Dear Editor, Diaphragm weakness is a common complication in critically ill patients and can develop within days after the initiation of invasive mechanical ventilation.(,) It is characterized by a rapid loss of diaphragm contractile capacity, which compromises the patient’s ability to breathe independently.(,) Diaphragm weakness is strongly associated with worse clinical outcomes, including prolonged weaning from mechanical ventilation (MV), longer intensive care unit (ICU) and hospital length of stay, and higher mortality.(-) Because of its high prevalence and major clinical […]

This is where danger lies for the unwary Naturally gluten-free foods are rarely the problem. Processed foods labeled as gluten-free often are. Regulatory definitions allow foods labeled gluten-free to contain up to 20 parts per million of gluten.() Some countries adopt stricter limits, below 10 parts per million.() For patients with celiac disease, these differences matter. Since my son’s diagnosis, I have learned to read every label, scrutinize every ingredient list, and carefully check for gluten-free claims. In the United […]

Dear Editor, The article “Socioeconomic inequities in prostate cancer care: private versus public treatment settings pose a significant impact on overall survival”() addresses an urgent question by comparing outcomes among men with metastatic prostate cancer treated within Brazil’s public and private healthcare systems at a single tertiary center. The reported 37-month median overall-survival gap (115 versus 78 months), along with the finding that patients treated in the public system received fewer treatment lines, is striking and warrants urgent scrutiny. […]

Dear Editor, We would like to thank D’Elia et al. for their thoughtful and constructive comments regarding our article, “Socioeconomic inequities in prostate cancer care: private versus public treatment settings pose a significant impact on overall survival” published in einstein (São Paulo).() We fully agree with the authors regarding the relevance and urgency of this discussion. […]

Dear Editor, Following the publication of our editorial on evidence-based approaches to simulation-based education (SBE),() we received multiple requests from educators and the simulation community for a concise resource to support implementation at the point of curriculum design and faculty training. To address this gap, we created a one-page infographic that translates the editorial’s arguments into a practical visual aid (). […]

Dear Editor, What does Mangomoments mean? In 2018, Kris Vanhaecht, a professor at Leuven University in Belgium, published a paper in the Lancet Oncology Journal titled “In search of Mangomoments”.() The title drew inspiration from a documentary filmed at a Belgian hospital featuring a patient in the intensive care unit (ICU) and a journalist. Upon awakening from a coma, the patient described the difficulty of lying motionless, staring at the ceiling, listening to her family during visits, and witnessing the […]

Dear Editor, We read the article by Dr. Schollemberg et al. with great interest.() In their prospective cohort study, they assessed the complications and associated risk factors following transrectal ultrasound-guided prostate biopsy (TRUSB) at a Brazilian public reference center. A total of 1,043 consecutive patients were assessed using the Global Prevalence of Infections in Urology form, and complications were classified based on the Clavien-Dindo system. Most bleeding events were mild (Grade 1), whereas 1.5% were of Grades 2–3 and were […]

Dear Editors, We would like to thank Drs Hüsnü Tokgöz and Özlem Tokgöz for their thoughtful correspondence regarding our prospective cohort study on complications after transrectal ultrasound-guided prostate biopsy in a Brazilian public reference centre.() In their letter, they accurately summarise our main findings, including a marked association between recent quinolone use and post-biopsy infectious complications. […]

Dear Editor, The widespread adoption of telemedicine has transformed healthcare delivery. However, the inability to perform hands-on physical examinations remains a significant limitation, particularly when accurate intravascular volume assessment is critical for conditions such as acute decompensated heart failure, sepsis, or renal failure.() Conventional clinical signs—including elevated jugular venous pressure, peripheral edema, hepatojugular reflux, or pulmonary rales—are either difficult to reproduce consistently or challenging to assess reliably through standard videoconferencing. Moreover, even at the bedside, their individual diagnostic utility is […]

Dear Editor, We write in reference to the recently conducted article, ‘Multifocal Papillary Thyroid Microcarcinomas: is the Total Tumor Diameter Associated with Tumor Behavior? A Retrospective Cohort Study,” by Nardi et al.() While the authors’ efforts are commendable, we feel it is necessary to critically assess some of their findings and limitations. The primary conclusion of the study suggests that total tumor diameter (TTD)—defined as the sum of the largest diameters of all tumor foci—shows no significant association with initial […]