This study evaluates the residence time (RT) and total phosphorus (TP) in a small hypereutrophic lake in the city of Fortaleza, Brazil. The results indicate that RT predicted by a complete-mix model is very similar (R² = 0.83) to that simulated with a 2-D hydrodynamic model (CE-QUAL-W2). Simple power-laws were fitted to describe RT and TP concentration at the lake inlet as functions of lake inflow, yielding correlations of R² = 0.84 and 0.70, respectively. The combination of these correlations with a complete-mix approach provided a comprehensive model that predicted TP values measured at the lake outlet reasonably well (R² = 0.60). In addition, a direct empirical correlation between simulated TP concentration and precipitation was also obtained. The simulations indicate a nearly periodic behaviour of RT and TP, with the seasonal variations being much higher than the interannual ones. Finally, an application of the model showed that a reduction of 99% of the input TP load was required to reach 100% compliance with the required water quality standards; this could be achieved by connecting the residences to the sewage network. The methodology proposed in this research can be easily applied to other lakes in the Brazilian northeast and extended to other tropical regions around the globe.

RESUMO A macaúba (Acrocomia aculeata) é uma palmeira oleaginosa de alto valor econômico pela sua grande produtividade e pelas amplas possibilidades de aproveitamento das diferentes partes da planta. Esta palmeira é uma das espécies mais promissoras para a produção de biodiesel, e, durante o seu uso, há geração de grande quantidade de resíduos. O objetivo deste trabalho foi produzir e avaliar a qualidade de briquetes confeccionados com epicarpo da macaúba, em associação aos resíduos da madeira de Pinus sp. Para caracterização dos resíduos foram realizadas as análises: densidade a granel, composição química imediata e poder calorífico superior. Na produção de briquetes foram adotados diferentes tratamentos, sendo T1 (100% Macaúba), T2 (75% Macaúba + 25% Pinus), T3 (50% Macaúba + 50% Pinus), T4 (25% Macaúba + 75% Pinus) e T5 (100% Pinus). Os briquetes foram produzidos à pressão de 1000 PSI, temperatura de 120-130 ºC, tempos de prensagem e resfriamento de 5 minutos e umidade média de 9.88% para a macaúba e 8.00% para o Pinus. Para qualificar os briquetes avaliou-se as dimensões, densidade aparente, carga de ruptura, poder calorífico inferior, poder calorífico útil e densidade energética. De modo geral, recomenda-se a mistura de pelo menos 50% de epicarpo de macaúba para a produção de briquetes, pois este material confere maior resistência e densidade energética ao produto.

ABSTRACT The macaúba palm (Acrocomia aculeata) is a palm-seed-oil producing tree of great economic value for its high productivity, and the broad range of possible uses for the different parts of the plant. This palm is one of the most promising species for the production of biodiesel, however, its use generates large amounts of waste. The aim of this work is to produce and evaluate the quality of briquettes made from the epicarp of the macaúba palm, in association with the waste of the Pinus sp. For the characterization of the residues, the following analyses were carried out: bulk density, immediate chemical composition, and higher calorific value. Different treatments were adopted in the production of the briquettes, namely: T1 (100% macaúba palm), T2 (75% macaúba palm + 25% pine), T3 (50% macaúba palm + 50% pine), T4 (25% macaúba palm + 75% pine) and T5 (100% pine). The briquettes were produced at a pressure of 1000 PSI, and at a temperature of 120-130 ºC, press and cooling times of 5 minutes, and an average humidity of 9.88% for the macaúba palm and 8.00% for the Pinus. In order to qualify the briquettes’ dimensions, the following were evaluated: apparent density, rupture load, lower calorific value, useful calorific value and energy density. In general, mixing at least 50% macaúba epicarp is recommended to produce briquettes, as this material provides increased strength and energy density to the product.

Objetivos: Caracterizar a referenciação à consulta de memória pelos cuidados primários, nomeadamente os motivos de referenciação, o estudo diagnóstico realizado ao nível dos cuidados primários e o tempo decorrido até à consulta hospitalar. Tipo de estudo: Estudo observacional, transversal, descritivo. Local: Hospital de Braga. População: Utentes referenciados pelos cuidados de saúde primários à consulta de memória do hospital de Braga, com primeira consulta entre maio de 2011 e dezembro de 2015. Métodos: Estudo realizado entre fevereiro e junho de 2016. Foram consultadas as referenciações informáticas dos utentes selecionados. As variáveis analisadas foram género, idade, profissão, escolaridade, estado civil, antecedentes de risco, motivos de referenciação, presença de defeito cognitivo, estudo diagnóstico analítico e imagiológico prévio e tempo decorrido até à referenciação e à consulta hospitalar. Resultados: Foram identificadas 290 referenciações, maioritariamente de utentes do género feminino (69%), idade média de 75 anos, reformados (81%), com menos de quatro anos de escolaridade (51%). Cinquenta e oito por cento dos casos foram referenciados por perda de memória. Sessenta e oito por cento das referenciações indicavam antecedentes pessoais de risco e 10% antecedentes familiares de demência, 17% mencionavam a avaliação breve do estado mental, 51% indicavam realização prévia de tomografia computorizada cerebral e 32% de estudo analítico. A referenciação demorou mais de 24 meses (55%) e a consulta hospitalar entre sete a 12 meses (55%). O principal motivo de referenciação está de acordo com outros estudos. As referenciações revelaram-se incompletas relativamente aos antecedentes de risco, ao rastreio cognitivo e à investigação diagnóstica prévia. As referenciações e a resposta hospitalar são efetuadas tardiamente. Conclusão: Este estudo revelou lacunas na informação das referenciações que devem ser aperfeiçoadas, de modo a melhorar a articulação dos cuidados de saúde. Estes dados sugerem que pode haver limitações à abordagem destes doentes nos cuidados primários

Objectives: To characterise the referrals from primary care to the memory, including the reasons for referral, the diagnostic study performed in primary care, and the time elapsed until the hospital consultation. Type of study: Observational, cross-sectional, descriptive study. Setting: Hospital de Braga. Participants: Patients referred by primary care to the memory consultation of Hospital de Braga, with first consultation taking place between May 2011 and December 2015. Methods: The study was carried out between February and June 2016. Informatic referrals of selected patients were retrieved. The variables analysed included gender, age, occupation, educational level, marital status, previous risk factors, reasons for referral, presence of cognitive impairment, previous diagnostic study, and time elapsed until referral and hospital consultation. Results: We identified 290 referrals, mostly concerning female patients (69%), mean age of 75 years (69%), pensioners (81%) and with less than 4 years of schooling (51%). Fifty eight percent of the cases were referred by loss of memory. Sixty eight percent of the referrals had a personal history of risk, 10% has a family history of dementia, 17% had a brief assessment of mental status, 51% had a previous computed tomography scan, and 32% had previous analytic investigation. In 55% of the cases, the referral took more than 24 months and the waiting time until hospital consultation took between 7-12 months. The main reason for referral is in agreement with other studies. The referrals were incomplete regarding previous risk factors, cognitive screening and previous diagnostic investigation. Both referrals and hospital responses still take place late. Conclusions: This study revealed information gaps in referrals that should be improved in order to optimise the transition between different levels of care. These results suggest that there may be limitations in approaching these patients in primary care

Calcific Uraemic Arteriolopathy (CUA) or calciphylaxis, is a thrombotic disorder of skin and subcutaneous tissue which typically presents with painful purpuric nodules that may progress to necrotic ulcers, and is a severe, life-threatening condition. CUA is an uncommon clinical entity that affects mostly haemodialysis (HD) patients. Although the process of vascular calcification was initially thought to be the result of a passive deposition of calcium-phosphate crystals, current knowledge suggests a distinct mechanism, including cellular activity with differentiation of vascular smooth muscle cells (VSMCs) into chondrocyte as well as osteoblast-like cellular phenotypes and deficiencies in calcification inhibitors. Although multiple studies suggest a potential relationship between warfarin and CUA, larger prospective studies are needed in order to better evaluate this association, and randomised controlled trials are needed to assess the benefit of distinct interventions in this setting. In this article the topic of CUA is reviewed based on a clinical case of a 65-year-old man undergoing haemodialysis, who underwent an aortic valve replacement one year earlier, receiving a mechanical heart valve, and who has been under warfarin therapy since then

Introdução: O aumento crescente da população em hemodiálise tem implicado o recurso a acessos vasculares de maior complexidade técnica. A introdução de modificações na técnica cirúrgica da transposição da veia basílica (TVB) pretende agilizar o procedimento e diminuir a sua morbilidade. Métodos: Análise prospectiva das TVB efectuadas no CHP-HSA entre Setembro de 2005 e Setembro de 2009. Resultados: Efectuaram-se 74 TVB em 74 doentes, os quais tinham, em média, 2 acessos autólogos prévios. A TVB foi o primeiro acesso em 20,3% dos doentes. O intervalo médio de seguimento foi de 14,5 meses. Ocorreram 2 falências nos primeiros 30 dias. A taxa de patência secundária aos 3, 12 e 24 meses foi de 95,7%, 85,1% e 62,2%, respectivamente. A Diabetes associou-se a pior taxa de patência (p=0,018). A taxa de complicações perioperatórias foi de 28,4%, sendo a infecção a mais frequente (n=6, 8,1% do total de TVB). A trombose foi a principal causa de falência, tendo ocorrido em 24,3% de todas as TVB. Conclusões: Reconhece-se a superioridade do acesso autólogo, como a melhor opção de acesso vascular para hemodiálise. A TVB é subutilizada, devido às exigências técnicas e necessidades logísticas. Melhoramos a técnica cirúrgica e de tunelização, ao reduzir o tamanho das incisões e o tempo cirúrgico. Os nossos resultados revelaram uma boa patência a longo prazo, pelo que consideramos que deve ser mais utilizada.

Introduction: The expanding haemodialysis population has lead to increased requirement for more complex vascular accesses. Modifications introduced in basilic vein transposition technique are intended to streamline the procedure and reduce its morbidity. Methods: All patients who underwent BVT from September 2005 to September 2009 in CHP-HSA were prospectively reviewed. Results: Seventy-four BVT were performed in 74 patients. Patients had a mean of 2.0 previous access attempts. BVT was the first access in 20.3% of the patients. Median follow-up was 14.5 months. There were two primary failures. Secondary patency rates were 95.7%, 85.1% and 62.2% at 3, 12 and 24 months, respectively. Diabetes was associated with poor patency. Perioperative complication rate was 28.4%, with infection being the most frequent (n=6, 8.1% of all TVB). Thrombosis was the main cause of failure, occurring in 24.3% of all TVB. Conclusion: Autologous access superiority is well established. BVT is an underused technique due to its surgical expertise needs and logistic demands. We improved the surgical technique and the tunneling technique, reducing the size of the incisions and the time of operation. Our results showed a good secondary patency rate and, in the authors view, this technique should be more widely used.

Sirolimus, a mammalian target of rapamycin inhibitor, is an increasingly used immunosuppressant in solid-organ transplantation. There are an increasing number of reports of unusual oedematous adverse effects associated with this drug, including lymphoedema, ascites and pleural effusions, and a few reports of pericardial effusions. No pathophysiological explanation for these phenomena has been disclosed. We report a 33-year-old sirolimus-treated kidney transplant recipient with chronic pericardial and pleural effusions identified nine years after transplantation. He was initially treated for a presumed tuberculous pericarditis, even though cultures for Mycobacterium tuberculosis were negative. After 12 months of antitubercular therapy, visceral effusions persisted. Pericardial effusion was drained and stabilised. After exclusion of other causes, sirolimus toxicity was considered the most likely cause. Two months after discontinuation of sirolimus, visceral effusions disappeared. Interaction of mammalian target of rapamycin inhibitors with mediators of lymphangiogenesis may be a common link in oedematous states associated with sirolimus.

Alguns estudos sugerem que a trombólise endovenosa (TE) conduz a melhor recanalização nos acidentes vasculares cerebrais isquêmicos (AVCI) cardioembólicos. Neste trabalho questionamos se isto terá tradução em benefício clínico. MÉTODO: Avaliamos 177 doentes submetidos a TE, os quais foram categorizados como cardioembólicos (CE) e não cardioembólicos (NCE). Compararam-se a National Institutes of Health Stroke Scale (NIHSS) e escala de Rankin modificada. RESULTADOS: A idade média foi 67,4±12,01 e 53,8% eram homens. NIHSS média foi: 14 (admissão), 9 (24 h), 6 (alta), semelhante nos subgrupos. A diferença entre NIHSS à admissão e 24 h foi de 4,17±4,92 (CE: 4,08±4,71; NCE: 4,27±5,17, p=0,900) e entre a admissão e a alta de 6,74±5,58 (CE: 6,97±5,68; NCE: 6,49±5,49, p=0,622). A classificação na mRS não foi significativamente diferente nos subgrupos (alta e 3 meses), mas os doentes com eventos NCE estavam mais independentes aos 3 meses. CONCLUSÃO: Os nossos resultados não documentam um papel específico da TE nos CE, o que pode resultar da heterogeneidade do grupo NCE.

It was suggested that intravenous thrombolysis (IT) leads to larger extent recanalization in cardioembolic stroke. In this work we assess if this has beneficial clinical traduction. METHOD: We evaluated 177 patients undergoing IT, which were categorized into cardioembolic (CE) and non-cardioembolic (NCE). National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale were compared. RESULTS: The mean age was 67.4±12.01 and 53.8% were male. The mean NIHSS was: 14 (admission), 9 (24 h) and 6 (discharge), similar in subgroups. The difference between NIHSS at admission and 24 hours was 4.17±4.92 (CE: 4.08±4.71; NCE: 4.27±5.17, p=0.900) and at admission and discharge there was an average difference of 6.74±5.58 (CE: 6.97±5.68; NCE: 6.49±5.49, p=0.622). The mRS at discharge and 3 months was not significantly different by subtype, although individuals whose event was NCE are more independent at 3 months. CONCLUSION: Ours findings argue against a specific paper of IT in CE. It can result from heterogeneity of NCE group.