Is Mandatory Vaccination for COVID-19 Constitutional under Brazilian Law?

Mandatory vaccination for COVID-19 has been the object of heated debate in Brazil. This article discusses the legality and constitutionality of such a policy. First, it analyzes the laws, regulations, and Supreme Court decisions that provide for the possibility of mandatory COVID-19 vaccination. Subsequently, it analyzes the constitutionality of a mandatory vaccination policy through the proportionality method to address the conflict between, on one side, the right to individual autonomy, which includes the right to refuse a medical intervention, and, on the other, health policies that interfere with individual autonomy to protect the rights to life and health. The application of this method allows for the identification of key questions that need to be answered to determine the constitutionality of a mandatory vaccination program. These questions cannot be answered a priori and in the abstract because they depend on the concrete circumstances of the pandemic, on the characteristics of the vaccine(s) against COVID-19, and on how a mandatory vaccination policy might be designed and implemented by authorities.

COVID-19 in prisons: a study of habeas corpus decisions by the São Paulo Court of Justice / COVID-19 en las prisiones: un estudio de las decisiones sobre habeas corpus en el Tribunal de Justicia de São Paulo / COVID-19 nas prisões: um estudo das decisões em habeas corpus no Tribunal de Justiça de São Paulo

Abstract Brazil has become the epicenter of the COVID-19 pandemic in the Global South-a pandemic that disproportionately affects vulnerable populations, especially those detained and imprisoned. Legal institutions are struggling to respond. In this paper, we focus on the National Council of Justice's Recommendation 62, issued March 17, 2020, which recommends that judges take several measures to reduce the risk of COVID-19 infection in prisons. We test this recommendation's impact by looking at habeas corpus decisions in the São Paulo Court of Justice. The exploratory findings presented here indicate that Recommendation 62 has little impact on habeas decisions. In general, citing the recommendation does not lead the Court to grant early release or house arrest to those detained, and most habeas actions are decided against petitioners. This is true even when petitioners claim to be part of a risk group, or their alleged offense did not involve violence or serious threat-factors that should favor habeas relief under Recommendation 62.

Resumen Brasil se ha convertido en el epicentro de la pandemia de COVID-19 en el Sur global, una pandemia que afecta desproporcionadamente a las poblaciones vulnerables, especialmente a las detenidas y encarceladas. A las instituciones jurídicas les resulta difícil ofrecer una respuesta adecuada. En este artículo, analizamos una de esas respuestas, la Recomendación 62 del Consejo Nacional de Justicia, emitida el 17 de marzo de 2020 y que recomienda que jueces tomen diferentes medidas para reducir el riesgo de infección por COVID-19 en las prisiones. Evaluamos el impacto de esta recomendación analizando las decisiones sobre habeas corpus del Tribunal de Justicia de São Paulo. Los hallazgos exploratorios presentados aquí indican que la Recomendación 62 tiene poco impacto en estas decisiones. En general, citar la recomendación no lleva al Tribunal a conceder la libertad anticipada o el arresto domiciliario a las personas detenidas y la mayoría de los habeas corpus son decididos en contra de los demandantes. Esto es cierto incluso cuando estas personas afirman ser parte de los grupos de riesgo o que su supuesto crimen no implica violencia o amenaza grave, factores que deberían favorecer las decisiones por la concesión de los habeas corpus, de acuerdo con la Recomendación 62.

Resumo O Brasil se tornou o epicentro da pandemia da COVID-19 no Sul Global — uma pandemia que afeta desproporcionalmente populações vulneráveis, especialmente as detidas e presas. As instituições jurídicas encontram dificuldades em oferecer uma resposta adequada. Neste artigo, analisamos uma destas respostas, a Recomendação 62 do Conselho Nacional de Justiça, emitida em 17 de março de 2020 e que recomenda que juízes e juízas adotem diferentes medidas para reduzir o risco de infecção por COVID-19 nas prisões. Testamos o impacto dessa recomendação analisando decisões em habeas corpus junto ao Tribunal de Justiça de São Paulo. Os achados exploratórios aqui apresentados indicam que a Recomendação 62 tem pouco impacto nestas decisões. Em geral, citar a recomendação não leva o Tribunal a conceder liberdade antecipada ou prisão domiciliar às pessoas presas e a maioria dos habeas corpus são decididos contra demandantes. Isso é verdade mesmo quando estas pessoas afirmam fazer parte de algum dos grupos de risco ou que seu suposto delito não envolvera violência ou grave ameaça — fatores que deveriam favorecer decisões pelo provimento do habeas corpus, segundo a Recomendação 62.

Withdrawing treatment from patients with prolonged disorders of consciousness: the wrong answer is what the wrong question begets.

In a recent paper, Charles Foster argued that the epistemic uncertainties surrounding prolonged disorders of consciousness (PDOC) make it impossible to prove that the withdrawal of life-sustaining treatment can be in a patient's best interests and, therefore, the presumption in favour of the maintenance of life cannot be rebutted. In the present response, I argue that, from a legal perspective, Foster has reached the wrong conclusion because he is asking the wrong question. According to the reasoning in two leading cases-Bland and James-the principle of respect for autonomy creates a persuasive presumption against treatment without consent. Therefore, it is the continuation of treatment that requires justification, rather than its withdrawal. This presumption also works as the tiebreaker determining that treatment should stop if there is no persuasive evidence that its continuation is in the best interests of the patient. The presumption in favour of the maintenance of life, on the other hand, should be understood as an evidential presumption on a factual issue that is assumed to be true if unchallenged. However, the uncertainties regarding PDOC actually give reasons for displacing this evidential presumption. Consequently, decision-makers will have to weigh up the pros and cons of treatment having the presumption against treatment without consent as the tiebreaker if the evidence is inconclusive. In conclusion, when the right question is asked, Foster's argument can be turned on its head and uncertainties surrounding PDOC weigh in to justify the interruption of treatment in the absence of compelling contrary evidence.

Effects of melanocortin 1 receptor (MC1R) gene polymorphisms on plumage color in mule ducks

The objective of the present study was to investigate the effect of single nucleotide polymorphism (SNP) of the melanocortin 1 receptor (MC1R) gene on plumage coloration in mule ducks. PCR-high-resolution melting analysis (PCR-HRM) and DNA sequencing were used to identify the SNP variability of the MC1R gene in white common ducks. Three non-synonymous SNP (MC1R gene exon 1, c.52G>A, c.376G>A, and c.409G>A) were identified in white Tsaiya ducks. Mating test (white Tsaiya ducks × white Muscovy drakes) in combination with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed to investigate the effect of non-synonymous SNP of different maternal lines on plumage coloration in mule ducks. Genotyping results from 58 white Tsaiya ducks revealed the significant associations between genetic variations (c.52G>A, c.376A>G, and c.409G>A) and plumage color in two maternal populations. After genotyping of 266 mule ducks, these three non-synonymous SNP identified in white Tsaiya ducks were significantly associated with plumage color of mule ducks. Therefore, the polymorphisms of MC1R gene at c.52G>A, c.376A>G, and c.409G>A in white Tsaiya duck could be used in marker-assisted selection to improve the plumage color of mule ducks.(AU)

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Result Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.(AU)

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan.

BACKGROUND: Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. METHODS: This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. RESULTS: Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (≥250 mm H2O). CONCLUSIONS: We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Result Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.

Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

BackgroundCryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.MethodsThis cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.ResultsFifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H2O).ConclusionsWe strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.(AU)

Impacted lower third molar fused with a supernumerary tooth--diagnosis and treatment planning using cone-beam computed tomography.

This paper reported a case of fusion between an impacted third molar and a supernumerary tooth, in which a surgical intervention was carried out, with the objective of removing the dental elements. The panoramic radiography was complemented by the Donovan's radiographic technique; but because of the proximity of the dental element to the mandibular ramus, it was not possible to have a final fusion diagnosis. Hence, the Cone-Beam Computed Tomography-which provides precise three-dimensional information-was used to determinate the fusion diagnosis and also to help in the surgical planning. In this case report we observed that the periapical, occlusal and panoramic were not able to show details which could only be examined through the cone-beam computed tomography.