Our intention in editing the "Revista de Medicina" is to support students' scientific production and stimulate the reading of scientific articles. Undoubtedly, medical practice requires constant updating and the unquestionable need to read scientific articles. Therefore, it is important to get used to this since Graduation.
Universidade de São Paulo. Faculdade de Medicina
Vertical mastopexy for treatment of tuberous breast: case report and literature review
Introduction: Tuberous breasts are aberrant breast shapes. Surgical management of tuberous breast deformities is a challenge for plastic surgeons. Due to the aesthetic implications, it is important for the surgeon to be able to identify them in order to provide appropriate patient management. Case Report: A twenty-year-old healthy patient sought outpatient plastic surgery due to breast asymmetry and bilateral areolar dilation, presenting a clinical picture compatible with type 1 tuberous breast deformity. She underwent vertical mastopexy, associated with bilateral breast implantation with a prosthesis, to correct the tuberous breast deformity. Method: Case information was obtained through anamnesis and medical records. The patient signed an informed consent form and rigorous research into the Helsinki principles was performed. Results: Correction of tuberous breasts involves several technical factors and individuals to be considered; several surgical techniques have been described. Vertical mastopexy, associated with breast implantation, may be effective for the correction of constricted breasts. Conclusions: The treatment of choice for tuberous breasts is based on individual assessment. The vertical mastopexy described in this study is an alternative for the treatment of constricted breasts.
Copyright (c) 2026 Igor Fagundes Sartori, Maria Eduarda Tomasetto, Renan Mathias Ferreira Saltiél, Bruno Luiz do Amaral, Eduardo Madalosso Zanin, Luís Gustavo Raupp https://creativecommons.org/licenses/by-sa/4.0
Invasive fungal rhinosinusitis due to mucormycosis associated with the abuse of corticosteroids: case report
INTRODUCTION Mucormycosis is a rare invasive disease caused by fungi of the order Mucorales, with the genus Rhizopus spp being the most common [1]. It is predominantly found in immunosuppressed patients, such as those with diabetes mellitus [2]. The infection has two main forms: the rhino-orbito-cerebral form, which is more prevalent and leads to ocular inflammation, facial pain and even brain involvement; and the pulmonary form, which is less common [2]. It is noted that hyperglycemia provides an environment for the proliferation of fungi, while compromising the immune system, making the patient more susceptible to infection [3]. Finally, it can be mentioned that the abuse of corticosteroids aggravates this scenario by causing both immunosuppression and increased blood glucose levels. OBJECTIVES Primary: To evaluate the negative effect of the abusive use of corticosteroids on the worsening of the clinical picture of mucormycosis. Secondary: To report a case of an uncommon infection by a species of fungus in an immunosuppressed patient.
Copyright (c) 2025 João Ricardo Ramos Rosa, Carolline Siqueira Lembo, Isabella Marques da Silva, Júlia Rodrigues da Silva https://creativecommons.org/licenses/by-sa/4.0
It argues that confronting racism should guide clinical practice, research, and medical education as a quality criterion. It articulates a critical analysis of historical references, institutional documents, and epidemiological indicators on maternal mortality, infant mortality, homicides, hypertension, COVID-19, and mental suffering among Black people in Brazil. It showed that structural and institutional racism produces persistent inequities, distorts health records, restricts access to care, and undermines public policy implementation. The findings remained consistent with previous investigations by reaffirming racism as a social determinant of health and a barrier to equity in the Brazilian Unified Health System. It discusses that antiracist initiatives in teaching, extension, and research, including Race.ID, AfirmaSUS, and AquilombaSUS, offer concrete responses to improve Brazilian medicine and confront racially produced inequalities.
Copyright (c) 2026 Catarina Daniel da Cruz, Rogério Binow Schmidt Andrade, Joyce Cristina Araujo Silva, Júlio César de Oliveira, Ana Claudia Camargo Gonçalves Germani, Bruno Eduardo de Menezes Pequeno, Patricia Lima Ferreira Santa Rosa, Rondinelli Salvador Silva https://creativecommons.org/licenses/by-sa/4.0
Type 2 Diabetes Mellitus: a critical approach between pathophysioloy, lifestyle, and socioeconomic determinants
Type 2 Diabetes Mellitus (T2DM) is characterized as a metabolic disorder marked by hyperglycemia resulting from insulin resistance, which may or may not be accompanied by a relative deficiency of this hormone. In this context, the present study aims to analyze, through a literature review, the main risk factors associated with T2DM, as well as the influence of dietary habits and physical activity on the prevention and management of the disease. This study consists of a descriptive literature review conducted through searches in the SciELO, PubMed, and Google Scholar databases. Studies addressing Type 2 Diabetes Mellitus, pathophysiology, dietary habits, physical activity, and metabolic syndrome were included. Scientific articles published in Portuguese and English, as well as institutional documents and legislation relevant to the topic, were considered. Priority was given to recent studies; however, earlier publications recognized as important references for understanding the pathophysiology of T2DM were also incorporated due to the enduring scientific relevance of their concepts. A total of 67 studies were identified, of which 18 met the inclusion criteria related to thematic relevance and updated information. The analyzed studies demonstrated that conditions such as obesity, particularly visceral fat accumulation, physical inactivity, unhealthy eating patterns, and metabolic syndrome are directly associated with the onset and progression of T2DM. Furthermore, unfavorable socioeconomic conditions and limited access to healthcare services were found to negatively affect glycemic control among patients. Conversely, the adoption of healthy lifestyle habits, including balanced nutrition and regular physical activity, combined with the implementation of health promotion policies, contributes significantly to disease prevention and management. Therefore, it is concluded that the integration of healthy lifestyle practices, multidisciplinary follow-up, and strengthened public health policies is essential for reducing the incidence of T2DM and improving the quality of life of individuals affected by the disease.
Copyright (c) 2026 Maria Eduarda Rocha Mesquita, Larissa Silva Barbosa, Milena Ramos Silva, Talitha Araújo Velôso Faria https://creativecommons.org/licenses/by-sa/4.0
From curriculum to care: Libras workload and the readiness for inclusive Primary Health Care
Primary Health Care (PHC) is recognized as the main point of entry for users into Brazil’s Unified Health System (SUS). Therefore, professionals working at this level must be prepared to care for the entire population, including deaf individuals. To fully uphold SUS principles such as universality, humanization, comprehensiveness, and equity, medical training must include the Brazilian Sign Language (Libras) in its curriculum. The 2014 Medical National Curriculum Guidelines recommend Libras as mandatory content, but its implementation still requires evaluation. The objective was to examine the workload dedicated to Libras in medical schools in São Paulo. This was a descriptive, cross-sectional study exempt from ethics approval because it used public data. Seventy-five medical schools (MS) were identified through the e-MEC system; available pedagogical documents were analyzed for references to Libras and workload. Of the 66 MS included in the study, 41 mentioned Libras instruction, and 33 provided workload information. A wide variation was observed, from 27 to 80 hours, with a mean of 44.75 hours and a median/mode of 40 hours. Even in institutions where Libras is mandatory, there was no standardized workload. Libras instruction remains limited and heterogeneous, lacking standardization and showing documentation gaps, reflecting the absence of detailed guidelines.
Copyright (c) 2026 Sheyla Ribeiro Rocha, Claudia Aparecida Stefane, Bianca Caseiro Chiuratto https://creativecommons.org/licenses/by-sa/4.0
Reversible cerebral vasoconstriction syndrome: a case report
This study aimed to report the case of a patient who presented with a thunderclap headache associated with neurologic manifestations and was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). This is a clinical case report based on access to the patient's medical record, prescriptions, and imaging examinations provided by the patient, as well as an interview. An adult male patient receiving escitalopram and bupropion sought emergency care after a sudden episode of severe headache, followed by right-sided hemiparesis, confusion, language disturbances, nausea, and vomiting. A second episode occurred two days later. In both episodes, history taking, laboratory tests, and imaging studies were performed. The initial therapeutic approach targeted migraine. Ten days after the first episode, magnetic resonance angiography showed that the middle cerebral arteries had returned to normal caliber, after previously demonstrating irregular contours and areas of narrowing. Early recognition and identification of the triggering medication were essential for effective treatment and rapid clinical resolution. This case underscores the importance of a careful differential diagnosis in sudden-onset headache.
Reversible cerebral vasoconstriction syndrome
Copyright (c) 2026 Daiane Marcelino de Barros, Gabriel Henrique Leite Ribeiro, Árlen Almeida Duarte de Sousa https://creativecommons.org/licenses/by-sa/4.0
Adherence to the World Health Organization Surgical safety checklist in a large public hospital in Recife, PE, Brazil
ABSTRACT: Objective: To assess adherence to the World Health Organization (WHO) Surgical Safety Checklist in surgical procedures performed at a large public hospital in Recife, PE, Brazil. Methods: Observational, cross-sectional, documentary study with in-person data collection through direct observation of 20 elective medium- and large-sized surgical procedures from different specialties. Data were recorded in a structured form based on the three stages of the WHO checklist: before anesthetic induction, before skin incision, and before the patient left the operating room. Results: In the first stage, confirmation of patient identity, surgical site, procedure, and consent occurred in 35% of procedures, with overall adherence of 45%. In the second stage, formal introduction of the surgical team was observed in 5% of cases, and verbal confirmation of patient identity, surgical site, and procedure in 10%, with overall adherence of 15%. In the third stage, no verbal confirmation of the complete intraoperative record was observed, and communication regarding postoperative care and challenges occurred in 5% of cases, with approximately 10% adherence. Overall adherence to the checklist was 25%. Conclusion: Adherence to the WHO Surgical Safety Checklist was low in the service evaluated, particularly in stages involving team communication and final procedural review, highlighting the need for institutional standardization and strategies to improve effective checklist use in surgical practice.
Copyright (c) 2026 Davi Bezerra, Breno Sobral Cavalcanti Maciel, Kimbelly Andrade de Araújo, Dr. Paulo Sergio Vieira de Melo https://creativecommons.org/licenses/by-sa/4.0
Clinical and epidemiological characterization, intraoperative pharmacological approach and postoperative analgesia in neurosurgical patients
Background: Interventional neurosurgeries are highly complex procedures which require detailed knowledge of preoperative clinical and epidemiological characteristics, optimized intraoperative anesthetic–pharmacological aspects, and individualized postoperative analgesic management. Therefore, this study aims to describe the clinical-epidemiological profile, pharmacological management and pain management in patients undergoing neurosurgical procedures. Methods: This is a descriptive cross-sectional study conducted at a tertiary hospital involving patients undergoing elective neurosurgery from January 2020 to December 2022, with data collected from electronic medical records. Results: Males predominated (53.8%) in the total sample (n=171), age between 60 and 69 years (21.0%; mean 56.1 ± 2.5 years), current or previous smokers (33.9%), consumed alcohol (55.6%), presented inadequate weight (60.4%), comorbidities (94.2%) and previous surgeries (86.0%). The most commonly used intraoperative medications were propofol (89.5%), remifentanil (90.6%), sevoflurane (9.9%), intravenous lidocaine (90.1%), cisatracurium (73.7%), neostigmine (16.4%) and levobupivacaine (43.9%). Tramadol, dipyrone, and ketoprofen showed the highest prevalences in immediate and late postoperative pain management. Conclusion: Elective neurosurgical patients are predominantly men aged 60 to 69 years with inadequate weight, comorbidities, previous surgeries and multimodal postoperative analgesia.
Copyright (c) 2026 Lucas Dalla Maria, Eugenio Pagnussatt Neto, Shana Ginar da Silva, Ivana Loraine Lindemann https://creativecommons.org/licenses/by-sa/4.0
Angiosarcoma of the scalp: report of an aggressive case
Angiosarcoma is a rare and highly aggressive type of malignant neoplasm that originates from the endothelial cells of blood or lymphatic vessels and can affect the head and neck regions. We report the case of a 63-year-old woman who presented with a rapidly progressive ulcerated plaque on the scalp and whose diagnosis of scalp angiosarcoma was confirmed by histopathological and immunohistochemical examination. Furthermore, the importance of early diagnosis and appropriate therapeutic management in such cases is emphasized so that the patient may have a better prognosis and quality of life
Copyright (c) 2026 Nivin Mazen Said, Airton Kenji Motizuki, Adriani Ferreira do Carmo, Mariana Bastos Amanajás, Rossana Ruth Garcia da Veiga, Maraya de Jesus Semblano Bittencourt https://creativecommons.org/licenses/by-sa/4.0
Health-related limiting conditions as risk factors for medication-induced suicide attempts among women: a cross-sectional study
Introduction: Suicide is a multifactorial phenomenon that disproportionately affects women. Chronic health conditions and psychiatric disorders may heighten vulnerability and increase the severity of suicidal behaviors. Objective: To evaluate whether health-limiting conditions are associated with the occurrence and clinical severity of suicide attempts by medication ingestion in women. Methods: A retrospective cross-sectional study was conducted at a public emergency hospital. Medical records of women treated after suicide attempts by drug ingestion were analyzed. Sociodemographic, clinical, and psychiatric variables were collected. Associations between health-limiting conditions and severity of suicide attempts were examined using chi-square and Fisher’s exact tests, with a significance level of p < 0.05. Results: Psychiatric disorders were identified in 72% of the cases, with mood disorders being the most prevalent. Chronic diseases were also common and showed a significant association with greater clinical severity of attempts. Health-limiting conditions, especially mental disorders, correlated strongly with indicators of severe suicide attempts. Conclusion: Health-limiting conditions, particularly psychiatric disorders, were significantly associated with increased severity of suicide attempts by medication ingestion. These findings reinforce the need for integrated clinical and mental-health strategies to prevent self-harm behaviors among women.
Copyright (c) 2026 Roberta R. M. Chaves, Rodrigo M. Faleiro, Flávio J. Rosário, Renata S. P. Lima https://creativecommons.org/licenses/by-sa/4.0
Women's Health in Focus: Challenges and Possibilities in Communication between a Gynecologist and a Deaf Patient
Objective: To understand the challenges and possibilities in medical care between gynecologists and deaf patients in the municipality of Itumbiara-GO, in preventive care for women's health. Method: This is a qualitative study involving gynecologists and deaf patients in the municipality of Itumbiara-GO. Data collection took place in March and April 2024, using semi-structured interviews as a data collection tool, containing questions about the challenges and potential encountered by deaf patients and what gynecologists find in the medical care of these patients. Three gynecologists and two deaf women who use Brazilian Sign Language (Libras) took part in the study. The research was submitted to and approved by the Ethics Committee and all the participants signed an informed consent form. Results: The results of the research show significant challenges in communication between gynecologists and deaf patients in Itumbiara-GO, highlighting the urgent need for more inclusive medical training. The interviews reveal that, although there is a mutual effort to overcome communication barriers, the lack of knowledge in Libras on the part of health professionals often results in dependence on companions or interpreters, which compromises patients' autonomy. Conclusion: In order to improve public health in gynecological care for deaf women, it is crucial to implement public and educational policies that encourage the continuous training of health professionals in Libras and the hiring of qualified interpreters in health services
Copyright (c) 2026 Barbara Antunes Braga, Ana Clara Leal, Isabela Samara Gomes, Jéssica Antonieta Reis Borges, Rogério Pacheco Rodrigues https://creativecommons.org/licenses/by-sa/4.0
Mortality in myocardial revascularization surgery: an overview of systematic reviews
The analysis of mortality rates associated with coronary artery bypass grafting (CABG), with or without cardiopulmonary bypass, is relevant, as is its comparison with other therapeutic approaches for severe coronary artery disease, such as percutaneous coronary intervention (PCI), hybrid coronary revascularization (HCR), and medical therapy. This study is an overview of systematic reviews, based on the selection of full-text, open-access articles from three databases (LILACS, PubMed, and Cochrane Library), published between October 2013 and October 2023, in English, Portuguese, and Spanish. Of the 117 reviews identified, 10 were included in the final analysis. CABG showed lower mortality compared with PCI, especially in diabetic patients. The comparison between on-pump and off-pump CABG showed a 72% reduction in 30-day postoperative mortality in the off-pump group among patients at high risk for acute myocardial infarction. No statistically significant differences were found between mortality rates in CABG and HCR. The combination of CABG with medical therapy reduced mortality from cardiac causes, although it did not demonstrate a significant difference in all-cause mortality. Bilateral internal thoracic artery grafting was associated with lower long-term mortality. Complete arterial revascularization showed a lower risk of mortality compared with incomplete revascularization. The compiled results indicate that CABG appears to be the best option for certain outcomes and clinical situations. However, the choice among different approaches and surgical techniques should be individualized, with careful evaluation of the cost-benefit-risk balance in each clinical context.
Copyright (c) 2026 Letícia Martins Cavalcanti, Luana Gomes Ribeiro, Rafaella Montagnier Eskenazi de Lima, Yanne Luisa Leite Barros, Gabriela de Andrade Lima Molina, Aurélio Molina da Costa https://creativecommons.org/licenses/by-sa/4.0
Child Neurodevelopment at 36 Months of Age: The Role Early Life Adversities Analysis
Early life adversities (ELAs) represent a major public health concern due to their long-term consequences for clinical and developmental outcomes (1). Understanding how ELAs shape child development is essential for informing effective prevention and intervention strategies aimed at improving both individual and population-level development outcomes. The Dimensional Model of Adversity and Psychopathology (DMAP) offers a neurobiologically grounded framework to conceptualize how distinct environmental experiences influence neurodevelopment via partially unique mechanisms (2). Moreover, DMAP also contemplates the examination of multiple, co-occurring adversities that children are exposed to (3), especially in underdeveloped countries, where certain forms of adversity remain insufficiently studied (4). Here, we report our contribution to this discussion by examining how the dimensions of threat and deprivation relate to neurodevelopment at 36 months within a context of multiple overlapping adversities. We analyzed data from 36-month-old participants of the São Paulo Western Region Birth Cohort (ROC) (5). Composite measures of threat and deprivation were derived from validated caregiver-reported questionnaires. The threat dimension captured exposure to domestic and community violence, whereas deprivation reflected indicators of household quality, food security, and caregiver education. Multivariable regression models adjusted for contextual confounders were used to assess associations between ELA dimensions and neurodevelopmental outcomes, including effortful control, global development, and internalizing and externalizing problems. Of the 3,619 children enrolled, 1,567 met eligibility criteria based on data availability and absence of comorbidities. Bootstrapped estimates revealed that threat exposure was significantly associated only with internalizing problems (β = 0.43, 95% CI [0.11–0.74], p = 0.008). In contrast, deprivation showed consistent associations across all assessed outcomes, including internalizing problems (β = 0.17, 95% CI [0.03–0.29], p = 0.022), externalizing problems (β = 0.29, 95% CI [0.11–0.47], p = 0.002), reduced effortful control (β = –1.46, 95% CI [–2.08 to –0.88], p < 0.001), and poorer global development (β = –2.44, 95% CI [–3.11 to –1.80], p < 0.001).
Copyright (c) 2025 Tiago Choi; Alexandra Brentani, Verônica Euclydes, Helena Brentani https://creativecommons.org/licenses/by-sa/4.0
The hazing gap: The concealed burden in Brazilian medical schools and the need for validated assessment tools
The university learning environment plays a crucial role in shaping students’ mental health and overall well-being. Although these settings are often associated with personal and academic growth, they can also expose students to conditions that contribute to psychological distress1. Recent evidence shows that certain aspects of college life, especially in medical schools, are linked to high rates of anxiety and depression among medical students. Factors such as academic pressure, performance demands, and the broader institutional culture help explain these findings2,3. For newly admitted students, these factors are predominantly linked to the process of entering a new environment. The transition into university often involves seeking belonging within groups such as sports teams, student organizations, and residence communities4. Initiation rituals are part of this integration process and can range from welcoming and harmless to violent and abusive5. These violent and potentially abusive practices are collectively known as “hazing”, which includes various forms of violence, such as gender or racial violence, bullying, and institutional violence6.
Juliane Piasseschi de Bernardin Gonçalves
Copyright (c) 2025 Euripedes Constantino Miguel, Giancarlo Lucchetti, Rodolfo Furlan Damiano, Clarissa Garcia, Laura Fernandes Berto, Rodrigo Hadade, Juliane Piasseschi de Bernardin Gonçalves, Bianca Besteti Fernandes Damiano, Elizabeth J. Allan, David Kerschner, Oscarina da Silva Ezequiel, Alessandra Lamas Granero Lucchetti, Lisabeth F. Dilalla, Homero Vallada https://creativecommons.org/licenses/by-sa/4.0
Epidemiological profile of sickle cell trait in blood collection units in the North and Northeast regions of Brazil: a narrative review
Introduction: Sickle cell trait is a condition caused by a mutation in hemoglobin, leading to the formation of a variant molecule, hemoglobin S (HbS). Its prevalence among blood donors in Brazil is higher in men and is present in 2.49% of the national population. Objective: To investigate the epidemiological profile of sickle cell trait in blood collection units in the North and Northeast regions of Brazil, based on the scientific literature. Method: This is a narrative literature review. The searches were conducted in six databases, using the following Health Sciences Descriptors (DeCS/MeSH): Sickle Cell Trait, Blood Donors and Brazil, applying the Boolean operator AND. Original qualitative and quantitative studies conducted in blood collection units, systematic reviews with or without meta-analyses, case studies, and technical notes published from 2014 to 2024 in English or Portuguese were included. Duplicate studies, course completion papers, master's dissertations and doctoral theses were excluded. Results: Ten articles were selected, of which two refer to studies conducted in the North Region and eight refer to studies in the Northeast Region. In the blood centers of the North Region, there is a prevalence of 1.3 to 1.41% of donors affected by the HbAS allele, with a predominance of black and mixed-race males, while in the Northeast Region there is a variable prevalence of 0.79% to 3.92% of carriers of the sickle cell trait, with a predominance of mixed-race or mixed-race men aged between 20 and 40 years. Conclusion: A similar epidemiological pattern was observed in the North and Northeast regions, with a predominance of male donors and of mixed-race individuals. In addition, there is a scarcity of studies on the sickle cell trait in these regions, highlighting the need for further research on this subject.
Francisco Dimitre Rodrigo Pereira Santos
Copyright (c) 2026 João Pedro Ferreira Duarte, Ana Alice Coutinho de Oliveira, Lucas dos Santos, Francisco Dimitre, Saulo Meira, Beatriz Roriz https://creativecommons.org/licenses/by-sa/4.0
Mental health promotion in older adults with mental disorders: an integrative review of psychological interventions
Aims: This study aimed to conduct an integrative literature review on the main psychological interventions applied to older adults with Severe Mental Illness. Methods: The search was carried out in PubMed/MEDLINE, SCOPUS, Scielo and Web of Science via standardized descriptors combined with Boolean operators. Eight studies investigating approaches such as Cognitive‒Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Emotional Awareness and Expression Therapy (EAET), Expressive Therapies, Gestalt Therapy, and telemonitoring were included. Results: The results indicate that these interventions have positive effects on reducing depressive and anxious symptoms, improving daily functionality, and enhancing the quality of life of older adults. Despite favorable evidence, several limitations were identified, such as methodological heterogeneity, a lack of longitudinal studies, and the absence of culturally adapted approaches. Conclusion: Structured and personalized psychological interventions are essential for promoting mental health in aging populations, and further research is needed to explore the long-term impact of these strategies.
Copyright (c) 2026 Marilia da Matta Silva, Amanda Santana Pintinha, Marilice Lira Ribeiro, Sophia Ivantes Rodrigues, Leonardo Pestillo de Oliveira, Lucas França Garcia https://creativecommons.org/licenses/by-sa/4.0
Rare case of recurrent thymoma with invasion of the thoracolumbar spine.
Does not apply - letter to the editor.
Copyright (c) 2025 Giovanni Scorzoni Paro, Italo Gerardo Rotondo, Douglas Kenji Narazaki, Matheus Augusto Maciel Santiago https://creativecommons.org/licenses/by-sa/4.0
Understanding how Nonsuicidal Self-injury occurs in low- or middle-income countries
Nonsuicidal self-injury (NSSI), defined as the deliberate destruction of body tissue without suicidal intent, represents a major public health concern among adolescents and young adults worldwide [1]. However, data from low- and middle-income countries (LMICs) remain scarce, particularly from community-based samples. In this context, Souza et al. conducted the first representative community-based study on NSSI in Brazil, using data from the Brazilian High-Risk Cohort Study (BHRC) [2]. This research provides novel findings on the six-month prevalence and psychopathological correlates of occasional and repetitive NSSI among Brazilian youth. Weighted analyses revealed patterns consistent with global findings, highlighting the importance of understanding NSSI in diverse sociocultural contexts. Importantly, the study demonstrated a robust association between NSSI and psychiatric comorbidities, particularly depressive and anxiety disorders, as well as a dose–response relationship between the number of concurrent diagnoses and NSSI severity. While occasional NSSI was not significantly associated with psychopathology, repetitive NSSI showed strong correlations with mood, anxiety, and externalizing disorders, highlighting distinct clinical trajectories and developmental pathways [3]. By integrating survey-weighted models and zero-inflated negative binomial regressions, this study contributes essential epidemiological evidence on NSSI in a large LMIC population. These findings emphasize the need for early detection and preventive strategies, as well as longitudinal investigations to understand how NSSI evolves from adolescence into adulthood. Overall, this work represents a significant contribution to developmental psychiatry, bridging an important knowledge gap in the epidemiology of self-injurious behaviors in emerging countries.
Copyright (c) 2025 Gabriel Ângelo Ferreira Faria de Souza, Caio Fernandes Lins Peixoto , Giovanni Abrahão Salum, Pedro Mario Pan, Marcelo José Abduch Ada Brañas, Euripedes Constantino Miguel, Marcos Signoretti Croci https://creativecommons.org/licenses/by-sa/4.0
Demographic differences and distribution patterns of autoimmune diseases in a city in southeastern of Minas Gerais, Brazil
This study aims to describe the epidemiological profile of autoimmune diseases in residents of Juiz de Fora (Minas Gerais, Brazil), according to sex, age group, self-reported race, and affected body system. This cross-sectional study used secondary data from the Integrated Pharmaceutical Assistance Management System (SIGAF) including residents of Juiz de Fora diagnosed with autoimmune diseases between 2019 and 2023. Data on sex, age, self-reported race, diagnosis (ICD-10), dispensed medications, and affected body system were collected. Descriptive statistics and chi-square tests were performed, with a significance level set at 5%. A total of 2,229 patients were included, mostly women (n = 1520, 68.2%), white individuals (n = 1404, 63%), and those aged 45-59 years (n = 783, 35.1%). The most frequent diseases were rheumatoid arthritis (n = 827, 37.1%), type 1 diabetes mellitus (n = 387, 17.4%), and Crohn’s disease (n = 364, 16.3%). Musculoskeletal (n = 976, 43.8%) and digestive (n = 659, 29.6%) autoimmune diseases were the most prevalent, showing significant differences by sex, age, and self-reported race (p < 0.05). The most frequently dispensed medications were rapid-acting insulin analogs (n = 387, 17.4%), leflunomide (n = 379, 17.0%), azathioprine (n = 284, 12.7%), and mesalazine (n = 247, 11.1%). The study highlights the predominance of musculoskeletal and digestive autoimmune diseases among middle-aged adults, with higher occurrence in women and white individuals, emphasizing the need for targeted surveillance and health planning strategies for these groups.
Copyright (c) 2026 Vanderleia Soeli de Barros Zampier, Yuri de Lima Medeiros, Jacy Gameiro, Isabel Cristina Gonçalves Leite https://creativecommons.org/licenses/by-sa/4.0
The Impact of the MadAlegria Project on Humanized Training and the Development of Empathy among Alumni
In recent decades, the remarkable scientific and technological progress in healthcare has been accompanied by a marked distancing in interpersonal relationships within care settings. This scenario contrasts with the definition of health proposed by the World Health Organization — as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity¹ — and with the principles of Brazil’s National Humanization Policy (Política Nacional de Humanização, PNH) within the Unified Health System, which recognizes the centrality of the individual in all dimensions of care². In Brazil, the concept of health was further expanded in 1990, when it was established as a fundamental human right under the Law 8.080/1990³. In 2003, the National Humanization Policy was created to value all subjects involved in the care process — including users, professionals, and managers — guided by principles such as transversality, inseparability between care and management, and autonomy, co-responsibility, and protagonism of individuals and collectives²,⁴. Humanization is therefore an essential component of both clinical practice and the education of healthcare professionals. In the training of such professionals, the development of competencies such as empathy, active listening, and receptiveness is fundamental to ensuring patient-centered care⁵⁻⁷. However, the growing gap between technical-scientific advancement and the quality of human interactions in healthcare underscores the need for educational strategies focused on humanized training⁸⁻¹². Within this context, the MadAlegria Project was created to foster humanized practices in both learning and professional behavior. Established in 2011 by students and faculty members at the University of São Paulo (USP), MadAlegria is a Culture and University Extension Project aimed at promoting humanization in healthcare education—particularly at the undergraduate level—and at improving the hospital environment, making it more welcoming for patients, families, and healthcare staff. Since 2012, the project has incorporated two artistic and playful languages: hospital clowning and storytelling. These approaches are used as pedagogical tools to enhance relational competencies such as empathy, active listening, teamwork, and sensitivity to others’ experiences¹³⁻¹⁵.
Copyright (c) 2025 Elizabeth Alves Gonçalves Ferreira, Lorena Cristina São Leão Ribeiro, Priscila Berenice da Costa, Jéssica Almeida dos Santos https://creativecommons.org/licenses/by-sa/4.0
Melting-Curve qPCR-based to detect Enterococcus and Veillonella genus in human gut microbiota
The human gut microbiota is composed of about 100 trillion organisms, such as bacteria, viruses, protozoa, and fungi, that live in symbiosis with the host. These microorganisms play an essential role in maintaining intestinal homeostasis and preventing diseases. However, changes in its composition lead to a state of imbalance, dysbiosis, which is associated with inflammatory bowel diseases and colorectal cancer. Among the genera of interest, Enterococcus spp. and Veillonella spp. have distinct functions related to intestinal pH regulation, nutrient synthesis, and lactate fermentation. The study aimed to develop a method based on real-time PCR (qPCR) for the qualitative detection of these two bacterial genera in the human gut microbiota. For this, 13 and 27 ribosomal RNA gene sequences of Enterococcus and Veillonella, respectively, were retrieved from the GenBank database, used to create a consensus sequence and design specific primer pairs. The reactions were conducted in a Rotor-Gene Q-5Plex HRM thermocycler, with an optimized girdling temperature of 58 °C and 56 °C, and peak dissociation determined at 82,1 °C and 82 ºC for Enterococcus and Veillonella, respectively. The methodology demonstrated efficacy and specificity in the identification of microorganisms, validating the use of qPCR as a viable and lower-cost alternative to sequencing techniques for taxonomic analysis of intestinal bacteria
Copyright (c) 2025 Thiago França-Soares, Bruno Shimokava, Alessandra Sonomura, Artur N Mizuno, Heloísa Borges da Silveira, Lucy Megumi Yamauchi, Sueli Fumie Yamada-Ogatta, Eliandro Tavares https://creativecommons.org/licenses/by-sa/4.0
MadAlegria: An academic outreach project restoring humanization in healthcare through the art of presence, connection, and empathy
Introduction: IIllness often provokes distress in patients and their support networks. Humanization should be part of the training of healthcare professionals. Founded in 2011 by undergraduate students in Medicine, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Nursing, and Nutrition, MadAlegria draws on storytelling and hospital clowning to foster empathy, promote humanized care, create more welcoming hospital environments, and expand students’ understanding of illness beyond its biological aspects. Objectives: To describe the MadAlegria Project, that promotes humanization in the education of healthcare professionals. Methods: MadAlegria develops two main activities: (1) annual training in Hospital Clowning or Storytelling; and (2) weekly visits to inpatients in oncology, dermatology, and obstetrics units. Teams engage in brief, respectful interactions guided by consent and institutional availability. Other actions include organizing the Humanization in Healthcare Symposium, participating in institutional events, promoting blood donation and integrative workshops. Results: Between 2017 and 2023, MadAlegria trained 578 volunteers, conducted 2.345 visits, involving 1.193 companions and 2,354 healthcare professionals. Data collected via REDCap® revealed that 99% of participants reported a positive impact, mainly in terms of empathy, humanization, and attentive listening. Only 6% of volunteers remain active. Discussion: MadAlegria has been achieving its goal of humanizing the training of healthcare professionals with empathy, while also conducting a large number of visits and interactions with patients, companions, and healthcare professionals in the hospital. Keeping volunteers active in the project for many years is a challenge influenced by other variables such as time and priority. Even if the volunteer does not continue with the project's activities, it is considered a success if they have become a more empathetic healthcare professional. Conclusion: MadAlegria strengthens humanized practice in healthcare education, promoting empathy and compassion in the hospital environment. The continuation of the project depends on institutional support.
Copyright (c) 2025 Lorena Cristina São Leão Ribeiro, Jéssica Almeida dos Santos, Priscila Berenice da Costa, Elizabeth Alves Gonçalves Ferreira https://creativecommons.org/licenses/by-sa/4.0
Letter to the editor - Hypoparathyroidism after parathyroidectomy in patients with multiple endocrine neoplasia type 1
Multiple endocrine neoplasia type 1 (MEN1) is a genetic syndrome caused by inactivation of the MEN1 tumor suppressor gene, which confers increased susceptibility to the development of neoplasms, especially endocrine tumors such as parathyroid adenomas.¹ Although it is a rare disease, primary hyperparathyroidism resulting from hyperplasia and/or neoplasia of the parathyroid glands occurs in up to 97% of individuals with the syndrome.² The treatment for hyperparathyroidism is surgical, and the two main techniques currently used are subtotal parathyroidectomy, involving the removal of 3.5 glands, and total parathyroidectomy with autotransplantation, in which all four glands are removed and a graft is prepared in the forearm.³ Although both approaches are employed, the choice of the optimal surgical technique for this condition remains under debate. A single study with a small cohort of 32 participants compared these two procedures and found no significant differences between them.⁴ The choice of surgical technique must consider the risk of recurrent hyperparathyroidism, given the multiglandular nature of the disease, and the risk of complications for example, hypoparathyroidism — defined by inappropriately low PTH levels in the presence of hypocalcemia.⁵ Traditionally, postoperative hypoparathyroidism is considered permanent when it persists for more than six months after surgery.⁶ However, this arbitrary definition is based on patients undergoing thyroidectomy and who do not have MEN1. Patients with MEN1 may have additional factors that delay the recovery of parathyroid function, such as previous malabsorptive surgeries, prolonged hungry bone syndrome, and removal of multiple glands. The latest international hypoparathyroidism guideline, published in 2022, proposed extending this limit to twelve months⁷, recognizing that functional recovery may be slower in specific contexts.
Copyright (c) 2025 Rafaela Mendes Battiferro, Delmar Muniz Lourenço Junior, Felipe Ferraz Magnabosco, Fábio Luiz de Menezes Montenegro, Marília D'Elboux Guimarães Brescia https://creativecommons.org/licenses/by-sa/4.0
Forklift-Induced Thoracic Trauma with Bronchial Rupture: A Survival Case Report in a Referral Center
Tracheobronchial injuries are rare but potentially fatal events, usually associated with high-energy chest trauma and often diagnosed late. Proper airway management is essential for survival in such cases. This report describes the case of a 34-year-old man who sustained thoracic crush trauma after being struck by a forklift, presenting with a penetrating wound to the right hemithorax, subcutaneous emphysema, and severe respiratory failure. He was intubated in the prehospital setting and transferred by air to a trauma referral center. Upon admission, he exhibited hemodynamic instability and refractory hypoxemia, prompting immediate transfer to the operating room. During the procedure, a complete transection of the trachea approximately 3 cm above the carina was identified, associated with extensive laceration of the right main bronchus. It was noted that the patient had been selectively intubated into the left bronchus, which unintentionally allowed effective ventilation of the left lung, maintaining minimal oxygenation until surgical repair. A tracheobronchial anastomosis was performed, followed by vascular evaluation that revealed vertebral artery dissection. The patient progressed with respiratory stability but developed sequelae, including posterior circulation ischemic stroke, partial visual deficit, tracheal stenosis, and motor-sensory impairment of the right upper limb. This case highlights the importance of early recognition of tracheobronchial injuries, appropriate airway management, and timely transfer to specialized centers. The accidental left main bronchus intubation played a crucial role in survival, serving as a temporarily protective ventilation strategy in the setting of complete tracheal rupture.
Copyright (c) 2025 Lara Leiro Passos Santos, Amanda Uneida Vieira, Flávio Roberto da Silva, Sérgio Henrique Bastos Damous, Fernando da Costa Ferreira Novo, Edivaldo Massazo Utiyama https://creativecommons.org/licenses/by-sa/4.0
Overview of research in homeopathy: a narrative review on the evidence of efficacy, efficiency, and safety
The text seeks to clarify for the medical community and health professionals the assumptions and scientific evidence of homeopathy which, despite being part of the list of Brazilian medical specialties since 1980, is not taught in most medical schools. Associated with this gap in the education of medical students, which is reflected in the lack of information and ignorance of future doctors, the application of assumptions different from those propagated by hegemonic medicine, contributing to the dissemination of prejudices rooted in the medical culture. This distance hinders undergraduates and graduates from learning a bi-secular therapy that should be part of the current therapeutic arsenal. Employing a principle of healing that stimulates the organism to react against its own disorders and valuing the individuality of the diseased in its multiple aspects, the homeopathic method of treatment favors the doctor-patient relationship and encourages holistic reasoning in the understanding of the complex phenomenon of human illness, providing a low-cost therapy, with a low risk of adverse events, which increases the clinical resolution of diseases in general. This narrative review of the literature was developed to correlate homeopathic assumptions with the scientific evidence that supports them, describing hundreds of experimental and clinical studies that demonstrate the efficacy, efficiency, and safety of individualized homeopathic treatment.
Copyright (c) 2026 Marcus Zulian Teixeira https://creativecommons.org/licenses/by-sa/4.0
Persistent odynophagia, is there a malignant neoplasm?
This study aimed to describe the clinical course and management of a p16-negative tonsillar squamous cell carcinoma (SCC) in a smoker with high-risk histopathological features. A 60-year-old man with persistent odynophagia underwent oral examination and videolaryngoscopic evaluation, which revealed a leukoplakic lesion in the left palatine tonsil. Biopsy confirmed grade 2 invasive keratinizing SCC. Imaging showed no distant metastases, and left tonsillectomy was performed. Histopathological analysis revealed an infiltrative growth pattern, vascular invasion, and extension to the salivary gland and skeletal muscle, while surgical margins could not be assessed. Immunohistochemistry demonstrated p63 positivity and p16 negativity, supporting the diagnosis of HPV-independent SCC. Adjuvant radiotherapy was indicated; however, the patient developed severe post-radiation mucositis, refeeding syndrome, sepsis, and multiorgan failure, ultimately resulting in death. These findings reflect national data showing late diagnosis and high mortality rates for oropharyngeal SCC and are consistent with previous studies reporting similar oncological outcomes between surgery followed by radiotherapy and definitive chemoradiotherapy. In early-stage disease, tonsillectomy prior to radiotherapy remains associated with improved survival. This case highlights that HPV-negative tumors, particularly in smokers, tend to exhibit aggressive behavior and poorer prognosis. Consistency with previous evidence reinforces the importance of early biopsy of persistent tonsillar lesions, p16-based stratification for appropriate staging, and integrated multidisciplinary care to reduce post-treatment morbidity and mortality.
Copyright (c) 2026 Álef Lamark Alves Bezerra https://creativecommons.org/licenses/by-sa/4.0
Registration of the epidemiological and cunctional clinical profile of patients post traumatic brain injury at a high complexity hospital in the interior of the state of São Paulo
Traumatic Brain Injury (TBI) results from physical forces that cause brain lesions and functional impairment. Although the Glasgow Coma Scale (GCS) is widely used, it fails to capture all neurological deficits, leading to the development of the Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI), based on the NIHSS and designed to assess post-TBI sequelae. This prospective study aimed to create a clinical registry of TBI cases at FSCMF (Franca, São Paulo, Brazil), characterize the clinical and functional profile of patients, and analyze predictive factors for six-month outcomes. Adults with TBI admitted between October 2023 and December 2024 were included. Clinical assessments were conducted at admission, during hospitalization, and six months after discharge using the GCS, NOS-TBI, TICS-M, Modified Rankin Scale, and Edinburgh Handedness Inventory. The final sample consisted of 40 patients, predominantly male (72.5%), with a median age of 51 years. The main causes of TBI were traffic accidents (44.7%) and falls (31.6%). Regarding severity, 70% had mild TBI, 12.5% moderate, and 17.5% severe. The NOS-TBI demonstrated excellent internal consistency (α>0.9) and high interrater reliability (K>0.8), with perfect agreement in some items (K=1). Despite the strong reliability of the scale, only nine patients completed the six-month follow-up, limiting the analysis of functional outcomes. Most showed satisfactory recovery, although severe TBI, older age, and high-impact trauma mechanisms were associated with poorer prognosis. This study reinforces the utility of the NOS-TBI as a sensitive tool for early identification of neurological deficits and as a complement to the GCS. Difficulties in patient follow-up highlight the need to improve post-discharge tracking strategies and strengthen the integration of care within the Brazilian Unified Health System (SUS).
Copyright (c) 2026 Leonardo Ribela de Alvarenga, Mariana de Oliveira Lima, Giovanna Dorneles e Silva, Maria Júlia Sindou Siqueira https://creativecommons.org/licenses/by-sa/4.0
Complicated diabetic foot and multidisciplinary management: a case report from iatrogenesis to resolution
Diabetic foot infections, or diabetes-related foot disease (DRFD), represent one of the leading causes of emergency hospital admissions among patients with diabetes and often precede unfavorable outcomes such as amputations. These complications may be associated with iatrogenic initial management, which can be prevented or mitigated through an appropriate multidisciplinary approach. We report the case of an 80-year-old male patient with type 2 diabetes mellitus, well controlled with oral antidiabetic agents, who developed tissue necrosis following a laceration of the second toe of the left foot. Upon seeking care at his local Primary Health Unit, he underwent an amputation of the affected region under suboptimal aseptic and antiseptic conditions, performed by a non-specialist physician, which resulted in severe forefoot infection and sepsis. This evolution prompted an orthopedic consultation and subsequent transmetatarsal amputation. From that point onward, with the implementation of well-established multidisciplinary strategies, the clinical outcome was satisfactory. This case illustrates a peculiar situation, in which an initial iatrogenic intervention evolved favorably after appropriate multidisciplinary management was instituted.
Copyright (c) 2026 Thais Cristina de Aquino Lima, Dr. Tiago Soares Baumfeld, Dr. Ávila Souza Júnior https://creativecommons.org/licenses/by-sa/4.0
Therapeutic Management of Exocrine Pancreatic Insufficiency in Patients with Cystic Fibrosis: An Integrative Review
The study analyzed evidence on therapy for exocrine pancreatic insufficiency in patients with cystic fibrosis, based on a search conducted in the PubMed and Virtual Health Library (Biblioteca Virtual de Saúde) databases. Studies published between 2019 and 2024 were included, resulting in a final selection of 48 articles, 24 of which focused on therapeutic interventions. The management of pancreatic insufficiency relies on three pillars: pancreatic enzyme replacement therapy (PERT), nutritional support, and continuous monitoring. PERT is essential for correcting malabsorption, utilizing enzymes derived from pigs, but it faces challenges such as patient adherence and variability in treatment response. The need to take multiple capsules and errors in administration are obstacles that require ongoing follow-up. Nutritional support is crucial, involving high-calorie diets and supplementation with fat-soluble vitamins. Despite the importance of nutrition, patient adherence to interventions remains low. CFTR modulators, such as ivacaftor, have emerged as innovative alternatives, but treatment discontinuation reverses the benefits, highlighting the need for further research. The article underscores the importance of integrated and personalized strategies for managing pancreatic insufficiency in cystic fibrosis.
Copyright (c) 2025 Helena Meurer Heidemann, Laís Corrêa de Carvalho, Bruna Eduarda Weirich, Yasmin Guimarães Rodrigues https://creativecommons.org/licenses/by-sa/4.0
Aspecto linear da hanseníase borderline em paciente do sexo feminino: uma apresentação atípica de lesão no tegumento
Leprosy is a chronic infection influenced by the immune response of each host, and its inflammatory immunopathology can present both neural and dermatological manifestations. This case involves a 17-year-old female patient, phototype IV, diagnosed with leprosy, who developed a hypochromic, erythematous, infiltrated linear plaque along the ulnar pathway, accompanied by claw hand deformity in the right upper limb. Additionally, complementary examinations, including histopathological analysis, confirmed the diagnosis of borderline leprosy. During the second month of clinical follow-up, the patient’s β-HCG test returned positive, indicating pregnancy. Literature suggests that the heterogeneous cutaneous presentation observed in DD leprosy reflects an intensely variable immune response, with lesions oscillating between the multibacillary and paucibacillary poles of the disease spectrum. This leprous lesion exhibits a unique aspect not documented in the literature, highlighting the need for further investigation into these diverse manifestations in order to prevent misdiagnosis and facilitate early treatment.
Copyright (c) 2025 Nivin Mazen Said, Airton Kenji Motizuki, Nirlando Igor Fróes Miranda, Marília Brasil Xavier https://creativecommons.org/licenses/by-sa/4.0