RESUMO A cultura do sorgo é considerada uma das mais importantes do mundo devido a sua versatilidade de utilização. No entanto, o estresse hídrico pode ser considerado uma ameaça significativa para sua produtividade. A busca por produtos mitigadores do estresse hídrico é uma área de pesquisa crucial na agricultura e na gestão de recursos hídricos. Assim, o objetivo deste trabalho foi avaliar a viabilidade do uso do ácido salicílico como atenuante de estresse hídrico na cultura do sorgo. O experimento foi conduzido em ambiente telado, em delineamento em blocos ao acaso com esquema fatorial 4 × 2, com quatro repetições. Foram avaliados quatro níveis hídricos (40, 60, 80 e 100% da evapotranspiração) e duas concentrações de ácido salicílico (0 e 2,76 g L-1). Foram analisados a altura das plantas, diâmetro do caule, número de folhas, trocas gasosas, pigmentos fotossintéticos e fluorescência da clorofila a. A aplicação de lâminas de irrigação deficitárias reduziu a altura da planta, diâmetro do colmo, número de folhas e clorofila total no sorgo. No entanto, quando essas lâminas foram associadas ao ácido salicílico, foi observado que houve atenuação dos danos, especialmente em relação a clorofila a e b. Além disso, o ácido salicílico quando aplicado isoladamente, contribuiu para redução da temperatura da folha e aumento da eficiência de uso da água. Assim, o ácido salicílico pode ser usado para mitigar os efeitos do estresse salino em plantas de sorgo. utilização entanto produtividade Assim telado 2 repetições 40, 40 (40 60 8 100 evapotranspiração 0 ( 276 76 2,7 L1. L1 L 1 . L-1) caule gasosas planta colmo danos b disso isoladamente água (4 6 10 27 7 L-1 L-

ABSTRACT The sorghum crop is considered one of the most important worldwide due to its versatility. However, water stress can be considered a significant threat to its yield. The search for products that mitigate water stress is a crucial area of research in agriculture and water resources management. Thus, the objective in this study was to evaluate the feasibility of using salicylic acid as a water stress attenuator in sorghum. The experiment was conducted in a screened environment in a randomized block design with a 4 × 2 factorial scheme, with four replicates. Four levels of water (40, 60, 80, and 100% of evapotranspiration) and two concentrations of salicylic acid (0 and 2.76 g L-1) were evaluated. Plant height, stem diameter, number of leaves, gas exchange, photosynthetic pigments, and chlorophyll a fluorescence were analyzed. Application of deficit irrigation depths reduced plant height, stem diameter, number of leaves, and total chlorophyll in sorghum. However, when these depths were associated with salicylic acid, it was observed that the damage was attenuated, especially in chlorophyll a and b. Furthermore, salicylic acid reduced leaf temperature and increased water use efficiency when applied alone. Thus, salicylic acid can be used to mitigate the effects of salt stress on sorghum plants. versatility However yield management Thus scheme replicates 40, 40 (40 60 80 100 evapotranspiration 0 ( 276 76 2.7 L1 L 1 L-1 evaluated height diameter leaves exchange pigments analyzed attenuated b Furthermore alone plants (4 6 8 10 27 7 2. L-

ABSTRACT The interaction between bean (Phaseolus vulgaris L.) genotypes and N-fixing microorganisms has the potential to be utilized in sustainable agricultural production. Thus, the aim of this study was to verify the effects of the interaction for growth, production and nodulation characteristics between the bacteria Rhizobium tropici and Azospirillum brasilense among different bean genotypes. The experiments were conducted in the Selvíria, Mato Grosso do Sul, Brazil, in 2018 and 2019, in randomized block design with three replicates in a 20 × 3 factorial scheme; 20 common bean genotypes were tested under three forms of inoculation (no inoculation, inoculation with R. tropici, co-inoculation of R. tropici + A. brasilense). The number of grains per pod and nodule mass had the most significant direct positive effect on grain yield. For nodulation, a positive correlation of strong magnitude was observed between mass of the aerial part and number of pods per plant (0.68), stem diameter and mass of nodules (0.92) and first pod insertion height and number of nodules (0.64). In the path analysis, the number of grains per pod had the most significant direct effect (0.57) on the grain productivity variable. Regarding nodulation characteristics, selection for nodule mass was preferred due to its direct effect on grain yield as opposed to the number of nodules, which has a negative effect. This suggests an advantage of larger nodules with greater individual mass than a large number of small nodules for both improved yield and N fixing by common bean plants.

Abstract Objetivo: Avaliar a concordância da terapêutica com medicamentos modificadores de prognóstico (MMP) em pessoas com insuficiência cardíaca crónica com fração de ejeção reduzida (P-CICFEr), em cuidados de saúde primários (CSP) na região Centro de Portugal, com as diretrizes da Sociedade Europeia de Cardiologia (ESC) de agosto de 2021. Métodos: Estudo observacional transversal de uma amostra representativa do tamanho, intervalo de confiança de 95% e margem de erro de 8%, da população com CICFEr em 31/dezembro/2021. Foram estudados idade, sexo, ano de diagnóstico da introdução da Classificação Internacional para Cuidados Primários-2 (ICPC-2, K-77), anos desde o último ecocardiograma, MMPs para P-CICFEr e outras terapêuticas para P-CICFEr. Participaram, convidadas por conveniência, 11 Unidades de Saúde Familiar após parecer positivo da Comissão de Ética. Resultados: Num universo de n=2.381 pessoas com insuficiência cardíaca (PCIC) encontraram-se n=453 (19,0%) (P-CICFEr) estudando-se uma amostra representativa de n=133 (5,6%), n=95 homens (71,4%). Verificou-se prescrição de medicamentos inibidores do sistema renina-angiotensina-aldosterona (iSRAA) 91,0%, de betabloqueadores em 75,2%, de antagonistas mineralocorticoides em 40,6%, de inibidores da SGLT2 em 44,4%, de inibidores da neprilisina em 38,3% e de diuréticos de ansa em 72,2%. A terapêutica farmacológica quádrupla verificou-se em n=28 (21,1%) P-CICFEr e a tripla em n=38 (28,6%). Verificou-se idade média de 74,3±11,6 anos, 75,1±4,0 no homem e 76,6±6,0 na mulher, p=0,088. A mediana de tempo desde o diagnóstico ICPC-2 foi de 6,0 anos no homem e de 4,0 anos na mulher, p=0,031. O tempo mediano desde o último ecocardiograma foi de três anos, p=0,750. Conclusão: Os medicamentos modificadores de prognóstico, segundo as diretrizes mais recentes da ESC para a CICFEr, estavam subutilizados em 50,4% dos casos. Apesar dos resultados encontrados é necessária reflexão acerca das barreiras que os médicos possam encontrar para aplicar as diretrizes em P-CICFEr.

Resumo Objective: To evaluate the accordance of prognostic medicines prescription (PMP), for persons with chronic heart failure with reduced ejection fraction (P-CHFrEF), attended in primary health care units in Central Portugal, with the European Society of Cardiology (ESC) 2021 August, guidelines. To know about mean age, median time since the diagnosis and last echocardiogram performance in P-CHFrEF. Methods: Observational, cross-sectional study of a random size representative sample, 95% confidence interval, and 8% error margin of the P-CHFrEF of a population on 31st December 2021. Age, gender, year of International Classification for Primary Care-2 (ICPC-2, K-77) problem classification input data, years since the last echocardiogram, ongoing PMP and the use of other chronic heart failure (CHF) drugs were gathered. Data were obtained from 11 Portugal Primary Health Care Units, invited by convenience, after an Ethics Committee approval. Results: From a universe of n=2,381 persons with CHF, n=453 (19.0%) P-CHFrEF was found. A size representative sample of P-CHFrEF of n=133 (5.6%), n=95 males (71.4%) was studied. Prescription of a renin-angiotensin system inhibitor (RAAS-I) was ongoing in 91.0%, beta-blocker (BB) in 75.2%, mineralocorticoid antagonists (MRA) in 40.6%, inhibitors of the sodium-glucose cotransporter-2 (SGLT2i) in 44.4%, neprilisine inhibitors 38.3% and loop diuretics in 72.2%. The optimized medical quadruple therapy was established in 28 patients (21.1%) and the triple one in 38 (28.6 %). Mean age was of 74.3±11.6 years, males 73.4±11.0 and females 76.6±12.9, p=0.088. The median time since the diagnosis was 6.0 for men and 4.0 for women, p=0.031. The median time since the last echocardiogram was 3.0, p=0.750 between genders. Conclusion: According to the 2021 ESC guidelines, prognostic modifying medicines were underused for 50.4% of P-CHFrEF. Even with these results, a reflection must be made, on the barriers physicians encounter, to comply with the ESC guidelines in such patients.

Resumo A literacia em saúde, a capacidade de obter e compreender conhecimentos sobre saúde, é essencial para promover a saúde e reduzir as disparidades. A comunicação em saúde tem por objetivo melhorar a saúde, assegurando uma compreensão e aplicação eficazes da informação sobre saúde. Apesar dos desafios atuais, existem muitas oportunidades para melhorar a comunicação na prática da literacia em saúde. A promoção da comunicação na literacia em saúde é essencial para capacitar os indivíduos, melhorar os resultados e reduzir as disparidades nos cuidados de saúde. Uma comunicação eficaz permite o acesso, a compreensão e a tomada de decisões informadas dos indivíduos e das comunidades relativamente à sua saúde, reforçando o seu papel central na promoção da literacia em saúde. Este artigo destaca os desafios e as oportunidades no mundo atual, especialmente numa era pós-pandémica, dominada pela infodemia e pelos influenciadores nas redes sociais, ao mesmo tempo que apresenta soluções, incluindo a formação profissional dos profissionais de saúde em comunicação e competências digitais, e uma estratégia global para as instituições de saúde. A tradução do conhecimento em comportamentos promotores da saúde e do bem-estar só pode ser eficaz se a comunicação for tida em conta na literacia em saúde.

Abstract Health literacy, the ability to obtain and comprehend health knowledge, is essential to promote health and reduce disparities. Health communication aims to improve health by ensuring an effective understanding and application of health information. Despite current challenges, there are many opportunities for improving communication in the health literacy practice. Promoting communication in health literacy is essential in empowering individuals, improving outcomes, and reducing healthcare disparities. Effective communication enables access, comprehension, and informed decision-making of individuals and communities regarding their health, strengthening their central role in promoting health literacy. This paper highlights the challenges and opportunities in today’s world, especially in a post-pandemic era, dominated by infodemic and social media influencers, while providing solutions, encompassing professional training of health professionals on communication, digital skills, and an overarching strategy across health institutions. Translating knowledge into health-promoting behaviors and well-being can only be effective by accounting for communication in health literacy.

Resumo As varizes periestomais são varizes ectópicas raras na doença hepática crónica. Estas desenvolvem-se na junção enterocutânea do estoma e representam um shunt venoso portossistémico entre a circulação portal e a circulação venosa sistémica da parede abdominal. As varizes periestomais são dificilmente visíveis ao exame objetivo e não são acessíveis na avaliação endoscópica, portanto o seu diagnóstico surge geralmente só após o primeiro episódio hemorrágico. Nos casos mais graves, a hemorragia das varizes pode evoluir rapidamente para choque hipovolémico, estimando-se que a mortalidade por episódio hemorrágico seja de 3 a 4%. As revisões clínicas recentes não definem o standard of care, devido ao reduzido número de casos descritos. Neste trabalho, apresentamos um caso de hemorragia massiva de varizes peri-estoma tratado com sucesso por embolização endovascular percutânea transhepática.

Abstract Peristomal varices are rare ectopic varices in chronic liver disease. They develop at the enterocutaneous junction of a stoma and represent a portosystemic venous shunt between the portal circulation and venous systemic circulation of the abdominal wall. Peristomal varices are hardly visible on clinical examination and are not accessible on endoscopic evaluation, therefore their diagnosis generally only surge after the first bleeding episode. In most severe cases, variceal bleeding can quickly progress to hypovolemic shock, with an estimated mortality rate of 3 to 4% per hemorrhagic episode. Recent clinical reviews do not define the standard of care, due to the small number of cases described. In this article, we present a case of massive peristomal varices hemorrhage successfully treated by transhepatic percutaneous endovascular embolization.

Resumo O cuidador informal presta cuidados permanentes ou regulares a pessoas idosas em situação de dependência, sem remuneração. Objetivou-se identificar as percepções de cuidadores informais sobre motivações, necessidades e benefícios do cuidado ao idoso dependente. Estudo qualitativo realizado com 10 cuidadoras informais portuguesas, a partir de um instrumento com questões sobre o cuidado prestado ao idoso e suas percepções sobre o exercício dessa função. Os resultados revelaram como motivações para o cuidado: relação de proximidade e confiança, dever de cuidar, familiar mais disponível, proximidade da residência, inexistência de vagas e elevado custo das instituições de acolhimento e desejo do idoso permanecer na sua habitação. Os principais cuidados aos idosos são: hidratação, higiene, alimentação, administração terapêutica, companhia, apoio emocional, conforto, entretenimento, promoção da autonomia e dignidade. As necessidades identificadas pelas cuidadoras foram: apoio domiciliário, da segurança social e da entidade empregadora do cuidador, ajuda financeira, suporte psicológico e capacitação para cuidar do idoso. Os benefícios do cuidado informal para o idoso dependente apontados foram: celeridade do apoio familiar, segurança física e emocional, afeto e companheirismo. Este estudo dá voz a cidadãos cruciais. dependência remuneração Objetivouse Objetivou se 1 portuguesas função confiança disponível residência habitação são hidratação higiene alimentação terapêutica companhia emocional conforto entretenimento dignidade foram domiciliário financeira companheirismo cruciais

Abstract The informal caregiver provides non-remunerated permanent or regular care to dependent older adults. This qualitative study aimed to identify the perceptions of informal caregivers about motivations, needs, and benefits of caring for dependent older adults. It was conducted with ten Portuguese informal caregivers, based on an instrument with questions about the care provided to older adults and their perceptions about performing this role. The results revealed the following motivations for care: proximity and trust relationship, duty of care, more available family members, home proximity, lack of vacancies, high cost of shelter institutions, and older adults’ desire to remain in their homes. The primary care activities for older adults are hydration, hygiene, food, therapeutic administration, companionship, emotional support, comfort, entertainment, and promoting autonomy and dignity. The needs identified by the caregivers were home, social security, and the caregiver’s employer support, financial help, psychological support, and training to care for the older adults. The benefits of informal care for dependent older adults were prompt family support, physical and emotional security, affection, and companionship. This study gives voice to crucial citizens. nonremunerated non remunerated role relationship members vacancies institutions homes hydration hygiene food administration companionship support comfort entertainment dignity security s help affection citizens

RESUMO Neste trabalho, destacam-se aprendizados com pesquisa realizada pelo Núcleo Ecologias e Encontros de Saberes para a Promoção Emancipatória da Saúde (Neepes) em parceria com o Centro de Integração na Serra da Misericórdia (CEM) e o Movimento dos Sem Teto da Bahia (MSTB), que atuam em territórios periféricos no Rio de Janeiro e em Salvador. A pesquisa buscou apoiar e sistematizar conhecimentos e práticas emancipatórias de promoção da saúde protagonizados por essas experiências, tendo por base quatro eixos temáticos transversais: alimentação, cuidado, moradia e proteção ambiental, além de comunicação. No artigo, enfocaram-se as reflexões coletivas em relação ao primeiro eixo temático, envolvendo estratégias para promover agroecologia e soberania alimentar, com experiências de produção, circulação e acesso a alimentos saudáveis. Com base nessas reflexões, visou-se contribuir com discussões sobre Territórios Sustentáveis e Saudáveis (TSS), especialmente pelos aprendizados possibilitados com a sistematização das experiências territoriais com base na noção de Promoção Emancipatória da Saúde, que aponta para importantes aportes nas dimensões de justiça ambiental e cognitiva. Com a sistematização dessas experiências, destaca-se sua capacidade de resistir, a partir de um movimento de reexistência de saberes tradicionais e comunitários em periferias urbanas, que apontam caminhos possíveis para a construção de TSS em periferias urbanas. trabalho destacamse destacam se Neepes (Neepes CEM (CEM MSTB, MSTB , (MSTB) Salvador transversais alimentação cuidado comunicação artigo enfocaramse enfocaram temático alimentar produção saudáveis visouse visou TSS, (TSS) cognitiva destacase destaca resistir urbanas (MSTB (TSS

ABSTRACT In this work, we highlight lessons learned from research carried out by the Nucleus Ecologies and Encounters of Knowledge for Emancipatory Health Promotion (NEEPES) in partnership with the Center of Integration in Serra da Misericórdia (CEM) and the Movement of Homeless People of Bahia (MSTB), in peripheral territories in Rio de Janeiro and Salvador. The research sought to support and systematize knowledge and emancipatory practices of health promotion carried out by these experiences, based on four transversal thematic axes: food, care, housing and environmental protection, in addition to communication. The article focused on collective reflections on the first thematic axis, involving strategies to promote agroecology and food sovereignty, with experiences of production, circulation, and access to healthy food. Based on these reflections, we aim to contribute to discussions regarding the idea of Sustainable and Healthy Territories (SHT), especially through the lessons learned from the systematization of territorial experiences based on the notion of Emancipatory Health Promotion, which points to important contributions from the dimensions of environmental and cognitive justice. The systematization of these experiences highlights a movement of re-existence of traditional and community knowledge, which points to possible paths for the construction of SHT in urban peripheries. work NEEPES (NEEPES CEM (CEM MSTB, MSTB , (MSTB) Salvador axes care protection communication axis sovereignty production circulation SHT, (SHT) justice reexistence re existence peripheries (MSTB (SHT

ABSTRACT Introduction: Primary immunodeficiencies (PID) manifest as increased susceptibility to infectious diseases and are associated with significant morbimortality. COVID-19 has a variable clinical presentation, with unpredictable impact on immunocompromised patients. Knowing how this population responds to vaccination may be important to adjust future approaches. Objectives: To analyse immunological response to anti-COVID-19 vaccination in patients with PID. Methods: Prospective study of a population of patients with PID, followed in an Immunoallergology Unit, who were vaccinated against COVID-19. Clinical records were consulted to assess demographic, clinical, and laboratory data. Determination of total immunoglobulin G (IgG) and IgG SARS-CoV-2 before vaccination and serial measurement of IgG anti-spike after vaccination was performed. Results: Twenty patients were included, 55% female, with a mean age of 36,8±13,1 years old, 60% with common variable immunodeficiency (CVID), 30% selective antibody deficiency, and 10% X-linked agammaglobulinemia (XLA). In CVID patients, the median CD19 basal count was 180 cells/μL (IQR, 60;372). Twelve patients with CVID/XLA were under replacement treatment with subcutaneous gammaglobulin. All patients presented negative pre-vaccinal serology, with a median total IgG of 419 mg/dL (IQR, 238;896); IgG anti-spike after the primary vaccinal scheme was positive in 75% [median 796 AU/mL (IQR, 107;3772)]. Concerning CVID subpopulation: IgG anti-spike was positive in 67% after the primary vaccinal scheme, 75% before the booster dose, and 100% afterward. Lower counts of CD19 cells correlated with lower levels of IgG anti-spike (95% CI=0.117-0.898; p=0.023). No patient reported significant adverse reactions to vaccination. Conclusions: Anti-COVID-19 vaccination showed good response and safety in patients with PID. In the CVID subpopulation, more severe cases with lower counts of CD19 cells presented lower antibody titles after vaccination. Booster dose enhanced immune response, suggesting the need for additional inoculations to ensure sustained protection against COVID-19.

RESUMO Fundamentos: As imunodeficiências primárias (IDP) manifestam-se por suscetibilidade aumentada a doenças infeciosas e estão associadas a elevada morbimortalidade. A COVID-19 tem apresentação clínica variável, com impacto imprevisível nos doentes imunocomprometidos. Conhecer a resposta à vacinação desta população poderá ser importante para adequar medidas no futuro. Objetivos: Analisar a resposta imunológica à vacinação contra a COVID-19 em doentes com IDP. Métodos: Estudo prospetivo de uma população de doentes com IDP, seguidos numa unidade de Imunoalergologia, vacinados contra a COVID-19. Consulta dos processos clínicos para colheita de dados demográficos, clínicos e laboratoriais. Determinação de imunoglobulina G (IgG) total e IgG SARS-CoV-2 antes da vacinação e doseamentos seriados de IgG anti-spike após vacinação. Resultados: Incluídos 20 doentes, 55% do sexo feminino, com idade média 36,8±13,1 anos, 60% com imunodeficiência comum variável (IDCV), 30% deficiência seletiva de anticorpos e 10% agamaglobulinemia ligada ao X (ALX). Nos doentes com IDCV, a contagem basal de células CD19 mediana foi 180 células/μL (IIQ, 60;372). Realizavam terapêutica de substituição com gamaglobulina subcutânea 12 doentes com IDCV/ALX. A serologia pré-vacinal foi negativa em todos os doentes, a IgG total mediana foi 419 mg/dL (IIQ, 238;896) e a IgG anti-spike após esquema vacinal primário foi apositiva em 75% [mediana 796 AU/mL (IIQ, 107;3772)]. Na subpopulação com IDCV: a IgG anti-spike foi positiva em 67% após esquema vacinal primário, 75% antes da dose de reforço e 100% após reforço. Níveis mais baixos de células CD19 correlacionaram-se com valores inferiores de IgG anti-spike (95% IC=0,117-0,898; p=0,023). Nenhum doente reportou reações adversas significativas à vacinação. Conclusões: A vacinação contra a COVID-19 apresentou boa resposta e segurança nos doentes com IDP. Na subpopulação com IDCV, formas mais graves com contagens reduzidas de células CD19 apresentaram títulos mais baixos de anticorpos após vacinação. A dose de reforço potenciou a resposta imune, sugerindo a necessidade de inoculações adicionais para conferir proteção sustentada contra a COVID-19.

Abstract Human myiasis is the infestation of humans with dipterous larvae. Cutaneous myiasis is the most common form and is one of the most common travel-associated skin diseases. The condition should be suspected when furuncle or boil-like skin lesions are observed in patients travelling from endemic regions. Herein is described the case of a toddler who had travelled from Guinea-Bissau seven days earlier and presented with a six-day history of painful furuncle-like swellings on the left thigh and scrotum. Two larvae were collected from one of the lesions, and entomological analysis confirmed the diagnosis of cutaneous myiasis. Complete larvae extraction is the primary treatment goal, and adequate preservation of the maggots is essential for public health analysis.

Resumo A miíase humana é a infestação de humanos por larvas de dípteros. A forma cutânea é a mais frequente apresentação da doença e também uma das doenças dermatológicas do viajante mais comuns. Deve haver suspeita de miíase cutânea quando são observadas lesões do tipo furúnculo ou bolha em doentes que estiveram numa região endémica. É descrito o caso de um rapaz de 17 meses oriundo da Guiné-Bissau que se apresentou com lesões do tipo furúnculo dolorosas na coxa esquerda e escroto com seis dias de evolução. Foram recuperadas duas larvas numa das lesões, cuja análise entomológica confirmou o diagnóstico de miíase cutânea. A extração completa das larvas é o principal objetivo do tratamento e a sua correta preservação para análise é fundamental numa perspetiva de saúde pública.

Abstract Neuroendocrine tumors (NETs) are the most common primary lung neoplasms. Clinical manifestations can be subtle, and chest radiograph usually shows non-specific findings, often leading to delayed or inaccurate diagnosis. Despite their indolent nature, NETs have metastatic potential and can cause significant morbidity. Early diagnosis is critical for optimal management, as surgical resection can be curative. The challenge is to correctly diagnose this rare entity while avoiding unnecessary testing. Patients with suspected NETs should be referred to a tertiary hospital for multidisciplinary evaluation, and bronchoscopy should not be delayed. Herein is reported the case of an adolescent with asthma who presented with nonspecific respiratory and constitutional symptoms. The persistence of symptoms and imaging alterations despite multiple treatments for recurrent pneumonia raised clinical suspicion of a more serious underlying condition, leading to the diagnosis of bronchial NET.

Resumo Os tumores neuroendócrinos (TNEs) são as neoplasias pulmonares primárias mais comuns. O diagnóstico pode ser desafiante, pois as manifestações clínicas são geralmente subtis e as alterações imagiológicas inespecíficas. Apesar da sua natureza indolente, os TNEs têm potencial metastático e podem causar morbilidade significativa. O diagnóstico precoce é fundamental para uma abordagem otimizada, uma vez que a ressecção cirúrgica pode ser curativa. O desafio é estabelecer o diagnóstico desta entidade rara evitando avaliações e exames complementares desnecessários. Perante suspeita de TNE, o doente deve ser referenciado para um hospital terciário para avaliação multidisciplinar e realização de broncoscopia. É descrito o caso de um adolescente com asma que se apresentou com sintomas respiratórios e constitucionais inespecíficos. A persistência dos sintomas e alterações imagiológicas apesar da realização de múltiplos tratamentos por pneumonia recorrente motivou a continuação da investigação etiológica e possibilitou o estabelecimento do diagnóstico de TNE endobrônquico.

Abstract Introduction: Thoraco-bifemoral bypass (TBF) is an alternative to aorto-bifemoral bypass (ABF) or axilo-bifemoral bypass for severe aortoiliac occlusive disease. TBF may be particularly useful in select patients with concurrent visceral aortic branch vessel disease, infrarenal aortic occlusions, or after failed ABF. We describe a clinical case of a symptomatic Leriche syndrome in the presence of concurrent visceral aortic branch vessel disease. Case report: A 57-year-old male patient with a history of Leriche syndrome and acute thrombosis of the right renal artery with acute kidney injury underwent parallel grafting of the celiac trunk, superior mesenteric artery, and right renal artery 12 months before the current episode. He developed intermittent claudication for very short distances (around 5 meters), with significant limitations for activities of daily living and an inability to carry out his work activity. We decided to perform a TBF bypass through a left thoracotomy, which was uneventful. The patient is asymptomatic and has palpable pedal pulses at the 24-month follow-up. Postoperative computed tomography angiography revealed visceral aorta branches and TBF bypass patency. Conclusion: TBF bypass can be performed with good outcomes for patients with severe AIOD, especially if concomitant visceral/infrainguinal reconstruction is warranted. These results support a continued role for TFB in selected patients.

Abstract Introduction: Arteriovenous Malformations (AVMs) are high-flow anomalous connections between the arterial and venous systems composed of dysplastic vessels resulting from aberrant angiogenesis. They are congenital and when symptomatic they rarely manifest before adolescence. Depending on the location, size, stage and severity of the symptoms, treatment options vary from conservative management to surgical resection. We report a case of a giant arteriovenous malformation of abdominal wall (tipe IIIb of Yakes Classification) treated with surgical resection after prior attempts of scleroembolization. Clinical case: 54-year-old woman with known history of osteoarticular pathology and dyspepsia presented a mass on the left side of the abdominal wall with hard consistency, warm, slightly pulsating and tenderness to touch with several years of evolution. The mass showed infiltration of the internal and external oblique muscles sparing the transverse muscle. Clinically she presented easy fatigue with efforts. Due to the risk of abdominal wall herniation after excision of the AVM, scleroembolization was considered first-line treatment in this case. This strategy resulted in regression of the mass and symptoms improvement. Four years after the last intervention, the patient presented lesion growth, recurrence and worsening of symptoms with severe interference in the quality of life (QoL). After multidisciplinary discussion, she was proposed for complete resection of the AVM. She was first submitted to scleroembolization with Onyx of identified arterial afferents and sclerosis of the lesion nidus with 2% polidocanol. One month after she underwent successfully total resection of the AVM with the collaboration of General Surgery. Conclusion: No unified agreement exists on the best treatment of these complex high flow lesions and it is difficult to establish a comprehensive strategy given the pathology’s clinical variability, complex stratification and the risk of relapse. A case-by-case approach is needed in managing these types of lesions.

Abstract Objective: To evaluate the success rate of high-flow nasal cannula (HFNC) therapy using an adapted obsolete mechanical ventilator (MV), Optiflow™ and Vapotherm™ in newborns (NBs). Method: This was a retrospective observational study conducted in the neonatal intensive care unit (NICU). The sample comprised NBs who underwent HFNC therapy due to ventilatory dysfunction, for weaning from non-invasive ventilation (NIV), or post-extubation. The three groups, stratified according to gestational age (GA) and birth weight, and corrected GA and weight at the beginning of HFNC use, were as follows: Optiflow ™, Vapotherm ™, and obsolete Mechanical Ventilator (MV) adapted for high flow therapy. Subsequently, the NBs were divided into a success group (SG) and a failure group (FG). HFNC success was defined as a therapy duration exceeding 72 h. Results: A total of 209 NBs were evaluated, with 31.1 % using HFNC due to ventilatory dysfunction, 2.4 % after extubation, and 66.5 % after NIV weaning. HFNC success rate was observed in 90.9 % of the NBs, with no difference between equipment types (Vapotherm ™, Optiflow ™, and adapted VM). Conclusion: Different types of HFNC equipment are equally effective when used in neonatology for respiratory dysfunction, as a method of weaning from NIV and post-extubation. Adapted obsolete MV can be an alternative for HFCN therapy in resource-constrained settings. Objective highflow (HFNC MV, , NBs. . (NBs) Method NICU. NICU (NICU) dysfunction noninvasive non invasive NIV, (NIV) postextubation. postextubation post extubation. extubation post-extubation groups (GA use follows ™ (MV Subsequently SG (SG FG. FG (FG) 7 h Results 20 evaluated 311 31 1 31. 24 2 4 2. 665 66 5 66. 909 90 9 90. VM. VM VM) Conclusion resourceconstrained resource constrained settings (NBs (NICU (NIV (FG 3 6

Abstract Introduction: Portuguese estimates point out that nearly 20% of aortic aneurysms are treated in a ruptured setting, with in-hospital mortality reaching up to 50%. Although unfractionated heparin (UFH) is routine during elective surgery, this technical point is debatable when treating ruptured aneurysms. The authors aimed to review the literature on the topic of intraoperative heparinization with UFH within the intraoperative period of ruptured aortic aneurysms. Methods: A MEDLINE and Scopus database search using the terms “unfractionated heparin," “aortic aneurysm," and “ruptured aortic aneurysm” was performed. No time or language limitations were imposed. The last search was run in July 2023. Manuscripts were considered irrespective of study design. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing. Results: In the rupture setting, UFH usage rates have widely varied throughout time and geographical sites, and they are reported to be as low as 16%. Overall, the evidence of UFH in clinical practice in this scenario is limited. Notwithstanding, there is some evidence from observational studies of an increased pro-coagulant activity in this clinical scenario, favoring a theoretical physiologic benefit. A prospective, non-randomized study of 131 OSR patients found that patients treated with UFH had improved 30-day survival (84% vs 67%, P=0.001). Non-significant differences in blood product usage were noted. Therefore, societal guideline recommendations about intraoperative UFH in ruptured aortic aneurysms are often missing. Conclusion: UFH may potentially reduce death after open repair of rAAA. These findings should be carefully interpreted, as the evidence is scarce and heterogeneous and only portrays open repair.

Abstract Introduction: Fenestrated and branched stent graft technology has come a long way over the past few years, enabling the treatment of complex juxtarenal aneurysms, thoracoabdominal aneurysms, and arch pathologies. Many innovations have been developed, namely device and delivery optimization and technical tricks. These concepts have proven to work well when there is sufficient time to plan and manufacture a custom-made device for the patient. However, this is different in urgent or emergent cases. Using parallel graft techniques or off-the-shelf stent grafts may be efficient in urgent situations, but it is also associated with selection limitations. Recent publications have demonstrated similar mid-term technical and clinical results between physician-modified endografts (PMEGs) and customized devices. The authors aim to describe their institutional series of PMEGs. Methods: The clinical files of all patients undergoing PMEGs were consulted, and demographic data as surgery outcomes were collected. Technical success: creating the intended number of fenestrations, target vessel catheterization, and patency. Procedural success: technical success with adequate aneurysm exclusion and without endoleak in the final angiography. 30-day complications and mortality were also evaluated. Technical and procedural success were assessed, as well as morbidity and mortality. Results: Between December 2020 and December 2022, 3 patients underwent PMEGs. The indications were a juxtarenal aortic aneurysm, a type V thoracoabdominal aneurysm and a persistent type 1a endoleak. All patients were symptomatic, with one stable rupture. All cases were performed with technical and procedural success and no morbidity and mortality at 30 days. Conclusion: Stent graft modification is a valuable and valid tool in emergencies and should be a vascular surgeon's trump card when dealing with complex aortic pathologies. Nevertheless, due to the absence of long-term evidence, it should be reserved for acute patients unfit for open repair and in aneurysms with unfavorable anatomy for an off-the-shelf device.