Abstract The technological structure of organizations has expanded, and the number of users has increased considerably with the advance in the digitalization of services. Therefore, it is necessary to implement security measures to preserve the threats and risks related to data security. To this end, a survey was developed to provide an overview of the cybersecurity status quo in organizations containing the main control points to be observed. This work was carried out based on a literature review and expert interviews. The objective of this survey is to enable the verification of cybersecurity-related issues in the administrative organs of municipal governments so that they can better prevent cyber attacks.

Resumo A estrutura tecnológica das organizações expandiu-se e o número de utilizadores aumentou consideravelmente com o avanço na digitalização dos serviços. Por conseguinte, é necessário implementar medidas de segurança para preservar as ameaças e riscos relacionados com a segurança dos dados. Para isso, foi desenvolvido um inquérito com o objetivo de fornecer um panorama da situação em que se encontra a segurança cibernética nas organizações contendo os principais pontos de controlo a serem observados. Este trabalho foi realizado com base na revisão da literatura e entrevistas com especialistas. O objetivo deste inquérito é possibilitar a verificação dos quesitos relacionados com a cibersegurança nos orgãos da administração de governos municipais para que estes se previnam melhor dos ciber ataques.

Abstract European hedgehogs, Erinaceus europaeus (Linnaeus, 1758), are small mammals found in western Europe and also in parts of northern Europe. They can be seen in rural, suburban and urban areas, but are usually found in grassland with edge habitats. These animals are omnivorous and serve as definitive or paratenic hosts for several parasites, including acanthocephalans (phylum Acanthocephala). During necropsy of a European hedgehog, a single adult parasite was collected from the intestinal lumen and preserved in 70% ethanol. After morphological evaluation of the specimen, it was identified as Moniliformis cestodiformis (von Linstow, 1904) (Acanthocephala: Moniliformidae). This is the first report of M. cestodiformis in a European hedgehog, as well as in Europe. More epidemiological studies need to be carried out to map the location and prevalence of this parasite in Portugal and the European continent.

Resumo Os ouriços, Erinaceus europaeus (Linnaeus, 1758), são pequenos mamíferos que se localizam na Europa ocidental e também em regiões do Norte da Europa. Eles podem ser avistados em áreas rurais, suburbanas e urbanas, mas são geralmente encontrados no campo no limite daqueles hábitats. São animais omnívoros e servem de hospedeiros definitivos ou paratênicos de muitos parasitas, incluindo acantocéfalos (filo Acanthocephala). Durante a necropsia de um ouriço, um exemplar adulto acantocéfalo foi recolhido do lúmen intestinal e preservado em etanol a 70%. Depois de uma avaliação morfológica desse exemplar, este foi identificado como Moniliformis cestodiformis (von Linstow, 1904) (Acanthocephala: Moniliformidae). Esta é a primeira referência de M. cestodiformis num ouriço, assim como na Europa. Mais estudos epidemiológicos necessitam ser realizados, para localizar este parasita e calcular a sua prevalência em Portugal e no continente europeu.

Abstract The technological structure of organizations has expanded, and the number of users has increased considerably with the advance in the digitalization of services. Therefore, it is necessary to implement security measures to preserve the threats and risks related to data security. To this end, a survey was developed to provide an overview of the cybersecurity status quo in organizations containing the main control points to be observed. This work was carried out based on a literature review and expert interviews. The objective of this survey is to enable the verification of cybersecurity-related issues in the administrative organs of municipal governments so that they can better prevent cyber attacks.

Resumo A estrutura tecnológica das organizações expandiu-se e o número de utilizadores aumentou consideravelmente com o avanço na digitalização dos serviços. Por conseguinte, é necessário implementar medidas de segurança para preservar as ameaças e riscos relacionados com a segurança dos dados. Para isso, foi desenvolvido um inquérito com o objetivo de fornecer um panorama da situação em que se encontra a segurança cibernética nas organizações contendo os principais pontos de controlo a serem observados. Este trabalho foi realizado com base na revisão da literatura e entrevistas com especialistas. O objetivo deste inquérito é possibilitar a verificação dos quesitos relacionados com a cibersegurança nos orgãos da administração de governos municipais para que estes se previnam melhor dos ciber ataques.

Resumen Objetivo. Evaluar un modelo predictivo de sintomatología postraumática (SPT) y de crecimiento postraumático (CPT), que incluía variables psicológicas, relacionadas con la pandemia y con las clases virtuales, en estudiantes de educación superior durante la pandemia. Método. Participaron 552 estudiantes cuya mayoría corresponde a un 68.5% de mujeres. Se aplicaron instrumentos para medir distintas variables psicológicas. Resultados. Se estableció que un modelo predictivo que incluía la rumiación intrusiva y deliberada, la severidad subjetiva, la supresión emocional, la revaluación cognitiva, el apoyo social, un espacio adecuado para conectarse a clases en línea y el nivel de estudios predecía en forma significativa la SPT. La rumiación deliberada, el apoyo social, la reevaluación cognitiva y la edad predecían el CPT. Se discute la relevancia de estos resultados para el apoyo que se podría brindar a los estudiantes.

Abstract Objective. To evaluate a predictive model of posttraumatic symptomatology (PTS) and posttraumatic growth (PTC), which included psychological, pandemic-related, and online classroom-related variables, in higher education students during the pandemic. Method. A total of 552 students participated, 68.5% of whom were women. Instruments were applied to measure different psychological variables. Results. It was established that a model that included intrusive and deliberate rumination, subjective severity, emotional suppression, cognitive reappraisal, social support, adequate space to connect to online classes, and educational attainment significantly predicted PTS. Deliberate rumination, social support, cognitive reappraisal, and age predicted CPT. The relevance of these findings to the academic support that could be provided to students is discussed.

Abstract Background and Aims: Colorectal cancer (CRC) is a heterogeneous disease with distinctive genetic pathways, such as chromosomal instability, microsatellite instability and methylator pathway. Our aim was to correlate clinical and genetic characteristics of CRC patients in order to understand clinical implications of tumour genotype. Methods: Single-institution retrospective cohort of patients who underwent curative surgery for CRC, from 2012 to 2014. RAS and BRAF mutations were evaluated with the real-time PCR technique Idylla®. Mismatch repair deficiency (dMMR) was characterized by absence of MLH1, MSH6, MSH2 and/or PMS2 expression, evaluated by tissue microarrays. Overall survival (OS) and disease-free survival (DFS) were assessed using survival analysis. Results: Overall, 242 patients were included (males 57.4%, age 69.3 ± 12.9 years; median follow-up 49 months). RAS-mutated tumours were associated with reduced DFS (p = 0.02) and OS (p = 0.045) in stage I-III CRC. BRAF-mutated tumours were more predominant in females and in the right colon, similarly to dMMR tumours. BRAF status did not influence OS (4 years)/DFS (3.5 years) in stage I-III disease. However, after relapse, length of survival was 3.5 months in BRAF-mutated tumours in contrast to 18.6 months in BRAF wild-type tumours (p = NS). No germline mutations in mismatch repair genes were so far identified in the patients with dMMR tumours. Molecular phenotype (RAS, BRAF and MMR) did not influence OS in metastatic patients. Our small sample size may be a limitation of the study. Conclusion: In our cohort, RAS-mutated tumours were associated with worse DFS and OS in early-stage CRC, whereas the remaining molecular variables had no prognostic influence.

Resumo Introdução: O cancro colo-rectal (CCR) é uma doença heterogénea, com vias genéticas distintas, nomeadamente instabilidade cromossómica, instabilidade de microssatélites e via metiladora. O nosso objetivo foi correlacionar as características clínicas e genéticas dos doentes com CCR e, deste modo, conhecer as implicações na prática clínica do genótipo tumoral. Métodos: Estudo de coorte retrospectivo unicêntrico de doentes diagnosticados com CCR e submetidos a cirurgia com intuito curativo, entre 2012 e 2014. As mutações RAS e BRAF foram avaliadas pela técnica de real time PCR Idylla®. A deficiência de mismatch repair(MMR) foi avaliada pela técnica de tissue microarrayse definida pela ausência de expressão de MLH1, MSH6, MSH2 e/ou PMS2. A sobrevivência global (SG) e a sobrevivência livre de doença (SLD) foram avaliadas por análise de sobrevivência. Resultados: No total, foram incluídos 242 doentes (homens 57.4%, idade 69.3 ± 12.9 anos, mediana de seguimento de 49 meses). Os tumores RAS-mutados associaram-se a menor SLD (p = 0.02) e SG (p = 0.045) em doentes com CCR estadio I-III. Os tumores BRAF-mutados foram mais frequentes em mulheres e nos tumores do cólon direito, assim como os tumores com deficiência para MMR. O status BRAF não influenciou a SG (4 anos)/SLD (3.5 anos) nos estadio I-III. Contudo, após a recidiva, o tempo de sobrevivência foi de 3.5 meses nos tumores BRAF-mutados, em comparação com 18.6 meses nos tumores sem esta mutação (p = NS). Não se identificaram mutações germinativas nos genes de mismatch repair nos doentes com tumores deficientes para estas proteinas (dMMR). O perfil molecular (RAS, BRAF e MMR)não influenciou a sobrevivência global dos doentes com metástases ao diagnóstico. O tamanho da amostra pode ser uma limitação do estudo. Conclusão: Na nossa coorte, os tumores RAS-mutados associaram-se a pior SLD e SG nos estádios precoces de CCR. Os restantes marcadores moleculares não influenciaram o prognóstico dos doentes.

RESUMO Introdução: Diversas patologias não infeciosas podem afetar a vulva, por vezes necessitando de realização de biopsia cutânea. O objetivo deste trabalho foi caracterizar todas as patologias vulvares não infeciosas em que foi realizada biopsia cutânea, num Hospital Central, durante um período de 10 anos. Métodos: Foi realizado um estudo retrospetivo de todas as patologias vulvares não infeciosas com confirmação histológica na nossa instituição, entre 1 de janeiro de 2008 e 31 de dezembro de 2017. Resultados: A amostra incluiu 323 biópsias de 317 doentes, entre os 11 e os 98 anos (média de idades de 54,2 anos), tendo sido identificadas 36 patologias distintas. As patologias neoplásicas foram as mais frequentes, nomeadamente as máculas pigmentadas da vulva (22,3%). A neoplasia maligna mais diagnosticada foi a neoplasia intraepitelial da vulva (6,2%) e o carcinoma espinocelular (5,6%). Já a dermatose inflamatória mais frequente foi o líquen escleroso (12,7%). Conclusão: A maior parte das biopsias envolveu patologias neoplásicas sendo a exclusão de malignidade o principal motivador da sua realização. Este estudo evidencia a grande diversidade de patologias não infeciosas que podem afetar a vulva e que são fonte de sofrimento e angústia, o que torna o seu correto diagnóstico e orientação essenciais.

ABSTRACT Introduction: The vulvar area may be affected by many noninfectious conditions with similar clinical appearance, requiring a cuta-neous biopsy. Our goal was to characterize the noninfectious vulvar diseases that required a biopsy in a southwestern Europe Central Hospital during a 10-year period. Methods: A retrospective study of all the noninfectious vulvar diseases with histological confirmation diagnosed in our institution was conducted be-tween January 1, 2008 and December 31, 2017. Results: The sample included a total of 323 biopsies from 317 patients, aged between 11 and 98 years (mean age of 54.2 years). A total of 36 vulvar diseases was identified. Neoplastic conditions were the most frequently found, particularly melanotic macules (22.3%). The most frequent malignant tumor was vulvar intraepithelial neoplasia (6.2%) and squamous cell carcinoma (5.6%). The most common dermatosis was lichen sclerosus (12.7%). Conclusion: Neoplasms were the most frequently diagnosed conditions affecting the vulvar area that required a biopsy. Ruling out malignancy was also the main reason to perform a biopsy. This study highlights the variety of noninfectious diseases that may affect the vulva and require a biopsy. Since vulvar diseases may be serious and carry high levels of patient distress a correct understanding of these conditions is crucial.

Resumo Fundamento: Embora a elevação não isquêmica da troponina seja frequentemente observada em pacientes admitidos no pronto-socorro (PS), não há consenso quanto ao seu manejo. Objetivos: Este estudo teve como objetivo caracterizar os pacientes admitidos no PS com elevação da troponina não-isquêmica e identificar potenciais preditores de mortalidade nessa população. Métodos: Este estudo observacional retrospectivo incluiu pacientes do PS com resultado positivo no teste da troponina entre junho e julho de 2015. Pacientes com diagnóstico clínico de síndrome coronariana aguda (SCA) foram excluídos. Os dados demográficos dos pacientes e as variáveis clínicas e laboratoriais foram extraídos dos prontuários médicos. Os dados do seguimento foram obtidos por 16 meses ou até a ocorrência de morte. O nível de significância estatística foi de 5%. Resultados: A elevação da troponina sem SCA foi encontrada em 153 pacientes no PS. A mediana (IIQ) de idade dos pacientes foi de 78 (19) anos, 80 (52,3%) eram do sexo feminino e 59 (38,6%) morreram durante o seguimento. A mediana do período de seguimento (IIQ) foi de 477 (316) dias. Os sobreviventes eram significativamente mais jovens 76 (24) vs. 84 (13) anos; p=0,004) e apresentaram uma maior proporção de elevação da troponina isolada (sem elevação da creatina quinase ou mioglobina) em duas avaliações consecutivas: 48 (53,9%) vs. 8 (17,4%), p<0,001. Os sobreviventes também apresentaram menor taxa de tratamento antiplaquetário e internação no mesmo dia. Na regressão logística multivariada com ajuste para variáveis significativas na análise univariada, a elevação isolada da troponina em duas avaliações consecutivas mostrou hazard ratio = 0,43 (IC95% 0,17–0,96, p=0,039); hospitalização, tratamento antiplaquetário anterior e idade permaneceram independentemente associados à mortalidade. Conclusões: A elevação isolada da troponina em duas medidas consecutivas foi um forte preditor de sobrevida em pacientes no PS com elevação da troponina, mas sem SCA.

Abstract Background: Although non-ischemic troponin elevation is frequently seen in patients admitted to the emergency department (ED), consensus regarding its management is lacking. Objectives: This study aimed to characterize patients admitted to the ED with non-ischemic troponin elevation and to identify potential mortality predictors in this population. Methods: This retrospective observational study included ED patients with a positive troponin test result between June and July of 2015. Patients with a clinical diagnosis of acute coronary syndrome (ACS) were excluded. Data on patient demographics and clinical and laboratory variables were extracted from medical records. Follow-up data were obtained for 16 months or until death occurred. The statistical significance level was 5%. Results: Troponin elevation without ACS was found in 153 ED patients. The median (IQR) patient age was 78 (19) years, 80 (52.3%) were female and 59(38.6%) died during follow-up. The median (IQR) follow-up period was 477(316) days. Survivors were significantly younger 76 (24) vs. 84 (13) years; p=0.004) and featured a higher proportion of isolated troponin elevation (without creatine kinase or myoglobin elevation) in two consecutive evaluations: 48 (53.9%) vs. 8 (17.4%), p<0.001. Survivors also presented a lower rate of antiplatelet treatment and same-day hospitalization. In the multivariate logistic regression with adjustment for significant variables in the univariate analysis, isolated troponin elevation in two consecutive evaluations showed a hazard ratio= 0.43 (95%CI 0.17–0.96, p=0.039); hospitalization, previous antiplatelet treatment and age remained independently associated with mortality. Conclusions: Isolated troponin elevation in two consecutive measurements was a strong predictor of survival in ED patients with troponin elevation but without ACS.

Resumo Este ensaio discute aspectos relativos à produção das textualidades indígenas, tomando como referência duas versões do Watunna, a cosmogonia ye’kwana: a do francês Marc de Civrieux e a do ye’kwana Marcos Rodrigues. Para tanto, acerca-se da pluralidade poética indígena do circum-Roraima, que é um rico espaço em termos de diversidade humana e cultural, localizado na tríplice fronteira Brasil-Guiana-Venezuela. Nossa proposta parte do pressuposto da necessidade de se cultivar uma área de investigação que aproxime a teoria literária da antropologia e que atente para as particularidades advindas das culturas e línguas indígenas. Isso significa que o registro escrito das artes verbais indígenas põe em jogo um processo complexo de criação, recriação, tradução e circulação, envolvendo não apenas uma dimensão poética, como também uma dimensão ética e política.

Abstract This essay discusses aspects related to the production of indigenous textualities, taking as reference two versions of Watunna, the Ye'kwana cosmogony: that of the French Marc de Civrieux and that of the Ye’kwana Marcos Rodrigues. To do so, we approach the indigenous poetic plurality of circum-Roraima, which is a rich space in terms of human and cultural diversity, located on the triple border Brazil-Guyana-Venezuela. Our proposal assumes the need to cultivate an area of investigation that brings literary theory closer to anthropology and that takes into account the particularities arising from indigenous cultures and languages. This means that the written record of indigenous verbal arts brings into play a complex process of creation, recreation, translation, and circulation, involving not only a poetic dimension, but also an ethical and political one.

Résumé L'essai aborde certains aspects concernant la production des textualités indigènes, en prenant comme référence deux versions de Watunna, la cosmogonie ye'kwana: celle du Français Marc de Civrieux et celle du Ye’kwana Marcos Rodrigues. Pour ce faire, nous abordons la pluralité poétique indigène du circum-Roraima, qui est un espace riche en termes de diversité humaine et culturelle, situé sur la triple frontière Brésil-Guyane-Venezuela. Nous considérons ainsi la nécessité de cultiver un champ d'investigation qui rapproche la théorie littéraire de l'anthropologie et qui s'occupe des particularités issues des cultures et des langues autochtones. Ce qui signifie que les archives écrites des arts verbaux autochtones mettent en jeu un processus complexe de création, de recréation, de traduction et de circulation, impliquant non seulement une dimension poétique, mais aussi une dimension éthique et politique.

Background and objectives: To evaluate RRT benefits and risks and to inform patients and their families about ESRD treatment options, we have developed a prognostic score to predict 6-month mortality in elderly ESRD patients initiating dialysis. Five independent predictors were identified and a point system was constructed: age 75 years or older (2 points), coronary artery disease (2 points), cerebrovascular disease with hemiplegia (2 points), time of nephrology care before dialysis [< 3.0 months (2 points); ≥ 3 to < 12 months (1 point)], serum albumin levels [3.0 - 3.49 g/dL (1 point); < 3.0 g/dL (2 points)]. Model performance was good in both discrimination and internal validation. Before adopting our risk score into practice, our aim is to externally validate this initial predictive model by assessing its performance on a new data set. Methods: We apply the predictive score developed in a cohort of CKD patients, aged 65 years and over who started dialysis between 2009 and 2016, to an independent cohort of ESRD patients, aged 65 years and over who started dialysis between 2017 and 2019, in our Nephrology department. The performance of the prediction equation created in development cohort, was assessed using discrimination and calibration metrics in the validation cohort. Results: Our validation study cohort included 168 individuals, with a mortality rate of 12.5% (n=21) within 6-months of dialysis initiation. Model performance in the validation cohort had an acceptable discrimination [AUC of 0.79; (95% confidence interval, 0.70 to 0.88)]. The Hosmer and Lemeshow goodness-of-fit test was not statistically significant, indicating good calibration of the model (χ2, 5 degrees of freedom = 2.311; P = 0.805). Conclusions: Our predictive simple score based on readily available clinical and laboratory data demonstrates a good performance when externally validated, namely with respect to discrimination and calibration. Model validation is crucial for adequately informing patients and their families about ESRD treatment options and providing a more patient-centered overall approach to care. Before we start general implementation in clinical practice, our score needs further validation in larger patient cohorts.

Abstract Extramammary Paget disease is a rare neoplastic condition that more commonly affects postmenopausal Caucasian women. Although the vulvar area is the most frequently affected location, it corresponds solely to 1 to 2% of all vulvar malignancies. A 72-year-old female patient was observed in our outpatient clinic with a 2-year history of an erythematous and pruritic plaque on the vulva. Histopathology and immunohistochemistry studies were compatible with extramammary Paget disease of the vulva. Associated neoplastic conditions were excluded. Due to multiple relapses, the patient was submitted to three surgical interventions, including a total vulvectomy, and to external radiotherapy. The present case illustrates the chronic and recurrent nature of extramammary Paget disease despite aggressive procedures as well as the challenge in obtaining tumor-free resection margins.

Resumo Portugal possui alguns centros de reabilitação de animais silvestres, responsáveis pela reabilitação e reintrodução de aves, entre outros animais, na natureza. Os coccídios parasitas dessas aves silvestres em centros de reabilitação são especialmente importantes porque esses centros podem introduzir espécies de coccídios em novos ambientes através da reintrodução de seus respectivos hospedeiros. Neste contexto, o presente estudo visou identificar coccídios intestinais de aves silvestres em dois centros de reabilitação de animais silvestres localizados em dois municípios de Portugal. Oitenta e nove aves silvestres de 9 ordens e 11 famílias foram amostradas, das quais 22 (25%) foram positivas para coccídios. Avispora spp. foram encontradas em aves de rapina. Esporocistos de coccídios da subfamilia Sarcocystinae foram encontrados em corujas. Uma Isospora sp. foi encontrada em Turdus merula Linnaeus, 1758 e uma Eimeria sp. foi encontrada em Fulica atra Linnaeus, 1758. Entre as espécies de coccídios, Avispora bubonis (Cawthorn, Stockdale, 1981) pode ser destacada. O encontro dessa espécie indica que a transmissão de coccídios do Novo Mundo para o Velho Mundo pode estar ocorrendo, potencialmente através da dispersão por Bubo scandiacus (Linnaeus, 1758) pelas regiões árticas ou por meio de atividades antrópicas, e/ou através de outros mecanismos desconhecidos.

Abstract Portugal has some rehabilitation centers for wild animals, which are responsible for the rehabilitation and reintroduction of birds, among other animals, into the wild. Coccidian parasites of these wild birds in rehabilitation centers are especially important because these centers can introduce coccidian species into new environments through the reintroduction of their respective hosts. In this context, the current study aimed to identify intestinal coccidia from wild birds at two rehabilitation centers for wild animals located in two municipalities of Portugal. Eighty-nine wild birds of 9 orders and 11 families were sampled, of which 22 (25%) were positive for Coccidia. Avispora spp. were found in raptors. Sporocysts of Sarcocystinae subfamily were recovered from owls. An Isospora sp. was found in Turdus merula Linnaeus, 1758, and an Eimeria sp. was found in Fulica atra Linnaeus, 1758. Among the coccidian species, Avispora bubonis (Cawthorn, Stockdale, 1981) can be highlighted. The finding of this species indicates that transmission of coccidians from the New World to the Old World may be occurring, potentially through dispersion by Bubo scandiacus (Linnaeus, 1758) through Arctic regions or by means of anthropic activities, and/or through other unknown mechanisms.

RESUMO Introdução: Doença renal crônica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular (DCV), particularmente em idosos, o segmento de crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT. Neste artigo caracterizamos uma coorte de idosos com DRC, referenciados para a nefrologia, com particular ênfase para o risco e carga de doença cardiovascular. Métodos: Foram incluídos todos os pacientes com DRC com 65 anos ou mais encaminhados ao nosso departamento em 2012. Os dados basais incluíram: demografia, estágio da DRC, medicação e comorbidades. A taxa de filtração glomerular (TFGe) foi calculada pela fórmula CKD-EPI. Resultados: Metade dos 416 pacientes incluídos foram encaminhados por médicos da atenção primária; sua idade era 77 ± 7 anos; 52% eram homens; a TFGe mediana era de 32 mL /min/1,73 m2. Metade tinha diabetes (DM), 85% dislipidemia, 96% hipertensão; 26% eram fumantes atuais/ antigos; 24% tinham índice de massa corporal > 30 kg/m2. A prevalência de DCV foi de 62%, sendo maior entre pacientes nos estágios 4-5; em diabéticos, aumentou gradualmente com a progressão da DRC (estágio 3a < estágio 3b < estágio 4-5) (39%, 58%, 82%; p < 0,001). Conclusões: A coorte de idosos com DRC apresentava inicialmente maior carga de DCV. A prevalência de DCV foi maior que em outras coortes europeias com DRC. Níveis menores de TFGe foram associados a carga maior de DCV e foram mais pronunciados entre diabéticos, destacando a importância de objetivar estrategicamente a redução do risco cardiovascular nesses pacientes.

ABSTRACT Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.

Background: The goal of this study was to compare the risk of peritoneal dialysis-related infections in younger and older patients and to identify risk factors for infection in elderly patients. Methods: We performed a longitudinal retrospective study on a population of Portuguese peritoneal dialysis patients treated at the same center between January 2005 and December 2015. Clinical and laboratory data were collected from medical reports. Two groups of patients were compared: non elderly (< 65 years) and elderly (≥ 65 years). Results: Among 100 patients, there were 73 non elderly (median age 52 years) and 27 elderly (median age 74 years). Elderly patients were not associated with higher PD-infection rates or with less time to PD-related infections. Cerebrovascular disease was the only significant adverse predictor of peritonitis in elderly (crude HR 3.8; 95% CI 1.10 to 13.34; P = 0.035) and those with higher levels of serum albumin were less likely to developperitonitis (crude HR 0.47 per each g/dl of increase; 95% CI 0.24 to 0.89; P = 0.023). Conclusions: In our study, elderly patients did not present a greater risk for peritonitis or catheter-related infections.

Background: Juxta-anastomotic stenosis (JAS) is a common complication of radiocephalic arteriovenous fistulas. There is diverging data as to the best therapeutic approach being angioplasty or surgery. Pre-operative color Doppler ultrasound (CDU) is accurately used for initial assessment of the vascular access and follow-up monitoring. The aim of this study was to evaluate immediate and long-term results of endovascular versus open surgical intervention of juxta-anastomotic venous stenosis of forearm radiocephalic fistulas and to test if CDU assessment can be used to ameliorate preoperative strategy and long-term outcomes. Methods: This retrospective cohort study included 63 patients with JAS radiocephalic fistulas referred to vascular access consultation. CDU was used to assess preoperative morphological, functional and hemodynamic stenosis characteristics and according to specific criteria, allocate patients to endovascular or surgical treatment. Results: Surgical revision was proposed in 68.2% of patients (N=43), namely the creation of a new proximal fistula (N=41), while angiographic evaluation was proposed in 31.7% of the cases (N=20). Mean follow-up time was 720±524 days with a maximum follow-up of 4.6 years. In the surgical group, primary patency was 92% and 84% at 6 and 12 months respectively, while in the endovascular group, it was 76% and 47% (p=0.013). There was no significant difference in the assisted primary patency between the interventional groups at 12 months: 94% in the endovascular vs. 93% in the surgical group (p=0.542). Conclusion: Pre-operative CDU assessment of JAS and specific allocation criteria with an access-centered approach choosing the best option in each fistula allowed the correct diagnosis of the lesion, improved the global results of the treatment and optimized the financial resources by reserving PTA for selected cases where surgery could be more difficult with higher risk of access loss

ABSTRACT Objective: to build municipal responsibility with the permanent education in health policy from the interaction between research and innovation of work practices. Method: experience reports structured through dialogic meetings that allowed the participative diagnosis and strategic administration considering research in health education. Results: from the activities and interactions, we identified active forces in the reinvention of training for workers in the municipal network of health services, in which we found three streams: “inside and outside interactions”, “movement towards meetings” and “strategic collective arrangements”. Final considerations: through action research and a collaborative critique, collective movements were constructed, they showed ways to produce new directions in health education and allowed the strategic creation of the Núcleo de Educação Permanente as a responsibility of the municipal government, not depending on Federal policies.

RESUMEN Objetivo: construir responsabilidad municipal con la política de educación permanente en la salud a partir de la interacción entre prácticas de investigación e innovación en el trabajo. Método: relato de experiencia con estructuración de encuentros dialógicos que posibilitaran el diagnóstico participativo y la gestión estratégica articulada a la investigación en enseñanza de la salud. Resultados: con las actividades y la interacción identificamos fuerzas activas en la reinvención de la formación de trabajadores insertos en la red de servicios sanitarios en esfera municipal, y fue posible comprender tres flujos: “interacciones dentro y fuera”, “movimientos de encuentros” y “arreglos colectivos estratégicos “. Consideraciones finales: la investigación-acción colaborativa-crítica posibilitó la construcción de movimientos colectivos que apuntaron caminos para la producción de nuevos sentidos en la formación en salud y permitieron la creación estratégica del Núcleo de Educación Permanente en Salud, como tarea de gestión municipal independiente de la política del gobierno federal.

RESUMO Objetivo: construir responsabilidade municipal com a política de educação permanente na saúde a partir da interação entre práticas de pesquisa e inovação no trabalho. Método: relato de experiência com estruturação de encontros dialógicos que possibilitaram o diagnóstico participativo e a gestão estratégica articulada à pesquisa em ensino da saúde. Resultados: com as atividades e a interação identificamos forças ativas na reinvenção da formação de trabalhadores inseridos na rede de serviços sanitários na esfera municipal, em que foi possível compreender três fluxos: “interações dentro e fora”, “movimentos de encontros” e “arranjos coletivos estratégicos”. Considerações finais: a pesquisa-ação colaborativo-crítica possibilitou a construção de movimentos coletivos que apontaram caminhos para produção de novos sentidos na formação em saúde e oportunizaram a criação estratégica do Núcleo de Educação Permanente em Saúde, como tarefa de gestão municipal não dependente da política de governo federal.