Resumen Este artículo profundiza en la cuestión del reciente acceso a la vivienda social en Portugal, habida cuenta de los crecientes desafíos para garantizar una vivienda adecuada. La inversión pública sin precedentes en el pilar de la vivienda suscita importantes consideraciones. Nos lleva a cuestionar si la eficacia de las actuales políticas de vivienda y las leyes básicas para garantizar una vivienda adecuada, y explorar si hay un intento urbano de relacionar la casa con el hábitat desarrollos recientes en materia de vivienda social. Para abordar estas cuestiones iniciales, el estudio se centra en tres aspectos concretos de los recientes programas de vivienda social: i) las políticas de vivienda; ii) las leyes básicas; y iii) los programas preliminares para concursos de proyectos y pliegos de condiciones para contratos de rehabilitación. La metodología implica la selección de estudios de caso de urbanizaciones en el Área Metropolitana de Lisboa para su análisis, centrándose en parámetros como i) ubicación; ii) tipo de intervención iii) número de viviendas y tipologías; iv) dimensiones de la construcción bruta de viviendas; y v) la relación entre la casa y su hábitat. Los resultados preliminares subrayan los avances en materia de vivienda social, destacando la importancia y la necesidad no sólo de la articulación entre los actuales programas de vivienda, las políticas y las leyes básicas, con el fin de garantizar una vivienda y un hábitat adecuados, sino también el papel insustituible del Estado y del Gobierno Central para definir estas políticas y dirigirse a los municipios para ejecutarlas. Portugal adecuada consideraciones iniciales i ii iii rehabilitación análisis ubicación tipologías iv v adecuados ejecutarlas

Abstract This article delves into the issue of recent access to social housing in Portugal, given the escalating challenges in securing adequate housing. The unprecedented public investment within housing raises important considerations. It leads us to question the effectiveness of current housing policies and basic laws in guaranteeing adequate housing and exploring if there an urban attempt to relate the house to the habitat in recent developments on social housing. To address these initial inquiries, we focus on three specific aspects within the realm of recent social housing programmes: i) housing policies; ii) basic laws; and iii) preliminary programmes for design contests and specifications for rehabilitation contracts. The methodology involves selecting case studies of housing estates in the Lisbon Metropolitan Area, while analysing parameters such: i) location; ii) intervention type, iii) number of dwellings and their typologies; iv) dimension of the housing gross construction; and v) relation between the house and the habitat. Preliminary findings underscore advancements in social housing, emphasizing the importance and need not only for the articulation between current housing programmes, policies and basic laws, in order to guarantee adequate housing and habitat, but also the irreplaceable role of the State and the Central Government to define these policies and approach municipalities to execute them. Portugal considerations inquiries i ii iii contracts Area such location type typologies iv construction v them

Resumo Este artigo aborda a questão do recente acesso à habitação social em Portugal, tendo em conta os desafios crescentes para garantir uma habitação adequada. O investimento público sem precedentes no pilar da habitação suscita reflexões importantes. Leva-nos a questionar a eficácia das actuais políticas habitacionais e leis de bases na garantia de habitação adequada e a explorar a existência de uma tentativa urbana de relacionar a casa com o habitat nos desenvolvimentos recentes de habitação social. Para responder a estas questões iniciais, o estudo centra-se em três aspectos específico no âmbito dos recentes programas de habitação social: i) políticas habitacionais; ii) leis de bases; e iii) programas preliminares de concursos de concepção e cadernos de encargos de empreitadas de reabilitação. A metodologia envolve a selecção de estudos de caso de conjuntos habitacionais na Área Metropolitana de Lisboa para análise, centrando-se em parâmetros como i) localização; ii) tipo de intervenção iii) número de fogos e tipologias; iv) dimensões da construção bruta da habitação; e i) a relação entre a casa e o seu habitat. Os resultados preliminares evidenciam avanços da habitação social, enfatizam a importância e a necessidade não só da articulação entre os actuais programas, políticas e leis de bases da habitação, de forma a garantir uma habitação e um habitat adequados, mas também o papel insubstituível do Estado e do Governo Central na definição dessas políticas e na aproximação dos municípios à sua execução. Portugal importantes Levanos Leva iniciais centrase centra se i ii iii reabilitação análise centrandose centrando localização tipologias iv adequados execução

Resumo As doenças hepáticas colestáticas podem associar-se a um aumento do colesterol à custa de uma lipoproteína anómala, a lipoproteína X (LpX). Os agentes hipolipemiantes convencionais não apresentam benefício nesta entidade, pelo que o tratamento da hipercolesterolemia associada de LpX baseia-se na correção da causa subjacente da colestase. A plasmaferese pode ser necessária para evitar complicações, como a síndrome de hiperviscosidade. Os autores apresentam o caso de um homem de 44 anos com antecedentes de pseudotumor inflamatório da órbita sob prednisolona, admitido por lesão hepatocelular e colestática e hipercolesterolemia grave. A investigação laboratorial permitiu estabelecer a hepatite E aguda como responsável da lesão hepática e mostrou que a hipercolesterolemia grave foi mediada pela LpX. A redução da carga imunossupressora facilitou a eliminação do vírus da hepatite E. A consequente resolução da colestase coadjuvada pela remoção de colesterol por plasmaferese, permitiu a normalização mantida do perfil lipídico. Os autores relatam o primeiro caso de hipercolesterolemia associada a LpX em contexto de colestase induzida pelo vírus da hepatite E, e revisitam a importância do fígado no metabolismo dos lípidos.

Abstract Cholestatic liver diseases may be associated with increased plasmatic cholesterol due to an abnormal lipoprotein - lipoprotein X (LpX). Correcting the underlying cause of cholestasis is the critical treatment of LpX-associated hypercholesterolemia without any proven benefit from conventional lipidlowering agents. In some situations, plasma exchange may apply to prevent associated complications, such as hyperviscosity syndrome. The authors present the case of a 44-year-old man with orbital inflammatory pseudotumor on prednisolone, admitted due to hepatocellular and cholestatic lesion and severe hypercholesterolemia. Laboratory investigation established that hepatitis E virus was responsible for liver injury and showed that LpX mediated the severe hypercholesterolemia. Reduction of the immunosuppressive load contributed to virus clearance. The consequent resolution of cholestasis and cholesterol removal by plasmapheresis allowed lipid profile normalization. The authors report the first case of LpX-associated hypercholesterolemia in a patient with hepatitis E-induced cholestasis and revisit the role of the liver in lipid metabolism.

Resumo O artigo tem como objetivo compreender os impactos psicossociais vivenciados por trabalhadores de saúde após situação de desastre no estado de Santa Catarina, na região Sul do Brasil. Para tal, realizou-se estudo qualitativo de múltiplos casos e entrevistas narrativas com profissionais de serviços de saúde mental, atenção primária à saúde e gestores municipais em Itajaí, Blumenau e Rio do Sul. A análise das narrativas seguiu as etapas do método de Fritz Schütze. Descreveram-se os impactos psicossociais sobre a saúde e o trabalho dos entrevistados, afetados direta e/ou indiretamente pelo desastre natural ocorrido em 2008 na região, e subsequentes eventos de menor intensidade. Nos três casos, os impactos foram percebidos semelhantemente, ainda que as consequências do evento na rede municipal tenham sido enfrentadas de formas diferentes em cada localidade. Os resultados revelam a importância da promoção da saúde no trabalho e do desenvolvimento de habilidades pessoais, a resiliência frente a situações adversas e a necessidade de educação contínua e permanente.

Abstract The article aims to understand the psychosocial impacts experienced by health workers after a disaster situation in the state of Santa Catarina in Southern region of Brazil. To that end, a qualitative study of multiple cases and narrative interviews with professionals from mental health services, primary health care, and municipal managers in Itajaí, Blumenau, and Rio do Sul was carried out. The analysis of the narratives followed the steps of the Fritz Schütze method. The psychosocial impacts on the health and work of respondents, directly and/or indirectly affected by the natural disaster that happened in 2008 in the region, and subsequent events of lesser intensity, were described. In the three cases the impacts were perceived similarly, although the consequences of the event in the municipal network were faced differently in each location. The results reveal the importance of promoting health at work and developing personal skills, resilience in the face of adverse situations, and need for continuing and constant education.

Abstract The article aims to understand the psychosocial impacts experienced by health workers after a disaster situation in the state of Santa Catarina in Southern region of Brazil. To that end, a qualitative study of multiple cases and narrative interviews with professionals from mental health services, primary health care, and municipal managers in Itajaí, Blumenau, and Rio do Sul was carried out. The analysis of the narratives followed the steps of the Fritz Schütze method. The psychosocial impacts on the health and work of respondents, directly and/or indirectly affected by the natural disaster that happened in 2008 in the region, and subsequent events of lesser intensity, were described. In the three cases the impacts were perceived similarly, although the consequences of the event in the municipal network were faced differently in each location. The results reveal the importance of promoting health at work and developing personal skills, resilience in the face of adverse situations, and need for continuing and constant education.

Resumo O artigo tem como objetivo compreender os impactos psicossociais vivenciados por trabalhadores de saúde após situação de desastre no estado de Santa Catarina, na região Sul do Brasil. Para tal, realizou-se estudo qualitativo de múltiplos casos e entrevistas narrativas com profissionais de serviços de saúde mental, atenção primária à saúde e gestores municipais em Itajaí, Blumenau e Rio do Sul. A análise das narrativas seguiu as etapas do método de Fritz Schütze. Descreveram-se os impactos psicossociais sobre a saúde e o trabalho dos entrevistados, afetados direta e/ou indiretamente pelo desastre natural ocorrido em 2008 na região, e subsequentes eventos de menor intensidade. Nos três casos, os impactos foram percebidos semelhantemente, ainda que as consequências do evento na rede municipal tenham sido enfrentadas de formas diferentes em cada localidade. Os resultados revelam a importância da promoção da saúde no trabalho e do desenvolvimento de habilidades pessoais, a resiliência frente a situações adversas e a necessidade de educação contínua e permanente.

ABSTRACT Objective: The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low- and intermediate-risk PTC with no evidence of disease at the one-year assessment. Materials and methods: We conducted a retrospective longitudinal study of patients with low- and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV: 100.0% (95% confidence interval (CI): 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV: 98.8% (95% CI: 93.2%-100.0%); mean follow-up: 6.7 years]. In group 2, two patients’ USs presented suspicious findings at the five-year evaluation [NPV: 75.0% (95% CI: 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV: 87.5% (95% CI: 47.4%-99.7%); mean follow-up: 6.5 years]. Conclusion: Low- and intermediate-risk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.

Abstract Food has always been an urban issue. The role of cities in building more sustainable food systems is already recognized and related to other urban domains, such as transport, health, land use planning for agriculture and multifunctional areas, community development, employment generation and waste management. The implications of these on urban planning and practice are however less evident. A proper spatialization of the food system and of its metabolic flows is missing, inhibiting their necessary readings for urban design. This paper addresses this gap. After introducing the concept of food system and discussing its spatial components - production, transformation, distribution, commercialization/consumption and waste management - we expose how a set of food-related activities and initiatives are shaping the Lisbon Metropolitan Area. The socio-ecological metabolic flows established by these operations on the ground and their sustainability impacts are established, based on the analysis of five municipalities: Lisbon, Oeiras, Alcochete, Palmela and Montijo. The results reveal how food is already an opportunity for the creation of jobs, healthy food markets and the promotion of land productivity, in particular on a micro scale. The paper recognizes the importance of localized food systems and their particular metabolic flows, capable of boosting opportunities to overcome physical and social obstacles and to increase the possibilities for urban planning to target the urban food system on a wider scale. Finally, it concludes that the overall food system of a metropolitan area is more than the sum of the several food systems operating in that same region.

ABSTRACT Objective: Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. Subjects and methods: Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. Results: In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. Conclusions: FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.

This paper discusses the existing urban-rural dichotomy in Portuguese urban planning, assuming its importance on food-provision, a basic human need. Our analysis stems from an historical overview at two scales, regional and municipal, within the Lisbon Region. Specifically, we identify key changes between two time-periods: the mid-twentieth century, when design-based planning was established in Portugal for larger settlements, and nowadays, when it covers the totality of the national territory, based on land-use. We review these strategies, assessing what approaches would best encompass a sustainable transition of the food system. We start with the scheme of regional radial axis by architect Étienne de Gröer in contrast with the 2002 Lisbon Regional Plan. We furthermore expose two urbanization plans from 1940s: that of Vila Franca de Xira (1946) by Miguel Jacobetty and Faria da Costa and that of Palmela (1948) by João António Aguiar. Such plans, highly representative of the planning practices of that era, are then compared with their contemporary counterparts and subsequently with samples of their physical impacts on the ground, based on a morphological analysis of settlements and productive spaces in urban and rural contexts. Finally, we identify key changes for better use of productive soils within the Lisbon Region, considering challenges posed by international and national agendas.

Schwannomas are neurogenic tumors, commonly located in the costovertebral angle of the posterior mediastinum, but with many intrathoracic locations. They usually present as a solitary, well-circumscribed and encapsulated mass with a size between 2 and 10 cm. We report a case of a 66-year-old male, referred to our hospital for a mass located at the left lower hemithorax with 13 cm in size. A percutaneous biopsy was performed, and magnetic resonance imaging confirmed the diagnosis of a resectable giant mediastinal nerve sheath tumor. Surgery was performed without complications.

El schwannoma es un tumor neurogénico que se presenta más frecuentemente en el ángulo costovertebral del mediastino posterior, pero también en otras localizaciones dentro del tórax. Habitualmente suele ser una masa única, encapsulada, bien definida, con un tamaño aproximado 2 a 10 cm. Presentamos el caso de un paciente de 66 años, derivado a nuestro hospital por una masa de 13 cm localizada en el hemitórax inferior izquierdo. Se realizó una biopsia, y la resonancia magnética corroboró el diagnóstico de un tumor mediastínico gigante de la vaina neural. Se procedió a su resección completa sin complicaciones.

Abstract A 36-year-old-woman, smoker, without other relevant medical history, presented with symptoms of dyspnea, right localized chest pain, and non-productive cough. On the emergency department, the chest X-ray was interpreted as a giant right pneumothorax and a chest drain was inserted. Thoracic computed tomography demonstrated a giant emphysematous bulla with 23 cm on her right upper lobe. We report the first uniportal video-assisted thoracic surgery bullectomy for a bulla greater than 20 cm, in a patient with vanishing lung syndrome.

Resumen Una mujer de 36 años de edad, fumadora, se presentó en la sala de emergencias por disnea, tos y dolor torácico derecho. La radiografía fue interpretada como neumotórax y se colocó un tubo de drenaje. La tomografía computarizada del tórax mostró una bulla enfisematosa gigante, de aproximadamente 23 cm. Reportamos el primer caso de bullectomía por uniportal VATS en una paciente con síndrome del pulmón evanescente que presentaba una bulla mayor de 20 cm.