ABSTRACT Introduction: Optimal fluid balance in peritoneal dialysis requires adequate urinary and peritoneal water and sodium removal and restriction of dietary sodium intake (<2 g/day). We aim to study the relationship between sodium intake, blood pressure control and medication burden in peritoneal dialysis patients. Methods: Observational, cross-sectional study of chronic peritoneal dialysis patients followed in our hospital in March 2022. We estimated patient’s sodium intake according to the equations proposed by Kim et al. Mean ambulatory blood pressure was categorized in controlled, stage one, stage two and stage three hypertension. A qualitative evaluation of sodium intake was done by asking patients about their compliance with a low-salt diet. Results: Eighty-two patients: mostly men, with a mean age of 54.1±14.7 years and dialysis vintage of 26.2±18.7 months. Most patients were on continuous ambulatory peritoneal dialysis (63.4%) and the mean weekly Kt/V was 2.2±0.4. A percentage of 85.4% of our patients had residual diuresis, averaged at 1257±867 mL/day. Mean dietary sodium intake was 3.5±1.1 g; it was higher in men and patients with uncontrolled hypertension, regardless of age, dialysis vintage and other comorbidities. We found a strong correlation between dietary sodium intake and residual diuresis, systolic blood pressure, diastolic blood pressure and the number of anti-hypertensive drugs. Patients with a sodium intake ≥ 3.3 g had higher risk of uncontrolled BP and higher medication burden. Qualitative evaluation of this sub-population revealed that only 2.3% (n=1) admitted non-compliance with a low-sodium diet. Conclusion: We found a strong correlation between estimated dietary sodium consumption, blood pressure control and medication burden. Most importantly, there was a striking difference between patient’s perception of sodium consumption and the actual results. Our results highlight the importance of dietary salt restriction in blood pressure control and reinforce the need for a dietary consultation in peritoneal dialysis patients.

Resumo Neste ensaio examino as diferenças existentes entre o multiculturalismo e o interculturalismo assumindo que não somente representam modelos diferentes, como a sua institucionalização se situa a escalas distintas. Primeiro, ofereço um sistema de premissas para identificar o âmbito de uma prática ou política multicultural. Segundo, coloco em relevo os autores que entendem o interculturalismo como uma mera variação retórica do anterior multiculturalismo. Terceiro, procuro mostrar como podemos diferenciar os dois modelos partindo das suas lógicas institucionais. Finalmente, e com a brevidade de um ensaio, aponto algumas fragilidades ao multiculturalismo que tornam mais pertinente a crítica ensaiada pelos defensores do interculturalismo, bem assim como as suas principais propostas. Concluo salientando algumas premissas do interculturalismo onde se sustentam diferenças substantivas com o multiculturalismo.

Abstract In this essay, I examine the differences between multiculturalism and interculturalism assuming that not only they represent different models, but also their institutionalization occurs at different scales. First, I offer a system of premises to identify the scope of a multicultural practice or policy. Second, I highlight those authors who understand interculturalism as a mere rhetorical variation of earlier multiculturalism. Third, I try to show how we can differentiate the two models starting from their institutional logics. Finally, and with the brevity of an essay, I point out some weaknesses of multiculturalism that make the critique rehearsed by the defenders of interculturalism more pertinent, as well as their main proposals. I conclude by emphasizing some premises of interculturalism where substantive differences with multiculturalism are supported.

Abstract The intrauterine device is the most used long-acting reversible contraceptive method, presenting a low incidence of complications. The authors present a case of an intrauterine device migration, with an uterine perforation by its lower extremity.

Resumo O dispositivo intrauterino é o método contracetivo reversível de longa duração mais utilizado, apresentando uma baixa incidência de complicações. Os autores apresentam um caso de migração de um dispositivo intrauterino, em que se verificou perfuração uterina a partir da sua extremidade inferior.

ABSTRACT Introduction: Sleep disorders affect up to 70% of peritoneal dialysis (PD) patients and appear to have significant negative effects on their quality of life (QoL). We compared life and sleep quality between patients on automated PD (APD) and continuous ambulatory PD (CAPD). Material and Methods: Cross-sectional study in chronic PD patients followed in our Dialysis Unit in February 2022. We evaluated sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) and QoL with EUROHIS-QOL-8. Results: Fifty-two patients, mostly men (65.4%, n=32), with a mean age of 52.7±14.2 years and PD vintage of 24.3±17.1 months. Our sample had similar distribution between APD and CAPD; we found no difference between groups regarding demographic data, PD-related quality parameters or prevalence of previous sleep disturbances. Mean QoL index was 69.9%±9.3% and similar between APD and CAPD patients; EUROHIS-QOL-8 negatively correlated with the scores on ESS (p=0.004) and PSQI (p=0.011). Regarding sleep quality, the mean ESS was 8.8±4.2 and PSQI was 7.6±3.6. APD patients had similar scores on ESS, but higher prevalence of severe daytime sleepiness (ESS≥18) (p=0.04) and higher scores on PSQI (p=0.002). Within the PSQI, sleep’ latency (p=0.003), duration (p=0.002) and efficiency (p=0.013) were the most affected parameters. Higher PSQI scores also correlated with worse blood pressure control; a cut-off value for PSQI of 6 was found to increase the risk of uncontrolled hypertension. Conclusion: In our series, APD patients had worse global sleep quality (PSQI) when compared to ACPD patients. This difference was mainly due to worse sleep latency, duration and efficiency. The assessment of the quality of life showed no difference between groups, however there was a clear link between quality of life and sleep quality.

ABSTRACT A 43-year-old male patient followed for 27 years in a Nephrology consultation with negative autoimmune diagnostic workup and a histologically proven membranous nephropathy (MN), interpreted as a primary MN. During the follow-up he had multiple relapses, requiring continuous immunosuppression. Eventually, end-stage renal disease developed and the patient started hemodialysis (HD) in January 2018. Soon after initiating HD, he was admitted to the ward due to persistent fever of unknown origin, refractory to antipyretic and antibiotic therapy, but responsive to prednisolone (40 mg/day). Again, the diagnostic workup was negative and the patient was discharged with a corticosteroid taper over 16 weeks. In a posterior admission, after prednisolone suspension, the patient presented to the emergency room with persistente fever, involuntary weight loss, pruriginous macular rash and inflammatory joint pain. As the anti-nuclear antibody and anti-dsDNA came up positive and there was complement consumption, a diagnosis of a systemic lupus flare was established. His stay was complicated by sudden respiratory distress associated with hemoptysis and hemoglobin drop, with a confirmed diffuse alveolar hemorrhage. Daily plasma Exchange and intensive immunosuppression was necessary and the patient evolved into complete clinical remission with partial serological response. Usually, patients with systemic lupus erythematosus (SLE) develop clinical and serological remission upon initiating HD, reducing the number of flares and need for medication. This case depicts a lupus flare after starting HD, on a previously serologically negative patient, complicated with a rare type of lung parenchyma involvement, which is associated with a high mortality and required intensive immunosuppression for disease control. One can speculate whether or not the initial glomerulopathy was the first manifestation of SLE, previously controlled due to the continuous use of immunosuppression.

ABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations.

ABSTRACT We admitted a 21‑year‑old female to the Nephrology ward due to proteinuria and generalized oedema, which started soon after consuming clonixin 300mg thrice a day for two weeks. Her initial blood work showed nephrotic‑range proteinuria, hypoalbuminaemia, hypercholesterolaemia and normal kidney function. We conducted a full auto‑immune and serological study: there were no signs of infection, complemente consumption or underlying auto‑immune diseases. Suspecting minimal change disease, we started prednisolone 1mg/kg/day, with good clinical response and a reduction of urinary protein losses. By the third day, a kidney biopsy was performed: the glomeruli were morphologically normal and no immune deposits were found, which suggested minimal change disease. After seven days, the patient was discharged from the hospital with a corticoid taper until her Nephrology consultation. In the following weeks she maintained clinical and laboratorial remission and prednisolone was stopped after six months. Two months after, the patient noticed a growing bilateral cervical mass and went to the emergency room. The diagnostic workup was inconclusive, so an ultrasound‑guided biopsy was requested. The biopsy revealed lymphoid cell proliferation, positive for CD30, CD15, MUM‑1 and BCl6. These findings confirmed a Hodgkin’s Lymphoma diagnosis and the patient started radiotherapy and chemotherapy (ABVD‑doxorubicin, bleomycin, vinblastin, dacarbazine). In the following months her clinical status improved and the cervical mass had a significant size reduction. The kidney disease remained in remission, without therapeutic adjustments. A post‑treatment PET scan was requested, showing only a residual mediastinal mass.

ABSTRACT A 56-year-old male with a poorly controlled human immunodeficiency virus infection presents to the emergency room due to anorexia and weight loss. The patient was emaciated, hypertensive and his laboratory tests showed thrombocytopenia, anaemia, an elevated lactate dehydrogenase and an acute kidney injury. The patient was admitted to the Infecciology ward and by the fourth day, as the kidney function did not improve, a Nephrology consultation was requested. We collected a full auto-immune and serological panel and a urinalysis to rule out glomerular pathologies. Two days later, the patient developed a hypertensive emergency associated with an acute respiratory distress, responsive to furosemide and anti-hypertensive medications. The complementary study showed a high LDH, unmeasurable haptoglobin, thrombocytopenia and schizocytes on peripheral blood smear. These findings suggested a thrombotic microangiopathy associated with human immunodeficiency virus infection and so, he restarted antiretroviral therapy. The kidney function deteriorated and, despite starting haemodialysis, the patient died shortly after.

Resumo As fraturas de Tillaux são fraturas da margem lateral da tíbia distal, geralmente relatadas em crianças entre 12 e 14 anos. Como fraturas intra-articulares, requerem redução e fixação anatômica para evitar complicações pós-traumáticas. Como o mecanismo de lesão é a rotação externa do pé na perna, essas lesões são comumente associadas a outras fraturas ou lesões ligamentares. Atualmente, a artroscopia está sendo cada vez mais utilizada para auxiliar e melhorar o tratamento cirúrgico das fraturas do tornozelo. Os autores descrevem um acompanhamento de 12 meses de um caso raro de uma fratura não percebida de Tillaux associada a lesão por sindesmose em um paciente de politrauma com 76 anos de idade, tratado com sucesso por redução e fixação interna assistida por artroscopia.

Abstract Tillaux fractures are fractures of the lateral margin of the distal tibia, usually reported in children between 12 and 14 years old. As intraarticular fractures, they require anatomic reduction and fixation to avoid posttraumatic complications. Since the injury mechanism is external rotation of the foot on the leg, these injuries are commonly associated with other fractures or ligamentous lesions. Currently, arthroscopy is being increasingly used to assist and improve surgical treatment of ankle fractures. The authors describe a 12-month follow-up of a rare case of a missed Tillaux fracture associated with syndesmosis injury in a 76-year-old polytrauma patient, successfully treated by arthroscopically-assisted reduction and internal fixation.

Resumo A síndrome de Ramsay Hunt é uma causa incomum de otalgia, caracterizada por uma tríade de otalgia, paralisia facial periférica ipsilateral e rash vesicular no ouvido externo ou orofaringe, causada pela reativação do vírus Varicella-Zoster. Descreve-se o caso de um homem de 21 anos que recorre aos Cuidados de Saúde Primários por otalgia como “picadas” à direita, com uma semana de evolução, diagnosticado com otite externa e medicado com antibioterapia tópica. Posteriormente desenvolve paralisia facial periférica direita, mantendo a otalgia e é diagnosticado com síndrome de Ramsay Hunt. Esta síndrome é uma condição médica emergente e potencialmente grave, que requer uma abordagem e tratamento precoces. O seu diagnóstico é clínico e o seu tratamento inclui fármacos antivíricos e corticosteroides. Este é muitas vezes protelado, estando associado a pior prognóstico e a possíveis complicações, como a nevralgia pós-herpética, úlceras da córnea de exposição e sequelas neurológicas.

Abstract Ramsay Hunt syndrome is an uncommon cause of otalgia and is described as a triad of otalgia, ipsilateral peripheral facial paralysis and vesicular rash in the external ear or oropharynx, caused by the reactivation of the Varicella-Zoster Virus. We report the case of a 21-year-old man who attended a consultation with his family doctor with a one-week history of right sided otalgia, being diagnosed with otitis externa and treated with topical antibiotics. Two days later, he developed right peripheral facial paralysis, and was diagnosed with Ramsay Hunt Syndrome. This syndrome is an emerging and potentially serious medical condition that requires an early approach and treatment. Its diagnosis is clinical and its treatment includes antiviral drugs and corticosteroids. The treatment is often postponed, associated with a worse prognosis and possible complications, such as post-herpetic neuralgia, corneal exposure ulcers and neurological sequelae.

Neste texto interessa-me explorar a ideia segundo a qual o cosmopolitismo é mais do que uma condição urbana, do viver em comum com a diferença cultural, e que se transformou numa das linguagens da máquina de crescimento urbanístico e da sua configuração política. No âmbito das estratégias de governança urbana um tal cosmopolitismo é intrinsecamente territorializado, ou seja, estabelece interdependências com as dimensões simbólicas e económicas de um território específico. Para iluminar estas interdependências sirvo-me das políticas culturais e de marketização do lugar que incorporam a noção de vantagem da diversidade na cidade de Lisboa e em particular na zona do Eixo Almirante-Reis e Mouraria. Metodologicamente o texto recolhe contributos de uma constelação de actores-chave que compreende actores estatais, comerciantes de origem imigrante, e líderes associativos. Serve-se igualmente de um corpus de documentos e discursos oficiais que sustentam algumas das premissas propostas. Termino sugerindo um conjunto de domínios onde a diversidade cultural se integra em novas dinâmicas de reconhecimento que estruturam a noção da cidade cosmopolita.

In this text I am interested in exploring the idea that cosmopolitanism is more than an urban condition, of living in common with cultural difference, and which has become one of the languages ??of the urban growth machine and its political configuration. Within urban governance strategies such cosmopolitanism is intrinsically territorialized, that is, it establishes interdependencies with the symbolic and economic dimensions of a specific territory. To illuminate these interdependencies I use the cultural and place-marketing policies that incorporate the notion of diversity advantage in the city of Lisbon and in particular in the Almirante-Reis and Mouraria axis area. Methodologically the text gathers input from a constellation of key actors comprising state actors, immigrant traders, and associative leaders. It also uses a corpus of official documents and speeches that support some of the proposed premises. I conclude by suggesting a set of domains where cultural diversity is integrated into new recognition dynamics that structure the notion and practice of the cosmopolitan city.

RESUMO O World Health Organization Disability Assessment Schedule (WHODAS 2.0) é uma ferramenta desenvolvida pela Organização Mundial de Saúde (OMS) para medir deficiência e incapacidade, apoiando o modelo da Classificação Internacional de Saúde, Incapacidade e Funcionalidade. A versão brasileira do WHODAS 2.0 foi traduzida e disponibilizada para uso pela OMS em 2015. Assim, este estudo pretende validar a versão brasileira do WHODAS 2.0 para uso em pessoas com cegueira. Participaram 56 pessoas com cegueira (idade média: 48,4±13,6 anos). Foram utilizadas duas ferramentas de avaliação: a versão de 36 itens do WHODAS 2.0 e o World Health Organization Quality of Life-bref (WHOQOL-abreviado). As propriedades psicométricas testadas foram consistência interna, teste-reteste e validade de critério. Houve boa confiabilidade teste-reteste (ICC≥0,63). Os valores de a de Cronbach mostraram boa consistência interna na maioria das áreas, exceto no subdomínio de atividades escolares ou de trabalho (a=0,55). A validade do critério foi adequada, com correlações moderadas entre os domínios do WHODAS 2.0 e áreas do WHOQOL-abreviado. Os resultados indicaram a validade do WHODAS 2.0 para avaliar a funcionalidade de pessoas com cegueira.

ABSTRACT The World Health Organization Disability Assessment Schedule (WHODAS 2.0) is a tool developed by the World Health Organization (WHO) to measure functioning and disability, supporting the ICF model. The Brazilian version of WHODAS 2.0 was translated and made available for use by WHO in 2015. Thus, this study aims to validate the Brazilian version of WHODAS 2.0 for use in blind people. Participants were 56 blind people (mean age: 48.4 ± 13.6) years. Two assessment tools were used, the 36-item version of WHODAS 2.0 and the World Health Organization Quality of Life-BREF (WHOQOL-bref). The psychometric properties tested were internal consistency, test-retest and criterion validity. There was good test-retest reliability (ICC≥0.63). Cronbach’s alpha values showed good internal consistency in most areas, except in the subdomain of school or work activities (α = 0.55). The validity criterion was adequate, with moderate correlations between WHODAS 2.0 domains and WHOQOL-bref areas. The results indicated the validity of the WHODAS 2.0 for assessing the functionality of blind people.

RESUMEN La World Health Organization Disability Assessment Schedule (WHODAS 2.0) es una herramienta desarrollada por la Organización Mundial de la Salud (OMS), la que se utiliza para medir la discapacidad y la incapacidad, basándose en el modelo de la Clasificación Internacional del Funcionamiento de la Discapacidad y de la Salud. La versión brasileña de WHODAS 2.0 fue traducida por la OMS y puesta a disposición para su uso en 2015. Este estudio pretende validar la versión brasileña de WHODAS 2.0 para uso en personas con ceguera. Participaron 56 personas con ceguera (promedio de edad: 48,4±13,6 años). Se utilizaron dos herramientas de evaluación: la versión de 36 ítems de WHODAS 2.0 y la World Health Organization Quality of Life-bref (WHOQOL-abreviado). Las propiedades psicométricas probadas fueron: consistencia interna, test-retest y validez de criterio. Hubo una buena confiabilidad test-retest (ICC≥0,63). Los valores de a de Cronbach mostraron una buena consistencia interna en la mayoría de las áreas, excepto en el subdominio de actividades escolares o de trabajo (a=0,55). La validez del criterio fue adecuada, con correlaciones moderadas entre los dominios de WHODAS 2.0 y las áreas de WHOQOL-bref. Los resultados demuestran la validez de WHODAS 2.0 para evaluar la funcionalidad de las personas con ceguera.

A endocardite é uma doença caracterizada pela sua elevada mortalidade. O tratamento preconizado nas recomendações engloba, muitas vezes, o uso simultâneo de vários antibióticos por um longo período. Frequentemente, os doentes afetados por esta doença têm várias comorbilidades associadas, que limitam o uso dos antimicrobianos recomendados. O presente caso clínico descreve um doente com endocardite que pelas suas patologias e limitações orgânicas foi impedido de fazer um tratamento prolongado para a endocardite, todavia com cura documentada, apesar do esquema terapêutico de curta duração

Endocarditis is a disease characterized by its high mortality. The treatment recommended in the guidelines often involves the simultaneous use of several antibiotics for a long period. Often, patients affected by this disease have several associated comorbidities, which limit the use of recommended antimicrobials. The present case describes a patient with endocarditis who, due to his pathologies and organic limitations, was prevented from comply a prolonged treatment for endocarditis, nevertheless he achieved a documented cure, despite the short-term treatment regimen

Among thrombotic microangiopathies (TMA), the hemolytic uremic syndrome associated with dysregulation of the alternative complement pathway (aHUS) is one of the most challenging diseases a nephrologist can face. By the end of the XXth century, the complement’s role was unraveled with the discovery that mutations in the factor H coding gene were responsible for aHUS. But it was the acknowledgment that pharmacological C5-9 blockage provided a cure for aHUS that fostered the interest of the nephrology community in the genetics, pathophysiology and therapeutics of, not only of aHUS, but TMA in general. The molecular genetics of aHUS is technically demanding and, as such, in Portugal (alike many other European countries) a single laboratory emerged as a national reference center. The fact that all samples are evaluated in a single center provides a unique opportunity for data collection and a forum for discussion for all those interested in the field: immunologists, molecular geneticists, pathologists and nephrologists. The current consensus document emerged from such a discussion forum and was sponsored by the Portuguese Society of Nephrology. The goal is more to portray the Portuguese picture regarding the diagnostic approach and therapeutic options than to extensively review the state of the art of the subject. The accompanying documents that are published as supplementary data are in line with that goal. They range from the informed consent and clinical form to be sent together with the biological samples for genetic testing, to the appendix regarding the actual sampling and storing conditions. The document is also intended to set an example for future documents and independent discussion forums on other kidney diseases for which emerging diagnostic and/or therapeutic strategies are reaching clinical practice