Resumo Objetivo: Avaliar o Rácio de gânglios linfáticos (RGL) como preditor de sobrevida e recidiva de cancro da laringe com metastização cervical (pN+). Desenho do estudo: Estudo retrospetivo, que incluiu doentes submetidos a laringectomia total associada a esvaziamento ganglionar cervical bilateral, entre outubro/2010 e abril/2023. Resultados: Foram incluídos 73 doentes. Entre os doentes pN+ (n=37;50,7%), aqueles com evidência de recidiva tumoral (n=16;43,2%) apresentaram uma mediana de RGL superior (0,159 versus 0.060), p=0,007. Após análise da curva ROC, o RGL>0,063 indicou recidiva tumoral (sensibilidade:87%; especificidade:48%). Para além disso, o RGL>0,063 manteve-se como um preditor independente de recidiva tumoral, após análise multivariada ajustada para potenciais fatores de confundimento (idade, extensão extraganglionar, margem de resseção e estadio patológico T),(HR=6,58; p=0,049). Por último, um RGL elevado (>0,063) esteve associado à morte específica por cancro em doentes pN+ (OR=8,64; p=0,008). Conclusão: Este estudo indica que doentes com RGL>0,063 têm maior probabilidade de doença agressiva. Assim, o RGL é um parâmetro prognóstico relevante, podendo ser útil para complementar o estadiamento TNM no cancro da laringe pN+.

Abstract Objectives: To evaluate Lymph node ratio (LNR) as a predictor for survival and recurrence of laryngeal cancer with metastatic lymph nodes (pN+). Study design: This retrospective study included patients who underwent primary laryngectomy combined with bilateral neck dissection, between October/2010 and April/2023. Results: A total of 73 patients were included. Among pN+ patients (n=37;50.7%), those with disease recurrence (n=16;43.2%) exhibited a higher median LNR (0.159 versus 0.060), p=0.007. ROC curve analysis showed that LNR>0.063 predicted recurrence (sensitivity 87%;specificity 48%). Moreover, multivariate analysis confirmed LNR>0.063 as an independent predictor of disease recurrence, after controlling for potential confounders, namely age, extracapsular spread, resection margin and pathological T category, (HR=6.58; p=0.049). Finally, high LNR (>0.063) was associated with cancer-specific death (OR=8.64; p=0.008) in pN+ patients. Conclusion: Our findings highlight that patients with LNR>0.063 are more likely to have aggressive disease, suggesting LNR as a significant prognostic factor complementing TNM staging in pN+ laryngeal cancer.

Abstract Introduction Colorectal cancer (CRC) is the third most prevalent tumor. Right colon cancer (RCC) comprises one-third of CRC cases and is associated with poorer outcomes, emphasizing the need for optimized treatment strategies. The present study aims to explore the nuances in the management of RCC across Portugal, focusing on surgical approaches and multidisciplinary treatment. Materials and Methods The CodiReal-PT was a cross-sectional survey-based study adhering to the guidelines of the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), focusing on current practices in RCC oncological surgery. The survey comprised 31 questions divided into 4 sections (demographics, multidisciplinary approach, surgery practices regarding RCC, and postoperative management). It was made available via e-mail to all active members of the Portuguese Society of Surgery (Sociedade Portuguesa de Cirurgia, SPCIR, in Portuguese), and data collection lasted from November to December 2022. Results Data from 69% of Portuguese public hospitals was obtained. All the participant hospitals had multidisciplinary team meetings to manage CRC cases. However, 17% (n = 6) did not discuss all elective-setting cases during their meetings. Dedicated colorectal surgical teams were present in 86% (n = 31) of hospitals. Furthermore, the presence of these dedicated teams was associated with better practices, namely a higher volume of right colectomies (mean: 51.8 ± 32.6 versus 23.8 ± 4.8; p = 0.001), a preference for the laparoscopic approach (93.5 versus 60.0%; p = 0.021), and standardization of anastomotic techniques (83.9 versus 40.0%; p = 0.029). Conclusion The present nationwide survey-based study provides a comprehensive landscape of RCC management practices across Portugal, underscoring the significant role of dedicated colorectal surgical teams and the need for further practice standardization. Nevertheless, multidisciplinary team meetings in all surveyed hospitals are an important indicator of improved RCC care. Future research should focus on the impact of specific surgical techniques on oncological outcomes and the potential benefits of centralizing care to high-volume centers. (CRC tumor (RCC onethird one strategies Portugal CodiRealPT CodiReal PT crosssectional cross sectional surveybased based ESurveys E Surveys CHERRIES, CHERRIES , (CHERRIES) 3 demographics, demographics (demographics management. . management) email e mail Sociedade Cirurgia SPCIR Portuguese, Portuguese) 2022 69 obtained However 17 n 6 electivesetting elective setting 86 Furthermore mean (mean 518 51 8 51. 326 32 32. 238 23 23. 4.8 48 0.001, 0001 0.001 0 001 0.001) 93.5 935 93 5 (93. 60.0% 600 60 0.021, 0021 0.021 021 0.021) 83.9 839 83 9 (83. 40.0% 400 40 0.029. 0029 0.029 029 0.029) Nevertheless highvolume high centers (CHERRIES 202 1 2 4. 000 0.00 00 93. (93 60.0 002 0.02 02 83. (83 40.0 20 0.0 (9 60. (8 40. 0. (

Abstract: Far from being established in a natural, or a-temporal way, Atlantic history presupposes precise circumscriptions, socially and politically configured. In this sense, this issue seeks to contribute to the perception of what is defined as the Ibero-Atlantic space, focusing on a specific aspect: the circulation of written culture, expressed in the movements made by books, periodicals, pamphlets and other sets of papers. Our aim is to understand the multiple processes of literate circulation over time. We also intend to think about long-term processes in order to grasp the changes in the configurations of the Ibero-Atlantic world and their persistence. The issue thus tries to demonstrate how each space of creation and appropriation of texts put into circulation is a concrete product of contingent insertion in networks of diverse complexity and density, through which a flow of manuscript, printed objects and ideas materializes, a movement in which systems of links are established between several regions of the Ibero-Atlantic world.

Resumo: Distante de se estabelecer de modo natural, ou atemporal, a história atlântica pressupõe circunscrições precisas, social e politicamente configuradas. Nesse sentido, este dossiê temático busca contribuir para a percepção do que se define como espaço iberoatlântico, focando em um aspecto específico: a circulação da cultura escrita, declinada dos movimentos realizados por livros, periódicos, panfletos e papéis vários. O objetivo é compreender os múltiplos processos de circulação letrada no decorrer dos tempos. Buscou-se pensar os processos em longa duração, para vislumbrar as mudanças nas configurações do mundo iberoatlântico e suas persistências. Evidencia-se, assim, no dossiê, como cada espaço de criação e apropriação de textos postos em circulação é um produto concreto de inserção contingente em redes de diversa compleição e densidade, por meio das quais se materializa um fluxo de objetos manuscritos, impressos e de ideias, movimento no qual se estabelecem sistemas de ligações entre várias regiões do mundo iberoatlântico.

Resumo Introdução: O vírus da hepatite C (VHC) é uma causa importante de doença hepática, apresentando várias evoluções clínicas. A descoberta dos antivirais de ação direta revolucionou o seu tratamento, uma vez que permitem a erradicação do vírus em mais de 95% dos casos. A pandemia de SARSCoV-2 alterou o normal funcionamento dos serviços de saúde, comprometendo esse objetivo. Métodos: Análise retrospetiva dos doentes tratados e seguidos num hospital distrital entre 1 de janeiro de 2015 e 31 de dezembro de 2020. Resultados: Foram 267 doentes, 77,9% homens com idade média de 50 ± 10,3 anos. O fator de risco mais frequente foi o consumo de drogas endovenosas (55%). O genótipo 1 foi o mais comum (64%), 27% apresentavam cirrose hepática, 32% já tinham experimentado outros tratamentos. O tempo médio de espera pelo tratamento foi de 3, 19 meses, antes da pandemia 3, 11 meses e 4, 15 meses em 2020, diferença estatisticamente significativa (p = 0,017). Houve uma diminuição do número de doentes tratados ao longo dos anos. O tratamento mais utilizado foi o ledispasvirlsofosbuvir. A taxa de resposta virológica sustentada foi de 99%. Tiveram alta 70% dos doentes. Discussão: Este estudo retrospetivo é o primeiro, a nível nacional, a avaliar o impacto da pandemia de SARS-CoV-2 no tratamento da infeção por VHC. Mostrou-nos um aumento do tempo de espera pelo tratamento no ano 2020. O impacto da pandemia de SARS-CoV-2 sobre esta patologia ainda não é claro. Conclusão: A pandemia de SARS-CoV-2 levou a um aumento do tempo de espera pelo tratamento e diminuição do número de doentes tratados, dificultando o objetivo da eliminação.

Abstract lntroductíon: Hepatitis C vírus (HCV) is an important cause of liver disease, presenting several clínical manifestations. The discovery of direct acting antivirais has revolutionized the treatment of this infectíon, these new antivirais allowed the eradication of the vírus in more than 95% of the cases. The SARS-CoV-2 pandemic changed the normal functioning of health services, and this could compromise this goal. Methods: Retrospective analysis of patients treated and followed in a distríct hospital between January 1, 2015, and December 31, 2020. Results: We treated 267 patients, 77.9% men, the average age being 50 years old. History of intravenous drug use was de risk factor in 55%. Genotype 1 was the most common (64%), 27% had liver cirrhosis and 32% had been submitted to other treatments. The average of the waiting time for treatment was 3. 19 months, before the pandemic it was 3. 11 months and in 2020 it was 4. 15 months, this difference is statistically significant (p = 0.017). The number of patients treated over the years has been decreasing. The most used treatment was ledispasvirl sofosbuvir. The sustained virological response was 99%. Patients were discharged in 70% of the cases. Discussion: This retrospective study is the first, at national levei, to evaluate the impact of the SARS-CoV-2 pandemic on the treatment of HCV infection. lt showed an increase in the waiting time for treatment in the year 2020. The impact of the SARS-CoV-2 pandemic on this pathology is still unclear. Conclusion: The SARS-CoV-2 pandemic led to an increase in the waiting time for treatment and a decrease in the number of patients with HCV infection treated, making it difficult to eradicate the vírus.

ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

Resumo: A proctite rádica crónica desenvolve-se habitualmente 3 meses após radioterapia. Não obstante a ausência de recomendações em relação ao tratamento desta patologia, a terapêutica endoscópica com árgon-plasma é segura e eficaz. Contudo, as úlceras retais são uma complicação frequente, apesar da maioria dos doentes serem assintomáticos e não requerem vigilância e/ou tratamento. Os autores apresentam um caso clínico de um doente com o diagnóstico de proctite rádica crónica, submetido a terapêutica com árgon-plasma com posterior desenvolvimento de úlcera retal refratária a tratamento médico conservador. O doente foi submetido a oxigenoterapia hiperbárica com resolução completa da úlcera retal. De acordo com a literatura, a oxigenoterapia hiperbárica apresenta eficácia na proctite rádica crónica grave e nas úlceras retais induzidas por radioterapia. Contudo, a utilização da oxigenoterapia hiperbárica nas úlceras retais secundárias a terapêutica com árgon-plasma ainda não foi descrita. Neste caso, a oxigenoterapia hiperbárica foi uma opção terapêutica eficaz, podendo ser considerada nas úlceras retais refratárias secundárias a terapêutica com árgon-plasma.

Abstract: Chronic radiation proctitis usually develops 3 months after therapy. Despite the lack of standard guidelines regarding treatment, argon plasma coagulation is often a safe and effective endoscopic therapy. However, rectal ulcers are a common complication after argon plasma coagulation. Nevertheless, most patients are asymptomatic and do not require additional monitoring or treatment. We report a case of an argon plasma coagulation-induced ulcer with relevant symptoms and refractory to medical treatment. The patient was treated with hyperbaric oxygen therapy and had complete resolution of the rectal ulcer. Hyperbaric oxygen therapy has shown efficacy in severe chronic proctitis and radiation-induced rectal ulcers, but no clinical report has ever been published on using hyperbaric oxygen therapy for ulcers after argon plasma coagulation. In this case, hyperbaric oxygen therapy was an effective alternative option and can be considered in patients with refractory argon plasma coagulation-induced rectal ulcers.

Resumo Introdução: A síndrome de Grisel é uma entidade rara que corresponde a uma subluxação rotatória atlanto-axial não-traumática, por norma secundária a infeção das vias aéreas superiores ou a cirurgia da cabeça e pescoço. Os pacientes apresentam-se com torcicolo, e um grau de suspeição elevado é necessário para o diagnóstico. Caso clínico: Criança do sexo masculino, 6 anos, admitida por odinofagia, febre e torcicolo. Exame objetivo revelava flexão cervical com rotação para a direita. Tomografia computorizada cervical demonstrava abcesso parafaríngeo e subluxação anterior atlanto-axial de 3 mm, configurando uma subluxação tipo II de Fielding. A criança foi internada para realização de antibioterapia endovenosa, vigilância e imobilização cervical. Discussão: A síndrome de Grisel é um diagnóstico a considerar numa criança com torcicolo e infeção cervical. Os otorrinolaringologistas devem relembrar-se das possíveis apresentações e fatores de risco para esta síndrome. O tratamento conser vador é muitas vezes suficiente, e a identificação precoce com imobilização parecem levar a melhores outcomes.

Abstract Introduction: Grisel syndrome is a rare entity that corresponds to a non-traumatic atlantoaxial rotatory subluxation, usually secondary either to an infection of the upper airway or to a head and neck procedure. Patients usually present with torticollis, and a high index of suspicion is needed for correct diagnosis. Case report: A 6-year-old boy was admitted to the ER with sore throat, fever, and torticollis. Clinical examination revealed neck flexion with rotation to the right. Computed tomography scan revealed a parapharyngeal abscess and an anterior displacement of the atlanto-axial joint of 3 mm, configuring a type II of Fielding. The child was admitted for endovenous antibiotic treatment, surveillance, and cervical immobilization. Discussion: Grisel syndrome may present in a child with torticollis and neck infection. Otorhinolaryngologists should remember the possible presentations and risk factors for this syndrome. Conservative treatment is often enough, and early identification and immobilization seem to lead to better outcomes.

Resumo A situação de multiculturalidade é hoje uma realidade crescentemente vivida nas sociedades de acolhimento de imigrantes, onde emergem cidades que se constituem como lugares de passagem, de encontro ou mestiçagem cultural, mas também de contraste ou antagonismo social. A interculturalidade aparece como utensílio de favorecimento de vinculação à ideia de outro, promovendo, por um lado, a integração e a defesa do direito à diferença, e, por outro, evitando – ou mesmo denunciando – as estruturas de hegemonização sobre minorias. Mas esta diversidade cultural só pode ser protegida, promovida e aceite desde que não coloque em causa os direitos humanos nem provoque exclusões ou desigualdades. É neste campo, difícil e persistentemente aberto ao debate (e não raro promotor de polarizações), que nos propomos a apresentar um conjunto breve de apontamentos que contribua para pensar a mutilação genital feminina na sua indissolúvel condição de violência sobre a mulher, partindo do exemplo da realidade portuguesa actual.

Abstract Multiculturalism is an ever-growing reality in societies with increasing numbers of immigrants, where cities emerge as places of passage, encounter or cultural miscegenation, but also of social contrast or antagonism. Interculturalism appears as a tool for encouraging links with the idea of otherness, promoting integration and upholding the right to difference, while avoiding – or even denouncing – structures of domination over minorities. But this cultural diversity can only be protected, promoted and accepted as long as it does not question human rights or provoke exclusion or inequality. It is in this difficult realm, which is open to constant debate (and that frequently promotes polarizations), that we present brief notes that contribute to considering female genital mutilation in its inextricable condition as violence against women, based on the current Portuguese reality.

The evaluation of swimming technique is one of the main aspects to be considered in any training program, with biomechanics being an important source of knowledge. It was our objective to characterize the biomechanical parameters (SL and SF) relating them to the swimming velocity (v) at different intensities and to analyze within each swimming stroke cycle the intra-cyclic velocity variation (IVV) in a group of motor disabled swimmers. Eight disabled male swimmers (25.83 ± 2.93 years old, 72.45 ± 9.26 kg body mass and 1.79 ± 0.11 m of height) of the following functional classes: S6 (n = 1), S8 (n = 2) and S9 (n = 5) participated in this study. Swimmers were evaluated in the kinematic parameters v, stroke frequency (SF) and stroke length (SL) along with an incremental protocol of 6 x 200 m in the the crawl stroke. Data were registered in each step at the distances of 100 and 175 m. With increasing velocity, the mean values of SL decreased while the mean values of SF increased. To achieve higher swimming velocities, swimmers compensated the lack of the propulsive segment increasing SF to increase swimming speed. For the mean values of IVV at 100m distance, a decrease between the first and second levels, followed by a tendency to stabilize from the 2nd to the 6th level is presented. For the 175 m distance, there was a decrease in IVV with an increase in swimming velocity. Stroke frequency is directly related to the magnitude of IVV, which directly influences swimming performance.

ABSTRACT The objective of this study was to evaluate menthol and eugenol as anesthetics for early juveniles of curimba, Prochilodus lineatus. Juveniles of 4.0±0.5 g and a total length of 8.8±0.1 cm were exposed to the anesthetics menthol (20, 30, 40, 50, 60, 70, and 80 mg L−1) and eugenol (20, 30, 40, 50, 60, and 70 mg L−1) up to deep anesthesia. The anesthetic effects were evaluated measuring the induction time to deep anesthesia (characterized by loss of equilibrium, absence of swimming, reduction of opercular movements, and responses only to intense tactile stimuli), recovery time, time to appetite return, and mortality rate after 96 h of procedure. The concentrations between 60 to 80 mg of menthol L−1 provided the lowest time of induction. Increased concentrations led to a decrease in recuperation time. The concentrations between 50 to 70 mg of eugenol L−1 provided the lowest induction times; however, recovery time was not affected by eugenol concentrations. The return to appetite was observed 24 h after anesthesia, while the survival after 96 h was >90%. Concentrations of 60 and 50 mg L−1 of menthol and eugenol, respectively, are recommended for effective anesthesia with limited side effects.

RESUMO A leucemia linfoblástica aguda é uma neoplasia maligna das células hematopoiéticas, incomum em adultos. Apesar da maioria dos casos apresentar alterações no fundo ocular no decurso da doença, estas são raramente forma de apresentação da mesma. Descreve-se o caso de uma doente com diminuição progressiva e indolor da acuidade visual (OD 2/10 e OE 3/10), que apresentava concomitantemente febre e adenopatias cervicais, com duas semanas de evolução. À oftalmoscopia apresentava descolamento seroso macular bilateral, confirmado por tomografia de coerência ótica. A angiografia fluoresceínica revelou pequenas lesões hiperfluorescentes tipo pinpoints no polo posterior. Nos tempos médios e tardios do exame adivinham-se os limites da bolsa do descolamento do neuroepitélio. As alterações encontradas no hemograma suscitaram um estudo sistêmico extenso. O diagnóstico de leucemia linfoblástica aguda B (CD10+) foi efetuado, iniciando-se, de imediato, quimioterapia sistêmica intensiva. Um ano após o diagnóstico a doente continua em remissão e sem alterações oftalmológicas de novo.

ABSTRACT Acute lymphoblastic leukemia is a malignant hematopoietic neoplasia, which is rare in adults. Although ocular fundus alterations may be commonly observed in the course of the disease, such alterations are rarely the presenting signs of the disease. Here we describe the case of a patient with painless and progressive loss of visual acuity (right eye, 2/10; left eye, 3/10) developing over two weeks, accompanied by fever and cervical lymphadenopathy. Fundus examination showed bilateral macular serous detachment, which was confirmed by optical coherence tomography. Fluorescein angiography revealed hyperfluorescent pinpoints in the posterior poles. The limits of the macular detachment were revealed in the late phase of the angiogram. The results of blood count analysis triggered a thorough, systematic patient examination. The diagnosis of acute lymphoblastic leukemia B (CD10+) was established, and intensive systemic chemotherapy was immediately initiated. One year after the diagnosis, the patient remains in complete remission without any ophthalmologic alterations.

Analisa-se um conjunto de dinâmicas presentes no mercado editorial atual do livro universitário em Portugal. Apesar do atraso português na área da edição universitária, sobretudo por comparação com outros países como o Brasil, têm-se revelado, embora de modo heterogéneo, traços claros de mudança. Um número crescente de editoras universitárias portuguesas demonstra vontade de se vincular de forma efetiva aos canais geradores de conhecimento, dentro e fora das instituições a que pertencem. Esta vaga modernizadora, porém, não parece ainda ter conseguido resolver alguns problemas. Neste cenário, o setor da edição académica e científica em Portugal continua em boa medida a depender, em termos de circulação e visibilidade, de editoras não universitárias, principalmente no campo das ciências sociais e humanas.

This article explores recent dynamics within the Portuguese university book market. The activity of the university presses in Portugal, despite lagging a decade and a half behind countries such as Brazil regarding a similar set of transformations, clearly depicts ongoing changes, albeit in a heterogeneous fashion. On the other hand, a growing number of Portuguese university presses demonstrate a commitment towards knowledge generating channels, inside and outside their institutions. Nevertheless, such a modernizing wave has not been the solution to all the problems the university presses have to face. Given this set of circumstances, the scientific and scholarly publishing sector still relies heavily for visibility and circulatory purposes on privately-owned non-university presses, particularly in the field of the social sciences and humanities.