Resumen: Esta investigación buscó adaptar y obtener evidencias de validez de la estructura interna de la Escala de Experiencias de Microagresiones LGBT en el Trabajo (EEM-LGBT) para el contexto brasileño. Participaron 226 profesionales que se identificaron como LGBT, con una edad media de 28.5 años (DE = 7.19), que respondieron el EEM-LGBT y un cuestionario sociodemográfico. El proceso de adaptación de EEM-LGBT siguió las etapas de traducción, síntesis, evaluación de expertos, evaluación de la audiencia objetivo y retrotraducción. Para evaluar la plausibilidad de la estructura tridimensional, se realizó un análisis factorial confirmatorio. La versión portuguesa presentó CVI adecuado, según los jueces expertos. La estructura tridimensional propuesta presentó un excelente ajuste a los datos (χ2/gl = 1.22; CFI = .994; TLI = .993; SRMR = .076; RMSEA = .031) y buenos índices de confiabilidad (alfa de Cronbach y confiabilidad compuesta ≥ .84). La versión adaptada del EEM-LGBT fue de calidad satisfactoria, lo que lo convierte en el primer instrumento en el contexto brasileño para investigar experiencias de microagresiones LGBT en el trabajo.

Abstract: This research aimed to adapt and obtain validity evidence of the internal structure of the LGBT Microaggression Experiences at Work Scale (LGBT-MEWS) for the Brazilian context. The sample consisted of 226 professionals who identified themselves as LGBT, with a mean age of 28.5 years (SD = 7.19) who answered the LGBT-MEWS and a sociodemographic questionnaire. The LGBT-MEWS adaptation process followed the stages of translation, synthesis, evaluation by expert judges, evaluation by the target population, and back translation. Confirmatory factor analysis was performed to assess the plausibility of the three-dimensional structure (workplace values, heteronormative assumptions, and cisnormative culture). The Brazilian version presented adequate CVI, according to expert judges. The proposed three-dimensional structure presented an excellent fit to the data (χ2/df = 1.22; CFI = .994; TLI = .993; SRMR = .076; RMSEA = .031), and good reliability indices (Cronbach's alpha and composite reliability ≥ .84). The adapted version of the LGBT-MEWS presented satisfactory quality, making it the first instrument in the Brazilian context to investigate experiences of LGBT microaggressions at work.

Resumo: Esta pesquisa buscou adaptar e obter evidências de validade de estrutura interna da Escala de Experiências de Microagressões LGBT no Trabalho (EEM-LGBT) para o contexto brasileiro. Participaram 226 profissionais que se identificaram como LGBT, com idade média de 28,5 anos (DP = 7,19) que responderam à EEM-LGBT e um questionário sociodemográfico. O processo de adaptação da EEM-LGBT seguiu as etapas de tradução, síntese, avaliação por experts, avaliação pelo público-alvo e tradução reversa. Para avaliar a plausibilidade da estrutura tridimensional (valores no local de trabalho, suposições heteronormativas e cultura cisnormativa) foi realizada análise fatorial confirmatória. A versão em português apresentou IVC adequado, segundo juízes experts. A estrutura tridimensional proposta apresentou um ótimo ajuste aos dados (χ2/gl = 1,22; CFI = 0,994; TLI = 0,993; SRMR = 0,076; RMSEA = 0,031) e bons índices de confiabilidade (alfa de Cronbach e confiabilidade composta ≥ 0,84). A versão adaptada da EEM-LGBT apresentou qualidade satisfatória, tornando-se o primeiro instrumento no contexto brasileiro destinado a investigar experiências de microagressões LGBT no trabalho.

Abstract The developed study aims to explore the public communication of the Lisbon City Council (LCC) with a focus on climate change. The specific objectives are to highlight the environmental themes addressed in LCC’s public communication, to allow comparison with the goals of the EU Green Deal. In this sense, the study tends to be deductive and comparative. In order to fulfil the objectives, a mapping of the communication initiatives was carried out, through documentary research and direct observation. The contents shared on the official LCC pages on social networks are identified and systematized on their Facebook, Instagram, Twitter, and LinkedIn profiles, as well as on the Facebook and Instagram pages of Lisboa Capital Verde 2020. Direct observation of LCC events was held between October 2021 and March 2022. This involved observing and recording events based on an original theoretical model guiding data collection. The results of the subsequent thematic analysis show LCC’s concern about addressing the various environmental themes focused on the EU Green Deal, with, however, a sub-approach to issues of health and well-being and digital transformation.

Resumo O estudo desenvolvido visa explorar a comunicação pública da Câmara Municipal de Lisboa (CML) com foco nas alterações climáticas. Os objetivos específicos são evidenciar as temáticas ambientais abordadas na comunicação pública da CML, para permitir comparar as temáticas ambientais comunicadas pela CML com as metas do PEE. Neste sentido, é um estudo tendencialmente dedutivo e comparativo. Para cumprir os objetivos realizou-se um mapeamento das iniciativas de comunicação, através de pesquisa documental e observação direta. São identificados e sistematizados os conteúdos partilhados nas páginas oficiais da CML nas redes sociais online, nomeadamente, nos seus perfis de Facebook, Instagram, Twitter, e LinkedIn, assim como, nas páginas de Facebook e Instagram da Lisboa Capital Verde 2020. Também foi utilizada a técnica de observação direta de eventos da CML, realizados entre outubro de 2021 e março de 2022. Tal implicou a observação dos eventos e o seu registo tendo por base um modelo teórico original que guia a recolha de dados. Os resultados da análise temática subsequente evidenciam preocupação da CML em abordar as várias temáticas ambientais focadas no PEE, havendo, contudo, uma sub-abordagem a questões de saúde e bem-estar e transformação digital.

Resumo Introdução: A intervenção em saúde mental na infância e adolescência deve ser uma prioridade, tendo em conta a elevada prevalência das perturbações mentais nesta faixa etária associadas a uma alta taxa de comorbilidade e a tendência à cronicidade de psicopatologia para a idade adulta. A literatura realça a importância de descentralizar os cuidados de saúde mental infantil, promovendo uma intervenção baseada na comunidade e em interface entre os serviços especializados e os cuidados de saúde primários. Métodos: Realização de uma formação sobre saúde mental infantil, dirigida a médicos e técnicos dos cuidados de saúde primários. Os participantes, no início e no final do curso, responderam a um questionário de 22 perguntas, elaborado pela comissão científica. Os resultados foram avaliados através do Teste Qui Quadrado de Pearson. Resultados: Do total de 120 participantes, 109 questionários foram preenchidos no início (90% dos participantes) e 97 questionários foram preenchidos no final da ação de formação (81% dos participantes). A diferença na pontuação dos questionários inicial e final global foi estatisticamente significativa (valor p<0,05, intervalo de confiança de 95%), sendo a média de respostas corretas dos questionários iniciais de 75,15% e dos questionários finais de 86,40%. Em 15 das 22 questões foi obtida uma diferença estatisticamente significativa. Discussão e Conclusão: Tendo em consideração os resultados é possível reconhecer o impacto significativo que esta formação parece ter tido na aquisição de novos conhecimentos em saúde mental infantil. A equipa de cuidados de saúde primários é uma área privilegiada de articulação, com o potencial de promover estratégias de prevenção e promoção da saúde mental, identificar os problemas precocemente, intervir nos casos menos graves e referenciar aos serviços especializados atempadamente. A equipa de saúde mental deve colaborar com as diferentes estruturas comunitárias, em consultoria, formação, coordenação ou catalisação de iniciativas ou projetos.

Abstract Introduction: Intervention in mental health in childhood and adolescence should be a priority, considering the high prevalence of mental disorders in childhood and adolescence associated with a high rate of comorbidity and the frequent continuity of severe psychopathology in adulthood. The literature highlights the importance of decentralizing child mental health care, promoting community-based intervention, and an interface between specialized services and primary health care. Methods: Conducting specialized training in child mental health, aimed at primary care physicians and technicians. Participants, at the beginning and end of the course, answered a 22-question questionnaire prepared by the scientific committee. The results were evaluated using Pearson's Chi-squared test. Results: Out of a total of 120 participants, 109 questionnaires were completed at the beginning (90% of participants), and 97 questionnaires were completed at the end of the training course (81% of participants). The score of the global initial and final questionnaires was statistically significant (p-value <0.05, 95% confidence interval), with the average of correct answers from the initial questionnaires being 75.15% and the final questionnaires of 86.40%. In 15 of the 22 questions, a statistically significant difference was obtained. Discussion and Conclusion: Considering the results, it is possible to recognize the significant impact that this training seems to have had in the acquisition of new knowledge in child mental health. Primary health care teams are privileged areas for articulation, with the potential to promote prevention and mental health promotion strategies, identify problems early, intervene in less severe cases and refer to specialized services in a timely manner.

Abstract In the last 20 years, dark tourism - a tourism dynamic based on the act of visiting places marked, namely, by suffering - is one of the subjects explored by the sociology of tourism. The objective of this article is to advance with a contribution to the understanding of this practice in Portugal, based on exploratory research on the preservation of the Peniche Fortress, which housed a political prison during the Portuguese dictatorship. This analysis is conducted by the articulation between the theoretical framework, which explores how dark tourism has been approached, with the fieldwork developed in Peniche Fortress, through an interview with the director of the space and documentary analysis. As a result, a vision of what this place under construction is intended to be is presented, as well as the interpretation strategy that has been prepared, which is essential for the moment of encounter between visitors and the past.

Resumo Nos últimos 20 anos, uma das matérias que tem sido aprofundada pela Sociologia do Turismo é o dark tourism, dinâmica turística assente na visita a lugares marcados, nomeadamente, pelo sofrimento. Pretende-se com este artigo dar um contributo para a compreensão desta prática em Portugal, a partir de uma pesquisa exploratória sobre a preservação da Fortaleza de Peniche, que albergou uma prisão política do Estado Novo. A reflexão parte da articulação entre o quadro teórico, que explora várias abordagens ao conceito de dark tourism, sua amplitude e fragilidades, com o trabalho de campo desenvolvido na Fortaleza de Peniche, através de uma entrevista com a diretora do espaço, observação não participante e análise documental. Como resultado, apresenta-se uma visão do que se pretende que seja este lugar em construção, nomeadamente a estratégia de interpretação que tem sido pensada, essencial para o momento de encontro entre visitantes e passado.

RESUMEN Introducción: Actualmente, se reconoce que tan importante como sobrevivir a una enfermedad crítica es vivir con calidad, dignidad y pleno ejercicio de la ciudadanía, luego del alta de cuidados intensivos. Este reconocimiento pone un foco importante en el rol de la Enfermera Especialista en Enfermería de Rehabilitación en Unidades de Cuidados Intensivos. Objetivos: Reflexionar sobre la contribución de la Enfermería de Rehabilitación en Unidades de Cuidados Intensivos. Principales temas en análisis: complicaciones derivadas de la hospitalización en cuidados intensivos; la Enfermera Especialista en Enfermería de Rehabilitación en Unidades de Cuidados Intensivos; criterios de seguridad para la rehabilitación temprana; y barreras y factores facilitadores de la rehabilitación temprana en Unidades de Cuidados Intensivos. Conclusión: Es imperativa la presencia de Enfermeros Especialistas en Enfermería de Rehabilitación en las Unidades de Cuidados Intensivos, de manera consistente y sostenida. Sus intervenciones, basadas en la mejor evidencia disponible y atentas a la seguridad de la persona en situación crítica, puede contribuir a mejorar la calidad de la atención brindada, lo que trae beneficios tanto al enfermo/familia como a las instituciones hospitalarias.

RESUMO Introdução: Atualmente, reconhece-se que tão importante quanto sobreviver à doença crítica, é viver com qualidade, dignidade e pleno exercício da cidadania, após a alta dos cuidados intensivos. Este reconhecimento, coloca um foco importante no papel do Enfermeiro Especialista em Enfermagem de Reabilitação nas Unidades de Cuidados Intensivos. Objetivos: Refletir sobre o contributo da Enfermagem de Reabilitação nas Unidades de Cuidados Intensivos. Principais tópicos em análise: as complicações decorrentes do internamento em cuidados intensivos; o Enfermeiro Especialista em Enfermagem de Reabilitação nas Unidades de Cuidados Intensivos; critérios de segurança para a reabilitação precoce; e as barreiras e fatores facilitadores na reabilitação precoce nas Unidades de Cuidados Intensivos. Conclusão: a presença dos Enfermeiros Especialistas em Enfermagem de Reabilitação nas Unidades de Cuidados Intensivos, de modo consistente e sustentado, é imperativa. As suas intervenções, baseadas na melhor evidência disponível e atentas à segurança da pessoa em situação crítica, podem contribuir para a melhoria da qualidade dos cuidados prestados, o que acarreta benefícios quer para a pessoa doente/família quer para as instituições hospitalares.

ABSTRACT Introduction: Currently, it is recognized that as important as surviving critical illness, is to live with quality, dignity and full exercise of citizenship, after discharge from intensive care. This recognition places an important focus on the role of the Specialist Nurse in Rehabilitation Nursing in Intensive Care Units. Objectives: To reflect on the contribution of Rehabilitation Nursing in Intensive Care Units. Main topics under analysis: complications resulting from hospitalization in intensive care; the Specialist Nurse in Rehabilitation Nursing in Intensive Care Units ; safety criteria for early rehabilitation; and barriers and facilitating factors in early rehabilitation in Intensive Care Units. Conclusion: the presence of Specialists Nurses in Rehabilitation Nursing in Intensive Care Units, in a consistent and sustained manner, is imperative. Their interventions, based on the best available evidence and attentive to the safety of the person in critical situation, can contribute to the improvement of the quality of care provided, which brings benefits both for the sick person/family and for hospital institutions.

Resumo Introdução: A Competência Parental Percecionada (PSE) tem sido associada a comportamentos parentais positivos e, consequentemente, promotores do bem-estar e desenvolvimento harmonioso da criança. A identificação dos seus potenciais determinantes continua a ser um foco de atenção em saúde mental ao avaliar as perceções e cognições parentais ou ao planear intervenções com os mesmos. Materiais/Métodos: Este foi um estudo transversal com uma amostra clínica de uma Unidade de Pedopsiquiatria da Primeira Infância. Todos os pais de crianças avaliadas pela primeira vez foram incluídos e preencheram o questionário de Sentimento de Competência Parental (Parenting Sense of Competence); tradução portuguesa, α=0.75-0.83) e duas perguntas sobre a perceção de apoio recebido pelo outro progenitor e pela família de origem. Foram corretamente preenchidos 34 questionários. A perceção média de competência parental foi comparada entre ambos os pais e foi testada a correlação com as perceções de apoio. A análise estatística foi efetuada no software SPSS® versão 21 através de análise descritiva e correlação de dados (t-test e Pearson r). Resultados: Um total de 34 questionários foram preenchidos. O Sentimento de Competência Parental não diferiu significativamente entre pai e mãe (73.44 vs 72.24, p=0.533). Os pais percecionam-se como mais apoiados, quer pela família de origem (5.09 vs 4.2, p=0.001), quer pelas mães (4.9 vs 4.09, p=0.011). Foi identificada no pai uma correlação positiva entre o Sentimento de Competência Parental e o Sentimento de Apoio pela Família de Origem (Pearson r=0.639, p<0.01). Conclusão: Entre as mães, as perceções de apoio não se correlacionaram com o sentimento de competência parental. Contudo, a correlação encontrada entre os pais enfatiza como a respetiva família de origem poderá influenciar a tríade relacional. As perceções de apoio parental deverão ser exploradas ao considerar as relações horizontais intrafamiliares como um potencial mecanismo de influência das relações verticais, pela sua associação com a competência parental percecionada.

Abstract Introduction: Perceived parental self-efficacy (PSE) has shown an association with positive parental behavior, highlighting its benefit in promoting child well-being and healthy development. The identification of its potential determinants remains a focus of attention in mental health when assessing parental perceptions and cognitions or planning parental interventions. Material/Methods: This was a cross-sectional study in an Early Childhood Child Psychiatry Unit. All parents of babies and toddlers assessed for the first time were included and completed a Parenting Sense of Competence (PSOC) scale (portuguese translation, α= 0.75-0.83) and two additional questions concerning perceptions of support from the other parent and family of origin. Average PSOC was compared between both parents and correlations with perceptions of support were tested. Statistical analysis was conducted in SPSS® version 21 through descriptive analysis and variable correlation (t-test and Pearson r). Results: A total of thirty-four questionnaires were completed. Average PSOC was similar between father and mothers (73.44 vs 72.24, p=0.533). Fathers perceived themselves as more supported than mothers, either from the family of origin (5.09 vs 4.21, p=0.001), as from the other parent (4.91 vs 4.09, p=0.011). A positive correlation was found between father’s PSOC and perception of support from the family of origin (r=0.639, p <0.01). Conclusions: Among mothers of children followed in this Child Psychiatry Unit, support perceptions did not correlate with perceived parental self-efficacy. However, father’s perceived self-efficacy could relate to perceptions of support, raising clinical attention on how fathers and their family of origin can influence the relational triad. Perceptions of parental support should be explored when considering within-family horizontal relations as a potential mechanism influencing vertical relations through its association with perceived self-efficacy.

ABSTRACT Chronic kidney disease is an increasingly common diagnosis in the very elderly and identifying the patients who benefit from a nephrologist’s intervention and the ones who would not might avoid wasteful or harmful interventions. The aim of this study is to identify the risk factos for progressive versus non‑progressive chronic kidney disease in a population aged over 80 years old. We performed a cohort single‑center retrospective study including 101 patients over 80 years old with chronic kidney disease diagnosed for at least five years and followed regularly by a nephrologist. Progressive disease was defined as glomerular filtration rate declines greater than 5 mL/min/1.73 m2/year. Of the 101 patients, 33.7% had progressive chronic kidney disease. The median glomerular filtration progression rate was 3.0 [2.1‑6.0] mL/min/1.73m2/year. Hypertension and diabetes mellitus prevalence was similar between groups. Nephrology follow‑up time was longer in the progressive group (5.0 vs 2.0 years, p=0.01). Regarding chronic kidney disease complications, 37.6% had anemia and half of these needed erythropoiesis‑stimulating agents. None of the patients had hyperphosphatemia. About 18.8% presented metabolic acidosis. In multivariable analysis, after adjusting for covariables such as age, hypertension, and diabetes mellitus only the presence of metabolic acidosis (OR 0.4, CI: 0.1‑0.8) was associated with the development of progressive chronic kidney disease. Progressive chronic kidney disease group presented higher mortality (log rank 4.5, p=0.03). Ischemic cardiomyopathy (OR: 0.5, CI: 0.2‑0.9) and progressive chronic kidney disease (OR: 0.6, CI:0.3‑0.8) were associated with all‑cause mortality. Our results showed that most elderly patients have non‑progressive chronic kidney disease. Patients with metabolic acidosis seem to be at an increased risk for developing progressive disease. Most elderly patients die before reaching end‑stage kidney disease, so it is importante to look at progressive kidney disease in those patients as an important marker of comorbidity and privilege cardioprotective measures.

ABSTRACT Coronavirus disease 2019 (COVID-19) has affected millions worldwide, and in particular the care of patients on maintenance hemodialysis. These patients are thought to be at high risk of severe SARS-CoV-2 infection due to their older age and multiple comorbidities. The aim of this study was to compare hemodialysis and non-dialysis COVID-19 patients and find possible risk factors for mortality in hemodialysis patients. We developed a single-center retrospective cohort study, from March 1st to December 31st, 2020, that included maintenance hemodialysis patients hospitalized with laboratory confirmed SARS-CoV-2 infection, and age and sex propensity matched non-dialysis patients also hospitalized with a laboratory confirmed SARS-CoV-2 infection (1:1). A total of 34 hemodialysis patients were included, 70.6% male, mean age 76.5 years and on maintenance hemodialysis for 3.0 [0.5-23] years. At admission, 50.0% needed oxygen supply. Median hospital stay duration was 11.0 [5.8-17.0] days, and 38.2% developed bacterial superinfection. Maintenance hemodialysis patient mortality rate was 32.4%. When matched to the non-dialysis group, the hemodialysis group developed more often respiratory insufficiency (50.0% vs 8.8%, p<0.001) and had higher ferritin (1658.0 vs 623.5, p=0.004) and troponin T (130.0 vs 31.0, p<0.001) levels, whereas the non-dialysis group had higher transaminases levels. There was no statistical difference regarding hospitalization time, bacterial superinfection, or mortality between groups. When the logistic regression was performed, only bacterial superinfection was a predictor for mortality in hemodialysis COVID-19 patients (0.01 [0.00-0.26]). There was no difference in hospital stay nor in death rate between hemodialysis and non-dialysis COVID-19 patients. Despite these results, we must emphasize that mortality in the dialysis group was particularly high, with up to 32% of in-hospital mortality, and that bacterial superinfection has been shown to be an independent predictor of mortality. These results highlight the importance of interventions, such as full vaccination coverage, to mitigate the burden of COVID-19 in hemodialysis patients.

RESUMEN Antecedentes: La educación postural es esencial para promover una postura corporal adecuada y evitar la adopción de posturas incorrectas, que pueden provocar dolor y lesiones musculoesqueléticas (1, 2, 3, 4, 5). La implementación de programas escolares tiene una fuerte influencia en la salud y la calidad de vida de los niños (6, 7). Objetivo: Analizar la evidencia existente sobre los programas de educación postural implementados a nivel escolar. Metodología: Mediante una revisión bibliográfica integradora, se utilizó la metodología PEO (participantes, exposición y resultados). La recopilación de datos se llevó a cabo en abril de 2020, en las bases de datos CINAHL y PubMed. Resultados: El análisis de los artículos incluidos nos permitió identificar que los programas de educación postural presentan beneficios en términos de conocimiento, parámetros posturales estáticos y dinámicos, reducción de peso en la mochila, nivel de dolor musculoesquelético y desalineación del hombro. Conclusión: La evidencia muestra que la implementación de programas de educación postural, a nivel escolar, tiene resultados positivos en la promoción de la salud de los niños.

RESUMO Enquadramento: A educação postural é essencial para promover uma postura corporal adequada e prevenir a adoção de posturas incorretas, das quais podem resultar dor e lesões musculosqueléticas (1,2,3,4,5). A implementação de programas a nível escolar tem uma forte influência na saúde e na qualidade de vida das crianças(6,7). Objetivo: Analisar a evidência existente relativa aos programas de educação postural implementados a nível escolar. Metodologia: Através da realização de uma revisão integrativa da literatura, utilizou-se a metodologia PEO (participantes, exposição e resultados). A colheita de dados foi realizada em abril de 2020, nas bases de dados CINAHL e PubMed. Resultados: A análise dos artigos incluídos permitiu identificar que os programas de educação postural apresentam benefícios ao nível do conhecimento, dos parâmetros posturais estáticos e dinâmicos, da redução do peso das mochilas, do nível de dor musculosquelética e do desalinhamento do ombro. Conclusão: A evidência demonstra que a implementação de programas de educação postural, a nível escolar, tem resultados positivos na promoção da saúde das crianças.

ABSTRACT Background: Postural education is essential to promote proper body posture and prevent the adoption of incorrect postures, which can result in pain and musculoskeletal damage (1, 2, 3, 4, 5). The implementation of school-level programs has a strong influence on children's health and quality of life (6, 7). Objective: To analyze the existing evidence concerning postural education programs implemented at school level. Methodology: Through an integrative literature review, the PEO methodology (participants, exposure and results) was used. The data collection was conducted in April 2020 in the CINAHL and PubMed databases. Results: The analysis of the articles included allowed us to identify that postural education programs have benefits in terms of knowledge, static and dynamic postural parameters, backpack weight reduction, musculoskeletal pain level and shoulder misalignment. Conclusion: The evidence shows that the implementation of postural education programs, at school level, has positive results in promoting children's health.

Novel Coronavirus disease (COVID-19) is a newly discovered contagious disease that has affected many countries around the world. Although diffuse alveolar damage and acute respiratory failure are the main features, involvement of other organs is recognized and needs to be explored. Information on kidney disease in patients with COVID-19 is limited, with many studies showing that acute kidney injury is an uncommon disorder in COVID-19. Despite this low prevalence, it can lead to potentially significant morbidity and mortality in these patients. Thus the authors consider the development of acute kidney injury in patients with COVID-19 an important issue, worthy of clinical attention, and they present this point in the current review.

Introduction: Tuberous sclerosis complex is an autosomal dominant neurocutaneous disorder which is characterized by multisystem involvement, including the kidney. Since renal disease is one of the causes of morbidity and mortality, close management is essential. Subjects and Methods: In this retrospective observational,single-center study, authors analyse patients with a definite diagnosis of tuberous sclerosis complex who attended Pediatric Nephrology consultation between 1998 and 2019. Results: 20 patients were included. The median age at the time of the diagnosis was 3 years, mostly after seizures and the median age of the first Pediatric Nephrology consultation was 9 years. Seventeen patients had renal disease, the majority with angiomyolipomas and a smaller number with cysts. None had hypertension or history of acute kidney failure. Systemic mTOR inhibitors were used in three patients. Discussion: The present results were similar to those found in the literature regarding presentation features and kidney disease. The authors emphasized the importance of early diagnosis of renal involvement in order to reduce renal morbidity and mortality (especially when these patients reach adulthood) and highlighted the need for early guidance for pediatric nephrology consultation.

Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody that has been associated with delayed pulmonary toxicity. In patients receiving RTX, hypersensitivity pneumonitis, although rare, should be considered in the appropriate clinical and radiographic setting. The authors present a case of hypersensitivity pneumonitis associated with a single dose of RTX treatment in a kidney transplanted patient with acute antibody-mediated rejection.

RESUMO O índice de gravidez de mulheres em diálise permanece ainda muito baixo quando comparado ao da população restante. Contudo, nos últimos anos, o sucesso dessas gestações tem aumentado. Entre os principais cuidados que se deve ter com as grávidas em diálise estão a manutenção de níveis baixos de ureia pré-diálise, a adequação do perfil tensional, o controle da anemia e os cuidados para evitar infecções, deficit nutricionais, alterações do metabolismo fosfo-cálcio e flutuações eletrolíticas. O monitoramento rigoroso do crescimento e desenvolvimento fetal é também necessário. Gravidezes em diálise estão associadas à maior probabilidade de complicações maternas e fetais, por isso é de extrema importância uma abordagem multidisciplinar entre nefrologistas, obstetras e pediatras. O objetivo principal do presente trabalho consiste na revisão da evidência literária disponível sobre a gravidez em diálise, sobre os princípios básicos da fisiopatologia da grávida e de suas particularidades na doença renal. Serão abordadas as opções de tratamento disponíveis, as vantagens e os riscos, antevendo possíveis desafios futuros. No final, será apresentado um caso clínico ilustrativo da temática.

ABSTRACT The pregnancy rate of women on dialysis is still very low when compared to that of the remaining population. However, recent years have seen an increase in the success rates of these pregnancies. Among the main precautions that must be taken with pregnant women on dialysis are the maintenance of low levels of pre-dialysis urea, the adequacy of the tension profile, the control of anemia and care to avoid infections, nutritional deficits, changes in phosphorus-calcium metabolism and electrolytic fluctuations. It is also necessary to strictly monitor fetal growth and development. Pregnant women on dialysis have a higher probability of maternal and fetal complications; thus the importance of a multidisciplinary approach among nephrologists, obstetricians and pediatricians. The main objective of this study was to review the literature evidence available on pregnancy on dialysis, on the basic principles of the pathophysiology of pregnant women and their particularities in kidney disease. We will address available treatment options, benefits and risks, anticipating possible future challenges. At the end, we will present a clinical case to illustrate the topic.

Atheroembolic renal disease is a multisystem clinical entity of unknown incidence. It is often associated with severe atherosclerotic disease and its etiology can be spontaneous or iatrogenic. Its pathophysiology is based on renal dysfunction secondary to embolization of cholesterol crystals, followed by occlusive phenomena affecting the renal vasculature. The present report describes the case of a patient with several cardiovascular risk factors, with a recent introduction of rivaroxaban. The clinical course presented was suggestive of renal atheroembolic disease, and the histological evaluation corroborated this diagnosis.

Introduction: ABO incompatibility was considered a barrier to kidney transplant. However, the shortage of available organs for transplantation and the excellent long-term results further establish ABO-incompatible (ABOi) as a safe and effective therapeutic strategy. The aim of the present study was to evaluate the outcomes of ABOi transplantation in terms of graft survival and function, rejection episodes and infections complications. Methods: The authors present a single-center retrospective observational study in a unit with approximately 370 living donor kidney transplants registered. This study includes the analysis of 12 patients who underwent ABOi living donor kidney transplantation between November 2014 and July 2019. Desensitization protocol consisted of intravenous Rituximab 375mg/m2 single dose administration 2 weeks pretransplant. Tacrolimus and Mycophenolate Mofetil were started before transplantation one week and 48 hours respectively. Plasmapheresis was performed to remove anti-A or B antibodies until their titers were <1:8 during the first post-operative week and <1:16 at the second. All kidney recipients of both ABOi grafts received Basiliximab (20mg on days 0 and 4) as antibody induction therapy. Maintenance immunosuppression consisted of Tacrolimus, Mycophenolate Mofetil and corticosteroid. Results: A total of 12 patients were included in the study, 75% male; 43 years (IQR 31-50). The most common blood group mismatch was A to O (n=4; 33%). In the first year, 2 of patients (25%) developed acute rejection. The follow-up time was 17 months (IQR 7-36). Five patients (42%) developed infectious complications. None patients developed cytomegalovirus or BK polyomavirus infections. At the end graft and patient survival were 100%. Conclusion: ABOi kidney transplantation has become a routine procedure. With this approach, about 30% of living donors who were refused in the past can now donate their kidneys and thereby significantly expand the living donor pool. The immunosuppressive protocol of this unit can be considered safe.