Brazilian Journal of Clinical Medicine and Review

Electrocardiographic Changes Associated with Cardiovascular Risk Factors in Institutionalized Older Adults in Luanda

Nelson Muetcheno Francisco — 2026-09-11

Introduction: Several studies have demonstrated an association between electrocardiographic abnormalities and hypertension, diabetes, hypercholesterolemia, obesity, alcohol consumption, and tobacco use. They have also shown that electrocardiography (ECG) provides independent prognostic value beyond traditional cardiovascular risk stratification models, reinforcing the importance of systematic screening in geriatric populations. Objective: To identify the frequency of major and minor electrocardiographic abnormalities among institutionalized older adults at Beiral in 2025. Methods: A cross-sectional quantitative study was conducted involving 63 older adults aged ≥60 years, selected by convenience sampling. Data collection included interviews, standardized measurements of blood pressure, blood glucose, and anthropometric parameters, as well as 12-lead ECG recordings classified according to the Minnesota Code. Fisher's exact test and Cramér's V coefficient were used for statistical analysis. Results: The sample was predominantly male (61.9%), with a mean age of 69.3 years. Hypertension was present in 73.0% of participants, while smoking and alcohol consumption were reported by 60.3% and 34.9%, respectively. Among the ECGs analyzed, 54.0% showed some type of abnormality, with 34.9% classified as major abnormalities, particularly left ventricular hypertrophy associated with repolarization abnormalities (23.8%). Minor abnormalities accounted for 19.0%, with premature beats being the most common finding (7.9%). The presence of electrocardiographic abnormalities was significantly associated with hypertension, smoking, and alcohol consumption (p<0.001). Conclusion: The high frequency of electrocardiographic abnormalities, particularly major abnormalities, is concerning in this specific population. These findings suggest that incorporating ECG into the routine assessment of institutionalized older adults may be an important step toward closer cardiovascular surveillance and the prevention of cardiovascular events in the Angolan context.

Mitral Valve Fenestration Associated with Severe Mitral Re-gurgitation: A Case Report

Juliana Camoço Garcia — 2026-09-11

Introduction: Mitral regurgitation in pediatric patients represents a complex diagnostic challenge and may have either congenital or acquired etiology. In developing countries, rheumatic carditis secondary to untreated streptococcal infections remains one of the leading causes of mitral valve disease. Mitral valve fenestration is a rare structural abnormality characterized by a perforation in the valve leaflet. Its association with rheumatic carditis may increase the severity of regurgitation and promote progression to pulmonary hypertension. Case Report: We present the case of a 10-year-old male patient with a history of recurrent untreated chronic tonsillitis who was admitted to the emergency department with persistent fever, dry cough, progressive dyspnea, orthopnea, and lower-limb edema. On physical examination, the patient was febrile and tachycardic (heart rate, 145 bpm), hypoxemic despite supplemental oxygen therapy, with pulmonary crackles on auscultation and audible murmurs over the mitral, tricuspid, and aortic valve areas. Laboratory tests showed elevated inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and antistreptolysin O [ASO] titer), consistent with previous streptococcal exposure. Transthoracic echocardiography revealed remodeling of the left cardiac chambers, including a dilated left ventricle with moderate systolic dysfunction (ejection fraction, 45%) and a dilated left atrium. Valvular assessment demonstrated a thickened aortic valve with mild-to-moderate regurgitation and a thickened mitral valve with prolapse and fenestration of the anterior leaflet (A3 segment), resulting in severe mitral regurgitation. Moderate pulmonary and tricuspid regurgitation were also identified, with an estimated pulmonary artery systolic pressure (PASP) of 98 mmHg, suggestive of severe pulmonary hypertension. The clinical and echocardiographic findings suggested severe mitral regurgitation of mixed etiology, combining a congenital leaflet abnormality with rheumatic involvement. The patient was admitted for clinical stabilization and, after his condition improved, was transferred to a specialized cardiovascular disease hospital. Conclusion: Mitral valve fenestration is a rare structural abnormality. In the present case, echocardiography, as an available imaging modality in the hospital setting, enabled its identification and characterization of its hemodynamic consequences, contributing to the diagnostic assessment of severe mitral regurgitation with a complex etiology.

Clinical Profile of Children with Congenital Heart Disease at Benguela General Hospital

Ivanilson Ramos — 2026-09-11

Introduction: Congenital heart diseases are structural abnormalities of the heart and/or great vessels that are present at birth and represent an important cause of pediatric morbidity and mortality. This study aimed to describe the frequency and clinical profile of congenital heart diseases among children treated at Benguela General Hospital, Angola. Methods: An observational, descriptive, cross-sectional study was conducted based on a retrospective review of medical records of children aged 0 to 17 years diagnosed with congenital heart disease at Benguela General Hospital between February 2024 and July 2025. The sample consisted of 44 children. Data were analyzed using IBM SPSS version 30 through descriptive statistics, with presentation of absolute frequencies and percentages. Results: There was a predominance of females, with 25 cases (56.8%), and of children aged ≤5 years, with 36 cases (81.8%). Most patients came from suburban areas, accounting for 39 cases (88.6%). The most frequent clinical manifestations were cardiac murmur, observed in 36 cases (81.8%), and respiratory difficulty, observed in 34 cases (77.3%). Ventricular septal defect was the most frequent congenital heart disease, with 18 cases (40.9%), followed by Tetralogy of Fallot, with 5 cases (11.4%). Most patients received antibiotics, 40 cases (90.9%); ACE inhibitors/beta-blockers/digitalis, 31 cases (70.5%); and oxygen therapy, 28 cases (63.6%). Conclusion: The congenital heart diseases observed were predominantly acyanotic, particularly ventricular septal defects, with cardiac murmurs and respiratory difficulty being the most frequent clinical manifestations.

Beyond Chest Pain: Pericarditis as the Initial Manifestation of Systemic Reactivation in a Patient with Systemic Lupus Erythe-matosus

Catarina David — 2026-09-11

Introduction: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by periods of remission and disease activity, with the potential to involve multiple organs simultaneously or sequentially. Cardiovascular involvement is common, with pericarditis being one of the most recognized cardiac manifestations. In patients with previously diagnosed SLE, the development of pericarditis may represent disease reactivation and precede the recognition of involvement of other organs. Case Report: We present the case of a 19-year-old female patient with a previous diagnosis of SLE, under regular follow-up and treated with hydroxychloroquine, prednisolone, and azathioprine, who had experienced recurrent episodes of chest pain in the preceding weeks. She presented to the emergency department because of worsening symptoms, including asthenia, fever, and severe retrosternal chest pain characterized as sharp and non-radiating, aggravated in the supine position and relieved by sitting upright. On admission, she was in poor general and nutritional condition, febrile and tachycardic, with a blood pressure of 104/56 mmHg. Laboratory tests revealed moderate microcytic hypochromic anemia (hemoglobin, 8.8 g/dL), leukocytosis (11,940 cells/mm³), and negative troponin I. Electrocardiography revealed sinus tachycardia, diffuse ST-segment elevation, and PR-segment depression, findings consistent with acute pericarditis. Chest radiography showed no significant abnormalities. Transthoracic echocardiography demonstrated preserved global biventricular systolic function, mild pericardial thickening, and circumferential pericardial effusion. The combination of chest pain with characteristic pericardial features, typical electrocardiographic changes, and pericardial effusion established the diagnosis of acute pericarditis. During further investigation, abnormalities in renal function suggestive of possible renal involvement by SLE were also identified, raising the possibility of systemic disease activity initially manifested by pericardial involvement. Given the unavailability of intensive immunosuppressive therapy with pulse therapy, the oral corticosteroid dose was increased, combined with ibuprofen and colchicine, while maintenance SLE therapy was continued. The patient remained hospitalized in the Cardiology Department for four days, with favorable clinical evolution, and was discharged in improved condition with follow-up arranged in the Cardiology and Rheumatology clinics. Conclusion: Acute pericarditis may constitute the initial manifestation of systemic SLE reactivation, including in patients receiving regular treatment and follow-up. In this case, pericardial involvement preceded the identification of renal abnormalities suggestive of involvement of a second organ, reinforcing the possibility of multisystem disease activity. Recognition of the characteristic features of the chest pain, together with electrocardiographic and echocardiographic findings, was essential for establishing the diagnosis. This case also highlights the therapeutic challenges associated with managing lupus disease activity in settings with limited availability of intensive immunosuppressive therapy.

Epidemiological and Clinical Characteristics of Patients Undergoing Cardiac Valve Replacement Surgery in Angola: A Retrospective Study of 100 Cases

Núria Machado — 2026-09-11

Introduction: Valvular heart disease is a significant and growing global health concern. It is one of the leading causes of cardiovascular morbidity and mortality in sub-Saharan Africa. Historically, rheumatic heart disease has been the predominant form of cardiovascular disease in sub-Saharan Africa. Objective: To characterize the clinical and epidemiological profile of patients undergoing cardiac valve replacement surgery at the Cardiorespiratory Diseases Hospital Complex Cardinal Dom Alexandre do Nascimento between 2022 and 2025. Methods: This was a retrospective, descriptive, cross-sectional observational study using non-probability convenience sampling and incorporating quantitative and qualitative variables. The study population consisted of patients who underwent cardiac valve replacement surgery between 2022 and 2025. A total of 100 patients comprised the study sample. Patients aged ≥18 years who underwent cardiac valve replacement surgery during the study period were included. Patients who underwent valve repair without replacement and those with incomplete medical records were excluded. Results: The mean patient age was 34.9 years, ranging from 18 to 73 years, with a predominance of patients aged 18–40 years. Female patients predominated (66%), as did patients from Luanda Province. The most prevalent comorbidities were hypertension (18%), atrial fibrillation (7%), and diabetes mellitus (2%). Rheumatic etiology was the leading cause of valvular disease (66%), with the mitral valve being the most frequently affected and mitral regurgitation the predominant lesion. Biological prostheses were the most commonly used (70%). The main postoperative complications included bleeding, pulmonary thromboembolism, and stroke, while in-hospital mortality was only 1%. Conclusion: Rheumatic etiology remained the leading cause of cardiac valve replacement, predominantly affecting young women, with the mitral valve being the most frequently involved. Low in-hospital mortality and predominant use of biological prostheses were observed. These findings reinforce the need to strengthen strategies for the prevention of rheumatic heart disease and the planning of cardiac surgery services in Angola.

Knowledge, Attitudes, and Practices Regarding Hypertension Prevention Among Medical Students: A Cross-Sectional Study at Agostinho Neto University

Celma de Oliveira — 2026-09-11

Introduction: Hypertension is a chronic medical condition characterized by persistently elevated blood pressure and is the most important modifiable risk factor for cardiovascular disease. It is one of the leading causes of morbidity and mortality worldwide and is considered a major public health problem. Effective management depends not only on medical treatment but also on knowledge, attitudes, and practices related to hypertension prevention among future healthcare professionals. Objective: To assess the level of knowledge, attitudes, and practices regarding hypertension prevention among medical students at Agostinho Neto University. Methods: An observational, cross-sectional, quantitative and qualitative study was conducted among medical students at Agostinho Neto University, including 213 participants enrolled from the second to the sixth year of medical school. The study used a structured questionnaire addressing sociodemographic characteristics, knowledge, attitudes, and practices. Data were analyzed using descriptive statistics, including means and standard deviations. Results: The mean age of participants was 22.4 ± 3.39 years, and 59.4% were female. Most students demonstrated a good level of knowledge about hypertension, recognizing its causes, clinical diagnosis, complications, and the need for continuous medication use (73.7%). A total of 98.1% recognized that the disease is not transmissible, 88.2% stated that it has no cure, and 84.5% correctly identified hypertension as being characterized by blood pressure levels ≥140/90 mmHg. Furthermore, 94.8% correctly stated that the medication dose should not be doubled after a missed dose, and 70.4% described appropriate blood pressure measurement procedures. Attitudes were generally positive, particularly regarding the commitment to avoiding a sedentary lifestyle and maintaining mental health. Conclusion: Medical students demonstrated a good level of knowledge and appropriate practices regarding hypertension prevention, although some gaps remain, particularly concerning the continuous use of antihypertensive medications and proper blood pressure measurement procedures. Future studies should expand the sample to include other institutions and regions and adopt longitudinal methodologies to assess changes in health-related behaviors over time.

Sickle Cell Cardiopathy and Rheumatic Valvular Disease: A Double Burden

Preciosa Lourenço — 2026-09-11

Introduction: Sickle cell disease (SCD) and rheumatic heart disease (RHD) are important causes of cardiovascular morbidity and mortality, particularly in low- and middle-income countries. SCD is an autosomal recessive hemoglobinopathy that causes chronic vaso-occlusion, inflammation, and multiorgan dysfunction, including cardiac involvement. Rheumatic heart disease, in turn, remains an important public health problem that predisposes patients to cardiac disease. Although their underlying mechanisms differ, the coexistence of these conditions may impose a double cardiovascular burden. Case Report: We present the case of a 20-year-old female patient with sickle cell disease who presented to the emergency department with progressive fatigue, dyspnea on moderate and minimal exertion, weight loss, and lower-limb edema. One week before admission, she had experienced feverishness, chest pain, and osteoarticular pain. On admission, she was in poor general condition, tachypneic, and showing signs of respiratory distress. Blood pressure was 116/76 mmHg, heart rate 71 bpm, respiratory rate 23 breaths/min, and oxygen saturation 94%. On cardiopulmonary examination, there were decreased breath sounds at the right lung base, prominent heart sounds with an S3 gallop, and a grade III holosystolic murmur with an opening snap over the mitral area. Laboratory tests revealed leukocytosis (21,005 cells/mm³), severe anemia (hemoglobin, 5.4 g/dL; hematocrit, 15.1%; mean corpuscular volume, 84.8 fL; mean corpuscular hemoglobin, 30 pg; mean corpuscular hemoglobin concentration, 35.4 g/dL), platelet count of 404,000/mm³, positive malaria testing with 1,000 parasites/mm³, creatinine of 1.2 mg/dL, and total bilirubin of 4.1 mg/dL. Abdominal ultrasonography revealed hepatomegaly with regular contours. Chest radiography showed cardiomegaly and an inflammatory infiltrate at the right lung base. Electrocardiography revealed signs of left ventricular overload. Echocardiography demonstrated a thickened mitral valve with rheumatic morphology, estimated pulmonary artery systolic pressure of 51 mmHg, a dilated left ventricle with a left ventricular ejection fraction of 36%, and a mild circumferential pericardial effusion measuring approximately 9 mm. Decompensated heart failure with reduced ejection fraction was diagnosed, precipitated by malaria and pneumonia. During hospitalization, the patient received ceftriaxone 1 g every 12 hours, clarithromycin 500 mg every 12 hours, antimalarial therapy, oral bisoprolol 5 mg daily, intravenous furosemide 40 mg daily, oral spironolactone 25 mg daily, and oral enalapril 10 mg daily. After 10 days of hospitalization, the patient was discharged with clinical improvement, outpatient follow-up, heart failure therapy, and intramuscular benzathine penicillin 1,200,000 IU every 21 days. Conclusion: Although traditionally considered distinct conditions, the coexistence of sickle cell disease and rheumatic valvular disease imposes a double cardiovascular burden. This case report highlights this uncommon coexistence and discusses its clinical implications in an African setting, where both diseases continue to represent important public health challenges.

The Spectrum of Cardiac Pathology in a Private Hospital in Luanda

Artur Alfredo — 2026-09-11

Introduction: Cardiovascular diseases are the leading cause of death worldwide and of mortality from chronic noncommunicable diseases in Africa. Data on their prevalence and mortality in Angola remain scarce; however, recent World Health Organization data ranked cardiovascular diseases as the eighth leading cause of death in the country in 2021, with 40.9 deaths per 100,000 inhabitants. Objective: To characterize the main causes of hospitalization and the clinical and epidemiological profile of patients admitted to the Cardiology Department of Sagrada Esperança Clinic (CSE). Methods: A retrospective descriptive study was conducted to assess the spectrum of cardiac diseases in the Cardiology Department of CSE from October 2024 to October 2025. A total of 234 patients participated in the study, with data obtained from medical records through the hospital information systems “2 Soft” and “Portia.” Patients hospitalized in the Cardiology Department during the study period were included. Patients with a hospital stay of less than 24 hours in the department were excluded. Results: There was a predominance of males (n=153; 65.4%), with a mean age of 57±14 years. Cardiovascular risk factors were present in 90% of patients (n=210), with hypertension being the most prevalent (n=96; 45.7%). Nonadherence to treatment was identified in 76 cases (38.4%). The main causes of hospitalization were heart failure (HF) (n=89; 38.0%) and acute coronary syndromes (n=46; 19.6%). Clinically, patients with HF were predominantly classified as New York Heart Association class III (n=73; 82%), hemodynamic profile B (n=75; 85.2%), American Heart Association stage C (n=86; 97.7%), and reduced left ventricular ejection fraction (n=53; 65.4%). The main complication was acute kidney injury (n=34; 14.5%). Regarding outcomes, 24% of patients developed complications (n=56), and mortality was 1.7% (n=4). Conclusion: Overall, the findings were similar to those reported in other regions of sub-Saharan Africa. Patients were predominantly relatively young, male, and hypertensive, with more than one-third demonstrating treatment nonadherence. Many presented to the hospital at advanced stages of disease, with structural and functional cardiac abnormalities leading to heart failure and generally associated with poor prognosis. Nevertheless, the rates of complications and mortality were low.

Clinical, Epidemiological, and Echocardiographic Profile of Children with Down Syndrome Followed at Luanda Pediatric Hospital

Irina Cristina Pacavira Gaspar — 2026-09-11

Introduction: Down syndrome (DS) is the most common chromosomal disorder and is strongly associated with congenital heart disease (CHD), particularly atrioventricular septal defects. In sub-Saharan Africa, epidemiological and echocardiographic data on these patients remain scarce, hindering the development of appropriate healthcare policies. Objective: To characterize the clinical, epidemiological, and echocardiographic profile of patients with DS evaluated at the Cardiology Clinic of David Bernardino Pediatric Hospital (HPDB) between June 2024 and January 2025. Methods: A retrospective, descriptive, observational study was conducted involving a sample of 117 children aged 0 to 17 years with DS who were followed at the HPDB Cardiology outpatient clinic and had undergone at least one echocardiographic examination. Sociodemographic, clinical, epidemiological, and echocardiographic data were collected using a structured form based on the Cardiology Department database, stored and analyzed using SPSS version 21 through descriptive statistics. Results: The sample was predominantly female (53.8%), with the 1–5-year age group being the most represented (41.9%). Congenital heart disease was identified in 89.7% of patients, predominantly acyanotic forms (80.3%): ventricular septal defect (27.3%), patent ductus arteriosus (21.2%), atrial septal defect (17.0%), and atrioventricular septal defect (12.8%). Cyanotic congenital heart diseases accounted for 9.4%, with Tetralogy of Fallot being the most frequent (5.8%). All patients presented characteristic facial features, and dyspnea was the most common symptom (81%). Cognitive developmental delay was present in 83.3% of cases. Pulmonary hypertension occurred in 13% of patients with CHD, and only 6.8% underwent corrective cardiac surgery. Maternal age ≥35 years was identified as a risk factor in 58.1% of cases, and overall mortality was 6.9%. Conclusions: The high prevalence of congenital heart disease among children with Down syndrome confirms the need for early cardiological assessment and echocardiography as an integral component of the clinical management of these patients. The low rate of surgical correction and the persistence of complications such as pulmonary hypertension reflect important gaps in pediatric cardiovascular care in Angola. Strengthening diagnostic capacity, specialized follow-up, and congenital cardiac surgery should be prioritized to reduce morbidity and mortality in this population.

Giant Left Atrium: A Clinical Case of Extreme Atrial Remodeling

António de Oliveira Catchuco — 2026-09-11

Introduction: Left atrial enlargement is an important marker of cardiac remodeling and is associated with an increased risk of atrial fibrillation, stroke, and cardiovascular mortality. Giant left atrium is a rare condition, generally associated with mitral valve disease, particularly of rheumatic etiology, although it may occur in different settings of chronic volume and/or pressure overload. Case Report: We report the case of a 56-year-old Black male patient with a history of long-standing hypertension, hypertensive heart disease with reduced left ventricular ejection fraction (LVEF), permanent atrial fibrillation, and previous stroke with residual motor impairment. He presented to the emergency department with a 15-day history of progressive exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and easy fatigability. On physical examination, he was conscious and tachypneic, with bilateral jugular venous distension and a positive hepatojugular reflux, and was unable to tolerate the supine position. Pulmonary auscultation revealed decreased breath sounds at the lung bases, bilateral fine crackles, and diffuse wheezing. Cardiac auscultation revealed irregular, normophonic heart sounds with a grade III/VI holosystolic murmur over the mitral area. Bilateral ankle edema and left-sided spastic hemiparesis secondary to the previous stroke were also present. Electrocardiography revealed atrial fibrillation with a ventricular rate of 78 bpm, left-axis deviation, and signs of left ventricular overload. Chest radiography showed an increased cardiothoracic ratio and signs of pulmonary congestion, without evidence of an infectious process. Transthoracic echocardiography demonstrated dilated hypertensive heart disease with reduced LVEF, right ventricular systolic dysfunction, and moderate mitral regurgitation. Marked left atrial enlargement was noted, with an area of 217.9 cm² and an estimated volume of 2,036 mL, consistent with a giant left atrium. Conclusion: Giant left atrium is a rare manifestation of chronic atrial remodeling, traditionally associated with significant mitral valve disease, particularly of rheumatic etiology. However, giant left atrium may also occur in the absence of severe mitral valve disease. In this case, the extreme atrial enlargement appears to have resulted from a multifactorial process involving hypertensive heart disease, permanent atrial fibrillation, and heart failure. Recognition of this condition should raise awareness of the high risk of complications, particularly thromboembolic events and worsening heart failure, warranting systematic clinical and echocardiographic assessment.

Cardiology in Angola: From Global Evidence to Local Reality

Mauer Gonçalves — 2026-09-11

Dear Participants of the IV Huambo Cardiology Conference – 2026,

It is with great pleasure that we welcome all participants to the Cardiology Conference, which will take place on September 11 and 12 in this historic and welcoming city of Huambo. The theme of this edition, “Cardiology in Angola: From Global Evidence to Local Reality,” reflects one of the major challenges of our practice: keeping pace with advances in global cardiology while remaining attentive to the epidemiological, social, and economic characteristics of our country.

Contemporary cardiology is evolving rapidly, with new strategies for prevention, diagnosis, and treatment, as well as increasingly sophisticated technologies. However, translating scientific evidence into better healthcare requires the ability to adapt knowledge to our realities, our needs, and the resources available to us. It is within this context that this Conference assumes particular importance. The scientific program includes 10 round-table sessions and 6 lectures, providing opportunities for updating knowledge, discussion, and the exchange of experiences among professionals from different fields. These activities are complemented by several pre-conference courses, representing a clear commitment to continuing education and the development of professional competencies.

Scientific research also holds a prominent place in this edition. Thirteen scientific abstracts were submitted, of which 10 were selected following peer review. Once again, the selected works will be published, continuing our commitment to recognizing and disseminating national scientific production. This is particularly important. Angola needs not only to apply evidence generated internationally, but also to produce evidence based on its own reality. We need to study our patients, better understand the burden of cardiovascular diseases, identify barriers to access to healthcare, and evaluate the outcomes of our interventions.

The Conference is therefore much more than a scientific update meeting. It is a space for sharing knowledge, fostering research, strengthening continuing education, and developing responses that are better suited to the cardiovascular challenges facing our country. May these two days in Huambo allow us to return to our institutions with new knowledge, new ideas, new partnerships, and, above all, a renewed commitment to the quality of cardiovascular care in Angola.

We warmly welcome you all to Huambo, the Pearl of the Central Plateau! May this Conference be a celebration of science, knowledge sharing, and our commitment to an increasingly strong, qualified, and locally adapted cardiology in Angola.

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

Luís Fernando Rosati Rocha — 2026-02-05

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

Luís Fernando Rosati Rocha — 2026-02-13

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

Luís Fernando Rosati Rocha — 2026-02-26

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.

Shock Index, FAST, and Hemostatic Resuscitation in Trauma-Induced Coagulopathy: Physiological Thresholds, Occult Shock, and Contemporary Decision-Making

Luís Fernando Rosati Rocha — 2026-03-05

Trauma-induced coagulopathy (TIC) is increasingly recognized as an early, endogenous, and pathophysiologically complex response to hemorrhagic shock, frequently preceding overt hypotension and clinical deterioration. Despite substantial advances in trauma systems, the timely identification of patients who will require massive transfusion remains a major determinant of survival. The Shock Index (SI), defined as the ratio of heart rate to systolic blood pressure, has emerged as a practical and physiologically grounded marker capable of identifying occult hypoperfusion during the compensated phase of shock. This perspective provides an in-depth discussion of SI thresholds, integration with bedside imaging, contemporary hemostatic resuscitation strategies, and the evolving role of machine learning–based decision support. Particular emphasis is placed on real-world clinical implementation across heterogeneous healthcare systems, including low-resource environments.

Obesity, Glycemic Control, and Surgical Outcomes: Exploring the Relationship Between Body Mass Index, HbA1c, and Postoperative Morbidity

Luis Fernando Rosati Rocha — 2026-05-11

Obesity and poor glycemic control are increasingly prevalent among surgical patients and are independently associated with adverse postoperative outcomes. However, their combined impact and potential synergistic effects remain incompletely understood. To critically evaluate the relationship between body mass index (BMI), glycated hemoglobin (HbA1c), and postoperative complications, with emphasis on their interaction and clinical implications. Narrative review based on analysis of key observational studies, meta-analyses, and clinical trials addressing obesity, glycemic control, and surgical outcomes. Elevated BMI and HbA1c are consistently associated with increased risk of postoperative complications, particularly infectious events and impaired wound healing. Their coexistence appears to amplify surgical risk beyond isolated effects. The combined assessment of BMI and HbA1c represents a clinically relevant strategy for perioperative risk stratification and may guide optimization of surgical patients.

Beyond BMI: Metabolic Dysfunction as the True Determinant of Surgical Risk

Luis Fernando Rosati Rocha — 2026-05-11

Body mass index (BMI) remains one of the most used variables in perioperative risk assessment, yet its ability to represent the biological complexity of obesity is increasingly questioned. Contemporary surgical patients frequently present not only excess body weight, but also varying degrees of insulin resistance, chronic inflammation, endothelial dysfunction, and impaired immune response. This perspective argues that surgical vulnerability is more accurately explained by metabolic dysfunction than by adiposity alone. We propose the concept of a metabolic risk phenotype, integrating anthropometric and biochemical variables such as BMI and glycated hemoglobin (HbA1c) into a unified framework for perioperative risk stratification. By moving beyond BMI as an isolated marker, this approach may improve the identification of high-risk patients, refine preoperative optimization, and support more personalized surgical decision-making.

Keywords: Obesity; Hemoglobin A, Glycosylated; Postoperative Complications; Surgical Outcomes; Metabolic Risk.

Metabolic Phenotype and Biological Reserve in Non-Operative Management of Perforated Peptic Ulcer: Systematic Review and Rosati's Metabolic Matrix for Hyperacute Emergency Triage

Luis Fernando Rosati Rocha — 2026-09-24

Non-operative management (NOM) of perforated peptic ulcer (PUP) presents unpredictable failure rates (10% to 50%) and associated mortality when inadequately indicated. Classical prognostic scores (Boey and PULP) rely primarily on anatomical and physiological parameters of acute response, neglecting the role of the host's metabolic reserve and body composition. This systematic review and methodological reformulation aim to establish the quantitative matrix of metabolic factors determining NOM success or failure and to propose a hyperacute triage model (< 2 hours). Furthermore, recognizing the dynamic nature of these metabolic parameters allows for serial reevaluations duringiotensin the early clinical course. A systematic review was conducted across PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library in accordance with PRISMA guidelines, resulting in the inclusion of 29 quantitative and qualitative studies (total N = 20,892 patients). Five metabolic domains were analyzed: glycemic control, visceral protein (13), CT-based sarcopenia, frailty, and immunonutritional scores. Integrated analysis revealed that anatomical sealing and the absence of diffuse peritonitis constitute absolute, non-negotiable prerequisites for NOM. Once sealing is confirmed, the metabolic phenotype acts as the primary modifier of biological resilience. Deep hypoalbuminemia (< 3.0 g/dL) and C-reactive protein-to-albumin ratio (CAR > 3.5) increase NOM failure (OR = 3.8, p<0.001) and post-operative omental patch dehiscence (18.6% vs. 3.2%, p = 0.005 in perforated gastric ulcers). L3 sarcopenia (OR=5.2, p=0.002) and the Clinical Frailty Scale (CFS≥5, OR = 4.8, p<0.001) were independent predictors of failure and 90-day mortality. Perforated gastric ulcers (PGU) demonstrated an older epidemiological profile (72 vs. 58 years), higher malnutrition, and a 10% to 12.4% risk of occult malignancy, necessitating biopsy or wedge resection and ruling out primary NOM. Integrating Rosati's Metabolic Matrix with classical scores (Boey/PULP) improves predictive accuracy for NOM failure (AUC = 0.89 vs. 0.71). The two-stage measurement strategy enables risk stratification within less than 2 hours in the emergency setting, optimizing surgical decision-making.

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

Ana Paula de Carvalho Miranda Rosati Rocha — 2026-01-14

Chain of Prevention versus Chain of Survival: Reframing Hospital Safety from Rescue to Anticipation

Esmael Tomás — 2026-06-29

The “Chain of Survival” has become one of the most influential conceptual models in resuscitation medicine, emphasizing early recognition of cardiac arrest, rapid activation of emergency systems, immediate cardiopulmonary resuscitation, defibrillation and advanced post-resuscitation care. Although this approach has contributed substantially to improvements in cardiac arrest outcomes worldwide, evidence suggests that many in-hospital cardiac arrests are preceded by hours of detectable physiological deterioration. Consequently, increasing attention has shifted toward prevention-oriented models, particularly the “Chain of Prevention”, which prioritizes early detection of deterioration before catastrophic events occur. This Perspective argues that the Chain of Prevention and the Chain of Survival should be viewed as complementary components of a unified continuum of care and examines the implications of this integrated perspective for patient safety, resuscitation science and healthcare system design. It further proposes that modern healthcare systems should evolve from predominantly reactive rescue-based paradigms toward integrated anticipatory systems capable of identifying, escalating and treating clinical deterioration at earlier stages. The article further examines the role of Early Warning Systems, rapid response teams, implementation science and health-system organization in operationalizing prevention-based models, particularly in low- and middle-income countries. Finally, the article proposes that the future of resuscitation science depends not only on improving survival after cardiac arrest but increasingly on reducing the incidence of preventable cardiac arrest itself.

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

Ana Paula de Carvalho Miranda Rosati Rocha — 2025-12-14

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

Luís Fernando Rosati Rocha — 2026-02-13

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.

Pressure Injuries and the Perspective of Forensic Nursing: A Care Management

Wanderson Santos de Farias — 2026-03-04

Pressure injuries represent frequent adverse events among hospitalized patients, particularly those in critical condition, constituting an important indicator of the quality of health care delivery. Beyond their clinical repercussions, these injuries may assume criminal-legal relevance when associated with failures in care, potentially characterizing bodily injury under Article 129 of the Brazilian Penal Code. This study aimed to analyze the applicability of Article 129 of the Brazilian Penal Code to pressure injuries in patients hospitalized in health services, from the perspective of Forensic Nursing. This is an exploratory integrative literature review conducted in the Virtual Health Library (VHL), PubMed, and Google Scholar databases, using the descriptors Pressure Ulcer, Forensic Nursing, and Wounds and Injuries. Studies published between 2021 and 2026, in Portuguese, English, and Spanish, that addressed the research objective were included. The analyzed studies indicate that pressure injuries may be legally classified as bodily injury when resulting from acts or omissions characterized by negligence, recklessness, or malpractice, particularly in contexts involving human resource shortages, failures in preventive measures, prolonged use of medical devices, and lack of adequate documentation. The role of nurses, and particularly forensic nurses, is highlighted in the assessment, classification, and technical-legal documentation of these injuries. It is concluded that Article 129 of the Brazilian Penal Code is applicable to pressure injuries when a breach of the duty of care is demonstrated, and that Forensic Nursing is fundamental to technical-legal analysis, ethical and legal accountability, and the promotion of patient safety in health services.

Relationship Between COVID-19 and Cardiovascular Disease in Critically Ill Patients: A Systematic Review of the Literature

Sergio Andrés Puerto Horta — 2026-03-06

Cardiovascular complications are frequently reported in patients with severe COVID-19; however, their spectrum and clinical relevance in critically ill patients have not been fully characterized. To systematically review the literature to identify the main cardiovascular complications occurring in patients with severe COVID-19 admitted to intensive care units (ICUs). A systematic search of three electronic databases was conducted from December 1, 2019 to December 31, 2025. Observational studies including adult patients with severe COVID-19 admitted to ICUs and reporting cardiovascular complications were eligible, without language restrictions. Study selection and qualitative synthesis were performed according to predefined criteria. The primary outcomes were pre-existing cardiovascular comorbidities and cardiovascular complications occurring during ICU stay. Eight observational cohort studies met the inclusion criteria. A high prevalence of baseline cardiovascular comorbidities was consistently reported, particularly arterial hypertension, obesity, smoking history, and diabetes mellitus. The most frequently described cardiovascular complications in critically ill patients included circulatory failure, thromboembolic events, myocardial injury, cardiac arrhythmias, and cerebrovascular events. The reported frequency of these complications varied across studies. Cardiovascular complications are common among critically ill patients with COVID-19, with circulatory failure and thromboembolic and arrhythmic events being the most consistently reported. These findings highlight the need for early cardiovascular monitoring and multidisciplinary management in this population.

Viscoelastic-Guided Hemostatic Resuscitation in Trauma: From Endothelial Endotype to System-Level Precision

Luis Fernando Rosati Rocha — 2026-03-07

Trauma-induced coagulopathy (TIC) is a biologically heterogeneous and rapidly evolving response to severe injury characterized by endothelial dysfunction, dysregulated thrombin generation, platelet impairment, and divergent fibrinolytic phenotypes. While balanced transfusion strategies have improved early hemorrhage control, they do not fully account for the phenotypic variability observed in TIC. Viscoelastic hemostatic assays (VHA), including thromboelastography and rotational thromboelastometry, provide real-time assessment of clot formation, strength, and fibrinolysis, enabling targeted hemostatic resuscitation. However, randomized trials have demonstrated improvements in transfusion targeting without consistent reductions in overall mortality. This structured narrative review synthesizes contemporary evidence on the biological mechanisms of TIC, fibrinolytic endotypes, and the role of viscoelastic testing in trauma resuscitation. A systematic search of PubMed/MEDLINE, Scopus, and Web of Science from January 2000 to February 2026 was performed, prioritizing landmark randomized trials, mechanistic studies, and international guidelines. The literature suggests that the effectiveness of VHA-guided resuscitation is influenced not only by diagnostic capability but also by the interaction between biological phenotype, timing of intervention, and trauma system performance. A hybrid model integrating early empiric balanced transfusion with subsequent phenotype-guided calibration may represent the most physiologically coherent strategy. Ultimately, viscoelastic testing should be understood as a decision-support modality embedded within mature trauma systems rather than a standalone determinant of survival. Future research should focus on phenotype-stratified clinical trials and system-integrated approaches capable of translating hemostatic precision into consistent outcome improvement.

Precarious Work and Occupational Health in Contemporary Dentistry: An Integrative Review (2013-2025)

Luth Savy de França Costa — 2026-04-27

Dentistry combines intense biomechanical exposure with growing psychosocial and organizational pressure. To synthesize evidence on precarious work and occupational health in dentistry and compare Brazilian and international findings. An integrative review with a PRISMA-informed selection flow was conducted in PubMed/MEDLINE, SciELO, and BVS/LILACS on 27 March 2026 for studies published from 2013 to 2025. Backward citation tracking complemented database searches. Eligible studies addressed dentists or dental staff and examined musculoskeletal, psychosocial, autonomy-related, or labor-market outcomes. Nineteen studies were included. Seven focused on musculoskeletal and ergonomic outcomes, nine on burnout, stress, or job satisfaction, and three on precarization, autonomy, or ethical strain. Musculoskeletal disorders remained highly prevalent, while meta-analyses estimated burnout prevalence at 13%. Brazilian studies added evidence on low reimbursement, loss of autonomy, and harassment in supplemental care and popular clinics. Occupational illness in dentistry is produced by both biomechanical exposure and labor organization. Prevention should integrate ergonomic protection with regulation of workload, remuneration, and clinical autonomy.

Influence of Extracorporeal Circulation on The Inflammatory Cascade

Juliana Bezerra Frota Oliveira — 2026-07-07

Extracorporeal circulation (ECC) represents a major technological advance in modern cardiac surgery, enabling complex procedures by temporarily replacing cardiac and pulmonary functions. However, its use is closely associated with a multifactorial systemic inflammatory response that contributes to several postoperative complications, such as multiple organ dysfunction, bleeding, acute kidney injury, neurological changes, and pulmonary inflammation. This narrative literature review aimed to analyze the main pathophysiological mechanisms involved in the inflammatory activation induced by ECC, as well as to discuss strategies for modulating this response. Topics addressed include activation of the complement system, release of pro-inflammatory cytokines (such as IL-6 and TNF-α), leukocyte recruitment, and the impact of mechanical, hemodynamic, and biochemical factors occurring during the procedure. Furthermore, the study explores technological advances aimed at mitigating these effects, including the use of heparin-coated circuits, biocompatible membrane oxygenators, cytokine hemoadsorption, thermal control, pharmacological strategies with corticosteroids, anti-inflammatory agents and antioxidants, as well as minimally invasive approaches (MiECC) and individualized nutritional support. The rational use of these strategies is essential to reduce morbidity and mortality, shorten hospital stays, and improve clinical outcomes in patients undergoing cardiac surgery with ECC. This review also highlights the need for further clinical studies to support greater standardization of therapeutic approaches, especially regarding drug selection, optimal ECC duration, the impact of circuit coatings, and interdisciplinary integration between perfusionists, surgical teams, and intensive care providers. A multidisciplinary approach is key to developing safer, more effective, and personalized practices. The data synthesized here reinforces the critical role of understanding inflammatory mechanisms and implementing advanced technologies and nutritional interventions as strategies to optimize surgical patient care.

Use of the Lateral Thoracodorsal Flap for Post-Mastectomy Breast Reconstruction

Ana Liz Faria Bittencourt — 2026-07-28

Breast cancer is the most common malignancy among women and represents a major public health concern. With the advancement of breast-conserving surgery and oncoplastic breast surgery, breast reconstruction has become an integral component of surgical treatment, aiming to combine oncological safety with satisfactory aesthetic and functional outcomes. In this context, thoracolateral flaps, particularly the lateral thoracodorsal flap, have emerged as important options for partial breast reconstruction and the correction of small- to medium-volume defects. This study aimed to analyze, through a systematic review of the literature, the use of these flaps in breast surgery, with emphasis on their indications, surgical techniques, and clinical applicability. The findings demonstrate that this technique is associated with low morbidity, high reproducibility, and high patient satisfaction rates, being particularly suitable for small- to medium-volume breast reconstructions, especially following breast-conserving surgery and for defects located in the lateral breast quadrants. Furthermore, patient selection, surgical planning, and technical variations directly influence both clinical and aesthetic outcomes. In conclusion, the lateral thoracodorsal flap represents an effective, safe, and versatile option for oncoplastic breast reconstruction, providing favorable functional and aesthetic results when used in appropriately selected patients.

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

Mauer Alexandre da Ascensão Gonçalves — 2025-09-10

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

Howard Lopes Ribeiro Junior — 2025-09-10

Not applicable

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

Mauer Alexandre da Ascensão Gonçalves — 2025-09-10

Cardiovascular Health in Africa: The Long Road Toward Sustainable Solutions

Humberto Morais — 2025-09-10

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.

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

Aurora Cassoco — 2025-10-14

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

Neida Neto Vicente Ramos — 2025-10-24

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

Carmel Helena Vita — 2025-11-08

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

Catarina David — 2025-11-11

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

Capela António Dicazeco Pascoal — 2025-11-25

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

Márcio Arsénio Silva — 2026-01-20

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.

Perception of Physicians' Knowledge Regarding Guidelines and Clinical Practice in Prescribing Diagnostic Imaging Exams at a Hospital in Luanda, Angola

Helder Nguto — 2026-03-09

This study aimed to assess physicians' perceptions of their knowledge of guidelines and clinical practice in prescribing imaging exams. A cross-sectional study was conducted from October to December 2025 at the Military Hospital in Luanda, Angola. Data were collected through an online questionnaire, the link to which was shared in several WhatsApp groups of physicians. The chi-square or Fisher's exact test, univariate and multivariate logistic regression analyses were used. A p-value <0.05 was considered significant. A total of 109 physicians participated in the study, 53.2% were women, with a mean age of 35.8±7.7 years and 78.0% were resident physicians. Of those, 51.4% had never heard of the guidelines, and 60.6% had inadequate knowledge regarding questions about the exams that use ionizing radiation. Specifically, 33.9% and 19.3% incorrectly stating that computed tomography and radiography, respectively, do not use ionizing radiation, and 34.9% incorrectly stating that magnetic resonance imaging does use it, without significant differences between being a specialist or resident, or having specific training in prescribing imaging exams or in radiation protection. A major investment in training and awareness among physicians is necessary to avoid the indiscriminate and incorrect use of imaging exams, service overload, and increased healthcare costs.

Therapeutic Adherence of Hypertensive Patients Attended at the Outpatient Clinic of a Specialized Hospital in Luanda

Áurea Patrícia Oliveira — 2026-03-24

Therapeutic adherence rates in arterial hypertension range from 15.2% to 90%, depending on the region studied. Poor adherence compromises clinical outcomes and quality of life, increasing morbidity, mortality, and healthcare costs. This study evaluated therapeutic adherence among hypertensive patients attending the outpatient clinic of a specialized hospital in Luanda during the fourth quarter of 2024. This was an observational, cross-sectional study with a convenience sample of 130 patients. Sociodemographic, behavioral, and clinical variables were analyzed, as well as adherence level according to the Morisky scale, whose internal consistency in this sample was confirmed by a Cronbach’s alpha of 0.735. The Kolmogorov–Smirnov test was used to assess variable distribution; mean and standard deviation were used for normally distributed continuous variables, and relative frequencies for categorical variables. The correlation between adherence levels and other variables was evaluated using Spearman’s coefficient, and ordinal logistic regression analysis was performed to identify predictors of adherence. The mean age was 59.25 ± 10.8 years; most participants (43.8%) were over 60 years old and female (66.9%). Participants were predominantly married (59.2%), had secondary education (24.6%), and a monthly income equivalent to 1–2 minimum wages (67.7%). When applying the Morisky adherence scale, which demonstrated good psychometric properties in this sample, the majority (89.2%) were classified as non-adherent. The main predictors of adherence were age (older age associated with better adherence) and monthly income, with lower-income patients showing lower adherence. Therapeutic adherence was low. Age and household income were the main predictors of therapeutic adherence.

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

Gabriel Santos da Silva — 2025-09-10

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

Maria Regina Pereira de Godoy — 2025-09-16

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

Ana Paula Fernandes Silva — 2025-11-03

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

Guilherme Simas do Amaral Catani — 2025-11-06

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.

Clinical and Epidemiological Characteristics of Lymph Node Tuberculosis: A Retrospective Observational Study

João Kleber de Almeida Gentile — 2026-03-05

Lymph node tuberculosis is the most common form of extrapulmonary tuberculosis and remains a diagnostic challenge due to nonspecific clinical manifestations and low microbiological confirmation rates. To describe the clinical, epidemiological, and diagnostic characteristics of patients with lymph node tuberculosis and to evaluate associations between clinical variables, lymph node localization, and short-term outcomes. A retrospective observational study was conducted including 66 patients diagnosed with lymph node tuberculosis. Demographic, clinical, histopathological, and microbiological variables were analyzed. Associations between categorical variables were assessed using Pearson’s chi-square or Fisher’s exact test, and age comparisons were performed using one-way ANOVA or Kruskal–Walli’s test. The mean age was 38.1 ± 11.6 years, and 54.5% of patients were male. Constitutional symptoms were present in 92.4% of cases, while cough was absent in most patients (92.4%). Cervical lymph nodes were the most frequently affected (48.5%). Caseating granuloma was identified in 7.6%, and mycobacterial culture was positive in 27.3%. Significant associations were observed between lymph node localization and sex, constitutional symptoms, and histopathological findings (all p < 0.001). Lymph node tuberculosis predominantly affects young adults and presents mainly with systemic symptoms and cervical lymphadenopathy. Despite limited diagnostic confirmation, short-term outcomes were favorable.

Comparative Effectiveness of Esomeprazole versus Vonoprazan for Helicobacter pylori Eradication: A Multicenter Retrospective Cohort Study in Brazil

João Kleber de Almeida Gentile — 2026-06-25

Helicobacter pylori infection remains a major public health concern and an important risk factor for peptic ulcer disease and gastric cancer. Although proton pump inhibitor (PPI)–based triple therapy has been the standard first-line treatment, eradication rates have declined due to antibiotic resistance and variable acid suppression. Vonoprazan, a potassium-competitive acid blocker (P-CAB), provides more potent and sustained acid inhibition; however, real-world data from Latin American populations are limited. To compare the effectiveness and safety of vonoprazan-based versus esomeprazole-based triple therapy for first-line Helicobacter pylori eradication in Brazil. A multicenter retrospective cohort study was conducted including 200 adult patients treated in three Brazilian tertiary centers between 2020 and 2023. Patients received 14-day triple therapy with either esomeprazole 40 mg twice daily or vonoprazan 20 mg twice daily, combined with amoxicillin and clarithromycin. H. pylori eradication confirmed by histology eight weeks after treatment was the primary outcome. Secondary outcomes included retreatment rates, adverse events, and treatment adherence. Multivariable logistic regression was used to adjust for potential confounders. Eradication rates were significantly higher in the vonoprazan group compared with the esomeprazole group (94.0% vs. 68.0%, p<0.001), with lower retreatment rates (6.0% vs. 32.0%, p<0.001). After adjustment for age and sex, vonoprazan-based therapy remained independently associated with eradication success (adjusted OR 7.24; 95%CI 3.12–16.81). Adverse event rates were similar between groups, with no severe events reported. In this multicenter real-world cohort, vonoprazan-based triple therapy was associated with significantly higher H. pylori eradication rates compared with esomeprazole-based therapy in Brazilian patients.

Quality of Oral Anticoagulation Control with Warfarin in Patients Followed at the Hematology Service of a Public Referral Hospital in Fortaleza, Ceará, Brazil: A Retrospective, Single-Center, Exploratory Study

Pedro Everson Alexandre de Aquino — 2026-08-05

Warfarin, a vitamin K antagonist, remains widely prescribed within resource-limited public health systems, but its narrow therapeutic index requires close monitoring through the International Normalized Ratio (INR) and the Time in Therapeutic Range (TTR). Real-world data on warfarin control within the Brazilian Unified Health System are scarce. We conducted a retrospective, single-center, exploratory observational study, reported following STROBE, to describe the quality of anticoagulation control in patients on chronic warfarin therapy at a public referral hematology service in Fortaleza, Brazil. Between August and September 2023, the longitudinal records of 34 adult patients (a convenience sample; about 12% of clinic warfarin users) were reviewed, comprising 879 PT/INR determinations analyzed against a target range of 2.0–3.0; TTR was estimated as the proportion of determinations within range. No sample-size calculation was performed, and analyses were descriptive. Approximately half of the determinations (456/879; 51.9%) were in range, and approximately one-third of patients (12/34; 35.3%) achieved a TTR above 60%, indicating predominantly suboptimal control. No thromboembolic events occurred during warfarin therapy; 28 patients (82.4%) self-reported adherence difficulties. These findings do not establish effectiveness but highlight the need to strengthen monitoring, adherence support, and multidisciplinary anticoagulation care. Results are hypothesis-generating.