Alternativas na Colocação de Cateteres em Hemodiálise

Background: Although vascular access is essential for adequate haemodialysis delivery, the systematic use of a patient's venous patrimony may eventually lead to exhaustion of suitable sites for placement of a new vascular access. Case Report: We present two cases of such patients. In the first one we inserted a 55cm catheter through the left external iliac vein, and a 40cm translumbar catheter was placed in the second one. Both interventions were performed percutaneously under radiological guidance. Both patients were anticoagulated after the procedure. Conclusion: Unusual sites for haemodialysis catheter placement may be life saving in selected situations and offer safe and viable alternatives for adequate haemodialysis delivery

Validation of Blood Gas Analysis in Arteriovenous Fistula for Hemodialysis

Introduction: Arterial blood gas analysis is a minimally invasive technique used in our daily practice but is not a complication free technique. The aim of this study was to validate results from blood gas analysis obtained from the arteriovenous fistula (AVF)/graft as a surrogate marker of the arterial blood gas analysis. Methods: A prospective observational study was made in 45 patients. We performed arterial and AVF/graft blood gas analysis and results were compared by a paired sample t Student test. Results: Most of our subjects was male (68.9%) and the mean age was 67 years (±14). Hemodialysis vintage was 63 months (±66), and vascular access age was 62 months (±56). The more prevalent vascular access was left radiocephalic AVF (n = 16; 35.6%) and the main puncture artery was right radial artery (n = 27; 60.0%). There were no statistically significant differences between the samples collected. Conclusions: Our results suggest a possible alternative of arterial blood gas analysis in AVF/graft for hemodialysis patients. This could result in making an uncomfortable procedure almost painless and reducing complications. Future research should take place to include anatomical characteristics of the AVF or the circulation of recirculation.info:eu-repo/semantics/publishedVersio

Redefining the Genus Corollospora Based on Morphological and Phylogenetic Approaches

The present study, initially to resolve the cryptic species within Corollospora maritima, is to determine how to attain taxonomic discrimination at species and generic levels. Multiple sequence alignments (MSAs) of the ITS, 28S, and 18S regions of the nuclear ribosomal cistron were separately subjected to pairwise distance assessments, Bayesian, and Maximum likelihood phylogenetic analyses. Morphological descriptions of 15 type strains of Corollospora species, along with MSAs involving representatives of the whole genus Corollospora (268 isolates, many from C. maritima sensu lato) totaling 355 published sequences, allowed phylogenetic assessments conducted to the following p-distance thresholds in the ITS/28S regions: ≥3%/1% for species segregation and ≥8%/2% for generic segregation. This resulted in the introduction of 10 new genera encompassing 13 new combinations of current Corollospora species: Ajigaurospora pseudopulchella, Corollosporella anglusa, Corollosporella ramulosa, Corollosporopsis portsaidica, Garethelia parvula, Honshuriella fusca, Keraliethelia pulcehlla, Nakagariella filiformis, Paracorollospora angusta, Paracorollospora luteola, Paracorollospora marina, Shirahamella gracilis, and Tokuratelia colossa. Furthermore, seven undefined genera considered putative new genera (pNGenus A to G), and 16 undefined putative new species (seven spp. come from the resolution of the C. maritima complex), await re-assessment of their morphology and additional molecular data, which may result in the recognition of new taxa.info:eu-repo/semantics/publishedVersio

Biodiversity and characterization of marine mycota from Portuguese waters

Biodiversity and characterization of marine mycota from Portuguese waters.— The occurrence, diversity and similarity of marine fungi detected by the sum of direct and indirect observations in Fagus sylvatica and Pinus pinaster baits submerged at two Portuguese marinas are analyzed and discussed. In comparison with the data already published in 2010, the higher number of specimens considered in this study led to the higher number of very frequent taxa for these environments and substrata; the significant difference in substrata and also in fungal diversity detected at the two environments is also highlighted, in addition to the decrease in fungal similarity. Because the identification of Lulworthia spp., Fusarium sp., Graphium sp., Phoma sp. and Stachybotrys sp. down to species level was not possible, based only on the morphological characterization, a molecular approach based on the amplification of the LSU rDNA region was performed with isolates of these fungi. This was achieved for three isolates, identified as Fusarium solani, Graphium eumorphum and Stachybotrys chartarum. To achieve this with the other isolates which are more complex taxa, the sequencing of more regions will be considered.Biodiversidad y caracterización de los hongos marinos de las aguas portuguesas.— Se analiza y discute la presencia, la diversidad y la similitud de los hongos marinos detectados mediante la suma de observaciones directas e indirectas utilizando cebos de Fagus sylvatica y Pinus pinaster sumergidos en dos puertos deportivos portugueses. En comparación con los datos ya publicados en 2010, el mayor número de especímenes aquí considerados condujo a un mayor número de taxones muy frecuentes en estos sustratos y medios ambientales; también debe destacarse la diferencia significativa en los sustratos y también en la diversidad fúngica en los dos medios ambientales, además de la disminución de la similitud fúngica. Dado que no fue posible la identificación de Lulworthia spp., Fusarium sp., Graphium sp., Phoma sp., y Stachybotrys sp. hasta el nivel de especie, basándose únicamente en la caracterización morfológica, se llevó a cabo un estudio molecular basado en la amplificación de la región LSU ADNr con extractos de dichos hongos. Ello se consiguió en tres extractos puros, identificados como de Fusarium solani, Graphium eumorphum y Stachybotrys chartarum. Para llevar a cabo este proceso con otros extractos puros pertenecientes a taxones más complejos, se considerará la secuenciación de más regiones.publishe

Efficacy of Percutaneous Transluminal Angioplasty on Dysfunctional Fistulae Because of Inflow Stenosis

PURPOSE: Autogenous fistulas are the preferential vascular access for hemodialysis. The aim of this retrospective study was to determine the efficacy of angioplasty for dysfunctional fistulas because of inflow dysfunction. 
 METHODS: We reviewed all the angiographic procedures performed on our institution between April 2007 and April 2009. Procedures performed in dysfunctional fistulas because of inflow stenoses were analyzed. Fistulas with stenoses out of these areas were excluded. The following data were collected: patient age and sex, fistula age at the time of intervention, location of fistula, number and location of stenosis, angiography referral criteria, clinical findings (presence or absence of thrills, bruits and pulsatility) and date of reintervention or failure. 
 RESULTS: During the study period 215 fistulas were submitted to angiography of which, seventy-one presented inflow stenosis (33%). Mean follow-up was 21.72±9.26 months, and average age was 7.03 months. Two groups were considered: 31 fistulas comprising ≤6 months old, and 40 fistulas >6 months old. Primary patency rates±SE for older fistulas at 6, 12, 18 and 24 months, respectively, was 91.3%± 0.04%, 80.7%± 0.07%, 53.8% ±0.10% and 34.2±0.1% versus 91.7±0.08%, 57.1±0.14%, 23±0.14%, 11.4%± 0.1% for younger fistulas (P=0.04). Fistulas ≤6 months old and multiple stenosis were associated with a poorer primary patency rate (P=0.005).
 CONCLUSIONS: Inflow stenosis is frequently associated with fistula dysfunction. In this study we only analyzed AVF with inflow stenosis and we have shown that angioplasty can have great patency results, particularly for single lesions in matured fistulas.info:eu-repo/semantics/publishedVersio

Assessment of the presence of Hepatitis E virus in surface water and drinking water in Portugal

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Hepatitis E virus (HEV) is a non-enveloped single-stranded positive-sense RNA virus, belonging to the Hepeviridae family, resistant to environmental conditions, and transmitted by the consumption of contaminated water. This virus is responsible for both sporadic and epidemic outbreaks, leading to thousands of infections per year in several countries, and is thus considered an emerging disease in Europe and Asia. This study refers to a survey in Portugal during 2019, targeting the detection and eventual quantification of enteric viruses in samples from surface and drinking water. Samples positive for HEV RNA were recurrently found by reverse transcription quantitative PCR (RT-qPCR), in both types of matrix. The infectivity of these samples was evaluated in cultured Vero E6 cells and RNA from putative viruses produced in cultures evidencing cytopathic effects and was subjected to RT-qPCR targeting HEV genomic RNA. Our results evidenced the existence of samples positive either for HEV RNA (77.8% in surface water and 66.7% in drinking water) or for infectious HEV (23.0% in surface water and 27.7% in drinking water). These results highlight the need for effective virological control of water for human consumption and activities.This research was funded by Empresa Portuguesa das Águas Livres (EPAL) and Foundation for Science and Technology (FCT) Portugal through a Ph.D. grant to D. Salvador (PDE/BDE/114582/2016) and FCT/MCTES projects UIDP/50017/2020+UIDB/50017/2020 and UIDB/04295/2020 through national funds.info:eu-repo/semantics/publishedVersio

Treatment of Hepatitis C Virus Infection in Kidney Transplant Recipients: Case Report

Chronic hepatitis C virus (HCV) infection exists in a large proportion of patients undergoing renal transplantation. Nowadays it is not considered to be an absolute contraindication to transplantation; however, it is associated with an increased risk for the patient and accounts for a shorter half-life of the renal allograft. We present three transplant recipients who displayed serious hepatic dysfunction after renal transplantation due to an HCV infection. In two of these cases, the liver biopsies established the diagnosis of FCH. In the third case, the liver biopsy was compatible with the early stages of FCH. All patients were started on peg-interferon alfa 2-b and ribavirin with subsequent normalization of hepatic function and early complete viral responses

Ham, Mozart, & Limits to Freedom of Expression

Focusing on two recent controversies—the cancellation of Mozart’s Idomeneo in Berlin and the death threats against a French teacher for criticizing Islam—this article revisits the flawed construction of a clash between Islam and freedom of expression, and seeks to show how the debates are connected to a problematic vision of Europe which necessarily excludes Muslims

Tuberculous Meningitis: an Endemic Cause of Intracranial Hypertension

Tuberculous meningitis (TBM) presents a complex clinical scenario, often marked by delayed recognition and high mortality. Our case involves a 27-year-old woman from Nepal with no significant medical history, presented with a two-week history of fatigue, altered consciousness, dizziness, vomiting, fever, holocranial headache, and photophobia. Initial examination revealed signs consistent with meningitis, including fever, hypertensive state, prostration, bilateral exophthalmos, sixth cranial nerve paresis, and positive Kernig/Brudzinski signs. Cerebrospinal fluid (CSF) exhibited characteristics typical of TBM: turbidity, lymphocytic-predominant pleocytosis, low glucose, and elevated protein. The patient was promptly started on meningeal doses of vancomycin, ceftriaxone, and acyclovir. However, persistent fever, neurological deterioration, and signs of increased intracranial pressure led to the decision to initiate conventional empiric treatment of tuberculosis (TB) with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) and dexamethasone 1 week before cultural positivity for Mycobacterium tuberculosis of CSF. The case underscores the importance of considering TBM in patients from endemic regions, interpreting CSF findings, and initiating empirical treatment in critical scenarios, contributing to a positive patient outcome despite the diagnostic challenges.info:eu-repo/semantics/publishedVersio

HPV: Uma visão multidisciplinar

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