Brazilian Journal of Clinical Medicine and Review

Physiology-Driven Decision-Making in Trauma-Induced Coagulopa-thy: Integrating Shock Index, FAST, and Hemostatic Resuscitation

2026-01-20T14:47:31-05:00

Trauma-induced coagulopathy (TIC) is a major determinant of early mortality in severely injured patients and represents a complex, multifactorial physiological disorder that develops shortly after injury. It results from the interaction between tissue hypoperfusion, endothelial dysfunction, inflammatory activation, and dysregulation of coagulation and fibrinolysis pathways. Contemporary evidence demonstrates that tissue hypoperfusion may precede overt hypotension, requiring integrated diagnostic and therapeutic strategies. This narrative review discusses the role of the Shock Index, focused assessment with sonography for trauma (FAST/eFAST), and computed tomography in the early stratification of hemorrhagic shock, as well as their integration with damage control resuscitation principles, including early tranexamic acid administration. The coordinated application of these tools allows earlier surgical decision-making, reduces therapeutic delays, and improves clinical outcomes, particularly in emergency settings and public healthcare systems.

Patients with Acute Kidney Injury Undergoing Hemodialysis: Epidemiology and Factors Associated with Catheter-Related Bloodstream Infection

2025-07-03T12:30:23-04:00

Acute kidney injury (AKI) has a high mortality rate, especially when hemodialysis (HD) is required. Catheter-related bloodstream infection (CRBSI) is a reported complication, with Staphylococcus aureus as the main causative agent. The objectives of this study were to analyze the epidemiological profile of patients undergoing HD for AKI and to identify CRBSI characteristics and outcomes. This was an observational, retrospective study of patients with AKI undergoing HD via non-tunneled double-lumen catheters (LCLC) during hospitalization. Clinical, microbiological, and HD-related data were collected. A total of 290 patients were included (65.9% male; mean age 62.2 ± 2 years); 26.9% were septuagenarians, 49.3% hypertensive, and 35.9% diabetic. Sepsis-related AKI was the leading etiology (33.4%); the mean number of HD sessions was 4.9 ± 3.6 per patient. The incidence of CRBSI was 14.5%; S. aureus was the main agent (30%; 46% MRSA), followed by A. baumannii (9.6%). There was no association between sex, age, or NTDLC insertion site and CRBSI. A higher incidence of CRBSI was observed among those who underwent a greater number of HD sessions (p<0.001). Overall mortality was 54.5%. AKI requiring HD is associated with high mortality, and CRBSI is frequent. The prevalence of elderly patients and multidrug-resistant bacteria in the sample studied is noteworthy.

Method: observational, retrospective study of patients with AKI undergoing HD via non-tunneled dialysis catheter (NTCD) during hospitalization. Clinical, microbiological and HD-related data were collected.

Results: 290 patients were included (65.9% male; 62.2±2 years); 26.9% were in their septuagenarian years, 49.3% hypertensive and 35.9% diabetic. AKI in sepsis was the main etiology (33.4%); mean number of sessions of 4.9±3.6/patient. The incidence of CRBSI was 14.5%; S. aureus was the main agent (30%; 46% MRSA) followed by A. baumannii (9.6%). There was no association between sex, age and site of NTCD with CRBSI. There was a higher incidence of CRBSI in those who underwent a greater number of HD sessions (p<0.001). There was a higher mortality, regardless of CRBSI, if NTCD was in the femoral vein (65.2%; p<0.001). Overall mortality was 54.5%.

Conclusions: AKI in HD is associated with high mortality and CRBSI is frequent. The prevalence of elderly patients and multidrug-resistant bacteria in the studied sample is notable.

Prophylaxis for Deep Vein Thrombosis and Pulmonary Embolism Failed or was Insufficient COVID-19

2025-08-14T14:03:25-04:00

Patients with COVID-19 exhibit distinct laboratory findings that are compatible with a pro-thrombotic state, in which the key associated underlying episode to thrombotic complications is an excessive inflammatory response of the host to infection. The aim of the present study was to evaluate routine prophylaxis for pulmonary thromboembolism (PTE) at a teaching school and the effect of COVID-19 on the prevalence of deep vein thrombosis (DVT) and PTE in the year 2020. The study was conducted analyzing records the patients, monthly prevalence of adequate prophylaxis and the monthly incidence of DVT and PTE in patients with moderate to high risk based on the Wells score in the year 2020, with an investigation of the effect of COVID-19 on this incidence at São José do Rio Preto Hospital. An analysis was performed of hospital data on the prevalence of adequate prophylaxis for deep vein thrombosis and pulmonary embolism in patients with moderate to high risk for PTE based on the Wells score in the year 2020. For prophylaxis, conventional and low molecular weight heparin, rivaroxaban, warfarin, antithrombotic elastic stockings and pneumatic boots were used, depending on the needs of each patient. Our results show that June and July were the peaks of the COVID-19 pandemic, with a significant increase in the incidence, going from an annual level of 0.29% to 0.88%. The monthly mean incidence went from 0.13% through June to 0.46% from July to December; this difference was statistically significant (p = 0.002, Mann-Whitney U test). The coronavirus has increased the incidence of deep vein thrombosis and pulmonary embolism, suggesting a failure in mechanisms of prophylaxis for PTE implanted prior to COVID-19.

Detection of Calprotectin S100A8/A9 in Inflammatory Bowel Disease by Immunochemiluminescence and Immunohistochemistry

2025-04-22T13:33:21-04:00

Calprotectin (S100A8/A9) constitutes approximately 60% of the cytosolic protein content of neutrophils and serves as a marker of leukocyte activation and migration, providing valuable insight into the intensity and pattern of inflammation. This study aimed to evaluate the tissue expression and quantification of calprotectin in anorectal samples from patients with inflammatory bowel disease (IBD) using immunochemiluminescence and immunohistochemistry. Anti-calprotectin antibodies were conjugated with acridine ester for chemiluminescent detection and applied to tissue extracts. In parallel, indirect immunohistochemistry was performed on paraffin-embedded anorectal sections from patients with Crohn’s disease and ulcerative colitis, and from non-IBD controls. Quantitative and semiquantitative analyses were compared between groups. Calprotectin levels were significantly elevated in IBD tissues compared with controls (p < 0.05) in both detection methods. The chemiluminescent assay demonstrated higher analytical sensitivity, enabling quantification even in samples with mild histological inflammation. Increased tissue calprotectin reflects enhanced neutrophil infiltration and activation within the intestinal mucosa, corroborating its role as a local biomarker of inflammatory activity in IBD.

Recurrent Respiratory Papillomatosis: Current Insights into Epidemiology, Pathogenesis, and Emerging Therapeutic Strategies

2025-10-08T15:38:43-04:00

Recurrent respiratory papillomatosis (RRP) is a benign, HPV 6/11-driven airway disease with frequent recurrences, often requiring multiple surgeries and imposing significant clinical and economic burdens. This narrative review synthesizes evidence from 2010–2025 on epidemiology, pathogenesis, clinical features, and therapies, emphasizing advances like bevacizumab, immune checkpoint inhibitors, and gene therapy (PRGN-2012, announced for FDA approval as Papzimeos™ on August 14, 2025). A structured literature search in PubMed, Scopus, and Web of Science identified 26 studies (clinical trials, cohorts, reviews). Key findings: HPV vaccination reduced juvenile RRP (JoRRP) incidence by >90% in vaccinated populations (e.g., Australia). Bevacizumab prolongs surgery-free intervals (up to 85% response rate systemically), while PRGN-2012 achieved a 51% complete response (no surgery for ≥12 months) with sustained benefits >2 years and mild adverse events, pending confirmation in peer-reviewed publications. INO-3107 reduced mean surgeries from 4.1 to 0.9 over two years, with an 86% overall response rate (ORR) in Year 2. Traditional adjuvants like cidofovir remain relevant in low-resource settings. Multimodal strategies (surgery, anti-angiogenics, immunotherapy) shift toward disease modification. Enhanced vaccination and biomarker research are crucial for global control.

Between the Stethoscope and the Diagnosis: The Experience of Angolan Doctors as Patients

2025-07-27T16:59:01-04:00

Physicians’ experiences as patients expose a distinctive tension between their professional role of caregiver and the lived vulnerability of being cared for. This duality challenges both professional and personal identities. This study investigated perceptions, challenges and emotional consequences of illness among Angolan doctors and examined implications for medical practice and the humanization of care. We conducted a descriptive, cross-sectional, study in Luanda, Angola, between March and May 2024. A total of 139 physicians completed a culturally adapted questionnaire based on Medscape. Quantitative data was analyzed using Epi Info (v.7.2.6.0) and presented as absolute and relative frequencies. Open-ended responses were examined thematically to complement quantitative findings. Most participants were women (64.8%) and worked in the public sector (60.4%). Disclosure of professional identity during consultations occurred “sometimes” for 64.3% of respondents. Almost 70% reported increased fear of illness, though 48.9% reported no career repercussions. While 71.2% did not expect preferential treatment, 46.8% perceived receiving better care because of their status. Importantly, 42.5% indicated that personal illness enhanced empathy towards patients. Illness affects physicians beyond the physical dimension, reshaping professional identity and catalyzing empathy in clinical practice. This pioneering Angolan study underscores the need for institutional policies addressing physicians’ health, confidentiality, and psychological support. Facilitating reflective spaces for physicians’ illness narratives may strengthen patient‑centered, humanized care.

Commercial Determinants of Health in Africa: A Look Behind Health Literacy

2025-08-14T20:19:26-04:00

Modern globalization has profoundly affected public health in Africa, promoting the widespread consumption of unhealthy products through aggressive marketing and mass media. In Luanda, Angola, traditional diets are increasingly replaced by sugary drinks and ultra-processed foods, illustrating the influence of commercial determinants of health (CDoH). Multinational corporations exploit weak regulatory frameworks, low health literacy, and social vulnerabilities, contributing to a rapid nutritional transition and the emergence of non-communicable diseases (NCDs) such as obesity, diabetes, cardiovascular diseases, and cancer. This article highlights how structural economic and commercial forces, rather than individual lifestyle choices alone, drive these “industrial epidemics” and exacerbate health disparities. Addressing these challenges requires coordinated political action, regulation of the food and beverage industry, promotion of health literacy, and accountability mechanisms to hold corporations responsible for their impact. By empowering communities and fostering systemic change, African nations can mitigate the health consequences of commercial pressures and support sustainable public health development.

The globalisation of unhealthy foods has not happened accidentally but has been mediated by international commercial groups that have been expanding their brands for decades and have influenced the global market toward a permanent consumption of these harmful products. This expansion has also taken place in developing countries.

In this paper, we focus on Africa, where political and health systems are already struggling with a high burden of infectious diseases and lack the capacity for rapid intervention to control the consequences of adopting these trends.

Association between Waist Circumference, Diabetes Mellitus, Hypertension and Dyslipidemia in a Population in Northern Angola

2025-08-07T17:17:42-04:00

Obesity, particularly when it is centrally located, is an important risk factor for the development of cardiovascular diseases. This study aimed to assess the relationship between waist circumference and the presence of diabetes mellitus, hypertension, and dyslipidaemia. A community- based cross-sectional study was conducted as a sub-analysis of CardioBengo in the municipality of Dande, Bengo Province, involving 2,244 individuals aged 18– 84 years. The study included a structured questionnaire and the collection of sociodemographic, anthropometric, hemodynamic and biochemical data. Analyzes were carried out using correlation methods, the construction of ROC (Receiver Operating Characteristic) curves, and the determination of optimal cut- off points according to the Youden index. Waist circumference was positively associated with metabolic risk factors, particularly hypertension, in both sexes. It demonstrated moderate sensitivity and specificity (area under the curve (AUC): 0.725 in men and 0.612 in women). Waist circumference also proved to be a moderate predictor of diabetes mellitus (AUC: 0.648 in men and 0.596 in women) and hypercholesterolaemia (AUC: 0.673 in men and 0.612 in women), with cut-off points varying between 71.5 cm and 89 cm depending on gender. For hypertriglyceridaemia, however, the association was weak (AUC: 0.557 and 0.503). Waist circumference can be used as an indicator of the risk of developing metabolic factors, highlighting its usefulness in predicting hypertension in the Angolan population.

Clinical Parameters and In-hospital Mortality from COVID-19 in Diabetic Patients: Evidence from a Study in Angola

2025-05-25T13:14:23-04:00

COVID-19 was first identified in China and, within a few months, declared a pandemic by the World Health Organization (WHO). Among the risk factors associated with unfavorable outcomes, diabetes mellitus stands out, often related to a higher incidence of complications and mortality. This study aimed to assess the demographic and laboratory characteristics of diabetic patients admitted to the ward and ICU with COVID-19 in Luanda, Angola, and analyze their relationship with in-hospital mortality. This is an observational, analytical, and retrospective study involving 234 patients diagnosed with COVID-19 and diabetes mellitus admitted to Clínica Sagrada Esperança between March 2020 and March 2022. The primary outcome was in-hospital mortality. The median age of the patients was 61 years, with a predominance of males (70.1%). The in-hospital mortality rate was 21%. Patients who died were significantly older (65 vs. 59 years; p = 0.016), had a shorter interval between symptom onset and hospital admission (5 vs. 7 days; p = 0.019), and a shorter length of stay (8 vs. 10 days; p = 0.032). These patients also had significantly higher levels of leukocytes, neutrophils, urea, creatinine, lactate dehydrogenase (LDH), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR), as well as lower lymphocyte counts. In the logistic regression analysis, age, creatinine, NLR, and LDH emerged as independent risk factors for mortality, with creatinine being the main predictor (OR = 12.035). These findings reinforce the prognostic value of clinical and laboratory markers in risk stratification and clinical decision-making in diabetic patients with COVID-19, especially in a population that is still underrepresented in scientific literature.

Factors Associated with Prolonged ICU Stay in the Postoperative Period of Cardiac Surgery in a Reference Hospital in Angola

2025-08-14T15:25:41-04:00

Cardiac surgery is a complex procedure, and the number of patients with high surgical risk has increased due to the rise in elderly patients with a greater number of comorbidities. Several risk factors influence the length of stay in the intensive care unit (ICU). This study aimed to evaluate risk factors associated with prolonged ICU stay in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A retrospective study was conducted from January to December 2024 with adult patients undergoing surgery with CPB. Data related to pre-, intra-, and postoperative variables were collected. Prolonged ICU stay exceeding four days was considered. Among the 47 patients included, the median age was 47 years; 26 (55.3%) were male. Valvular surgery was the most frequent procedure (66%). Nine (19.2%) presented with prolonged ICU stay. The median age was higher in the TIP group (33.06 years vs. 21.86; p=0.027). There was a positive correlation between TIP and mechanical ventilation (r=0.30; p=0.04), intubation time (r=0.30; p=0.04), neutrophil/lymphocyte ratio (r=0.30; p=0.01), and a negative correlation with the absolute lymphocyte count (r=-0.39; p=0.005). Pre- and postoperative variables, including age, mechanical ventilation, intubation time, INL, and lymphocyte count, were associated with TIP in the ICU.

Lifestyle of Patients with Ischemic Heart Disease Followed at the Outpatient Clinic of a Referral Hospital in Luanda

2025-08-14T15:59:52-04:00

Ischemic heart disease (IHD) is one of the leading causes of mortality worldwide and has an increasing impact in low- and middle-income countries. In Angola, scientific production addressing the clinical and behavioral profile of these patients remains limited, particularly in outpatient settings. This study aimed to exploratorily assess the lifestyle of patients with IHD followed at the outpatient clinic of a referral hospital in Luanda during the first quarter of 2025. A cross-sectional, descriptive, mixed-methods study was conducted at the Cardeal Dom Alexandre do Nascimento Cardiopulmonary Disease Hospital Complex, including 27 patients selected by convenience sampling. A sociodemographic questionnaire and the FANTASTIC Lifestyle Questionnaire were applied. Data analysis was performed using SPSS version 20.0, employing descriptive statistics. The mean age was 64.2 years, with a predominance of males (66.7%). Most participants had low educational attainment and a monthly income below 50,000 Kz. Hypertension was the most frequent comorbidity (88.9%). Lifestyle was classified as fair in 52% of cases, good in 41%, very good in 4%, and “needs improvement” in 3%. The lowest scores were observed in the physical activity and work domains, whereas the tobacco and toxic substances domain showed higher scores, reflecting a more favorable profile in this aspect. Given the small sample size and descriptive design, the results should be interpreted with caution and considered preliminary findings that highlight priority areas for future research and health interventions.

Artificial Intelligence–Assisted Three-Dimensional Modeling as a Dynamic Decision-Support Framework for Surgical Planning

2025-12-27T08:13:32-05:00

Artificial intelligence (AI)–assisted three-dimensional (3D) modeling has expanded the role of medical imaging in surgical planning; however, its clinical value is often conflated with advanced visualization rather than true decision support. This Mini Review critically examines AI-driven 3D modeling as a precision tool for surgical planning, emphasizing the distinction between static anatomical reconstructions and dynamic, intelligence-driven systems capable of adapting to intraoperative conditions. Beyond classical convolutional neural networks, contemporary architectures such as Vision Transformers and diffusion-based models are discussed, highlighting their implications for generalizability, uncertainty estimation, and robustness. Attention is given to imaging standardization, algorithmic responsibility, economic thresholds for adoption, and the persistent gap between visualization and quantifiable surgical benefit.

Selective Nonoperative Management of Abdominal Gunshot Wounds: Contemporary Protocols, Patient Selection, and Failure Rescue

2026-01-22T12:03:55-05:00

Penetrating abdominal trauma caused by firearm injuries has traditionally been managed with mandatory exploratory laparotomy. Advances in imaging, critical care, and clinical monitoring have progressively supported selective nonoperative management (NOM) in carefully selected patients, challenging historical dogma and reducing nontherapeutic laparotomy rates. To review contemporary evidence and protocols guiding nonoperative management of abdominal gunshot wounds, with emphasis on patient selection, diagnostic strategies, monitoring protocols, and criteria for conversion to operative intervention. A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and SciELO databases. A total of 247 records were identified, of which 20 articles met predefined inclusion criteria and were selected for qualitative synthesis. Evidence supports selective nonoperative management in hemodynamically stable patients without signs of peritonitis, provided that structured protocols and close monitoring are implemented. Computed tomography plays a central role in patient selection, while serial physical examinations remain essential for early detection of treatment failure. Reported success rates exceed 80–90% in experienced trauma centers. Protocol-driven nonoperative management of abdominal gunshot wounds is a safe and effective strategy in selected patients and should be integrated into modern trauma algorithms.

Focused Assessment with Sonography for Trauma (FAST) in the Early Diagnosis of Visceral Injuries in Trauma Patients: A Narrative Review

2026-01-13T19:47:45-05:00

Focused Assessment with Sonography for Trauma (FAST) has become a cornerstone of early trauma evaluation due to its rapid execution, bedside availability, and noninvasive nature. Its primary role is the detection of free fluid, serving as an indirect marker of significant intra-abdominal injury. However, the accuracy of FAST for diagnosing specific visceral injuries remains variable, particularly when distinguishing solid organ from hollow viscus lesions. This narrative review analyzes current evidence regarding the role of FAST in the early diagnosis of visceral injuries in trauma patients. A structured literature search was conducted in PubMed, SciELO, and Scopus databases. The diagnostic performance of FAST, its clinical applicability in hemodynamically unstable and stable patients, and its limitations in comparison with computed tomography are discussed. The findings indicate that FAST is highly specific for detecting hemoperitoneum and is particularly valuable in unstable patients, where it facilitates rapid surgical decision-making. Nevertheless, its limited sensitivity for isolated visceral and hollow viscus injuries underscores the need for integration with clinical assessment and advanced imaging.

Integration of Tranexamic Acid into Massive Transfusion Protocols: Current Evidence and Clinical Considerations

2025-12-16T12:35:38-05:00

Hemostatic Resuscitation in Severe Trauma: Early Administration of Tranexamic Acid Integrated with Massive Transfusion Protocols

2025-11-16T18:28:51-05:00

U.S. Withdrawal from UNESCO Threatens Health and Educational Progress in Sub-Saharan Africa

2025-09-02T14:10:35-04:00

A Values-Driven Code to Restore Trust in Post-Pandemic Research: The Impact of PREPARED Code

2025-09-04T09:22:07-04:00

Not applicable

Trump’s Cut to DEI: Silencing Research on Structural Racism and Equity

2025-09-02T15:12:36-04:00

Cardiovascular Health in Africa: The Long Road Toward Sustainable Solutions

2025-08-29T08:17:06-04:00

Cardiovascular health in Africa has been a subject of medical observation for nearly a century, yet it remains a neglected priority within health agendas. Since Donnison and Lond’s 1929 report on blood pressure in African populations, the continent has undergone an epidemiological transition marked by rising non-communicable diseases. Today, cardiovascular disease (CVD) is a leading cause of mortality in sub-Saharan Africa, with a prevalence that has increased more than 130% between 1990 and 2019. Unlike high-income countries, where early detection, pharmacological advances, and robust prevention programs have driven a steady decline in CVD mortality, Africa continues to face disproportionately high rates of premature deaths. Contributing factors include uncontrolled hypertension, limited access to diagnostics, scarce and centralized cardiology services, and unaffordable essential medicines. These challenges perpetuate economic instability and deepen inequalities, constituting a “silent cardiovascular epidemic.” Future solutions require strategies adapted to African realities rather than direct importation of high-income models. Hypertension control should be the cornerstone, supported by systematic blood pressure monitoring, community-based education, and intersectoral policies promoting healthier lifestyles. Strengthening health systems through training, access to affordable medicines, and basic diagnostic tools is critical. Regional cooperation and international solidarity, modeled on successful infectious disease programs, are equally essential. Moreover, digital health innovations, including mobile health platforms, telemedicine, portable devices, and artificial intelligence, offer cost-effective opportunities to expand access and enhance data-driven decision-making. The African cardiovascular crisis is not a distant threat but a present reality. Closing the gap demands political will, investment, and global partnerships. Just as HIV/AIDS and malaria mobilized unprecedented action, cardiovascular health in Africa must now be recognized as a priority for equity, economic stability, and the right to health.