http://hdl.handle.net/11422/25231 Wed, 29 Jul 2026 15:54:10 GMT 2026-07-29T15:54:10Z http://hdl.handle.net/11422/29572 Title: Nódulo pulmonar: uma abordagem diagnóstica Author(s)/Inventor(s): Rittershaussen, Victoria Pinho Tavares Advisor: Sales Filho, Fernando Abstract: The pulmonary nodule is a frequent radiological finding and represents a clinical challenge due to the need to distinguish between benign and malignant etiologies. This review analyzed the main international guidelines — the Fleischner Society, the American College of Chest Physicians, and the British Thoracic Society — focusing on their specific differences in risk stratification, radiological characteristics, and diagnostic methods. There was convergence regarding the importance of a structured evaluation, but divergences were noted in probabilistic calculation methods, risk thresholds, and indications for PET-CT and biopsy. When considering the Brazilian context, limitations related to unequal access to advanced technologies become evident, requiring practical adaptation of the proposed algorithms. It is concluded, therefore, that the approach to pulmonary nodules must integrate scientific evidence, resource availability, and individualized clinical judgment to ensure safe and efficient management while avoiding unnecessary interventions. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Wed, 10 Dec 2025 00:00:00 GMT http://hdl.handle.net/11422/29572 2025-12-10T00:00:00Z http://hdl.handle.net/11422/29555 Title: Abordagem diagnóstica e terapêutica de tumores cardíacos: revisão narrativa Author(s)/Inventor(s): Correia, José Fernando Ornelas de Sousa Alves Advisor: Pinho, Gabriel Alves Oliveira de Abstract: Introduction: Cardiovascular diseases remain the main global cause of mortality and disability. Cardiac tumors are rare and show wide epidemiological variation, with benign primary lesions being the most prevalent. There is increasing diagnostic incidence due to advances in imaging techniques, which allow differentiation from pseudotumoral lesions such as intramural thrombi. For this reason, the study sought to synthesize recent evidence on diagnosis and therapeutic strategies for the main tumor types, highlighting existing gaps in the literature. Methods: Narrative review with a PubMed search for review articles using the descriptors “cardiac tumors” OR “myxoma” OR “papillary fibroelastoma” OR “cardiac rhabdomyoma” OR “cardiac angiosarcoma” OR “cardiac metastasis.” A total of 188 articles from the initial search and 76 from references were screened, with 93 reviews included. Results and discussion: Myxomas and papillary fibroelastomas are the most frequent benign tumors, predominate in atria, and are associated with embolic risk. Rhabdomyomas are mainly pediatric tumors, strongly associated with the tuberous sclerosis complex and prone to spontaneous regression. Among primary malignant neoplasms, angiosarcomas stand out as infiltrative tumors with early metastases. Cardiac metastases may originate from virtually any primary site, present heterogeneously, and predominantly affect the pericardium. Echocardiography is the initial exam of choice for evaluating cardiac tumors, complemented by computed tomography or magnetic resonance imaging for better structural characterization. The preferential therapy is complete surgical resection; however, the strategy must be individualized, with possible use of chemotherapy, radiotherapy, targeted therapy, and immunotherapies depending on tumor type and the patient's clinical condition. Conclusion: Physicians of any specialty should recognize signs that justify the investigation of cardiac masses. There is a noted scarcity in the literature regarding diagnostic and therapeutic approaches for these tumors. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Mon, 15 Dec 2025 00:00:00 GMT http://hdl.handle.net/11422/29555 2025-12-15T00:00:00Z http://hdl.handle.net/11422/29551 Title: Cardiomiopatia arritmogênica de ventrículo direito: uma revisão bibliográfica Author(s)/Inventor(s): Pereira Júnior, Heliomar da Silva Advisor: Alencar, Andrea Tavares de Abstract: Arrhythmogenic Cardiomyopathy (ACM) configures a hereditary cardiac disorder characterized by progressive replacement of myocardium with fibroadipose tissue, predominantly in the right ventricle, affecting an estimated prevalence between 1:1000 to 1:5000 inhabitants. Mutations in desmosomal genes, particularly plakophilin-2 (PKP2), desmoglein-2 (DSG2), and desmocollin-2 (DSC2), determine dysfunction in cellular adhesion, resulting in myocyte death, adipose infiltration, and scar formation that create substrate for malignant ventricular arrhythmias. The disease manifests clinically with palpitations, syncope of arrhythmogenic origin, dyspnea on exertion, and sudden cardiac death, predominantly affecting young individuals and athletes. Diagnosis integrates electrocardiographic findings (epsilon waves and T-wave inversion in right precordial leads), cardiac magnetic resonance imaging (demonstrating fibroadipose infiltrate and late gadolinium enhancement), genetic testing, and revised Task Force criteria published in 2010, conferring superior diagnostic accuracy. Clinical evolution presents three distinct stages: the concealed stage, characterized by genetic-electrophysiologic alterations without manifest clinical symptoms; the arrhythmogenic stage, marked by palpitations, syncope, and documentation of ventricular arrhythmias; and the established cardiomyopathy stage, wherein progressive ventricular dilation and dysfunction occur with risk of heart failure. Therapeutic management articulates in individualized manner according to sudden cardiac death risk stratification of each patient, including restriction of intense and competitive physical activities as fundamental measure, use of beta-blockers or calcium channel blockers (verapamil) as first-line pharmacological therapy, implantation of implantable cardioverterdefibrillator (ICD) in high-risk patients for fatal events, catheter ablation for control of refractory arrhythmias, and in selected cases of advanced disease with severe biventricular dysfunction, cardiac transplantation. Systematized integration of clinical, electrocardiographic, imaging, electrophysiologic, and genetic findings optimizes early diagnosis, enables precise risk stratification, and directs appropriate therapeutic interventions aimed at preventing sudden cardiac death and improving quality of life in patients affected by this important arrhythmogenic syndrome. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Thu, 13 Nov 2025 00:00:00 GMT http://hdl.handle.net/11422/29551 2025-11-13T00:00:00Z http://hdl.handle.net/11422/29550 Title: Uso de antibióticos no cuidado de fim de vida: uma revisão narrativa Author(s)/Inventor(s): Costa, Letícia Chalréo Ribeiro Advisor: Vasconcellos, Caio Cesar Alves Abstract: End-of-life care presents a significant challenge regarding the use of antimicrobials, as terminal patients receive antibiotic therapy with high frequency despite clinical benefits that are often limited and inconsistent. The analysis is based on a narrative review of scientific literature, selecting observational studies, guidelines and epidemiological data that demonstrate high prescription rates, especially in hospital and palliative care settings, where use may exceed 50% of cases and reach up to 90% in terminal admissions. Patients in this stage face increased infection risk due to immunosuppression, malnutrition, immobility and the use of invasive devices, factors that favor the initiation or continuation of antibiotic therapy even in the presence of a poor prognosis. Evidence indicates that urinary tract infections tend to respond better to treatment, whereas pneumonia in advanced dementia shows inconclusive results and rarely leads to meaningful improvement, suggesting that therapeutic benefit depends on infection type and patient clinical condition. It is also noted that therapeutic decisions are influenced by family expectations and by the perception that discontinuing antibiotics represents abandonment, which may lead to futile treatments, increased adverse effects, prolonged suffering and contribution to antimicrobial resistance on a global scale. In this context, significant gaps persist in the literature, such as the absence of standardized clinical indicators, scarcity of studies measuring symptomatic impact and limited understanding of cultural factors that support low-benefit prescriptions. Given this scenario, there is a reinforced need for patient-centered decisions aligned with goals of comfort, proportionality and dignity in the dying process, with integration of palliative care principles and antimicrobial stewardship programs, in addition to encouraging more robust scientific production to support future recommendations. Publisher: Universidade Federal do Rio de Janeiro Type: Trabalho de conclusão de especialização Fri, 07 Nov 2025 00:00:00 GMT http://hdl.handle.net/11422/29550 2025-11-07T00:00:00Z