Abstract Objective The purpose of this study was to analyze the available evidence regarding the efficacy of iPDE5 in the treatment of female sexual dysfunction (FSD). Methods A comprehensive literature search was conducted in March 2023 through the main scientific databases. Results A total of 53 articles were identified, out of which, 6 met the predefined inclusion criteria. All of these were randomized controlled trials. Among the included studies, 4 demonstrated the effectiveness of sildenafil in improving sexual response and addressing FSD, while 2 studies failed to establish its efficacy in this context. Conclusion Overall, the efficacy of sildenafil in the treatment of FSD remains controversial and inconclusive based on the available evidence. Further research is necessary to clarify the therapeutic potential of iPDE5 in addressing FSD and to better understand the factors that influence treatment outcomes. iPDE FSD. . (FSD) 202 databases 5 identified which criteria trials context Overall outcomes (FSD 20

RESUMO O transplante renal é o tratamento de excelência para a doença renal em estágio terminal, melhorando a sobrevivência e a qualidade de vida dos doentes em comparação com a diálise. No entanto, o uso de terapêutica imunossupressora para prevenção da rejeição do enxerto torna os recetores vulneráveis a infeções, uma complicação importante no período pós-transplante. As estratégias de profilaxia são indispensáveis para minimizar os riscos infeciosos e otimizar os resultados obtidos. Esta revisão pretende sistematizar as estratégias de profilaxia nas fases de pré-, peri- e pós-transplante, oferecendo uma visão abrangente das indicações, timing, doses e efeitos adversos. A profilaxia pré-transplante envolve a pesquisa meticulosa de infeções ativas, atualização do estado vacinal e tratamento de infeções latentes. A profilaxia peri-transplante concentra-se em abordagens antimicrobianas personalizadas, de forma a reduzir os riscos de infeção cirúrgica e relacionados com o dador durante o período do peri-operatório. A profilaxia pós-transplante é crucial para prevenir infeções oportunistas, com foco na pneumonia por Pneumocystis jirovecii e na infeção por citomegalovírus. Esta discussão pretende abranger as diferenças dos diversos regimes profiláticos, destacando a eficácia e os desafios associados aos agentes disponíveis e utilizados na prática clínica. Pretende ainda enfatizar o papel fundamental da instituição de profilaxias na minimização dos riscos infeciosos e na melhoria dos resultados dos recetores de transplante renal, defendendo uma abordagem proativa e multifacetada na gestão de doenças infeciosas nesse contexto. terminal diálise entanto póstransplante. póstransplante pós transplante. obtidos pré, pré , pré- peri póstransplante, transplante, indicações timing adversos prétransplante ativas latentes peritransplante concentrase concentra se personalizadas perioperatório. perioperatório operatório. operatório peri-operatório oportunistas citomegalovírus profiláticos clínica contexto

ABSTRACT Kidney transplantation is the gold standard treatment for end-stage renal disease, improving survival and quality of life compared to dialysis. However, the use of immunosuppressive therapy to prevent allograft rejection renders recipients vulnerable to infections, a major concern in the posttransplant period. Prophylaxis strategies are indispensable in minimizing infectious risks and optimizing patient outcomes. This narrative review synthesizes current prophylaxis strategies across pretransplant, peritransplant, and posttransplant phases, providing a comprehensive overview of indications, timing, dosing, and adverse effects. Pretransplant prophylaxis involves thorough screening for infections, updating immunization status, and managing latent infections. Peritransplant prophylaxis focuses on tailored antimicrobial approaches to mitigate surgical and donor-related infection risks during the perioperative period. Posttransplant prophylaxis is a crucial component against opportunistic infections, particularly focusing on preventing Pneumocystis jirovecii pneumonia and cytomegalovirus infection. This discussion encompasses the nuances of prophylactic regimens, highlighting the efficacy and challenges associated with the agents available and used in clinical practice. This review emphasizes the pivotal role of prophylaxis in minimizing infectious risks and optimizing outcomes in kidney transplant recipients, advocating for a proactive and multifaceted approach to infectious disease management in the transplant setting. endstage end stage dialysis However infections period pretransplant peritransplant phases indications timing dosing effects status donorrelated donor related regimens practice setting

Abstract Introduction: Chimney EVAR (ChEVAR) for the treatment of complex abdominal aortic aneurysm (AAA) has been largely relegated for when fenestrated endografts are unavailable, especially due to durability concerns. However, the off-the-shelf nature of ChEVAR makes it a good option for emergent AAA repair. We report our institutional experience in ChEVAR in an urgent setting. Methods: ChEVAR procedures were collected f rom 2019 to 2023 in a tertiary hospital, and a retrospective analysis was performed. This includes gathered information f rom electronic medical records, surgical reports and the picture archiving system. Descriptive statistics were applied. The main endpoints were technical success,30-day and 1-year survival. Results: Five patients were submitted to urgent aneurysm repair using the chEVAR technique. Average age was 73,4 years and all patients were male. Arterial hypertension was present in 100% patients and all patients were ASA 4. Indications for surgery were post EVAR type 1a endoleak with associated rupture or abdominal pain in two patients; symptomatic/contained rupture of pararenal AAA in two patients; and contained rupture of a thoracoabdominal aneurysm in one patient. A total of eight target vessels were catheterized: two patients required single-vessel chimney and the remainder two-vessel chimney. Target vessels were two superior mesenteric arteries and six renal arteries. Technical success rate was 100% and 30-day mortality was 0%. There were no major complications. Follow-up time is 20.2 months (4.7-38). Target vessel patency during the follow-up period was 87.5%. Three patients (60%) died due to non-aortic related pathologies, on average 18 months after surgery (4.7-38), with a 1-year survival of 80%. Conclusion: Our experience with ChEVAR for emergent AAA repair is satisfactory, with high technical success rates and low short-term mortality. Sac regression, low rates of target vessel occlusion and type 1a endoleaks reveal a favourable profile for aneurysm exclusion. ChEVAR is a viable option in emergent setting for patients unfit for open repair.

ABSTRACT Inflammation, changes in nutrient absorption and gut dysbiosis are common conditions in patients with inflammatory bowel disease. These factors may lead to variations in macro- and micronutrients and, particularly, to an imbalance of protein metabolism, loss of muscle mass and development of sarcopenia. This narrative review aims to present the set of factors with impact in muscle strength and physical performance that may potentially mediate the relation between inflammatory bowel disease and sarcopenia. Studies that associated changes in muscle strength, sarcopenia and inflammatory bowel disease were selected through a literature search in databases Medline, Pubmed and Scielo using relevant keywords: muscle strength, physical performance, sarcopenia and inflammatory bowel disease. Chronic inflammation is currently reported as a determinant factor in the development of muscle atrophy in inflammatory bowel disease. In addition, strength decline in inflammatory bowel disease patients may be also influenced by changes in body composition and by gut dysbiosis. Measures of muscle strength and physical performance should be considered in the initial identification of sarcopenia, particularly in patients with inflammatory bowel disease, for a timely intervention can be provided. Presence of proinflammatory cytokines, high adiposity, malabsorption and consequent deficits of macro and micronutrients, loss of muscle mass, and gut dysbiosis may be the main factors with impact in muscle strength, that probably mediate the relation between inflammatory bowel disease and sarcopenia. Inflammation metabolism Medline keywords addition provided cytokines adiposity

RESUMO Inflamação, alterações na absorção de nutrientes e a disbiose intestinal são condições comuns em indivíduos com doença inflamatória intestinal. Estes fatores podem levar a variações corporais do teor de macro e micronutrientes e, em particular, a um desequilíbrio no metabolismo de proteínas com perda de massa muscular e desenvolvimento de sarcopenia. Esta revisão narrativa visa apresentar o conjunto de fatores com impacto na força e função muscular que podem potencialmente mediar a relação entre doença inflamatória intestinal e sarcopenia. Estudos que associaram as alterações de força muscular, sarcopenia e doença inflamatória intestinal foram selecionados, através de uma pesquisa bibliográfica nas bases de dados Medline, Pubmed e Scielo, usando palavras-chave relevantes: força muscular, desempenho físico, sarcopenia e doença inflamatória intestinal. A inflamação crónica é atualmente citada como um fator determinante no desenvolvimento de atrofia muscular nos casos de doença inflamatória intestinal. Além disso, o declínio de força em indivíduos com doença inflamatória intestinal, também pode ser influenciado pelas alterações na composição corporal e pela disbiose instestinal. Indicadores de força muscular e de desempenho físico devem ser considerados na identificação inicial de sarcopenia, principalmente em indivíduos com doença inflamatória intestinal, para que uma intervenção precoce possa ocorrer. A presença de citocinas pró-inflamatórias, elevada adiposidade corporal, má absorção intestinal com consequente déficit de macro e micronutrientes, perda de massa muscular e disbiose intestinal poderão ser os principais fatores com impacto na força muscular, que provavelmente medeiam a relação entre doença inflamatória intestinal e sarcopenia. Inflamação particular selecionados Medline Scielo palavraschave palavras chave relevantes disso instestinal ocorrer próinflamatórias, próinflamatórias pró inflamatórias, inflamatórias pró-inflamatórias

Resumo: A estrongiloidíase é uma infecção causada por Strongyloides stercoralis. As manifestações gastrointestinais tipicamente incluem duodenite, enterocolite crónica e má absorção, sendo o envolvimento gástrico muito raro. Neste caso clínico, os autores apresentam um caso de hemorragia digestiva alta causada por uma úlcera gástrica com um diagnóstico etiológico desafiante. Em Portugal no século passado existiram casos autóctones de infecção a S. stercoralis sugerindo zonas endémicas, mas com a actual infraestrutura de saneamento a estrongiloidíase é rara. Homem de 56 anos de idade, caucasiano, fumador, com história de perda ponderal significativa, admitido no Serviço de Urgência por hematemeses e dor abdominal. A endoscopia digestiva alta realizada revelou uma úlcera gástrica gigante com aparência macroscópica sugestiva de malignidade. A investigação subsequente com tomografia computadorizada (TC) destacou a presença de espessamento gástrico e uma lesão pulmonar espiculada no lobo superior direito, sem envolvimento ganglionar ou doença metastática. Foi realizada broncofibroscopia com escovado brônquico tendo o exame histológico identificado carcinoma pavimento celular do pulmão, pelo que o doente foi referenciado para a Pneumologia Oncológica. As biópsias da úlcera gástrica descartaram malignidade e identificaram fragmentos de nemátodes com infiltrados inflamatórios e exsudado fibrino-granulocítico, sugestivo de Strongyloides stercoralis. Consequentemente, foi feito o diagnóstico de estrongiloidíase, confirmado com métodos moleculares e sorologia. Admitiu-se que a úlcera gástrica gigante terá sido causada pela infecção por Strongyloides stercoralis e o doente foi tratado com ivermectina com melhoria da dor epigástrica. Em reavaliação, seis semanas depois, o doente estava assintomático, com ganho ponderal, os exames parasitológicos das fezes estavam negativos e a endoscopia digestiva alta mostrou cicatrização completa da úlcera. Foram realizados exames adicionais para investigação de factores de risco para estrongiloidíase, tendo sido excluídas outras causas de imunossupressão subjacente para além da presença de malignidade. Neste caso clínico, a estrongiloidíase manifestou-se por envolvimento gástrico com hemorragia digestiva alta num doente que foi posteriormente diagnosticado com carcinoma pavimento celular do pulmão.

Abstract: Strongyloidiasis is an infection caused by Strongyloides stercoralis. Gastrointestinal manifestations typically include duodenitis, chronic enterocolitis, and malabsorption, while gastric involvement is very rare. In this case report, the authors present a case of upper gastrointestinal bleeding caused by a gastric ulcer with a challenging etiological diagnosis. In Portugal, there have been reports in the past century of autochthonous cases of S. stercoralis infection suggesting endemic zones, but with the current sanitation infrastructure strongyloidiasis is thought to be rare. A 56-year-old Caucasian male smoker with a history of significant weight loss presented to the emergency department with hema temesis and abdominal pain. Upper endoscopy revealed a giant gastric ulcer with a macroscopic appearance suggestive of malignancy. Further investigation with CT scan highlighted gastric wall thickness and a spiculated lung lesion in the upper right lobe without lymph node involvement or metastatic disease. Bronchoscopy with bronchial brushing was performed. Histological examination identified squamous cell carcinoma of the lung and the patient was referred to Oncological Pneumology. Gastric ulcer biopsies ruled out malignancy and identified fragments of nematodes with inflammatory infiltrates and fibrinogranulocytic exudate, suggestive of S. stercoralis. Accordingly, the diagnosis of strongyloidiasis was made and further confirmed with molecular methods and serology. The giant gastric ulcer was affirmed to be caused by S. stercoralis infection and the patient was treated with ivermectin with improvement of epigastric pain. On reevaluation 6 weeks later the patient was asymptomatic, had gained weight, parasitological stool examinations were negative, and upper endoscopy showed complete ulcer healing. Further tests were done targeting risk factors for strongyloidiasis, and in addition to the presence of malignancy, other underlying causes for immunosuppression were ruled out. In this case report strongyloidiasis was manifested by gastric involvement with upper gastrointestinal bleeding in a patient who was subsequently diagnosed with squamous cell carcinoma of the lung.

ABSTRACT Background: Adverse childhood experiences (ACEs) have been identified as a risk factor for the development of mental health and behavioural outcomes throughout life, including delinquent behaviours. This article focuses on the relationship between ACEs and delinquent behaviour (DB), seeking to identify predictors and mediating variables. Methods: The quantitative study comprised 175 Portuguese adolescents, aged 12 and 17 years of age (M = 14.99, SD = 2.26). Results: ACEs and exposure to traumatic events (ETE) are predictive of DB. Antisocial traits (AT) was found to be mediating the relationship between ACEs and DB, as well as the relation between ETE and DB. Conclusion: The results indicate that it is necessary that professionals in health behaviour field prevent and intervene in ACEs and in ETE, both predictors of DB. The results of this study allow to understand the role of ACEs in DB and its mediating variables, which must be considered to mitigate the harmful impact of ACEs in DB.

RESUMO Objetivo: A cistografia é um exame invasivo que apresenta potencial iatrogenia, nomeadamente infecção urinária (IU). Os estudos sobre a incidência de complicações associadas a esse exame são escassos. O objetivo deste trabalho foi avaliar a incidência de IU após realização de cistografia. Métodos: Estudo retrospetivo por consulta dos prontuários clínicos dos doentes com idade inferior a 15 anos, seguidos em consulta nesse hospital, que realizaram cistografia (radiológica ou isotópica) entre 2009 e 2018. Admitiu-se relação de causalidade quando o diagnóstico de IU ocorreu até sete dias após a realização do exame. Foi realizada análise estatística descritiva e utilizados testes não paramétricos para avaliar possíveis fatores preditores da ocorrência de IU após cistografia. Resultados: Realizaram-se 531 cistografias (55% isotópicas e 45% radiológicas). A mediana de idade foi de 11,5 meses; 62% eram do sexo masculino. Todos os doentes efetuaram urocultura prévia (negativa); 50% recebiam profilaxia antibiótica (ATB) à data do exame. A indicação mais frequente foi o estudo pós-natal de hidronefrose (HN) congênita/outra malformação nefrourológica (53%), seguida do estudo da IU febril (31%). Documentou-se refluxo vesicoureteral (RVU) em 40% dos exames. Ocorreu IU após cistografia em 23 casos (incidência de 4,3%). O microrganismo mais frequente foi a E. coli (52%). Verificou-se associação entre a presença de RVU e a ocorrência de IU. Conclusões: A incidência de IU pós-cistografia foi relativamente baixa na amostra deste estudo. Observou-se associação entre a ocorrência de IU após cistografia e a presença de RVU. Sublinha-se a importância de uma técnica adequada de cateterização vesical e da vigilância clínica após o exame.

ABSTRACT Objective: Cystography an invasive procedure with potential complications such as urinary infection (UI). There are few studies about the incidence of complications associated with this procedure. The purpose of this study is to evaluate the incidence of post-cystography urinary infection (UI.). Methods: Retrospective study with a review of clinical records of patients under 15 years of age, followed in this hospital, who underwent cystography (radiologic or indirect radionuclide) between 2009 and 2018. Post-cystography UI was defined when it occurred until seven days after the procedure. Descriptive and nonparametric statistics were applied to assess possible predictive factors related with post-cystography UI. Results: In the study period, 531 cystograms were undertaken (55% indirect radionuclide and 45% radiologic). The mean age at the procedure was 11.5 months; 62% were boys. Every patient had a previous negative urine culture; 50% were under antibiotic prophylaxis at the time of the procedure. The most common indication for the procedure was the post-natal study of congenital hydronephrosis/other nephrological malformation (53%), followed by the study of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%). The most frequent microorganism was E. coli (52%). The presence of VUR was significantly associated with the occurrence of post-cystography IU. Conclusions: The incidence of post-cystography UI was low in our sample. The presence of VUR was significantly associated with the occurrence of post-cystography UI. The authors highlight the importance of an adequate catheterization technique and the need for clinical surveillance after the procedure.

Abstract Introduction: The phenomenon of media tabloidization, based on the predominance of light news, increase of the visual and hyper-concurrence, is more pronounced in face of the economic pressures surrounding the media sector. Objetives: To evaluate the front pages of the four Portuguese generalist daily newspapers during a year, in order to understand whether the formal characteristics of tabloidization have any expression in these periodicals. Methods: Through a direct analysis of 54 covers of each diary, and based on the scheme proposed by Colin Sparks (2000), we quantified the number of news and imagens on the front pages and categorized them in terms of the focus (public or private) and the theme (light or hard). Results: We concluded that Correio da Manhã and Jornal de Notícias are the press titles in which the singularities of the tabloidization phenomenon are most visible. On the contrary, Jornal i and Público are the newspapers with the least signs of tabloidization. Conclusions: Tabloidization is more visible in the two generalist daily newspapers that are market leaders, which confirms the idea that argues that the journalistic treatment of lighter themes may be a way to overcome the economic media crisis.

Resumen Introducción: El fenómeno de la tabloidización de los medios, basado en el predominio del contenido ligero, el dominio de lo visual y la hipercompetencia, es más pronunciado frente a las presiones comerciales que rodean al sector de los medios. Objetivos: Evaluar las primeiras paginas de los cuatro diarios generalistas portugueses durante un año, a fin de comprender si las características formales de la tabloidización tienen alguna expresión en estas publicaciones periódicas. Métodos: A través de un análisis directo de 54 ediciones de cada diario, y en base al esquema propuesto por Colin Sparks (2000), cuantificamos el número de noticias e imágenes en las primeras paginas y los clasificamos en términos del enfoque (público o privado) y del tema (leve o serio). Resultados: Concluimos que el Correio da Manhã y el Jornal de Notícias son los títulos de prensa donde las singularidades del fenómeno de tabloidización son más visibles. Por el contrario, el Jornal i y Público son los periódicos con menos signos de tabloidización. Conclusiones: La tabloidización es más visible en los dos diarios generalistas que son líderes del mercado, cumplindo con la idea de que el tratamiento periodístico de temas más ligeros puede ser una forma de sortear la crisis de los medios de comunicación.

Resumo Introdução: O fenómeno da tabloidização dos media, assente no predomínio de conteúdos leves, domínio do visual e hiperconcorrência tem uma expressão mais acentuada face às pressões comerciais que cercam o setor dos meios de comunicação social. Objetivos: Avaliar as capas dos quatro jornais diários generalistas portugueses durante um ano, de modo a compreender se as caraterísticas formais da tabloidização têm expressão nestes periódicos. Métodos: Através de uma análise direta de 54 capas de cada diário, e com base no esquema proposto por Colin Sparks (2000), quantificámos o número de destaques e de imagens nas primeiras páginas e categorizámos esses destaques face ao enfoque (público ou privado) e face à temática (leves ou sérias). Resultados: Concluímos que o Correio da Manhã e o Jornal de Notícias são os títulos de imprensa onde as caraterísticas do fenómeno da tabloidização são mais visíveis. Em sentido contrário, o Jornal i e o Público são os diários que apresentam menos indícios de tabloidização. Conclusões: A tabloidização está presente de forma mais visível nos dois jornais diários generalistas que são líderes de mercado, o que vai ao encontro da corrente que defende que o tratamento jornalístico de temáticas mais leves pode ser uma forma de contornar a crise dos media.

A síndrome stroke-like migraine attacks after radiation therapy (SMART) é uma condição extremamente rara que consiste no aparecimento de sinais e sintomas neurológicos complexos ou estados confusionais, em doentes submetidos a radioterapia cerebral prévia. Encontram-se alterações características na ressonância magnética cerebral que normalizam com a resolução dos sintomas. O presente caso clínico descreve uma doente de 64 anos com antecedentes de radioterapia cerebral e aparecimento de hemiparesia direita de novo, confusão e depressão do estado de consciência, com alterações na ressonância magnética cerebral compatíveis com síndrome SMART. Os autores pretendem alertar para a existência desta síndrome e para o seu eventual subdiagnóstico.

Stroke-like migraine attacks after radiation therapy (SMART) is an extremely rare syndrome that involves the appearance of complex neurological signs and symptoms or confusional states in patients who have undergone brain radiation years earlier. There are characteristic changes in brain magnetic resonance imaging that normalize with the resolution of symptoms. We report the case of a 64-year-old woman with a history of brain radiotherapy and the onset of inaugural right hemiparesis, confusion and decreased level of consciousness, presenting brain magnetic resonance imaging changes compatible with the diagnosis of stroke-like migraine attacks after radiation therapy. The authors intend to draw attention to the existence of this syndrome and its possible under-diagnosis.

Os aneurismas da artéria femoral superficial (AFS) são entidades clínicas raras, com poucos casos clínicos e pequenas séries publicadas, normalmente relativas a aneurismas de etiologia aterosclerótica. Nós reportamos o caso clínico de degenerescência aneurismática da artéria femoral superficial, num doente previamente submetido a endarterectomia da AFS e encerramento com patch de veia grande safena. Um homem de 73 anos apresentou-se numa consulta de rotina de cirurgia vascular. O paciente tinha sido submetido a endarterectomia da AFS e angioplastia com patch de veia, dezasseis anos atrás, por claudicação intermitente. Ao exame físico, o doente apresentava uma massa pulsátil na coxa direita. O pulso pedioso era palpável e amplo. O ecodoppler e AngioTC confirmaram o diagnóstico de aneurisma da AFS com 78x71x240mm. O doente foi proposto para aneurismectomia e pontagem femoro-poplítea. Durante o procedimento, foi realizado o controlo proximal e distal da AFS, e o aneurisma foi aberto. Após remoção de quantidade considerável de trombo, foi realizado uma pontagem femoro-poplítea inlay, com recurso à veia grande safena ipsilateral. No caso descrito, a zona aneurismática coincidia precisamente com a extensão de AFS endarterectomizada e nenhum outro aneurisma foi detectado. Este é um caso incomum de degenerescência aneurismática da AFS após endarterectomia e angioplastia com patch de veia.

Superficial femoral artery (SFA) aneurysms are rare clinical disorders, with few case reports and small series published concerning atherosclerotic aneurysms. We report a clinical case a giant aneurysm of the SFA, in a patient previously submitted to extensive SFA endarterectomy and vein angioplasty. A 73-year-old man presented at a routine vascular surgery consultation. The patient had been submitted to a right SFA endartectomy and vein patch angioplasty, sixteen years ago, for intermittent claudication. Physical examination demonstrated a large pulsatile mass of the right thigh. His right pedal pulse was palpable. Ultrasound and computed tomography scan confirmed a 78x71x240mm aneurysm of the right superficial femoral artery. He was proposed to aneurysmectomy and femoro-popliteal bypass. During operative intervention, proximal and distal control was obtained and the aneurysm opened. A large amount of thrombus was removed and a femoro-popliteal bypass was performed using the ipsilateral great saphenous vein. The postoperative period was uneventful, as was the patient recovery. In our report, the aneurysmal area matched precisely to the endarterectomised area and no other aneurysms were found. So we are facing an uncommon case of a SFA degeneration into a giant aneurysm after extensive endarterectomy and vein angioplasty.

Introduction: Peritonitis is a common complication in peritoneal dialysis, playing a weighty role in patient morbidity and a major cause of transfer to hemodialysis Relapsing or repeat episodes are associated with the development of a biofilm-trapping bacteria, and catheter removal is recommended in these cases. Since October of 2013 our peritoneal dialysis unit has developed a protocol that adds a fibrinolytic agent to an intraperitoneal antibiotic, aiming to reduce the number of relapsing/repeat episodes. Objective: To demonstrate the efficacy and safety of associating a fibrinolytic agent to intraperitoneal antibiotics in the prevention of relapsing or repeat peritonitis. Methodology: Observational study comparing the number of relapsing/repeat peritonitis events between two groups during a four-year period: a historic one, treated with intraperitoneal antibiotics only (control group) and one group that received an association of intraperitoneal antibiotics with alteplase (alteplase group). Secondary and fungi peritonitis were excluded from this study. Results: During the study period, a total of 103 peritonitis episodes were registered (control group: 61 episodes; alteplase group: 42 episodes) corresponding to 17 relapsing/repeat events, with statistical significance between groups (control group: 15 episodes (24.6%); alteplase group: 2 episodes (4,7%); p=0.008). There was no difference in demographic characteristics or the presence of exit site infection between the groups. The microorganisms most frequently involved in relapsing/repeat episodes were S.epidermidis and E.coli. Regarding the outcomes of the treatment, no patient in the alteplase group had to undergo catheter removal due to relapsing/repeat episodes of peritonitis. There were no adverse events following alteplase administration. Three deaths due to peritonitis-related sepsis were registered. Conclusion: Although relapsing/repeat peritonitis are still an important cause of catheter removal, this study demonstrates the potential benefit of fibrinolytic association with intraperitoneal antibiotics in preventing these events and potentially reducing modality drop-out.

Abstract: Leadership is an essential element for promoting innovation. The literature has primarily focused on the effect of “constructive” leadership on innovation, although numerous studies point out that destructive leadership affects organizational performance. However, such literature pays little attention to the relationship between destructive leadership and innovation. This study uses an online survey of 210 employees from 80 Portuguese firms in different sectors, to test the effect of destructive leadership on behavioural innovation and how a caring climate influences such relationship. The analysis uses multiple linear regressions to test the hypotheses. Findings reveal that destructive leadership has a negative effect on innovation and on caring climate. The results show that a caring climate influences innovation in a positive way that mitigates the relationship between destructive leadership and innovation.

Introduction: Studies have shown no clear superiority between surgical and percutaneous methods for peritoneal dialysis (PD) catheter insertion, so the preferred method usually depends on each center’s experience. In our center we perform both percutaneous technique with fluoroscopic guidance (PTFG) and laparoscopic technique (LT). Objective: Our main goal is to present our experience with PTFG and our results. We also aim to compare PTFG with LT in terms of complications associated with catheter placement and 1-year catheter survival. Methods: We performed a retrospective study that included the 17 incident patients submitted to first PD catheter placement using PTFG from 28th October 2014 to 15th March 2018 and the last equivalent number of patients that were submitted to first PD catheter placement using LT, until 15th March 2018. Results: We observed no statistically significant differences between groups with respect to 1-year catheter survival and complications related to PD catheter insertion, apart from dialysate leakage, which was higher in the LT group. There were complications to take into account in the PTFG group. Conclusion: PTFG performed by nephrologists seems to be an effective technique for PD catheter placement, although no substitution for surgical techniques when clinically indicated, and results can be improved with increased experience with this technique.