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The available measure to prevent Streptococcus agalactiae (Group B Streptococcus, GBS) neonatal infection is intrapartum antibiotic prophylaxis (IAP), but it is threatened by bacterial resistance. Therefore, this study aimed to investigate antimicrobial resistance and bacterial targets of vaccines at the most advanced stage of development. GBS isolates (n = 222) recovered from pregnant women between 2019 and 2024 were subjected to capsular polysaccharides and alpha-like proteins investigation and antimicrobial susceptibility testing. Macrolide and fluoroquinolone resistance determinants and genetic diversity of multidrug-resistant (MDR) isolates were also investigated. The main capsular types were Ia (78, 35.1%), III (42, 18.9%), V (39, 17.6%) and II (32, 14.4%). Vaccines based on hexavalent capsular polysaccharides and alpha-like proteins would have 97.3% and 87.5% of predicted efficacy, respectively. Isolates were categorized as not susceptible (NS), that is, intermediate and resistant, to levofloxacin (5, 2.3%), clindamycin (11, 5%), erythromycin (58, 26.1%) and tetracycline (171, 77%). Among erythromycin NS isolates, the M phenotype/mef(A) gene predominated (47, 81%). All levofloxacin-resistant isolates showed amino acid substitutions in both GyrA (S81L) and ParC (S79F). MDR isolates (10, 4.5%) had distinct genetic backgrounds. Both immunization approaches would be effective in the population. Although the elevated erythromycin resistance rate, one of the highest reported in the country, clindamycin remains an efficient option in IAP. MDR isolates have not resulted from the dissemination of a single clone, but instead showed a polyclonal origin.

This study aimed to evaluate the configural and metric structure, as well as internal consistency, of the Brazilian Portuguese adaptation of an instrument designed to assess mistreatment during childbirth. Data were drawn from the "Birth in Brazil" II, carried out in 2023/2024, comprising 1,881 women hospitalized for childbirth in the state of Rio de Janeiro, Brazil. Initially, confirmatory factor analysis was conducted to test the original dimensional structure. Due to an inadequate model, exploratory factor analysis was performed to reassess the factorial structure. Applying predefined criteria, items presenting cross-loadings or possible residual correlations were removed. The remaining items were subsequently evaluated using confirmatory factor analysis, and reliability was assessed using Cronbach's α coefficients. The final solution comprised 17 items distributed across four dimensions: verbal abuse; neglect and disrespect; stigma, discrimination and lack of privacy; and innappropriate vaginal examinations. The final model presented acceptable fit indices, satisfactory factorial definition, and no item redundancy. Most dimensions showed reasonable internal consistency, except the stigma, discrimination, and lack of privacydimension. The findings suggest that further psychometric evaluation is necessary to establish the instrument's validity and reliability. Its use for assessing mistreatment during childbirth or obstetric violence in Brazil should be done with caution. Future psychometric studies using this instrument are recommended.

The article analyzes health policies in Brazil from 2016 to 2022, a period marked by a shift in national politics and the COVID-19 pandemic. The study examines federal health policy management under the administrations of Michel Temer (2016-2018) and Jair Bolsonaro (2019-2022), considering the context, the political process, and policy content, as well as the different phases of the pandemic response. Drawing on historical institutionalism and the concept of critical juncture, the analysis explores continuities, changes, and disputes surrounding the Brazilian Unified National Health System (SUS). The study drew on document research, news articles, and the academic literature. The results indicate that the period was a critical juncture, with immediate and severe effects on policy implementation and the pandemic response. There were constraints on sectoral funding, setbacks in specific policies, institutional weakening, and forms of resistance within the state and society. During the period studied, no radical changes were observed in the direction of the Brazilian health system, due to structural factors, the institutional density of the SUS, competing policy agendas, the interaction of coalitions of actors with varied interests, or even the period's short duration. However, fully understanding the impact of this critical juncture, which is still recent, requires assessing its medium- and long-term repercussions at the global, regional, and national levels.

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This case study evaluated the access of people with disabilities (PwD) to public health network services in Rio de Janeiro, Brazil in the primary health (PHC), specialized, and hospital care levels. Access dimensions (accessibility, availability, and adequacy) constituted the criteria to judge the degree of implementation of oral health care within the Brazilian National Health Policy for Persons with Disabilities. Quantitative and qualitative approaches and multiple sources and data collection techniques were used. This study considered the access of PwD to oral health services as "incipient", with the most critical points of implementation being professional training, shared construction of care, human and material resources, architectural accessibility, and provision of services. Barriers outnumbered facilitators. The former included long distances from reference hospitals to certain regions of the city, low quality and little integration between public transport modes, urban violence and inadequacy of public roads, insecurity of PHC dentists in assisting PwD, few opportunities for professional training, low frequency of matrix support from the Dental Specialties Centers to PHC, low oral health coverage in PHC, and limited offer of dental care under general anesthesia. The implementation of the policy has been taking place gradually without consistently considering PWD's health needs. The recommendations in this study can contribute to the comprehensive care of PWD by improving the components of the network in Rio de Janeiro. Trata-se de um estudo de caso para avaliar o acesso das pessoas com deficiência (PcD) aos serviços da rede pública de saúde do Município do Rio de Janeiro, Brasil, segundo os níveis de análise: atenção primária à saúde (APS), atenção especializada e atenção hospitalar. O acesso e suas dimensões (acessibilidade, disponibilidade e adequação) foram os critérios de julgamento para aferir o grau de implantação da atenção à saúde bucal no âmbito da Política Nacional de Saúde da Pessoa com Deficiência. Utilizou-se em paralelo as abordagens quantitativa e qualitativa com o emprego de múltiplas fontes e técnicas de coleta de dados. O acesso das PcD aos serviços de saúde bucal foi considerado “incipiente”, sendo os pontos mais críticos da implantação: qualificação profissional, construção compartilhada do cuidado, recursos humanos e materiais, acessibilidade arquitetônica e oferta de serviços, com mais barreiras do que fatores facilitadores. Entre as barreiras: longa distância dos hospitais de referência a determinadas regiões da cidade; baixa qualidade e pouca integração entre modais de transporte público; violência urbana e inadequação das vias públicas; sensação de insegurança do dentista da APS para atender a PcD; poucas oportunidades para qualificação profissional; baixa frequência de apoio matricial dos Centros de Especialidades Odontológicas à APS; baixa cobertura de saúde bucal na APS; oferta limitada de atendimento odontológico sob anestesia geral. A implantação da política vem ocorrendo de forma paulatina sem considerar de forma consistente as necessidades de saúde das PcD. As recomendações deste estudo podem contribuir para o cuidado integral das PcD por meio da qualificação dos componentes da rede no Município do Rio de Janeiro. Se trata de un estudio de caso para evaluar el acceso de las personas con discapacidad (PcD) a los servicios de salud pública en la ciudad de Río de Janeiro, Brasil, de acuerdo con los niveles de análisis: atención primaria de salud (APS), atención especializada y atención hospitalaria. El acceso y sus dimensiones (accesibilidad, disponibilidad y adecuación) fueron los criterios de evaluación del grado de implementación de la atención de salud bucodental en el ámbito de la Política Nacional de Salud para Personas con Discapacidad. Se utilizaron enfoques cuantitativos y cualitativos en paralelo y múltiples fuentes y técnicas de recopilación de datos. El acceso de las PcD a los servicios de salud bucodental se consideró “incipiente”, y los puntos más críticos de implementación fueron cualificación profesional, construcción compartida de cuidados, recursos humanos y materiales, accesibilidad arquitectónica y prestación de servicios, con más barreras que factores facilitadores. Entre las barreras están larga distancia de los hospitales de referencia a ciertas regiones de la ciudad; baja calidad y poca integración entre los modos de transporte público; violencia urbana e inadecuación de las vías públicas; sensación de inseguridad del odontólogo de APS para atender a las PcD; pocas oportunidades de cualificación profesional; baja frecuencia de apoyo matricial de los Centros de Especialidades Odontológicas a la APS; baja cobertura de salud bucodental en la APS; y limitada oferta de atención odontológica bajo anestesia general. La implementación de la política viene llevándose a cabo gradualmente sin tener en cuenta de manera consistente las necesidades de salud de las PcD. Este estudio puede contribuir a la atención integral de las PcD mediante la cualificación de los componentes de la red en el Municipio de Río de Janeiro.

This article explores the expansion of public-private partnerships in the Colombian healthcare system, focusing on the institutional mechanisms of healthcare policies that facilitate private sector participation in service provision and resource management. The study analyzes the legal and political reforms that have driven these partnerships, as well as the disputes between public and private actors over the approach and functioning of the healthcare system. The study seeks to understand how these types of alliances have impacted health management, access, and service provision. A case study was conducted with a thematic analysis of official documents, Constitutional Court rulings, and press releases, complemented by a critical review of the specialized literature. The findings indicate that institutional mechanisms have favored the consolidation of the private sector, facilitating its access to financial resources and the formation of strategic networks to legitimize the business perspective in health. Este artículo indaga por la expansión de las alianzas público-privadas en el sistema de salud colombiano, enfocándose en los dispositivos institucionales de las políticas sanitarias que facilitan la participación del sector privado en la prestación de servicios y la gestión de recursos. Se analizan las reformas legales y políticas que han impulsado estas alianzas, así como las disputas entre actores públicos y privados por el enfoque y funcionamiento del sistema de salud. El estudio busca entender cómo este tipo de alianzas ha impactado la gestión de la salud, el acceso y la provisión de los servicios. Se realizó un estudio de caso con análisis temático de documentos oficiales, sentencias de la Corte Constitucional y notas de prensa, complementados con una revisión crítica de la literatura especializada. Los hallazgos indican que los mecanismos institucionales han favorecido la consolidación del sector privado, facilitando su acceso a recursos financieros y la formación de redes estratégicas para legitimar la perspectiva empresarial en la salud. Este artigo investiga a expansão das parcerias público-privadas no sistema de saúde colombiano, com foco nos dispositivos institucionais das políticas de saúde que facilitam a participação do setor privado na prestação de serviços e na gestão de recursos. São analisadas as reformas legais e políticas que impulsionaram essas parcerias, bem como as disputas entre atores públicos e privados em relação ao enfoque e ao funcionamento do sistema de saúde. A pesquisa busca compreender como esse tipo de aliança tem impactado a gestão da saúde, o acesso e a prestação de serviços. Foi realizado um estudo de caso com análise temática de documentos oficiais, decisões do Tribunal Constitucional e notas de imprensa, complementado por uma revisão crítica da literatura especializada. Os resultados indicam que os mecanismos institucionais favoreceram a consolidação do setor privado, facilitando seu acesso a recursos financeiros e a formação de redes estratégicas para legitimar a perspectiva empresarial na saúde.

Estimar la prevalencia de autolesión no suicida en adolescentes y jóvenes mexicanos, y caracterizar la conducta considerando variables sociodemográficas. Material y métodos. Análisis secundario de la Encodat 2025, con una muestra de 7 428 adolescentes y jóvenes mexicanos de 12 a 29 años. La prevalencia nacional de ANS alguna vez fue de 7.1%, con un promedio de edad de inicio de 13 años. El principal método de autolesión fueron los cortes, y la zona más frecuente, las extremidades superiores. El 19.1% requirió tratamiento médico debido a las lesiones. Las mujeres, población adolescente, personas que viven en la Ciudad de México y quienes estudian y trabajan o no tienen actividad, tuvieron mayor probabilidad de ANS. Conclusión. Es prioritario el trabajo preventivo con los adolescentes que refuercen herramientas de regulación emocional, así como en su contexto social.

Benzenesulfonylpiperazines have been previously identified as a promising class against Chagas disease and leishmaniasis, two parasitic neglected tropical diseases. Thus, the pharmacokinetic profile of two potential leads against visceral leishmaniasis was assessed in vitro. Both lead candidates 1 and 2 exhibited a satisfactory ADME profile, with 2 proving slightly superior in terms of metabolic stability. Therefore, after complementary toxicity assessment which revealed that 2 did not exert hepatotoxicity in vitro or acute toxicity in vivo, the evaluation of its efficacy in a mouse model highlighted that 2 indeed displays antileishmanial efficacy in vivo. Albeit moderate at a dose of 50 mg/kg/day, its efficacy increased at a dose of 100 mg/kg/day, reducing the parasite burden by 90% in the spleen of infected mice, though safety concerns were raised at this dose. In vitro investigation of its mode of action revealed that 2 exerts a cytostatic effect on Leishmania infantum promastigotes, promoting cell cycle arrest during the G0/G1 phase which may potentially be linked to the production of reactive oxygen species.

To evaluate the feasibility of a 12-week, randomized, double-blind, placebo-controlled intervention with capsules containing green coffee extract enriched with magnesium di-malate in women with type 2 diabetes mellitus, including overall adherence to capsule use and tolerability, as well as to explore preliminary between-group differences in glycemic and cardiovascular biomarkers. This randomized, double-blind, placebo-controlled pilot trial included 48 eligible women with type 2 diabetes mellitus, equally assigned to the placebo group (n=24) or the experimental group (n=24). Participants received capsules daily for 12 weeks and were followed up through nursing consultations. Overall retention was 83.3% (40/48), and overall adherence to capsule use was estimated at over 82%. Glycemic biomarkers included fasting glucose, estimated mean glucose, HbA1c, insulin, HOMA-IR, and HOMA-β. Cardiovascular biomarkers included urea, creatinine, uric acid, apolipoprotein B, triglycerides, and the triglycerides-glucose index. Data were analyzed based on avail-able data from participants who completed follow-up and the final evaluation. The protocol was feasible under the study conditions, although retention differed between groups. Glycemic biomarkers varied during follow-up in both groups, without conclusive evidence of a consistent between-group effect. In the experimental group, triglycerides and the triglycerides-glucose index showed numerical reductions, while uric acid fluctuated in both groups. These findings should be interpreted as exploratory. This pilot trial provided preliminary information on the feasibility of implementing this intervention in women with type 2 diabetes mellitus. The biomarker findings were exploratory and imprecise and do not allow for definitive conclusions on efficacy. Evaluar la factibilidad de una intervención de 12 semanas, aleatorizada, doble ciego y controlada con placebo, con cápsulas que contenían extracto de café verde enriquecido con di-malato de magnesio en mujeres con diabetes mellitus tipo 2, incluyendo la adherencia global al uso de las cápsulas y la tolerabilidad, así como explorar diferencias preliminares entre grupos en biomarcadores glucémicos y cardiovasculares. Este ensayo piloto aleatorizado, doble ciego y controlado con placebo incluyó a 48 mujeres elegibles con diabetes mellitus tipo 2, asignadas equitativamente al grupo placebo (n=24) o al grupo experimental (n=24). Las participantes recibieron cápsulas diariamente durante 12 semanas y fueron seguidas mediante consultas de enfermería. La retención global fue de 83,3% (40/48) y la adherencia global al uso de las cápsulas se estimó en más del 82%. Los biomarcadores glucémicos incluyeron glucosa en ayunas, glucosa media estimada, HbA1c, insulina, HOMA-IR y HOMA-β. Los biomarcadores cardiovasculares incluyeron urea, creatinina, ácido úrico, apolipoproteína B, triglicéridos e índice triglicéridos-glucosa. Los datos se analizaron con base en los datos disponibles de las participantes que completaron el seguimiento y realizaron la evaluación final. El protocolo fue factible en las condiciones del estudio, aunque la retención difirió entre los grupos. Los biomarcadores glucémicos variaron durante el seguimiento en ambos grupos, sin evidencia concluyente de un efecto consistente entre grupos. En el grupo experimental, los triglicéridos y el índice triglicéridos-glucosa mostraron reducciones numéricas, mientras que el ácido úrico fluctuó en ambos grupos. Estos hallazgos deben interpretarse como exploratorios. Este ensayo piloto aportó información preliminar sobre la factibilidad de implementar esta intervención en mujeres con diabetes mellitus tipo 2. Los hallazgos en biomarcadores fueron exploratorios e imprecisos y no permiten establecer conclusiones definitivas sobre eficacia.

The kinetics of IgG-specific antibody responses against chikungunya virus (CHIKV) is poorly understood. A total of 559 paired serum samples were collected at baseline and at first follow-up in a cohort of women aged 15-39 years from endemic areas of Fortaleza, Ceará State, following the major 2017 outbreak from February 2018 to August 2019. To estimate longitudinal seroprevalence, combining antibody markers (anti-CHIKV IgM and IgG) were screened by using enzyme-linked immunosorbent assays. We found an overall seroprevalence of 34% (190/559; 95%CI, 30.2-38.0) and 31.3% (175/559; 95%CI, 27.6-35.3) at baseline and first follow-up, respectively. Also, the distribution of seroprevalence did not differ significantly by age group [15-24 years, 35.4% (92/260); 25-39 years, 32.8% (98/299)]. Additionally, we found that median IgG level decreased over time across all age groups, and independent of prior history of symptomatic infection. We also observed four cases of seroreversion. Our findings provided valuable information regarding the decline of anti-CHIKV IgG levels in a post-epidemic scenario, highlighting the importance of serological surveillance to better understand the kinetics of antibody responses and to characterize epidemic risk.

Sepsis and sarcopenia are intertwined clinical challenges characterized by profound immunometabolic dysregulation. Traditionally viewed as a passive reservoir, skeletal muscle is now recognized as an active immunometabolic rheostat that dynamically influences systemic inflammation and homeostasis. This review synthesizes recent advances that redefine our understanding of muscle in critical illness, moving beyond simplistic views of catabolism to encompass complex adaptive strategies. This review summarizes recent advances and discusses septic autocannibalism, a process in which muscle proteolysis, driven by a metabolic defense priority, provides key substrates, glutamine for immune function and alanine for hepatic gluconeogenesis. Initially adaptive, sustained activation of this response leads to severe muscle wasting and long-term functional impairment. We analyze the bidirectional relationship between these conditions, focusing on shared risk factors such as immunosenescence and obesity. Key molecular pathways, including the IL-6/JAK/STAT and NF-κB axes, are examined, with particular emphasis on how the temporal release of myokines (e.g., IL-6, IL-15, IGF-1) dictates their shift from adaptive signals to chronic catabolic drivers. Furthermore, we discuss how energy reprogramming, characterized by aerobic glycolysis and mitochondrial failure, disrupts muscle homeostasis. We highlight physical activity as a potent modulator of immunometabolic health through the release of anti-inflammatory myokines and enhanced mitochondrial biogenesis. To propel the field forward, we propose experimental avenues: single-cell spatial transcriptomics to map cellular crosstalk, mitochondrial transplantation to restore energetic capacity, and the identification of "muscle resilience" biomarkers for early intervention. This review underscores the urgent need for integrated immunometabolic approaches to improve outcomes in critically ill patients.

Background: Transgender women and travestis (TWT) in Brazil have a disproportionately high prevalence of psychoactive substance use, contributing to increased vulnerability to sexually transmitted infections (STI). The use of substances before or during sex has been linked to risky sexual behaviors but remains understudied among TWT in Latin America. Objective: To investigate the association between the use of cannabis, cocaine, or crack before or during sex and inconsistent condom use with casual partners among TWT. Methods: We analyzed data from 533 TWT in the TransOdara study (2019-2021), who reported penetrative sex with casual partners in the past six months. In the previous year, 47.8% used cannabis, 37.3% cocaine, and 8.1% crack - mostly before or during sex. Inconsistent condom use was reported by 48.9%. Cocaine (PR: 1.40; 95% CI: 1.16-1.70) and crack (PR: 1.42; 95% CI: 1.06-1.91) use during sex were associated with higher inconsistent condom use, while cannabis showed no association. Discussion and Conclusions: These findings underscore the need for targeted public health interventions that address the intersection of substance use and sexual health risks among TWT in Brazil. In particular, drug use specifically before or during sex should be prioritized in research on sexual behavior.

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Germline GATA2 deficiency is a pleiotropic condition 1-8 characterized by numerous phenotypes, including monocytopenia, immunodeficiency, microbial susceptibilities, and high rates of myeloid malignancies 1,8. Accurate curation of germline GATA2 variants is critical for patient care and requires well-defined phenotypes associated with GATA2 deficiency. The many phenotypes attributed to the condition render a simple description of GATA2 deficiency difficult, complicating the development of GATA2 variant curation rules. Therefore, the Myeloid Malignancy Variant Curation Expert Panel (MM-VCEP) sought to define GATA2 deficiency based on a statistical comparison of phenotype data. To do so, the MM-VCEP systematically analyzed phenotype data and applied statistical comparisons to define the phenotypic features of GATA2 deficiency to inform germline variant curation. The MM-VCEP assembled an international cohort of 339 people with clinically diagnosed GATA2 deficiency from 16 centers in seven countries. The 73 phenotypes of these individuals were compared statistically to those of control participants from the UK Biobank (UKBB). We compared single phenotypes as well as combinations of two, three, and four phenotypes in people with clinically diagnosed GATA2 deficiency to UKBB controls. We defined GATA2 deficiency as any of the 2,903 combinations of two or three phenotypes with log10Odds Ratio ≥3 (OR ≥ 1000). This definition of GATA2 deficiency will inform gene-specific phenotypic criteria used in GATA2 variant curation guidelines that will facilitate standardized variant curation by clinical laboratories worldwide.

To propose the Health Research Standard Process for Artificial Intelligence framework, adapted from the Cross-Industry Standard Process for Data Mining approach, and apply it using time series and artificial intelligence techniques to analyze data from the Sistema de Informação de Agravos de Notificação (SINAN - Notifiable Diseases Information System) on violence against women in São Paulo, exploring sociodemographic, spatial, and predictive dimensions. The methodology was adapted to health research, replacing the original Business Understanding stage with Research Understanding by incorporating essential technical-scientific elements. We analyzed 80,148 reports of violence against women aged between 20 and 59 living in the city of São Paulo between 2013 and 2023. The analyses included descriptive statistics, calculation of prevalence ratios, decomposition and predictive modeling of time series capturing trends and seasonality, and geospatial analysis of notifications. We observed temporal patterns and sociodemographic characteristics of the victims, with increasing trends in reports of physical, psychological, and sexual violence after 2015 and seasonal behavior. Among the associations, there was a 32% increase in the prevalence of sexual violence when the aggressor was under the influence of alcohol and a 2.47 times greater risk of sexual violence among pregnant women. The geospatial distribution revealed concentrations of notifications in peripheral areas of the municipality, such as the south, east, and central zones. Predictive modeling indicated that the upward trend will persist over the next 24 months, with estimated rates reaching up to 12 cases per 100,000 inhabitants. The applicability of the Health Research Standard Process for Artificial Intelligence was effective as a model for data analysis and the development of predictive algorithms in public health. It was possible to propose a replicable methodological matrix for future research and evidence-based interventions. Propor o framework Health Research Standard Process for Artificial Intelligence, adaptado da abordagem Cross-Industry Standard Process for Data Mining e aplicá-lo por meio de técnicas de séries temporais e inteligência artificial na análise dos dados do Sistema de Informação de Agravos de Notificação sobre violência contra mulheres em São Paulo, explorando dimensões sociodemográficas, espaciais e preditivas. A metodologia foi adaptada às pesquisas em saúde, substituindo a etapa original do Business Understanding por Research Understanding ao incorporar elementos técnico-científicos essenciais. Foram analisadas 80.148 notificações de violência contra mulheres entre 20 e 59 anos, residentes no município de São Paulo, no período de 2013 a 2023. As análises incluíram estatísticas descritivas, cálculo de razões de prevalência, decomposição e modelagem preditiva de séries temporais capturando tendências e sazonalidade, e análise geoespacial das notificações. Observou-se padrões temporais e características sociodemográficas das vítimas, com tendências crescentes nas notificações de violência física, psicológica e sexual após 2015 e comportamento sazonal. Entre as associações, identificou-se aumento de 32% na prevalência de violência sexual quando o agressor estava sob efeito de álcool e risco 2,47 vezes maior de violência sexual entre gestantes. A distribuição geoespacial revelou concentrações de notificações em áreas periféricas do município, como a zona sul, leste e central. A modelagem preditiva indicou que a tendência de aumento persistirá nos próximos 24 meses, com estimativas de taxas alcançando até 12 casos por 100.000 habitantes. A aplicabilidade do Health Research Standard Process for Artificial Intelligence foi eficaz como modelo para análises de dados e desenvolvimento de algoritmos preditivos em saúde pública. Foi possível propor uma matriz metodológica replicável para futuras pesquisas e intervenções baseadas em evidências.

The objectives were to evaluate the differences in the nutritional profile between 2015/2016 and 2019/2021 and to estimate the number of Brazilians (≥ 50 years) with nutritional profile inadequacies. This is a cross-sectional study that used data from participants in waves 1 (2015/2016; n = 8,724) and 2 (2019/2021; n = 7,729) from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Anthropometric parameters included body mass index and waist circumference (WC) and weekly food consumption of fruits, vegetables, fish, poultry, and red meat in both waves. Seven criteria for nutritional profile inadequacy were analyzed. There was an increase in the prevalence of high WC [70.0% (95%CI 68.5-71.5) and 75.5% (95%CI 72.8-78.0)] and fruit consumption in 3-4 days of the week [16.5% (95%CI 15.4-17.6) and 23.0% (95%CI 20.1-26.1)] between waves 1 and 2, respectively. The prevalence estimates of underweight and overweight (around 2% and 70%, respectively) remained stable during this period. It was estimated that, in 2022, around 29 million Brazilians aged ≥ 50 years had ≥ 4 inadequate criteria of the nutritional profile. It is concluded that the nutritional profile of the participants showed slight changes during the period. Public Health actions are necessary to improve this population's anthropometric parameters and food consumption. Os objetivos foram avaliar as diferenças do perfil nutricional entre 2015/2016 e 2019/2021 e estimar o número de brasileiros (≥ 50 anos) com inadequações do perfil nutricional. Trata-se de um estudo transversal que utilizou dados de participantes das ondas 1 (2015/2016; n = 8.724) e 2 (2019/2021; n = 7.729) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). Os parâmetros antropométricos incluíram índice de massa corporal e circunferência da cintura (CC) e consumo alimentar semanal de frutas, hortaliças, peixes, aves e carnes vermelhas nas duas ondas. Foram analisados sete critérios de inadequação do perfil nutricional. Houve aumento na prevalência de CC elevada [70,0% (IC95% 68,5-71,5) e 75,5% (IC95% 72,8-78,0)] e do consumo de frutas em 3-4 dias da semana [16,5% (IC95% 15,4-17,6) e 23,0% (IC95% 20,1-26,1)] entre as ondas 1 e 2, respectivamente. As prevalências de baixo peso e excesso de peso (em torno de 2% e 70%, respectivamente) se mantiveram estáveis nesse período. Estimou-se que, em 2022, cerca de 29 milhões de brasileiros com ≥ 50 anos tinham ≥ 4 critérios inadequados do perfil nutricional. Conclui-se que o perfil nutricional dos participantes apresentou mudanças discretas no período. Ações de saúde pública são necessárias para melhorar os parâmetros antropométricos e o consumo alimentar dessa população. Los objetivos fueron evaluar las diferencias en el perfil nutricional entre 2015/2016 y 2019/2021 y estimar el número de brasileños (≥ 50 años) con insuficiencias del perfil nutricional. Este estudio transversal utilizó datos de las ondas 1 (2015/2016; n = 8.724) y 2 (2019/2021; n = 7.729) del Estudio Longitudinal de Salud del Anciano Brasileño (ELSI-Brasil). Se analizaron parámetros antropométricos como índice de masa corporal, circunferencia de la cintura (CC) y consumo semanal de frutas, verduras, pescado, aves y carnes rojas en ambas oleadas. Se analizaron siete criterios de insuficiencia nutricional. Se observó un aumento en la prevalencia de CC alta [70,0% (IC95% 68,5-71,5) y 75,5% (IC95% 72,8-78,0)] y en el consumo de frutas 3-4 días a la semana [16,5% (IC95% 15,4-17,6) y 23,0% (IC95% 20,1-26,1)] entre las ondas 1 y 2, respectivamente. Las prevalencias de bajo peso y sobrepeso (alrededor del 2% y 70%, respectivamente) se mantuvieron estables. Se estimó que, en 2022, unos 29 millones de brasileños ≥ 50 años presentaban ≥ 4 criterios inadecuados del perfil nutricional. Se concluye que el perfil nutricional mostró ligeros cambios durante el período. Se requieren acciones de Salud Pública para mejorar los parámetros antropométricos y el consumo de alimentos en esta población.

To conduct a meta-analysis assessing the effectiveness of cine MRI in evaluating tumor invasion of the chest wall, using surgical and histopathologic analysis as the reference standard. This systematic review and meta-analysis was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420250654330. Five prospective studies comprising 190 patients with suspected chest wall invasion were included. The pooled sensitivity of cine MRI for detecting chest wall invasion was 99% (95% CI: 34%-100%), with a specificity of 74% (95% CI: 64%-82%), a negative predictive value of 100% (95% CI: 52%-100%), and a positive predictive value of 50% (95% CI: 39%-61%). No substantial heterogeneity was observed across studies. Cine MRI showed high sensitivity and excellent negative predictive value for ruling out chest wall invasion in lung cancer. These findings suggest cine MRI may be a useful noninvasive tool for preoperative assessment, particularly in cases with inconclusive CT or static MRI; however, CIs were wide due to the limited evidence base. Conversely, when cine MRI suggests invasion, the modest specificity and positive predictive value highlight the importance of invasive confirmation before definitive therapeutic decisions. Further prospective, multicenter studies using standardized protocols are warranted to validate and expand its clinical application.

Sensitivity studies are used to evaluate measuring instruments and assess their ability to capture differences in measurements taken from the same object at different times or from different objects at the same time. The Longitudinal Bond Evaluative Matrix (MAVIL) is a method for evaluating care in Primary Health Care. It is based on the concept of longitudinal bond, consisting of three dimensions: recognition of the team as a regular source of care, interpersonal relationship between professional and patient, and continuity of information, from which the indicators are derived. The objective was to study the degree of the sensitivity of the MAVIL method. A descriptive analysis of the data and a hypothesis test of equality of sample means were performed when applying the MAVIL in two UBS in Dourados. These results were compared with the results of a previous application in two UBS in Rio de Janeiro. For Dimension 1, three of the four UBS had equivalent results. For dimension 2, the UBS in Rio de Janeiro presented similar values, and in Dourados, significant differences. For Dimension 3, the performance was low in both locations. The results indicated MAVIL's ability to identify differences in the degree of bond between UBS. O estudo de sensibilidade é utilizado para avaliar instrumentos de medição e averigua a capacidade destes instrumentos em captar diferenças em medidas tomadas de um mesmo objeto em períodos distintos ou em objetos distintos no mesmo tempo. A Matriz Avaliativa do Vínculo Longitudinal (MAVIL) consiste em método para avaliar o cuidado na Atenção Primária à Saúde. Tem por base o conceito de vínculo longitudinal, constituído de três dimensões: reconhecimento da equipe como fonte regular de cuidados, relação interpessoal profissional/paciente e continuidade da informação, das quais derivam os indicadores. O objetivo foi estudar o grau de sensibilidade do método MAVIL. Realizou-se a análise descritiva dos dados e o teste de hipótese de igualdade das médias amostrais da aplicação da MAVIL em duas UBS de Dourados. Estes resultados foram cotejados com os resultados de aplicação anterior, em duas UBS do Rio de Janeiro. Para a Dimensão 1, das quatro UBS, três tiveram resultados equivalentes. Para a dimensão 2 as UBS do Rio de Janeiro apresentaram valores próximos e, em Dourados, diferenças significativas. Para a Dimensão 3 o desempenho foi baixo em ambas as localidades. Os resultados indicaram a capacidade da MAVIL em identificar diferenças no grau de vínculo entre UBS. Los estudios de sensibilidad se utilizan para evaluar instrumentos de medición y averiguar su capacidad para capturar diferencias en mediciones tomadas del mismo objeto en diferentes momentos o de diferentes objetos al mismo tiempo. La Matriz de Evaluación del Vínculo Longitudinal (MAVIL) es un método para evaluar la atención en Atención Primaria de Salud. Se basa en el concepto de vínculo longitudinal, que consta de tres dimensiones: reconocimiento del equipo como fuente regular de atención, relación interpersonal profesional/paciente y continuidad de la información, de los cuales se derivan los indicadores. El objetivo era estudiar el grado de sensibilidad del método MAVIL. Se realizó un análisis descriptivo de los datos y una prueba de hipótesis de igualdad de medias muestrales utilizando la aplicación de MAVIL en dos Unidades de Atención Primaria de Salud (UBS) en Dourados. Estos resultados se compararon con los resultados de una aplicación previa en dos UBS en Río de Janeiro. Para la Dimensión 1, tres de las cuatro UBS tuvieron resultados equivalentes. Para la dimensión 2, la UBS en Río de Janeiro mostró valores similares, y en Dourados, diferencias significativas. Para la dimensión 3, el desempeño fue bajo en ambas ubicaciones. Los resultados indicaron la capacidad de MAVIL para identificar diferencias en el grado de vinculación entre UBS.

Bidirectional ventricular tachycardia is a rare electrocardiographic (ECG) finding, associated with a restricted group of clinical conditions, particularly hereditary channelopathies. An 11-year-old girl, asymptomatic from a cardiovascular point of view, was identified by family screening after detection in her father of a pathogenic variant in the KCNJ2 gene. The admission ECG showed bidirectional ventricular tachycardia. Clinical investigation revealed periodic paralysis and skeletal dysmorphisms, confirming a diagnosis of Andersen-Tawil syndrome. Pharmacological treatment significantly reduced the arrhythmic burden, with reverse ventricular remodeling at follow-up. This case illustrates the central role of ECG as a diagnostic tool in rare cardiovascular diseases, allowing early recognition, targeted genetic investigation, and prevention of arrhythmia-induced cardiomyopathy. Bidirectional ventricular tachycardia is a distinct ECG pattern that should raise suspicion of Andersen-Tawil syndrome and warrants genetic evaluation with cascade family screening. In this patient, the combination of propafenone and beta-blocker therapy was associated with suppression of bidirectional ventricular tachycardia, significant reduction in ventricular arrhythmic load, and reversal of tachycardiomyopathy, suggesting a potential therapeutic alternative when flecainide is not available.