Instituto de Medicina Integral Professor Fernando Figueira

This theoretical-reflective essay addresses ethics in nursing care for transgender people, emphasizing the tension between the care provided and the institutional invisibilities that perpetuate the exclusion of this population in the healthcare system. Based on universal principles of human rights and contemporary philosophical concepts, such as Axel Honneth's ethics of recognition and Judith Butler's performative theory of gender, the text problematizes professional practice in the face of the specific demands and vulnerabilities of transgender people. Structural invisibility, sustained and reinforced by cisnormativity norms and the absence of specific content in professional training, represents an ethical barrier to ensuring humanized and inclusive care. The study highlights that the denial of gender identity, the incorrect use of the chosen name, and the perpetuation of prejudices constitute ethical and human rights violations, aggravating suffering and health inequalities. The proposed reflection also emphasizes the responsibility of nursing professionals to transcend technique and take a critical, ethical, and political stance that recognizes others in their uniqueness and promotes care practices that respect diversity. The essay advocates the adoption of an ethic of recognition as the foundation for transforming care into a space of welcome, justice, and redress for structural inequalities. Finally, the text reaffirms the importance of transforming invisibilities into visibilities, and that nursing should position itself as an active agent in promoting equity and the rights of the transgender population, ensuring care that legitimizes, values, and respects their identities and histories.

The Pediatric Nephrology Standard of Care is essential for the diagnosis, monitoring, and management of children with Chronic Kidney Disease (CKD). Early detection of kidney changes is essential since many conditions can be silent, but have a major impact on the child's growth and development. The Standard of Care structure includes neonatal screening, assessment of predisposing conditions for kidney disease, calculation of the estimate of renal function and classification of the CKD stage to propose drug and nondrug therapeutic interventions. Challenges such as shortage of specialists, need for screenings and unequal access to services reinforce the importance of robust public policies and training programs. Personalized protocols are recommended to delay progression to Renal Replacement Therapy. In September 2024, the Clinical Guidelines and Therapeutic Protocol (CGTP) for CKD in adults was launched. In this Opinion article, a group of Pediatric Nephrologists comment on the perspectives for creating a CGTP for children and adolescents with CKD.

Background Diastasis recti abdominis (DRA) is characterised by a separation of the rectus abdominis muscles, which is common in the postpartum period. This randomised controlled trial investigated the effects of a physiotherapy protocol combining abdominal exercises and physical agents—namely electromagnetic shock waves, transfer of energy capacitive and resistive (TECAR) therapy, and neuromuscular electrical stimulation—on reducing the inter-rectus distance in women with DRA six months after childbirth. Methods Sixty women diagnosed with DRA were randomised into three groups: kinesiotherapy (Group A); electromagnetic shock waves, TECAR therapy, and neuromuscular electrostimulation (Group B); and a combination of both (Group C). The inter-rectus distance (IRD) of participants was assessed before and after treatment, with re-evaluation conducted sixty days after the initial assessment, using ultrasound and abdominal perimeter measurements. Results group C showed a 0.80 cm reduction in supraumbilical IRD when compared with Group B. In the infraumbilical region, Group C had a 0.74 cm reduction compared to Group A and 0.85 cm compared to Group B. Regarding abdominal perimeter, Groups B and C showed greater reductions in the infraumbilical circumference than Group A, with mean differences of approximately 10 cm. No significant differences were observed in the supraumbilical and umbilical regions. Conclusions the combination of kinesiotherapy and physical agents is more effective in reducing inter-rectus distance and abdominal circumference than either approach alone in postpartum women with diastasis recti abdominis.

Bainbridge-Ropers syndrome (BRPS) is a rare neurodevelopmental disorder caused by pathogenic variants in ASXL3. We report the first Brazilian pediatric case of BRPS associated with a duplicated pyelocaliceal system, adding evidence to a possible, but still poorly understood, relationship between ASXL3 mutations and urinary system developmental abnormalities. The patient presented typical BRPS features, including hypotonia, severe developmental delay, feeding difficulties requiring gastrostomy, seizures, and craniofacial dysmorphisms. Additionally, renal imaging revealed a duplicated pyelocaliceal system, with preserved renal function. Whole-exome sequencing identified a de novo truncating ASXL3 variant. This case reinforces the expanding phenotypic spectrum of BRPS and highlights the importance of comprehensive systemic assessment, including increased vigilance and consideration of renal evaluation, in children with syndromic features and global developmental delay. Early genetic testing remains essential to diagnostic confirmation and management planning.

A cannabis tem sido utilizada medicinalmente desde a pré-história, sendo criminalizada ao longo do século XX por pressões políticas e industriais. No Brasil, o cenário começou a mudar a partir do século XXI, com revisões jurídicas e regulamentações da ANVISA e do Conselho Federal de Medicina, permitindo sua prescrição em alguns casos específicos. Este trabalho apresenta um relato de experiência sobre o Ambulatório de Cannabis Medicinal da Universidade Federal de Pernambuco (UFPE), criado em 2018 como um projeto de extensão. O ambulatório oferece assistência a pacientes que necessitam de cannabis para fins terapêuticos, além de divulgar informações sobre aspectos legais e promover formação de prescritores. Desde sua fundação, o ambulatório realizou 376 atendimentos clínicos. Os principais desafios incluem a falta de médicos prescritores, estrutura física adequada e apoio institucional. Em 2024, o projeto foi renovado, permitindo a retomada dos atendimentos e das Rodas Canábicas – encontros educativos e de acolhimento. A principal demanda dos pacientes foi para o tratamento de dores crônicas e transtornos como fibromialgia e ansiedade. Apesar da ausência de estudos clínicos robustos, muitos relataram melhora na qualidade de vida. Não foram registrados efeitos colaterais graves. O acesso à cannabis medicinal ainda enfrenta barreiras legais, sociais e institucionais. Entre os principais desafios: oferta/acesso ao medicamento, preconceito social e inclusão de profissionais prescritores no SUS. O ambulatório desempenha papel essencial na assistência e formação, mas necessita de maior apoio para garantir sua continuidade. A expansão de estudos científicos e mudanças regulatórias são fundamentais para ampliar acesso ao tratamento. PALAVRAS-CHAVE: cannabis, direito à saúde, saúde.

Abstract Introduction Heart transplantation (HT) is the gold standard treatment for refractory heart failure, offering a life-saving intervention for patients with end-stage cardiac dysfunction. However, this procedure is associated with significant haemodynamic alterations, which may impact both vascular function and autonomic regulation. Arterial stiffness, represented by the augmentation index (AI), and heart rate variability (HRV) are well-established cardiovascular risk markers in HT recipients. However, the interaction between these two parameters remains poorly understood, particularly considering that post-transplant duration may modulate both indices. Objective To investigate the relationship between arterial stiffness and HRV in heart transplant recipients, with the aim of elucidating potential interactions between vascular function and autonomic cardiac modulation. Methods This cross-sectional study was conducted between August 2018 and December 2023. Participants were 18–65 years old, of both sexes, had undergone HT at least six months prior, were clinically stable, and were on regular immunosuppressive therapy. Arterial stiffness was assessed via the augmentation index (AI), while HRV was evaluated using frequency-domain components. These parameters were measured through pulse wave amplitude variation using peripheral arterial tonometry. Results A total of 33 participants were included, with a mean age of 48.85 ± 12.29 years, 82% male, and a mean post-transplant duration of 34.39 ± 25.43 months. The recorded values were as follows: Augmentation Index (AI): -3.95 ± 13.71 (%); Low-frequency to high-frequency ratio (LF/HF): 0.66 ± 0.73 ms²; Low-frequency (LF): 76.35 ± 58.81 ms²; High-frequency (HF): 161.02 ± 75.46 ms². A positive correlation was observed between AI and HF (r = 0.434, p = 0.012) and between AI and the LF/HF ratio (r = 0.579, p < 0.001), suggesting a direct association between arterial stiffness and parasympathetic autonomic modulation. However, no significant correlation was found with LF. Conclusion These findings indicate that greater arterial stiffness is associated with increased parasympathetic autonomic modulation, as evidenced by the positive correlation between AI and HF. Furthermore, the correlation between AI and the LF/HF ratio suggests a potential autonomic imbalance linked to vascular function in heart transplant recipients. The lack of correlation with LF underscores the need for further investigation to elucidate the underlying mechanisms governing these associations and their prognostic implications for post-transplant follow-up.