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Scientific judgment cannot be replaced by artificial intelligence
Resistance to the use of artificial intelligence (AI) in scientific writing is often grounded not in technophobia but in concerns about the role of intellectual effort in the development of scientific reasoning, particularly among non-native English-speaking researchers. Writing for international peer-reviewed journals is a demanding and formative process through which authors develop conceptual clarity, argumentation, and an identifiable authorial voice. This article examines the practical use of AI during the preparation of responses to reviewers in manuscripts submitted to international journals. Two real cases are analyzed: one involving conceptual clarification about stroke-related mobility measurement and another concerning statistical reasoning and variable selection in regression analysis. In both situations, AI produced grammatically fluent but generic responses that failed to address the underlying scientific logic of the reviewer’s critique. In contrast, the final author responses required explicit articulation of methodological decisions and theoretical reasoning. These examples illustrate that while AI may assist with language refinement and structural editing, it cannot replace scientific judgment or the reasoning processes that precede writing. Empirical evidence from controlled comparisons of human-written, AI-generated, and AI-assisted review articles supports this distinction, showing that AI may reduce writing time but still requires extensive human fact-checking and revision. The implications are particularly significant for students and early-career researchers, for whom writing is a central component of learning how to think scientifically. Premature reliance on AI may produce fluent text while interrupting the development of intellectual independence and authorial voice. AI can therefore be most beneficial after a researcher has already developed a clear conceptual writing style through years of training, supervision, and scholarly practice. In this context, AI may enhance clarity and efficiency, especially for non-native English speakers, without replacing the human reasoning that underpins scientific knowledge. Writing may be accelerated, but thinking remains an irreducibly human process.
Copyright (c) 2025 Brazilian Journal of Health Research https://creativecommons.org/licenses/by-nc-nd/4.0
Granulomatous lymphocytic interstitial lung disease in a patient with Sjögren’s Disease
Introduction: Sjögren’s Disease (SjD) is a multisystem autoimmune disease that can affect the lungs, leading to interstitial lung disease (ILD). Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) is a rare form of ILD, commonly associated with Common Variable Immunodeficiency (CVID), but rarely described in cases of secondary immunodeficiency. Case report: We present the case of a 51-year-old female patient diagnosed with SD in 2021, who developed Nonspecific Interstitial Pneumonia (NSIP). After treatment with Cyclophosphamide and Mycophenolate Mofetil, the patient developed hypogammaglobulinemia, without fulfilling CVID criteria, suggesting secondary immunodeficiency. In 2024, decreased pulmonary function and nodular consolidations appeared in the lung bases. Pulmonary biopsy revealed lymphocytic and granulomatous infiltration, confirming GLILD. Following treatment with corticosteroids and Rituximab, the patient showed a good initial response. Discussion: Although the overlap of SjD and CVID has been described, no reports of GLILD in patients with SjD, with or without CVID, have been identified to date. Hypogammaglobulinemia in SjD is recognized as a clinical manifestation and a marker of disease activity. Pulmonary biopsy plays a key role in differentiating forms of ILD in patients with autoimmune diseases and immunodeficiencies. Conclusion: This case highlights the importance of considering GLILD as a differential diagnosis of ILD in patients with SjD and hypogammaglobulinemia, even in the absence of CVID. A multidisciplinary approach and histological investigation were essential for appropriate management and contributed to the favorable outcome of the patient.
Dossier: Medical Residency Commission (COREME-HUCAM)
Maria Carmen Lopes Ferreira Silva Santos
Copyright (c) 2024 Brazilian Journal of Health Research https://creativecommons.org/licenses/by-nc-nd/4.0
Evaluation of the efficiency and tolerability of colonoscopy preparation with lactulose
Introduction: Colonoscopy is the most important method for screening colorectal cancer by detecting and excising polyps. High-quality bowel preparation is essential to consider the examination effective and allow therapeutic interventions. Objective: To evaluate the efficiency and tolerability of colonoscopy preparation with 12.5% ​​lactulose and the polyp detection rate in cancer screening colonoscopy. Methods: Cross-sectional and retrospective study of 27 medical records of patients who underwent elective colonoscopy in the “Blue March” campaign at the Cassiano Antonio Moraes University Hospital, in March 2024. The Boston Bowel Preparation Scale (BBPS) assessed the quality of colon preparation and a questionnaire applied after the examination verified tolerability. Results: The quality of preparation was considered excellent in 24/27 cases (88%); polyps were detected in 18/27 patients (66.7%), of which 9 were adenomas (33%); One patient had advanced colorectal carcinoma and underwent surgery, and one patient had a polyp with high-grade dysplasia. One diagnosis of schistosomiasis was made. As side effects, nausea/vomiting was reported in 5 patients, anal irritation (4), dry mouth (3), and abdominal distension in only 1 case. All patients approved the preparation and stated that they would repeat it if necessary. Palatability was only considered poor in 3 cases. Conclusion: The polyp detection rate was higher than expected, the colon preparation was considered good/excellent, and the study concludes that the 12.5% ​​Lactulose solution can be indicated as an option for colon preparation for colonoscopy exams, respecting its contraindications and restrictions.
Correlation between ultrasonographic and cytopathological findings obtained by fine needle aspiration biopsy in the evaluation of thyroid nodules
Introduction: Thyroid nodules are prevalent, being identified by palpation in 4% to 7% of adult women and 1% of adult men and by ultrasonography (US) in 20% to 68% of patients. The incidence of thyroid cancer is approximately 24/100,000 population. It is important to define which nodule requires fine needle aspiration biopsy (FNAB) and which should be monitored. Objectives: To correlate the findings of the ultrasound aspects obtained by the TI-RADS classification with the data obtained by the cytopathological classification (Bethesda) of thyroid nodules that underwent FNAB. Methods: Retrospective, descriptive and cross-sectional study, in which the electronic medical records of ultrasound examination reports of patients with thyroid nodules and indication for FNAB were analyzed, in a clinic in Vitória/ES, between January/2023 and June/2023. Results: A total of 777 nodules in 659 patients (538 women and 121 men) were analyzed. The mean age was 51.94 years. Most nodules were larger than 1.0 cm and classified as TI-RADS 3 (74.5%), followed by classification 4 (14.5%), 2 (7.3%) and 5 (3.6%). An association was found between TI-RADS and the Bethesda classification (p<0.001). Most individuals with TI-RADS 2 or 3 presented Bethesda 2 results (91.2% and 82.6%, respectively). Of those classified as TI-RADS 4 and 5, most presented Bethesda III, IV, V or VI (45.1% and 81.4%). The proportion of malignancies among TI-RADS 2 was 1.7% and TI-RADS 3 was 10.0%. Conclusion: An association between TI-RADS and Bethesda was observed, confirming the importance of its use. The TI-RADS classification is appropriate to avoid unnecessary procedures.
Successful oral desensitization to voriconazole in a patient with fungal arthritis caused by Exophiala sp.
Introduction: The impossibility of treatment due to allergy to antimicrobials is a major limitation in the treatment of infections. In these cases, desensitization becomes an alternative, especially when dealing with etiological agents with few treatment options available. Methods: Report of a successful case of desensitization to voriconazole, orally. Case report: We report the case of a 61-year-old man with systemic lupus erythematosus who developed fungal arthritis caused by exophiala sp., during treatment with voriconazole he developed erythematous skin lesions. With the discontinuation of voriconazole, the lesions improved, however, the change to itraconazole was not effective in treating the infection. Conclusion: Therefore, it was decided to carry out desensitization to voriconazole, which allowed a gradual increase in the dose of the antifungal with good tolerance to the treatment.
Introduction: Direct Oral Anticoagulants (DOACs), represented by dabigatran, apixaban, rivaroxaban, and edoxaban, are widely used in the treatment of venous thromboembolism and the prevention of embolic events associated with atrial fibrillation. This article addresses the applicability of these medications in these conditions as well as in other clinical situations. Objective: To review the use of direct oral anticoagulants in deep vein thrombosis and discuss their growing application in cardiovascular prevention and the management of claudication, analyzing benefits and limitations in different clinical groups. Methods: Literature review of selected articles from PubMed and Clinical Guidelines. Results: DOACs have become the mainstay in the treatment of venous thromboembolism, enabling outpatient management of many of these cases from diagnosis. Their applicability extends to oncology patients with thrombosis, orthopedic surgical prophylaxis, cardiovascular prevention, and peripheral arterial disease. Despite the need for dose adjustments in special groups, such as chronic kidney disease patients, and restrictions in populations like pregnant women, lactating women, those with antiphospholipid syndrome, or dialysis patients, these medications have gained increasing clinical relevance. Conclusion: Since their approval, DOACs have gained popularity. In addition to treating deep vein thrombosis, they can be used for cardiovascular prevention and the symptomatic relief of intermittent claudication. However, the need for further studies remains to expand their safety and application in specific patient groups.
Clinical response to the CHAPRR protocol in refractory livedoid vasculopathy
Introduction: Livedoid vasculopathy is a chronic and recurrent thrombo-occlusive vascular disease of the distal lower limbs and feet that can lead to the formation of ulcers. Connective tissue diseases, antiphospholipid antibody syndrome, systemic vasculitis and neoplasms may be associated. Treatment is challenging, as the pathophysiology of the lesions involves multiple mechanisms. Case report: we report the case of a middle-aged woman diagnosed with livedoid vasculopathy, a clinical condition that is difficult to manage, with remission of skin lesions after the introduction of the CHAPRR regimen (calcium channel blocker, hydroxycloquine, AAS, pentoxifylline, rivaroxaban and Rituximab). Conclusion: As it is a rare entity, there is no defined consensus on its treatment, therefore the relevance of the topic exemplified in this case report is emphasized.
Introduction: Popliteal artery aneurysm is the most common peripheral arterial aneurysm, although rare in the general population, and carries a high risk of severe complications, especially when rupture occurs. Objectives: To report the case of a patient with a ruptured popliteal artery aneurysm, describing the clinical presentation, diagnostic imaging findings, and therapeutic management. Methods: Case report of an 83-year-old male patient with multiple comorbidities, admitted with intense pain and a pulsatile mass in the right popliteal fossa; clinical examination, Doppler ultrasonography, CT angiography, and arteriography were performed for diagnostic confirmation, followed by open surgical repair with revascularization. Results: Imaging revealed a 9-cm popliteal aneurysm with contained rupture extending to the tibioperoneal trunk; the patient underwent a superficial femoral–posterior tibial bypass using reversed ipsilateral great saphenous vein, hematoma evacuation, and drainage. He showed satisfactory postoperative vascular recovery and graft patency, later developing limb lymphedema and surgical-site infection requiring readmission and clinical management, with good final evolution. Conclusion: A ruptured popliteal artery aneurysm is a vascular emergency with high risk of limb loss and death, requiring early diagnosis and immediate surgical intervention; open repair with revascularization proved effective, highlighting the importance of prompt management and postoperative follow-up to prevent further complications.
Introduction: Diseases associated with the carotid arterial system have become more prevalent, likely due to the increased availability of complementary diagnostic tests. Atherosclerotic disease stands out as the leading cause of clinical complications, particularly in stroke cases. However, congenital alterations are relevant and often remain asymptomatic until diagnosis. Internal carotid artery agenesis is rare and often diagnosed incidentally, yet holds significant clinical importance. Cerebral blood flow is typically maintained by compensatory mechanisms, such as the formation of collateral circulations through the Circle of Willis, persistence of embryonic arteries, or transcranial collaterals from the external carotid artery. Following diagnosis, it is essential to investigate the encephalic and carotid vascular system, as other malformations or anomalies may be present. Case report: A 52-year-old female patient, hypertensive and diabetic, in whom left internal carotid artery agenesis was diagnosed incidentally, highlighting the clinical significance of this condition and the importance of appropriate management and follow-up guidance. Conclusion: Internal carotid artery agenesis, although frequently asymptomatic, can be associated with severe complications such as aneurysms. Early diagnosis through imaging is crucial to differentiate from acquired stenosis and prevent complications, especially in patients with severe atherosclerosis. A thorough investigation of the carotid arteries allows for proper management and the selection of the correct treatment.
Invasive gastric carcinoma with metastasis to the small intestine and colon simulating stenosing Crohn disease
Introduction: Signet ring cell gastric cancer is an aggressive neoplasm, with rare metastases to the intestines. However, when it occurs, it can cause intestinal subocclusion syndrome, although it can generate nonspecific symptoms, which makes diagnosis difficult. Objectives: Report a rare case of gastric cancer with metastases to the small intestine and colon, simulating Crohn's disease, thus helping physicians to broaden their vision for differential diagnoses when faced with similar cases. Methods: Data collection from the patient's medical records. Case presentation: Woman, 71 years old, with recurrent intestinal subocclusion and unintentional weight loss, with severe impairment of nutritional status. Colonoscopy showed an insurmountable stenosing lesion in the right colon, in addition to abdominal tomography showing stenosis of small bowel loops with upstream dilatation and colonic stenosis associated with signs suggestive of a local inflammatory process. Upper digestive endoscopy showed ulceroinfiltrative lesion in the gastric antrum with histopathology indicative of invasive signet ring cell gastric carcinoma. The patient was not clinically fit for curative chemotherapy or surgical treatment, and an attempt at strictureplasty and/or enterectomy was chosen to improve the quality of life. However, exploratory laparotomy revealed intestinal metastases secondary to gastric neoplasia, and the diagnosis of Crohn's disease was ruled out. Conclusion: Despite being a rare presentation, intestinal metastasis from gastric cancer can occur and simulate other conditions, such as Crohn's disease, becoming a diagnostic challenge, especially when it affects loops of the small intestine.
Adolescent with Prader-Willi Syndrome, superobesity, and associated comorbidities
Introduction: Prader-Willi Syndrome (PWS) is the most common syndromic form of obesity, caused by the absence of the expression of paternally active genes on chromosome 15q11.2-q13. Its features include hyperphagia, early-onset obesity, hypogonadism, developmental delay, behavioral changes, and characteristic facial traits. Neonates typically present with hypotonia and feeding difficulties. Case Report: A 15-year-old patient diagnosed with PWS through the absence of the paternal allele. Since the first year of life, the patient presented an ascending weight curve, leading to superobesity, hypertension, diabetes, and sleep apnea. The patient also developed anxiety disorders, depression, severe food compulsions, and mobility difficulties. During hospitalization, nutritional control, behavioral therapy, and continuous positive airway pressure (CPAP) were initiated. Conclusion: Comorbidities associated with PWS require integrated multidisciplinary management. The patient’s superobesity was exacerbated by poor therapeutic adherence and familial challenges in managing hyperphagia, highlighting the importance of personalized interventions to improve quality of life.
Perfil clínico-epidemiológico de prematuros con leucomalacia periventricular y hemorragia peri-intraventricular en un programa de seguimiento.
Introduction: Premature infants account for 10% of births, with a gradual reduction in their mortality due to improved care and technologies, but there is an increase in chronic morbidities. Neonatal brain alterations can contribute to worse neurodevelopmental outcomes, such as peri-intraventricular hemorrhage (PIVH) and periventricular leukomalacia (PVL), making it important to understand the profile aimed at quality of care. Objectives: To describe the clinical-epidemiological profile of premature infants with PIVH and PVL in the follow-up clinic for at-risk newborns (follow-up). Methods: Cross-sectional, retrospective and documentary study of premature infants in the follow-up program with HPIV and LPV diagnosed in the neonatal period, from October 2020 to September 2021. Results: Among 110 patients with neuroimaging, 47 had alterations (42.73%), with 11 (23.40%) being severe (PIVH grade III or IV or PVL). The average maternal age was 30.63 years (±7.21), with 53.19% having incomplete prenatal care, twins in 23.4%, and cesarean delivery in 53.19%. The gestational age at 28 to 31 weeks accounted for 59.67%, with a need for neonatal resuscitation in 46.81%. The average weight was 1394 grams (±438.37), appropriate for gestational age in 80.85%, with prolonged hospitalization greater than 60 days in 31.91% (average of 56.74 days), with invasive mechanical ventilation for an average of 8.57 days. Conclusion: Aproximately 40% of the patients in follow-up had some neonatal intracranial lesion, mostly moderate preterm infants, with incomplete prenatal care, non-twin, with very low birth weight but appropriate for gestational age. We emphasize the importance of performing neonatal neuroimaging in at-risk patients, which may be correlated with unfavorable neurodevelopmental outcomes.
Clinical features, prognostic factors, and treatment response in severe acute colitis
Introduction: Severe acute colitis is an important complication of inflammatory bowel disease and an emergency in Gastroenterology. Objective: To analyze a case series of severe acute colitis patients admitted to a tertiary hospital in 2023 and 2024. Methods: A retrospective study of the epidemiological characteristics, prognostic factors, therapeutic response, and clinical outcomes of 12 patients with severe acute colitis. Results: Mean age was 44.5 years (±18.9); average hospitalization time was 17 days; 7 female patients; 5 with Crohn's disease and 7 with ulcerative colitis; fulminant colitis occurred in 2 cases. Mean albumin was 3 g/mL, with 6 patients having albumin ≤ 2.9 g/mL and 6 patients having albumin > 3.0 g/mL. Younger patients had lower albumin levels, but this difference was not statistically significant (p=0.08). The mean initial C-reactive protein (CRP) was 93.4 mg/L and was higher in patients with deep ulcers (p=0.03); after 3 days of corticosteroid treatment, the mean CRP was 35.5 mg/L. Seven patients did not respond to corticosteroids and received rescue therapy: 4 with infliximab (all responded) and 3 with tofacitinib (only 1 responded). Three patients tested positive for Clostridioides difficile; there were no cytomegalovirus infections, and 3 patients developed deep vein thrombosis. Colectomy was performed in 3 patients (2 who were refractory to corticosteroid treatment and rescue therapy, and 1 who had toxic megacolon). Conclusions: Management of severe acute colitis represents a challenge in clinical practice. Recognizing prognostic factors, criteria for treatment failure with corticosteroids, options for rescue therapies, as well as the timing and indications for surgery, are crucial for clinical outcomes.
Inflammatory bowel disease in pediatrics and its particularities
Introduction: Inflammatory Bowel Diseases (IBD) are chronic and idiopathic diseases that involve an inflammatory process in the gastrointestinal tract, with periods of exacerbation and remission. They include Crohn's Disease (CD) and Ulcerative Colitis (UC). In pediatrics, they present with initial symptoms of greater severity and extent. In recent years, there has been an increase in incidence among younger children and, despite the early onset, most are diagnosed at later stages. The objective of this study is to present a series of cases of children and adolescents with IBD, admitted in 2023 to the pediatric ward of a university hospital in Espírito Santo. Six patients were selected, 3 females and 3 males, 2 diagnosed with UC, 3 with CD, and 1 with very early onset IBD. Ages ranged from 10 months to 16 years. Discussion: Given the increased incidence of IBD in the pediatric age group, its more severe presentation in childhood and its chronic evolution, early diagnosis becomes essential, but due to the different forms of clinical presentation, difficulties in making an adequate diagnosis may occur. Conclusion: The description of the particularities of each clinical case presented in this work can contribute to the development of more effective actions related to the comprehensive care of children with IBD. This includes promoting early diagnosis and implementing rapid and effective interventions, minimizing the impact on the quality of life of patients and their families.
Profile of patients treated by the palliative care team in the gastroenterology ward of a tertiary hospital
Introduction: Palliative care is a competence of gastroenterology, considering mainly chronic diseases and neoplasms treated by the specialty. Care is often provided by the attending physician, but specialized professionals have a broader view of the needs and conduct with patients and caregivers. Objectives: To analyze requests for interconsultations with the palliative care team for patients with gastroenterological diseases in a tertiary hospital, for 01 year. Methods: Longitudinal, retrospective study, evaluating data from patients with interconsultations for palliative care, comparing with those without interconsultation. Results: only 10.1% of the 336 patients received interconsultations, answered within 24 hours. Patients with consultation-based intervention were older than the others (63.5 x 54.7 years – p<0.001), had a longer hospital stay (22 x 13 days – p<0.001), and there was no difference in gender. 42% died (15/34 x 15/302 – p<0.001). Only 16 of the 154 cirrhotic patients (10.4%) and 1 of the 32 patients with inflammatory bowel disease received consultation-based intervention, while 39.1% and 41.1% with neoplasia and cirrhosis associated with hepatocellular carcinoma were evaluated. Severely impaired clinical functionality was observed on 12/27 (44.5%). Discussion: Even though it is a hospital unit that has a palliative care team, the gastroenterology service requested few opinions for chronic and disabling diseases, a result not observed in the request for consultation-based intervention for oncological diseases. Conclusion: Increasing interdisciplinarity between gastroenterology and the team specialized in palliative care may provide shared objectives in improving quality of life, preventing and alleviating suffering, with an approach centered on the person with serious health-related suffering.
Palliative approach to symptom control and planning for patients with chronic liver disease, inflammatory bowel disease and in need of endoscopic procedures
Introduction: Palliative care requires an interdisciplinary approach to prevent and alleviate diseases that cause suffering, meeting physical, psychosocial, and spiritual demands, as well as health care resources, to improve the quality of life of patients, families, and caregivers. The gastroenterology specialty treats complex chronic diseases and has an interface with other specialties, including many endoscopic procedures frequently requested in neoplastic, neurological, and other patients. Objectives: To develop an article describing the main situations in the daily practice of a gastroenterologist and the necessary palliative care skills. Methodology: Search for works with the terms “Palliative Care”, “Gastroenterology”, “Digestive Endoscopy”, “Liver Cirrhosis”, and “Hepatocellular Carcinoma”. Results: In Gastroenterology and Hepatology, inflammatory bowel diseases and liver cirrhosis are diagnoses that often require palliative care and should be initiated at diagnosis, including prevention and guidance of complications, symptom management and quality of life. For hepatocellular carcinoma, there are protocols that include a palliative approach, but restricted to disease management. The procedures in digestive endoscopy have a great interface with other specialties, alleviating symptoms, obtaining alternative dietary routes and always individualizing decision-making. Conclusion: Integrating different health professionals in care, with relief of the individual's suffering and improvement of quality of life, in addition to better management of hospital resources. Thinking about palliative care early benefits the patient, the family, public and private institutions that provide health care and society.
Paucibacillary case of Hansen’s disease affecting the skin and nasal mucosa
Introduction: Hansen’s disease is an infectious disease caused by Mycobacterium leprae. Nasal mucosa is the main entry point and initial site of lesions. Nasal symptoms are uncommon in paucibacillary forms. Case report: Man, 72 years old, presented with erythematous-violaceous infiltrated patches on the back and buttocks for 1 year and 6 months, associated with nasal obstruction, rhinorrhea, and episodes of epistaxis in the right nostril. Rhinoscopy revealed septal bulging to the right and infiltrative lesions. Granulomatous inflammation observed in the nasal mucosa histopathology supported the diagnosis of leprosy tuberculoid borderline with nasal involvement. Conclusion: Nasal cavity examination aids in diagnosing early forms of leprosy. Hansen’s disease rhinitis should be suspected in the presence of chronic nasal obstruction, epistaxis, crusting, and rhinorrhea.
Introduction: Mucopolysaccharidosis type II (MPS II) or Hunter syndrome is defined as an enzyme deficiency of genetic origin, whose inheritance is recessive and X-linked. In this syndrome, there is a mutation in the gene responsible for encoding the enzyme iduronate-2-sulfatase (IDS), leading to the accumulation of glycosaminoglycans (GAGs). Therefore, GAGs accumulate in various organs and tissues, leading to their dysfunction. Case report: This study consists of a case report of this rare syndrome, in which the patient presents suggestive physical characteristics from birth and a family history of a sibling with the same disease, allowing early diagnosis. On physical examination, the patient presents phenotypic manifestations of the disease, such as low nasal bridge and hirsutism. Laboratory tests confirmed the increase in urinary glycosaminoglycans, and the genetic study confirmed an alteration in the IDS gene. With early diagnosis, the patient began intrathecal gene therapy at a specialized center in the South of the country and, despite the limitations of the disease, has shown favorable progress. He is being monitored by a physiotherapist, speech therapist, occupational therapist, pediatrician and geneticist. Conclusion: MPS II is a rare disease, whose most commonly used treatment in Brazil currently involves the management of signs and symptoms. However, advances in hematopoietic stem cell transplantation and enzyme and gene replacement therapies have provided longer survival and quality of life for patients. Healthcare professionals in various specialties should be alerted to ensure early diagnosis and intervention, modifying the natural history of these patients.
Acquired thrombotic thrombocytopenic purpura in a 16-year-old patient
Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare and severe disease characterized by the formation of abnormal blood clots that can lead to damage in various organs. It is marked by reduced ADAMTS13 activity levels and can be either acquired or congenital. Although conventional treatment with immunosuppressants and plasmapheresis is effective in most cases, a subgroup of patients develops refractory forms. The scarcity of therapeutic options for these patients, especially in resource-limited settings, makes managing refractory TTP challenging. We describe the case of an adolescent with acquired refractory TTP who achieved a complete response to treatment with bortezomib, focusing on age, diagnosis, therapy for refractory TTP, and its association with Systemic Lupus Erythematosus. Objective: To share this case with healthcare professionals in order to increase knowledge about refractory TTP and propose the inclusion of bortezomib as an alternative therapeutic option in selected cases. Methods: This is a descriptive observational study approved by the Medical Ethics Committee, with data obtained from the medical records of the Cassiano Antônio Moraes University Hospital (HUCAM). Results: Complete response after bortezomib therapy and the diagnosis of Systemic Lupus Erythematosus after 12 months of outpatient follow-up. Conclusion: In patients with acquired refractory TTP, the use of bortezomib shows efficacy and an appropriate safety profile, and should be considered in this scenario, as it is available in most specialized healthcare services.
Descriptive analysis of the epidemiological, clinical and laboratory profile of patients at the spondyloarthritis outpatient clinic of a university hospital
Introduction: The term Spondyloarthritis (SpA) is used to describe a group of diseases with common clinical, laboratory and genetic characteristics, which may involve the axial and/or peripheral skeleton. Objectives: To study the epidemiological profile, the current clinical status of the patients and the drugs most commonly used to control the disease. Methods: Cross-sectional study of patients who were regularly followed up at the Cassiano Antônio de Moraes University Hospital (HUCAM-UFES), one of the centers participating in the prospective and observational cohort of the Brazilian Spondyloarthritis Registry (RBE). Additional data was obtained from the patients’ electronic medical records. Results: 105 patients were studied; there was a predominance of brown individuals 52 (49.5%), men (64/61%) and the average age was 49 years; with a higher prevalence of ankylosing spondylitis (62/59%), axial form (76/72.4%), with HLA-B27 positivity in 55 (52.4%) individuals. We identified 50 (47.6%) patients with csDMARDs and 87 (82.9%) with bDMARDs, with a mean ASDAS-PCR: 3.3 (± 1.8), BASDAI: 3.6 (± 2.5) and DAPSA: 21.5 (± 21.8). White color was associated with greater positivity for HLA-B27 and black color with greater disease activity by ASDAS-PCR. Conclusion: In this study, there was a predominance of men of African descent and greater axial involvement. HLA-B27 was identified as an important genetic marker associated with the patients’ phenotype. Black patients had higher activity rates compared to the other groups. Treatment with bDMARDs was predominant, with patients in disease activity, demonstrating a sample with a profile of greater severity and difficult treatment.
Lucio's Phenomenon, a rare complication of leprosy
Introduction: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae, an intracellular microorganism that primarily affects the skin and nerves. Its chronic course can be interrupted by immune episodes of acute inflammation, known as leprosy reactions. Case Report: This describes a clinical case of Lucio's Phenomenon, a complication of leprosy, in a patient with irregular erythematous lesions that rapidly progressed to gangrenous ulcerations with tendon and muscle exposure, and diagnosis confirmation through a biopsy of the skin lesions. Conclusion: The relevance of the topic lies in the fact that Lúcio's phenomenon is a rare and potentially fatal condition of leprosy. Therefore, the aim is to expand the understanding of this manifestation of the disease, contributing to better chances of success in treatment and improving the prognosis for these patients.
Evidence-Based Speech-Language Pathology
This editorial discusses the consolidation of Evidence-Based Practice (EBP) within Speech-Language Pathology (SLP), highlighting its conceptual origins in Evidence-Based Medicine and its evolution as a methodological and ethical imperative for health professionals. EBP is founded on three pillars: clinical expertise, the best external and internal evidence, and patient perspectives. The text emphasizes the necessity of integrating EBP into academic training, fostering critical appraisal, and applying research findings to clinical decision-making. It argues that systematic reviews and meta-analyses are essential tools for synthesizing high-quality evidence and guiding effective, cost-efficient clinical practices. The article stresses the importance of protocol registration on platforms such as PROSPERO and ReBEC to ensure transparency, reproducibility, and compliance with open science principles. It critiques the predominance of low-level evidence studies, such as case reports, which often lack adherence to CARE guidelines, and calls for stricter editorial and methodological standards in SLP research. The editorial concludes that strengthening a scientific culture grounded in rigor, ethics, and collaboration, particularly with fields like Epidemiology, is vital for transitioning from experience-based to evidence-based practice, enhancing the quality, safety, and effectiveness of clinical care in Speech-Language Pathology.
Introduction: After the end of the COVID-19 pandemic, another colossal challenge continues to be faced by the health system worldwide: the post-acute COVID-19 syndrome. Objectives: This study aimed to evaluate respiratory symptoms and QoL (quality of life) in a cohort of previously hospitalized COVID-19 patients after twelve months of discharge. Additionally, the study aimed to identify clinical factors related to these symptoms. Methods: This longitudinal study, with a 12-month cohort, was conducted with adults discharged home after hospitalization for COVID-19. Twelve months post-discharge, the participants were assessed through video or phone calls and answered a questionnaire regarding persistent symptoms and QoL. The modified Medical Research Council scale (mMRC) was used to grade the impact of dyspnea on daily activities, and the WHOQoL-BREF questionnaire was used to assess the QoL. Results: The cohort included 15 patients, with a mean age of 63.53±7.32 years. Twelve months after discharge, 10 (66.66%) individuals suffered from at least one symptom, among which 40% reported cough, 20% reported fatigue, 20% had dyspnea at rest, and 40% had dyspnea during activities. The physical domain of QoL had the lowest score (9.14±3,54) among the WHOQoL domains. Age, sex, diabetes, and mMRC≥1 correlated with QoL. Conclusion: The high prevalence of respiratory symptoms and impaired QoL even 12 months after hospital discharge highlight the need to adopt protocols for in-hospital rehabilitation and prepare patients for practice physical activity or exercise-based rehabilitation programs after discharge.
Evaluation of the blood donation process from the donor's perspective
Introduction: Blood donation is essential for maintaining blood transfusion services. Optimizing the donation process can improve donors' experiences throughout the act of donating blood. The Disney® Integration Matrix is a useful tool for monitoring service standards and evaluating quality of care. Objective: To analyze the service process of three blood centers through blood donors' written feedback using the four elements of the Disney® service standard. Methods: Donor feedback categorized as Satisfaction, Suggestion, and Complaint between 2012 and 2019 was adapted to the Disney® Integration Matrix. Each report was classified according to process safety, efficiency, courtesy, and show. Results: A total of 38,376 written reports were obtained from three blood centers. Of these, 10,271 (26.8%) were related to the service process, including 53.6% satisfaction reports, 29.2% suggestions, and 17.2% complaints. Complaints regarding process efficiency were the most frequent, whereas courtesy received the highest number of positive comments across all three centers. Process efficiency was inversely associated with safety and courtesy indicators. Among the four dimensions, the show category presented the lowest percentages in all blood centers. Considerable variation in satisfaction related to process efficiency was observed in 2015. Conclusion: The methodology proved useful for identifying strengths and weaknesses in the service process and for supporting the assessment of individual donor needs.
1st HUCAM Congress on Teaching, Research, Extension, and Innovation
The 1st HUCAM Congress on Teaching, Research, Extension, and Innovation (CONPEI), held on November 28–29, 2024, had as its central theme “Integration as a strategy for excellence in health care.” The event represented a milestone for the academic and health professional community in Espírito Santo, fostering dialogue among institutions, services, and knowledge, with the aim of strengthening teaching practices, scientific research, university extension, and technological innovation. With the participation of state authorities, representatives from the Federal University of Espírito Santo (Ufes) and Ebserh’s top governance, as well as guest professors, health professionals, residents, and students, the congress brought together different perspectives around a common goal: to enhance hospital and outpatient care and broaden the social impact of HUCAM-Ufes initiatives. The activities were structured around round tables, lectures, workshops, and scientific sessions, covering key thematic areas: Care: integration of Ebserh Network hospitals and their impact on public health; care lines such as obesity; and health simulation as a teaching-learning strategy in different care settings. Extension: experiences of university integration and the social impact of projects developed in collaboration with communities. Research: advances in translational research within the Ebserh Network; HUCAM’s participation in prominent studies in the fields of infectious diseases, cardiology, women’s health, rheumatology, and oncology. Innovation: implementation of transformative methodologies in teaching, care, and digital education, along with discussions on emerging technologies applied to health. The congress also featured thematic workshops, oral communication sessions, and poster presentations, which enabled a wide exchange of experiences among researchers, professionals, and students. The event concluded with the awarding of the three best works, recognized in the fields of research, innovation, and extension, in a ceremony that highlighted the quality of the contributions and the academic community’s commitment to excellence in health. The texts gathered in these Proceedings thus reflect the plurality of perspectives, experiences, and contributions that marked CONPEI, offering the reader not only the abstracts of the presented works but also the extended versions of the studies awarded by the scientific committee. It is hoped that this record will serve both as a memory of the event and as an encouragement for the continuity of integrated actions in pursuit of excellence in health care.
Ensaios Clínicos Randomizados vs. Estudos Observacionais
The choice of the most appropriate study design in clinical research should not be reduced to a rigid hierarchy of evidence. While Randomized Clinical Trials (RCTs) are often considered the gold standard, their superiority over observational studies depends on the research question, ethical considerations, feasibility, and clinical context. Well-designed observational studies can yield results consistent with RCTs and are especially valuable for investigating prognosis, incidence, prevalence, and long-term safety in real-world practice. Conversely, RCTs provide strong internal validity but may lack external applicability due to strict eligibility criteria. In several fields — such as rehabilitation, palliative care, mental health, and rare diseases — RCTs face practical and ethical limitations, reinforcing the role of observational research. Ultimately, the reliability of evidence depends less on the study label than on methodological rigor, validity, and applicability. Rather than debating superiority, RCTs and observational studies should be seen as complementary approaches that, together, strengthen clinical decision-making.
The publication of the abstracts presented at DOF UPDATE: 2nd Interprofessional Immersion in TMD and Orofacial Pain reflects the success of a multidisciplinary event organized by the Federal University of Espírito Santo (UFES). Held at the FAESA auditorium in Vitória, Brazil, the meeting brought together specialists and researchers committed to advancing knowledge in this field. In its second edition, the event featured the participation of health professionals and renowned researchers who shared innovations and technologies aimed at the treatment and prevention of temporomandibular disorders and other orofacial pain conditions. Considering that such disorders represent the third most common cause of non-odontogenic pain worldwide, the initiative highlights the relevance of promoting spaces for scientific updating, professional training, and the exchange of experiences. The event was consolidated as an opportunity to strengthen academic collaboration networks and to disseminate knowledge in favor of population health. We congratulate the organizing committee, lecturers, and authors for their dedication, and we thank all participants for their engagement and trust.
III Symposium on Innovation and Health Management
The Proceedings of the 3rd Symposium on Innovation and Health Management bring together the abstracts of the works presented during the event held on June 14, 15, and 16, 2023, in Vitória, Espírito Santo, Brazil. The symposium was promoted by the Center for Teaching, Research and Innovation of the iNOVA Capixaba Foundation (CEPiNOVA), in partnership with the Teaching, Research and Innovation Units (UEPI) of the hospitals under its management. Established as one of the main public health events in the state, the symposium focused on discussing innovative solutions, emerging technologies, and management practices aimed at improving healthcare delivery. The program included lectures by renowned experts, such as Gonzalo Vecina Neto — former president of Anvisa and one of the creators of the Brazilian Unified Health System (SUS) — as well as thematic panels and hands-on workshops addressing key contemporary health issues: patient safety, data integration, assistive technologies, person-centered care, and applied research in the context of public health in Espírito Santo. The works published in this volume reflect the diversity of experiences, research, and proposals developed by professionals, managers, researchers, and students committed to innovation and to strengthening the SUS.
iNOVA Capixaba - Fundação Estadual de Inovação em Saúde
Violence and the importance of networking in service provision
Individuals experiencing violence must be seen in their individuality and subjectivity. Professionals working with this group must recognize both victims — direct or indirect — and perpetrators of violence as subjects of rights. This understanding requires humanized care and demands a networked approach, given the complexity of the harm and its impacts on health and the social sphere. Assistance to victims of violence still faces challenges due to the invisibility of the phenomenon, lack of knowledge about established care flows, and the fragility of structured care networks. Integrated action among health, education, justice, public security, social assistance, and community sectors is essential to promote safe and healthy environments, prevent violence, and ensure the protection of human rights. Building effective, articulated, and cooperative intersectoral networks is fundamental for addressing violence. Investing in the continuous training of professionals, the establishment of care flows, and the strengthening of public policies is indispensable for ensuring comprehensive and humanized care for individuals experiencing violence.
Incidence and characterization of physical violence against women aged 20 to 59 in Brazil and its regions in 2022
Introduction: Understanding the updated epidemiological situation of reported cases and the profile of violence against women—particularly physical violence, one of the most frequent forms, often indicative of other types of violence—is essential for surveillance and for the development of intersectoral public policies focused on prevention and health promotion. Objective: To describe the reported cases of physical violence against women aged 20 to 59 years in Brazil in 2022. Methodology: Ecological study using data from the Information System for Notifiable Diseases, referring to reports of interpersonal violence against adult women in Brazil. Results: In 2022, 179,594 episodes of interpersonal violence against individuals aged 20 to 59 years were reported in Brazil, 75.76% (95% CI: 75.66–75.86) of which involved women. Of these, 75.07% (95% CI: 74.84–75.30) were cases of physical violence. The incidence of physical violence was 16.32 reported cases per 10,000 women in this age group. Most victims were young, Black or Brown, experienced recurrent episodes in the domestic environment, had or had had an affective relationship with the aggressor, and frequently suffered concurrent psychological violence. Conclusion: Despite underreporting, domestic violence against women in Brazil remains alarming. Addressing this issue requires more representative and comprehensive research, as well as more effective measures to protect and provide integral support to victims.