Mycobacterium marinum is a ubiquitous and opportunist agent that may cause infections related to water activities in humans. It causes mainly skin and soft tissue infections, and other forms of presentation are uncommon. A 27-year-old man presented to the Emergency Department of a tertiary hospital due to a cervical foreign-body sensation that evolved into right cervical swelling and consumption symptoms. He was a waiter on a cruise in the Douro river. Weeks after the initial presentation, the diagnosis of Mycobacterium marinum infection was made by positive nucleic acid amplification tests (NAAT) in tissues obtained by excisional biopsy of cervical adenopathy. Treatment with rifampicin and clarithromycin was started. The symptoms improved, and there was a decrease in the adenopathy number and size. Although Mycobacterium marinum adenitis as initial presentation of the disease is rare, the identification of the agent by NAAT and favorable response to treatment supported the diagnosis.

As a teaching subject, animal welfare is challenging for educators and learners, as was recently shown in a recent survey on the evolution of animal welfare teaching in Europe. Among several suggestions to overcome the current resistance to implementing animal welfare education, we highlight two. The first is that animal welfare education should be based on learner-centred approaches; the second is that it should encompass both animal welfare science and ethics and law. To the best of our knowledge, there are no learner-centred pedagogical approaches that can simultaneously explore scientific and ethical concepts. Furthermore, when exploring ethical concepts within the educational context, there is the additional challenge of being able to depart from discussion and debate to a systematic organization of knowledge. Our work simultaneously addresses these two challenges, presenting the design and implementation of a novel web-based learner-centred pedagogical platform for farm animal welfare teaching. The platform, named ANIPHI, uses the Delphi method's iterative nature as a learning process to generate both reflection and (online) debate among learners. ANIPHI can be used by educators in an online environment, in a classroom environment, or in a combination of the two environments. ANIPHI was developed within the ERASMUS+ ANICARE project and is an open web-based platform for all educators interested in teaching farm animal welfare. Given ANIPHI's flexible and user-friendly nature, the platform simultaneously exposes learners to ethical and scientific concepts in different educational realities, according to the educator's objectives. Furthermore, videos depicting different husbandry practices across different types of animal production and countries are embedded in the platform. These videos are commented on by the farmer himself and by animal scientists, which enriches the learner's experience. Educators across the ANICARE consortium have already successfully tested the ANIPHI platform for different farm animal welfare topics. We conclude this article by presenting one example of using ANIPHI in a real-life educational context, where we discuss some aspects of the design and use of our pedagogical platform.

The assessment of feed intake in stabled horses is a difficult task to accomplish. Faecal markers, namely n-alkanes, have been used successfully for the estimation of this important nutritional parameter. This usually involves the dosing of synthetic n-alkanes via different matrices, a laborious task that may also influence the animal normal foraging behaviour. An experiment was conducted to evaluate a relative simple methodology to quantify feed intake in horses, based on the provision of measured amounts of a concentrate supplement labelled with beeswax and the utilisation of n-alkanes as faecal markers. Four Lusitano horses were used in three consecutive experimental periods. Animals were fed on cereal straw and different proportions of a previously prepared beeswax-labelled concentrate supplement (BLCS; 0.05, 0.10 and 0.20, DM basis). Beeswax labelling was performed to provide a distinct n-alkane profile for the concentrate feed. Prior to feed intake calculations, proportions of labelled concentrate supplement in the diets were estimated using n-alkanes C25 to C33 by least-square optimisation procedures. Results showed that the beeswax labelling resulted in high n-alkane concentrations in the concentrate feed, especially for the odd-chain n-alkanes. Estimates of diet composition did not differ from the measured values, except for the diet with highest BLCS incorporation, with an underestimation of 10%. DM intake was accurately estimated by the “labelled supplement method” in all diets. However, for the lowest BLCS incorporation, DM intake was underestimated by 16% whereas for the higher levels of BLCS in the diet, measured and estimated DM intake values were almost identical with a slight overestimation of only 0.7 and 0.2% (10 and 20% of BLCS, respectively). Results indicate that both diet composition and feed intake can be accurately estimated in horses using the “labelled supplement method”, even when very low levels of the labelled concentrate supplement are included in the animals’ diet. This method eliminates the need for daily dosing with external synthetic markers, providing advantages in terms of minimising animal management and interference with their normal foraging behaviour.

The electrical potential drop (EPD) technique has previously shown promising results using a combination of AC and DC EPD (or DCPD) on large pressure vessel creep tests, detecting final cracking as well as incipient creep cavitation damage in welded P91 steel, with DCPD showing subtle but steady rises of around 5% over ca 10,000 h of testing before rising exponentially at failure. The work presented here has attempted to shed light upon this using a simple numerical model. The model uses an array of spherical cavities to constrain the current path and hence raise the DCPD, however it was only able to show a modest rise in DCPD, and not match experimentally determined rises. Modelled DCPD values were a fifth of those experimentally observed, but both the nature of the model (simplified to aid timely computation) and the assumption that only cavitation is responsible for the changes seen, could be the reason for the discrepancies reported here. The possibility remains that other mechanisms are at play, which could magnify the measured DCPD – particularly those mechanisms that could be associated with embryonic or micro-crack formation, and these are discussed herein.

Vaccination remains a main weapon against Coronavirus Disease 2019 (Covid-19). Although its efficacy is reduced in the immunocompromised population, we felt empirically that outcomes of Covid-19 in lung transplant recipients (LTRs) were better after widespread vaccination than in earlier phases of the pandemic. We aimed to compare outcomes of unvaccinated and vaccinated LTRs infected with SARS-CoV-2. All LTRs followed in our hospital were reviewed and those with a positive polymerase chain reaction test were included. We analysed disease severity (using World Health Organization criteria) and mortality rates in unvaccinated and fully vaccinated patients (pts). Twenty-four pts were included, two-thirds of which were male, with a mean age of 51 years. Main diagnoses were hypersensitivity pneumonitis (25%), chronic obstructive pulmonary disease (16,7%), idiopathic pulmonary fibrosis (12,5%) and cystic fibrosis (12,5%). Lung transplant was bilateral in 79,2% of pts, unilateral in 16,7% and lobar in one pt (4,1%). The most common immunosuppression regimen was tacrolimus, mycophenolate-mofetil and prednisolone. Thirteen pts were unvaccinated and 11 were vaccinated at time of infection, with a mean time since transplant of 746 and 1641 days, respectively. In the unvaccinated group 69,2% had mild disease, 30,8% had severe disease and mortality was 25%. No deaths occurred among fully vaccinated pts; disease was mild in 72,7%, moderate in 18,2% and severe in 9,1%. Neither the difference in severity (p=0,156) or mortality (p=0,089) reached statistical significance, presumably due to the small sample size. Nevertheless, we confirmed that, in our centre, vaccinated LTRs had better overall outcomes than unvaccinated pts.

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.

Introduction: COVID-19 promotes inflammation and a hypercoagulable state.Antithrombotic therapies may be administered for thromboprophylaxis in those with severe infection requiring hospitalization.Spontaneous bleeding is an infrequent, yet life-threatening complication in patients receiving systemic anticoagulation.Case Report: Two bilateral lung transplant recipients -77-year-old female with idiopathic pulmonary fibrosis (patient A) and 69-year-old male with chronic obstructive pulmonary disease (patient B) -each presented with several days' history of dyspnea, cough, and fatigue at 29-months and 11months post-transplant, respectively; RT-PCR was positive for SARS-CoV-2 infection in both.Over the course of the next few days, patient A rapidly deteriorated with need for intubation despite initial treatment with antibiotics and corticotherapy.Patient B experienced gradual worsening of respiratory symptoms, which required high-flow oxygen supplementation and IV antibiotics.Inflammatory markers were elevated in both patients, and CT of the chest was consistent with atypical pneumonia in each.Patient A received convalescent plasma as a rescue therapy, and patient B received remdesivir with convalescent plasma.Given the hypercoagulable state in each, patient A and B received enoxaparin and IV heparin, respectively.Slowly, hemoglobin and platelet counts dropped in both patients, with need for transfusion and hemodynamic support.CT of the abdomen revealed a left gluteal intramuscular hematoma in patient A; CT of the chest, abdomen, and pelvis revealed a spontaneous chest wall hematoma and small area of retroperitoneal bleeding in patient B (Figure 1A andB).Summary: These cases raise awareness for the viral-induced hypercoagulable state observed during the disease course.Clinicians should be cautious to avoid any hemorrhagic complications associated with thromboprophylaxis in selected cases, particularly in at-risk immunosuppressed patients.

Immunosuppression (IS) is considered a risk factor for severe COVID-19. It remains unclear if solid organ transplantation (SOT) affects its presentation or outcome. We aimed to describe the clinical course of SOT recipients hospitalized due to SARS-CoV-2 infection. Hospitalizations due to COVID-19 in the Infectious Diseases Department from March 2020 to January 2021 were reviewed, and SOT recipients were selected. Seventeen patients (pts) were included, 13 of which were male, with a median age of 58 years. Transplanted organs were kidney (n=11, of which 2 were kidney-pancreas), liver (n=4), and lung (n=2). Mean post-transplant time was 83.8 months (SD 99.2). Main comorbidities were diabetes (n=13), hypertension (n=13) and obesity (n=6). Fever (n=12, 71%) and cough (n=10, 59%) were the most common symptoms. Ten pts developed hypoxemic pneumonia, five required invasive mechanical ventilation (IMV), one required dialysis and three died during hospitalization. Before admission, most pts (n=9) were on prednisolone (PDN), tacrolimus and mycophenolate (MP). In most pts, MP was stopped and PDN was started or its dosage increased, to the equivalent of 6 mg dexamethasone if indicated. IS was not adjusted in five pts (29%). Antimetabolites are stopped to prevent lymphopenia, and calcineurin inhibitors are maintained to inhibit IL-6 and IL-1 pathways. The presence of known risk factors for severity in most pts makes impact of SOT difficult to assess. Other series of SOT recipients hospitalized due to COVID-19 reported dialysis rates of 20-32%, IMV rates of 19-56% and in-hospital mortality rates of 14-24%. In this cohort, 6% of pts required dialysis, 29% needed IMV, and 18% died during hospitalization.

Adults infected with SARS-CoV-2 may develop a multisystem inflammatory syndrome (MIS-A) characterized by elevated inflammatory markers and multisystem organ involvement. We report the case of a patient who presented with fever and vomiting at hospital admission. He tested positive for SARS-CoV-2 infection and blood tests showed elevated inflammatory markers. The patient developed acute cardiac dysfunction and shock in less than 24 hours and the echocardiogram revealed an LVEF of 30%. He was discharged 3 weeks later fully recovered. MIS-A should be considered if a compatible syndrome is observed in patients with evidence of SARS-CoV-2 infection by PCR test or serology.LEARNING POINTS:Multisystem inflammatory syndrome should be considered in young adults presenting with shock and elevated inflammatory markers.Multisystem inflammatory syndrome may be highly responsive to parenteral steroids.

BackgroundAcute respiratory distress syndrome (ARDS) is a severe complication of malaria that remains largely unstudied. We aim to describe the development of ARDS associated with severe P. falciparum malaria, its management and impact on clinical outcome.MethodsRetrospective observational study of adult patients admitted with severe P. falciparum malaria in an Intensive Care Unit (ICU) of a tertiary care hospital from Portugal from 2008 to 2018. A multivariate logistic regression analysis was used to identify factors associated with the development of ARDS, defined according to Berlin Criteria. Prognosis was assessed by case-fatality ratio, nosocomial infection and length of stay.Results98 patients were enrolled, of which 32 (33%) developed ARDS, a median of 2 days after starting antimalarial medication (IQR 0-4, range 0-6). Length of stay in ICU and in hospital were significantly longer in patients who developed ARDS: 13 days (IQR 10-18) vs 3 days (IQR 2-5) and 21 days (IQR 15-30.5) vs 7 days (IQR 6-10), respectively. Overall case-fatality ratio in ICU was 4.1% and did not differ between groups. The risk of ARDS development is difficult to establish.ConclusionARDS is a hard to predict late complication of severe malaria. A low threshold for ICU admission and monitoring should be used. Ideally patients should be managed in a centre with experience and access to advanced techniques.

Malignancy is an important complication after lung transplantation (LT), which is related to common risk factors in these patients, oncogenic viruses and immunosuppression therapy (IST).We retrospectively analyzed all cases of malignancy in the 182 patients that underwent LT between June 2001 and December 2017 in Portugal.We noticed an incidence of 7.6%, similar to that described in the literature, with a mean age of 53 years and a mean time after LT of 25 months.As in other series, the most common types of cancer were skin cancer (2.7%), post transplant lymphoproliferative disorders (2.2%) and lung cancer (1.6%).Unexpectedly we found an important incidence of gastric cancer (1,1%) not previously described in the literature that we relate to the elevated incidence of this cancer in our country.All patients underwent treatment and IST adjustments, according to a multidisciplinary team approach.In this series, 4 patients died due to cancer (33.3%) with a median survival of 26 months.We conclude that cancer is an important complication after LT and further investigation and awareness is needed to optimize diagnosis and management of this condition.

Introduction: Lung transplant (LTx) is a recognized treatment for end stage non-cystic fibrosis bronchiectasis (BE), but precise referral criteria and outcomes is still limited. Objective and Methods: to retrospectively describe the experience in BE of the portuguese LTx center, by analyzing data of all patients (pts) undergoing LTx with diagnosis of BE between Nov. 2009 and May 2018. Survival was compared to the total cohort of LTx pts in our center and the results in literature. Results: In this period 177 LTx were performed in our center, where 20 (11,2%) of these had BE as a main diagnosis. Median age at transplantation was 42y (IQR 26) with male predominance (65%). The most common BE etiology was idiopathic (70%) and the majority had previous bronchial colonization (90%), mainly with Pseudomonas aeruginosa (75%). Median BSI score was 13 (IQR 4) and 65% of pts had “severe BE” according to FACED score. Before LTx the median FEV 1 (% predicted) was 25,5%. All LTx were bilateral, none of our pts had bronchial colonization after LTx and CLAD rate was 30%. Kaplan-Mier 1-year survival for BE was 79%, similar to 80% of the total LTx group. 5-year survival for BE kept 79%, superior to 56% of the total cohort of LTx pts, despite lack of significance (p=0,25). In the BE group 80% of pts were alive at date, with the longest survival of 8 years. Conclusion: BE accounts for 11,2% of all LTx done in our center, a distribution that is superior to ISHLT registry. Comparing to all LTx pts we recognize a good BE post-transplant outcome, with a similar survival rate at 1-year and even superior at 5-years. These results reinforce the need to referral pts with severe and end stage BE and supports the role of LTx as valuable treatment for this disease.

Introduction: Solid organ transplant recipients have a three to four-fold increased risk of developing malignancies. The management of cancer in patients (pts) undergoing immunosuppressive therapy (IST) is a real challenge. Aims: Analyze the incidence of malignancies in pts undergoing lung transplantation (LT) in Portugal between June 2001 and December 2017. Methods: Epidemiological study. Retrospective analysis of medical records. Results: During this period our center performed 182 LT. We identified a total of 12 malignancies (6,6%) affecting 10 pts: 4 cutaneous squamous cell cancer (2,2%), 3 lymphomas (1,6%), 3 lung cancers (1,6%) and 2 gastric cancers (1,1%). The average time between LT and diagnosis of 1st cancer was 27 months, 60% of pts were male with an average age of 51y. Among the skin cancer group, 2 pts had relapses and 2 developed another type of cancer. 2 lung cancers occurred in the native lung of single LT recipients and the other was an unexpected cancer in the explanted lungs. Despite treatment and IST adjustment, 7 pts died, only 4 directly related to cancer, but with a low median survival after diagnosis (3,5 months). Conclusion: In our center, the overall incidence of malignancies was lower than described in the literature. As in other series, skin cancer was the most common and with frequent relapses, but we also had two unusual cases of gastric adenocarcinoma. In an agressive disease with a poor prognosis, it is a real challenge the balance between the oncological therapy and the IST. We hope the advances in Oncology could help us in this goal.

Background: COPD and emphysema due to alpha-1 antitrypsin deficiency (AATD) are the 1st and 5th indications for lung transplantation (LT) worldwide, respectively. A different prognosis can occur in both entities. Aims: Comparative analysis of characteristics, surgical complications and post-operative survival between both groups (g). Methods: Retrospective analysis of pts who underwent LT between 2010-2017 in our center. Log-rank tests and Kaplan-Meier methods were used. Results: 38 pts were included: 23 (60,5%) with COPD and 15 (39,5%) with AATD, with average age of 56,2y vs. 50,4y, male predominance (87% vs. 60%) and average of smoking package per-year of 44 vs. 30,3. Most pts in the AATD-g were PiZZ (n=14, 93,3%) and 10pts (66,7%) were under substitution therapy. At the time of LT, COPD-g had an average FEV1 of 19,5% (±5,65) and 6-min-walk distance (6MWD) of 265,94m (±103,98). AATD-g had: FEV1 of 18,43% (±6,18) and 6MWD of 247,25m (±137) (NS). BODE index was similar (7,11±1,4 vs. 7,67±1,6). The median length of stay was higher for COPD-g (46 vs. 39 days), with no differences for surgical complications and acute graft rejection. AATD-g had more infectious complications (86,7% vs. 73,9%). Six-months post-LT, the average for FEV1 was 70,5% (±30,2) vs. 78,14% (±20,63) and 6MWD was 419,6m (±136,8) vs. 446,83m (±148,3), for COPD-g vs. AATD-g, respectively (NS). The 1st-year survival was 80,5% for COPD-g vs. 71% for AATD-g (NS). Conclusions: Despite the small sample, both groups had similar characteristics before and after LT, with a tendency for a lower survival rate in AATD-g.

Background: Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are common after lung transplantation (LT) and their treatment can be challenging. Aims: Evaluate the prevalence and timing of perioperative AAs, identify risk factors, management and its impact on outcomes. Methods: Retrospective analysis of consecutive patients (pts) submitted to LT between 2015-2017, in our center. Results: 74pts were included with average age of 47,2±14 years(y). The most common indications for LT were COPD (n=23, 31,1%), IPF (n=14, 18,9%) and cystic fibrosis (n=10, 13,5%). No patient had preoperative AAs, and 32pts (43,2%) developed postoperative AAs: 28pts (87,5%) had AF and 4 (12,5%) had AT. Incidence of AAs peaked 3 days after LT (n=16, 50%). Older age (>50y) was the only risk factor associated with increased risk for AAs (42,5y±14,6 vs. 53,3y±10,4, p=0,009). Pharmacologic treatment consisted of rhythm control agents in 23pts (71,9%), rate-control agents in 2pts (6,2%) and both in 7pts (21,9%). Due to failure of medical therapy, electrical cardioversion was used in 8pts (25%). At discharge, 30pts (93,75%) had sinus rhythm conversion and 2pts (6,2%) remained in FA. 24pts (75%) were discharged with rate-control agents, 6pts (18,75%) with rhythm control agents and 2pts (6,2%) with both agents. The length of stay was higher for AAs-g with a significant correlation (p=0,007). The 1st-year survival was 73,9% for AAs-g vs. 77,5% for non-AAs-g (p=0,874). Conclusions: AAs after LT are common, with occurrence peaking 3 days after LT. Older age is associated with elevated risk. AAs-g had increased length of stay, although with no long-term survival impact.

The electron and photon reconstruction and identification algorithms used by the D0 Collaboration at the Fermilab Tevatron collider are described. The determination of the electron energy scale and resolution is presented. Studies of the performance of the electron and photon reconstruction and identification are summarized. The results are based on measurements of Z boson decay events of Z-ee and Z-γll ðl1⁄4 e;μÞ collected in pp collisions at a center-of-mass energy of 1.96 TeV using an integrated luminosity of up to 10 fb . & 2014 Published by Elsevier B.V.

Knowledge on diet selection of different herbivore species under each specific vegetation community is essential to develop and apply appropriate management decisions for each grazing system in order to, simultaneously, have a more efficient and sustainable utilization of pasture resources and the best animal performance level. In this chapter, traditional and more recent methodologies that can be used for studying diet selection of both domestic and wild herbivores are briefly presented, identifying the main advantages and limitations of their use. Particular emphasis is given to the utilization of epicuticular compounds, namely alkanes, long-chain fatty acids and long-chain alcohols, as faecal markers. The validation of their use is presented taking into account studies performed with different animal species under controlled conditions. The main advantages and shortcomings for their application to field studies with grazing animals are highlighted. Data indicate that the combination of these epicuticular compounds seems promising to overcome the enumerated constraints, allowing its application to more complex vegetation communities.

Electrical potential drop (EPD) is a well-established technique for the measurement of crack initiation/growth in metals. Two variants exist, one using AC excitation, the other using DC. EPD provides crack dimensions (principally depth) in contexts such as fracture/fatigue testing, and in-field NDE. Whilst it has been employed for on and off-line assessment of creep damage, use within a non-lab (i.e. industrial) context is limited by connection issues and, significantly, data interpretation – especially with regard to detecting subtle changes in EPD over general background ‘noise’. We describe, here, a methodology where high sensitivity detection of creep damage can be achieved by looking for a characteristic ‘signature’ within data. This is based on the combination of AC-EPD with its DC equivalent so as to generate a synergistic approach to damage detection. The methodology has been successfully applied to a semi-industrial context to provide prior warning of failure in excess of several weeks.