Abstract Introduction: The reorganization of health care imposed by the COVID-19 pandemic revealed the work capacity of all health professionals, mirroring the fundamental role of In-ternal Medicine. This work intended to highlight the complexity of managing the COVID-19 patient, often guided by the absence of theoretical/scientific support in the face of the unknown. Methods: A retrospective and descriptive evaluation of all patients with SARS-COV2 infection admitted to a ward of the Internal Medicine service, Unidade Local de Saúde de Viseu Dão-Lafões (ULS Viseu Dão-Lafões), in the period between January-April and July-November 2021 (pandemic peaks of 2021). Results: During the nine months under study, 394 patients were evaluated, with a predominance of males 56.60% (n = 223) and an average age of 70.42 years. The average length of stay was 13.95 days. Most had at least one cardiovascular risk factor, and only 29.44% (n = 116) were vaccinated against COVID-19. Of the therapy, 84.26% (n=332) received dexamethasone, 85.79% (n =3 38) needed supplemental oxygen therapy; approximately 22.08% (n = 87) required non-invasive mechanical ventilation, and 7.61% (n = 30) underwent invasive mechanical ventilation/high-flow oxygen therapy. There were 23.86% (N = 94) dea-ths. COVID-19 infection was the primary diagnosis in most patients, but many were secondary diagnoses. Conclusion: The severity and complexity of an unknown nosological disease, in the pandemic phase, is of enormous professional and personal demand, as represented by the characterization of this sample. The spectrum of critically ill patients in need of mechanical ventilatory support stands out, in an admissions curve that turned out to be exponential.

Resumo Introdução: A reorganização dos cuidados de saúde imposta pela pandemia COVID-19 relevou a capacidade de trabalho de todos os profissionais de saúde, espelhando o papel basilar da Medicina Interna. Este trabalho pretende evidenciar a complexidade da gestão do doente COVID-19, pautada muitas vezes pela ausência de suporte teórico/científico face ao desconhecido. Métodos: Avaliação retrospetiva e descritiva de todos os doentes com infeção SARS-CoV-2 internados numa enfermaria do serviço de Medicina Interna, da Unidade Local de Saúde de Viseu Dão-Lafões (ULS Viseu Dão-Lafões), no período compreendido entre janeiro-abril e julho-novembro de 2021 (picos pandémicos de 2021). Resultados: Durante os 9 meses em estudo, foram avaliados 394 doentes, com predomínio do género masculino 56,60% (n = 223) e uma idade média de 70,42 anos. O tempo médio de internamento foi de 13,95 dias. A maioria apresentava pelo menos um fator de risco cardiovascular e apenas 29,44% (n = 116) eram vacinados contra a COVID-19. Quanto à terapêutica, 84,26% (n = 332) realizaram dexametasona e 85,79% (n = 338) necessitaram de oxigenoterapia suplementar; cerca de 22,08% (n = 87) necessitaram de ventilação mecânica não invasiva e 7,61% (n = 30) de ventilação mecânica invasiva. Registaram-se 23,86% (n = 94) óbitos. A infeção SARS-CoV-2 foi o diagnóstico principal na maioria dos doentes, mas muitos foram os diagnósticos secundários. Conclusão: A gravidade e complexidade de uma entidade nosológica totalmente desconhecida num contexto pandémico é de uma enorme exigência profissional e pessoal, como representado através da caracterização desta amostra. Salienta-se o espetro de doentes graves e com necessidade de suporte ventilatório mecânico, numa curva de admissões que se revelou exponencial.

Introdução: Gliomas são os tumores primários mais comuns do sistema nervoso central e a maioria é formada por glioblastomas, com graus elevados de proliferação e invasão, com heterogeneidade biológica e pouca resposta aos tratamentos atuais. Imunoterapia e geneterapia não têm mostrado eficácia e, por isso, é necessário buscar conhecimento de novas moléculas e genes envolvidos na sua carcinogênese. Objetivos: Avaliar se o receptor do ácido gama-aminobutírico alfa 5 (GABRA5) é potencial alvo terapêutico ou biomarcador para gliomas de diferentes subgrupos, e a correlação entre os níveis de ácido ribonucleico mensageiro (mRNA) de GABRA5 com a sobrevida global. Métodos: Revisão integrativa feita em plataformas virtuais, em português e inglês, realizada por descritores relacionados ao tema, descritos no DeCS como “glioma, sistema nervoso central, glioblastoma” com busca AND ou OR, considerando-se inicialmente o título e/ou resumo. Após, naqueles que tinham maior relação ao tema, foi realizada a leitura na íntegra dos textos. Resultados: Foram incluídos 36 artigos. Conclusão: Os níveis de mRNA de GABRA5 em amostras de gliomas de todos os subgrupos histológicos são menores, em comparação ao controle. Não foi observada correlação entre os níveis de mRNA de GABRA5 com a sobrevida global dos subgrupos avaliados.

Introduction: Gliomas are the most common primary tumors of the central nervous system. The majority are formed by glioblastomas, with high degrees of proliferation and invasion, with biological heterogeneity and little response to current treatments. Immunotherapy and genetherapy have not shown efficacy and, therefore, it is necessary to seek knowledge of new molecules and genes involved in their carcinogenesis. Objectives: To evaluate whether the alpha 5 gamma-aminobutyric acid receptor (GABRA5) is a potential therapeutic target or biomarker for gliomas of different subgroups, and the correlation between GABRA5 messenger ribonucleic acid (mRNA) levels and overall survival. Methods: Integrative review carried out on virtual platforms in Portuguese and English, carried out using descriptors related to the topic, described in DeCS as “glioma, central nervous system, glioblastoma, GABA, GABRA5” with AND or OR search, initially considering the title and/or summary. Afterwards, in those that were most related to the topic, the texts were read in full. Results: 36 articles were included. Conclusion: GABRA5 mRNA levels in glioma samples from all histological subgroups are lower compared to control. No correlation was observed between GABRA5 mRNA levels and overall survival in the evaluated subgroups.

The Latin Grammaticography in Brazil is one of the subjects of interest in the discipline of Historiography of Linguistics (HL) within our national context. In our text, we discuss theoretical and methodological aspects regarding the construction of a historiographical narrative on the history of Latin grammar in Brazil, following the "koernian" model developed by Konrad Koerner (2014) and Pierre Swiggers (2013; 2019). As an exemplary model for a (meta)historiographical narrative of the history of Latin grammar in Brazil, we also have the recent publication by Ricardo Cavaliere (UFF/ABL) on the history of grammar in Brazil (CAVALIERE, 2022), which can serve as a model for applying the "koernian" historiography for an analysis of our specific context. The topic of the history of Latin grammar in Brazil was approached in a pioneering way by the Latinist and philologist Ernesto Faria (1906-1962) in two of his main works: Gramática Superior da Língua Latina (FARIA, 1958) and Introdução à Didática do Latim (FARIA, 1959).

A Gramaticografia latina no Brasil é um dos temas de interesse da disciplina de Historiografia da Linguística (HL), em nosso contexto nacional. Em nosso texto, debateremos aspectos teórico-metodológicos, acerca da constituição de uma narrativa historiográfica sobre a história da gramática latina no Brasil, pelo modelo “koerniano”, desenvolvido por Konrad Koerner (2014) e Pierre Swiggers (2013; 2019). Como modelo exemplar, para uma narrativa (meta)historiográfica da história da gramática latina no Brasil, temos também a recente publicação de Ricardo Cavaliere (UFF/ABL), sobre a história da gramática no Brasil (CAVALIERE, 2022), que pode nos servir de modelo à aplicação da historiografia “koerniana”, para uma análise de nosso contexto específico. O tema da história da gramática latina no Brasil foi abordado de forma precursora pelo latinista e filólogo Ernesto Faria (1906-1962), em duas de suas principais obras: a Gramática Superior da Língua Latina (FARIA, 1958) e Introdução à didática do Latim (FARIA, 1959).

Juvenile hormone (JH III) is an important example of a chemical signaling derived from the terpene biosynthetic pathway. Because of its impact on many species’ reproductive and developmental processes, analytical approaches must be developed to accurately identify and measure it in biological samples. In this technical note, we explored the gas-phase dissociative behavior of JH III using tandem mass spectrometry combined with electrospray ionization to provide diagnostic fragment-ions for quantitative purposes.

ABSTRACT Wild birds have great prominence in the transmission of diseases to humans, mainly due to their ease of access to human populations, raising concerns about the potential impact of that proximity on public health. The present study reports ARV and PBV occurrence in wild birds from an environmental protection area in the Amazon biome, in Pará state, Brazil. We obtained 155 fecal specimens from 47 species of wild birds for RNA extraction, ARV and PBV detection utilizing molecular methods, nucleotide sequencing, and phylogenetic analysis. ARV prevalence was 0.6% (1/155), being positive in an individual of Myrmotherula longipennis, and PBV prevalence was 1.29% (2/155), affecting two individuals of Guira guira. The PBV strains were assigned to genogroup I based on phylogenetic analysis, and they shared a strong phylogenetic link with strains isolated from different geographic locations. The ARV strain was more closely related to strains that had previously circulated in the same region. The presence of ARV and PBV in this habitat suggests that infection cycles of these agents occur naturally in the wild ecosystem, potentially triggering transmission events between bird species and humans. This is the first study on ARV detection in wild birds in Brazil and the first report on the occurrence of PBV in wild Guira guira. Additional studies are required to determine the epidemiology, origin, evolution, and emergence of new potentially pathogenic viruses in the Amazon.

RESUMO As aves silvestres têm grande destaque na transmissão de doenças ao homem, principalmente pela facilidade de acesso à população humana, levantando preocupações sobre o potencial impacto dessa proximidade no contexto da saúde pública. O presente estudo relata a ocorrência de ARV e PBV em aves silvestres de uma área de proteção ambiental no bioma Amazônico. Obtivemos 155 espécimes fecais de 47 espécies de aves silvestres, que foram submetidos a extração de RNA, detecção de ARV e PBV por técnicas moleculares, sequenciamento nucleotídico e análise filogenética. A prevalência de infecção por ARV foi 0,6% (1/155), sendo positivo em um indivíduo de Myrmotherula longipennis, e a prevalência de PBV foi 1,29% (2/155), afetando dois insdivíduos de Guira guira. A análise filogenética agrupou as cepas de PBV no genogrupo I, mostrando intensa relação filogenética com cepas isoladas de outras regiões geográficas. A cepa de ARV esteve mais relacionada filogeneticamente a cepas previamente circulantes na mesma região. Este é o primeiro estudo sobre detecção de ARV em aves silvestres no Brasil e o primeiro relato sobre a ocorrência de PBV em Guira guira. A circulação de ARV e PBV nesse ambiente demonstra que os ciclos desses agentes estão ocorrendo de forma natural no ecossistema silvestre, o que pode desencadear possíveis eventos de transmissão entre as espécies aviárias e humanos. Estudos adicionais são necessários para determinar a epidemiologia, origem, evolução e surgimento de novos vírus potencialmente patogênicos na Amazônia.

ABSTRACT The method of applying fertiliser to the soil affects grain productivity. The aim of this study was to determine the dynamics of phosphorus, potassium and sulphur in the arable layer of the soil during the third year of agricultural production, as a function of the method of application. The study took place in the district of Diamantino, Mato Grosso, in an area of soybean-maize succession under minimum tillage. Five treatments were tested in a randomised block design: no phosphorus or potassium (P0-K0); broadcast phosphorus and in-furrow potassium (Pb-Kf); in-furrow phosphorus and potassium (Pf-Kf); in-furrow phosphorus and broadcast potassium (Pf-Kb); broadcast phosphorus and potassium (Pb-Kb). When the soybeans reached physiological maturity, soil samples were collected from the 0-0.05, 0.05-0.10, 0.10-0.15 and 0.15-0.20 m layers for analysis of the pH, and P, K, S and organic matter content. The soil attributes were submitted to analysis of variance and Tukey’s test at 5%, and the nutrient dynamics in the soil profile were analysed by regression. The in-furrow application of phosphorus (Pf-Kb and Pf-Kf) improved P availability in the 0-0.05 m layer by 69.12% and 46.54% compared to the Pb-Kb treatment, by 73.93% and 50.71% compared to the Pb-Kf treatment, and by 136.77% and 105.16% compared to the P0-K0 treatment. The in-furrow application of phosphate fertiliser proved to be more effective in terms of phosphorus availability in the soil. The residual effect of broadcasting phosphate fertiliser on phosphorus availability in the soil can be seen from the third year of production onwards.

Abstract The use of computational simulation techniques is an important tool for the coffee harvesting issues, particularly the finite element method. The method is widely used in the structural analysis of agricultural machinery, as well as in the analysis of the stresses and vibrations of coffee branches and peduncles during the harvesting process. The present study aimed to develop three-dimensional finite element models of the plagiotropic branches of the Catuaí Vermelho variety of Arabica coffee in different positions along the orthotropic branches of the plant; considering high-fidelity models. Additionally, by considering the branches’ experimental properties (physical-mechanical), the natural frequencies and vibration modes of the branches were determined by means of computer simulations. First, the geometric properties of the coffee branches were obtained by means of two images taken using a professional camera to obtain the input data of the virtual simulation. For the mechanical properties, it was used a semi-analytical digital scale, to obtain the mass of the specimens. The modulus of elasticity was determined using a universal testing machine. The variability in the simulated natural frequencies could be identified, which was on the order of 30% for the first frequency, regardless of the position of the branch in the plant. These values were lower for the other frequencies. Linear regression fits showed a coefficient of determination, and correlation tests were used to verify the relationship between the values obtained numerically and experimentally, which were validated by using experimental data using the modal analysis techniques.

Abstract We quilombola women, a documentary that considers the quilombola identity and the right to COVID-19 vaccination, evokes notions of priority, rights, privileges and identity during the process of matching the number of vaccine doses available to citizens’ arms. Omission by a Brazilian federal government grounded in necro-politics and denial, plus a lack of information, led quilombo communities to take it on themselves to draw up lists of those eligible for vaccination. The production team’s aim was to use images as political language in the health field, so as to document and give visibility to these issues as one illustration of combating social and health inequalities and inequities rooted in structural racism. By combining science and art and interlacing references from the sociology of images, visual anthropology, plus the work and aesthetic devices of Eduardo Coutinho, the audiovisual production method brought out three key categories: I, We, and They, quilombola women. This article explores these categories underpinning construction of the documentary narrative, which drew on the potential of images, which in turn served as anti-racist, political and educational devices, both in the course of the production process and during the public screenings.

Resumo Eu, nós... ELAS quilombolas, documentário que aborda a identidade quilombola e o direito à vacinação contra a COVID-19, faz emergir noções como prioridade, direito, privilégio e identidade durante o processo que precisa vincular os números de doses a braços de cidadãos. No Brasil, diante da omissão do governo federal, fundamentada na necropolítica e no negacionismo, a falta de informações levou as comunidades quilombolas a se responsabilizarem pela construção das listas de aptos a receberem a vacina. O objetivo da produção foi utilizar as imagens como linguagem política na área da saúde, documentando e dando visibilidade para essas questões, como ilustração de processos de enfrentamento das desigualdades e iniquidades sociais e de saúde pautadas no racismo estrutural. Ao associar ciência e arte, o método de produção audiovisual, entrelaçado com os referenciais da sociologia das imagens, da antropologia visual e dos dispositivos de produção e estética de Coutinho, emergiram três categorias: o eu, o nós e o elas. Este artigo apresenta as categorias que embasaram a construção narrativa do documentário a partir das potencialidades das imagens, que se apresentaram como dispositivo político-pedagógico antirracista, tanto durante o processo de produção quanto ao longo das exibições públicas.

ABSTRACT Objective: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. Methods: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91–95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). Results: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. Conclusions: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

RESUMO Objetivo: Descrever o impacto do projeto Coala (Controle Ativo de Oxigênio Alvo) nos desfechos clínicos em pacientes nascidos com menos de 36 semanas de gestação, em duas maternidades, comparando antes e depois da implementação da estratégia. Métodos: Trata-se de um estudo de intervenção com cem prematuros vivos, com idade gestacional ≤36 semanas, que utilizaram oxigênio em duas maternidades entre janeiro de 2020 e agosto de 2021. A meta para a saturação de oxigênio alvo com este projeto foi de 91–95%. Comparações entre as duas etapas (antes e depois da implantação do projeto) foram feitas avaliando os desfechos de retinopatia da prematuridade, displasia broncopulmonar, enterocolite necrosante e óbitos. As variáveis contínuas foram descritas por meio de média, mediana, desvio padrão e intervalo interquartil. O nível de significância adotado foi de 5% e o software empregado foi o R Core Team 2021 (versão 4.1.0). Resultados: Observou-se que, após o uso de controle de oxigênio segundo o protocolo Coala, houve redução significativa nos casos de retinopatia da prematuridade (p<0,001) e displasia broncopulmonar (p<0,001). Não houve óbitos na segunda etapa e houve aumento não significativo no número absoluto de casos de enterocolite necrosante. Conclusões: O projeto Coala parece ser uma estratégia eficaz e viável para reduzir situações adversas no manejo de crianças prematuras, mas pesquisas com amostras maiores são necessárias.

ABSTRACT Antiphospholipid syndrome is an acquired autoimmune disease characterized by hypercoagulability associated with recurrent venous and arterial thromboembolism in the presence of antiphospholipid antibodies. Herein, we report a case of rapid sequential retinal vein and artery occlusion as the first manifestation of a primary antiphospholipid syndrome triggered by an acute Mycoplasma infection in a previously healthy 11-year-old patient. On day 1, ophthalmoscopy revealed a central retinal vein occlusion. The patient developed temporal branch retinal artery occlusion the next day. On day 3, a central retinal artery occlusion was observed. Serum lupus anticoagulant, immunoglobulin (Ig) G anticardiolipin, IgG anti-β2-glycoprotein 1 antibody, and Mycoplasma pneumoniae IgM antibody levels were increased. Thus, retinal vascular occlusions can be the first manifestation of primary antiphospholipid syndrome. Although it may not improve visual prognosis, prompt diagnosis and treatment are essential to avoid further significant morbidity.

RESUMO A síndrome antifosfolipide é uma doença autoimune adquirida caracterizada por hipercoagulabilidade associada a tromboembolismo venoso e arterial recorrente na presença de anticorpos antifosfolipídicos. Aqui, relatamos um caso clínico de oclusão sequencial de veia e artéria da retina como primeira manifestação de uma síndrome antifosfolipíde primária desencadeada por uma infeção aguda por Mycoplasma num paciente de 11 anos previamente saudável. No primeiro dia, a oftalmoscopia revelou uma oclusão da veia central da retina. No dia seguinte, o paciente desenvolveu uma oclusão do ramo temporal da artéria central da retina. No terceiro dia, uma oclusão da artéria central da retina foi diagnosticada. Os níveis de anticoagulante lúpico sérico, anticorpos IgG anticardiolipina e IgG anti-β2-glicoproteína 1 e anticorpos IgM para Mycoplasma pneumoniae estavam aumentados. As oclusões vasculares retinianas podem ser a primeira manifestação da síndrome antifosfolipíde primária. Apesar do prognóstico visual ser reservado, o seu diagnóstico e o tratamento imediatos são essenciais para evitar outras morbilidades associadas.

ABSTRACT Harvest delay can alter the physiological and sanitary quality of sorghum seeds due to the longer exposure time of seeds to adverse environmental conditions in the field. In this study, we investigated the impact of delayed Sorghum sp. harvest on the physiological and sanitary quality of seeds in four hybrids grown in the tropical soil of the Brazilian Cerrado region. Plants from four Sorghum sp. hybrids (IPA SUDAN 4202, BRS 658, BRS 810, and BRS 373) were grown and submitted to four seed harvest periods (0, 7, 14, and 21 days after stage 9 - seed physiological maturity). The treatments were arranged in a completely randomized block design in a 4 × 4 factorial, with four replicates. At each harvest period, the thousand-seed weight, water content, first count of the germination test, germination, seedling emergence, emergence speed index, seedling dry matter, accelerated aging, electrical conductivity, and sanitary quality of seeds were determined. Seeds of higher physiological and sanitary quality of the IPA SUDAN 4202 and BRS 658 sorghum hybrids can be obtained when the harvest is carried out up to 7 days after the physiological maturity stage. However, the delay in seed harvesting at 14 and 21 days after physiological maturity results in a higher incidence of Colletotrichum sp., Curvularia sp., Rhizoctonia sp., and Alternaria sp. on the seeds of these hybrids. Delaying the harvest of sorghum seeds from 7 days after the physiological maturity stage compromises seed vigor and viability and increases the incidence of pathogens.

ABSTRACT The coffee sector is estimated to have a retail market value in excess of USD 83 billion, and over 125 million jobs have been created in the global coffee chain. The coffee specialty market has recently increased significantly, generating opportunities to certify coffee beans produced by sustainable practices. This avoids practices potentially harmful to the environment. Agroforestry, organic farming, intercropping, and soil conservation strategies are examples of sustainable alternatives in the production of coffee. In this review, we focus on practices for the sustainable management of coffee plantations that can help farmers fight problems caused by global warming. More specifically, we address soil organic matter and microbiota, the use of Urochloa grass as intercrop in coffee plantations, shading systems (including agroforestry), and organic coffee production. We concluded that from the agronomic viewpoint, we already have production techniques that can replace traditional ones with significant advantages accruing to the quality of coffee orchard ecosystems. Nevertheless, we need scientific research efforts to deal with the existing gaps and the engagement of the whole coffee chain as a means of guaranteeing an adequate profit to those smallholders who adopt and maintain sustainable practice and are capable of bringing several positive changes to the coffee crop, including the use of microbia-based commercial products and new organic sources of nutrients to complement chemical fertilizers and improve coffee quality.

Resumo Avaliou-se a puericultura na ESF em município-sede de macrorregião de saúde do Nordeste brasileiro. Realizou-se estudo avaliativo com dois níveis de análise: a gestão municipal e local. Aprofundou-se a avaliação local em quatro EqSF mediante entrevistas com gestores, profissionais e puérperas, análise documental e observação não-participante. As fontes de dados foram trianguladas e processadas no software Nvivo, e o material empírico cotejado com uma situação-objetivo segundo os níveis de análise da pesquisa e elaborada pelos pesquisadores. No nível municipal, a definição clara de atribuições para os pontos de atenção em puericultura e fluxos assistenciais foi um dos critérios mais críticos e, no âmbito local, a integração de ações com outros serviços primários, a contrarreferência e ações educativas coletivas no território. A implementação das práticas de puericultura nas EqSF é fortemente dependente dos determinantes político-organizacionais entre o âmbito municipal e local, e os resultados aqui evidenciados podem se aplicar a outros sistemas municipais de saúde com configurações semelhantes. Este estudo contribuiu para a avaliação da puericultura sustentada na proposição de critérios que consideraram a interdependência municipal e local na organização das ações de avaliação do crescimento e desenvolvimento infantil.

Abstract Childcare was evaluated in the ESF in a municipality that is the headquarters of a health macro-region in the Brazilian Northeast. An evaluative study was carried out with two levels of analysis: municipal and local management. The local assessment was deepened in four EqSF through interviews with managers, professionals and postpartum women, document analysis and non-participant observation. The data sources were triangulated and processed in the Nvivo software, and the empirical material was compared with an objective situation according to the research analysis levels and prepared by the researchers. At the municipal level, the clear definition of assignments for childcare care points and assistance flows was one of the most critical criteria and, at the local level, the integration of actions with other primary services, counter-referral and collective educational actions in the territory. The implementation of childcare practices in EqSF is strongly dependent on political-organizational determinants between the municipal and local levels, and the results shown here may apply to other municipal health systems with similar configurations. This study contributed to the evaluation of childcare based on the proposition of criteria that considered municipal and local interdependence in the organization of actions to evaluate child growth and development.

Abstract Introduction: Even though pneumomediastinum cases are t frequent, it has been described as a non-negligible complication in patients with SARS-CoV-2 infection. According to the available literature at this moment, development of pneumomediastinum in patients with SARS-CoV-2 infection does not seem to be related to the classic mechanism of pulmonary barotrauma. This work aims to raise awareness of this nosological entity and its pathophysiology. Methods: The authors conducted a retrospective study of all COVID-19 cases with pneumomediastinum between January and February 2021 in an Internal Medicine ward at a Central Hospital - analysis of their comorbidities, disease evolution, complications, and a review of the available literature. Results: From 400 patients admitted with COVID-19, in 2 months under study, 4 developed pneumomediastinum: all male, aged between 68 and 81 years, with various comorbidities, mainly cardiovascular. All were subjected to non-invasive mechanical ventilation, with three of them additionally subjected to invasive mechanical ventilation. They evolved unfavorably and ended up dying. Conclusion: Pneumomediastinum, as a complication of SARS-CoV-2 infection, proved to be very serious, with a negative outcome in all the identified patients. It is important to be aware of predisposing factors, for early diagnosis and timely intervention.

Resumo Introdução: Apesar de raro, o pneumomediastino tem sido descrito como uma complicação não desprezível nos doentes com infeção SARS-CoV-2, o que, segundo a literatura, não parece estar relacionado com o mecanismo clássico de barotrauma pulmonar. Pretende-se, com este trabalho, alertar para esta entidade nosológica e potencial fisiopatologia, através da descrição de casos de pneumomediastino em doentes com COVID-19 e revisão dos dados disponíveis até ao momento atual. Métodos: Análise retrospetiva e descritiva dos casos de pneumomediastino ocorridos em doentes com COVID-19, entre janeiro e fevereiro de 2021, no serviço de Medicina Interna, de um hospital central - avaliação epidemiológica e das comorbilidades de cada doente, evolução da doença, complicações e revisão da literatura disponível até ao momento. Resultados: Dos 400 doentes admitidos com COVID-19 ao longo dos 2 meses em estudo, 4 desenvolveram pneumomediastino: todos do género masculino, idade entre os 68 e 81 anos, com várias comorbilidades, predominantemente cardiovasculares. Todos foram submetidos a ventilação mecânica não invasiva, sendo que três deles foram adicionalmente sujeitos a ventilação mecânica invasiva. Evoluíram desfavoravelmente, acabando por falecer. Conclusão: O pneumomediastino, como complicação da infeção SARS-CoV-2, revelou-se de grande gravidade, com desfecho negativo em todos os doentes identificados, importando estar atento aos fatores predisponentes, para um diagnóstico precoce e uma atuação atempada.

Abstract Many capital cities are expanding bicycle lanes or investing in public bike-sharing systems to make cycling mobility a viable transport solution within urban areas. While bicycles are fit for short-distance trips (<15 minutes), their attractiveness declines for longer trips (Ton et al., 2020; Handy et al., 2014; Jäppinen et al., 2013). So, it is opportune to estimate to what extent the accessibility can be increased when intermodal solutions are available. In this paper, a quantitative analysis of different mobility scenarios is conducted. The aim is to evaluate how time travel and accessibility to amenities by bike, can be improved if public transportation such, as the train, is considered. The analysis uses open data and detailed GIS-based network analysis to examine the spatial relationship between transport opportunities, travel time and amenities access in Lisbon, Portugal. Three mobility scenarios are considered: in the first scenario, short-distance trips by bike from home are evaluated (15- minute travel). Then, to evaluate the contribution in time travel of potential modal shift (bike and train) vs individual car, second and third scenarios are presented considering longer distance travels within the city of Lisbon, during peak hours. Results suggest that for longer trips, the combined use of bicycle and train infrastructure can be a faster or more convenient alternative to individual car use. Also, multimodal cycling can expand riders’ area of influence and thus increase the accessibility to opportunities. So, people living near train stations can beneficiate from a “potential” proximity to a diversity of amenities that are geographically more distant. In Lisbon, 34% of the population live within the 10-minute bicycle catchment areas around the 8 train stations from Cintura Line and can thus benefit from this combination of transport modes. City planners can use this methodology to prioritize spaces where investing in accessibility can have the largest impact in terms of improving connections between homes and destinations. This methodology, developed and tested in Lisbon, can be applied in other cities to support planning interventions regarding sustainable transport alternatives.