Einstein-Sao Paulo最新文献

{"title":"Reconstructing medical practice: political-philosophical reflections on care from a Brazilian healthcare context.","authors":"José Ricardo de Carvalho Mesquita Ayres","doi":"10.31744/einstein_journal/2026RW2282","DOIUrl":"https://doi.org/10.31744/einstein_journal/2026RW2282","url":null,"abstract":"<p><p>This essay presents a political-philosophical reflection on the need to reconstruct health practices in order to make them more effective and sensitive in identifying and responding to the needs of diverse individuals and populations. To this end, it draws on the experience of health sector reforms in Brazil and the development of the Brazilian Public Health System, focusing in particular on the relevance of three conceptual constructs associated with this process: comprehensiveness, vulnerability, and care. Inspired by philosophical hermeneutics (Gadamer, Ricoeur), the discussion emphasizes the importance of a broader and more integrated understanding of health needs; the use of social markers of difference as indicators of vulnerabilities that require differentiated responses from health services and policies; and the value of a dialogical approach to health practices that is existentially sensitive and informed by multiple forms of knowledge, enabling productive integration of technical efficacy with practical success.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe1","pages":"eRW2282"},"PeriodicalIF":1.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"i-motifs: DNA structures with regulatory functions and therapeutic potential.","authors":"Murilo Porfírio de Aguiar, Eleni Solange de Brito Gomes, Jéssica Ferreira Vieira","doi":"10.31744/einstein_journal/2026RW1900","DOIUrl":"10.31744/einstein_journal/2026RW1900","url":null,"abstract":"<p><p>Non-B DNA structures represent alternative conformations to the canonical double helix, characterized by unconventional base pairing that diverge from the Watson-Crick model. Among these, the i-motifs, formed in cytosine-rich regions, has attracted considerable attention due to its potential regulatory roles. This review examines the molecular mechanisms underlying the formation and stability of i-motifs, which rely on hydrogen bonding between protonated cytosines. These structures can form under slightly acidic and even neutral pH conditions, depending on the DNA sequence context. Their diverse topologies and capacity to interact with specific proteins and ligands suggest that i-motifs play important roles in the regulation of gene expression, particularly within promoters of oncogenes, as well as in telomeric and centromeric regions. Understanding the behavior and biological relevance of i-motifs may deepen our insight into genomic regulation and reveal novel therapeutic opportunities. Targeting i-motif structures therefore represents a promising strategy for the treatment of cancer and other complex diseases.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eRW1900"},"PeriodicalIF":1.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing education: use of clinical simulation in the care of patients with dengue fever.","authors":"Thais Lazaroto Roberto Cordeiro, Marcia Bucco, Karyna Turra Osternack, Karin Rosa Persegona Ogradowski","doi":"10.31744/einstein_journal/2026AO2278","DOIUrl":"https://doi.org/10.31744/einstein_journal/2026AO2278","url":null,"abstract":"<p><strong>Objective: </strong>To analyze how clinical simulation impacts nursing students' proficiency in clinical evaluation, decision-making, therapeutic communication, and reporting of dengue fever with warning signs within a primary health care context.</p><p><strong>Methods: </strong>Third-term nursing undergraduates participated in the activity, which involved a standardized patient, a 45-year-old female with persistent vomiting, fever, and abdominal pain after a trip to an endemic dengue area. A structured checklist was used to assess their performance in terms of diagnostic suspicion, anamnesis, physical examination, tourniquet test, recognition of severity signs, completion of the reporting formulary, patient referral decisions, and communication with the patient. The actor received detailed instructions to ensure realism and standardization. This project followed ethical tenets and was approved by the Research Ethics Board.</p><p><strong>Results: </strong>Students showed high engagement, with improvements in their logical reasoning, confidence in approaching patients, and communication. Most of them correctly identified dengue fever suspicion, although they had difficulties recognizing the warning signs, which enriched the debriefing and promoted reflection on decision-making.</p><p><strong>Conclusion: </strong>Clinical simulation is a powerful tool for teaching dengue fever and integrating theory and practice. Thus, it provides significant learning and strengthens the education of better-prepared nurses for qualified performance in primary healthcare.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 spe1","pages":"eAO2278"},"PeriodicalIF":1.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends in LDL cholesterol levels from 2009 to 2023: a comprehensive analysis of 2.4 million patient records in São Paulo, Brazil.","authors":"Paulo Roberto Telles Pires Dias, Queoma Silveira Mariante, Flavia Paiva Proença Lobo Lopes","doi":"10.31744/einstein_journal/2026AO1104","DOIUrl":"10.31744/einstein_journal/2026AO1104","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate monthly trends in low-density lipoprotein cholesterol (LDL-C) levels in the examined population.</p><p><strong>Methods: </strong>Monthly trends in LDL-C levels from 2009 to 2023 were analyzed in a predominantly outpatient cohort that underwent testing at Laboratório Dasa units in São Paulo, Brazil. A comprehensive analysis was conducted using 2,469,979 complete records with valid LDL-C results obtained from databases of a national clinical laboratory. Monthly mean and median LDL-C values were calculated and analyzed according to sex and age groups.</p><p><strong>Results: </strong>Piecewise regression analysis of temporal trends identified a breakpoint in 2018, indicating a change in slope. The average monthly decline in LDL-C levels from 2009 to 2018 was 0.159 mg/dL (p<0.001). After 2018, the average LDL-C level increased, with a monthly increase of 0.142 mg/dL (p<0.001). This pattern was consistent across both sexes and across most of the examined age groups. Autoregressive integrated moving average time series analysis revealed seasonal variations in LDL-C levels, with a tendency towards lower levels during warmer months and higher levels during colder months.</p><p><strong>Conclusion: </strong>Model projections suggest a potential upward trend in LDL-C levels in the coming years. These trends indicate that the historical decline in LDL-C levels observed from 2009 to 2018 has not persisted in recent years. Further research is needed to elucidate the underlying causes of these observed trends and to develop strategies aimed at reducing serum lipid levels associated with cardiovascular risk.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1104"},"PeriodicalIF":1.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of cerebral concussion using the SCAT-5 tool: translation into Brazilian Portuguese and cultural adaptation.","authors":"Ana Camila de Castro Gandolfi, Patrícia Logullo, Cristina Casagrande Miranda Teixeira, Moisés Cohen, Rachel Riera","doi":"10.31744/einstein_journal/2026AO2124","DOIUrl":"10.31744/einstein_journal/2026AO2124","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to translate and culturally adapt the Sports Concussion Assessment Tool version 5 (SCAT-5) in Brazilian Portuguese for the follow-up of patients diagnosed with cerebral concussion.</p><p><strong>Methods: </strong>The components of the SCAT-5, which includes an assessment of level of consciousness using the Glasgow Coma Scale, were translated from English to Brazilian Portuguese, back-translated, and evaluated by an expert committee. The final version was tested twice, with a 2-week interval between assessments, in 36 athletes admitted to the cerebral concussion outpatient clinic with concussion. Statistical analyses were subsequently performed using prevalence-adjusted and bias-adjusted kappa to assess the degree of agreement between the first and second tests.</p><p><strong>Results: </strong>The athletes were predominantly rugby players (23/36) and female (23/36), and none were in the acute phase of concussion. Their ages ranged from 18 to 45 years, and the median time from the last concussion to assessment was 104 days. A significant difference was observed between the first and second tests for three variables evaluated: \"total number of symptoms,\" \"balance test [standing on one foot]\" and \"total balance score,\" with an increase in the number of symptoms and a decrease in balance scores between tests, possibly indicating worsening symptoms or increased awareness about symptoms. The agreement between the first and second assessments was deemed moderate only for \"irritability\" and good or very good for all other variables.</p><p><strong>Conclusion: </strong>The SCAT-5 was successfully translated and culturally adapted for use in Brazilian patients. This tool will contribute to improving and standardizing the healthcare of patients with cerebral concussion in Brazil, improving medical care, and guiding medical staff toward orienting patients to a gradual and adequate return to sports-related activities following concussion.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2124"},"PeriodicalIF":1.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between self-initiated changes in physical activity patterns and erectile dysfunction: a longitudinal follow-up study.","authors":"Rafael Mathias Pitta, Oskar Grau Kaufmann, Eduardo Rossato de Victo, Gabriel Grizzo Cucato, Raphael Mendes Ritti-Dias, Luana de Lima Queiroga, Nelson Wolosker","doi":"10.31744/einstein_journal/2026AO1905","DOIUrl":"10.31744/einstein_journal/2026AO1905","url":null,"abstract":"<p><strong>Objective: </strong>The effect of self-initiated changes in physical activity patterns over time on erectile dysfunction remains unclear. We aimed to analyze the relationship between self-initiated changes in physical activity over time and erectile dysfunction in a large sample of men.</p><p><strong>Methods: </strong>This study included 925 adults and older men with erectile dysfunction who underwent routine health screening. Erectile dysfunction was determined using the 5-item version of the International Index of Erectile Function questionnaire, with a score of <21 indicating the condition. The participant's physical activity levels, body mass index, blood pressure, blood samples, alcohol consumption, tobacco use, perceived stress, depressive symptoms, and lower urinary tract symptoms were measured at baseline and follow-up (531,9±149,7 days). The participants were grouped into four categories based on their physical activity levels at baseline and follow-up: i) persistently physically inactive, ii) became physically inactive, iii) became physically active, and iv) persistently physically active.</p><p><strong>Results: </strong>Hierarchical regression analysis revealed that individuals who became physically active and those who remained physically active were independently associated with decreased odds of erectile dysfunction (odds ratio [OR], 0.656; 95%CI=0.432-0.980 and OR=0.717; 95%CI=0.508-0.992, respectively).</p><p><strong>Conclusion: </strong>Self-initiated changes in physical activity patterns were longitudinally associated with erectile dysfunction in adults and older individuals. These data suggest that initiating and maintaining physical activity can reduce the risk of erectile dysfunction.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO1905"},"PeriodicalIF":1.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive thoracic surgery: beyond the access route - have we truly become minimally invasive?","authors":"Ricardo Mingarini Terra","doi":"10.31744/einstein_journal/2026Suppl_3ED0001","DOIUrl":"10.31744/einstein_journal/2026Suppl_3ED0001","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 suppl 3","pages":"eED0001"},"PeriodicalIF":1.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world genomic profiling of solid tumors: validation and clinical insights from a Brazilian cohort.","authors":"Thalita Xavier de Souza, Roberta Cardoso Petroni, Larissa Barbosa de Lima, Luiz Gustavo Ferreira Cortes, Gustavo Santos de Oliveira, Caroline Nunes Silveira, Nair Hideko Muto, Joice Rosa Santana, Priscila Iamashita Higaki, Amanda Centenaro Ramos, Susana Elaine Alves da Rosa, Rodrigo Reis, Miguel Zugman, Fernando Moura, Pedro Luiz Serrano Usón Junior, Paulo Vidal Campregher","doi":"10.31744/einstein_journal/2026AO2000","DOIUrl":"10.31744/einstein_journal/2026AO2000","url":null,"abstract":"<p><strong>Background: </strong>Precision medicine has transformed cancer management by tailoring treatments to the molecular characteristics of a patient's tumor. Comprehensive Genomic Profiling enables the simultaneous analysis of multiple genomic alterations using next-generation sequencing assays, providing detailed molecular profiles of tumors. This approach allows more accurate cancer classification, guides decisions regarding targeted therapies, enhances the precision of treatment strategies, and improves patient outcomes in oncology.</p><p><strong>Objective: </strong>In this article, we describe the analytical validation of the Illumina TruSight Oncology 500 (TSO500) assay in a (CAP)-certified clinical laboratory in Brazil and present real-world findings from Comprehensive Genomic Profiling performed on 454 patients with cancer, highlighting the genomic landscape, including novel fusion events.</p><p><strong>Methods: </strong>Tumor samples collected between January 2020 and September 2023 were subjected to Comprehensive Genomic Profiling using the TSO500 assay. Library preparation and sequencing (Illumina NextSeq) were performed according to the manufacturer's protocol, followed by bioinformatics processing using an in-house pipeline for alignment, variant calling, and annotation. Variants were classified according to the Variant Interpretation for Cancer Consortium guidelines. Analytical performance metrics, including specificity and positive predictive value, were calculated for assay validation.</p><p><strong>Results: </strong>The test demonstrated a specificity of 93.39% and a positive predictive value of 73.36%. Regarding Comprehensive Genomic Profiling, 57.85% of all detected variants were classified as variants of uncertain significance, and 42.15% were oncogenic. Gene fusions, including both novel and canonical events, were detected in 13% of cases.</p><p><strong>Conclusion: </strong>The TSO500 assay provides crucial insights into patient genomics, aiding diagnosis, prognosis, and treatment decisions. Demonstrating high levels of accuracy, reproducibility, and sensitivity, the TSO500 advances cancer research to the forefront of molecular technology.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eAO2000"},"PeriodicalIF":1.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rigid cystoscopy versus flexible outpatient cystoscopy: the economic cost behind the epidemiological and social impact.","authors":"Guilherme Andrade Peixoto, Matheus Pascotto de Salles, Edson Amaro Junior, Fernando Korkes","doi":"10.31744/einstein_journal/2026GS1136","DOIUrl":"10.31744/einstein_journal/2026GS1136","url":null,"abstract":"<p><strong>Introduction: </strong>The Brazilian Public Health System predominantly performs cystoscopy in hospitals using rigid cystoscopes in operating room settings. This approach results in high operational costs and scheduling delays associated with hospital admission and preoperative protocols. Flexible cystoscopy can be performed in an outpatient setting and may substantially reduce both costs and waiting times.</p><p><strong>Objective: </strong>To compare the costs and waiting times associated with rigid and flexible cystoscopy in São Paulo, Brazil.</p><p><strong>Methods: </strong>A retrospective review at a municipal hospital in Brazil identified patients who underwent diagnostic rigid cystoscopy. The analysis estimated the cost of the procedure and the time from indication to examination. Because no public hospital performed flexible cystoscopy during the study period, fees from private hospitals were collected as a proxy and incorporated into a one-way sensitivity analysis.</p><p><strong>Results: </strong>The mean cost per rigid cystoscopy reached BRL 8,319.45 (US$1,618.82), ranging from BRL 6,187.10 (US$1,203.90) to BRL 10,512.34 (US$2,045.52). Costs were higher when biopsy occurred (mean BRL 9,744.20) and lower when biopsy was not performed (mean BRL 6,609.75). Fees for flexible cystoscopy ranged from BRL 1,523.81 (US$296.51) to BRL 2,300.00 (US$447.54), with a mean value of BRL 1,800.60 (US$350.37). The mean interval from indication to procedure was 55.64 days for rigid cystoscopy compared with 6.34 days in centers that perform flexible cystoscopy. In sensitivity analysis, even when public-sector flexible cystoscopy costs reached 1.5-3.0× the private fee (BRL 2,701-5,402), the procedure remained approximately 35-68% less expensive than rigid cystoscopy.</p><p><strong>Conclusion: </strong>Management of bladder cancer imposes a substantial economic burden on Brazilian Public Health System. Despite the asymmetry between public and private data sources, these findings support adoption of outpatient flexible cystoscopy to accelerate diagnosis and reduce costs, with important implications for health policy.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eGS1136"},"PeriodicalIF":1.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What to do with anti-science influencers?","authors":"Jacyr Pasternak","doi":"10.31744/einstein_journal/2026ED2641","DOIUrl":"10.31744/einstein_journal/2026ED2641","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"24 ","pages":"eED2641"},"PeriodicalIF":1.1,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}