Obesity is a multifactorial disease with endocrine, metabolic, and inflammatory underpinnings, leading to numerous comorbidities and increased mortality. This has driven research into adipose tissue’s role as an endocrine organ that secretes adipokines. This review critically analyzes three of these adipokines: chemerin, omentin-1, and visfatin. Chemerin and omentin-1 have well-defined roles as pro- and anti-inflammatory mediators, respectively. However, the function of visfatin remains controversial, with conflicting data regarding its role in glucose metabolism and inflammation. This conflicting evidence highlights an urgent need for standardized assays and population-specific studies to clarify its true function. We conclude that while chemerin and omentin-1 represent promising targets, the ambiguity surrounding visfatin limits its current clinical utility, and resolving these knowledge gaps is essential for developing effective biomarkers and therapies for obesity and its comorbidities.

Background: Primary Health Care plays an important role in the provision and coordination of palliative care in many healthcare contexts. Education and training of healthcare professionals are relevant strategies to support the delivery of quality palliative care. Objective: To evaluate whether training healthcare professionals working in Primary Health Care improves symptom assessment and clinical management of patients eligible for palliative care. Methodology: Systematic review conducted according to PRISMA 2020 guidelines, with a protocol registered on the PROSPERO platform under the number CRD420261370621. The eligibility criteria were structured according to the PICO approach: population composed of healthcare professionals working in primary care; educational interventions in palliative care; comparator without training or with different modalities; outcomes of symptom assessment and clinical control. The searches were conducted in seven databases: PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane Library, SciELO, and LILACS. Results: Eight studies were included in the review, with varied designs: a pilot randomized clinical trial, a quasi-experimental study, two evaluations of educational programs, a feasibility study, a retrospective population cohort, and two qualitative approaches. The findings revealed a generalist predominance in the provision of palliative care: 95% of the care was provided by generalists, 53% of patients did not receive identifiable palliative care in the last year of life, and specialists were virtually nonexistent in rural areas, where family doctors were responsible for nearly all care. Conclusions: Training of primary care teams is necessary, but insufficient on its own. Although it improves the confidence and knowledge of professionals, there is no robust evidence that it sustainably transforms patient clinical outcomes. The problem is structural: there is a lack of adequate clinical time, compatible remuneration, integration with specialists, and support infrastructure. It is necessary to go beyond education and promote reforms in the healthcare system so that palliative care in primary care is effectively qualified.

O hemangioendotelioma epitelioide hepático (HEH) é uma neoplasia vascular rara, de comportamento biológico intermediário, cuja evolução clínica pode variar de curso indolente até insuficiência hepática progressiva . Em estágios avançados, o transplante hepático constitui a principal opção terapêutica, embora sua viabilidade dependa do estado clínico do paciente no momento da oferta do órgão . Este estudo tem como objetivo relatar a experiência do acompanhamento clínico de uma paciente com hemangioendotelioma epitelioide hepático, inscrita em lista de espera para transplante hepático, acompanhada durante rodízio da residência médica em gastroenterologia em hospital terciário. O relato descreve a evolução clínica, as condutas terapêuticas adotadas e os aspectos éticos envolvidos na tomada de decisão, contextualizados por meio de revisão da literatura. Durante o acompanhamento, a paciente evoluiu com insuficiência hepática descompensada, encefalopatia hepática e síndrome hepatorrenal, necessitando internação em unidade de terapia intensiva. Apesar da priorização na lista de transplante, a deterioração clínica progressiva e a indisponibilidade de órgão compatível inviabilizaram o procedimento. Após discussão multidisciplinar, optou-se pela transição para cuidados paliativos integrais, e a paciente evoluiu para óbito. O relato evidencia os desafios do manejo clínico do HEH avançado, as limitações do escore MELD-Na em situações de rápida deterioração clínica e a importância da integração precoce dos cuidados paliativos, reforçando a necessidade de decisões éticas e centradas no paciente em contextos de alta complexidade.