Large language models (LLMs) are increasingly applied in clinical decision support, yet their diagnostic performance in Chinese-language settings and under realistic clinical workflows remains unclear. In particular, how LLMs perform across diseases with different prevalence and under stepwise diagnostic processes has not been well characterized. This study aimed to evaluate the diagnostic capabilities of LLMs for common diseases and rare diseases using clinical vignettes within a hypothetico-deductive framework and to identify their potential and limitations for clinical diagnosis. We evaluated 4 Chinese LLMs (Doubao 1.5, DeepSeek-V3, Kimi K1.5, and Leftdoctor GPT 3.5) using 56 clinical cases (28 chronic obstructive pulmonary disease [COPD], and 28 relapsing polychondritis [RP]) sourced from the China Clinical Case Results Database (March 31-April 14, 2025). Patient information was provided incrementally, starting with the initial medical history, followed by physical examination, and laboratory results. Evaluation metrics included top-3 accuracy (RTop3D), top-1 accuracy (RTopD), final diagnostic accuracy (RFA), and mean reciprocal rank (MRR). Statistical analysis was performed using generalized estimating equations (GEE), Friedman tests, and Wilcoxon signed-rank tests with Bonferroni correction. In addition, a qualitative analysis was conducted to characterize recurrent patterns of diagnostic errors. LLMs demonstrated significantly higher diagnostic accuracy for COPD compared to RP across all metrics (P<.001). Diagnostic accuracy improved after additional clinical information was provided, with the improvement mainly observed in RP cases. In RP, diagnostic accuracy increased from 32.14% to 71.43% for DeepSeek and from 35.71% to 78.57% for Doubao, whereas COPD accuracy remained consistently high across all diagnostic stages (82.14%-92.86%). For COPD, ranking performance was high and comparable among all models (MRR range: 0.82-0.89; P=.71). In RP, diagnostic performance differed significantly among models (MRR range: 0.10-0.39; P<.001). Qualitative analysis showed that COPD errors were mainly related to a failure to recognize specific features, whereas RP errors involved more diverse patterns, particularly the neglect of negative evidence and the failure to recognize specific features. Chinese LLMs demonstrated relatively strong diagnostic performance for common diseases such as COPD, but lower and less stable performance for rare diseases such as RP. Additional clinical information improved diagnostic accuracy primarily in RP cases, although differences between models remained evident under diagnostically complex conditions. Error patterns in RP cases suggest that current LLMs remain limited in their ability to integrate complex clinical information and exclusionary findings. Careful evaluation and appropriate clinical oversight remain important for their application in clinical practice.
Schistosoma mansoni infection remains a major public health concern in Brazil. Accurate diagnostic methods are essential for monitoring transmission and guiding control and elimination strategies. This systematic review and meta-analysis aimed to assess the performance of diagnostic tests used for S. mansoni infection in Brazil. Studies conducted in endemic areas of Brazil that used parasitological methods as the reference standard, reported sensitivity and specificity, and were published through October 2024, were included in the analysis. Diagnostic performance was synthesized using univariate and multivariate meta-analyses, and risk of bias was assessed with QUADAS-2. Thirty-three studies were included; most were conducted in Minas Gerais (63%). The main reference standard was Kato-Katz alone (48%) or combined with other parasitological methods (42.4%). Enzyme-linked immunosorbent (ELISA)-SEA results showed higher accuracy than ELISA-SWAP (81% vs 68%), although both exhibited heterogeneity above 80%. Point-of-care circulating cathodic antigen with trace results interpreted as positive (POC-CCA+) or negative (POC-CCA-) showed similar accuracy (70% vs 73%, respectively), with heterogeneity exceeding 80%. For conventional PCR, PCR-ELISA, real-time PCR, and loop-mediated isothermal amplification (LAMP), accuracy ranged from 67% to 82% (heterogeneity: > 90%. In multivariate analysis, conventional PCR had the highest diagnostic odds ratio (DOR: 99.4), followed by PCR-ELISA (DOR: 12.4), whereas the two POC-CCA reading criteria resulted in lower values (trace-positive: 8.5, trace-negative: 6.1). Overall, these observations support the use of combined diagnostic strategies and underscore the need for multicenter, methodologically rigorous studies to strengthen surveillance, control, and elimination efforts for Schistosoma mansoni infection in Brazil.
To present the diagnostic accuracy of the scored Clinical Examination of the MMBGR Orofacial Myofunctional Assessment Protocol for the age range of 24 to 71 months. Diagnostic accuracy validation study with a convenience sample. Fourteen speech-language pathologists analyzed images of 132 participants from the database of previous validation stages, divided into two groups (G1 = 24 to 35 months and 29 days; G2 = 36 to 71 months and 29 days). Each image was analyzed individually and independently by a panel of three expert speech-language pathologists, with agreement between at least two evaluators considered valid. Opinions regarding domains of the orofacial myofunctional examination, Orofacial Myofunctional Disorder (OMD), and referral needs were recorded using an electronic form. The speech-language pathologists' responses based on clinical experience, without using the protocol (gold standard), were compared with those obtained using the Protocol (index test). Receiver Operating Characteristic (ROC) curve analysis was applied, cutoff points were established, and sensitivity and specificity values were obtained using R Core Team software (2022). Diagnostic accuracy in preschool children in G1 was ideal and in G2 was reasonable for orofacial structures. For orofacial functions, accuracy was ideal in G1 and reasonable in G2; for tone, accuracy was reasonable in both groups. For OMD, accuracy was reasonable for both G1 and G2. The cutoff point for OMD was 15 (24-35 months) and 22 (36-71 months). Accuracy was reasonable for predicting multidisciplinary and speech-language pathology referrals. The MMBGR Protocol demonstrated adequate diagnostic accuracy for orofacial structures and functions in preschool children. It showed reasonable accuracy for diagnosing OMD and for predicting multidisciplinary and speech-language pathology referrals. Apresentar acurácia diagnóstica do Exame Clínico com escores, do Protocolo de Avaliação Miofuncional Orofacial MMBGR para faixa etária de 24 a 71 meses. Estudo de validação da acurácia diagnóstica com amostra de conveniência. Quatorze fonoaudiólogos analisaram imagens de 132 participantes do banco de dados das etapas anteriores de validação, divididos em dois grupos (G1 = 24 a 35 meses e 29 dias; G2 = 36 a 71 meses e 29 dias). Cada imagem foi analisada por trio de fonoaudiólogos especialistas, individual e separadamente, sendo considerada válida concordância entre dois deles. Emitidos pareceres sobre domínios do exame miofuncional orofacial, Distúrbio Miofuncional Orofacial (DMO) e necessidade de encaminhamentos, em formulário eletrônico. Foram comparadas as respostas dos fonoaudiólogos baseadas na experiência clínica, sem utilizar o protocolo (padrão ouro) com aquelas emitidas com uso do Protocolo (teste índice). Utilizado método Receiver Operating Characteristic Curve (ROC), atribuídos pontos de corte e obtidos valores de sensibilidade e especificidade; software R Core Team 2022. Acurácia diagnóstica em pré-escolares G1 é ideal e G2 razoável para estruturas orofaciais. Funções orofaciais acurácia ideal (G1) e razoável (G2), em tônus a acurácia foi razoável em ambos grupos. DMO a acurácia é razoável para G1 e G2.O ponto de corte para DMO é 15 (24 a 35 meses) e 22 (36 a 71 meses). A acurácia é razoável para encaminhamentos multidisciplinares e fonoaudiológicos. O Protocolo MMBGR apresentou acurácia adequada para estruturas e funções orofaciais de pré-escolares. É razoável para diagnosticar DMO e prever encaminhamentos multidisciplinares e fonoaudiológicos.
Congenital intestinal aganglionosis (Hirschsprung's disease - HD) is characterized by the absence of intramural parasympathetic ganglion cells in the submucosal and muscular layers of the intestinal wall, predominantly affecting the recto-sigmoid and determining functional intestinal obstruction. Rectal biopsy is the gold standard for diagnosis, and there are several techniques available for obtaining samples. Limitations related to cost, equipment maintenance and access to biopsy instruments have hindered the implementation of minimally invasive aspiration biopsies in Brazil. This study aims to evaluate the performance of the K punch method (MKP) as a minimal invasion and low cost alternative in obtaining submucosal rectal samples for histopathological analysis in the investigation of HD. Retrospective analysis of a 25 pediatric patients´ cohort, which has been submitted to histological evaluation for HD using the MKP biopsy method. The samples were suitable for histological analysis aiming at the diagnosis of HD in 24 cases (96%). One patient needed to repeat the procedure due to the insufficiency of the fragment obtained. A mild complication (self-limited bleeding) was observed, without the need for additional intervention (Clavien-Dindo 1). The results suggest that the MCK technique can provide adequate rectal submucosal samples for histological analysis towards the diagnosis of HD, and may be applicable in different health care contexts.
Poststroke cognitive impairment (PSCI) is a common and disabling complication after stroke; however, early screening remains challenging due to limited access to neuropsychological testing and the high cost of neuroimaging. Portable, tablet-based eye-tracking technology may offer a scalable, low-cost solution for early PSCI detection. This study aimed to evaluate the clinical utility of a tablet-based, AI-driven eye-tracking system for early screening of PSCI at 3 months after acute ischemic stroke. We sought to quantify oculomotor-cognitive associations and develop a practical nomogram for individualized risk prediction. We prospectively enrolled 142 hospitalized patients with acute cerebral infarction between May 2023 and October 2024, of whom 122 completed the 3-month follow-up and were included in the final analysis, along with 20 healthy community-dwelling controls. All patients underwent tablet-based eye tracking (visual paired comparison and antisaccade tasks) during the acute phase, as well as baseline and 3-month neuropsychological assessments. PSCI was defined using validated cutoffs. Multivariable logistic regression was used to identify independent predictors, and a nomogram was constructed. Internal validation was performed using bootstrap resampling (1000 samples). At 3 months, out of 122 patients, 47 (38.5%) met PSCI criteria. Compared with patients with non-PSCI (n=75), patients with PSCI showed significantly prolonged correct saccade latency (median 322.96, IQR 209.45-445.59 ms vs 194.55, IQR 141.50-299.75 ms; Z=-4.03, P<.001), increased uncorrected error rate (median 30.00%, IQR 15.00%-42.00% vs 5.00%, IQR 0.00%-28.00%; Z=-4.24, P<.001), and reduced novelty preference ratio (median 1.44, IQR 0.97-1.70 vs 2.12, IQR 1.27-4.56; Z=-3.44, P=.001). Multivariable analysis identified 4 independent predictors of 3-month PSCI: older age (odds ratio [OR] 1.067 per year, 95% CI 1.009-1.129; P=.02), lower education level (OR 0.841 per year, 95% CI 0.708-0.999; P=.049), higher NIHSS (National Institutes of Health Stroke Scale) scores (OR 1.557 per point, 95% CI 1.075-2.256; P=.02), and prolonged correct saccade latency (OR 1.004 per ms, 95% CI 1.000-1.007; P=.04). A nomogram incorporating these 4 factors achieved good discriminative performance (area under the receiver operating characteristic curve 0.86, 95% CI 0.793-0.927) with satisfactory calibration. Age, education, admission NIHSS, and correct saccade latency were identified as possible independent predictors of 3-month PSCI in this cohort. The tablet-based eye-tracking system, when combined with clinical variables, may represent a feasible approach for early PSCI screening. A nomogram based on these variables demonstrated high accuracy and potential clinical utility for early PSCI identification. This approach may facilitate early identification of high-risk patients and enable timely, personalized interventions in resource-limited settings.
The medical black bag is synonymous with physicians, especially general practitioners, who are expected to be ready to provide care across settings. The content of the devices they use will likely expand due to the proliferation of digital tools. As portable diagnostics diversify, guidance is increasingly needed on which tools clinicians should choose and what this shift may mean for the physical examination and point-of-care assessment. This study aimed to map the current, the possible, and the future content of the medical black bag using anticipatory methods, and to provide a general, practice-oriented outline of how portable diagnostic technologies may evolve in primary care. National equipment lists and the World Health Organization's MeDevIS database were compiled and filtered to define a contemporary reference set of reusable portable diagnostic instruments relevant to generalist practice. A 1-year trend analysis using major professional and medical technology news sources was conducted to identify possible additions, screening for devices with diagnostic relevance, portability, digital capability, market presence, and evidence visibility. To extend the outlook to the next decade, we performed a horizon-scanning exercise using the same review period. These devices were grouped into thematic categories. National equipment recommendations and World Health Organization lists yielded a stable core set of diagnostic tools used in routine primary care practice. Trend analysis and horizon scanning expanded this set by identifying possible and future additions of portable medical devices that can be used at the point of care. Overall, the identified technologies were increasingly digital, diverse, connected, and in some cases, AI-supported, reflecting a trajectory toward more integrated and data-enabled diagnostics. The medical black bag is likely to evolve from a stable set of familiar instruments toward a broader toolbox of portable and connected diagnostic devices. While these tools may expand the scope of bedside assessment and enable more reproducible and shareable clinical signs, their value depends on appropriate validation, usability, workflow integration, training, and supportive financial and organizational conditions. Regular evidence-informed updates of equipment recommendations, alongside practical implementation support, may help primary care systems adopt useful innovations while preserving the human dimensions of clinical care.
To map the strategies used for the early diagnosis of hearing loss in infants. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, Google Scholar, and ProQuest, with no restrictions on language or publication period. The search was initially performed in October 2024 and updated in January 2026. Controlled descriptors (DeCS/MeSH) and keywords related to hearing loss, newborn hearing screening, and early diagnosis were used. The protocol was registered in the Open Science Framework. Primary studies addressing strategies for the early diagnosis of hearing loss in children up to two years of age were included. Secondary studies, case reports, guidelines, duplicate publications, and studies without full-text availability were excluded. Study selection was performed independently by reviewers, with disagreements resolved by consensus. Extracted data included study design, population, diagnostic instruments, strategies, and care setting. A descriptive and narrative synthesis was conducted, grouping evidence according to diagnostic approaches. Of the 16,946 records identified, 58 studies published between 1991 and 2025 met the eligibility criteria. Universal Newborn Hearing Screening (UNHS) predominated, particularly protocols combining otoacoustic emissions and automated auditory brainstem response. Complementary strategies included two-stage screening, early retesting, community-based programs, genetic screening, and additional electrophysiological assessments. Variability in protocol implementation and persistent structural inequalities were observed. UNHS remains the cornerstone of early diagnosis of hearing loss in infants, with effectiveness dependent on well-organized care pathways and integration between screening, diagnosis, and follow-up. Mapear as estratégias utilizadas para o diagnóstico precoce da perda auditiva em lactentes. A busca bibliográfica foi realizada nas bases PubMed/Medline, Scopus, Embase, Web of Science, LILACS, Google Scholar e ProQuest, sem restrição de idioma ou período de publicação, inicialmente realizada em outubro de 2024 e atualizada em janeiro de 2026. Utilizados descritores controlados (DeCS/MeSH) e palavras-chave relacionados à perda auditiva, triagem auditiva neonatal e diagnóstico precoce. O protocolo foi registrado na Open Science Framework. Foram incluídos estudos primários que abordaram estratégias de diagnóstico precoce da deficiência auditiva em crianças de até dois anos. Excluíram-se estudos secundários, relatos de caso, diretrizes, artigos duplicados ou sem texto completo. A seleção foi realizada por revisores independentes, com consenso em caso de divergência. As informações extraídas abrangeram delineamento, população, instrumentos utilizados, estratégias diagnósticas e contexto assistencial. A síntese foi descritiva e narrativa, com agrupamento das evidências por tipo de abordagem. Dos 16.946 registros identificados, 58 estudos, publicados entre 1991 e 2025, atenderam aos critérios de elegibilidade. Predominaram estratégias baseadas na Triagem Auditiva Neonatal Universal (TANU), com associação entre emissões otoacústicas e potencial evocado auditivo de tronco encefálico automatizado. Estratégias complementares incluíram protocolos em dois estágios, reteste precoce, programas comunitários, triagem genética e exames eletrofisiológicos adicionais. Observou-se variabilidade na operacionalização dos protocolos e persistência de desigualdades estruturais. A TANU permanece como eixo central do diagnóstico precoce da perda auditiva em lactentes, com efetividade dependente da organização dos fluxos assistenciais e da integração entre triagem, diagnóstico e acompanhamento.
Cardiovascular magnetic resonance (CMR) is the reference standard for morphofunctional cardiac assessment. In Brazil, the application of international normal reference values faces challenges related to population admixture, technical heterogeneity among centers, and the absence of national standardization, all of which may affect diagnostic accuracy. To compare normal reference values for morphofunctional parameters obtained by CMR between a multicenter international review and a Brazilian publication, discussing concordance, methodological differences, and implications for Brazilian clinical practice. An analytical-comparative review was performed using summarized data from an international reference-value review and a Brazilian study. Means and standard deviations of key ventricular variables were compared, with assessment of 95% CI overlap, Welch's t-test, and effect size (Hedges' g). Standard-deviation-based cut-off points were proposed for grading abnormality. Overall concordance between means was observed for most variables. Statistically significant differences occurred in a few parameters, mainly ventricular diameters and left ventricular mass, with small to moderate effect sizes. Discrepancies were largely attributed to methodological differences in measurement and indexation. International normal reference values may be used in Brazilian clinical practice, provided they are adjusted for body surface area and interpreted in light of local particularities. Standardization of protocols and national multicenter studies are needed to strengthen regional validation. Keywords: Normal Values, Cardiac Magnetic Resonance, Reference Interval. A ressonância magnética cardiovascular (RMC) é o método de referência para avaliação morfofuncional cardíaca. No Brasil, a aplicação de valores de normalidade internacionais enfrenta desafios relacionados à miscigenação populacional, heterogeneidade técnica entre centros e ausência de padronização nacional, o que pode impactar a acurácia diagnóstica. Comparar valores de normalidade de parâmetros morfofuncionais obtidos por RMC entre uma revisão internacional multicêntrica e uma publicação nacional, discutindo concordância, divergências metodológicas e implicações para a prática clínica brasileira. Revisão analítico-comparativa entre dados sumarizados de uma revisão internacional de valores de referência em RMC e um estudo brasileiro. Foram comparadas médias e desvios-padrão das principais variáveis ventriculares, com avaliação de sobreposição de IC95%, teste t de Welch e tamanho de efeito (Hedges’ g). Propuseram-se pontos de corte baseados em desvios-padrão para gradação de anormalidade. Observou-se concordância global entre as médias na maioria das variáveis. Diferenças estatisticamente significativas ocorreram em poucos parâmetros, principalmente diâmetros ventriculares e massa ventricular esquerda, com tamanhos de efeito pequenos a moderados. As discrepâncias foram atribuídas, em grande parte, a diferenças metodológicas de mensuração e indexação. Os valores internacionais de normalidade podem ser utilizados na prática clínica brasileira, desde que ajustados por superfície corporal e interpretados à luz de particularidades locais. A padronização de protocolos e estudos multicêntricos nacionais são necessários para maior robustez e validação regional.
A growing body of evidence indicates that the oral and gut microbiota are closely linked to central nervous system (CNS) diseases, and their bacterial extracellular vesicles (BEVs) play a significant role in disease pathogenesis. BEVs can cross the blood-brain barrier, deliver bioactive cargo to host cells, and participate in disease processes. Notably, BEVs exhibit a functional dichotomy in which pathogen-derived BEVs promote neuropathology while probiotic-derived and engineered BEVs exert protective effects. In this review, we systematically examine this dual role of oral- and gut-derived BEVs in CNS diseases, covering their pathogenic mechanisms, protective and therapeutic effects, and emerging applications as diagnostic biomarkers. We also highlight key challenges limiting clinical translation and outline future directions for the field.
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, underscoring the need for effective risk prediction and early detection. Although the electrocardiogram (ECG) is a widely available and low-cost diagnostic tool, its traditional interpretation is limited by subjectivity. Artificial intelligence (AI) has emerged as a promising approach, capable of extracting hidden prognostic information from ECG signals. This systematic review aimed to assess original studies applying AI techniques to ECGs for cardiovascular risk prediction and mortality. Original studies that used ECG signals as the sole input variable for AI models, focusing on cardiovascular risk outcomes, were included. A systematic search was conducted in different databases, and data were synthesized narratively. Eleven studies were included, predominantly retrospective cohorts applying convolutional neural networks (CNNs) to predict cardiovascular risk or mortality. The sample primarily consisted of adult populations in high-income countries. Primary outcomes included all-cause mortality, cardiovascular death, and major adverse cardiovascular events (MACE). Reported AUROC values ranged from 0.63 to 0.961 in training sets, with some models outperforming traditional risk scores. AI-ECG models demonstrated the potential to detect subclinical disease, enabling early risk stratification even in normal ECGs. However, challenges remain regarding population diversity, model interpretability, and prospective validation. The application of AI to ECG analysis represents a promising advancement in personalized cardiovascular risk assessment. Nonetheless, further research is needed to ensure the safety, effectiveness, and equitable clinical integration of these technologies. As doenças cardiovasculares são a principal causa de mortalidade no mundo, destacando a necessidade de estratégias eficazes de predição de risco e detecção precoce. Embora o eletrocardiograma (ECG) seja um exame amplamente disponível e de baixo custo, sua interpretação tradicional é limitada pela subjetividade. A inteligência artificial (IA) surgiu como uma abordagem promissora, capaz de extrair informações prognósticas ocultas dos sinais de ECG. Esta revisão sistemática teve como objetivo avaliar estudos originais que aplicaram técnicas de IA a ECGs para predição de risco cardiovascular e mortalidade. Foram incluídos estudos originais que utilizaram sinais de ECG como única variável de entrada para modelos de IA, com foco em desfechos de risco cardiovascular. Uma busca sistemática foi realizada em diferentes bases de dados, e os dados fora msintetizados de forma narrativa. Onze estudos foram incluídos, predominantemente coortes retrospectivas que aplicaram redes neurais convolucionais (CNNs) para prever risco cardiovascular ou mortalidade. As amostras eram majoritariamente compostas por populações adultas de países de alta renda. Os desfechos primários incluíram mortalidade por todas as causas, morte cardiovascular e eventos cardiovasculares adversos maiores (MACE). Os valores de AUROC variaram de 0,63 a 0,961 nos conjuntos de treinamento, com alguns modelos superando escores tradicionais de risco. Os modelos de IA‑ECG demonstraram potencial para detectar doença subclínica, permitindo estratificação precoce de risco mesmo em ECGs normais. No entanto, persistem desafios relacionados à diversidade populacional, interpretabilidade dos modelos e validação prospectiva. A aplicação de IA à análise de ECG representa um avanço promissor na avaliação personalizada do risco cardiovascular. Contudo, mais pesquisas são necessárias para garantir a segurança, a eficácia e a integração clínica equitativa dessas tecnologias.
This study evaluated tympanometric cutoff points (tympanometric peak pressure and static compliance) for transient evoked otoacoustic emissions (TEOAEs) and determined their diagnostic accuracy. This analytical study, based on a randomized clinical trial, included 84 children (6-42 months; median 24 months) from public childcare centers in Brazil. Associations between cutoff points and TEOAEs were verified by Fisher's exact test and Chi-square. Kappa assessed agreement between ears, and the correlation between tympanometric peak pressure and static compliance was analyzed by Spearman. Diagnostic accuracy was determined using ROC (Receiver Operating Characteristic) curves and confirmed with EpiDat 3.1. In the 84 children, 66 right ears and 73 left ears were examined; however, 42 ears were randomly selected from each side for the final analysis. A significant correlation was found between peak pressure and static compliance. ROC analysis identified -180 daPa as the most accurate cutoff (AUC = 0.781; 95% CI: 0.656-0.905; p < 0.001). EpiDat indicated a specificity of 93.9%, a sensitivity of 55.6%, and an overall accuracy of 85.7%. Static compliance <0.2 mL showed comparable performance (specificity = 98.5%, sensitivity = 50.0%, accuracy = 88.1%). The cutoff point of -180 daPa combined with static compliance <0.2 mL improved screening accuracy and reduced unnecessary referrals. It provided the best balance between specificity, sensitivity, and accuracy, aligning more closely with TEOAEs results and supporting updating this tympanometric criterion in infant hearing screening.
This systematic review and meta-analysis aimed to determine the prevalence and impact of orofacial pain among older adults with dementia. Observational studies were retrieved from EMBASE, LILACS, PubMed/MEDLINE, Scopus, Cochrane, Livivo, and Web of Science databases, in addition to gray literature. The search included studies without language or date restrictions. Eligible studies included participants aged 60 years or older with any type of dementia, reporting the presence, frequency, or characteristics of orofacial pain. Case reports, reviews, and experimental animal studies were excluded. Data were extracted independently by calibrated reviewers. Meta-analyses were performed using RStudio software, calculating pooled prevalence rates with 95% confidence intervals. Heterogeneity was assessed using the I2 statistic. The overall prevalence of orofacial pain among older adults with dementia was 19%, regardless of dementia type. Associated factors included poor oral hygiene, presence of natural dentition, and xerostomia. Communication difficulties, particularly in non-verbal patients, represented the main diagnostic barrier. Approximately one in five older adults with dementia experiences orofacial pain, which significantly affects quality of life. However, underdiagnosis remains common due to cognitive and communicative limitations. Improving professional training, multidisciplinary collaboration, and public health strategies focused on oral healthcare in long-term care facilities are essential to enhance pain detection and management.
To assess the self-perception of health and disability of individuals with bilateral hearing loss (HL) before and after one year of using hearing aids, using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Longitudinal, observational and analytical-descriptive study, approved by the research ethics committee under opinion number 6.767.314, in which 15 individuals diagnosed with mild to severe hearing loss and wearing bilateral hearing aids (HA) were assessed. The WHODAS 2.0 was applied at the time of fitting and reapplied after one year of use. The mean scores in the six domains of the instrument (cognition, mobility, self-care, getting along, life activities and participation) were statistically analyzed. A reduction in disability was observed after using HA, with an average reduction of 12% in WHODAS scores. Domains such as cognition, self-care, and participation showed statistical differences. WHODAS 2.0 proved effective in assessing and monitoring disability and its impact on the functioning of individuals with HL, being sensitive to changes promoted by the use of HA, despite the absence of statistical significance in some variables. Avaliar a autopercepção de saúde e deficiência de indivíduos com perda auditiva (PA) bilateral antes e após um ano de uso de aparelho de amplificação sonora individual (AASI), utilizando o World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Estudo longitudinal, observacional e analítico-descritivo, aprovado pelo comitê de ética em pesquisa sob o número de parecer 6.767.314 no qual foram avaliados 15 indivíduos diagnosticados com PA de grau leve a severo, em uso de AASI bilateralmente. O WHODAS 2.0 foi aplicado no momento da adaptação e reaplicado após um ano de uso. As médias dos escores nos seis domínios do instrumento (cognição, mobilidade, autocuidado, relações interpessoais, atividades laborais e participação) foram analisadas estatisticamente. Observou-se redução da incapacidade após o uso do AASI, com redução média de 12% nos escores do WHODAS. Domínios como cognição, autocuidado e participação apresentaram diferença estatística. O WHODAS 2.0 mostrou-se eficaz para avaliar e monitorar a incapacidade e seu impacto na funcionalidade de indivíduos com PA, sendo sensível às mudanças promovidas pelo uso do AASI, apesar da ausência de significância estatística em algumas variáveis.
Chikungunya virus (CHIKV) can cause acute arboviral illness, usually accompanied by severe polyarthralgia. In 2025, live-attenuated CHIKV vaccine Ixchiq® (Valneva, Saint-Herblain, France) was authorised for use in Brazil, where CHIKV often co-circulates with other arboviruses. A central public health question emerges: how should this vaccine be optimally deployed in a country characterised by hyperendemic transmission, frequent underdiagnosis, and marked regional disparities? We conducted an epidemiological analysis using notified CHIKV cases from the Notifiable Diseases Information System (SINAN) and socioeconomic indicators from the Brazilian Human Development Atlas. This framework enabled the identification of municipal clusters with shared epidemiological and socioeconomic profiles, allowing exploration of the relationship between disease notification rate and social health determinants. Our results showed that CHIKV transmission exhibited a cyclic pattern with geographic expansion toward the Southeast/South - Brazil's most densely populated regions characterised by low population immunity. Cluster analyses showed that the greatest disease burden is concentrated in socioeconomically disadvantaged municipalities, particularly in the Northeast, where healthcare disparities may further impact diagnostic capacity. Based on the obtained results, we believe in a hybrid immunisation strategy starting from high-incidence municipalities in the northeast and reaching major urban centres in the southeast in order to prevent larger outbreaks. Implementation must account also for current vaccine contraindications in high-risk groups and be guided by real-time epidemiological and entomological surveillance.
American tegumentary leishmaniasis (ATL) remains a significant public health problem in the Americas, with the Amazon region standing out in Brazil for its high number of cases. This article aimed to present advances in the understanding of epidemiology, diagnosis, treatment and control of ATL in the state of Amazonas over the past decades. This study is a narrative review of scientific studies published in the literature between 2011 and 2025, retrieved from databases such as PubMed and SciELO, as well as public data from the Notifiable Diseases Information System (SINAN), official reports from the Ministry of Health and technical notes from the Amazonas Health Surveillance Foundation. The evolution of disease incidence is reported, highlighting the predominance of Leishmania (Viannia) guyanensis and the environmental factors associated with the increase in cases, such as deforestation and unplanned urbanization. Advances in diagnostic strategies include the expanded use of molecular techniques and the strengthening of the primary healthcare network. Regarding therapy, clinical trials with drugs such as pentamidine, miltefosine, tamoxifen and itraconazole have demonstrated their efficacy in treatment. The review also includes socio-environmental, genetic and experimental studies that have contributed to a better understanding of the disease. It emphasizes the need to establish a priority agenda that includes the use of telemedicine and the institutionalization of collaborative research for therapeutic innovation, integration between research and healthcare services and strategies adapted to the Amazonian context. Regional scientific advances can support more effective control policies and reduce the burden of ATL in this highly endemic setting.
Nasolacrimal duct obstruction (NLDO) is a common cause of chronic epiphora and visual disturbance. This project aims to evaluate the association between NLDO and a spectrum of mental health conditions in a racially and socioeconomically diverse national cohort. A retrospective cohort study with cross-sectional and time-to-event analyses was conducted with data from January 1, 2007, to January 1, 2022. The population-based cohort was derived from the National Institutes of Health All of Us Research Program, a multicenter national research initiative in the United States that compiles deidentified patient health record data. Adults with a coded diagnosis of NLDO (n = 420) were identified and compared with 1,260 adults without NLDO selected through 1:3 propensity score matching on age, sex, race, ethnicity, income, education, and insurance status. Psychiatric diagnoses, including depression, anxiety, and bipolar disorder, were ascertained from Systematized Nomenclature of Medicine diagnostic codes extracted from linked electronic health records available within the All of Us Research Program platform. Adjusted odds ratios (ORs) were estimated using multivariable logistic regression, and hazard ratios (HRs) for incident psychiatric diagnoses were estimated using Cox proportional hazards models. NLDO was associated with higher prevalences of anxiety (32.1% vs. 12.5%), depression (34.3% vs. 11.2%), and bipolar disorder (4.8% vs. 1.7%). After adjustment, NLDO remained significantly associated with anxiety (OR 3.60), depression (OR 4.79), and bipolar disorder (OR 3.37) (all p < 0.01). In time-to-event analyses, NLDO was linked to increased hazards of depression (HR 3.98), anxiety (HR 8.30), and bipolar disorder (HR 6.97). In this large, ethnically diverse national cohort, NLDO was associated with significantly increased prevalence and risk of mood and anxiety disorders. These findings suggest that NLDO carries a meaningful psychosocial burden and support consideration of mental health screening and integrated care in affected patients.
The splenic injuries are frequent among victims of blunt trauma, and the most appropriate approach must be based on the physiological status and anatomical complexity of the lesions balance. The alternatives must balance, in stable patients without peritonitis, the simplicity and prompt resolution of splenectomy and the potential complications and immunobiological consequences, considering modern minimally invasive diagnostic and therapeutic tools. This paper presents the Brazilian Trauma Society's (SBAIT) management guidelines, based on the most recent evidence and tailored to the reality of Brazilian trauma centers.
While knee kinematics are well-documented in primary TKA, less is understood regarding revision TKA (rTKA), where altered soft tissue conditions may influence kinematics. This study aimed to investigate the relationship between kinematic parameters, specifically anteroposterior (AP) translation and post-cam engagement, and patient-reported outcome measures (PROMs) in rTKA patients. Thirty patients who underwent rTKA between 2022 and 2024 were assessed at a minimum six-month follow-up. Tibiofemoral kinematics, measured as femoral AP translation relative to the tibia, were evaluated during open-chain flexion-extension (FE) and closed-chain exercises (sit-to-stand (STS) and a lunge) using fluoroscopy. Two clusters, categorized by higher and lower PROMs, were compared for AP translation and post-cam engagement. In the medial compartment, the low-PROMs group exhibited a more anterior femoral position compared to the high-PROMs group, with statistical significance observed during mid-flexion of the STS (50.87% (SD, 4.04) vs. 47.57% (SD, 2.75); p = 0.043) and FE exercise (51.97% (SD, 3.83) vs. 48.55% (SD, 3.62); p = 0.037). No significant differences were found in the lateral compartment. Post-cam engagement did not differ between the groups in either open- or closed-chain exercises. Poorer PROM scores were associated with a more anterior femoral position in the medial compartment during mid-flexion of STS and FE exercises. Further research is needed to explore the relationship between kinematic variations and PROMs in rTKA patients.
Malaria and stunting are highly prevalent in Papua, Indonesia, yet their association remains poorly understood. We examined dose-response relationships between postnatal malaria and stunting, trimester-specific prenatal effects, effect modification by insecticide-treated net (ITN) use, and risk by Plasmodium species. Unmatched case-control study of 1301 children 12-60 months (435 cases; 866 controls) from 25 primary health centres. Exposure was ascertained from health centre registers and maternal cohort records. Multivariable logistic regression with cluster-robust standard errors was used; ITN effect modification was assessed using an interaction term. One postnatal malaria episode was associated with increased stunting odds [adjusted OR (aOR) 1.52; 95% CI 1.02-2.29], with a significant dose-response trend compared with no malaria exposure. Prenatal malaria was not significant after adjustment. Low birth weight was the strongest predictor (aOR 2.22; 95% CI 1.29-3.82). ITN use modified the malaria-stunting association (interaction aOR 0.37; 95% CI 0.18-0.73). Plasmodium falciparum was associated with increased stunting odds vs no prenatal malaria (OR 1.84; 95% CI 1.18-2.89). Recurrent postnatal malaria is associated with stunting in a dose-response pattern, modified by ITN use. Findings support malaria control and nutrition programme integration in endemic settings.
To evaluate the combined predictive value of the frailty index (FI) and prognostic nutritional index (PNI) for prognosis in elderly hip fracture patients. Clinical data from 110 elderly hip fracture patients were prospectively analyzed with 1-year postoperative follow-up. Patients were stratified into survival (n = 76) and non-survival (n = 34) groups based on outcomes. Collected parameters included demographic characteristics, fracture patterns, treatment modalities, and laboratory indices. Receiver operating characteristic curve analysis assessed the predictive efficacy of FI and PNI individually and combined. Optimal cutoff values were determined for patient stratification. Kaplan-Meier analysis evaluated 1-year survival rates, while Cox proportional hazards modeling identified prognostic factors. Significant intergroup differences (P < .05) were observed for body mass index, intraoperative transfusion rates, American Society of Anesthesiologists classification, frailty prevalence, FI values, lymphocyte counts, albumin levels, and C-reactive protein (CRP). The nonsurvival group demonstrated significantly lower PNI (P < .05). Receiver operating characteristic analysis yielded area under the curve values of 0.713 (FI), 0.782 (PNI), and 0.816 (combined). Patients with high FI/low PNI showed the poorest 1-year survival. Multivariate analysis identified decreased lymphocyte counts and PNI, along with elevated CRP and FI, as independent risk factors for adverse outcomes (P < .05). The FI-PNI combination provides superior prognostic accuracy for elderly hip fracture patients, reflecting comprehensive pathophysiological changes. Key independent risk factors include lymphopenia, hypoalbuminemia, elevated CRP, and increased FI. Routine frailty and nutritional assessments should guide personalized care plans to optimize outcomes.