Introdução: A leishmaniose é uma doença infecciosa causada por protozoários do gênero Leishmania, transmitida por flebotomíneos. Apresenta as formas clínicas cutânea, mucosa e visceral, constituindo um importante problema de saúde pública. O diagnóstico e o tratamento impõem desafios relacionados à variabilidade clínica, à toxicidade dos medicamentos e à resistência parasitária. Método: Foi realizada uma revisão bibliográfica narrativa na base de dados PubMed, utilizando os descritores “Leishmaniasis” e “Therapeutics”. Selecionaram-se artigos publicados nos últimos cinco anos, nos idiomas português e inglês, que abordassem os aspectos diagnósticos e terapêuticos da doença. Resultados: O diagnóstico pode ser estabelecido por métodos parasitológicos, histopatológicos, sorológicos e moleculares, com destaque para a microscopia, os testes sorológicos e a reação em cadeia da polimerase (PCR). O tratamento inclui antimoniais pentavalentes, anfotericina B e miltefosina, sendo definido conforme a forma clínica e a gravidade. Na leishmaniose cutânea, terapias locais, como crioterapia e termoterapia, podem ser empregadas em casos selecionados. Novas abordagens, incluindo nanotecnologia, fitoterapia e imunoterapia, apresentam resultados promissores. Conclusão: O diagnóstico precoce e a escolha adequada da terapia são fundamentais para o manejo da leishmaniose. Apesar dos avanços, permanece a necessidade de novos métodos diagnósticos e terapêuticos que proporcionem maior eficácia, segurança e menor risco de resistência.
Stress-related mucosal damage (SRMD) is a common complication in critical care medicine. The necessity of stress ulcer prophylaxis (SUP) is debated due to advancements in supportive care and challenges in accurately stratifying bleeding risk. This narrative review evaluates contemporary evidence on stress ulcer prophylaxis in critically ill patients, with emphasis on bleeding risk stratification and implications for clinical practice. To construct this narrative review, we searched Embase and PubMed for randomized controlled trials (RCTs) evaluating SUP in adult intensive care unit (ICU) populations. The Population, Intervention, Comparison, and Outcome (PICO) framework was used to guide the search through March 2026. Major trials, relevant subgroup analyses, meta-analyses, and contemporary international clinical practice guidelines were reviewed to contextualize trial-level findings. Large randomized controlled trials demonstrated that acid-suppressive therapy reduces the incidence of clinically significant gastrointestinal bleeding (GIB), without demonstrating a mortality benefit. Inconsistent definitions of risk factors for GIB limit reproducibility and reduce the precision of pooled risk estimates. Meta-analyses confirmed a reduction in GIB and highlighted clinical heterogeneity. Current guidelines recommend stress ulcer prophylaxis for patients with high-risk presentations. However, these recommendations remain conditional due to the absence of a multivariable prediction model. Despite current uncertainty regarding the effects of stress ulcer prophylaxis on gastrointestinal bleeding prevention and mortality, it is recommended to consider SUP in selected critically ill patients based on individual risk assessment. In parallel, clinicians should optimize supportive measures, including early enteral nutrition, hemodynamic stabilization, and discontinuation of prophylaxis once the patient is clinically stable. Further prospective research is needed to guide individualized prophylaxis and avoid unnecessary treatment in low-risk populations.
SUMMARY BACKGROUND: Moral distress is defined as a psycho-emotional experience that occurs when individuals recognize the morally appropriate course of action but are unable to carry it out due to external constraints such as institutional hierarchies, organizational norms, or authority pressures. In medical education, this phenomenon is particularly frequent, given the deeply ethical nature of clinical decisions and patient care. OBJECTIVE: The aim of this study was to translate and adapt the Moral Distress from Professionalism Dilemmas checklist into Brazilian Portuguese. METHODS: The translation and cross-cultural adaptation process followed internationally recognized guidelines. It included independent translations by two professionals (one with and one without medical training), synthesis of the versions, back-translation, expert committee review, pretesting with 200 medical interns, and final evaluation. RESULTS: Of the 200 medical students invited, 160 (80%) completed the checklist, with no significant differences by year or gender. Depending on the item, between 0 and 57.5% of participants reported exposure to the professionalism dilemmas investigated. Among exposed students, the intensity of moral distress varied considerably across situations. CONCLUSION: Moral distress is a prevalent phenomenon in medical education. The adapted checklist demonstrated semantic and conceptual equivalence to the original and may serve as a valuable tool to identify, quantify, and understand moral distress among medical students in clinical training.
Objetivo: Avaliar aspectos pós-operatórios de pacientes que foram submetidos a laringectomia total por CEC que seguiram o protocolo ERAS em relação aos que não seguiram, analisando as complicações e mortalidade. Material e métodos: Foi realizada uma revisão sistemática na base de dados PubMed de forma independente. Foram incluídos nas buscas os estudos observacionais e ensaios clínicos que avaliaram os pacientes no pós-operatório de laringectomia total por CEC de laringe e que foram submetidos às intervenções propostas pelo protocolo ERAS comparados com pacientes que não foram incluídos neste protocolo. Resultados: O protocolo ERAS é uma abordagem sistemática baseada em evidências para melhorar a recuperação de pacientes após cirurgias, reduzindo o estresse cirúrgico, complicações e tempo de internação. A laringectomia, usada no tratamento do câncer de laringe, é desafiadora devido às complicações respiratórias e deglutições que afetam a qualidade de vida dos pacientes. A aplicação do ERAS demonstrou melhorar a recuperação e reduzir as complicações pós-operatórias, além de aumentar a satisfação dos pacientes. Conclusão: A partir da revisão de diversos estudos, é possível concluir que o uso do protocolo ERAS reduziu o tempo de internação hospitalar e diminuiu o número de complicações, como formação de fístulas e problemas respiratórios. Além disso, dois estudos avaliaram a presença de complicações através da Classificação Clavien-Dindo, revelando que o grupo submetido ao ERAS apresentou um menor número de pacientes com classificação maior que três quando comparado ao grupo de pacientes que não seguiu o protocolo.
Background: Artificial intelligence (AI) is transforming medicine by enabling real-time data analysis and improved decision-making. In anaesthesiology, AI tools are increasingly used for perioperative risk assessment and intraoperative monitoring, but evidence on their real-world performance and safety remains limited. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines, including studies from 2010 to May 2025 that evaluated AI applications—machine learning (ML), deep learning, neural networks, and fuzzy logic— in adult patients undergoing general or regional anaesthesia. Primary outcomes were perioperative complications (e.g., hypotension, hypoxia, bradycardia, delirium, vomiting, cardiac arrest, mortality, acute kidney injury [AKI]); secondary outcomes included haemodynamic stability, ICU admission, and length of stay. Risk of bias was assessed using RoB 2 and ROBINS-I, and random-effects models were applied. Results: Eighteen studies with diverse surgical settings and sample sizes (60 to >450,000 patients) were included. ML models consistently outperformed conventional statistical methods. Ensemble algorithms, such as XGBoost and random forests, achieved AUROC values of 0.942 and 0.96, respectively. Deep learning models, including Max-Pooling Convolutional Neural Networks, predicted mortality with AUROC 0.867. Hypotension Prediction Index (HPI) trials showed 88% sensitivity, 87% specificity, and a 77% reduction in hypotension burden. Hybrid models integrating waveform and electronic health record data reported AUROCs of 0.807 for mortality and 0.766 for AKI. Conclusions: AI-based monitoring, especially ML and biomarker-guided strategies, offers substantial improvements in perioperative risk stratification and haemodynamic management. Wider clinical adoption requires external validation, explainable AI frameworks, and rigorously designed randomized controlled trials demonstrating meaningful patient outcome benefits.
