Underactive bladder (UAB) is a multifactorial symptom complex often related to detrusor underactivity (DU). Although recognized as a common cause of lower urinary tract symptoms and with significant effects on quality of life, UAB/DU is largely underresearched. Herein, we review upto-date knowledge on the pathophysiological mechanisms of UAB/DU, with an emphasis on the relationship between UAB and bladder outlet obstruction (BOO). Original articles and reviews concerning UAB/DU were identified through a search of the PubMed/Medline and Scopus databases. DU can result from several pathological mechanisms, which can be categorized as idiopathic, neurogenic, myogenic, or functional. The main etiological factors of UAB/DU are aging, diabetes mellitus, neurogenic disorders, and BOO. Although conventional models focus primarily on efferent nerve and myogenic mechanisms, contemporary views highlight the importance of the afferent pathway. Specifically, recent findings in BOO showed that afferent dysfunction, such as altered expression of muscarinic and purinergic P2X 3 receptors or diminished urothelial ATP may play a role in the initial and reversible stages of DU, with potential diagnostic and therapeutic implications. K E Y W O R D S bladder outlet obstruction, detrusor underactivity, lower urinary tract symptoms, pathophysiology

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Wave overtopping, mainly caused by growing coastal erosion processes, directly affects populations, causing coastal flooding and potential damages. This work aims to develop the relationship between overtopping phenomena and their impact costs through an approach that considers wave runup, corresponding overtopping events, their flow volume and related flooding costs. Herewith, it is possible to evaluate the relationship between the structure construction and maintenance costs and the consequent costs due to overtopping and flooding damages, leading to the design of optimised coastal structures solutions. To apply the proposed approach, a real case study on the Portuguese northwest coast (Ovar municipality) was analysed, evaluating overtopping and flooding data recorded by the Portuguese Environment Agency (APA), allowing costs per unit flooded volume to be estimated. Then, future scenarios were predicted to assess the influence of climate change, discuss intervention scenarios and evaluate the uncertainty of economic parameters’ evolution. The proposed methodological approach represents a step forward in the estimative of coastal overtopping and flooding impacts, leading to increasing the knowledge about flooding and overtopping costs and optimised mitigation measures in artificialised coastal areas, where coastal defence works (longitudinal revetments) are present. This approach fills a gap in knowledge regarding this type of forecast in a medium- to long-term perspective.

Introduction Candida glabrata is classified as an emerging threat due to its resistance profile to antifungal drugs. Associated to this, there is also the fact that recently, new species of Candida sp. phylogenetically related to Candida glabrata have been discovered: Candida bracarensis and Candida nivariensis [ 1 ]. Once that is only possible to identify these species through molecular methods [ 2 ], that identification represents a crucial step, since these species have been associated with a higher virulence and resistance to antifungals, in particular to the azole class [ 3 ], including the new extended-spectrum triazoles [ 4 ]. The aim of this study is to characterise C. glabrata clinical isolates from a culture collection. Materials and methods Seventy clinical isolates from the “Micoteca IUEM” were used, presumedly classified as Candida sp. Their phenotypic identification was performed, and all isolates classified as Candida glabrata were subjected to molecular identification through the PCR technique followed by electrophoresis, to verify the presence of cryptic species. Susceptibility tests were performed using the disc diffusion method in order to evaluate the susceptibility of the complex to fluconazole and voriconazole. Results Phenotypic identification showed that only 43 (61%) corresponded to C. glabrata . Molecular identification of these 43 isolates was carried out but led to inconclusive results. Susceptibility tests showed that one of the 43 samples of C. glabrata lost viability, 13 (31%) were sensitive to fluconazole, 12 (29%) were dose-dependent intermediates and 17 (40%) were resistant to fluconazole. Testing voriconazole, only 2 (5%) were resistant and the great majority, 40 (95%), was shown to be sensitive to voriconazole. Discussion and conclusions This study showed that resistance to fluconazole is increasing and needs to be resolved quickly, since resistance in most cases was verified. However, voriconazole appears to be a good option for resistance to fluconazole, because it has been shown to be effective in the vast majority of strains resistant to fluconazole. One of the negative implications of this study is the fact that it is not possible to identify the users who have this resistance. Finally, it is important to highlight the need to produce new antifungal agents with different mechanisms of action, in addition to moderate and optimise the use of existing drugs.