A significant dysfunction of another organ is usually considered an absolute contraindication for lung transplantation, unless multiorgan transplantation is indicated and practical, as is the case of combined lung-kidney transplantation. Few cases of combined lung-kidney transplantation have been described in the literature; however, it is known that, in certain cases, it is the only way to offer an opportunity to selected patients with renal and lung dysfunction. The authors are not aware of any previously published case of a patient receiving both extracorporeal membrane oxygenation and continuous venovenous hemodiafiltration as a bridge for combined kidney-lung transplantation. The authors present the first case of combined lung-kidney transplantation performed in Portugal.

The majority of drugs prescribed have not been tested in children and safety and efficacy of children's medicines are frequently supported by low quality of evidence. Therefore, a large percentage of prescriptions for children in the clinical daily practice are used off label. Despite the several recent legislation and regulatory efforts performed worldwide, they have not been successful in increasing availability of medicines adapted to children. Moreover, if we consider that 30% of the prescribed drugs for children are for the respiratory field and only 4% of new investigation projects for children research were proposed to access drugs for respiratory and allergy treatment, there is a clear imbalance of the children needs in this therapeutic area. This narrative review aimed to describe and discuss the off-label use of medicines in the treatment and control of respiratory and allergic diseases in children. It was recognized that a large percentage of prescriptions performed for allergy treatment in daily clinical practice are off label. The clinicians struggle on a daily basis with the responsibility to balance risk-benefits of an off-label prescription while involving the patients and their families in this decision. It is crucial to increase awareness of this reality not only for the clinician, but also to the global organizations and competent authorities. New measures for surveillance of off-label use should be established, namely through population databases implementation. There is a need for new proposal to correct the inconsistency between the priorities for pediatric drug research, frequently dependent on commercial motivations, in order to comply to the true needs of the children, especially on the respiratory and allergy fields.

ABSTRACT: Hydrogen is one of the most valuable alternatives to fossil fuels to produce energy. However, although it is abundant in the universe and has the highest gravimetric density, it is difficult to obtain and store in its molecular form and in safe conditions. One alternative to the conventional hydrogen storage is to use the high hydrogen content (10.66 wt. %) of sodium borohydride to, simultaneously, produce and store it.

ABSTRACT: The biomass quality is an important issue for the operation of a thermoelectric plant. Independently of the combustion technology, the biomass fuels and its characteristics are responsible for some operating problems during the thermochemical conversion of the biomass in thermal energy. These operation problems are related to the boiler and heat exchangers, dedusting technologies (e.g., electrostatic precipitator). Some studies show the phenomena of corrosion and incrustation on the walls of the boiler (named as fouling phenomenon) and on the walls of superheater, economizer, and equipments for flue gas treatment (named as slag phenomenon). When the biomass presents high levels of alkaline metals, like herbaceous and agro-industrial residues, these problems will be intensified. For example, the potassium and sodium decrease the melting point of the ashes, causing the incrustations and slag formation. On the other hand, magnesium and calcium in the biomass lead to the increase of the melting point of the ashes. The influence of the biomass quality on the bottom and fly ashes properties is related with the quantity of inert material, unburned carbon content and chemical composition. Thus, the main goal of this research work is focused on the characteristics of the forest biomass residues used as fuel in a Portuguese thermoelectric plant equipped with grate furnace technology. The results obtained allow the evaluation of the influence of some physical-chemical characteristics of the biomass on the produced ashes, and in the overall power plant performance.

PURPOSE: Evaluate whether there are significant changes in choroidal thickness following trabeculectomy, and how they relate do the decline in intraocular pressure. METHODS: This was a prospective evaluation of 28 eyes who underwent Moorfields modified trabeculectomy. The choroidal thickness was measured via OCT with enhanced depth imaging, before surgery and 1 day, 1 week and 1 month after surgery. Measurements were taken at the fovea, 1000 µm temporal to the fovea and 1000 µm nasal to the fovea. The relationship between choroidal thickness and intraocular pressure was statistically evaluated. RESULTS: The mean intraocular pressure before surgery was 25.07 ± 4.64 mmHg; 8.57 ± 3.62 mmHg after 1 day; 10.36 ± 4.39 mmHg after 1 week and 13.71 ± 5.13 mmHg after 1 month. Mean choroidal thickness increased after trabeculectomy with maximal values at 1 week. The largest increase was found at the fovea, with an average before surgery of 253.54 ± 62.01 µm; 286.75 ± 64.20 µm at 1 day, 286.36 ± 63.14 µm at 1 week and 271.00 ± 60.31 µm at 1 month. Increase in choroidal thickness was significant 1 day and 1 week after surgery in the foveal (p = 0.012, p = 0.007) and temporal (p = 0.040, p = 0.000) locations and 1 week postoperatively on the nasal location (p = 0.016). None of them were significant at 1 month after surgery. Preoperative IOP and choroidal thickness were correlated at all macular locations (ρ = 0.449-0.525, p = 0.004-0.016) yet no correlation was found between increase in choroidal thickness and decline in intraocular pressure in the postoperative period. CONCLUSION: Choroidal thickness appears to increase temporarily after trabeculectomy and these changes were not correlated with the decline in intraocular pressure. Further research is required to fully understand this phenomenon.

Objective: Unilateral ocular leukemic infiltration with acute angle closure is an infrequent complication of B-cell acute lymphoblastic leukemia (ALL-B). We present a clinical case of leukemic ocular infiltration as the sole manifestation of ALL-B relapse. Methods: Case description Results: A 15-year-old female with a history of acute lymphoblastic leukemia in remission for 2 years and pulmonary tuberculosis treated in the past year presented with ocular redness and decreased visual acuity in the left eye (LE) with 5 days of evolution. Visual acuity was 20/20 in the right eye (RE) and absence of light perception in the left eye (LE). Biomicroscopy of LE showed a small hypopion, anterior chamber cells 4+, vitreous cells 3+, and a large white mass in the vitreous with associated vitreous hemorrhage in organization. In LE fundoscopy, the vitreous mass occupying most of the vitreous cavity and associated hemorrhage prevented retina visualization. B-scan ultrasound showed a multilobulated mass occupying virtually the entire vitreous cavity with associated choroidal detachment. Forty-eight hours later, she developed acute angle closure of LE with an IOP of 55 mmHg. A flow cytometric analysis of the anterior chamber and vitreous showed leukemic tumor cells. The microbiologic exam and PCR for Mycobacterium tuberculosis were negative. No other signs of relapse of the disease were identified after investigation by the oncology department. Rescue treatment of the underlying disease was started, with symptomatic improvement. Conclusion: Leukemic ocular infiltration can be the only manifestation of ALL-B relapse.

Objetivo: Determinar a prevalência de pré-hipertensão arterial (pré-HTA) e hipertensão arterial (HTA) em adolescentes portugueses da cidade de Lisboa e averiguar a relac¸ão da pressão arterial (PA) com os fatores de risco: sexo, obesidade, tabagismo, alcoolismo, prática de exercício físico e história familiar de HTA. Metodologia: Estudo epidemiológico observacional, descritivo e transversal, numa amostra de conveniência de adolescentes de ambos os sexos, com idades compreendidas entre os 16 e 19 anos. A informac¸ão referente a hábitos comportamentais e história familiar de HTA foi obtida através de um questionário estruturado, autopreenchido. Resultados: Foram incluídos 234 adolescentes, com idade média de 16,4 ± 0,9 anos, 57% do sexo masculino. Registou-se uma prevalência de HTA de 34%, superior no sexo masculino (44 versus 21%, p = 0,001) e uma prevalência de pré-HTA de 12%, superior no sexo feminino (13 versus 10%, p = 0,001). O aumento do índice de massa corporal associou-se de forma significativa a maior prevalência de pré-HTA (categoria normoponderais: 9,40%; excesso de peso: 16,10%; obesidade: 22,70%) e HTA (normoponderais: 30,4%; excesso de peso: 45,2%; obesidade: 45,5%). Na presenc¸a de história familiar de HTA, a prevalência de HTA e de pré-HTA foi aproximadamente o dobro (41 versus 28% e 18 versus 9%, respetivamente). A prática regular de exercício físico, os hábitos tabágicos e o consumo alcoólico não revelaram associac¸ão estatisticamente significativa com os valores de pressão arterial. Conclusão: A prevalência de pré-HTA e HTA na amostra estudada foi elevada. Dos fatores de risco avaliados, apenas o sexo, a obesidade e a história familiar de HTA se associaram de forma significativa aos valores de PA.

Objetivo: Avaliar a magnitude do erro das fórmulas usadas no cálculo de lentes intraoculares (SRKII, HofferQ, Holladayl, SRK-T) para comprimentos axiais extremos (<22mm e >26mm) e comparar o desempenho relativo destas fórmulas nos dois subgrupos. Métodos: Avaliaram-se retrospectivamente 78 olhos de 65 doentes, com biometria realizada no IolMaster*. Destes, 48 têm comprimento axial inferior a 22mm e 30 têm comprimento axial su- perior a 26mm. A refração prevista calculada pelas diferentes fórmulas foi comparada com a re- fração um mês após a cirurgia. Testou-se a correlação entre comprimento axial e erro verificado. Resultados: A refração final média foi 0,18+0,65D para comprimentos axiais inferiores a 22mm e -1,48+1,03D nos superiores a 26mm. O erro absoluto médio (diferença entre o cálculo de lente e refração final) para comprimentos axiais inferiores a 22mm foi menor na fórmula HofferQ, diferindo com significado estatístico da Holladayl (p=0,016), mas não da SRK-T (p=0,350). Para comprimentos axiais superiores a 26mm, o erro absoluto médio foi menor na fórmula SRK-T. Diferiu com significado estatístico da Holladayl (p=0,032), mas não da HofferQ (p=0,156). Houve correlação entre erro absoluto médio e comprimento axial em com- primentos axiais superiores a 26mm, para as fórmulas SRK-T (R=0,438, p=0,016), HofferQ (R=0,447, p=0,013) e Holladayl (R=0,386, p=0,035). Conclusão: A HofferQ tem o melhor desempenho nos comprimentos axiais menores que 22mm e a SRK-T nos superiores a 26mm. A comprimentos axiais sucessivamente mais extremos corresponde um aumento estatisticamente significativo do erro absoluto médio nos comprimentos axiais superiores a 26mm, mas não nos inferiores a 22mm.

Introduction: Internet gaming disorder has been associated with an excessive number of hours spent playing video games, which leads to a detriment of other daily activities and interests. In addition, it is associated with personality traits such as aggression and anger. In Portugal this relations are almost unexplored. Objectives: To explore the relationship between video game use, internet gaming disorder and aggression. Methods: This study was applied to a sample of 202 subjects, aged between 18 and 29 years old (M = 22.5, SD = 3.006). Subjects fulfilled a sociodemographic and viodeogame pattern questionnaire, and the Portuguese versions of the Internet Gaming Disorder Scale (short form), and the Buss-Perry Aggressiveness Questionnaire. Results: In this study 20.3% (n = 27) of the males and 5.8% (n = 4) of the females use excessively videogames, considering the screen time recommended by the American Academy of Pediatrics. However, 81% (n = 70) of the sample have a positive self-perception of their use. 21.4% (n = 45) use videogames during day, 71% (n = 49) during night and 3.8% (n = 8) during dawn. The total score for internet gaming disorder was of 15.17 (SD = 6.006), but only 1 subject (0.5%) presented probable videogame disorder considering the sutt-off points. A positive and significant correlation was found between internet gaming disorder and physical agressiveness (.32**), verbal agressiveness (.28**) and hostility (.45**). Finally, a positive correlation was found between internet gaming disorder and time spent playing video games. Conclusions: Our results, despite being merely exploratory, show us the relationship that exists between the use of video games, internet gaming disorder and aggressiveness. In that sense it is important to continue to explore internet gaming etiology and consequences.