service sector (hospital) building, either as an exterior skin, or as an enclosing component within the façade interior. The main contribution of this research is the characterization of the thermo-physical and mechanical properties of a new prefabricated panel made with recycled materials. The full characterization of the properties of these new materials is presented and discussed. The new prefabricated panel demonstrates adequate thermo-mechanical characteristics as a substitute for traditional materials, while improving the sustainability of the building. As a secondary objective, the energy behaviour of the new panels when integrated in a real building is presented by means of a case study simulation. The use of computational thermal simulation confirmed that the properties of the prefabricated block influenced the annual thermal demand of the building for heating and cooling. Improvements to the thermal inertia of the building envelope were also confirmed with the inclusion of PF waste, giving the mortar an energy performance that was similar to conventional materials, in such a way that its use in façade construction may be validated, in addition to its environmental benefits, due to it having been manufactured with critical recycled industrial waste such as EAF slag and PF, thereby contributing to both the circular economy and sustainable development.

Background: Histiocytic sarcoma (HS) is a rare hematologic neoplasm with a few hundred cases having been described to date. Case Presentation: We report the case of a 56-year-old woman with a history of hepatitis C infection and chronic kidney disease (CKD), submitted to a kidney transplant in 1984, under maintenance immunosuppression with prednisone and azathioprine. Patient presented with a relentlessly growing mass on her right front thorax. It was painless, smooth, and adherent to the deep muscle. Laboratory studies were unremarkable. Ultrasonography and computerized tomography (CT) scan revealed a highly vascularized heterogeneous mass (8×9 cm), with a necrotic centre. Positron emission tomography (PET) scan demonstrated multiple thoracic, abdominal, and pelvic nodules. Histology revealed a highly undifferentiated HS (vimentin, CD68, CD99, and CD4 positive). In spite of having started treatment with etoposide and thalidomide, no clinical response was achieved and the patient died three months later. Conclusions: To the authors’ knowledge, this is the first described case of HS in a solid organ transplant patient.

A utilização de materiais de isolamento térmico para a obtenção de edifícios energeticamente eficientes visa, na generalidade dos casos, a satisfação das respetivas necessidades de aquecimento e arrefecimento da fase operacional. O objetivo principal deste trabalho é o de - mediante a utilização de metodologia exploratória, nomeadamente revisão bibliográfica - identificar materiais de isolamento mais sustentáveis e, concomitantemente, expor o efeito paradoxal de outros com elevado Potencial de Aquecimento Global (GWP), destacando o papel da Avaliação de Ciclo de Vida (ACV), do Ecodesign e da Declaração Ambiental de Produto (DAP) para a conceção, comparação e seleção de materiais. Como principal conclusão, salienta-se a ausência generalizada de informação ambiental por parte dos produtores o que, a par de preços de aquisição que não internalizam Custos de Ciclo de Vida (LCC), tem conduzido à utilização de materiais com elevada pegada de carbono e ao “paradoxo do isolamento”.

The cooperative housing sector is directed at low and medium income residents who cannot afford to buy their homes in the regular private market. Due to social housing legislation, it is possible to build cooperative housing below regular market costs and use tax benefits, therefore providing affordable dwellings to their owners. Traditional cooperative housing used to provide less comfort and higher running costs in indoor and domestic hot water heating than in standard construction. However, cooperative housing has started to change its method of traditional construction towards sustainable construction, in order to benefit from the savings on energy consumption and domestic water as well as to provide an improvement as far as the comfort of its residents is concerned. Therefore, in this article, the savings in electricity and natural gas in different building settlements, calculated for Madalena building—sustainable construction—and for Azenha de Cima building—traditional construction—will be presented, according to two different criteria of calculation: efficiency of dwellings at a pre-determined standard level of indoor comfort opposed to real consumptions made by residents. For each building under analysis, an energy audit and further monitoring were brought in, in order to issue an energy evaluation according to the Portuguese energy agency rules. Results showed an expected decrease of the operational costs of natural gas and electricity, obtained by the use of efficient building systems and equipment, as well as a decrease of the payback period for each situation.

The construction sector is facing increasingly strict energy efficiency regulations. Existing buildings have specific technical, functional and economic constraints, which, in fulfilling regulations, could lead to costly and complex renovation procedures and also lead to missed opportunities for improving their energy performance. In this article, the methodology for comparing cost-optimality in building renovations, developed in the International Energy Agency (IEA)–Energy in Buildings and Communities (EBC) Annex 56 project, is extended with a life cycle assessment by including embodied primary energy and carbon emissions in the calculations. The objective is to understand the relevance of embodied energy and carbon emissions in the evaluation of the cost effectiveness of building renovation solutions towards nearly zero energy buildings, as well as the effect of the embodied values in the achievable carbon emissions and primary energy reductions expected in an energy renovation. Results from six case studies, representative of different regions in Europe, suggest that embodied values of energy and carbon emissions have a decreasing effect—ranging from 2 to 32%—on the potential reductions of energy and emissions that can be achieved with renovation measures in buildings. In addition, the consideration of the embodied energy and carbon emissions does not affect the ranking of the renovation packages.

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) has been suggested as potential early marker of delayed graft function (DGF) following kidney transplantation (KTx). We conducted a prospective study in 40 consecutive KTx recipients to evaluate serial changes of uNGAL within the first week after KTx and assess its performance in predicting DGF (dialysis requirement during initial posttransplant week) and graft function throughout first year. Urine samples were collected on post-KTx days 0, 1, 2, 4, and 7. Linear mixed and multivariable regression models, receiver-operating characteristic (ROC), and areas under ROC curves were used. At all-time points, mean uNGAL levels were significantly higher in patients developing DGF (n=18). Shortly after KTx (3–6 h), uNGAL values were higher in DGF recipients (on average +242 ng/mL, considering mean dialysis time of 4.1 years) and rose further in following days, contrasting with prompt function recipients. Day-1 uNGAL levels accurately predicted DGF (AUC-ROC = 0.93), with a performance higher than serum creatinine (AUC-ROC = 0.76), and similar to cystatin C (AUC-ROC = 0.95). Multivariable analyses revealed that uNGAL levels at days 4 and 7 were strongly associated with one-year serum creatinine. Urinary NGAL is an early marker of graft injury and is independently associated with dialysis requirement within one week after KTx and one-year graft function.

Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.

Kidney graft survival has been mainly evaluated using an up to 10-year threshold. Instead, in this study our aim was to evaluate predictive variables that impact long-term kidney graft survival (≥10 years). We enrolled 892 patients in our analysis: 638 patients with functioning graft at 10 years PT and 254 patients with graft failure at 10 years PT (considering patient death with a functioning graft

ABSTRACT Aim Background Methods Conclusion Relevance to clinical practice No patient or public contribution Trial Registration To evaluate the effectiveness of a positive mental health program for adults (PMHP) in the community.Positive mental health (PMH) can be seen as a construct represented by six factors (personal satisfaction, prosocial attitude, self‐control, autonomy, problem resolution, and self‐actualization, and interpersonal relationship skills) according to the Multifactorial Model for PMH. Although there are several interventions in promoting mental health, research on effective promotion of PMH for adults in the community with structured and validated programs of PMH is scarce.This study protocol describes a randomized controlled trial (RCT) following a wait‐list control design, aimed at evaluating the effectiveness of a PMHP in the community. This study was approved in June 2019 by the Ethics Committee. Participants will be recruited from the school community of teachers. Participants aged ≥ 18 years. The participants will be randomized 1:1 to either (a) an intervention group, which will integrate the PMHP, or (b) the standby control group. Three assessment moments for both groups will take place initial, after the intervention, and a follow‐up of 3–6 months. The evaluation instruments will include a sociodemographic questionnaire, a PMH questionnaire, and a psychological vulnerability scale.The current study provides an innovative approach to PMH. Further, the study may demonstrate new interventions in PMH in the community, based on a program with systematized guidelines and sessions structured according to individual needs. It is expected that at the end of the program, the experimental group will increase the level of PMH.To allow future official implementation of the PMH program and the replication of the study in other professional groups as a promotion tool.There was no funding to remunerate a participant for this study.ClinicalTrials.gov identifier: NCT04600401. Registered on May 15, 2020 [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Tyrosinemia type III (HT III) is the rarest form of tyrosinemia, and the full clinical spectrum of this disorder is still unknown. The neurological involvement varies, including intellectual impairment and attention deficit disorder with hyperactivity (ADHD). We report the case of two siblings diagnosed with HT III at different ages. Case description: The index case was diagnosed by newborn screening for endocrine and metabolic disorders, starting a low-protein diet immediately, with a consistent decrease in tyrosine levels. By the age of three, the child displayed a hyperactive behavior, starting treatment for ADHD two years later. At seven years of age, he shows a slight improvement in terms of behavior and attention span and has a cognitive performance slightly lower than his peers, despite maintaining acceptable tyrosine levels. His sister, who had a history of ADHD since age five, was diagnosed with HT III after family screening at the age of eight. Despite initiating a dietetic treatment, her behavior did not improve, and she has a mild intellectual impairment. Comments: This is the first case report describing siblings with HT III who underwent nutritional treatment with a low-protein diet in different phases of life, with a better neurological and behavioral evaluation in the patient who started treatment earlier.