Search

Introduction: Rituximab (RTX) has been reported as an effective treatment alternative in primary forms of minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) associated with steroid dependence and frequent relapses. However, the optimal RTX regimen and the outcomes of further doses of RTX remain unclear. This study aimed to evaluate the use of induction and maintenance RTX therapy for adults with primary podocytopathies. Methods: We performed a retrospective case series on adult patients with steroid-dependent podocytopathies who received an induction RTX therapy. Maintenance therapy was performed at physician’s discretion. Remission and relapse rates, concomitant corticosteroids and immunosuppressants use, B-cell depletion and adverse events were analyzed. Results: Fourteen patients (mean age at start of RTX 29.1 ± 21.9 years) with MCD (n = 7) or FSGS (n = 7) were treated with 2 doses of 1,000 mg 2 weeks apart (n = 13) or four doses of 375 mg/m2 (n = 1) of RTX. At last follow-up (mean 47.3 ± 101.7 months), 10 patients were in complete remission and two remained in partial remission. A reduction in the number of relapses, number of patients under corticosteroids and immunosuppressants, and dose of prednisolone was observed when compared to baseline (14 [100%] vs. 5 [35.7%]; 8/14 [57.1%] vs. 4/12 [33.3%]; 13/14 [92.9%] vs. 7/12 [58.3%]; 20 mg/day vs. 5.25 mg/day, respectively). Maintenance RTX therapy was used in 6 patients, with sustained complete remission. Infusion reactions were observed in 4 patients (one required treatment withdrawal). Conclusions: Our findings support the use of RTX for a steroid-free remission in podocytopathies and suggest that maintenance RTX is well-tolerated and associated with prolonged remission. Further studies are needed to confirm its efficacy and safety and establish the optimal induction and maintenance RTX regimen in steroid-dependent podocytopathies.

AbstractBackground The first few months of hemodialysis (HD) are associated with a higher risk of mortality. Protein-energy malnutrition is a demonstrated major risk factor for mortality in this population. The C-Reactive Protein to Albumin ratio (CAR) has also been associated with increased mortality risk. The aim of this study was to determine the predictive value of CAR for six-month mortality in incident HD patients.Methods Retrospective analysis of incident HD patients between January 2014 and December 2019. CAR was calculated at the start of HD. We analyzed six-month mortality. A Cox regression was performed to predict six-month mortality and the discriminatory ability of CAR was determined using the receiver operating characteristic (ROC) curve.Results A total of 787 patients were analyzed (mean age 68.34 ± 15.5 years and 60.6% male). The 6-month mortality was 13.8% (n = 109). Patients who died were significantly older (p

Objectives: Therapeutic options for pancreatic neuroendocrine neoplasia (Pan-NEN) have increased over the last decade. We aim to understand the evolution of the prognosis of patients with diagnosis of Pan-NEN within a 12-year period, considering the implementation of new treatments. Methods: This study is a retrospective cohort study of patients diagnosed with Pan-NENs between 2006 and 2017. Survival outcome estimates were calculated by Kaplan–Meier method. The impact of baseline clinicopathological characteristics on survival was explored with the use of Cox proportional hazard model. Results: Of the 97 patients, 77 (79.9%) had well-differentiated neuroendocrine tumor (NET) according to WHO 2010 classification, and 52 (53.6%) had l ocalized or locoregional disease. There were no differences between clinicopathological characteristics and survival outcomes when comparing patients diagnosed between 2006–2011 and 2012–2017. Neuroendocrine carcinoma – HR 2.76, 95% CI 1.17–6.55 – and stages III and IV at diagnosis were independent poor prognostic factors – HR 6.02, 95% CI 2.22–16.33 and HR 6.93, 95% CI 2.94–16.32, respectively. Conclusions: The new therapeutic approaches did not induce better survival outcomes on Pan-NEN in recent years. This is possibly due to the indolent nature of NET grades 1 and 2, even metastatic, allowing patients to be submitted to new target therapies along their disease course.

Urinary tract infection is an important cause of hospitalization, morbidity and mortality, being responsible for an important fraction of health expenses. The main risk factors are urine flow obstruction, urinary catheters, immunosuppression and diabetes mellitus. We present a case of pyelonephritis that culminated in nephrectomy, finally unravelling an unexpected diagnosis. A 52-year-old male presented in the emergency department with two weeks of pain in the left iliac fossa that irradiated to the lumbar region and cloudy urine. Lab work revealed severe anaemia (4.9 g/dL), inflammatory markers elevation, leucoerythrocyturia, serum creatinine of 4.33 mg/dL and metabolic acidosis. Computed tomography scan showed a swollen left kidney with a staghorn calculus and intraparenchymal hypodensities. After a failed trial of large spectrum antibiotics, he was submitted to left radical nephrectomy with significant clinical improvement. Gross examination showed a markedly dilated pyelocalicial tree, filled with several staghorn calculi and purulent secretions with associated parenchymal atrophy. Histopathologic evaluation revealed exuberant chronic pyelonephritis with an acute inflammatory infiltrate that extended into the perinephric fat and multiple Schistosoma ova, predominantly calcified. The authors describe the case of a severe pyelonephritis with exuberant clinical and imagiological features and rare microbiological findings, suggesting previous genitourinary Schistosomiasis that predisposed to nephrolithiasis and chronic pyelonephritis.

Abstract Background One hour plasma glucose concentration (1hPG) during an oral glucose tolerance test (OGTT) may be an alternative to 2-h plasma glucose concentration (2hPG) in the identification of individuals at increased risk of hyperglycaemia, although its role is not fully understood. Aim We aim to investigate the relationship of these measures with other glucose parameters, as well as their relationship with cardiometabolic risk markers and the level of agreement for prediabetes mellitus diagnosis, in a sample of patients with morbid obesity. Methods We retrospectively evaluated 656 patients with morbid obesity without diagnosed diabetes. To define prediabetes with 2hPG, 2022 American Diabetes Association guidelines criteria were used, while for 1hPG, glucose ≥ 155 mg/dL was considered. Cohen’s Kappa coefficient was used to assess the agreement between both measures of prediabetes mellitus diagnosis. Results A Cohen’s Kappa coefficient of 0.405 (p

Hematopoietic stem cell transplant (HSCT) is an important treatment option for hematologic malignancies. Acute kidney injury (AKI) is a common complication in HSCTs and is related to worse outcomes. We aimed to create a predictive risk score for AKI in HSCT considering variables available at the time of the transplant. We performed a retrospective cohort study. AKI was defined by the KDIGO classification using creatinine and urinary output criteria. We used survival analysis with competing events. Continuous variables were dichotomized according to the Liu index. A multivariable analysis was performed with a backward stepwise regression. Harrel’s C-Statistic was used to evaluate the performance of the model. Points were attributed considering the nearest integer of two times each covariate’s hazard ratio. The Liu index was used to establish the optimal cut-off. We included 422 patients undergoing autologous (61.1%) or allogeneic (38.9%) HSCTs for multiple myeloma (33.9%), lymphoma (27.3%), and leukemia (38.8%). AKI cumulative incidence was 59.1%. Variables eligible for the final score were: hematopoietic cell transplant comorbidity index ≥2 (HR: 1.47, 95% CI: 1.08–2.006; p = 0.013), chronic kidney disease (HR: 2.10, 95% CI: 1.31–3.36; p = 0.002), lymphoma or leukemia (HR: 1.69, 95% CI: 1.26–2.25; p < 0.001) and platelet-to-lymphocyte ratio > 171.9 (HR: 1.43, 95% CI: 1.10–1.86; p = 0.008). This is the first predictive risk score for AKI in patients undergoing HSCTs and the first study where the platelet-to-lymphocyte ratio is independently associated with AKI.

Abstract Bariatric surgery (BS) can lead to remission of type 2 diabetes mellitus (T2DM), however, the evidence on the influence of preoperative serum magnesium levels on this reversal is scarce. To study the influence of preoperative serum magnesium levels on the pre-T2DM and T2DM remission one year after BS. Retrospective study carried out among 1656 patients with obesity who underwent BS in the Centro Hospitalar Universitário São João. T2DM and pre-T2DM remission were defined as being normal glycaemic measures of at least one year’s after BS and without pharmacological therapy. To assess the association between preoperative serum magnesium levels and pre- and T2DM remission, logistic regression models, crude and adjusted for sex, age and body mass index were computed. Patients with normoglycaemia presented hypomagnesaemia less often than those patients with pre-T2DM and T2DM (17.0% vs. 21.3% vs. 39.9%) (p

Abstract: Background: CKD is a significant cause of morbidity, cardiovascular and all-cause mortality. CHA2DS2-VASc is a score used in patients with atrial fibrillation to predict thromboembolic risk; it also appears to be useful to predict mortality risk. The aim of the study was to evaluate CHA2DS2-VASc scores as a tool for predicting one-year mortality after hemodialysis is started and for identifying factors associated with higher mortality. Methods: Retrospective analysis of patients who started hemodialysis between January 2014 and December 2019 in Centro Hospitalar Universitário Lisboa Norte. We evaluated mortality within one year of hemodialysis initiation. The CHA2DS2-VASc score was calculated at the start of hemodialysis. Results: Of 856 patients analyzed, their mean age was 68.3 ± 15.5 years and the majority were male (61.1%) and Caucasian (84.5%). Mortality within one-year after starting hemodialysis was 17.8% (n = 152). The CHA2DS2-VASc score was significantly higher (4.4 ± 1.7 vs. 3.5 ± 1.8, p < 0.001) in patients who died and satisfactorily predicted the one-year risk of mortality (AUC 0.646, 95% CI 0.6–0.7, p < 0.001), with a sensitivity of 71.7%, a specificity of 49.1%, a positive predictive value of 23.9% and a negative predictive value of 89.2%. In the multivariate analysis, CHA2DS2-VASc ≥3.5 (adjusted HR 2.24 95% CI (1.48–3.37), p < 0.001) and central venous catheter at dialysis initiation (adjusted HR 3.06 95% CI (1.93–4.85)) were significant predictors of one-year mortality. Conclusion: A CHA2DS2-VASc score ≥3.5 and central venous catheter at hemodialysis initiation were predictors of one-year mortality, allowing for risk stratification in hemodialysis patients.

Objective: To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. Method: This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. Results: We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. Conclusions: Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders. Resumen: Objetivo: Analizar las desigualdades socioeconómicas en la mortalidad por todas las causas en hombres y mujeres de nueve áreas urbanas europeas durante la reciente crisis económica, y comparar los resultados con dos periodos previos a la crisis. Método: Estudio ecológico de tendencias basado en tres periodos (2000-2003, 2004-2008 y 2009-2014). Las unidades de análisis fueron las áreas pequeñas de nueve zonas urbanas europeas. Se utilizaron un índice compuesto de privación socioeconómica como indicador socioeconómico y otros indicadores simples. Como indicador de mortalidad se usó la razón de mortalidad estandarizada suavizada, calculada utilizando el modelo jerárquico bayesiano propuesto por Besag, York y Mollié. Para analizar la evolución de las desigualdades socioeconómicas se utilizó un modelo de regresión ecológico que incluía el indicador socioeconómico, el periodo y la interacción de ambos. Resultados: Se observaron desigualdades significativas en la mortalidad en los hombres para casi todos los indicadores socioeconómicos, periodos y áreas urbanas. Sin embargo, no hubo cambios significativos en las desigualdades en el periodo de crisis. Aunque las desigualdades entre las mujeres fueron menos comunes, hubo un incremento significativo en las desigualdades en mortalidad en el periodo de crisis en términos de desempleo y del índice de privación en Praga y Estocolmo, respectivamente. Conclusiones: Futuros análisis deberán tener en cuenta el tiempo transcurrido entre la crisis y su efecto en la mortalidad, así como diferentes causas de mortalidad y el efecto diferencial entre géneros.

Abstract Prior to bariatric surgery, endocrine causes of obesity must be excluded. The diagnosis of osteoporosis in a male requires the study of secondary causes of this condition. The diagnostic delay of Cushing's syndrome may have irreversible consequences.

Abstract Background Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced – (1) the ‘Failing Europe’ scenario (worst case/increasing inequalities), (2) the ‘Sustainable Prosperity’ scenario (best case/decreasing inequalities) and (3) the ‘Being Stuck’ scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.

Abstract Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.

BackgroundObesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain.AimTo evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity.MethodsRetrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery).ResultsThere were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = −1.04 [−1.82 to −0.26], p

Abstract Mixed medullary‐follicular‐derived carcinoma is a very rare event. It is extremely important to make the correct diagnosis, due to prognostic and treatment implications. A genetic study of these patients is advisable to exclude the presence of MEN 2.

Torre Velha 12 is located in Serpa (Beja) and was excavated and directed by two of the authors (LB and SG), during an emergency intervention within the Alqueva Project. This site is characterized by negative structures filled with pottery sherds and other materials dating to the 3rd and 2nd millennia BCE. The aim of this paper is to publish the study of the faunal remains dated from Bronze Age (2nd millennium BCE). The faunal assemblage is small and comes from non-funerary pits and from funerary hypogea. Other than a bone artefact and an undetermined shell fragment, all of the remains integrated in the pits were classified as mammals. Sheep/goat is was frequently found while other species such as cattle and swines had lower frequencies. Fragments of cattle limbs are the only faunal remains associated with human burials and reveal a clear taxonomical and anatomical pattern that may be an indicator of a careful and structured anthropogenic behavior. The aim of this paper is to understand the social relationship between animals and the Bronze Age communities.

IntroductionPheochromocytomas are rare catecholamine-producing neuroendocrine tumours arising from chromaffin cells of the adrenal medulla or extra-adrenal sympathetic paraganglia. Recent studies have indicated that up to 40% of pheochromocytomas could be attributable to an inherited germline variant in an increasing list of susceptibility genes. Germline variants of the MYC-associated factor (MAX) gene have been associated with familial pheochromocytomas and paragangliomas with an autosomal dominant pattern of inheritance, a median age at onset of 33 years and an overall frequency estimated at 1.9%. We describe a deleterious MAX variant associated with hereditary pheochromocytoma in a family with four affected individuals.Case presentationThe first patient presented with bilateral pheochromocytoma in 1995; genetic testing was proposed to his oldest son, when he was diagnosed with a bilateral pheochromocytoma with a synchronous neuroblastoma. Upon the identification of the MAX variant c.97C>T, p.(Arg33Ter), in the latter individual, his two siblings and their father were tested and the same variant was identified in all of them. Both siblings were subsequently diagnosed with pheochromocytoma (one of them bilateral) and choose to remain on active surveillance before they were submitted to adrenalectomy. All the tumours secreted predominantly norepinephrine, accordingly to the typical biochemical phenotype ascribed to variants in the MAX gene.ConclusionThis case series is, to our knowledge, the one with the largest number of individuals with hereditary pheochromocytoma with a deleterious MAX variant in the same family. It is also the first case with a synchronous pheochromocytoma and neuroblastoma in carriers of a MAX deleterious variant. This report draws attention to some ill-defined features of pheochromocytoma and other malignancies associated with a MAX variant and highlights the importance of understanding the genotype-phenotype correlation in hereditary pheochromocytoma and the impact of oriented genetic testing to detect, survey and treat patients and kindreds at risk.

BackgroundAn association between hypothyroidism and the risk of Non-alcoholic Fatty Liver Disease (NAFLD) has been suggested. This association remains to be elucidated in patients with morbid obesity.AimTo evaluate the association between thyroid function and parameters of liver function and hepatic scores in patients with morbid obesity.MethodsPatients with morbid obesity followed in our center between January 2010 and July 2018 were included. The ones without evaluation of liver and thyroid functions were excluded. Fatty Liver Index (FLI) and BARD scores were used as predictors of hepatic steatosis and fibrosis, respectively.ResultsWe observed a positive association between TSH and both BARD (OR 1.14; p = 0.035) and FLI (OR 1.19; p = 0.010) in the unadjusted analysis. We found a negative association between free triiodothyronine levels and BARD (OR 0.70; p

Gardner’s syndrome is an autosomal dominant disease caused by a mutation in the APC gene with 20–30% of cases presenting de novo. This entity is a variant of familial adenomatous polyposis, with a prevalence of 3/100,000 habitants. It may present as early as 2 months of age with a variety of both colonic and extracolonic symptoms. We report a case of a 21-year-old man, without any known family history, presenting with microcytic hypochromic anemia and constitutional symptoms for two months. Ultimately, after the etiological study, Gardner syndrome diagnosis was established as an index primary familiar case. Gardner syndrome is a clinical challenge which requires a prompt suspicion in order to reach its diagnosis. Given the malignant evolution of adenomas in 100% of untreated patients, early identification of extraintestinal manifestations (identifiable prior to colonic symptoms) is of the essence. A consequent endoscopic study to confirm gastrointestinal involvement is essential for a more favorable prognosis.

Oscar Niemeyer, el más internacional de los arquitectos brasileros, Premio Pritzker en 1988, es un personaje cuya trayectoria profesional prácticamente concurre con el desarrollo de la arquitectura moderna en el siglo veinte. El artículo se concentra sobre un punto específico de esa trayectoria que coincide, por un lado, con el despliegue de la carrera internacional de Niemeyer, ya como el arquitecto de Brasilia, la nueva capital de Brasil recién pasada a manos de los militares y, por otro, con el encargo asumido para proyectar la sede del Partido Comunista Francés, en París. Quiero sugerir que, en esa ocasión, las figuras del profesional, el vanguardista, el artista, y también del militante, se superponen y, a la vez, se desplazan unas con respecto a las otras.

Introduction: Suicide is considered a public health priority. It is a complex phenomenon resulting from the interaction of several factors, which do not depend solely on individual conditions. This study analyzes the spatio-temporal evolution of suicide mortality between 1980 and 2015, identifying areas of high risk, and their variation, in the 278 municipalities of Continental Portugal. Material and Methods: Based on the number of self-inflicted injuries and deaths from suicide and the resident population, the spatio-temporal evolution of the suicide mortality rate was assessed via: i) a Poisson joinpoint regression model, and ii) spatio-temporal clustering methods. Results: The suicide mortality rate evolution showed statistically significant increases over three periods (1980 - 1984; 1999 - 2002 and 2006 - 2015) and two statistically significant periods of decrease (1984 - 1995 and 1995 - 1999). The spatio-temporal analysis identified five clusters of high suicide risk (relative risk >1) and four clusters of low suicide risk (relative risk < 1). Discussion: The periods when suicide mortality increases seem to overlap with times of economic and financial instability. The geographical pattern of suicide risk has changed: presently, the suicide rates from the municipalities in the Center and North are showing more similarity with those seen in the South, thus increasing the ruralization of the phenomenon of suicide. Conclusion: Between 1980 and 2015 the spacio-temporal pattern of mortality from suicide has been changing and is a phenomenon that is currently experiencing a growing trend (since 2006) and is of higher risk in rural areas.

Introduction: The prevalence of chronic kidney disease (CKD) and heart failure (HF) has been rising over the past decade, with a prevalence close to 40%. Cardiovascular disease and malnutrition are common comorbidities and known risk factors for mortality in haemodialysis (HD) patients. We aimed to evaluate the one-year mortality rate after dialysis induction, and the impact of serum albumin levels on survival outcomes, in patients with CKD and HF. Methods: This was a retrospective analysis of patients with CKD and HF who underwent chronic HD between January 2016 and December 2019 in a tertiary-care Portuguese hospital. Variables were submitted to univariate and multivariate analysis to determine factors predictive of one-mortality after HD start. Results: In total, 204 patients were analysed (mean age 75.1 ± 10.3 years). Within the first year of HD start, 28.7% of patients died. These patients were significantly older [79.8 ± 7.2 versus 72.9 ± 10.9 years, p < 0.001; OR 1.08 (1.04–1.13), p < 0.001] and had a higher mean Charlson Index [9.0 ± 1.8 versus 8.3 ± 2.0, p = 0.015; OR 1.22 (1.04–1.44), p = 0.017], lower serum creatinine [5.1 ± 1.6 mg/dL versus 5.8 ± 2.0 mg/dL; p = 0.021; OR 0.80 (0.65–0.97), p = 0.022], lower albumin levels [3.1 ± 0.6 g/dL versus 3.4 ± 0.6 g/dL, p < 0.001; OR 0.38 (0.22–0.66), p = 0.001] and started haemodialysis with a central venous catheter more frequently [80.4% versus 66.2%, p = 0.050]. Multivariate analysis identified older age [aOR 1.07 (1.03–1.12), p = 0.002], lower serum creatinine [aOR 0.80 (0.64–0.99), p = 0.049] and lower serum albumin [aOR 0.41 (0.22–0.75), p = 0.004] as predictors of one-year mortality. Conclusion: In our cohort, older age, lower serum creatinine and lower serum albumin were independent risk factors for one-year mortality, highlighting the prognostic importance of malnutrition in patients starting chronic HD.

Corona Virus Disease-19 (COVID-19) recently emerged as a global pandemic. Advanced age is the most important risk factor for increased virus susceptibility and worse outcomes. Many older adults are currently treated with renin–angiotensin–aldosterone system (RAAS) inhibitors and there is concern that these medications might increase the risk of mortality by COVID-19. This is a retrospective cohort of 346 patients older than 65 years with COVID-19, at the Department of Medicine of the Centro Hospitalar Universitário Lisboa Norte, in Portugal, hospitalized between March 2020 and August 2020. Mean age was 80.9 ± 8.7 years old. Most patients had arterial hypertension (n = 279, 80.6%), almost half (n = 161, 46.5%) had cardiovascular disease and approximately one-third of patients had heart failure (n = 127, 36.7%) or diabetes Mellitus (n = 113, 32.7%). Ninety-eight patients (28.3%) had chronic kidney disease and almost half of the patients (49.4%) were chronically under renin–angiotensin–aldosterone system (RAAS) inhibitors. Twenty percent of patients died during hospitalization. In a multivariate analysis, older age (OR 1.11, 95% CI 1.04, 1.18, p = 0.002), absence of baseline medication with RAAS inhibitors (OR 0.27, 95% CI 0.10, 0.75, p = 0.011), higher serum ferritin (OR 1.00, 95% CI 1.00, 1.00, p = 0.003) and higher lactate levels (OR 1.08, 95% CI 1.02, 1.14, p = 0.006) were independent predictors of mortality. Older age, higher serum ferritin and lactate levels at admission were found to be independent predictors of mortality and might act as early predictors of worsening disease in clinical practice. Chronic treatment with RAAS inhibitors appeared to be protective, supporting guidelines in not discontinuing such drugs.

Abstract Background Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000–2014), and their associated financial burden. Methods We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000–2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. Results Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p

O objetivo desse trabalho é desenvolver um aplicativo pedagógico como tecnologia de informação e comunicação móvel com acesso à Internet, a fim de auxiliar a disciplina de Desenho Técnico nas escolas da rede pública. O projeto foi executado pelas alunas da especialização em Ciências e Tecnologias na Educação do Instituto Federal Sul-rio-grandense, nos meses de junho e julho de 2016, como parte da disciplina de Informática para Educadores. Para desenvolver o aplicativo, utilizou-se um site gratuito, denominado Appy pie, o qual apresenta uma interface intuitiva para criar novos apps em plataformas como IOS, Android e Windows Mobile. O aplicativo gerado visou tornar-se uma ferramenta de complementariedade do ensino de Desenho Técnico, sendo um facilitador na pesquisa de diferentes tópicos, porém não são todos que se adaptam à nova tecnologia, devido à dicotomia das escolas, gerando um entrave educacional para a realização de testes do aplicativo. Contudo, o software teve boa aceitação pelo corpo docente da Instituição Federal Sul-rio-grandense, podendo ser, futuramente, inserido na grade da disciplina, como assessório de consulta, visto que estimula a pró-atividade do educando em tarefas extra classe.

Infertility is a growing concern in developed societies. Two extreme phenotypes of male infertility are non-obstructive azoospermia (NOA) and severe oligospermia (SO), which are characterized by severe spermatogenic failure (SpF). We designed a genetic association study comprising 725 Iberian infertile men as a consequence of SpF and 1058 unaffected controls to evaluate whether five single-nucleotide polymorphisms (SNPs), previously associated with reduced fertility in Hutterites, are also involved in the genetic susceptibility to idiopathic SpF and specific clinical entities. A significant difference in the allele frequencies of USP8-rs7174015 was observed under the recessive model between the NOA group and both the control group (p = 0.0226, OR = 1.33) and the SO group (p = 0.0048, OR = 1.78). Other genetic associations for EPSTI1-rs12870438 and PSAT1-rs7867029 with SO and between TUSC1-rs10966811 and testicular sperm extraction (TESE) success in the context of NOA were observed. In silico analysis of functional annotations demonstrated cis-eQTL effects of such SNPs likely due to the modification of binding motif sites for relevant transcription factors of the spermatogenic process. The findings reported here shed light on the molecular mechanisms leading to severe phenotypes of idiopathic male infertility, and may help to better understand the contribution of the common genetic variation to the development of these conditions.

Abstract This study’s aims are: (i) identifying spatial patterns for the risk of hospitalization due to mental illness and for the potential risk resulting from contextual factors with influence on mental health; and (ii) analyzing the spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors in the metropolitan areas of Lisbon and Porto, Portugal. A cross-sectional ecological study was conducted by applying statistical methods for assessing spatial dependency and heterogeneity. Results reveal a spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors with a statistical relevance of moderate intensity. 20% of the population under study lives in areas with a simultaneously high potential risk resulting from contextual factors and risk of hospitalization due to mental illness. Porto Metropolitan Area show the highest percentage of population living in parishes with a significantly high risk of hospitalization due to mental health, which puts forward the need for interventions on territory-adjusted contextual factors influencing mental health.

We present the case report of a 6-year-old girl with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis associated with bilateral optic neuritis. She initially presented with disturbing behaviors and gait impairments and was hospitalized in the context of meningoencephalitis, without agent isolation and with inconclusive laboratory tests. After discharge, she noted a loss of vision with impaired color sensation and returned to the emergency department. Her best-corrected visual acuity was 20/400 in both eyes, and fundoscopy revealed bilateral optic disc edema. She was hospitalized once again. Anti-NMDAR antibodies were detected in serum and cerebrospinal fluid. The patient was successfully treated with a pulse of methylprednisolone, followed by a tapering regimen of prednisolone. She recovered to 20/20 vision in the right eye and left eye. Our report highlights additional aspects of anti-NMDAR encephalitis in children and suggests that the disease could present atypical visual manifestations, which requires multidisciplinary approaches.

A prematuridade é um dos grandes problemas de saúde pública, contribuindo fortemente para a morbi-mortalidade infantil, tanto em países em desenvolvimento como o Brasil, quanto em países europeus como Portugal. O nascido prematuro é aquele que nasce com menos de 37 semanas de gestação. Os fatores de risco individuais associados à incidência da prematuridade são conhecidos. No entanto, os fatores contextuais que podem influenciar a sua incidência têm sido pouco estudados. O principal objetivo deste estudo foi identificar o padrão espacial do risco relativo de nascimento pré-termo e possíveis agrupamentos espaciais, assim como examinar se as condições socioeconômicas estão espacialmente associadas com o risco relativo de nascimento pré-termo em duas áreas metropolitanas: Região Metropolitana de São Paulo (RMSP), no Brasil, e Área Metropolitana de Lisboa (AML), em Portugal. Foi recolhida informação relativa aos nascidos vivos (2000-2010) de mães residentes em ambas as áreas metropolitanas e às condições socioeconômicas das mães. Para análise de associação espacial entre o risco relativo de nascimentos pré-termo e as variáveis do contexto geográfico, foram aplicados testes de associação espacial global (I Moran) para ambas as áreas metropolitanas. A distribuição geográfica do risco relativo de nascimentos pré-termo ocorreu de maneira não aleatória e heterogênea tanto na RMSP como na AML: na RMSP verificou-se existir uma associação espacial global negativa significativa entre risco relativo e taxa de desemprego; na AML, foi revelada associação global positiva significativa entre o risco relativo e a taxa de analfabetismo, o índice de privação sóciomaterial e a da taxa de desemprego.

ACCESSIBILITY AND USE OF URBAN GREEN SPACES IN THE CITIES OF COIMBRA (PORTUGAL) AND SALAMANCA (SPAIN). In a society that values more and more wellbeing, health and free time, the introduction of urban green spaces (UGS) next to residential areas has become a citizen’s right and requirement. This paper analyses the distribution and accessibility of UGS in the cities of Coimbra and Salamanca and evaluates their influence on the needs of the resident populations, in terms of users’ age, frequency of usage, as well as of motivation and ways to enjoy the facilities. In Coimbra there is a concentration of UGS, whereas in Salamanca there is a dispersion of such spaces, which has resulted in the different usage that people make of them. In fact, although Coimbra offers more urban green space (per inhabitant), their usage is reduced as people go there mainly by car, contrary to what happens in Salamanca. Consequently, Coimbra’s inhabitants choose these green spaces because of the activities they can be used for, whereas Salamanca’s inhabitants choose them for their proximity.

Principalmente a partir do séc. XIII, as mulheres transformam-se em uma "questão" incômoda. Percebe-se um progressivo fechamento dos espaços a que elas tinham acesso mais livre, O mal-estar gerado por esse processo aguça o conflito entre os sexos, cuja maior expressão será a Querelle des Femmes.Isabel de Villena é uma representante ibérica desse movimento com sua obra Vita Christi.

Santa Rosa, capital of the young province of La Pampa, was founded in 1892 at the end of the military campaigns that annihilated the indigenous people and ensured republican control over the Patagonia region. In 1955, the city held a design competition for the construction of its Civic Center. This was not a current infill operation intended to renew the core of the city, since it was not just a matter of raising a new facade along one of the four sides of the main square. The task implied designing, almost from scratch, a new part of city. Competitors were supposed to organize new buildings and public spaces within an area of nine hectares standing between the existing city and the surrounding pampas. Clorindo Testa won the competition by proposing that it be built as a piece of a modern city. Situated in the middle of Argentinean pampas, the Santa Rosa Civic Center has been less extensively discussed than other of Testa’s great contemporary works, such as the London Bank (1959) and the National Library (1962), both in Buenos Aires, even in the South American context. The Government Building, the Bus Station and the covered central space were built before 1963. Testa finished the Legislature Building in 1976, and even though in 2006 he was able to conclude the little Legislature Library, half of the Civic Center area still remains as open space. Nevertheless, as a living piece of the never-completed modern project installed in the far south, La Pampa’s case seems to pose relevant urban questions. This paper explores the case from two complementary perspectives. One focuses on the results of the first competition, recognizing an original contribution to the relationship between modernity, monument, and place. The second discusses the unfinished condition of the Civic Center as constitutive to modern tradition in the very modern sense of the city as a never-completed work.

Os processos matrimoniais medievais constituem-se como um rico material para uma aproximação ao cotidiano medieval, por se tratar de um registro que envolve temas de grande riqueza, na perspectiva das relações humanas e da cultura do período. Referem-se aos conflitos que surgem das relações estabelecidas a partir do vínculo do matrimônio e os caminhos percorridos na dimensão jurídica. Estes processos são raros no contexto medieval, sendo a região da Catalunha uma das poucas exceções, com um importante corpus de processos dessa natureza, abertos no século XV. O conjunto processual inclui conflitos matrimoniais específicos do contexto medieval, como confirmações de promessas de matrimônio ou legitimações de matrimônios clandestinos, além dos processos de separação. Neste trabalho, trataremos da relação entre os litígios de separação e a política dos impedimentos matrimoniais, buscando uma aproximação aos resultados desta política.

OBJETIVO: Verificar os resultados da cirurgia de implante de segmentos de anel estromal para ceratocone e as possíveis correlações existentes entre o resultado cirúrgico e o estado biomecânico da córnea no pré-operatório. MÉTODOS: Dezenove olhos de 19 pacientes com ceratocone foram avaliados antes e 12 meses após a cirurgia de implante de segmento anel estromal. O implante de um ou dois segmentos de anel de Ferrara foi realizado de acordo com o nomograma, considerando-se espessura da córnea, padrão topográfico da ectasia e o astigmatismo. O teste de Wilcoxon signed rank foi realizado para verificar diferenças entre a acuidade visual (logMAR) corrigida com óculos antes da cirurgia (AVccPré) e a obtida sem correção (AVscPós) e com correção (AVccPós) após a cirurgia, bem como entre os valores pré e pós-operatórios de variáveis tomográficas medidas com o Pentacam e variáveis biomecânicas da córnea medidas com o ORA (ocular response analyzer). As diferenças absolutas antes e após a cirurgia (valores delta - Δ) das variáveis com diferenças significantes foram calculadas. Os valores Δ foram correlacionados com as medidas do ORA no pré-operatório por meio dos testes de Pearson ou de Spaerman, de acordo com a distribuição das variáveis ser normal ou não (teste de Kolmogorov-Smirnov). RESULTADOS: Observou-se melhora significante na AVcc, bem como na AVscPós em comparação com a AVccPré (teste de Wilcoxon, p0,05). Os parâmetros do ORA derivados das pressões de aplanamento: histerese da córnea (corneal hysteresis - CH), fator de resistência da córnea (corneal resistance factor - CRF) e as medidas da pressão ocular (IOPg e IOPcc) não apresentaram correlações significantes com os parâmetros delta (Δ). Quinze das 38 variáveis biomecânicas derivadas do sinal de reflexo da córnea do ORA apresentaram correlação significante com pelo menos um parâmetro Δ, destacando-se as correlações entre o ΔKMáx com aindex e path1 (teste de Pearson, p

AIM: This study presents length-weight regressions adjusted for the most representative microcrustacean species and young stages of copepods from tropical lakes, together with a comparison of these results with estimates from the literature for tropical and temperate regions; METHODS: Samples were taken from six isolated lakes, in summer and winter, using a motorized pump and plankton net. The dry weight of each size class (for cladocerans) or developmental stage (for copepods) was measured using an electronic microbalance; RESULTS: Adjusted regressions were significant. We observed a trend of under-estimating the weights of smaller species and overestimating those of larger species, when using regressions obtained from temperate regions; CONCLUSION: We must be cautious about using pooled regressions from the literature, preferring models of similar species, or weighing the organisms and building new models.OBJETIVO: Este estudo apresenta as regressões peso-comprimento elaboradas para as espécies mais representativas de microcrustáceos e formas jovens de copépodes em lagos tropicais, bem como a comparação desses resultados com as estimativas da literatura para as regiões tropical e temperada; MÉTODOS: As amostragens foram realizadas em seis lagoas isoladas, no verão e no inverno, usando moto-bomba e rede de plâncton. O peso seco de cada classe de tamanho (para cladóceros) e estágio de desenvolvimento (copépodes) foi medido em microbalança eletrônica; RESULTADOS: As regressões ajustadas foram significativas. Observamos uma tendência em subestimar o peso das espécies de menor porte e superestimar as espécies de maior porte, quando se utiliza regressões peso-comprimento obtidas para a região de clima temperado; CONCLUSÃO: Devemos ter cautela no uso de regressões peso-comprimento existentes na literatura, preferindo modelos para as mesmas espécies, ou pesar os organismos e construir os próprios modelos.

AIM: This study presents a scientometric analysis of studies on net cages in order to determine whether these studies are considering environmental issues or only seeking an increase in food production; METHODS: The survey of articles was accomplished using the Thomson Reuters Database (ISI Web of Knowledge), with "cage culture" and "net cage" as keywords. We selected 238 articles that were published between 1990 and 2009; RESULTS: There was a temporal increase in the number of articles published. These articles focused mainly on fish production and environmental impacts; CONCLUSION: The studies of net cages in fish farming mainly investigated fish production, although environmental issues relating to this recent human activity were also important. Policy makers should consider both sides of the coin (i.e., both the benefits and environmental impacts of fish production) in regulation of this activity.OBJETIVO: O presente estudo teve como objetivo apresentar uma análise cienciométrica sobre os estudos de tanques rede, a fim de responder se estes estudos estão considerando as questões ambientais ou, apenas, buscam um aumento na produção de alimentos; MÉTODOS: O levantamento dos artigos foi realizado na base Thomson Reuters (ISI Web of Knowledge), sendo utilizadas "cage culture" e "net cage" como palavras-chave. Foram selecionados 238 artigos durante o período de 1990 a 2009; RESULTADOS: Houve um incremento temporal no número de artigos publicados. Esses artigos enfocaram, principalmente, na produção pesqueira e impactos ambientais; CONCLUSÃO: Os estudos de tanques rede abordaram, principalmente, produção pesqueira, entretanto, as questões ambientais também foram importantes nesta recente atividade humana. Os decisores políticos devem considerar ambos os lados da moeda, ou seja, benefícios e impactos ambientais da produção pesqueira, antes de regular esta atividade.

O objetivo do estudo foi analisar os efeitos das condições e características do trabalho na saúde e no bem-estar dos trabalhadores de um serviço municipal de água e saneamento. Foi aplicado um questionário em autopreenchimento (INSAT) a 351 trabalhadores, tendo em vista obter informações relativas ao trabalho, aos constrangimentos do trabalho e ao estado de saúde percecionado. Este artigo apresenta os resultados mais relevantes da aplicação do INSAT nas temáticas da formação, da prevenção de riscos ocupacionais, dos constrangimentos ambientais e físicos, constrangimentos organizacionais, relacionais e características do trabalho e suas repercussões na saúde e bem-estar (dimensões do Perfil de Saúde de Nottingham – PSN). Os resultados demonstraram que a exposição a constrangimentos subjetivos, tais como, relações interpessoais de trabalho, reconhecimento profissional e perceção dos trabalhadores sobre a sua própria atividade de trabalho, têm um maior número de associações com os problemas de saúde e com as dimensões do PSN. O fenómeno de intensificação do trabalho tornou-se visível pela análise dos constrangimentos de ritmo e de autonomia e do seu impacto ao nível da saúde e do bem-estar. O estudo enfatiza a necessidade de dar uma especial atenção aos riscos psicossociais existentes e de desenvolver uma perspetiva integradora da saúde no trabalho.

The hydrological condition of floodplain systems alters the structure and dynamic of aquatic communities. We suggest that the structure of zooplankton community changes according to the flood phases and connectivity. This study was carried out in a floodplain lake located in the Northern Pantanal (Brazil). Zooplankton density varied considerably over time, although the sampling stations presented similar densities. The densities ranged from 2,000 ind. m-3 in the high water phase to more than 2,300,000 ind. m-3 during the low water phase when the lake remains isolated. The densities of the groups also presented a temporal variation. Rotifers described the community mainly in the low water phase and microcrustaceans during the high water phase. Variations in the total zooplankton and groups densities were significantly correlated to the PCA 1 axis (negatively composed by water depth and positively by turbidity) and to the food availability (phytoplankton).A condição hidrológica de sistemas inundáveis altera a estrutura e a dinâmica das comunidades aquáticas. Com isso, sugerimos que a estrutura da comunidade zooplanctônica se altera de acordo com as fases da inundação e conectividade. Este estudo foi realizado em uma lagoa de inundação da parte norte do Pantanal (Brasil). A densidade zooplanctônica variou consideravelmente ao longo do tempo, embora asestações amostrais apresentarem densidades similares. As densidades variaram de 2.000 ind. m-3 na fase de águas altas para mais de 2.300.000 ind. m-3 durante a fase de águas baixas quando a lagoa esteve isolada. As densidades dos grupos também apresentaram variação temporal. Os rotíferos foram relativamente mais importantes durante as águas baixas e os microcrustáceos durante a fase de águas altas. Variações na densidade do zooplâncton e grupos foram significativamente correlacionados com o eixo 1 da PCA (composta negativamente pela profundidade da água e positivamente com a turbidez) e a disponibilidade alimentar (fitoplâncton).

This article presents a participative analysis-training-action project, aimed at promoting working conditions in a group of sanitation workers belonging to the Water Municipal Services of Oeiras and Amadora (SMAS). Using the activity analysis and records of work related accidents in that sector, we designed an alternating session´s model training process based on a model alternating between theoretical expositive sessions and sessions of self-analysis, supported during work, and sessions of collective analysis and discussion. The training process ended with a session with the Administration, discussing and negotiating proposals for changing working conditions and implementing safety behaviours. All training sessions were recorded allowing for a thorough examination of their contents, concerning the used speech mode and the most broached subjects in the dialogue with the operators. In the year following the training sessions we monitored the implementation of the assumed commitments by the involved parties in the project and the accidents that occurred in the sanitation group. In short we established the participation of all people involved as active agents in the promotion of safety and change in working conditions.

Keywords: Liver Abscess; Morganella morganii.

Introdução: A Diabetes Mellitus é um problema de saúde pública em crescimento em todo o mundo e também em Portugal. Pretendemos identificar a evolução do padrão geográfico desta causa de morte e a associação com a privação sociomaterial, em Portugal. Material e Métodos: Estudo ecológico transversal dos óbitos por Diabetes Mellitus ocorridos nos municípios portugueses em três períodos (1989-1993, 1999-2003 e 2006-2010). Aplicámos um modelo hierárquico bayesiano, de modo a obter a Razão Padronizada de Mortalidade Suavizada e o Risco Relativo, de mortalidade por diabetes associado à privação sociomaterial. Resultados: Observámos os valores da Razão Padronizada de Mortalidade Suavizada mais elevados, em 1989-1993, nos municípios urbanos do litoral (80% dos municípios com Razão Padronizada de Mortalidade Suavizada ≥ 161, sendo 60% urbanos); em 2006-2010 verificámos o oposto, destacando-se, pelos valores de Razão Padronizada de Mortalidade Suavizada elevados, as áreas rurais localizadas no interior sul do país (76,9% dos municípios com Razão Padronizada de Mortalidade Suavizada ≥ 161 sendo 69,2% rurais), principalmente no Alentejo. O Risco Relativo de mortalidade por Diabetes Mellitus aumenta com o aumento da vulnerabilidade associada às condições sociais e económicas da área de residência, principalmente nos dois últimos períodos (Risco Relativo: 1,00; IC95%: 0,98-1,02). Discussão: A Diabetes Mellitus apresenta um padrão geográfico marcado pela assimetria litoral-interior e urbano-rural, que tem vindo a alterar-se ao longo dos últimos vinte anos, verificando-se uma transição geográfica: 48% da população reside em municípios em que a Razão Padronizada de Mortalidade Suavizada aumentou nos últimos vinte anos, com destaque para as áreas rurais do interior de Portugal. Conclusão: As Razões Padronizadas de Mortalidade Suavizada mais elevadas verificam-se, actualmente, em municípios rurais, com índice de privação sociomaterial mais elevado. Palavras-chave: Demografia; Diabetes Mellitus/epidemiologia; Diabetes Mellitus/mortalidade; Factores Socioeconómicos; Portugal.

Santa Rosa, capital da jovem província de La Pampa, Argentina, foi fundada em 1892, ao término das campanhas militares que exterminaram as populações indígenas e asseguraram o controle republicano sobre os territórios do sul, da região pampiana à Patagônia. Em 1955, a cidade promoveu um concurso público, para a construção do seu Centro Cívico. A tarefa colocada pelo concurso não correspondia a uma simples operação de preenchimento, destinada a renovar o centro urbano propriamente dito, com a elevação de uma nova fachada sobre um dos quatro lados da praça principal. Ao contrário, os competidores deveriam organizar um conjunto de novos edifícios e espaços públicos, sobre um terreno de nove hectares, excêntrico com relação ao core fundacional. Tratava-se de fazer, quase do zero, um pedaço novo de cidade, precisamente no limite entre a cidade existente e o imenso pampa que a circundava. A proposta de Clorindo Testa, vencedora, foi construí-lo como um pedaço de cidade moderna. Situado em meio ao pampa argentino, o Centro Cívico de Santa Rosa tem sido menos examinado que outros importantes edifícios de Clorindo Testa no mesmo período, como o Banco de Londres (1959) ou a Biblioteca Nacional (1962), ambos em Buenos Aires. A Casa de Governo, a Estação Terminal de Ônibus e a praça coberta se constroem antes de 1963. Testa finaliza o Palácio do Legislativo em 1976, e, ainda que em 2006 volte a construir em La Pampa, com a inclusão da pequena Biblioteca do Legislativo, a metade da área originalmente destinada ao Centro Cívico permanece livre. No entanto, como peça viva de um projeto moderno, talvez nunca concluído, instalado no extremo sul, o caso de La Pampa parece colocar questões urbanas relevantes. O artigo explora o caso em dois sentidos complementares. O primeiro focaliza o resultado do primeiro concurso, reconhecendo nele uma contribuição original para as relações entre modernidade, monumento e lugar. O segundo discute a condição inacabada do Centro Cívico como constitutiva da tradição moderna, no sentido intrinsecamente moderno da cidade mesma, como obra que jamais se completa.

The aim of this study was to evaluate the effect of Gd-chelate on renal function, iron parameters and oxidative stress in rats with CRF and a possible protective effect of the antioxidant N-Acetylcysteine (NAC). Male Wistar rats were submitted to 5/6 nephrectomy (Nx) to induced CRF. An ionic-cyclic Gd (Gadoterate Meglumine) was administrated (1.5 mM/KgBW, intravenously) 21 days after Nx. Clearance studies were performed in 4 groups of anesthetized animals 48 hours following Gd- chelate administration: 1--Nx (n = 7); 2--Nx+NAC (n = 6); 3--Nx+Gd (n = 7); 4--Nx+NAC+Gd (4.8 g/L in drinking water), initiated 2 days before Gd-chelate administration and maintained during 4 days (n = 6). This group was compared with a control. We measured glomerular filtration rate, GFR (inulin clearance, ml/min/kg BW), proteinuria (mg/24 hs), serum iron (µg/dL); serum ferritin (ng/mL); transferrin saturation (%), TIBC (µg/dL) and TBARS (nmles/ml). Normal rats treated with the same dose of Gd-chelate presented similar GFR and proteinuria when compared with normal controls, indicating that at this dose Gd-chelate is not nephrotoxic to normal rats. Gd-chelate administration to Nx-rats results in a decrease of GFR and increased proteinuria associated with a decrease in TIBC, elevation of ferritin serum levels, transferrin oversaturation and plasmatic TBARS compared with Nx-rats. The prophylactic treatment with NAC reversed the decrease in GFR and the increase in proteinuria and all alterations in iron parameters and TBARS induced by Gd-chelate. NAC administration to Nx rat did not modify the inulin clearance and iron kinetics, indicating that the ameliorating effect of NAC was specific to Gd-chelate. These results suggest that NAC can prevent Gd-chelate nephrotoxicity in patients with chronic renal failure.

The hydrological condition of floodplain systems alters the structure and dynamic of aquatic communities. We suggest that the structure of zooplankton community changes according to the flood phases and connectivity. This study was carried out in a floodplain lake located in the Northern Pantanal (Brazil). Zooplankton density varied considerably over time, although the sampling stations presented similar densities. The densities ranged from 2,000 ind. M-3 in the high water phase to more than 2,300,000 ind. M-3 during the low water phase when the lake remains isolated. The densities of the groups also presented a temporal variation. Rotifers described the community mainly in the low water phase and microcrustaceans during the high water phase. Variations in the total zooplankton and groups densities were significantly correlated to the PCA 1 axis (negatively composed by water depth and positively by turbidity) and to the food availability (phytoplankton).

Background Breast cancer frequently leads to reduced work capacity and increased absenteeism among working-age women diagnosed with this condition. In this study, we aimed to assess the effect of CDK4/6i combined with aromatase inhibitors (AIs) or fulvestrant on quality of life (QoL) and work activity in a cohort of Portuguese patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer who started this treatment regimen. Methods This unicentric prospective observational cohort study was conducted in 35 Portuguese women with stage IV HR+/HER2- breast cancer receiving CDK4/6i combined therapy. The objectives of the study were evaluated using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 version 3 (QLQ-C30) and the breast cancer-specific Questionnaire (EORTC QLQ-BR23), and the Work Productivity and Activity Impairment questionnaire - General Health (WPAI:GH) questionnaires at four different time points throughout treatment. Results The results obtained revealed a significant improvement in EORTC QLQ-C30 score from baseline in emotional functioning, social functioning, pain, dyspnea, insomnia, and financial difficulties, as well as in future perspective and breast symptoms, as assessed by EORTC QLQ-BR23 score. However, a significant deterioration from baseline in systemic therapy side effects was also observed. Despite the limitations regarding the cohort size, an increase in work absenteeism was also observed, as determined by WPAI:GH scores. This can possibly be attributed to pain-related bone metastases observed in those patients. Conclusions To the best of our knowledge, this is the first study to assess the impact of combined CDK4/6i therapy on the QoL and work activity of Portuguese patients with metastatic breast cancer. Our results indicate that although patients’ QoL did not appear to be affected, there was a significant decrease in work activity, as evidenced by preliminary results of the increased rate on work absenteeism.

O objetivo deste estudo foi discutir as variações horizontais na assembléias de tecamebas em diferentes regiões do reservatório de Corumbá. Foi identificado um total de 61 taxa pertencentes a 8 famílias. Difflugiidae foi a mais rica em número de taxa. O maior número de taxa foi registrado em ambientes lóticos. O aumento na velocidade de corrente, descarga e a lavagem da vegetação marginal resultaram em um incremento na riqueza de espécies nos ambientes lóticos. Por outro lado, a presença de muitas espécies acidentais nas zonas lacustre e transicional do reservatório pode ser em razão de essas serem regiões profundas e extensas. Centropyxis aculeata foi constante em todas as regiões, com exceção da zona lacustre do reservatório. Outros taxa foram constantes somente nos ambientes lóticos (rio Corumbá-jusante e tributários) e zona fluvial do reservatório: Arcella conica, A. costata, A. discoides, A. vulgaris, Centropyxis ecornis e Difflugia gramen