Dador com mais de 65 anos na transplantação renal : condição do dador e função do enxerto

Trabalho final de mestrado integrado em Medicina àrea científica de Urologia, apresentado á Faculdade de Medicina da Universidade de CoimbraIntrodução: O transplante com dadores marginais permitiu diminuir o número de doentes em lista de espera. Esta técnica possibilita uma melhor qualidade de vida, menor morbilidade e mortalidade que a hemodiálise. Dadores marginais definem-se por idade superior a 60 anos ou superior a 50 anos e dois ou mais dos seguintes factores de risco: história de Hipertensão Arterial, Diabetes mellitus tipo 2, Acidente Vascular Cerebral (AVC) como causa de morte ou creatinina sérica superior a 1,5 mg/dl. Objectivos: Avaliar as condições dos dadores marginais com mais de 65 anos de todos os transplantes renais realizados no Serviço de Transplantação dos Hospitais da Universidade de Coimbra (ST-HUC) e analisar a sobrevivência do doente, do enxerto, bem como, a sua função um e três meses após o transplante. Metodologia: Análise retrospectiva dos transplantes renais realizados no ST-HUC, entre Março de 1994 e Fevereiro de 2012, cujo dador tinha idade igual ou superior a 65 anos. Resultados: Foram transplantados 198 doentes, com idade média de 59,4 anos, maioria do sexo masculino (68,7%). A etiologia mais frequente de Doença Renal Crónica foi indeterminada e o tempo médio de diálise de 4,6 anos. A idade média dos dadores foi de 69,6 anos, a maioria do sexo feminino (55,6%). A principal causa de morte dos dadores foi AVC (68,8%). O tempo médio de isquémia foi de 19,0 horas. Do total de transplantados, 85,8% permaneceram vivos. As principais causas de morte foram pneumonia e doença cardiovascular. Verificou-se função inicial em 72,2%, rejeição aguda em 7,6% e perda de enxerto em 24,2%, cuja principal causa foi a morte. Os níveis médios de creatinina eram de 2,3 mg/dl e 1,9 mg/dl, um e três meses após o transplante, respectivamente. Metade dos doentes com tempo de diálise superior a 10 anos teve função tardia do enxerto. Quanto maior o tempo de isquémia, maior a função tardia, menor a sobrevivência do enxerto e maior a mortalidade. Para tempos de isquémia superiores a 30 horas, foram encontrados valores de creatinina significativamente mais elevados ao terceiro mês. Conclusões: Os dadores marginais são uma alternativa aceitável, com boa função do enxerto, permitindo combater a escassez de órgãos disponíveis para transplante. A idade do dador não foi causa de perda do enxerto, diminuição da sobrevivência do mesmo ou do doente. Contudo, verificou-se que tanto o tempo de diálise pré-transplante como o tempo de isquémia a que o enxerto foi sujeito são factores de mau prognóstico.Introduction: Transplantation from marginal donors has allowed the reduction of waiting lists. Comparing to hemodialysis, it gives patients a better quality of life, less morbility and mortality. A marginal donor is either over 60 years old, or over 50 years old but having two or more of the following risk factors: history of arterial hypertension, type 2 Diabetes mellitus, stroke as death cause or serum creatinine higher than 1,5 mg/dl. Objectives: To typify marginal donors over 65 years old of every renal transplantation performed in Serviço de Transplantação dos Hospitais da Universidade de Coimbra (ST-HUC) and analyze patient’s and graft’s survival as well as the grafting role one and three months after transplantation. Methods: Retrospective analysis of the renal transplantations performed in ST-HUC, between March 1994 and February 2012, whose donor was 65 years old or older. Results: One hundred ninety eight patients were grafted, on average of 59,4 years old, mostly men (68,7%). The most frequent etiology of Chronic Kidney Disease was indefinite and the average dialysis period was 4,6 years. The average donors’ age was 69,6 years old, mostly women (55,6%). The major donor’s death cause was stroke (68,8%). The average period of ischemia was 19,0 hours. Eighty five point eight percent of the people who received transplantation remained alive. The main causes of death were pneumonia and cardiovascular disease. Initial function has been found in 72,2%; acute rejection occurred in 7,6% and grafting loss happened in 24,2%, mainly because of death. The creatinine average levels one and three months after transplantation were 2,3 mg/dl and 1,9 mg/dl, respectively. Half the patients with dialysis period over 10 years had late graft function. The bigger the ischemia period, the later the function, the lower the graft survival and the bigger the mortality. Whenever the ischemia period was over 30 hours, significant higher creatinine values were found three months after transplantation. Conclusion: Marginal donors are an acceptable option, with an adequate grafting function, and they may help in cases of reduced organs’ availability for transplantation. The donors age was not referred as a grafting loss cause, or involved in its survival reduction, or so the patient’s. However, the dialysis period before transplantation and the ischemia period to which the grafting was submitted are bad prognosis factors

How to address sustainability at the city level

A brief analysis of the environmental, social and economic paradigm of nowadays cities, allows reaching a conclusion: current cities are not sustainable. Considering this, it is very important to study the causes of such unsustainability and to develop models for sustainable cities. There are a limited number of studies in this area, but the scientific community lacks even more studies related to the implementation of these models in current cities. Consequently there is the need to explore this field. This work emerges with the objective of analysing how it is possible to implement sustainability in cities throw the development of a sustainable city model and an urban regeneration plan. The development of sustainable city models is a very complex topic. The analysis of the state of the art shows that one must consider the relation between environmental and social aspects in the development of sustainable cities, while taking special concerns when considering the economic issues. It was also concluded that cities should be subject to performance assessments. It was also demonstrated that a city can only be sustainable if its population behaves in harmony with the city’s sustainability model and that the behavior of a community is determinant in the sustainability level that a model can achieve

Research on teaching portuguese as a second language for foreigners. Investigación sobre la enseñanza del portugués como segunda lengua para extranjeros

The objective of this work was to investigate, through a review of the state of knowledge type, the process of teaching and learning the Portuguese language to foreigners in Brazil. It is a qualitative, descriptive and analytical research. Academic publications dealing specifically with the subject were analyzed in the databases: Scientific Electronic Library Online (SciELO); Educational Resources Information Center (ERIC) and Brazilian Digital Library of Theses and Dissertations (BDTD), between 2005 and 2018, checking trends and references on the subject, through bibliographic review. It was possible to value and subsidize other types of studies with the same research interest. Through the works found, an in-depth analysis was carried out. Preliminary readings of popular science texts revealed the importance attributed to knowledge of culture in the teaching of a given language to these speakers. As a conclusion, the need for further studies on the subject is identified, due to the importance it has for the future of Brazilian education and its impacts

Yield, maturation cycle, and estimates of genetic parameters of Robusta coffee genotypes under irrigation in the Cerrado

Eighty-five Coffea canephora genotypes were evaluated for three crop seasons under irrigation in the Cerrado of the Distrito Federal, Brazil, to characterize the population regarding phenotype, yield and maturation cycle. The experiment was conducted through the Basic Model of Repeatability without Design methodology. Regarding the cycles, genotypes were divided into four groups with the following periods, in days, from resumption of irrigation to the cherry stage: very early (243-255), early (256-267), medium (268-280), and semi-late (281-293). For yield, the repeatability obtained was approximately 33%, a medium value that represents the proportion of the permanent phenotypic variance in relation to the total phenotypic variance. The average repeatability obtained surpassed 59%, and accuracy, with three crop seasons, reached 77%. The selection gains obtained may be higher than 38%. There are promising genotypes for cultivation in the region under study. The mean repeatability and the accuracy obtained favor selection based on phenotypes

Guidelines for analysing the building energy efficiency using BIM

Introduction The benefits of Building Information Modelling (BIM) for the construction industry are already known and proved. One of the applications of BIM is to estimate buildings energy demand and foster the introduction of more efficient design alternatives. BIM creates information to support designers' decision-making and to allow them to compare and select the best options, enhancing buildings energy efficiency. With the increasing use of BIM and energy simulation tools, there is a need to establish a common and valid procedure for buildings energy assessment. Material and Methods By carrying out a building simulation with BIM, this paper identifies and describes the fundamental stages and requirements to perform a reliable, concise and fast energy assessment. These guidelines will consider Autodesk Revit as a BIM platform to create and prepare the building 3D model. Results The proposed guidelines cover all the required tasks for a BIM energy assessment, as the building modulation details and requirements, the software interoperability modes and restrictions and the comparison and selection of improvement measures. Inputs and advice are given regarding the use of some of the existing energy simulation BIM tools. Conclusions With the increasing number of studies addressing energy simulations with BIM, it is essential to define a set of requisites to precisely perform them. By identifying the minimum requirements and tasks, the proposed guidelines will support future studies in achieving more reliable and comparable results. The possibility to estimate and improve the energy demand of a building during the initial project stages allows for the opportunity to build high performance and more sustainable buildings. BIM capabilities might be an essential support to effectively improve the built environment energy efficiency and accomplish environmental goals.FCT -Fundação para a Ciência e a Tecnologia(SFRH/BD/145735/2019

A systematic review of the role of BIM in building sustainability assessment methods

Building Information Modelling (BIM) is creating new opportunities for the Architecture, Engineering and Construction industry. One of them is the integration of the Building Sustainability Assessment (BSA) during the design process. Currently, an approach for using BIM to foster and optimise the application of BSA methods has not been clearly established yet, creating a knowledge gap on the application of BIM for sustainability assessment purposes. Thus, this paper analyses the current role of BIM to evaluate three BSA methods—LEED, BREEAM and SBTool. The current BIM applicability is assessed by performing a systematic review, where the criteria being assessed and the applied BIM software are identified. A comparison is made to determine which BSA method can currently take more advantage from BIM and to identify the number of assessed criteria from each one. Furthermore, the attractiveness of a BIM-based assessment for SBTool is analysed, facing the actual BIM scenario for LEED and BREEAM. Despite the restrictions, BIM use is increasing for sustainability purposes. Most of the analysed studies and identified software are still focused on the use of LEED for assessing sustainability during the design phase. However, BIM software capabilities can also support the assessment of the other BSA methods so that process replicability can happen. Among the most addressed criteria, the energy and material-related categories are the most eminent. Autodesk Revit is the most-used software. A BIM-based assessment for SBTool will have enough attractiveness. It can assess, at least, the same percentage of criteria as the other schemes, creating new opportunities to enhance building sustainability.This research was funded by the Portuguese Foundation for Science and Technology, grant number SFRH/BD/145735/2019

Smart interior design of buildings and its relationship to land use

Architectural design is often associated with aesthetics and style, but it is also very important to building performance and sustainability. There are some studies associating architectural design to the choice for materials from sustainable sources, to indoor air quality, to energy efficiency and productivity. This article takes a step further to analyse how the use of efficient interior design techniques can impact the habitable space in order to improve building sustainability in land use. Smart interior design, a current trend related to the use of efficient and flexible furniture and movable walls in tiny or compact apartments, is analysed. A building with a standard design is used as a case study reference building and compared to a proposed theoretical design alternative using smart interior design techniques. In order to correctly assess sustainability performance, a quantifiable and verified method is used. Results showed that the use of smart interior design techniques can greatly reduce buildingsâ impact on the environment