The antifouling booster biocides are frequently studied for toxic effects on the aquatic ecosystems. The present investigation proposes passive silicone rubber samplers as a collection method for biocides, once these methods can concentrate substances in aqueous matrices at very low levels. Through the passive sampler-water partition coefficient (Ksw) and the analyte chemical nature, we can optimize their extraction from the membrane to apply in the sample medium. We used the co-solvent method to determine the Ksw of three third-generation antifouling biocides, chlorothalonil, dichlofluanid, and dichlorooctylisothiazolinone (DCOIT), with log Ksw = 2.24, 4.01, and 2.38, respectively. Improving extraction also led to a recovery range higher than 70%, determinations were carried out by gas chromatography with an electron capture detector. Biocides concentration in seawater samples from Itaqui port (São Marcos Bay, northern Brazil) ranged from 0.058 to 0.72 µg L-1 for chlorothalonil, 0.001 to 0.008 µg L-1 for dichlofluanid, and 0.018 to 0.64 µg L-1 for DCOIT. ecosystems levels samplerwater sampler water (Ksw nature medium cosolvent co solvent thirdgeneration third generation chlorothalonil dichlofluanid DCOIT, DCOIT , (DCOIT) 224 2 24 2.24 401 4 01 4.01 238 38 2.38 respectively 70 70% detector São Bay Brazil 0058 0 058 0.05 072 72 0.7 L1 L 1 L- 0001 001 0.00 0008 008 0018 018 0.01 064 64 0.6 (DCOIT 22 2.2 40 4.0 23 3 2.3 7 005 05 0.0 07 0. 000 00 06 6 2. 4.

Electrooxidation is an efficient method for treating effluents with high concentrations of ammoniacal nitrogen and organic matter (R), in the presence of chloride ions (Cl-). The present study aimed at degrading ammoniacal nitrogen and organic matter from an effluent generated at a fertilizer storage port terminal. For this purpose, a batch electrochemical reactor with mechanical agitation was used, with a Ti/RuO2 anode. The parameters studied were the current density that varied in 20, 40 and 60 mA cm-2, the concentration of chloride ions that was 0.04, 0.74, 0.90 to 0.81 mol L-1 and the electrolysis time that varied from 4.0, 5.0, 7.0 and 8.0 h. A 22 experimental design was conducted to determine the significance level of the parameters studied. The results obtained indicated the removal of 99.99% of N-NH3 and 75.60% of total organic carbon (TOC) when a current density of 60 mA cm-2 and a Cl- concentration of 35.5 g L-1 were applied, after 4.0 h of electrolysis. R, R , (R) Cl. Cl . (Cl-) terminal purpose used TiRuO2 TiRuO Ti RuO2 RuO Ti/RuO anode 20 4 6 cm2, cm2 cm 2, 2 004 0 04 0.04 074 74 0.74 090 90 0.9 081 81 0.8 L1 L 1 L- 50 5 5.0 70 7 7. 80 8 8. 9999 99 99.99 NNH3 NNH N NH3 NH N-NH 7560 75 75.60 TOC (TOC cm- 355 35 35. applied 4. (R (Cl- 00 0.0 07 0.7 09 9 0. 08 5. 999 99.9 756 75.6 3 (Cl 99. 75.

ABSTRACT Purpose: Minimally invasive radical nephrectomy is often preferred for larger renal tumours not suitable for partial nephrectomy (1). When performed with a multiport robot, the procedure is routinely performed with a transperitoneal approach, with recent studies highlighting important factors for surgical outcomes, including predictive factors (2), segmental artery unclamping techniques (3), and comparisons of robotic techniques (4). This video shows that SP Robot-Assisted Radical Nephrectomy (RARN) via a lower anterior approach is valuable in challenging cases. Materials and Methods: We performed SP-RARN on two complex patients using a retroperitoneal lower anterior approach. The first patient, a 54-year-old female with a BMI of 36.8 kg/m2, had a ventral hernia and bowel obstruction history, with a 9 cm right middle kidney mass. The second patient, a 58-year-old male with a BMI of 31.19 kg/m2, had ESRD and was on peritoneal dialysis for 8 years, with a 3.4x3.7 cm mass in the right superior pole, suspected to be RCC. The surgical technique is detailed in the video. Results: Both procedures were successful, with operative times of 173 and 203 minutes and blood loss of 150 mL. No complications occurred. Patients were discharged after 31 and 38 hours, respectively. Histopathology confirmed RCC. At the 3-month follow-up, no complications or readmissions were reported. Second patient continued peritoneal dialysis without issues. Conclusion: Retroperitoneal SP-RARN via the lower anterior approach avoids the peritoneal cavity, making it suitable for certain patients. In these patients, more so than in others, this procedure is feasible, safe, and less morbid than the standard multiport approach. Purpose 1. 1 . (1) robot outcomes 2, 2 , (2) 3, 3 (3) 4. 4 (4) RobotAssisted Robot Assisted RARN (RARN cases Methods SPRARN 54yearold yearold 54 year old 368 36 36. kgm2 kgm kg m2 m kg/m2 history 58yearold 58 3119 19 31.1 years 34x37 x 4x3 7 3.4x3. pole RCC Results successful 17 20 15 mL occurred hours respectively 3month month followup, followup follow up, up follow-up reported issues Conclusion cavity others feasible safe (1 (2 (3 (4 5 kg/m 311 31. 34x3 4x 3.4x3 ( 34x 3.4x

ABSTRACT Introduction: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). Materials and Methods: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). Results: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. Conclusion: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen. Introduction DaVinci Da Vinci SinglePort Single Port (SP perioperative peri morbidity 1, 1 (1 2. 2 . 2) Methods 74yearold yearold 74 year old diabetes bypass hypertension hyperlipidemia 72 7 7.2 PIRADS5 PIRADS 5 PIRADS- midgland mid gland zone intermediaterisk intermediate biopsy 31 reversal 3, 3 (3 4. 4 4) Results 21 mL respectively 437 4+3=7 pTNxR pT NxR pT2NxR margins months Conclusion irritation violated mitigated abdomen ( 7. 43 4+3= 4+3 4+

ABSTRACT Introduction: The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1–3). Nevertheless, a comprehensive description of different supine access options is still lacking (4–6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes. Materials and methods: Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space. Results: Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%. Conclusion: The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning. Introduction SinglePort Single Port (SP robotassisted robot assisted 1–3. 13 1–3 . 1 3 (1–3) Nevertheless 4–6. 46 4–6 4 6 (4–6) light stepbystep step outcomes methods cm bone dome Similarly spread point Results Overall 62 occurred IQR 1221, 1221 12 21 , 12-21) 714 7 7-14 1018 10 18 10-18 transvesical respectively Notably 815 81 5 81. 73 73% Conclusion 1– (1–3 4– (4–6 122 2 12-21 71 7-1 101 10-1 8 (1– (4– 12-2 7- 10- (1 (4 12- (

Abstract The goal of this research was to comprehend the interrelation between the strategizing process and the constitutive aspects of organizational routines. Employing a qualitative methodology, a case study was conducted at the Port Authority of Valencia. Data collection encompassed interviews, observation, and document analysis. Through the analysis of narratives and pattern matching, a permeable relationship between strategizing and routines was identified, indicating an inseparable amalgamation of their key constituents. The demarcation between the components of strategizing and organizational routines is faint, uncertain, and intertwined within an indivisible process. Conceptualizing organizational routines as a fusion of actors, processes, and strategic content, localized spatially and temporally where reasoning and action intersect contingent upon context, underscores the relevance of approaching strategy as a practice, thereby broadening its scope.

Resumen El objetivo de esta investigación fue comprender la interrelación entre el proceso de formación de la estrategia (strategizing) y los aspectos constitutivos de las rutinas organizativas. Se llevó a cabo una investigación cualitativa a través de un estudio de caso en la Autoridad Portuaria de Valencia, España. Los datos se recopilaron a partir de entrevistas, observación y revisión documental. Desde un análisis cualitativo de las narrativas y encuentro de patrones, se identificó una relación de permeabilidad entre strategizing y las rutinas que no permite la disociación de los elementos que la componen. La frontera entre los elementos constitutivos de la formación de la estrategia y las rutinas organizativas es tenue, incierta y estos aspectos están entrelazados en un proceso unísono e indivisible. Comprender las rutinas organizativas como la amalgama entre actores, proceso y contenido de la estrategia, el lugar espacial y temporalmente situado donde se establece el pensamiento y la acción, dependiente de su contexto e historia, sugiere la idea de que es razonable adoptar la perspectiva de la estrategia como práctica (strategizing) para ampliar su alcance.

ABSTRACT Background: Despite the large use of folic acid supplements, there are very few cases of reported allergy. Clinical case: A 38-year-old woman, experienced palmoplantar pruritus, generalized urticaria, angioedema and conjunctival hyperemia, 30 minutes after the intake of a 5mg folic acid tablet. She was taken to the Emergency Department and on discharge was referred to the Allergy and Clinical Immunology Department, where the patient underwent a diagnostic workup. The Skin Prick Test (SPT) was positive for the 5 mg/mL concentration and the Basophil Activation Test (BAT) was considered positive for both dilutions, from an initial solution concentration of 5mg/ml: 1/100 dil (CD63=9.03%; SI=10.1) and 1/160 dil (CD63=7.46%; SI=8.4). Discussion/Conclusion: We report a patient with an immediate reaction to folic acid with positive SPT and BAT, which favors an IgE-mediated allergy. To our knowledge, this is the first case describing the use of a BAT in the diagnostic workup of folic acid allergy.

RESUMO Introdução: Apesar da grande utilização de suplementos de ácido fólico, existem poucos casos de alergia relatados. Descrição do caso: Mulher de 38 anos, que apresentou prurido palmoplantar, urticária generalizada, angioedema e hiperemia conjuntival 30 minutos após a ingestão de um comprimido de ácido fólico de 5mg. Foi levada ao serviço de urgência e, à data de alta, referenciada para o serviço de imunoalergologia para realização de estudo. O teste cutâneo por picada (TCP) foi positivo para a concentração de 5 mg/ml e o teste de ativação de basófilos (TAB) foi considerado positivo para ambas as diluições, a partir de uma concentração inicial de 5mg/ml: 1/100 dil (CD63=9,03%; SI=10,1) e 1/160 dil (CD63=7,46%; SI=8,4). Discussão/conclusões: Descrevemos uma doente com uma reação imediata ao ácido fólico com TCP e TAB positivos, o que favorece uma alergia IgE-mediada. Tanto quanto sabemos, este é o primeiro caso a descrever a utilização do TAB no estudo da alergia ao ácido fólico.

ABSTRACT Iodinated contrast media (ICM) is increasingly necessary to improve diagnostic accuracy. Despite the lack of association, several studies show that the myth that shellfish allergy confers an increased risk of adverse reactions to ICM persists. This erroneous concept can contribute to the suboptimal use of ICM, with consequent diagnostic and therapeutic delays, and increased morbidity and associated costs. In this sense, this work aims to review shellfish allergy and adverse reactions to ICM, and explore the perpetuation of this myth.

RESUMO A utilização de meios de contraste iodados (MCI) é cada vez mais necessária para aumentar a precisão diagnóstica. Apesar da ausência de associação já demonstrada, vários estudos mostram que persiste o mito de que a alergia a marisco confere um risco aumentado de reações adversas a MCI. Este conceito erróneo pode contribuir para uma utilização subótima dos MCI, com consequentes atrasos diagnósticos e terapêuticos, e aumento da morbilidade e dos custos associados. Neste sentido, este trabalho tem como objetivo fazer uma revisão sobre alergia a marisco e reações adversas a MCI e explorar a perpetuação deste mito.

ABSTRACT Exposure to airborne pollen allergens is an important environmental factor in triggering respiratory allergic diseases, such as rhinitis and asthma. These diseases lead to a reduction in patients’ quality of life and an increase in socioeconomic costs throughout Europe, including Portugal. One of the most common information available to patients with pollinosis and their clinicians is the concentration of pollen grains present in the atmosphere of outdoor environments, bioaerosols whose temporal distribution is contained in the pollen calendars. Another fundamental instrument is the Pollen Bulletin, which provides pollen forecasts. Given the scientific evidence of the relationship between pollen concentrations and allergic symptoms, such information and prevention tools have been essential for the general population and the medical community assisting in these pathologies. The aeropalynological information disclosed is only possible with the continuous environmental monitoring carried out by the Portuguese Aerobiology Network for more than two decades in Portugal. The Pollen incidence maps presented here, constructed based on the information that gave rise to the pollen calendars, show the incidence of the main allergenic pollen types to which the populations of each region of the country are exposed and shall constitute an essential tool in the clinical practice in the allergic disease field in Portugal.

RESUMO A exposição a aeroalergénios polínicos é um importante fator ambiental desencadeante de doenças alérgicas respiratórias, tais como a rinite e a asma. Estas patologias conduzem a uma redução da qualidade de vida dos doentes e a um aumento dos custos socioeconómicos por toda a Europa, incluindo em Portugal. Uma das informações mais comuns disponíveis para os doentes com polinose e seus clínicos é a concentração de grãos de pólen presentes na atmosfera dos ambientes exteriores, bioaerossóis cuja distribuição temporal se encontra contida nos calendários polínicos. Outro instrumento fundamental é o “Boletim Polínico”, instrumento que informa as previsões de grãos de pólen na atmosfera. Dada a evidência cientificamente comprovada da relação entre concentrações de pólen e sintomatologia alérgica, tais ferramentas de informação e de prevenção têm sido imprescindíveis quer para a população em geral, quer para a comunidade médica que a assiste nestas patologias. As informações aeropalinológicas divulgadas só são possíveis com a monitorização ambiental contínua que tem sido feita pela Rede Portuguesa de Aerobiologia há mais de duas décadas em Portugal. Os mapas de incidência polínica aqui apresentados, construídos com base na informação que deu origem aos calendários polínicos, mostram a incidência dos principais tipos polínicos alergizantes a que as populações de cada região do país estão expostas e constituirão um instrumento essencial na prática clínica no domínio da doença alérgica em Portugal.

Abstract The authors present a selection of articles published in 2023/2024 considered as the most relevant for clinical practice in Maternal Fetal Medicine, Tocology and Pre-Natal Diagnosis.

Resumo Os autores apresentam uma seleção de artigos publicados em 2023/2024 e que consideram mais relevantes para a prática clinica em Medicina Materno-Fetal, Tocologia e Diagnóstico Pré Natal.

Abstract Parvovirus B19 congenital infection is vertically transmitted after maternal infection. Fetal disease may be serious with anemia, hydrops or death. An IUT may be indicated. It has been described a great increase in number and severity in Europe and USA in 2023-2024. In our Centre we have also noticed this situation which correlates with a much higher number of IUT performed. So, it’s from the uttermost importance to alert health professionals to identify and counsel high risk pregnant women in order to promote primary prevention and early detection of the maternal/fetal infection allowing a quick referral to specialized centres.

Resumo A infeção congénita por PB19 ocorre por transmissão vertical após infeção materna. O efeito fetal pode ser grave com anemia, hidrópsia ou morte e indicada a transfusão intrauterina (TIU). Tem sido descrito um grande aumento da sua incidência e gravidade na Europa e EUA em 2023-2024. Também constatámos essa alteração que se traduziu num aumento do número de TIU realizadas em 2024 no nosso Centro. Pretendemos continuar a sensibilizar profissionais de saúde recomendando medidas que identifiquem grávidas em risco, promovendo a prevenção primária, a deteção precoce da infeção materna e fetal e uma rápida referenciação aos centros especializados.

Abstract Evidence suggests that a healthy lifestyle during pregnancy influences growth and development and affects chronic disease susceptibility. During pregnancy, energy and nutritional requirements increase to respond to the metabolic changes. Although the World Health Organization and Direção-Geral da Saúde recommend supplementation with folic acid, iron, and iodine during pregnancy, multiple-micronutrient supplementation is often recommended. This article aims to present evidence-based regarding these supplements during pregnancy.

Resumo O período da gravidez constitui uma etapa chave na qual se deve apostar na promoção de estilos de vida saudáveis. Durante esta fase, as necessidades energéticas e de alguns nutrientes estão aumentadas para dar resposta às alterações metabólicas que ocorrem. Apesar de só haver indicação por parte da Organização Mundial da Saúde e Direção-Geral da Saúde para suplementar a mulher grávida com ácido fólico, ferro e iodo, a utilização de suplementos alimentares com vitaminas e minerais destinados para mulheres grávidas, é muitas vezes recomendada. Pretende-se neste artigo, apresentar a evidência que existe relativamente à toma destes suplementos na gravidez.