Abstract Atopic dermatitis (AD) results from the interaction between dysfunction of the skin barrier, dysregulation of the immune system, and alteration of the skin microbiome. As the most common inflammatory skin disease worldwide and still increasing, it is a real health problem. Vitamin D deficiency is also considered a global problem affecting 13 out of 100 people in Europe. Since vitamin D is involved in the formation of the epidermal barrier, by the synthesis of structural proteins and regulation of keratinocyte proliferation and differentiation, there is a rational to evaluate the relation between vitamin D levels and the prevention or treatment of AD. The authors performed a review of the existing scientific literature on the role of vitamin D in AD. Although studies are scarce not very robust with no consensual results, most studies report lower serum levels of vitamin D in patients with AD. In addition, there seems to be an inverse relationship between plasma levels of vitamin D and clinical severity, a hypothesis that is reinforced by studies that demonstrated a statistically significant benefit of vitamin D supplementation for improving clinical symptoms and signs of AD. Some studies also suggest a possible influence of prenatal vitamin D levels on the onset of AD during childhood. Therefore, vitamin D supplementation may play a relevant role as a complement to the treatment of AD or for its prevention, but more and better scientific evidence is needed to confirm this.

Resumo A dermatite atópica resulta da interação entre a disfunção da barreira cutânea, a desregulação do sistema imunitário e a alteração do microbioma da pele. Sendo a doença inflamatória da pele mais comum a nível mundial e com incidência crescente é um verdadeiro problema de saúde. O défice de vitamina D é também um problema de saúde global, que afeta cerca de 13 em cada 100 cidadãos europeus. Uma vez que a vitamina D está envolvida na formação da barreira epidérmica, pela síntese de proteínas estruturais e pela regulação da proliferação e diferenciação dos queratinócitos, é expectável que os níveis séricos de vitamina D possam ter um papel na prevenção e/ou no tratamento da dermatite atópica. Neste artigo de revisão narrativa foi revista a literatura científica existente sobre o papel da vitamina D na dermatite atópica. Apesar de escassos, pouco robustos e não consensuais, a maioria dos estudos relatam níveis séricos de vitamina D mais baixos em doentes com dermatite atópica, com uma relação inversa entre os valores plasmáticos da vitamina e a gravidade da doença, hipótese reforçada por estudos que demonstraram uma relação estatisticamente significativa entre a suplementação e a melhoria dos sintomas e sinais clínicos. Existem também evidências que sugerem uma possível influência de valores pré-natais de vitamina D no surgimento de dermatite atópica durante a infância. Desta forma, a suplementação com vitamina D poderá ter um papel relevante como complemento do tratamento da dermatite atópica, mas são necessárias mais e melhores evidências científicas para o comprovar.

Abstract Introduction and Objectives: Oral food challenges (OFC) are the gold standard for the diagnosis of food allergy. The aim of this study was to characterize and analyze the OFCs performed in the Pediatric Department of the study hospital. Material and Methods: Retrospective analysis of all patients who underwent OFCs in the pediatric department of the study hospital from October 2016 to December 2021. All non-IgE-mediated reactions were excluded. Statistical analysis was performed using IBM Statistical Package for Social Sciences®. Results: A total of 301 OFCs were performed on a total of 172 patients during the study period. Most patients were preschool children (<6 years; 79.4%) and 40.1% had more than one OFC. The most frequently tested allergens were hen’s egg (26.2%), tree nuts (16.9%), and cow’s milk (16.7%). The positivity rate was 23.2%. Tests for milk and wheat were significantly associated with a positive result. The main reason for OFC testing was to establish a diagnosis (60.1%), but also to assess tolerance (25.6%) and to document the responsiveness threshold (14.3%). Most positive reactions were local/grade I (25.7%) or moderate/grade II (58.6%). Patients with a personal history of atopic comorbidities were more likely to have a positive test result (p=0.022), especially those with atopic dermatitis (p=0.022). Discussion and Conclusion: Most OFCs in this analysis were negative. Early recognition of food allergy resolution is essential to prevent unnecessary allergen avoidance. An increased risk of positive reactions to milk or wheat, or in the setting of a personal history of atopic dermatitis, should be considered.

Resumo Introdução e Objetivos: A prova de provocação oral é o gold standard para o diagnóstico de alergia alimentar. Este estudo pretendeu caracterizar e analisar as provas efetuadas no Serviço de Pediatria de um hospital de nível II. Material e Métodos: Estudo retrospetivo dos doentes submetidos a provas de provocação oral entre outubro 2016 e dezembro 2021 num hospital de nível II. As reações não mediadas por IgE foram excluídas. A análise estatística foi realizada através do software IBM Statistical Package for Social Sciences®. Resultados: Foram realizadas 301 provas num total de 172 doentes. A maioria dos doentes eram crianças com idade <6 anos (79,4%) e 40,1% realizou duas ou mais provas. Os alergénios mais frequentemente testados foram ovo (26,2%), frutos secos (16,9%) e leite de vaca (16,7%). Constatou-se que 23,2% das provas foram positivas. Verificou-se uma associação estatisticamente significativa entre as provas realizadas para o leite e trigo e a obtenção de um resultado positivo. Relativamente ao objetivo das provas, 60,1% destinavam-se a estabelecer o diagnóstico, 25,6% a avaliar a tolerância e 14,3% a documentar o limiar de reatividade. A maioria das reações positivas foram locais/grau I (25,7%) ou moderadas/grau II (58,6%). Foi identificada uma associação estatisticamente significativa entre antecedentes de atopia e um resultado positivo nas provas (p=0,022), particularmente antecedentes de dermatite atópica (p=0,022). Discussão: A maioria das provas realizadas foram negativas. O reconhecimento atempado da resolução de uma alergia alimentar permite suspender a evicção desnecessária de alergénios suspeitos. Deve ser considerado o risco acrescido de uma reação positiva com leite, trigo ou em contexto de antecedentes pessoais de dermatite atópica.

Abstract Terra firma-forme dermatosis is a dermatological condition characterized by the presence of hyperpigmented plaques, which are easily cleared with 70% isopropyl alcohol. Case 1: A 14-year-old boy, with no relevant past medical history, presented with a brown-colored skin lesion on his chest, which had appeared one year earlier. The lesion was cleared with 70% isopropyl alcohol, proving the diagnosis of terra firma-forme dermatosis. Case 2: A 12-year-old girl was referred to our consultation. She was obese and had insulin-resistance. On physical examination she had significant hyperpigmentation on her neck and axillae, which was interpreted as acanthosis nigricans. Nonetheless, we performed swabbing of the lesions with 70% isopropyl alcohol, which immediately cleared the skin, confirming the diagnosis of terra firma-forme dermatosis. In conclusion, terra firma-forme dermatosis is a benign and easily solved dermatosis. Nonetheless, its unesthetic appearance is often a cause of great distress to the patient. We aim to increased awareness of this entity.

Resumo A dermatose terra firme-forme é uma patologia comum, frequentemente subdiagnosticada. Caracteriza-se pela presença de placas hiperpigmentadas, facilmente removíveis com álcool isopropílico a 70%. Caso 1: Adolescente de 14 anos, sexo masculino, sem antecedentes de relevo. Recorre por lesão hiperpigmentada, localizada na porção superior do tronco, com 1 ano de evolução. Durante a observação foi realizada remoção da lesão descrita com álcool isopropílico a 70%, confirmando-se o diagnóstico de dermatose terra firme-forme. Caso 2: Adolescente de 12 anos, sexo feminino, com antecedentes pessoais de obesidade e insulinorresistência. Ao exame objetivo constataram-se lesões hiperpigmentadas no pescoço e axilas, interpretadas, inicialmente, como acantose nigricans. Não obstante, foi realizada limpeza com álcool isopropílico a 70%, com rápida remoção das lesões, estabelecendo-se o diagnóstico de dermatose terra firme-forme. Os casos clínicos descritos alertam para a necessidade de reconhecimento desta patologia que, embora benigna, é frequentemente geradora de grande ansiedade, conduzindo a investigações desnecessárias.

Abstract In some transcatheter aortic valve implantation (TAVI) procedures, difficulty in crossing the valve delivery system occurs. There are some described anatomical risk factors as extreme angulation, heavy calcification, and bicuspid morphology. A possible reason may be an unfavorable angle of approach because of the outward push by the incoming crimped bioprosthesis and insufficient support/trackability of the extra stiff wire. Several techniques, tips, and tricks have been developed to overcome this problem and avoid procedure failures, such as the “pull-and-push” technique, pre-dilation, buddy wire, balloon cushion, buddy balloon and snare techniques. Here, we report a case of TAVI complicated by the difficulty in crossing the calcified native aortic valve (AV) that was solved with the snare technique without complications. (TAVI procedures occurs angulation calcification morphology supporttrackability support trackability wire techniques tips failures pullandpush pull “pull-and-push predilation, predilation pre dilation, dilation pre-dilation cushion Here AV (AV complications

Abstract Introduction: Swallowing disorders are common after treatment for head and neck cancer. Exercises for the recovery of swallowing functions are important, but their prophylactic use is still poorly studied. Objective: To analyze the use of prophylactic swallowing exercises in people with head and neck cancer undergoing (neo)adjuvant treatment with radiotherapy and/or chemotherapy. Methods: Studies were retrieved from a systematic search of published work until October 2022 indexed in the PubMed central, LILACS, Scielo, CINAHL Complete, Cochrane Collection Plus, Nursing & Allied Health Collection and Medic Latina databases. Methodological quality and evidence synthesis were assessed with using the the “Quality Assessment Tool for Quantitative Studies” scale. Results: 1,401 studies were identified and only eight were selected for analysis and data extraction. Conclusion: The use of prophylactic exercises seems to have some benefit on swallowing functions, but the results are not consistent. Further research is suggested to study its potential benefits in a more specific way (i.e. type of exercise versus treatment).

Resumo Introdução: As alterações de deglutição são comuns após tratamento para cancro de cabeça e pescoço. Os exercícios para a recuperação das funções da deglutição são importantes, mas a sua utilização de forma profilática ainda é pouco estudada. Objetivo: Analisar a utilização de exercícios profiláticos para a deglutição em pessoas com cancro de cabeça e pescoço submetidas a tratamento (neo)adjuvante com radioterapia e/ou quimioterapia. Métodos: Revisão sistemática da literatura cuja seleção dos estudos decorreu em outubro de 2022 envolvendo pesquisas nas bases de dados PubMed central, LILACS, Scielo, CINAHL Complete, Cochrane Collection Plus, Nursing & Allied Health Collection e Medic Latina. A análise do nível de evidência foi realizada através da escala “Quality Assessment Tool for Quantitative Studies”. Resultados: Identificaram-se 1.401 estudos e selecionados apenas oito para análise e extração de dados. Conclusão: A utilização de exercícios profiláticos parece ter algum benefício nas funções da deglutição, mas os resultados não são consistentes. Sugerem-se novas investigações para estudar os seus potenciais benefícios de forma mais específica (i.e. tipo exercício versus tratamento).

Resumo Introdução e Objetivos: A prevalência da obesidade entre mulheres em idade fértil tem aumentado nos últimos anos, devendo ser considerada na escolha do método contracetivo. Estas mulheres apresentam maior risco de eventos tromboembólicos, sendo superior com a utilização de contraceção hormonal combinada (CHC). Por este motivo, algumas sociedades médicas não recomendam a utilização de CHC nas mulheres com obesidade classe 2 e 3. Este estudo tem como objetivo avaliar a terapêutica contracetiva nas mulheres obesas de classe 2 ou superior em nove Unidades de Saúde Familiar (USF’s) da região norte de Portugal. Tipo de Estudo: Estudo multicêntrico observacional retrospetivo transversal. População: Todas as mulheres em idade fértil (15-49 anos), com IMC ≥35 kg/m2, inscritas nas USF’s intervenientes e inseridas no programa de planeamento familiar (PF). Métodos: A amostra foi recolhida através da plataforma MIM@UF® e a identificação do método anticoncecional e antecedentes tromboembólicos através do processo clínico (SClínico®). Foram excluídas mulheres grávidas, mulheres sem consulta nos últimos cinco anos e mulheres com dados inválidos. Resultados: Da amostra inicial de 1063 mulheres, 123 foram excluídas. A idade média era 36,8 ± 8,8 anos e o IMC médio era 39,2 ± 4,0 kg/m2. Desta amostra, 36,2% (n=340) estavam sob progestativos (70,9% progestativo oral, 14,7% sistema intrauterino com levonorgestrel, 13,8% com implante progestativo, 0,6% com progestativo injetável); 27,7% (n=260) estavam sob CHC, 12,8% (n=120) estava sob métodos não hormonais (55,8% métodos de barreira; 37,5% dispositivo intrauterino de cobre; 6,7% métodos naturais); 6,4% (n=60) estavam com métodos permanentes e 17,0% não utilizavam método contracetivo (n=160). Nesta amostra, 2,2% (n=21) tinham antecedentes tromboembólicos. Conclusões: A CHC é o segundo método mais usado nas USF intervenientes, apesar do seu uso não estar recomendado. Dado o elevado risco de eventos tromboembólicos, é essencial implementar medidas corretivas para a melhoria do aconselhamento contracetivo nas consultas de PF.

Abstract Overview and Aims: The prevalence of obesity among fertile women has increased over the last few years and should be considered when choosing a contraceptive method. These women have a higher risk of thromboembolic events that increases with the use of combined hormonal contraception (CHC). Therefore, some medical societies do not recommend the use of CHC in women with class 2 obesity or higher. This study aims to assess the contraceptive methods used in women with class 2 obesity or higher in nine Primary Healthcare Units (PHU) in northern Portugal. Study Design: Multicentric retrospective, observational, cross-sectional study. Population: All women of reproductive age (between ages 15 and 49), with a BMI ≥ 35 kg/m2, enrolled in the intervening PHU and included in the family planning (FP) program. Methods: The sample was collected using the MIM@UF® database, obtaining the contraceptive method and thromboembolic history through the individual electronic medical record system, Sclínico®. Pregnant women, women without a medical appointment in the previous five years and women with invalid data were excluded. Results: From the initial sample of 1063 women, 123 were excluded. The mean age was 36.8 ± 8.8 years, the mean BMI was 39.2 ± 4.0 kg/m2. From the sample, 36.2% (n=340) were using progestogen (70.9% progestogen-only pill, 14.7% levonorgestrel intrauterine system, 13.8% progestogen-only implant, 0.6% progestogen-only injectables); 27.7% (n=260) were taking CHC; 12.8% (n=120) were with a non-hormonal methods (55.8% barrier methods; 37.5% copper intrauterine contraceptive device, 6.7% natural methods); 6.4% (n=60) were with permanent methods, 17.0% were not using any type of contraception (n=160). In this sample, 2,2% (n=21) had a thromboembolic event. Conclusions: CHC was the second most used method in the intervening FHU, although its use is not recommended. Given the high risk of thromboembolic events, it is essential to implement corrective measures to improve contraceptive counselling in FP consultations.

RESUMO A disfagia é uma comorbidade relevante da doença de Alzheimer (DA). No entanto, existem poucos estudos sobre as suas características e progressão. Objetivo: Identificar as características específicas, a progressão e a prevalência da disfagia na DA. Métodos: Pesquisa conduzida nas bases PubMed (Medical Literature Analysis and Retrieval System Online — MEDLINE), EBSCO, ScienceDirect e BASE. Avaliação crítica e análise do nível de evidência foram conduzidas usando as ferramentas do Joanna Briggs Institute e do Effective Public Health Practice Project (EPHPP). Resultados: Incluíram-se 26 estudos. Os sintomas iniciam-se no estádio inicial da DA, como alterações de fase oral, progredindo para alterações faríngeas e apraxia de deglutição no estádio grave. A disfagia progride, como a DA, num continuum, com a gravidade dependendo da variabilidade individual. Não foram encontrados estudos de prevalência. Conclusões: A disfagia é uma comorbidade complexa e importante que tem impacto na qualidade de vida. A escassez de publicações atuais de prevalência pode indicar que não é considerada como potencial causa de morte por pneumonia na DA.

ABSTRACT Dysphagia is described as a highly relevant comorbidity of Alzheimer’s disease (AD). However, there is a scarcity of studies aiming at the characteristics and progression of dysphagia. Objective: The objective of this study was to identify the specific characteristics, progression, and prevalence of dysphagia in AD. Methods: Publications were searched in the PubMed (MEDLINE), EBSCO, ScienceDirect, and BASE databases. Critical appraisal and evidence-level analysis were conducted using the Joanna Briggs Institute and Effective Public Health Practice Project’s (EPHPP) tools. Results: A total of 26 studies were reviewed. Symptoms begin in the early stage of AD, as oral phase impairments, and progress to pharyngeal symptoms and swallowing apraxia in the later stages of AD. Dysphagia progresses, as AD, along a continuum, with severity depending on individual variability. There were no studies found on prevalence. Conclusions: Dysphagia is a complex and important comorbidity in AD that impacts the quality of life. No recent publications on prevalence may imply that is not being coded as a potential cause for pneumonia deaths in AD.

Abstract The present study aimed at examining whether better mood and better intimate relationship quality are independently associated with better sexual function. The sample consisted of 401 subjects aged between 18 and 65 years (265 females and 136 males). Participants completed the Perceived Relationship Quality Components (PRQC) Inventory and the Depression Anxiety Stress Scale (DASS). Additionally, women completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale - Revised (FSDS-R), while men completed the International Index of Erectile Function (IIEF). For both sexes, intercorrelations between more negative mood, poorer intimate relationship quality, and poorer sexual function were confirmed. In multiple regressions, more negative mood, poorer relationship quality, and use of medicines for anxiety or depression were independently associated with more sexual difficulties.

Resumo O presente estudo teve como objetivo compreender se melhor humor e melhor qualidade da relação amorosa estão associados independentemente a uma melhor função sexual. A amostra é constituída por 401 sujeitos com idades compreendidas entre os 18 e os 65 anos, 265 do sexo feminino e 136 do sexo masculino. Os participantes responderam ao Inventário de Componentes de Qualidade de Relacionamento Percebido e à Escala de Depressão, Ansiedade e Stress (EADS). Para avaliar a função sexual, as mulheres responderam ao Índice de Função Sexual Feminina e à Escala de Distress Sexual Feminino - Revista, enquanto que os homens responderam ao Índice Internacional de Função Erétil. Em ambos os sexos, confirmaram-se intercorrelações entre pior humor, menor qualidade da relação amorosa e pior função sexual. Em regressões múltiplas, verificou-se que estados de humor negativos, menor qualidade da relação amorosa e uso de medicamentos para a ansiedade ou depressão se associaram independentemente a mais dificuldades sexuais.

Abstract Overview and aims: Cervical cancer (CC) is the fourth leading cause of cancer death in women globally, and accounts around 311,000 deaths annually, being the persistent infection with high-risk Human Papilloma virus the most common cause. The prevention of CC is based on gynecological screening, which allows to classify the degree of existing lesion, as well as to identify other changes which may contribute to the development of these lesions and subsequent neoplasia. We aim to analyze the prevalence of cancerous and pre-cancerous lesions in the Algarve population attending the Private Hospital of Algarve (HPA), through the study of the results of gynecological cytology performed in this Hospital. Study design: Retrospective observational study from the clinical database. Methods: Data collected from the gynecological cytological analysis of female users between 25 up to 65 years old, carried out between January 2013 and December 2017. Results: It was found that the number of samples increased over the five years, making a total of 28346 samples, in which the cytological result with the highest percentage is the negative, with 95.6%. Of the cytology’s with lesions (4.4%), the one with the highest percentage is ASCUS with 2.2%, followed by LSIL with 1.7%. The Algarve municipality with the highest number of injuries identified is Faro 19.7%, followed by Portimão 15.8%. On the other hand, Castro Marim is the county with the lowest frequency of injuries 0.3%, and Alcoutim did not present any detected injuries; the age range with the largest number of samples is from 35 to 40 years old. Conclusion: This study showed that, in Algarve, the adherence to greater female health care increased in the population that uses the HPA, with the negative cytologic result being the most prevalent.

Abstract Overview and Aims: In vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) show discouraging results in poor ovarian responders. We aim to characterize low prognosis women, stratifying them according to POSEIDON criteria -based on ovarian reserve markers and response in previous cycles. Study Design: data base retrospective study Population: women undertaking an IVF/ICSI cycle between May/2012 and December/2017 in our public centre. Methods: all women undertaking IVF/ICSI cycles with registered antimullerian hormone levels and antral follicule count (the ovarian reserve markers considered in POSEIDON criteria) were divided in 4 groups -women with normal ovarian reserve markers but low response in previous cycle (<35 years-G1; ≥35 years-G2) and women with at least one low ovarian reserve marker (<35 years-G3; ≥35years-G4). Ovarian reserve markers, previous ovarian response, socio-demographic features, type/etiology of infertility, number of oocytes collected, clinical pregnancy and delivery rates per cycle/ovarian puncture(OP)/transfer were determined. Ovarian response (categorized into optimal/non-optimal based on the number of oocytes collected), clinical pregnancy and delivery rates of the 4 groups were compared to population non-POSEIDON(PNP). X 2 test was used. Significance was set at p-value<0.05. Results: 1789 cycles were analysed; 49.6%(887/1789) of them met POSEIDON criteria - n=86(G1), n=129(G2); n=180(G3); n=492(G4). 85.7% of those reaching OP had a non-optimal response. G4 showed the worse pregnancy and delivery rates, significantly lower than PNP. The highest rates of pregnancy and delivery were verified in a subgroup of G2, except for delivery/cycle; no difference was observed between G1/G2 and PNP. Most women were Portuguese, Caucasian, normal weighted, non-smokers and presented primary infertility. Male factor was the most frequently identified cause. Conclusion: POSEIDON criteria showed high positive predictive value of having a non-optimal response. Results may help managing expectations of women undergoing IVF/ICSI with similar characteristics. Exclusion from POSEIDON group should not be considered reassuring due to low negative predictive value.

Abstract This article details the role of collaborative journalism during the process of rebuilding investigative journalism at its core thus assuring enduring investment in its quality. We will start by characterizing the concepts of investigative journalism and collaborative journalism, using leading scholars in both of these complementary areas; we will, then, identify the pressures that constrains investigative journalism, and analyse how journalistic collaboration has a potential for resistance that can protect both investigative journalism and the journalists who practice it. Our article path will be complemented with the case study of the “Daphne Project”, the first project of the consortium “Forbidden Stories”, the international platform created by Laurent Richard. This project will be characterized through a documentary analysis and with interviews we conducted with both its founder, Laurent Richard, and Mathew Caruana Galizia, the son of Daphne Caruana Galizia, the Maltese journalist murdered on October 16th 2017, during her investigations. The Daphne Project was created for the purpose of keeping alive stories of journalists who have been killed, imprisoned or, for some reason, were unable to pursue their investigations. Not only does collaborative journalism protect investigative journalism and investigative journalists, but cross-borders collaboration also allows “sharing the risk across a wide range of international players” (Sambrook, 2017). If the absolute exposure of the lonely investigative journalist turns him/her into a target in territories where freedom of speech is threatened, the murder of this Maltese journalist, followed by the murder of Slovakian Ján Kuciak, in 2018, placed Europe as an unlikely set on the risk map. While acknowledging the problems caused by international consortium of journalists, this research highlights, above all, how these partnerships, anchored in "radical sharing" (Guevara, 2016)1, are contributing to enhance investigative journalism.

Overview and Aims: Gestational diabetes (GD) is associated with increased risk for pregnancy and delivery complications. Ethnicity is a recognized risk factor for GD. Considering ethnic diversity in Portugal, it is important that health providers are familiar with differences in expected outcomes. This study was designed to compare Asian, Black and Caucasian women with GD. Study Design: Observational, retrospective study. Population: Women with singleton pregnancies and GD followed in our hospital, from 2012 to 2015. Materials and Methods: 323 women were divided according to country of birth and skin color - Caucasian (G1, n=230), Black (G2, n=79) and Asian (G3, n=14). Demographic characteristics, risk factors for GD and previous hypertension were compared. Maternal/fetal outcomes were analyzed - maternal weight gain, metabolic control, need of pharmacologic therapy, hypertensive complications, ultrasound biometric measures, intrauterine demise, mode of delivery, newborn weight and comorbidities. X2 and Fisher tests were performed. Significance was set at p-value<0.05. Results: G1 included women mainly from Portugal, G2 from Guinea Bissau, Angola and Portugal and G3 from India. Groups differed in level of education (p=0.023) and Body Mass Index categories (p=0.034) - G2 had the lowest level of education and the highest rates of overweight/obesity. Statistical difference was found in metabolic control, resulting in glycated haemoglobin below 6% (p=0.022) and mode of delivery (p<0,001); G2 and G3 had worse metabolic control than G1, with higher C-section rates. Neonatal comorbidity differed between groups (p=0.021), with G2 having higher rates, mainly hyperbilirrubinemia requiring phototherapy. Need or type of pharmacologic therapy (insulin/metformin) showed no difference between groups. Conclusions: Metabolic control in Asian and Black women with GD was more difficult to achieve than in Caucasians, with afterwards worse maternal/fetal outcomes. Health providers should acknowledge differences between ethnicities and a multidisciplinary and individualized approach should be provided.

Introdução: As doenças cardiovasculares são a principal causa de morte nos países desenvolvidos e os eventos cardiovasculares não-fatais contribuem para morbilidade significativa na população destes países. Modelos de risco cardiovascular usados atualmente: Os modelos de avaliação de risco cardiovascular, tendo em conta a conjugação de fatores de risco presentes num doente, atribuem um valor essencialmente quantitativo ao risco cardiovascular individual para determinados eventos fatais ou não fatais e permitem estabelecer metas para início de medidas terapêuticas preventivas. Entre os modelos de avaliação de risco cardiovascular mais amplamente usados estão o Systematic Coronary Risk Evaluation (SCORE) e as equações de Framingham. Estudos de validação dos modelos de risco cardiovascular: Não obstante a sua utilidade clínica, estudos europeus concluíram que estes modelos sobrestimam o risco de eventos cardiovasculares fatais e não-fatais observados quando aplicados a populações diferentes daquela em que foram desenvolvidos. Discussão: Atualmente não existe literatura que tenha validado a aplicação destes modelos de risco na população portuguesa, pelo que não podemos saber se estes modelos são suficientemente fiáveis na nossa população e se deverão ser usados para guiar decisões na prática clínica.

Introduction: Cardiovascular diseases are the most important cause of death in developed countries and non-fatal cardiovascular events contribute to significant morbidity in the population of these countries. Cardiovascular risk models currently used: Cardiovascular risk models consider the sum of risk factors present in a patient, attribute a quantitative value to the cardiovascular risk to certain fatal and non-fatal events and allow us to establish cut-offs to introduce preventive therapeutic measures. Among the most used cardiovascular risk models are the Systematic Coronary Risk Evaluation (SCORE) and Framingham equations. Validation studies of cardiovascular risk models: Despite their clinical utility, European studies showed that these models overestimate the observed risk of fatal and non-fatal cardiovascular events when applied to populations different from those they were derived from. Discussion: Currently there is no literature validating the use of these cardiovascular risk models in the Portuguese population, hence there is uncertainty whether or not the recommended models accurately measure risk in our population and if they should be used in clinical practice.

Assumindo o papel insubstituível dos espetros no questionamento do passado, em particular no que toca a momentos que representaram cesuras potencialmente traumáticas, proponho, no presente artigo, testar o valor de um conceito de origem marcadamente ocidental, como a fantasmagoria, na construção de políticas e práticas pós-coloniais da memória. Pretendo, deste modo, demonstrar as possibilidades sociológicas, políticas e literárias da figura do fantasma quando aplicada a um acontecimento com as especificidades histórico-culturais do “Massacre de 1953”, em São Tomé e Príncipe.

En assumant le rôle irremplaçable des spectres dans le questionnement du passé, en particulier pour ce qui a trait à des moments qui représentent des césures potentiellement traumatiques, je propose, dans le présent article, de tester la valeur d'un concept d'origine nettement occidentale, tel que la fantasmagorie, dans la construction de politiques et de pratiques post-coloniales de la mémoire. De la sorte, mon but est de démontrer les possibilités sociologiques, politiques et littéraires de la figure du fantôme lorsqu'appliquée à un évènement aux spécificités historico-culturelles du “Massacre de 1953”, à São Tomé e Príncipe.

Assuming the irreplaceable role of specters in questioning the past, in particular with respect to those moments which constitute potentially traumatic ruptures, in this article I propose to test the value of a concept with markedly western origins – the haunting – in the construction of postcolonial policies and practices of memory. I intend, therefore, to demonstrate the sociological, political and literary possibilities of the ghost figure when applied to an event with historical and cultural specificities, namely the “Massacre of 1953” in São Tomé and Príncipe.