ABSTRACT Wunderlich syndrome is a rare condition characterized by atraumatic spontaneous renal hemorrhage that can have serious associated complications, especially in chronic kidney disease and end-stage kidney disease patients due to their complexity. Diagnosis requires a high index of suspicion, since its classical presentation with Lenk’s triad is only seen in less than a quarter of patients. Early detection is of outmost importance because of this syndrome potential for causing hemodynamic instability and shock. Spontaneous renal hemorrhage has been reported much less frequently in peritoneal dialysis as compared to hemodialysis. To our knowledge, only 3 single-cases involving peritoneal dialysis patients were published since the year 2000. We describe an uncommon case report of a 68-year-old male undergoing continuous ambulatory peritoneal dialysis for 5 years and taking warfarin for permanent atrial fibrillation who developed Wunderlich syndrome presenting with Lenk’s triad. The patient was managed with percutaneous drainage of the renal hemorrhage and was able to continue peritoneal dialysis in the acute phase of disease. Unfortunately, he subsequently developed peritoneal membrane failure having to transition to hemodialysis 2.5 months after the WS episode. The authors will review literature on Wunderlich syndrome on end-stage kidney disease patients, discuss oral anticoagulation on peritoneal dialysis patients, maintenance of the technique, and finally, address the consequences of Wunderlich syndrome on peritoneal membrane diffusion capacity.

ABSTRACT Pembrolizumab is an immune checkpoint inhibitor used as a cancer therapy. The incidence of immune related adverse events in patients receiving immune checkpoint inhibitors can be as high as 59%-85. Renal adverse effects are uncommon, but the incidence of kidney toxicity related to pembrolizumab is rising as the use of this agent becomes more frequent. We present an uncommon case of biopsy-proven acute interstitial nephritis secondary to pembrolizumab in a patient with metastatic squamous cell carcinoma at the time of his fourth scheduled cycle. Despite the good initial tumor response, pembrolizumab had to be suspended and the patient started on corticosteroids with an initial good response. On his own initiative, the patient stopped prednisolone early, leading to a rebound acute kidney injury. Pembrolizumab was not reintroduced for the risk of further renal function worsening. His clinical status declined due to the progression of the neoplastic disease, and he was referred for palliative care. This case illustrates the importance of systematizing some key points in the approach to acute interstitial nephritis secondary to pembrolizumab: the role of the differential diagnosis of acute kidney injury in a patient under an immune checkpoint inhibitor, the role of glucocorticoids and the controversy about rechallenging this drug after a related acute interstitial nephritis.

There is long-standing evidence that thyroid disease and kidney disease have a two-way relationship, as they can aggravate and lead to each other. The exact nature of this association and its clinical implications have been a matter of debate, as co-sharing of risk factors and appropriate prospective studies that allow for causal relationships to be inferred are lacking. Hypothyroidism is currently regarded by the American Heart Association as a modifiable cardiovascular risk factor and a reversible cause of heart failure. Among the nephrology community, while hypothyroidism has been an increasingly prevalent issue, formal guidelines on how to proceed when such association occurs are lacking and its clinical implications are often underappreciated among practitioners. Whether renal disease caused the thyroid disturbance or vice-versa, there is evidence pointing to thyroid dysfunction being a risk factor for incident chronic kidney disease and its progression and it is linked to increased overall mortality in CKD patients. The authors provide a review of current scientific evidence on this complex relationship.

Self compacting concrete (SCC) requires a large quantity of fine materials compared to common concrete. In this work waste glass powder was used to replace (50%) of filler required. Two types of SCC were manufactured, a control SCC type (CTL) using cement and limestone filler and another with glass powder replacing 50% of the filler. Mechanical and durability properties, namely, compressive strength, resistivity, chloride ion penetration, carbonation, capillary water absorption and oxygen permeability were assessed on both SCC types. It could be concluded that waste glass powder can be used successfully in SCC improving chloride penetration and water absorption by capillarity and maintaining strength levels. The potential risk of alkali-silica observed on mortar was mitigated when incorporating glass powder.

Objectives: This study evaluated the development of the therapeutic alliance and the emergence of alliance ruptures, in a sample of patients with different diagnosis and different therapeutic outcome. Design: We examined the longitudinal data of 38 therapeutic dyads receiving cognitive-behavioural therapy, including dropouts as well as successful and unsuccessful cases. The sample included cases with Axis I and Axis II disorders. Method: At the end of each session, patients evaluated the alliance using the Working Alliance Inventory (WAI). Six judges trained in the observation of alliance rupture markers with an observational system of ruptures, rated 201 videotaped sessions. Longitudinal statistical models were applied to the data. Results: We found that the pattern of alliance development of successful cases was different from the unsuccessful and dropouts cases. In addition on average, patients with personality disorders began therapy with a lower WAI score that decreased over time, whereas patients with Axis-I disorders began therapy with a higher WAI score that increased over time.

Objetivos: Este estudio evaluó el desarrollo de la alianza terapéutica y la aparición de rupturas de alianzas, en una muestra de pacientes con diferentes diagnósticos y resultados terapéuticos. Diseño: Se analizaron los datos longitudinales de 38 diadas terapéuticas que recibieran terapia cognitivo-conductual. La muestra incluyó a casos de abandonos, asi como casos exitosos y no exitosos. La muestra incluyó a casos con trastornos del Eje I y Eje II. Método: Al final de cada sesión, los pacientes evaluaron la alianza mediante el Inventario de Alianza de Terapéutica (WAi). Seis jueces entrenados en la observación de los marcadores de ruptura de alianza con un sistema de observación de rupturas, codificaran 201 sesiones terapéuticas grabadas en video. Se aplicaran modelos estadísticos longitudinales a los datos. Resultados: Se encontró que el patrón de desarrollo de la alianza de los casos de éxito era diferente de la de los casos sin éxito y abandonos. En media, los pacientes con trastornos de la personalidad iniciaran la terapia con una menor puntuación en el WAI que disminuyó con el tiempo, mientras que los pacientes con trastornos del Eje I iniciaran la terapia con una mayor puntuación en el WAI que aumentó con el tiempo.

Cork powder, the major waste from cork processing industries, is generated from grinding, cutting and finishing operations throughout the industrial cork process. Cork powder has been used mainly as fuel in cork industries. Cork waste ash is usually landfilled but if efficiently used in cement based construction materials it could contribute to sustainability. Strength and durability testing was undergone on mortar with 10 and 20% cement replacement with cork waste ash. Although strength is acceptable for 10% cement replacement with cork ash (5% loss at 90 days, compared to control), most durability properties (tested up to 6 months according to test type) reduced performance probably due to a broader pore structure caused by coarse particles in the ash which tested non pozzolanic. Moreover, cork waste ash does not present the necessary requirements in terms of chemical properties considering several standards. Present work has revealed that this cork waste cannot be used as a pozzolan or as a filler in cement based materials. In fact it is known that chemical composition of biomass ash is highly variable due to moisture variations, ash yield and different genetic types of inorganic matter in biomass and therefore it is important to pinpoint which types of biomass waste are adequate or not to use as cement replacement in construction.

A redução de riscos associada ao trabalho sexual é hoje a política de intervenção de muitos projetos implementados em diversas partes do mundo com as pessoas que prestam serviços sexuais. Nesta investigação tivemos como objetivo conhecer a intervenção na área de redução de riscos associada ao trabalho sexual em Portugal, através do discurso dos técnicos de saúde dos projetos de redução de riscos, analisando os significados que estes constroem e veiculam. Nomeadamente, almejámos compreender as características que atribuem aos/às trabalhadores/as do sexo, a forma como qualificam as práticas de intervenção e a análise que fazem do seu trabalho e das implicações deste na sua saúde. Para tal, depois de efetuado um mapeamento dos projetos existentes, construímos um questionário que foi distribuído pela totalidade dos técnicos envolvidos. A devolução foi de cerca de 72% dos questionários (n = 60) cujas respostas analisámos. Os resultados da investigação apontam, entre outras, para uma visão compreensiva do trabalho sexual e dos seus atores e para uma especificidade da intervenção, que se centra na pessoa que faz trabalho sexual e que tem objetivos de empoderamento, apesar dos projetos ainda se centrarem maioritariamente na prevenção de doenças. Quanto à perceção sobre o impacto na sua saúde, metade dos técnicos considera que os aspetos positivos e negativos do trabalho não afetam subjetivamente a sua saúde, enquanto que a outra metade aponta implicações maioritariamente negativas, tais como o desgaste e o risco de contração de doenças ou infeções.

Sex work harm reduction is the intervention strategy of many projects implemented around the world towards people involved in sex industry. This study aimed to know sex work harm reduction in Portugal by knowing and understanding the discourse of health professionals who intervene with sex workers in harm reduction projects. In particular, we aimed to understand the characteristics professionals ascribe to sex workers, how they qualify the intervention practices, and the analysis they make of their work and its implications on their health. For this purpose, after mapping the existing projects, we constructed a questionnaire distributed to all the health professionals involved. At the end, we obtained 60 questionnaires, about 72% of the total of the professionals involved, and we analyzed the answers. The research results indicate, among others, a comprehensive view of sex work and sex workers. Also, despite the projects still focus mainly on the prevention of diseases, there is a need for intervention aiming the empowerment. Regarding the perception of the impact on their health, half of the professionals considers that the positive and negative aspects of the work does not affect their health subjectively, while the other half point mostly negative implications, such as wearing out and the risk of contracting diseases or infections.

O presente artigo procura ilustrar o modo como os desenvolvimentos das neurociências cognitivas poderão ajudar a compreender alguns dos processos psicológicos básicos e, simultaneamente, ser traduzidos para importantes domínios da psicologia aplicada, particularmente no domínio clínico. Exemplificaremos a partir de algumas linhas de investigação programática em curso nas diferentes subsecções do Laboratório de Neuropsicofisiologia da Escola de Psicologia da Universidade do Minho. As potencialidades metodológicas proporcionadas pela neurofisiologia, neuroimagiologia, neuromodelação, psicofisiologia, neurobioquímica e neurogenética serão exemplificadas nas suas aplicações à linguagem (e suas implicações para a compreensão da esquizofrenia), funcionamento sócio-cognitivo (e implicações para a compreensão das perturbações do neurodesenvolvimento), funcionamento executivo (com implicações para a compreensão das perturbações do espectro obsessivo), empatia (e implicações para a compreensão da psicoterapia), mecanismos de stress (com implicações para a compreensão das perturbações de ansiedade), e, finalmente, comportamento animal (com implicações para o conhecimento dos sistemas sensoriais e perceptuais).

The present article illustrates how developments in the cognitive neurosciences may contribute to the understanding of basic psychological processes and, simultaneously, translating this understanding to applied psychology, particularly in the clinical domain. We will illustrate with examples of current programmatic lines being carried out in the different subsections of the Neuropsychophysiology Lab at the School of Psychology at the University of Minho. The methodological potentialities available in neurophysiology, neuroimagiology, neuromodulation, psychophysiology, neurobiochemistry and neurogenetics will be exemplified in their applications to language (and the understanding of schizophrenia), social-cognitive functioning (and the understanding of neurodevelopmental disorders), executive functioning (and obsessive spectrum disorders), empathy (and its implications for psychotherapy), stress mechanisms (implications for the understanding of anxiety disorders) and, finally, animal.

Neste trabalho, cinzas de casca de arroz (RHA) e cinzas de cama de frango (BBA), dois resíduos agrícolas, foram avaliadas para uso como substitutos parciais do cimento para produção de concreto leve. Características físicas e químicas de RHA e BBA foram analisadas. Três tipos semelhantes de concreto leve foram produzidos, um controle em que o ligante era totalmente cimento CEM I (CTL) e dois outros tipos de concreto, com substituição de 10% com RHA e BBA, respectivamente. Todos os tipos de concreto leve foram feitos através do ajuste da quantidade de superplastificante para apresentarem a mesma trabalhabilidade. Propriedades de concreto investigados foram resistência à compressão e à flexão em diferentes idades, a absorção por capilaridade, resistividade e resistência à penetração de íons cloreto (método CTH) e carbonatação acelerada. Os resultados dos testes obtidos para o nível de 10% de de substituição de cimento em concreto leve indicam que, embora a adição de BBA tenha conduzido a desempenho inferior em termos dos testes indicativos de degradação, a RHA levou à melhoria das propriedades mecânicas, especialmente resistência inicial e também resultados relacionados ao envelhecimento acelerado, contribuindo para a construção sustentável.

In this study rice husk ash (RHA) and broiler bed ash from rice husk (BBA), two agricultural waste materials, have been assessed for use as partial cement replacement materials for application in lightweight concrete. Physical and chemical characteristics of RHA and BBA were first analyzed. Three similar types of lightweight concrete were produced, a control type in which the binder was just CEMI cement (CTL) and two other types with 10% cement replacement with, respectively, RHA and BBA. All types of similar lightweight concrete were prepared to present the same workability by adjusting the amount of superplasticizer. Properties of concrete investigated were compressive and flexural strength at different ages, absorption by capillarity, resistivity and resistance to chloride ion penetration (CTH method) and accelerated carbonation. Test results obtained for 10% cement replacement level in lightweight concrete indicate that although the addition of BBA conducted to lower performance in terms of the degradation indicative tests, RHA led to the enhancement of mechanical properties, especially early strength and also fast ageing related results, further contributing to sustainable construction with energy saver lightweight concrete.

CONTEXTO: As dificuldades de regulação emocional estão presentes em vários quadros psicopatológicos, sendo necessário o recurso a um instrumento que as possa medir adequadamente. OBJECTIVOS: Fazer a adaptação para o português da Escala de Dificuldades de Regulação Emocional e analisar as suas qualidades psicométricas. Um segundo objectivo do estudo era o de explorar a associação entre as dimensões da DERS e sintomas psicopatológicos específicos. MÉTODO: A escala original foi traduzida para o português e preenchida por uma amostra de 324 sujeitos que também preencheram o Inventário Breve de Sintomas. RESULTADOS: Os resultados revelam uma estrutura factorial muito semelhante à da versão original, bons valores de estabilidade temporal, de consistência interna (Cronbach's α = ,93) e bons níveis de validade externa com o BSI. A análise realizada com o subgrupo de 115 sujeitos que compuseram a amostra clínica revelou que os indivíduos com psicopatologia apresentam mais dificuldades de regulação emocional do que os indivíduos normais. Por meio da análise de correlação entre as diferentes subescalas da DERS e do BSI, verificamos que as subescalas Estratégias e Objectivos apresentam o valor mais elevado de associação com todos os sintomas psicopatológicos. DISCUSSÃO: Esses resultados sugerem que essas duas dimensões são transversais às várias perturbações psicopatológicas e poderiam, por isso, ser incluídas em intervenções psicológicas focadas na capacidade de regulação emocional.

BACKGROUND: Emotion dysregulation is a unifier dimension of several psychopathological symptoms thus an instrument that measures it is needed. OBJECTIVES: To adapt to Portuguese the Difficulties in Emotion Regulation Scale and study its psychometric qualities. A second goal was to explore the association between DERS dimensions and specific types of psychopathology symptoms. METHOD: The original measure was translated to Portuguese and completed by a sample of 324 individuals who also completed the Brief Symptom Inventory. RESULTS: The results show a very similar factor structure to the original measure: good testretest stability, very good internal consistency (Cronbach's α = ,93) and good external validity with BSI. The analysis performed with the subset of 115 individuals that composed the clinical sample showed that psychopathologic individuals present more difficulties in emotion regulation than normal individuals. Through the correlation analysis between the different DERS and BSI subscales, we found that the Strategies and Goals subscales present the highest level of association with all the psychopathological symptoms. DISCUSSION: This may suggest that these two dimensions are present in various psychological disorders and could, therefore, be included in psychological interventions focused on emotion regulation skills.

Este artigo apresenta as premissas básicas de uma abordagem relacional em psicoterapia, nomeadamente no que diz respeito às origens de natureza interpessoal da psicopatologia e consequentemente ao modo como a experiencia relacional que a psicoterapia oferece, pode servir para alterar os esquemas interpessoais disfuncionais do paciente subjacentes aos sintomas. Na 2ª parte do artigo, apresentamos as implicações clínicas do conceito do conceito de Rupturas na Aliança Terapêutica, entendidas como um comprometimento ou quebra na relação colaborativa entre terapeuta e paciente. Seguindo a conceptualização de Aliança de Bordin, as rupturas podem consistir num desacordo ao nível das tarefas ou objectivos do processo ou numa tensão no vínculo. São revistos os resultados mais relevantes que têm sido encontrados sobre o modo como estes ciclos interpessoais entre terapeuta e paciente podem conduzir à mudança quando eficazmente geridos, ou a resultados pobres ou finalizações unilaterais quando não resolvidos. Tendo já acumulado evidência para a importância da aliança terapêutica, uma segunda geração de investigadores na aliança, tem procurado compreender o modo como a aliança é, em si mesma, um mecanismo de mudança. Os resultados que aqui são revistos sugerem que o processo de reparação de alianças enfraquecidas pode oferecer uma resposta a esta questão.

This article presents the basic theoretical assumptions of a Relational Approach to Psycho-therapy, particularly in what concerns the interpersonal roots of psychopathology and consequently the way the relational experience therapy provides, may serve to change the client’s dysfunctional interpersonal schema subjacent to symptoms. In the second part of the article we present the clinical implications of the concept of Ruptures in Therapeutic Alliance, seen as a tension or breakdown in the collaborative relationship between therapist and patient. Following Bordin’s conceptualization of the alliance, ruptures may consist of a disagreement about the tasks or the goals of treatment or a strain in the bond. The most important findings that have been collected about the way these interpersonal cycles between therapist and patient can lead to change when efficiently addressed, or to poor outcome or unilateral termination when unresolved, are reviewed. Having already accumulated enough evidence about the importance of the therapeutic alliance, a second generation of alliance researchers is now trying to understand the way the alliance is a mechanism of change. The findings we review suggest that the process of repairing weakened alliances may offer an answer to that question.

O objectivo deste estudo exploratório é investigar a atitude das mulheres relativamente à amamentação. Participaram 460 mulheres, com mais de 14 anos de idade, com escolaridade superior ao 1.º ciclo do ensino básico, que constituíram uma amostra de conveniência. Responderam a um questionário de auto preenchimento, que incluía a caracterização sócio demográfica e uma escala de atitudes para com a amamentação.

The aim of the present exploratory study is to identify attitudes to breast-feeding of a sample of Portuguese women. Participants constitute a convenience sample of forty hundred sixty women with more than fourteen years of age, and school level above the first level of the basic school. Participants fulfil a questionnaire that includes a demographic questionnaire and an attitude questionnaire to breast-feeding.

O objectivo deste estudo foi descrever as crenças de saúde em homens com mais de 50 anos e investigar a sua influência nos comportamentos de adesão a exames de rasteio do cancro da próstata (toque rectal). Participaram neste estudo 80 homens com idade igual ou superior a 50 anos, de nacionalidade portuguesa e com ausência de anterior registo de cancro da próstata. Para avaliar as crenças de saúde dos sujeitos recorremos ao Modelo de Crenças de Saúde como suporte teórico e utilizámos uma adaptação para a língua portuguesa e para o Cancro da Próstata, da Escala de Crenças de Saúde aplicada ao Cancro da Mama, desenvolvida por Champion (1993).

This study aims to describe the health beliefs of man over 50 and to study it’s impact on prostate cancer screening (digital rectal examination). The sample consisted of 80 Portuguese male individuals older than 50 and with absence of previous prostate cancer records. To evaluate the health beliefs we took advantage of the Health Belief Model (HBM) as a theoretic support and we used an adaptation for Portuguese and for prostate cancer of the Health Belief Scale applied to breast cancer developed by Champion (1993).