Medicina
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Breastfeeding in newborn infants born to people living with HIV continues to be a controversial issue. However, there is numerous evidence that reveals that in the context of sustained virological suppression, the risk of postnatal HIV transmission through breast milk is less than 1%. From the activism of people with HIV, civil society and the medical and scientific community, there is a demand for reopening the issue, with the purpose of defining new guidelines for the feeding of children born to people with HIV. This review analyzes the available scientific evidence and the current knowledge gaps regarding breastfeeding in HIV situations and proposes an institutional approach and shared decision-making modality for HIV-positive pregnant people who wish to breastfeed.
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Rare encephalopathies are here described in order to summarize practical tools that should be considered in the anamnesis, as well as in the physical examination. The way in which the clinical picture was established was the primary point for structuring the review; subsequently, the encephalopathies were subclassified etiologically. Focal symptoms, headaches, abdominal pain, fever or extrapyramidalism, added to the findings in the magnetic resonance imaging, especially if damage to the gray or white matter is observed, and if the lesions are bilateral or not, can be helpful when hypothesizing the etiology of the encephalopathy.
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The clinical reasoning process for decision-making in medicine is complex and involves multiple factors, including diagnostic probabilities, study characteristics, costs, and patient preferences. This article highlights the role of pre-test probability in calculating the positive predictive value (PPV) and negative predictive value (NPV) of diagnostic tests and also likelihood ratios. ⋯ The notion of treatment and diagnostic thresholds is introduced, emphasizing their impact on medical decision-making. Finally, it underscores that diagnostic tests should only be requested if their results can change clinical management, promoting a rational and cost-effective approach to medical practice.
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Management in primary health care (PHC) focuses on system design, improvement policies, and implementation of evidence-based interventions. This review identifies and describes management strategies used to improve PHC in terms of quality, accessibility, efficiency, and satisfaction of health professionals and patients. A review of the literature published in PubMed, Ovid/Medline, Cochrane Library, ScienceDirect, and Google Scholar was conducted. ⋯ Strategies to improve the satisfaction of healthcare professionals and patients were the least studied, at 16.7% (n = 3) each. Strategies to improve management in PHC should cover several dimensions and adapt to the needs of the environment. It is recommended to emphasize optimizing quality, accessibility, efficiency, ensuring the well-being of professionals and improving the user experience, while fostering the ability to withstand challenges and innovate.
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Pediatric palliative care focuses on improving the quality-of-life in children with severe illnesses and their families, addressing relief of pain and other physical symptoms, as well as emotional, social and spiritual support. Its approach is comprehensive and multidisciplinary. Severe neurological diseases are life-limiting and threatening, significantly affecting the well-being of the child. ⋯ Early intervention can improve quality-of-life, reduce unnecessary hospitalizations, and provide emotional support for the family. Coordination between different health services is essential to ensure patient-centered care. Education and training of health professionals in this field are essential to improve the care of these children.