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Abstract Background Insecticide-based malaria vector control has been implemented on the islands of São Tomé and Príncipe (STP) for more than 20 years. During this period malaria incidence was significantly reduced to pre-elimination levels. While cases remained low since 2015, these have significantly increased in the last year, challenging the commitment of the country to achieve malaria elimination by 2025. To better understand the reasons for increasing malaria cases, levels and underlying mechanisms of insecticide resistance in the local Anopheles coluzzii populations were characterized. Methods Mosquito larval collections were performed in the rainy and dry seasons, between 2022 and 2024, in two localities of São Tomé and one locality in Príncipe. Susceptibility to permethrin, α-cypermethrin, pirimiphos-methyl and DDT was assessed using WHO bioassays and protocols. Intensity of resistance and reversal by PBO pre-exposure were determined for pyrethroid insecticides. The kdr locus was genotyped by PCR assays in subsamples of the mosquitoes tested. Results Anopheles coluzzii populations were fully susceptible to pirimiphos-methyl, but high levels of resistance to pyrethroids and DDT were detected, particularly in São Tomé rainy season collections. Increasing the pyrethroid and DDT dosages to 5 $$\times$$ × and 10 $$\times$$ × did not restore full susceptibility in all populations. Pre-exposure to PBO resulted into partial reversal of the resistance phenotype suggesting the presence of cytochrome P450 oxidases-mediated metabolic resistance. The L1014F knockdown resistance mutation was present in An. coluzzii on both islands but at much higher frequency in São Tomé where it was associated with the resistant phenotype. Conclusions Future vector control interventions should consider the use of non-pyrethroid insecticides or combination with synergists to overcome the high levels of pyrethroid resistance. Alternative control methods not dependent on the use of insecticides should be additionally implemented to achieve malaria elimination in STP.

Introduction and Objectives: Congenital lobar emphysema (CLE) is a rare congenital lung malformation that causes one or more pulmonary lobes to overinflate as a result of an air trapping-like mechanism and it may cause progressive respiratory distress. It is diagnosed in one in every 20,000 - 30,000 neonates. Diagnosis is usually made postnatally, with most cases identified in the first six months of life, but advances in ultrasound technology have allowed for some prenatal diagnosis. We report on the presentation, diagnostic methods, and management of a series of cases of CLE. Methods: Review of electronic files of patients diagnosed with CLE, over the past 10 years. Results: We identified four patients diagnosed with CLE: three female and one male. Two of these patients were diagnosed with CLE prenatally and remained asymptomatic for the entire recorded period, and the other two developed symptoms soon after birth. Chest radiographic imaging was performed in all four patients and a CT scan was carried out in three cases. The symptomatic cases required lobectomy and follow-up showed a slight decrease in residual volumes, total lung capacity, and forced expiratory volume, with no long-term pulmonary dysfunction. Discussion: Prenatal diagnosis of CLE is becoming more feasible with advances in imaging technology. In our population, we observed an inverted male-to-female ratio. Patients may remain asymptomatic and conservative management is advocated for such cases. When patients start to develop symptoms, there are progressive signs of increasing respiratory distress and, for these cases, surgery is recommended, with open thoracotomy being the preferred approach. Post-surgical complications are minimal and long-term pulmonary function remains stable.

Anemia of prematurity is a condition that is prevalent in neonatal intensive care units, especially among extremely low birth weight infants. Despite extensive practice and research, several preventive and therapeutic strategies remain controversial, giving rise to significant differences among centers. Preventive strategies include delayed cord clamping, umbilical cord milking, autologous and allogeneic cord blood transfusion, and reducing iatrogenic blood loss through innovative methods like microsample devices. The effectiveness of erythropoiesis-stimulating agents in reducing transfusions remains limited. Red blood cell transfusions, while beneficial, carry risks. Defining transfusion thresholds based on hemoglobin levels remains a challenge, with practices varying globally. Recent trials advocate for a restrictive transfusion approach, reducing the number of transfusions with no significant adverse effects. Near Infrared Spectroscopy evaluates tissue oxygenation, potentially aiding transfusion decisions based on individualized physiological markers of anemia. This review provides a summary of the latest literature on anemia of prematurity, emphasizing aspects related to pathophysiology, preventive measures, and therapeutic interventions to assist clinicians in managing this condition.

The Portuguese Neonatal Society updates the growth charts recommended for term and preterm infants. The suitability of the growth chart depends on the gestational age, the purpose of the measurement, and the life cycle stage. To classify intrauterine growth at birth, the Fenton 2013 growth charts, which are based on anthropometric records at birth, are the most appropriate for both term and preterm infants. For monitoring postnatal growth in full-term infants, the WHO 2006 Growth Prescriptive Standards are strongly recommended. To specifically monitor weight loss in the initial postnatal days, the NEWT® (http://newbornweight.org) nomogram is recommended. To assess body weight changes in preterm infants while in hospital, an accurate open-access online calculator (www.growthcalculator.org), based on weight trajectories that take into account the initial physiological weight loss, is recommended. The Fenton 2013 growth charts can be employed concurrently to monitor growth in length and head circumference. To assess growth in preterm infants following their discharge from hospital, the Intergrowth-21 prescriptive standards are appropriate for infants born at more than 27 weeks of gestation, up to 64 weeks postmenstrual age. Beyond this age, the prescriptive WHO 2006 growth standards should be employed.

Abstract This article analyses the Bolsonaro government’s foreign policy and the interests of the Brazilian internal bourgeoisie. The hypothesis is that the internal bourgeoisie supported the 2016 coup d’état and the 2018 election of Jair Bolsonaro but, over the years, they started to exhibit resistance to the government’s political practices and responded to the external pressures related to environmental policy and threats to democracy. The empirical research analysed the position papers of the internal bourgeoisie’s main employer organisations, focusing on the following agendas: i) the Mercosur-EU agreement; ii) entry into the OECD; iii) reformulation of Mercosur’s Common External Tariff (CET); and iv) environmental policy. The study concludes that there were conflicts within the internal bourgeoisie throughout the Bolsonaro administration and, in the end, there was a change in their interests that, alongside other elements, can explain Jair Bolsonaro’s 2022 electoral defeat.

The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.

Introduction: Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. Methods: An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. Results: In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate’s temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate’s transportation out of the delivery room. Conclusion: Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Bronchopulmonary dysplasia (BPD) is the most common long-term respiratory morbidity affecting very preterm infants and has a negative impact on future lung function and quality of life. BPD management during a neonatal intensive care unit (NICU) stay is mainly based on a set of preventive measures. Despite improvements in pharmacological and non-pharmacological research, only a few therapeutic measures available are supported by high-quality evidence. This review essentially focuses on preventive and therapeutic options for preterm neonates at risk of, or with established, BPD, during their NICU stay.

This study describes the synthesis and characterization of chlorambucil (CLB)-functionalized mesoporous silica nanoparticles (MSNs) for potential application in cancer therapy. The nanoparticles were designed with a diameter between 20 and 50 nm to optimize cellular uptake and avoid rapid clearance from the bloodstream. The synthesis method involved modifying a previously reported technique to reduce particle size. Successful functionalization with CLB was confirmed through various techniques, including Fourier transform infrared spectroscopy (FTIR) and elemental analysis. The cytotoxicity of the CLB-functionalized nanoparticles (MSN@NH2-CLB) was evaluated against human lung adenocarcinoma cells (A549) and colon carcinoma cells (CT26WT). The results suggest significantly higher cytotoxicity of MSN@NH2-CLB compared to unbound CLB, with improved selectivity towards cancer cells over normal cells. This suggests that MSN@NH2-CLB holds promise as a drug delivery system for targeted cancer therapy.

BackgroundThis study evaluated the long-term effects of percutaneous intervention in children and adolescents with transplant renal artery stenosis (TRAS).MethodsTwenty patients had significant stenosis (>50%) and underwent percutaneous transluminal angioplasty (PTA/stenting) (TRAS group-intervention); 14 TNS (non-significant group -control) patients did not have significant stenosis (≤50%) and were treated clinically. The combined primary endpoints were death from all causes and late graft failure. The secondary endpoints were serum creatinine (SCr), systolic blood pressure (SBP), and diastolic blood pressure (DBP).ResultsNo statistically significant difference was found between TRAS-Intervention(N = 20) and TNS groups-Control (N = 14) for these clinical parameters: deaths, 1 (5.0%) vs. 0 (0.0%) (p = 1.000) and graft loss, 4 (20.0%) vs. 2 (14.3%) (p = 1.000). For the secondary endpoints, after 1 month and 1 year the values of SCr, SBP, and DBP were similar between the two groups but not statistically significant.DiscussionIn the TRAS group (intervention), the stent implantation was beneficial for treating refractory hypertension and reducing blood pressure (BP) in children and adolescents. Despite the outcomes being similar in the two groups, it can be inferred that the patients in the TRAS group (intervention) would have had a worse outcome without the percutaneous intervention.ConclusionTRAS treatment with stenting can be considered for children and adolescents. Because the sample in the present study comprised of only a specific population, further studies are needed for generalization.Trial registrationThe trial was registered at clinictrials.gov with trial registration number NCT04225338.

The integration of 3D laser scanning and digital photogrammetry in the architecture, engineering, and construction (AEC) industry has facilitated high-quality architectural surveys. However, the processes remains constrained by significant costs, extensive manual labor, and accuracy issues associated with manual data processing. This article addresses these operational challenges by introducing automated Building Information Modeling (BIM) techniques that minimize manual input through the use of Dynamo for Autodesk Revit. We developed algorithms that efficiently convert point cloud data into accurate BIM models, enhancing productivity and reducing the potential for errors. The application of these algorithms is analyzed in a case study of the Old Lifeguard Station of Fuseta, showcasing notable reductions in modeling time and improvements in accuracy. The findings suggest that automated scan-to-BIM methods could provide a viable solution for enhancing BIM workflows across the industry, with the potential for wider adoption given their impact on efficiency and model quality.

Vomiting is a common clinical sign in the paediatric age group, including neonates. It is the forced expulsion of gastric content through the mouth and must be differentiated from gastro-oesophageal reflux. Vomiting in neonates is usually a non-specific clinical sign and may correspond to gastrointestinal abnormalities, but it can also signal systemic disorders such as infectious pathologies, intracranial injuries with intracranial hypertension, and endocrine and metabolic diseases. Physicians should be able to recognize life-threatening causes of vomiting in order to avoid serious complications. This review considers congenital gastrointestinal malformations, infections and other less common causes of vomiting in neonates.

Bronchopulmonary dysplasia (BPD) remains a significant contributor to the morbidity and mortality of infants delivered at very low gestational ages. The therapeutic approach to BPD is essentially preventive and supportive. Inflammation is the key contributor to the disease development. Mesenchymal cells (MSCs) have been described over 40 years ago and have been shown to possess potent anti-inflammatory and proangiogenic properties and to contribute to tissue regeneration in a variety of adult and children´s clinical diseases, leading to enthusiasm for their use in BPD. Preclinical animal studies and clinical trials in human preterm neonates point to a positive preventive, as well as reparative role in BPD. Recent work revealed that MSCs release extracellular vesicles, called exomes, that contain the therapeutic activity of MSCs. Several clinical trials on MSCs in BPD are currently taking place worldwide. This review briefly discusses the different types of stem cells, their clinical applications in paediatric contexts, with particular involvement in their use in BPD, and provides information on the current use of MSCs in BPD.

Building Information Modeling (BIM) has emerged as a revolutionary tool in the domain of architectural conservation and documentation. When combined with terrestrial 3D laser scanning, it presents a powerful method to capture and represent the intricate details and nuances of historic structures. Such buildings, with their unique architectural lineage, often exude a geometric complexity unparalleled by standard designs. Consequently, the transition from scan data to a BIM framework, or the scan-to-BIM process, becomes intricate and time-intensive. Beyond the challenge of digital translation, the true essence of these historic buildings lies not only in their geometric form but also in understanding and preserving their design logic, formal composition rules, and primitive geometry. It then becomes imperative that the resulting model maintains fidelity in terms of proportion, shape, symmetry, and spatial rationale. Considering these challenges and potentials, this article delves into the process of digitalizing and BIM modeling of the Lisbon Agricultural Exhibition Pavilion located in Portugal. Our study proceeds in a tripartite structure: initiating with an in-depth terrestrial 3D laser scanning of the pavilion, followed by a comprehensive registration, processing, and alignment of the acquired scans, and culminating in a detailed BIM model using the industry-standard Revit 2020 software.

Using straightforward and cost-effective methods, persimmon leaves were converted into high-quality powder. This powder was applied as an adsorbent for the removal of Cu(II) and Cd(II) from aqueous solutions. Scanning electron microscopy (SEM) revealed the presence of particles with non-homogeneous sizes and rough textures. The biosorbent exhibited a specific surface area of approximately 0.44 ± 0.015 m2 g−1. Elemental analysis and energy-dispersive X-ray spectroscopy (EDX) confirmed the presence of elements such as sulfur, phosphorus, nitrogen, and oxygen. The results of 13C nuclear magnetic resonance (13C-NMR), obtained using the cross-polarization technique, show the presence of groups containing sulfur and oxygen. Infrared spectroscopy (FTIR) indicated the existence of amine and hydroxyl groups. The material was used in the solid-phase extraction of Cu(II) and Cd(II) in batch experiments, and its adsorption capacity was evaluated as a function of time, pH, and analyte concentration. The fraction with a diameter between 63 and 106 μm was selected for the adsorption tests. Kinetic equilibrium was reached within 5 min, and the experimental data were fitted to the pseudo-second-order kinetic model. The optimum pH for the adsorption of both metal species was approximately 5.0. The adsorption isotherms were adjusted using the modified Langmuir equation, and the maximum amount of metal species extracted from the solution was determined to be 0.213 mmol g−1 for Cu(II) and 0.215 mmol g−1 for Cd(II), with high linear correlation coefficients for both metals. Persimmon leaves are typically abundant during the growing season, and because they are seasonal, the Diospyros kaki L.f. tree undergoes the natural process of leaf abscission, ensuring the availability of leaves for application.

Abstract Background Thyroid nodules are a challenge in clinical practice and thyroid ultrasonography is essential for assessing the risk of malignancy. The use of ultrasound-based malignancy risk classification systems has been recommended by several scientific societies but radiologist’s adherence to these guidelines may vary. The authors aimed to analyze the quality of the information provided by the thyroid ultrasound report, to assess the malignancy risk of thyroid nodules, in Portugal. Methods Multicenter and retrospective study, conducted in three of the five Portuguese NUTS2 corresponding to about 88.3% of the mainland population. We included 344 consecutive unselected participants aged ≥ 18 years who underwent thyroid ultrasonography in 2019. The description of six features of the dominant thyroid nodule was analyzed: maximum size, shape, margins, composition, echogenicity and echogenic foci. A utility score, including these six features, was used as an indicator of the report’s quality. A score of 4 was considered as a minimum value. Results Maximum diameter was reported for all nodules. Shape, margins, composition, echogenicity and echogenic foci were reported in 8.1%, 25.0%, 76.5%, 53.2% and 20.9%, respectively. Only 21.8% of the nodules had a score ≥ 4. At least one of four suspicious features, including marked hypoechogenicity, microcalcifications, irregular margins and non-oval shape, was identified in 8.7% of the nodules. Cervical lymph nodes’ status was reported in 93% of the exams. The risk category was only reported in 7.8% of the participants. Conclusion The adherence of Portuguese radiologists to a standardized reporting model and to an ultrasound-based malignancy risk stratification system is still low and has implications for the correct characterization of the malignancy risk of nodules and the decision to perform fine-needle aspiration biopsy.

Abstract Background Transplant renal artery stenosis (TRAS) is the main vascular complication of kidney transplantation. For research and treatment purposes, several authors consider critical renal artery stenosis to be greater than 50%, and percutaneous intervention is indicated in this scenario. However, there are no reports in the current literature on the evolution of patients with less than 50% stenosis. Method This retrospective study included data from all patients who underwent kidney transplantation and were suspected of having TRAS after transplantation with stenosis under 50% independent of age and were referred for angiography at a single centre between January 2007 and December 2014. Results During this period, 6,829 kidney transplants were performed at Hospital do Rim, 313 of whom had a clinical suspicion of TRAS, and 54 of whom presented no significant stenosis. The average age was 35.93 years old, the predominant sex was male, and most individuals (94.4%) underwent dialysis before transplantation. In most cases in this group, transplants occurred from a deceased donor (66.7%). The time between transplantation and angiography was less than one year in 79.6% of patients, and all presented nonsignificant TRAS. Creatinine levels, systolic blood pressure, diastolic blood pressure and glomerular filtration rate improved over the long term. The outcomes found were death and allograft loss. Conclusion Age, sex and ethnic group of patients were factors that did not interfere with the frequency of renal artery stenosis. The outcomes showed that in the long term, most patients evolve well and have improved quality of life and kidney function, although there are cases of death and kidney loss.

IntroductionRhodnius domesticus is a kissing bug with known occurrence around the Atlantic coast of South America and is considered to be the only endemic species of the Atlantic Forest for the Rhodniini tribe. In this study, we aimed to indicate the species trends in possible distribution in the current and paleoclimate scenarios from the last glacial maximum (LGM).MethodsWe revised R. domesticus distribution information and created ecological niche models (ENMs) between the current time and Pleistocene end scenarios for the study regions. Models were built and validated using Maxent, KUENM, and ENMeval packages in R and ArcMap. We considered the models' uncertainty when calculating the average model variance and using mobility-oriented parity (MOP) analyses to indicate extrapolation risk areas in transfer scenarios.ResultsWe found 44 different geographical species records, and our current time models indicate suitable areas in coastal regions of the Atlantic and surrounding locations in higher and lower latitudes. Paleoclimate models indicate general suitability in coastal regions and change in suitability in the interior region through time.DiscussionOur revision and ENMs indicate two main points: Despite the fact that R. domesticus records are spatial and time concentrated in some coastal regions of the Atlantic Forest, species could have a broader distribution area, including regions outside the biome delimitations in northeast and southwest areas of South America. Paleodistribution models indicate species broader distribution in Atlantic Forest-related areas in LGM and northern interior regions of South America from late Pleistocene to the current times. In glaciation scenarios, continental shelf distribution was relevant and species' different connectivity routes with other biomes may be developed after LGM.

The present study aimed to evaluate the body composition and cardiorespiratory fitness of overweight or obese people after COVID-19. 171 volunteers of both sexes (men, n = 93 and women, n = 78) between 19 and 65 years old were allocated into three groups according to the severity of their symptoms of COVID-19: non-hospitalized people/mild symptoms (n = 61), hospitalized (n = 58), and hospitalized in an intensive care unit-ICU (n = 52). Two laboratory visits were carried out 24 h apart. First, a medical consultation was carried out, with subsequent measurement of body weight and height (calculation of body mass index) and body composition assessment via electrical bioimpedance. After 24 h, a cardiorespiratory test was performed using the Bruce protocol, with a direct gas exchange analysis. Hospitalized individuals had significantly higher values for fat mass and body fat percentage than non-hospitalized individuals (p < 0.05). Significantly higher values were found for heart rate (HR) and peak oxygen consumption (VO2peak) for individuals who were not hospitalized when compared to those hospitalized in the ICU (p < 0.05). Significantly higher values for distance, ventilation, and the relationship between respiratory quotient were found for non-hospitalized individuals compared to hospitalized individuals and those in the ICU (p < 0.05). After the cardiorespiratory test, higher values for peripheral oxygen saturation (SpO2) were observed for non-hospitalized individuals than for all hospitalized individuals (p < 0.05). Diastolic blood pressure was significantly higher at the tenth and fifteenth minute post-Bruce test in hospitalized than in non-hospitalized participants (p < 0.05). Based on these results, proposals for cardiopulmonary rehabilitation are indispensable for hospitalized groups considering the responses of blood pressure. Monitoring HR, SpO2, and blood pressure are necessary during rehabilitation to avoid possible physical complications. Volume and intensity of exercise prescription should respect the physiologic adaptation. Given lower physical conditioning among all the groups, proposals for recovering from health conditions are urgent and indispensable for COVID-19 survivors.

Abstract In extreme preterm infants, massive congenital sacrococcygeal teratomas with great hemodynamic commitment may be a situation for limitation of care.

ABSTRACT Objective To evaluate the positioning of the distal tip of central venous catheters and the factors that contributed to inadequate positioning in patients admitted to intensive care. Methods This is a cross-sectional study, with a sample of 246 medical records of patients admitted to intensive care units. A catheter position analysis form was used as an instrument for data collection. Results It was seen that 86.2% of catheters used in intensive care were centrally inserted in the internal jugular veins, 74.4% were double-lumen catheter, and ultrasound was employed for puncture technique in 84.6% of cases. Of the distal ends of the catheters, 53.7% were at the cavoatrial junction (correct position). According to statistical tests, there was a positive correlation between the inadequate positioning of the distal extremity with the central insertion catheter (p=0.012). Patients with presumptive diagnosis associated with COVID-19 showed a positive correlation with inappropriate positioning of the catheter distal tip (p=0.017). Conclusion There are extrinsic factors related to improper positioning of the distal tip of catheters, such as the type of catheter used, the patients’ diagnosis and the puncture with insertion in the left jugular vein.

Introduction: Work satisfaction and stress for doctors working in Neonatal Intensive Care Units (NICU) depend on several factors. The purpose of this survey was to assess work satisfaction and stress of neonatologists in Portugal. Material and methods: Anonymous electronic survey, with 46 questions, sent by e-mail to all members of the Portuguese Society of Neonatology in 2019 (i.e., 205 neonatologists). Results: 92 (44.9%) questionnaires were analyzed. Respondents were mostly female, aged 50-59 years, married and with children, working at a level IIIB NICU linked to university teaching. Most classified their clinical activity as satisfactory and prestigious. They often feel tired due to overwork, and fatigue affects physical, mental and social health. Most consider that the annual vacation days are not enough. The most stressful reported aspects were the emergency services, dealing with death situations, deciding to withdraw care, and dealing with decisions on the threshold of viability. Most respondents consider the age between 50 and 59 years old as adequate to stop doing emergency service. Some adverse working conditions, low salaries and the unmet need for scientific activity promotion were complaints placed by a significant number of doctors. Discussion: The satisfaction level of neonatologists in Portugal is high. Emergency service is the main cause of stress. Overwork, low salaries, staff rejuvenation and scientific activity promotion are aspects that require a large investment. Conclusion: This survey contributes to the national characterization of work satisfaction and stress of neonatologists, which may inform policies and interventions targeted at the needs of this group of clinicians.

Pituitary adenomas are the most common cause of hypopituitarism associated with pituitary enlargement, but other aetiologies have been emerging, namely immune checkpoint inhibitor-induced hypophysitis (ipilimumab, nivolumab and pembrolizumab). Secukinumab is a recently approved human monoclonal antibody used for the treatment of psoriasis, with no know reported cases of hypophysitis. We describe a challenging case of panhypopituitarism in a patient with a pituitary incidentaloma and a temporal relationship between secukinumab initiation and the manifestation of clinical features suggestive of hypopituitarism. In such intricate work-up, the differential diagnoses should be carefully considered, taking into account the therapeutic and prognostic implications.

The synthesis of an organofunctionalized mesoporous silica was accomplished by a two-step process involving (1) the co-condensation of a silylant agent at the surface of silica, followed by (2) the immobilization of Purpald (ligand) at the organic termination of the silytant agent. The characterization of the organofunctionalized material indicated the presence of NH2 groups, and the immobilization of the ligand was confirmed by 29Si- and 13C-nuclear magnetic resonance. The material’s surface area was determined as 370 m2 g−1. Batch adsorption experiments enabled the determination of optimum pH conditions for the adsorption of Cu(II) and Cd(II). Under optimal pH, the pseudo-second-order kinetic model and Langmuir model provided the best correlations to describe the materials adsorption behavior, suggesting a chemisorption mechanism. When tested in continuous-flow preconcentration experiments, the flow rate and eluent concentration demonstrated to affect the removal of Cu(II) and Cd(II), while the buffer concentration had an effect only over the adsorption of Cu(II). Under optimized preconcentration conditions, it was possible both to determine the concentrations of Cu(II) and Cd(II) in samples such as mineral water, ground water, tap water and river water. Ions commonly found in drinking and natural waters (Na+, K+, Ca2+, Mg2+, Fe3+, Ba2+, Cl−, SO42−, HCO3−, and H2PO4−) did not affect the preconcentration of any of the studied analytes. Reutilization experiments indicated that the adsorbent material can withstand at least 40 adsorption/desorption preconcentration cycles with no efficiency loss.

Heritage buildings usually have complex (non-parametric) geometries that turn their digitization through conventional methods in inaccurate and time-consuming processes. When it comes to the survey and representation of historical assets, remote sensing technologies have been playing key roles in the last few years: 3D laser scanning and photogrammetry surveys save time in the field, while proving to be extremely accurate at registering non-regular geometries of buildings. However, the efficient transformation of remote-sensing data into as-built parametric smart models is currently an unsolved challenge. A pragmatic and organized Historic Building Information Modeling (HBIM) methodology is essential in order to obtain a consistent model that can bring benefits and integrate conservation and restoration work. This article addresses the creation of an HBIM model of heritage assets using 3D laser scanning and photogrammetry. Our findings are illustrated in one case study: The Engine House Paços Reais in Lisbon. The paper first describes how and what measures should be taken to plan a careful scan-to-HBIM process. Second, the description of the remote-sensing survey campaign is conducted accordingly and is aimed at a BIM output, including the process of data alignment, cleaning, and merging. Finally, the HBIM modeling phase is described, based on point cloud data.

Big defensins are two-domain antimicrobial peptides (AMPs) that have highly diversified in mollusks. Cg-BigDefs are expressed by immune cells in the oyster Crassostrea gigas, and their expression is dampened during the Pacific Oyster Mortality Syndrome (POMS), which evolves toward fatal bacteremia. We evaluated whether Cg-BigDefs contribute to the control of oyster-associated microbial communities. Two Cg-BigDefs that are representative of molecular diversity within the peptide family, namely Cg-BigDef1 and Cg-BigDef5, were characterized by gene cloning and synthesized by solid-phase peptide synthesis and native chemical ligation. Synthetic peptides were tested for antibacterial activity against a collection of culturable bacteria belonging to the oyster microbiota, characterized by 16S sequencing and MALDI Biotyping. We first tested the potential of Cg-BigDefs to control the oyster microbiota by injecting synthetic Cg-BigDef1 into oyster tissues and analyzing microbiota dynamics over 24 h by 16S metabarcoding. Cg-BigDef1 induced a significant shift in oyster microbiota β-diversity after 6 h and 24 h, prompting us to investigate antimicrobial activities in vitro against members of the oyster microbiota. Both Cg-BigDef1 and Cg-BigDef5 were active at a high salt concentration (400 mM NaCl) and showed broad spectra of activity against bacteria associated with C. gigas pathologies. Antimicrobial specificity was observed for both molecules at an intra- and inter-genera level. Remarkably, antimicrobial spectra of Cg-BigDef1 and Cg-BigDef5 were complementary, and peptides acted synergistically. Overall, we found that primary sequence diversification of Cg-BigDefs has generated specificity and synergy and extended the spectrum of activity of this peptide family.

Preparing a city for the impact of global warming is becoming of major importance. Adopting climate-proof policies and strategies in response to climate change has become a fundamental element for city planning. To this end, this research considers a multidisciplinary approach, at the local scale, able to connect urban planning and architecture, as a vital base for considering a coastal cities’ ability to control the consequences of climate change, specifically floods. So far, there is a scarcity of research connecting sea ground and land surveys, and this study could become a foundational reference for coastline settlement management using BIM. We found in BIM (Building Information Modeling) a possible tool for managing coastal risk, since it can combine crowdsourced data for geometric and information modeling of the city. The proposed BIM model includes a topography used for 3D thematic maps, a riverbed model, and a waterway model. This model aims to facilitate coordination across separate actors and interests since the urban area model is always updatable and improvable. Focusing on a case study of Lisbon, we developed risk-based 3D maps of the area close to the shoreline of the Tagus River.

Hydatidiform mole (HM) is a form of gestational trophoblastic disease, which can be classified as complete or partial and is characterized by high levels of human chorionic gonadotropin (HCG). Hyperthyroidism results from the effect of β-hCG on TSH receptors. Clinical case: A 53-year-old multiparous woman, with no relevant history, was admitted to the Gynaecology Emergency Department with a clinic presentation of hypogastralgia and hyperemesis gravidarum with 1 month of evolution and symptoms of hyperthyroidism. The investigation showed a distended uterus with echogenic material with a thickness of 81 mm at filled by uterine cavity. β-hCG> 10000mIU / mL. She was admitted for suction curettage, and the resulting sample was compatible with HM. The additional analytical study showed primary hyperthyroidism and negative thyroid autoimmunity. Thyroid ultrasound was unaltered. The patient started therapy with metibasol and propanolol, showing clinical and analytical improvement. She also underwent, total abdominal hysterectomy and bilateral annexectomy with general anaesthesia, without complications. Chest x-ray without changes. Through histological analysis it was determined that the diagnosis was that of an invasive complete HM. Sixteen weeks after surgery, she presented β-hCG

The atypical hemolytic uremic syndrome (aHUS) in the newborn is a rare disease, with high morbidity. Eculizumab, considered a first-line drug in older children, is not approved in neonates and in children weighing less than 5 kg. We present a 5-day-old female newborn, born at 36 weeks' twin gestation, by emergency cesarean section due to cord prolapse, with birth weight of 2,035 g and Apgar score of 7/7/7, who develops microangiopathic hemolytic anemia, thrombocytopenia, and progressive acute renal failure. In day 5, after diagnosis of aHUS, a daily infusion of fresh frozen plasma begins, with improvement of thrombocytopenia and very slight improvement in renal function. The etiologic study (congenital infection, Shiga toxin, ADAMTS13 activity, directed metabolic study) was normal. C3c was slightly decreased. On day 16 for maintenance of anemia and severe renal failure, she started 300 mg/dose eculizumab. Anemia resolves in 10 weeks and creatinine has normal values after 13 weeks of treatment. The genetic study was normal. In this case, eculizumab is effective in controlling microangiopathy and in the recovery of renal function. Diagnosis of neonatal aHUS can be challenging because of phenotypic heterogeneity and potential overlap with other manifestations that may confound it, such as perinatal asphyxia or sepsis/disseminated intravascular coagulation.

Bronchopulmonary dysplasia (BPD) is a serious problem in Neonatal Intensive Care Units (NICUs). It is a multifactorial disease that may influence the growth and development of preterm neonates. The aim of this retrospective case-control study of preterm infants with BPD who were born in our centre was to evaluate the growth of these infants in the first 2 years of life compared with healthy preterm infants and to determine risk factors associated with poor growth. Those with major congenital malformations, congenital TORCH infection, deceased before 36 weeks of postmenstrual age or during the first 28 days of life and those who were transferred during hospitalization and outborn neonates were excluded. A total of 90 preterm neonates were enrolled and 30 (33.3%) of them had BPD. At 12 months of corrected age, gestational age and pre-pregnancy mother’s weight were shown to be associated with short stature. Weight at birth was also associated with low weight and head circumference growth. At 12 months after term, no differences were found within the growth assessment. Our study showed that growth between 12 and 18 months of life in preterm infants with BPD was sufficient to catch up.

The positive effects of breastfeeding on the health of infants and mothers are largely established. It is generally recommended that a mother should breastfeed exclusively for at least 6 months. Sometimes, however, this is not possible owing to a maternal disease. The purpose of this review was to understand the possibility and the mechanisms of transmission of viral agents to breastfed infants when the mother is infected and to evaluate whether and when breastfeeding can be harmful and, therefore, a real contraindication exists. In order to produce this narrative review, an extensive literature search was conducted on PubMed. The query included “breastfeeding”, “mother to child” and “transmission” as keywords and a filter for publication date – from 2014 to 2019. Additionally, the bibliography of the selected articles was reviewed to identify further pertinent studies, which were then included. Only the following maternal infections were found to represent an absolute contraindication to breastfeeding: Human Immunodeficiency Virus and Human T-Lymphotropic Virus, because of their possible transmission via milk, and Ebola Virus, in which transmission to the child seems to be linked more to the close proximity relationship itself than the presence of the virus in human milk. Other viruses – Herpes Simplex Virus, Varicella Zoster Virus and Hepatitis C Virus – constituted a source of contraindication only in specific high-risk circumstances. To date, for the remaining viruses reviewed in this paper – including Severe Acute Respiratory Syndrome Coronavirus 2, no evidence exists that warrants contraindication of breastfeeding. Health professionals who deal with pregnant and puerperal women, such as obstetricians, pediatricians or family medicine doctors, must be aware of these particularities in the management of breastfeeding women in order to provide correct information and better take care of their patients and their respective infants.

Abstract INTRODUCTION: Rhodnius domesticus Neiva & Pinto, 1923 is a rare sylvatic triatomine endemic to the Atlantic Forest, with one known record for Espírito Santo (ES), Brazil from 1969. We present here its rediscovery in ES, 42 years after its first record. METHODS: In January 2011, a triatomine specimen was collected from a rural area of the municipality of Santa Teresa, ES. RESULTS: We confirmed this as a new record of R. domesticus in the Baixo Caldeirão locality. CONCLUSIONS: This finding supports the possibility of a wild population of R. domesticus in the mountainous region of the Atlantic forest of ES.

Summary: Considerable progress has been made regarding children’s morbidity and mortality. Nonetheless, recent developments have been insufficient to meet set targets. This study aims to evaluate trends and outcomes in respiratory management following a 14-year collaboration with the Vermont Oxford Network (VON). Methods: Data were collected prospectively at a Level III NICU in the North of Portugal and submitted to the VON between 2000 and 2013. The primary outcome was bronchopulmonary dysplasia (BPD). Pneumothorax and respiratory distress syndrome were secondary outcomes. Results: A total of 323 very low birth weight infants hospitalised in our centre met the inclusion criteria. Significant changes were observed with supplemental oxygen use and endotracheal intubation decreasing, whilst surfactant use rose. Conventional ventilation techniques at any time were used less often. No differences in the rates of BPD were observed. Conclusion: A review of current practice has led to a more cautious approach, privileging less invasive ventilatory techniques and pondered oxygen supplementation, albeit with no significant improvement in the evaluated respiratory outcomes.

Abstract Materials such as magnesium phosphate cement (MPC) have attracted significant attention of researchers, therefore, understanding the effects of dosage parameters, such as water content and MgO/NH4H2PO4 ratio on phase formation is essential for obtaining cementitious matrices with improved performance. In the present work MgO was sintered at 900 °C and 1110 °C in a conventional oven, and the effect of water concentration and MgO/NH4H2PO4 (or ADP) ratio on the properties of MPC was evaluated in terms of phase formation by X-ray diffraction, pore size distribution, mechanical properties, and microstructure. For less-reactive MgO (calcined at 1100 °C) with a high MgO/ADP ratio, increased water content did not cause additional solubilization of ADP or formation of more hydrated phases, although the cement porosity increased. Compositions with more reactive MgO (calcined up to 900 °C) formed dittmarite (NH4MgPO4.H2O) independent of water content. Higher water content and MgO calcination temperature were associated with increased MPC setting time and decreased mechanical strength due to higher porosity.

Magnesium phosphate cements (MPCs) are formed when an aqueous solution of ammonium dihydrogen phosphate (ADP, NH4H2PO4) and magnesium oxide (MgO) react in the presence of other aggregates for filling or reinforcement (e.g., fibers, waste, and sand). Therefore, understanding how the MgO/ADP ratio influences phase formation to produce cementitious matrices with better performance is essential. MgO dissolved in an acid solution undergoes numerous transformations because of which different opinions exist regarding the mechanisms by which the setting reactions and formation of hydrated phases occurs in MPCs. In this study, the effect of different MgO/ADP ratios on the properties of MPCs was evaluated regarding phase formation using X-ray diffraction, setting time, and pore size distribution. Increased ADP concentration was found to increase the concentration of hydrated phases, however, this increases the pore content while decreasing the apparent density of MPCs. Compared with compositions with lower MgO/ADP ratios, the composition with the highest MgO/ADP ratio required higher setting time due to the lower concentration of hydrated phases.

Big defensins are antimicrobial polypeptides believed to be the ancestors of β-defensins, the most evolutionary conserved family of host defense peptides (HDPs) in vertebrates. Nevertheless, big defensins underwent several independent gene loss events during animal evolution, being only retained in a limited number of phylogenetically distant invertebrates. Here, we explore the evolutionary history of this fascinating HDP family and investigate its patchy distribution in extant metazoans. We highlight the presence of big defensins in various classes of lophotrochozoans, as well as in a few arthropods and basal chordates (amphioxus), mostly adapted to life in marine environments. Bivalve mollusks often display an expanded repertoire of big defensin sequences, which appear to be the product of independent lineage-specific gene tandem duplications, followed by a rapid molecular diversification of newly acquired gene copies. This ongoing evolutionary process could underpin the simultaneous presence of canonical big defensins and non-canonical (β-defensin-like) sequences in some species. The big defensin genes of mussels and oysters, two species target of in-depth studies, are subjected to gene presence/absence variation (PAV), i.e., they can be present or absent in the genomes of different individuals. Moreover, big defensins follow different patterns of gene expression within a given species and respond differently to microbial challenges, suggesting functional divergence. Consistently, current structural data show that big defensin sequence diversity affects the 3D structure and biophysical properties of these polypeptides. We discuss here the role of the N-terminal hydrophobic domain, lost during evolution toward β-defensins, in the big defensin stability to high salt concentrations and its mechanism of action. Finally, we discuss the potential of big defensins as markers for animal health and for the nature-based design of novel therapeutics active at high salt concentrations.

Congenital vascular anomalies are a heterogeneous group of lesions, subdivided into vascular tumors and vascular malformations. Incorrect nomenclature and misdiagnoses are frequent. Arteriovenous malformations (AVM) are potentially the more aggressive type of vascular malformation. They are formed by a complex network of malformed arteries and veins without intervening capillary bed resulting in arteriovenous shunting. The clinical presentation ranges from tissue swelling to serious clinical issues, as right heart failure. We report the case of a female newborn affected by an AVM stage IV of Schobinger, evidenced in the immediate neonatal period, despite the lack of prenatal diagnosis. She underwent two endovascular embolizations procedures with Onyx 18®, with effective devascularization of the AVM. Although advantageous, embolization is a challenging procedure and the risks are real. Our patient experienced a life-threatening hemorrhage a few days after the first embolization. We considered that complete devascularization of the AVM was achieved after two embolization procedures. At 14 months old, she underwent surgery for resection of residual AVM, with fast postoperative recovery. Currently, she is 17 months old, and no AVM recidive occur until now. We report a clinical case that evidences the difficulties of approaching an AVM Schobinger stage IV in the neonatal period. We also present a review of the literature on vascular anomalies with special attention to AVM.

A 31+2 weeks gestational age, birthweight 1,490 g female was born after an emergency C-section due to abruptio placenta. The Apgar score was 4/8/8, needing positive pressure followed by nasal continuous airway positive pressure (NCPAP). One dose of poractant alfa was administered in the first hour of life. On day 4 (D4) of life, the 2D-echocardiogram performed due to a systolic murmur showed the presence of a hemodynamically significant patent ductus arteriosus. After two cycles of intravenous ibuprofen in standard doses (three doses per cycle: first dose 10 mg/kg/day once a day, followed by two doses of 5 mg/kg/day once a day), the ductus arteriosus (DA) remained significant. The DA was surgically ligated on D12, successfully. On D3 postoperative, she was extubated to NCPAP, maintaining mild respiratory distress. During a progressive increase of enteral feeding, she presented with increased work of breathing and maintenance of oxygen supply, despite a normal chest X-ray. On D25 of life, the chest X-ray revealed an elevation of the left diaphragm. • What is your diagnosis? • Would you perform any complementary test to confirm the suspected diagnosis? • What do you expect to observe on physical examination? • What approach and outcome are suggested for this patient?

PDA varies according to gestational age and birth weight; it is more frequent among girls too. According to some series, about 30% of preterm infants with a birth weight below 1,500 g present a hemodynamically significant PDA (HS-PDA) in the first days of life. Clinical course: On day 25 (D25) of life, a fluoroscopic exam confirmed the diagnosis of left hemidiaphragmatic paralysis. Due to the increase of the respiratory work despite support with NCPAP for 18 days and X-ray repetition, we decided to perform the plication. She had a good recovery after surgery and came out of respiratory support after 4 days. She was discharged off the NICU on D63. A comparative image showed the left hemidiaphragm in a neutral position. She maintains follow-up in Neonatology and Cardiology Outpatient Department, with a favourable clinical evolution.

Resumen: Los síndromes poliglandulares autoinmunes son un grupo raro de endocrinopatías caracterizadas por disfunción auto-inmune de una o más glándulas endócrinas, pudiendo atingir otros órganos. Los dos tipos más comunes, tipo 1 y 2, tienen la Enfermedad de Addison (EA) como principal componente, pero la disfunción de la glándula suprarrenal podrá no ser la primera manifestación. Los disturbios auto-inmunes de las glándulas endócrinas son considerados muchas veces como la “punta del iceberg”, ya que, en la mayoría de las veces coexisten otras patologías auto-inmunes. Los autores relatan el caso de una mujer de 56 años, admitida en el servicio de urgencia por un cuadro de nauseas, vómitos, dolor abdominal, hiponatremia y hiperpotasemia, y cuya investigación etiológica llevó al diagnóstico de síndrome poliglandular autoinmune tipo 2. Abstract: Polyglandular autoimmune syndromes are a rare and heterogeneous group of endocrine diseases characterized by autoimmune dysfunction of one or more endocrine glands, even though non-endocrine organs can also be affected. The two major autoimmune polyendocrine syndromes, type 1 and type 2, present Addison's Disease as a prominent component, although adrenal gland dysfunction is not usually the first manifestation. Autoimmune disorders of the endocrine glands are often regarded as the "tip of the iceberg" since they most often coexist with other autoimmune diseases, which may not be apparent at first sight. The authors report the clinical case of a 56 year old woman admitted to the emergency department with nausea, vomiting, abdominal pain, hyponatremia and hyperkalemia, whose etiological investigation led to the diagnosis of Polyglandular autoimmune syndrome type 2.

Cardiomyopathies are rare diseases of the heart muscle, of multiple causes, that manifest with various structural and functional phenotypes but are invariably associated with cardiac dysfunction. Dilated cardiomyopathy is the commonest cardiomyopathy in children, and the majority present before one year of age. Its etiology may be acquired or genetic. Myocarditis is an important cause and is responsible for the majority of acquired cases. Inherited (familial) forms of dilated cardiomyopathy may occur in 25-50% of patients. Echocardiographic and tissue Doppler studies are the basis for diagnosis of dilated cardiomyopathy in most patients. Marked dilatation of the left ventricle with global hypokinesis is the hallmark of the disease. This review will cover the classification, epidemiology and management of newborns with dilated cardiomyopathy. In particular, a comprehensive and up-to-date review of the genetic study of dilated cardiomyopathy and of detailed echocardiographic assessment of these patients will be presented. Resumo: As cardiomiopatias são doenças raras do músculo cardíaco, de múltiplas causas, que se manifestam com vários fenótipos estruturais e funcionais, mas invariavelmente associadas a disfunção cardíaca. A cardiomiopatia dilatada é a forma mais comum em crianças, apresentando-se maioritariamente antes do ano de idade. A sua etiologia pode ser adquirida ou genética. A miocardite é uma importante causa, responsável pela maioria dos casos adquiridos. As formas hereditárias (familiares) de cardiomiopatia dilatada podem ocorrer em 25-50% dos pacientes. Os estudos ecocardiográficos e Doppler são a base para o seu diagnóstico, caracterizando-se por uma acentuada dilatação do ventrículo esquerdo com hipocinesia global. Neste artigo serão abordadas a classificação, a epidemiologia e a abordagem dos recém-nascidos com cardiomiopatia dilatada. Em particular, será apresentada uma revisão abrangente e atualizada da avaliação genética desta entidade, bem como aspetos detalhados da ecocardiografia nestes pacientes. Keywords: Dilated cardiomyopathy, Neonatal, Genetic studies, Echocardiographic evaluation, Management, Palavras-chave: Cardiomiopatia dilatada, Neonatal, Estudo genético, Avaliação ecocardiográfica, Abordagem

Visceral leishmaniasis (VL) is an infectious disease caused by the protozoa Leishmania chagasi, whose main vector in South America is Lutzomyia longipalpis. The disease was diagnosed in the Brazilian state of Espírito Santo (ES) for the first time in 1968. Currently, this disease has been considered endemic in 10 municipalities. Furthermore, the presence of L. longipalpis has been detected in eight other municipalities where the transmission has not been reported thus far. In this study, we performed species distribution modeling (SDM) to identify new and most likely receptive areas for VL transmission in ES. The sandflies were both actively and passively collected in various rural area of ES between 1986 and 2017. The collection points were georeferenced using a global positioning system device. Climatic data were retrieved from the WorldClim database, whereas geographic data were obtained from the National Institute for Space Research and the Integrated System of Geospatial Bases of the State of Espírito Santo. The maximum entropy algorithm was used through the MIAmaxent R package to train and test the distribution models for L. longipalpis. The major contributor to model generation was rocky outcrops, followed by temperature seasonality. The SDM predicted the expansion of the L. longipalpis-prone area in the Doce River Valley and limited the probability of expanding outside its watershed. Once the areas predicted suitable for L. longipalpis occurrence are determined, we can avoid the inefficient use of public resources in conducting canine serological surveys where the vector insect does not occur.

Architectural survey methods using terrestrial 3D laser scanning and digital photogrammetry prove capable of registering a building with a level of accuracy far superior to traditional methods, minimizing errors, and reducing fieldwork. Current developments in the construction industry, and new requirements emerging worldwide, have increased the demand for building information modeling (BIM) models as the end product of these surveys. Still, because BIM is a new paradigm, many professionals find the transition challenging, especially when dealing with old and heritage buildings. The new ways of the market demand solutions to optimize processes and make architectural reconstruction from point clouds even more efficient. An online questionnaire survey was carried out with 208 industry professionals working in 78 countries to assess the scope of these demands. As a result, the article presents an overview of current scan-to-BIM practices worldwide with data regarding the architectural survey and BIM modeling derived from point clouds. The implemented survey also identifies in which countries BIM adherence is most accelerated for conventional buildings and for listed buildings and non-listed old buildings, the main benefits and difficulties encountered by professionals, tools and workflows used, and the role of different professionals in collaborative work.

Ectopic adrenocorticotropic hormone (ACTH) secretion is a rare disease. A 51 years old woman, with a Cushing syndrome secondary to ectopic ACTH secretion, diagnosed in 2009, with mediastinal lymphadenopathy, whose biopsy was compatible with lung small cell carcinoma, staged as IIIB using TNM classification. No other lesions were found in patient study. The patient was submitted to chemotherapy, associated to ketoconazole 200 mg twice daily, with partial remission of both conditions. Three years later was admitted with an aggravation of Cushing syndrome. There was no evidence of progression of pulmonary disease. A cystic lesion in the pancreatic uncinated process was found by abdominal CT scan and with avid uptake by DOTANOC PET discreet in anterior mediastinal lymphadenopathy. Biopsy of pancreatic mass revealed a neuroendocrine tumor. Pulmonary masses were biopsied again and was in favor of neuroendocrine tumor. It was assumed the diagnosis of pancreatic neuroendocrine tumor with mediastinal metastasis. The patient initiated lanreotid (120 mg, monthly, subcutaneous) in association with ketoconazole. After 5 months of therapy, patient died with sepsis secondary to pneumonia. Neuroendocrine tumours are rare, difficult to diagnose and with poor prognosis when associated with ectopic ACTH secreting Cushing syndrome.

Background: Pulmonary Sequestration (PS) is a rare congenital malformation, with few cases reported. Thus, the prenatal and postnatal natural history of PS and the best management approach have not been fully characterized. The aim of this study is to evaluate the experience with PS in our level III hospital, to improve our practice. Methods: A retrospective review of all cases with PS admitted to our hospital between January 1996 and December 2016 was performed. Results: Fifteen cases of PS were identified. Antenatal ultrasonography evaluation suggested the existence of 3 (20%) PS, 3 (20%) Congenital Pulmonary Airway Malformations (CPAM), 3 (20%) cases with no established diagnosis between CPAM and PS and 1 (6.7%) neuroblastoma. All newborns were admitted to Neonatal Intensive Care Unit and 7 (46.7%) became symptomatic. When postnatal X-ray and/or computer tomography scan were performed, the lesions corresponded to 12 (80%) PS, 1 (6.7%) CPAM, 1 (6.7%) suprarenal mass and 1 (6.7%) congenital diaphragmatic hernia. Eight (53.3%) cases had concomitant abnormalities. An invasive postnatal intervention was performed in 5 of 7 (71.4%) symptomatic patients and in 4 of 8 (50%) asymptomatic ones. Two patients underwent embolization. Surgery was performed in 8 (53.3%) cases (thoracotomy in 3 and thoracoscopy in 5). Respiratory morbidity was reported in 2 asymptomatic cases conservatively managed. Final diagnosis, based on histopathological examination or postnatal imaging when surgery wasn’t applied, was: 9 (60%) extralobar sequestrations and 3 (20%) intralobar sequestrations; in 3 (20%) cases, it wasn’t possible to confirm the type of lesion. Conclusion: PS was associated to a high rate of congenital abnormalities. Concordance between prenatal and postnatal findings was poor. According to our and other series, treatment of asymptomatic PS is controversial. Nevertheless an elective surgery should be preferred to prevent the risks of an urgent surgery. The outcome was generally good.

Background: Preterm birth is certainly a public health problem. Aside from being an important cause of mortality, prematurity increases the risk of serious lifetime disabilities. Objective: To assess the overall survival, causes of death and neonatal morbidities associated with prematurity of newborns less than 29 weeks of gestational age (GA). Methods: Retrospective study including all preterm infants less than 29 weeks of GA admitted to the level III Neonatal Intensive Care Unit (NICU) at Centro Hospital São João in Porto, Portugal, between January 1st, 2005 and December 31st, 2016. Newborns were grouped into three groups according to their GA: G23+0-24+6, G25+0-26+6, G27+0-28+6. Results: In this 12-year-period, 160 preterm neonates less than 29 weeks of GA admitted to this NICU met our inclusion criteria. Overall deaths were 60 (37.5%), variating between 25 (92.6%) in the G23+0-24+6, 23 (46%) in the G25+0-26+6 and 12 (14.5%) in the G27+0-28+6. The leading causes of death were intraventricular hemorrhage (IVH) and sepsis. Early neonatal mortality was 20.6%. Among survivors, 41% had bronchopulmonary dysplasia (BPD), 69% developed late sepsis, 56% retinopathy of prematurity (ROP), 44% IVH and 10% cystic periventricular leukomalacia (cPVL). Conclusions: Mortality rates in this preterm group were high in spite of all the technological and scientific advances. Pulmonary conditions (respiratory distress syndrome and BPD), sepsis and neurologic outcomes (ROP, IVH and cPVL) were still major causes of morbidity. In line with other series, the limit of viability in this cohort of preterm infants is 25 weeks of GA. Prenatal, perinatal and postnatal care still all have a long road ahead, especially when it comes to these “gray zone” newborns.

O sonho de Telêmaco, entre morcegos melancólicos, dá início a uma odisseia noturna pelos labirintos espelhados da historiografia da arquitetura. O livro A coluna e o vulto, publicado em 2017, trata das “permutas de significados entre corpo e arquitetura.” O que deveria ser uma resenha daquele inovador ensaio de Mario Henrique d’Agostino, terminou por se converter em “mal disfarçado pretexto” para uma profunda reflexão sobre os graus e direções da historiografia da arquitetura permeada por imaginação arquitetural e mitos literários de longa reverberação; por certezas e verdades; filologia e filosofia. Estão convocados para depor em juízo Homero e James Joyce; Manfredo Tafuri, Rudolf Wittkower, Joseph Rykwert, Giambattista Vico e Marco Lucchesi; Le Corbusier, Stanley Kubrick e Lewis Carroll.

We describe the case of a 1-month-old, full-term male infant with an NS (localized, well-delimited, waxy alopecic area on the scalp) that has been present since birth. He was re-evaluated 3 months after the first observation; apart from the lesion on his scalp, the patient was physically normal. Neurological and ophthalmologic evalua­tions were unremarkable, and the infant exhibited normal neuromotor development. The child is now 1 year old, the NS keeps the same characteristics and dimensions, and the general growth and de­velopment are within the normality.

A 1-month-old, full-term male infant received a neonatology consultation because of a localized, well-delimited, waxy alopecic area on his scalp that had been present since birth. Apart from the scalp lesion, a physical examination and neurological and ophthalmological observations revealed no abnormalities. The patient had a non-pathological medical history, and his development was appropriate for his age. He was born to a healthy mother via caesarian delivery, and his birth weight was 3,330 g. The infant had no family history of similar skin lesions or known genetic disorders. • What is your diagnosis? • How should you follow up this case? • When should you worry about this lesion and refer the patient to other specialists?