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Browsing by Author "Rosa, Nuno"

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  • Echocardiography and cardiovascular risk:The relationship in the renal transplant recipient
    Publication . Neto, Micaela; Gonçalves, Miguel; Resende, Luis; Vieira, Pedro; Gomes, Susana; Durães, José; Rosa, Nuno; Teixeira, José Alves; Silva, Gil
    Introduction: Cardiovascular disease (CVD) is the major cause of death among renal transplant recipientes (RTR). It is not known whether echocardiographic abnormalities are useful to identify RTR at high risk of CVD. Methods: Retrospective review of RTR with functioning and stable graft and an echocardiography performed in the last year. Risk of major adverse cardiac events (MACE) and death using a risk calculator specific for RTR. Results: Among 107 patients (57.9% males, 50.4±13.9 years), 7-year risk of MACE was >10% in 30.9% of patients and 7-year risk of death >10% in 56.1%. Left ventricular hypertrophy (LVH) was found in 55.1%, diastolic dysfunction in 39.3%, dilated left atrium (LA) in 53.3%, high pulmonary artery systolic pressure (PASP) in 9.0%, valvular calcifications in 22.4% and moderate to severe mitral regurgitation (MR) in 3.7%. Mean Ejection fraction was 68.36±6.87%. Univariate analysis showed an increased risk of MACE and death in patients with LVH, diastolic dysfunction, dilated LA, high PASP, valvular calcifications and MR. Multivariate analysis identified an independente association between the risk of MACE >10% and valvular calcifications and high PASP. Risk of death>10% in multivariate analysis had an independent association with diastolic dysfunction and elevated PASP. Conclusion: Echocardiographic abnormalities identify RTR at increased risk of MACE and death. Valvular calcifications and high PASP are predictors of MACE whereas diastolic dysfunction and high PASP predict death.
    2017Lecture Open access Show more
  • Obstructiva Acute Kidney Injury with maintenance of diuresis: A Case of Ureter Bifidity
    Publication . Silva, Francisca Gomes da; Rosa, Nuno; Pestana, Nicole; Silva, Gil
    Percutaneous kidney biopsy in transplanted kidneys remains an essential and commonly performed procedure required for diagnostic and prognostic information. Hemorrhage is the main complication of renal graft biopsy. We report a case of a 47-year-old caucasian woman admitted to perform an ultrasound (US)-guided biopsy of the renal graft. Six hours later, she presented with macroscopic hematuria which improved after urethral catheterization and intravenous hydration. However the hematuria reappeared associated with anemia and worsening of the serum creatinine value. Te US study, revealed hydronephrosis with high Doppler derived renal resistive index compatible with clot obstruction. Despite the vesical lavage nd intravenous hydration. However the hematuria reappeared associated with anemia and worsening of the serum creatinine value. Te US study, revealed hydronephrosis with high Doppler derived renal resistive index compatible with clot obstruction. Despite the vesical lavage with drainage of several clots, the patient rapidly progressed to hemorrhagic shock with worsening of renal function. Pelvic computed tomography (CT) revealed calyx and pelvis duplicity and ureter bifdity which merged into a single ureter and inserted into the right anterolateral wall of the bladder. Te inferior ureter was enlarged due to an obstructive clot. Most acute obstructive uropathies are associated with signifcant pain or the abrupt diminution of urine fow. Te presence of ureter bifdity in the CT study explained the maintenance of signifcant diuresis despite obstruction, located only to the lower ureter but with sufcient functional impact to condition acute kidney injury (AKI).
    2019Journal article Open access Show more
  • Recrutamento de quadros qualificados para ingresso em contratos de longa duração. Adequação dos tempos de regime de contrato às necessidades da Força Aérea
    Publication . Rosa, Nuno
    Perante as dificuldades em satisfazer as necessidades de recursos humanos, designadamente praças, tornou-se crucial estudar uma solução que promova a eficiência organizacional num quadro de contenção orçamental. Esta investigação pretendeu analisar se, da aplicação de contratos de longa duração, designadamente na classe de praças, resultam mais-valias para a Força Aérea, nomeadamente, ao nível da sua capacidade de recrutar e reter os recursos humanos necessários. Para o efeito foi adotada uma estratégia de investigação mista baseada no reforço, seguindo um raciocínio hipotético-dedutivo. A recolha de dados contemplou a análise documental, entrevistas e questionário, sustentada num estudo de caso. Os resultados permitiram concluir que os contratos de longa duração correspondem às expetativas de “estabilidade profissional” dos militares, contribuindo dessa forma para o melhoramento da capacidade de recrutamento e principalmente da retenção. No entanto, para a sua operacionalização torna-se necessário desenvolver uma estratégia comunicacional assertiva e coerente, centrada nos aspetos simbólicos-operacionais (vida militar) e profissionais (estabilidade profissional). Essencial ainda definir claramente as premissas e divulgá-las evitando correr o risco de defraudar as expetativas (quebra contrato psicológico), levando à saída prematura das fileiras. Também o reconhecimento da formação é um objetivo a concretizar minimizando o impacto aquando da reinserção no mercado de trabalho. Abstract: Given the difficulties in meeting the human resources needs, particularly corporals, it has become crucial to study a solution that promotes organizational efficiency within a framework of a constraint budget. This investigation aimed to analyze whether the application of long-term contracts, specially to corporals, provide benefits to the Air Force, namely, its ability to recruit and retain the necessary human resources. For this purpose, a mixed research strategy based on enhancement was used, following a hypothetical-deductive reasoning. Data collection included the analysis of documents, interviews and questionnaire, supported by a case study. By analyzing the results, it was possible to conclude that long-term contracts correspond to the expectations of "professional stability" of the military, thus contributing to the improvement of recruitment capacity and specially retention. However, for its operationalization it becomes necessary to develop an assertive and coherent communication strategy, centered on the symbolic-operational aspects (military life) and professional (professional stability). It is also essential to define the premises and publicize them, avoiding the risk of defrauding expectations (breaking the psychological contract), leading to the premature exit of the ranks. Recognition of courses is also an objective to be achieved allowing an easier reintegration into the labor market.
    2017Other Open access Show more
  • Renal Disease in Madera Islands: twenty years experience of native kidney biopsies
    Publication . Vieira, Pedro; Goncalves, Miguel; Durães, José; Rosa, Nuno; Resende, Luís; Silva, Gil; Teixeira, Alves; Rodrigues, Fernando; Galvão, Maria; Brinca, Ana; Viana, Helena; Carvalho, Fernanda; Araújo, José
    Renal biopsy plays an essential role either in the diagnosis or in the prognosis of patients with renal disease. In order to assess its epidemiology and evolution in Madeira Islands, we analysed twenty-seven years of native kidney biopsies. Methods: We performed a retrospective analysis of clinical records, including histological revision from 1986 to 2012, totalling 315 native kidney biopsies. They were assessed regarding the temporal evolution both for the quality/indications for renal biopsy and for the patterns of kidney disease. Results: A total of 315 native kidney biopsies were analysed. The patients’ mean age was of 40.8 ± 18.4 years and 50.5%(n = 159) were males. The most common indications for renal biopsy were nephrotic syndrome (36.2%, n = 114) and acute kidney injury (20.0%, n = 63). Among primary glomerular diseases (41.5%, n = 115) the most common were IgA nephropathy (26.1%, n = 30) and focal-segmental glomerulosclerosis (17.4%, n = 20) and among secondary glomerular diseases (31.4%, n = 87), lupus nephritis (51.7%, n = 45) and amyloidosis (20.7%, n = 18). Statistical analysis revealed significant correlation between gender and major pathological diagnosis (Fisher’s exact test, p <.01) and between indications for renal biopsy and major pathological diagnosis (χ2, p <.01). Regarding the temporal evolution, no statistically significant differences were found in the number of renal biopsies (χ2, p =.193), number of glomeruli per sample (Fisher’s exact test, p =.669), age (Kruskal-Wallis, p =.216), indications for renal biopsy (χ2, p =.106) or major pathological diagnosis groups (χ2, =.649). However, considering the specific clinico-pathological diagnoses and their temporal variation, a statistically significant difference (Fisher’s exact test, p <.05) was found for lupus nephritis and membranous nephropathy with an increasing incidence and for amyloidosis with an opposite tendency. Discussion: The review of the native kidney biopsies from a population with particular characteristics, geographically isolated, such as those from Madeira Islands, showed parallel between epidemiological numbers referring to other
    2014-04-09Journal article Open access Show more