The book Quando a Vida Pede Coragem – Uma jornada contra o câncer com consciência, esperança e ação (When life calls for courage: A journey confronting cancer with awareness, hope, and action) (GM Editora, 2025), by Tamara Prior, a historian who graduated from the University of São Paulo (USP), with an academic background focused on the history of health and the history of science.

After being diagnosed with breast cancer at age 29, the author joined patient groups, studied oncology in greater depth, and actively engaged with scientific evidence, developing a critical and participatory approach to therapeutic decision-making. 

This experience, marked by successive clinical challenges, led to the book Quando a Vida Pede Coragem, in which Prior combines personal experience, historical reflection, and scientific analysis to examine health, autonomy, and coping with illness.

WHY IS THIS BOOK RELEVANT?

The book is relevant because it seeks to move beyond simplistic dichotomies—for example, between science and sensitivity, between conventional medicine and patient autonomy, between hope and firm reality.

In the preface, science communicator Abner Santos describes how Tamara expanded her therapeutic “toolbox” without rejecting medical protocols. 

In this sense, the book advocates critical thinking in matters of personal health.

In an interview with Science Arena, Prior emphasized the importance of “developing filters” in response to information overload in the digital age. 

For those interested in the contemporary challenges of knowledge production and dissemination, the book offers a vivid case study of informational autonomy, patient agency, and the limits (and potential) of scientific paradigms in situations of high uncertainty.

WHAT MAKES THIS BOOK A MUST-READ?

First, Tamara Prior’s intellectual courage—she does not write from the perspective of someone offering a ready-made and comforting narrative. She challenges the often fatalistic and romanticized imagery surrounding cancer, discusses the shame experienced by patients and professionals, and questions simplistic explanations of causality (“Does everything cause cancer, or does nothing cause it?”).

Second, the book integrates personal experience and research. Throughout the work, each chapter balances her personal account with critical analysis and a review of evidence—from adaptive immune response to immunonutrition—culminating in a frank dialogue “between science and life.” 

“This is not a manual, nor is it the account of a miracle; it is about method, attitude, and responsibility,” Prior told Science Arena. 

“We often hear that it is enough to seek what is scientific, that is, ‘evidence-based medicine.’ But within this very field there are also pitfalls, interests, and even misconceptions disguised as promises,” the author warns.

The book also addresses the political dimension of care. 

This perspective echoes what Prior says in the interview: information without discernment can be confusing, but information combined with critical thinking can transform decisions.

This is a work that directly addresses a question of crucial importance to the scientific community: how can we navigate uncertainty without abandoning rigor? In an era of information overload and conflicting narratives about health and science, Quando a Vida Pede Coragem invites readers to cultivate something rare—lucidity with hope.

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The most striking gaps were found in Africa, Asia, and Latin America/the Caribbean, where low gross national income per capita is a determining factor.

In an interview with Science Arena, infectious disease specialist Dr. Fernanda Fernandes Fonseca, head of the AIDS Healthcare Foundation in Brazil and coauthor of the study, discussed the risks of late diagnosis, regional inequalities, and how this information can support more effective public policies.

Science Arena: Are there any countries that have efficiently overcome these resource challenges?

Fernanda Fonseca – The only region with adequate access to these resources is Europe, where per capita income is higher and the need for these resources is lower, given the reduced prevalence of people with advanced HIV/AIDS and late presenters. Recommendations to mitigate these challenges include targeted programs for under-served populations (including some supported by external funding) and local capacity building. Understanding and closing the gaps that restrict access to healthcare for this population can also help reduce the overall burden of HIV and AIDS.

What are the main consequences for patients without access to timely diagnostic tests and treatments, such as CD4 cell counts and prophylaxis for opportunistic infections?

People newly diagnosed with advanced HIV/AIDS and late presenters are at higher risk of adverse clinical outcomes than people diagnosed at earlier stages. Studies suggest that in low- and middle-income countries, 30% to 40% of people with HIV who start antiretroviral treatment have advanced HIV/AIDS. It is essential that every patient beginning or resuming HIV care has access to a baseline CD4 count. This allows for the identification of people with low CD4 counts who would benefit most from adequate resources to prevent and/or treat opportunistic infections in the first months of antiretroviral treatment, before immune recovery is established. Proper care can mitigate the morbidity and mortality associated with advanced HIV/AIDS.

How do stigma, discrimination, and lack of awareness contribute to high rates of late diagnosis?

Scientific studies suggest that factors associated with late presentation include being older, male, Latino, heterosexual, a migrant, with lower education, greater externalized stigma, and limited access to HIV testing.

How can the results of this study be used to influence public policy and improve the allocation of health resources?

Understanding and investigating public policies that remove barriers to healthcare for people living with HIV and who are receiving care later due to personal, community, and structural challenges will help mitigate the negative impacts of the global HIV/AIDS epidemic. The results of this analysis have been used to design and implement strategies for improving services at AHF-supported facilities, including by increasing the availability of rapid HIV testing and baseline CD4 counts for people starting or resuming treatment, allocating resources for the prevention and treatment of opportunistic infections, and continuing education for the clinical management of people with advanced HIV/AIDS. Ultimately, our findings can be used to inform future public health policies and other quality-improvement programs focused on comprehensive HIV care.

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The fifth edition of Plum and Posner’s Diagnosis and Treatment of Stupor and Coma (Oxford University Press, 2019), published by Jerome B. Posner, Clifford B. Saper, Nicholas D. Schiff, and Jan Claassen. The first edition was published in 1966.

WHY IS THIS BOOK RELEVANT?

Plum and Posner’s Diagnosis and Treatment of Stupor and Coma is a classic work and an important reference in neurology, particularly in the field of critical neuroscience and emergency neurology.

The book provides a comprehensive, systematic approach to the assessment and management of patients with consciousness disorders, combining a solid physiopathological base with practical clinical guidance.

Moreover, the book presents structured diagnostic strategies, emphasizing the rational use of complementary tests to differentiate between the multiple etiologies of compromised consciousness.

WHAT MAKES THIS BOOK A MUST-READ?

What makes Plum and Posner’s Diagnosis and Treatment of Stupor and Coma an essential read is its wealth of detail in the approach to lowering consciousness levels, a fundamental aspect for neurologists, critical-care professionals, and researchers in the field.

The book is logically structured and well laid out, facilitating understanding of aspects from physiopathological principles to diagnostic and therapeutic strategies.

What really captivated me was the way this book integrates classic knowledge and recent advances, providing not only a solid theoretical base, but also practical insights into the neurological assessment of critical patients.

Furthermore, the clear explanation of underlying coma mechanisms helps to interpret clinical exams and neuroimaging in a more detailed manner.

If you’re looking to enhance your understanding of stupor and coma, this work is essential. In addition to providing a trustworthy guide to clinical practice, it challenges the reader to think critically about differential diagnostics and therapy approaches.

For researchers and practitioners in the area of neurology, intensive medicine, and neurosciences, this is a must-read for its fundamental insights into clinical decision-making, and advances in scientific knowledge in this field.

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The study, commissioned by the US Department of Health and Human Services, was published in the New England Journal of Medicine in 2024.

The objective was to come up with an improved definition that considers the needs of the patient as well as the views and opinions of a range of experts.

In addition to reviewing the existing literature, the researchers used focus groups, a questionnaire, a public comment portal, and held several public meetings, including a two-day symposium.

More than 1,300 people participated in the activities, including patients, caregivers, health professionals, researchers, and public policy experts.

Although it is still seen as an acute infection—having killed approximately seven million people worldwide, 10% of them in Brazil alone—the SARS-CoV-2 virus also left millions of people with a variety of chronic, systemic, and often disabling symptoms.

The condition, which was deliberately not called a syndrome in the definition due to a lack of evidence, affects some 60 million people worldwide.

“As committee members and lead staff who produced the definition, we can attest that the process inspired discovery and deepening appreciation for the reality and severity of this condition,” the authors wrote.

One of the authors, E. Wesley Ely of Vanderbilt University Medical Center, admits that he was skeptical at first. Having worked with severely debilitated patients in intensive care units and researched their lives for 25 years, he believed the myriad signs and symptoms reported by long COVID patients could be a consequence of what is known as post-intensive care syndrome (PICS), which includes cognitive problems, neuromuscular disease, depression, and severe fatigue.

But this hypothesis proved unfeasible when symptoms began being reported by tens of thousands of patients from the first wave of the pandemic, most of whom were never hospitalized during the acute phase of the SARS-CoV-2 infection and experienced only mild symptoms.

Multiple manifestations

According to the article, long COVID is an “infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”

It manifests in multiple ways, with hundreds of possible signs, symptoms, and diagnosable conditions.

Any organ can be affected and patients may experience anything from shortness of breath, coughing, and persistent fatigue to difficulty concentrating, recurrent headaches, migraines, tachycardia, sleep problems, loss of taste and smell, constipation, and diarrhea.

The condition may also include interstitial lung disease, cardiovascular disease, kidney disease, fibromyalgia, diabetes, and autoimmune disorders such as lupus, rheumatoid arthritis, and Sjögren’s syndrome.

The researchers also identified cases involving cognitive problems, mood disorders, and anxiety.

Long COVID can occur after both mild and severe SARS-CoV-2 infections, as well as in asymptomatic cases.

It can continue from the acute phase of the disease or appear weeks or months after what appeared to be a complete recovery from the acute infection.

It affects children and adults regardless of health, disability, socioeconomic status, gender, sexual orientation, race, ethnic group, or geographic location. It can exacerbate preexisting health conditions or introduce new conditions.

Long COVID can also range from mild to severe, resolve over a period of weeks, or persist for months or years.

The article also noted that long COVID can impair the patient’s ability to work, attend school, and take care of relatives and themselves, resulting in profound physical and emotional impacts on both the patient and their family members and caregivers.

The researchers recommend reviewing the definition in three years (around 2027), based on scientific knowledge still to be produced. They also emphasize that the aim of the definition is to facilitate communication between patients and their family members and clinicians.

“A standard definition should enable better tracking of the burden of long COVID and facilitate the design and conduct of robust clinical trials that produce better treatments for this and other infection-associated chronic conditions,” the authors wrote.

“Above all, we hope that this definition contributes to compassionate and effective care for all patients in whom long COVID is diagnosed.”

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“I don’t know if it was fate or coincidence,” Cominetti says about the onset of her mother’s illness. “I don’t know if it’s good to know everything that might happen to her, or if ignorance would be better. But every person with dementia is different. The way the disease progresses depends on many factors,” she says.

According to Cominetti, her mother is doing very well and remains lively and happy. “She is aware of everything, she has her own opinions, and she has remained active since the diagnosis. The disease is progressing slowly in her case,” she says.

In one of Cominetti’s most recent investigations, she searched for a more accurate method for diagnosing Alzheimer’s—something as simple as a blood test.

Alzheimer’s is currently diagnosed by asking a set of questions about cognition and memory. If a patient does not achieve the score expected for their age and education level, the doctor can order biochemical tests to check for nutritional deficiencies that may be causing some form of dementia, or imaging tests, such as an MRI or CT scan, to help confirm the diagnosis.

Another test that can aid the diagnostic process is a lumbar puncture, which involves collecting a sample of cerebrospinal fluid (which circulates through the central nervous system).

“Imaging exams are expensive and not everywhere has the equipment,” explains the researcher. “A lumbar puncture is an invasive procedure that is painful and can cause side effects, especially in elderly people who may have other comorbidities. Questionnaires, meanwhile, are not enough to confirm a diagnosis.”

The idea is to screen the blood of people with suspected Alzheimer’s for specific proteins related to the disease. Neurologists already look for tau proteins and amyloid beta in MRI scans when seeking to diagnose Alzheimer’s.

They are too diluted to be identified in the blood, but a third protein, called ADAM10,which prevents the formation of amyloid beta,may offer an important clue.

High levels of ADAM10 in the plasma of a person with Alzheimer’s may indicate that the protein is not acting in the brain, therefore facilitating progression of the disease.

“Until a few years ago, there was no equipment sensitive enough to detect these biomarkers in the blood. It could only be identified in the cerebrospinal fluid that circulates through the brain,” says Cominetti. “Now, however, there are ultra-sensitive devices that allow for much less invasive examinations,” adds the researcher.

Biomarker validation

Scientists at LABEN, led by Cominetti, have been investigating ADAM10 since 2017, attempting to validate it as a blood biomarker to diagnose Alzheimer’s. The research is currently undergoing trials with volunteers aged over 60 years old.

“We took a very careful approach with these people because surprising as it may seem, after the last few years of government, they are wary of participating in research—they feel like guinea pigs,” says the biologist.

“We explained that we are going to do a health assessment and that we are working on finding an early diagnosis for Alzheimer’s,” she says.

The secret, according to Cominetti, is to be sensitive and empathetic with the volunteers. “There are ways to talk to an elderly person. You need to be attentive, patient, and to study the best strategies,” she advises.

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Cominetti expresses surprise that some people diagnosed with the disease in its early stages maintain an active life. “They know they have the disease and they work around it; if they forget a word, they choose a similar one to use instead,” says the researcher.

“It’s wonderful to see how people deal with dementia knowing they have it, how they find strategies to continue being as active as possible and living life to the fullest.”

In the early stages of the disease, patients are still able to hold opinions and make decisions. “Some people think that when a person has dementia, it’s the end—but it’s not. The person still has their own opinions and feelings. What happens is that in the most serious phase, it becomes difficult to interpret the signs they give us,” says the biologist.

A career shaped by science

Cominetti is fascinated by the study of aging, but that was not always the case. At the beginning of her career, shortly after she graduated from the Federal University of Santa Catarina (UFSC) in 1998, she worked in cellular biology, studying shrimp.

For her PhD, which she did at UFSCar, she studied venomous snakes. “There are several molecules in snake venom that cause hemorrhages and inhibit the proliferation of certain cells. This relates to cancer, which is nothing more than an uncontrolled proliferation of cells in different tissues,” she says.

Research into how these molecules function in cancer cases led her to spend a year in Paris, France, where she had a remarkable experience despite difficulties with the language. She also lived in Ireland, where she mastered English more easily and was part of the Global Brain Health Institute (GBHI) at Trinity College.

Upon returning to Brazil in 2006, she continued her research for a further three years with a postdoctoral fellowship, until she got a job teaching on the recently created gerontology course at UFSCar.

“I don’t think anyone really knew what it was,” she jokes.

Given the mission of teaching basic subjects about aging, Cominetti herself needed to study. “As a biologist, I understood the basics of aging, but I had to learn a lot of things that were not then in my wheelhouse,” she recalls.

As she began to understand more about aging, she fell in love. “I don’t think we define our own path, but the path defines us—it shapes us.”

“With her, I put into practice everything I teach in my courses: physical activity, cognitive stimulation—I gave her some of the cognitive stimulation materials that we use in the lab—and I tell her to keep going to the supermarket,” says the researcher, who does not live near her mother, but plays an active role in her life and takes care of her together with her sister.

“I think it makes things easier, because I know what’s to come, but knowing this also makes things harder,” she says.

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In a study published in the journal Einstein (Sao Paulo), researchers from the organization analyzed every telemedicine encounter from between March 2020 and August 2021 to evaluate how well the international guidelines were adopted and followed.

While unnecessary drug prescriptions—primarily of antimicrobials—exceeds 75% worldwide for suspected and confirmed COVID-19 patients treated via telemedicine, this figure was below 1% at the Brazilian institution in the time period analyzed.

“The quality of care and safety for telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications,” wrote the authors.

The results were obtained by examining medical records, with several quality indicators taken into account. Physicians were given feedback based on their own metrics, with recommendations based on the IDSA guidelines.

The study included all adults treated with respiratory symptoms in the prior 14 days who sought telemedicine consultations in the period under analysis. All patients had suspected or confirmed COVID-19 or other respiratory tract infections.

Antibiotic prescriptions reduced

Of the 221,128 patients evaluated:

• 42,042 (19%) were confirmed to have a SARS-CoV-2 infection
• 104,021 (47%) were suspected of having COVID-19
• 75,065 (33%) received other diagnoses

The average patient age was 35 years. In total:

• 125,107 (85%) of patients were treated at home
• 2,552 (1.7%) were referred for non-urgent hospital care
• 17,185 (11%) were referred to the emergency room

The rate of antibiotic prescription in suspected and confirmed cases was 0.46% to 0.65%, while the rate for prescriptions without scientific evidence was between 0.01% and 0.005%.

The study concluded that guideline-based training and feedback for physicians from supervisors can lead to fewer prescriptions of antibiotics and antimicrobials for suspected or confirmed cases of COVID-19.

“The adoption of prescription-focused protocols may improve guideline adherence and reinforce the quality of care and safety in telemedicine encounters,” the authors concluded.

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In the study, which only included “severe” cases, the algorithm identified the brain maps of people with ASD with 99% accuracy, according to an article published in the journal Scientific Reports. The software is still under development and is not expected to replace clinical exams, but it could provide data to help multidisciplinary teams reach a diagnosis.

Autism spectrum disorder is a neurological condition diagnosed on a scale of 1 to 3 based on the level of support the patient requires. The higher the number, the more help the patient needs to perform everyday tasks.

Most experts now use this scale rather than the previous method of classifying cases as mild, moderate, or severe, based on the guidelines of the American Psychiatric Association’s 2013 revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the 2022 version of the World Health Organization’s International Classification of Diseases (ICD-11). The data used by the researchers preceded these changes, so the terminology used in the study still reflects the previous ASD classification system.

“One of the main benefits of the algorithm will be preventing the misdiagnosis of disorders with similar symptoms to autism, such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and social anxiety disorder (SAD),” physicist Francisco Aparecido Rodrigues of the University of São Paulo (USP) explained to Science Arena.

The diagnosis of ASD is based on a subjective assessment and there is no test capable of providing an accurate result.

The algorithm was developed using data from 500 patients aged 7 to 64. The data was extracted from the Autism Brain Imaging Data Exchange (ABIDE), an open-access database of fMRI images and other information about patients with severe autism.

To do this, the researchers selected 122 regions of interest in the brain. When an fMRI image showed that activity in two of these regions spiked at the same time, the team inferred that these two spots were communicating with one another. They were thus able to connect all the points, forming a complex network like a set of roads or the internet.

Feeding the algorithm

Next, the scientists trained the algorithm with the brain maps—242 from people with ASD and 258 without—and it automatically looked for patterns that identified the brains of people with autism, part of a process known as machine learning.

“The neural network of an autistic person has a different pattern of connections than a person without the disorder,” explains neurologist Patricia Maria de Carvalho Aguiar, a researcher at Hospital Israelita Albert Einstein.

According to Aguiar, some areas are hyperconnected and others have weaker connections, altering the flow of information. She helped interpret the fMRI images that were analyzed by the algorithm, determining whether the diagnoses were compatible with the alterations shown in the images.

“The main difference with the software is that it explains the result, identifying the alterations in the neural network that led to the diagnosis,” highlights João Paulo Papa, a computer scientist from São Paulo State University (UNESP), who did not participate in the study.

Papa explains that most AI tools work like a “black box,” providing a result without any explanation of how it was obtained. “A diagnosis without justification has little clinical value,” he points out.

The data presented in the article showed that some of the most commonly altered connections in the sample involved the cerebellum—the posterior region of the brain responsible for motor control. For example, the researchers noted a weaker connection between this region and the visual cortex, which processes vision, and with the limbic system, which is involved in emotional response and behavior control.

Changes in the prefrontal cortex that are typical of autism and affect executive functions, such as organization and planning, were not observed in the sample. “This may be because the cases of autism were severe and highly varied, with different comorbidities,” says Aguiar.

The Einstein neurologist emphasizes that it will be important to repeat the study with patients without comorbidities, to better understand how these regions affect autism.

Diagnostic aid

Aguiar does not believe that this type of software will replace clinical assessment, which she says is more refined than mathematical models. “But neural network models could help understand the flow of information in the autistic brain, serving as a basis for therapies that help modify this flow,” she says.

The main limitation of the tool is that it has not been tested with “mild” cases, which are generally the most difficult to diagnose. “We still need to test the algorithm in larger populations and with people from different regions, including mild cases,” says Aguiar.

The algorithm can be run on standard computers by simply installing the program and providing the fMRI images. Collecting the data to train it, however, can be more difficult.

“Data obtained by fMRI are very sensitive. Any movement by the patient can completely alter the result of the exam,” points out Francisco Rodrigues, from USP. “The person needs to remain absolutely still, in an environment where there is no noise or movement.”

The researcher stresses that several more years are needed to perfect the data collection technique.

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