Einstein-Sao Paulo最新文献

■ This paper proposes a contextual and non-reductionist ontology of mental health disorders. ■ It reframes the diathesis-stress model through radical behaviorism and functional contextualism. ■ It emphasizes dynamic interactions between vulnerabilities and environmental stressors. ■ It guides clinical practice toward integrative, personalized, and system-sensitive interventions.

Patients diagnosed with fibrosing interstitial lung disease are at risk of several complications, some of which may be life-threatening. Computed tomography imaging plays an important role in diagnosing these overlapping conditions. This article summarizes the computed tomography imaging features of the most common conditions associated with fibrosing interstitial lung diseases, categorized by involvement of the lung parenchyma or extra-pulmonary compartments. Some steps may help to recognize such complications, such as having knowledge of the underlying fibrotic lung disease, being aware of potentially immunosuppressive treatments in use, noting new relevant symptoms, checking previous imaging examinations to detect subtle changes, and considering the exam technique, for example, to avoid false perception of ground-glass opacities in exams with insufficient inspiration. Unenhanced computed tomography may be enough to diagnose most situations, but in specific cases, for example, in the clinical suspicion of pulmonary embolism, dedicated computed tomography angiography may be warranted. Careful comparison with previous exams is advised, especially to detect subtle opacities suspicious for lung cancer, underscoring that its detection may be difficult owing to the baseline morphological lung changes. Radiologists must be aware of such possible complications to perform early diagnosis and ensure proper management.

The present study examines the development of medical science during the COVID-19 pandemic in light of Ernst Mayr's critique of Thomas Kuhn's philosophy of scientific revolutions. Kuhn's model, which emphasizes paradigm shifts and disruptive changes in scientific practice, contrasts with the evolutionary and cumulative nature of biological sciences, as argued by Mayr. Revisiting Mayr's critique, we question the applicability of Kuhn's model to the COVID-19 pandemic by using vaccine development as a case study. We argue that the rapid advancements in vaccine technology, particularly mRNA-based vaccines, are better understood as the outcome of multiple independent micro-revolutions in scientific fields, such as genetics, pharmacology, and molecular biology. These disciplines have advanced steadily over decades, facilitating the accelerated response to the pandemic. Consequently, the rapid, effective, and game-changing development and implementation of mRNA vaccines represented a major breakthrough in medical science; their trajectory diverged from Kuhn's concepts of scientific revolution and normal science. Through this analysis, we propose rethinking of medical epistemology - one that acknowledges the asynchronous yet non-disruptive progress of the medical sciences. Such a framework not only provides a more accurate understanding of scientific evolution but also offers a valuable tool for addressing societal challenges, such as vaccine hesitancy and public trust in science.

This paper examines the fitness industry as a by-product of neoliberal ideology, using "The New Way of the World: On Neoliberal Society" as a conceptual framework. Neoliberalism, as articulated by Dardot and Laval, extends beyond economic policy to shape governance and human behavior by embedding market-driven rationality into everyday life. The fitness industry, with its emphasis on individual responsibility for health and self-optimization, exemplifies core neoliberal tenets. It fosters the notion of the "entrepreneurial self," wherein success or failure is attributed to personal merit, thereby marginalizing collective health initiatives. The proliferation of fitness influencers further reinforces this paradigm, often disseminating misinformation and promoting unrealistic ideals of health and fitness. We argue that the commodification of health within the fitness industry aligns with neoliberalism's foundational principles: competitiveness, self-regulation, and the erosion of collective structures. In response, we advocate for a shift toward health frameworks rooted in inclusivity, equity, and shared responsibility, challenging the individualistic ethos embedded in current fitness discourse. Reimagining health policy through a lens of solidarity offers a pathway to dismantling neoliberal rationality and fostering a more democratic and equitable health system.

Background: Non-invasive respiratory support strategies, such as high-flow nasal cannula therapy and non-invasive ventilation, were widely employed during the coronavirus disease 2019 (COVID-19) pandemic, yet their comparative effectiveness remains uncertain.

Objective: To compare the effects of high-flow nasal cannula therapy, non-invasive ventilation, and conventional oxygen therapy on intubation rates and hospital mortality in adults with COVID-19-related acute respiratory failure.

Methods: A systematic review and meta-analysis was conducted following PRISMA and Cochrane guidelines, with searches performed in nine databases for publications up to May 2023. Eligible studies were those on adults (≥18 years) with confirmed severe acute respiratory syndrome coronavirus 2 infection and that included intubation and mortality as primary outcomes. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohorts and the Cochrane Risk of Bias tool. Pooled results were reported as odds ratios (ORs) with 95% confidence intervals (95%CIs).

Results: Forty-one studies were included in the review and ten in the meta-analysis (2,843 patients). High-flow nasal cannula therapy did not differ from non-invasive ventilation in terms of the intubation rate (OR=1.07, 95%CI=0.89-1.29, p=0.45) but was superior to oxygen therapy (OR=0.79, 95%CI=0.64-0.97, p=0.02). High-flow nasal cannula therapy was also associated with lower mortality than non-invasive ventilation (OR=0.62, 95%CI=0.51-0.76, p<0.0001) but did not differ from oxygen therapy (OR=1.06, 95%CI=0.84-1.33, p=0.64). Substantial heterogeneity was observed in the subgroup analyses (I2=64%-90%).

Interpretation: High-flow nasal cannula therapy may reduce the need for intubation compared with oxygen therapy and may lower the hospital mortality rate compared with non-invasive ventilation. However, heterogeneity in the studies suggests that patient-specific factors and disease severity may influence outcomes.

Conclusion: High-flow nasal cannula therapy shows potential benefits over oxygen therapy and non-invasive ventilation for COVID-19-related acute respiratory failure, particularly in the mortality rate. Clinical use of these therapies should be context-specific, given the need for cautious interpretation of our results and for further high-quality trials.

Prospero database registration: ID CRD 42020226936.

Postoperative intestinal obstruction is most commonly associated with adhesions but may also arise from unusual causes such as surgical staples adhering to adjacent structures. Although the use of endoscopic staplers in laparoscopic appendectomy is effective and generally safe, it can occasionally result in complications, including intestinal obstruction. We report the case of a 41-year-old woman who underwent surgical treatment for pelvic endometriosis, including appendectomy, and subsequently developed intestinal obstruction caused by an internal hernia formed by the entrapment of a surgical staple from the appendiceal suture line in the jejunal loop. The patient recovered uneventfully after laparoscopic release and removal of staple, with complete resolution of symptoms. This case underscores the importance of vigilance during staple application and reinforces the need for continued improvements in stapling techniques to prevent similar complications.

Objective: This study aimed to analyze the possible association between rs2814778, rs12075 ( ACKR1 gene), and rs4073 ( CXCL8 gene) single nucleotide variants and COVID-19 severity.

Methods: This cross-sectional study included 319 COVID-19 diagnosed patients at two hospitals in Paraná, Brazil between 2020 and 2021. Among them, 171 cases were classified as severe or critical and 148 were classified as non-severe. Genotyping was performed using polymerase chain reaction.

Results: We found an association between the rs2814778 variant of the ACKR1 gene and COVID-19 severity. The C allele in both the T/C and C/C genotypes was identified as a risk factor for severe COVID-19, independent of sex, age, smoking status, cardiovascular disease, diabetes, or obesity. No evidence of an association was observed for the other variants.

Conclusion: The presence of the C allele in the rs2814778 variant indicated an increased risk of severe or critical COVID-19 in the southern Brazilian population across all possible genotypes and genetic inheritance models.