To apply the NOA method, which integrates the dimensions of need, opportunity, and accessibility, to evaluate the effectiveness of kidney, liver, pancreas, heart, and lung transplants in Brazil. This retrospective cohort study used data from the Brazilian Transplant Registry regarding transplant need (the sum of the number of patients on waiting lists in 2022 and the total number of patients added to the lists in 2023). Opportunity considered the number of transplants from living and deceased donors in Brazil; for the latter, a correction factor derived from data from the Global Observatory on Donation and Transplantation was applied. Accessibility represented the sum of the number of organ transplants from deceased and living donors. A percentage score was generated to measure transplant performance relative to supply in relation to demand. Utilization and completed transplant rates were also estimated. Performance ranged from 10% for kidney transplants, reflecting the mismatch between the waiting list and available grafts, to 64% for heart transplants. The South region had the highest utilization rate, while the North showed low organ availability, technical difficulties, and limited installed capacity. The NOA method is an effective tool for measuring the performance of the donation and transplant system, identifying bottlenecks to guide public policies. In Brazil, it is urgent to implement strategies aimed at reducing regional disparities, strengthening technical capacity, and expanding equity and efficiency in access to transplantation. Aplicar o método NOA, que integra as dimensões de necessidade, oportunidade e acessibilidade, para avaliar a eficácia dos transplantes de rim, fígado, pâncreas, coração e pulmão no Brasil. Este estudo de coorte retrospectivo utilizou dados do Registro Brasileiro de Transplantes relativos à necessidade de transplantes (soma do número de pacientes em listas de espera em 2022 com o número total de pacientes incluídos nas listas em 2023). A “oportunidade” considerou o número de enxertos provenientes de doadores vivos e falecidos no Brasil; para estes últimos, foi aplicado fator de correção oriundo dos dados do Global Observatory on Donation and Transplantation. A “acessibilidade” representou a soma do número de transplantes de órgãos provenientes de doadores falecidos e vivos. Gerou-se um escore percentual para mensurar o desempenho dos transplantes relativamente à oferta em função da demanda. Também foram estimadas as taxas de utilização e de transplantes realizados. O desempenho variou de 10% para transplantes renais, refletindo o descompasso entre a lista de espera e os enxertos disponíveis, até 64% para transplantes cardíacos. A região Sul teve a melhor taxa de utilização, enquanto o Norte apresentou baixa disponibilidade de órgãos, dificuldades técnicas e limitada capacidade instalada. O método NOA é uma ferramenta eficaz para mensurar o desempenho do sistema de doação e transplantes, identificando gargalos para orientar políticas públicas. No Brasil, é urgente implementar estratégias voltadas à redução das disparidades regionais, ao fortalecimento da capacidade técnica e à ampliação da equidade e eficiência no acesso aos transplantes. Aplicar el método NOA, que integra las dimensiones de necesidad, oportunidad y accesibilidad, para evaluar la eficacia del sistema de trasplante de riñón, hígado, páncreas, corazón y pulmón en Brasil. En este estudio de cohorte retrospectivo se utilizaron datos del Registro Brasileño de Trasplantes para determinar la necesidad de trasplantes (la suma del número de pacientes en listas de espera en el 2022 y el número total de pacientes que fueron incluidos en las listas en el 2023). Para evaluar la “oportunidad”, se tuvo en cuenta el número de trasplantes de donantes vivos y de donantes fallecidos que se llevaron a cabo en Brasil; en estos últimos, se aplicó un factor de corrección derivado de los datos del Observatorio Mundial de Donación y Trasplante. La “accesibilidad” fue la suma del número de trasplantes de órganos de donantes vivos y de donantes fallecidos. Se generó una puntuación porcentual para medir el desempeño del sistema en términos de la oferta respecto a la demanda. También se estimaron las tasas de utilización y el número de trasplantes realizados. El desempeño del sistema osciló entre el 10% en el caso de los trasplantes de riñón, lo que refleja el desajuste existente entre la lista de espera y los órganos disponibles, y el 64% en el caso de los trasplantes de corazón. El sur del país es la zona que presenta la mejor tasa de utilización, mientras que el norte tiene poca disponibilidad de órganos, dificultades técnicas y una capacidad instalada limitada. El método NOA es una herramienta eficaz para medir el desempeño del sistema de donación y trasplante, ya que permite determinar los cuellos de botella a fin de orientar las políticas públicas. En Brasil, es urgente poner en marcha estrategias destinadas a reducir las disparidades regionales, fortalecer la capacidad técnica y aumentar la equidad y la eficiencia en el acceso a los trasplantes.
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Positron emission tomography (PET) with fluorodeoxyglucose {[18F]FDG} is a technique used to identify areas of increased glycolytic metabolism, aiding in the diagnosis, staging, and follow-up of neoplastic, infectious, or inflammatory disease. In people with diabetes mellitus (DM), hyperglycemia and hyperinsulinemia alter the radiotracer biodistribution, compromising the diagnostic accuracy of this test. The absence of clear guidelines may result in inadequate patient preparation and the need to postpone or repeat the test, causing harm to the patient and the institution. This clinical practice guideline results from a review of available evidence and a multidisciplinary consensus process between the Endocrinology and Nuclear Medicine services of Unidade Local de Saúde São João, aiming to establish recommendations applicable to the Portuguese hospital context. The document includes detailed recommendations on the management of antidiabetic drugs before performing [18F]FDG PET, organized by specific clinical scenarios: 1) type 2 DM; 2) type 1 DM, including patients with continuous subcutaneous insulin infusion systems; and 3) diabetes secondary to corticosteroid therapy. In case of hyperglycemia between 200 - 350 mg/dL on the day of the test, the guideline includes the administration of insulin according to a personalized scheme, adapted to body mass index and renal function. The implementation of this guideline aims to standardize the preparation of people with diabetes for [18F]FDG PET and minimize the need to postpone or repeat tests, allowing for the optimization of hospital resource management. A tomografia por emissão de positrões (PET) com fluorodesoxiglicose {[18F]FDG} é um exame utilizado para identificar áreas de metabolismo glicolítico aumentado, auxiliando no diagnóstico, estadiamento e seguimento de patologia neoplásica, infeciosa ou inflamatória. Em pessoas com diabetes mellitus (DM), a hiperglicemia e a hiperinsulinemia alteram a biodistribuição do radiofármaco, comprometendo a precisão diagnóstica deste exame. A ausência de normas claras pode resultar na preparação inadequada do doente e necessidade de adiar ou repetir o mesmo, acarretando prejuízo para o doente e para a instituição. Este protocolo de atuação clínica resulta de uma revisão da evidência disponível e de um processo de consenso multidisciplinar entre os serviços de Endocrinologia e de Medicina Nuclear da Unidade Local de Saúde São João, visando estabelecer recomendações aplicáveis ao contexto hospitalar português. O documento inclui recomendações detalhadas sobre a gestão dos fármacos antidiabéticos previamente à realização de PET com [18F]FDG, encontrando-se organizado por cenários clínicos específicos: 1) DM tipo 2; 2) DM tipo 1, incluindo doentes com sistemas de perfusão subcutânea contínua de insulina; e 3) DM secundária a corticoterapia. No caso de hiperglicemia de 200 - 350 mg/dL no dia do exame, o protocolo contempla a administração de insulina de acordo com um esquema personalizado, adaptado ao índice de massa corporal e função renal. A implementação deste protocolo visa uniformizar a preparação de pessoas com diabetes para a realização de PET com [18F]FDG e minimizar a necessidade de adiar ou repetir exames, permitindo a otimização da gestão de recursos hospitalares.
To investigate the capacity of the Auditory Processing Domains Questionnaire (APDQ), in its Brazilian Portuguese version, to differentiate children and adolescents with diverse neurodevelopmental conditions based on their caregivers' responses. This was an analytical, multicenter study. Consisted of guardians of individuals aged between seven and 17 years old, divided into three groups according to neurodevelopmental condition: Control Group (CG); Human Communication Disorders Group (HCDG); and Attention Deficit Hyperactivity Disorder Group (ADHDG). All caregivers completed the APDQ, a scale consisting of 50 questions divided into three domains. The questionnaire generates a percentage score for each domain, a total score, and an indication of risk for developmental impairment, referred to as the outcome. The data was analyzed descriptively and analytically, considering a significance level of 5% (p<0.05). There was a significant difference between the groups in the total score and in the APDQ domains, indicating that the instrument can differentiate between children with and without neurodevelopmental disorders. In the attention domain, there was a significant difference between ADHDG and HCDG, distinguishing the performance between these groups. In terms of outcomes, the APDQ was able to differentiate between the groups, classifying the majority of CG individuals as "normal listening", and those from HCDG and ADHDG as being at risk of "language, learning and listening difficulties". The use of the APDQ was effective in distinguishing the different neurodevelopmental conditions. The attention domain stood out, which enabled to differentiate between HCDG and ADHDG. Investigar a capacidade do “Auditory processing domains questionnaire (APDQ)”, em sua versão português brasileiro, de diferenciar crianças e adolescentes com diferentes condições de neurodesenvolvimento com base nas respostas de seus responsáveis. Estudo do tipo analítico e multicêntrico. Constituído por responsáveis de indivíduos entre sete e 17 anos de idade, distribuídos em três grupos em função da condição do neurodesenvolvimento, a saber: Grupo Controle (GC); Grupo Distúrbios da Comunicação Humana (GDCH) e Grupo Transtorno do Déficit de Atenção e Hiperatividade (GTDAH). Todos os responsáveis responderam o APDQ, que é uma escala composta por 50 questões reunidas em três domínios. O questionário gera um escore percentual para cada domínio, um total e a possibilidade de risco para alteração no desenvolvimento denominada como desfecho. Os dados foram analisados de forma descritiva e analítica, considerando um nível de significância de 5% (p<0,05). Houve diferença significativa entre os grupos na pontuação total e nos domínios do APDQ, indicando que o instrumento consegue diferenciar crianças com e sem alterações do neurodesenvolvimento. No domínio de atenção, verificou-se diferença significativa entre GTDAH e GDCH, permitindo distinguir o desempenho desses grupos. Em relação aos desfechos, o APDQ conseguiu diferenciar os grupos entre si, classificando a maioria dos indivíduos do GC como “escuta normal” e os do GDCH e GTDAH como de risco para “dificuldade na linguagem, aprendizagem e escuta”. O uso do APDQ foi eficaz para distinguir as diferentes condições de neurodesenvolvimento. Destacou-se o domínio da atenção que permitiu diferenciar o GDCH e o GTDAH. Investigar a capacidade do “Auditory processing domains questionnaire (APDQ)”, em sua versão português brasileiro, de diferenciar crianças e adolescentes com diferentes condições de neurodesenvolvimento com base nas respostas de seus responsáveis. Estudo do tipo analítico e multicêntrico. Constituído por responsáveis de indivíduos entre sete e 17 anos de idade, distribuídos em três grupos em função da condição do neurodesenvolvimento, a saber: Grupo Controle (GC); Grupo Distúrbios da Comunicação Humana (GDCH) e Grupo Transtorno do Déficit de Atenção e Hiperatividade (GTDAH). Todos os responsáveis responderam o APDQ, que é uma escala composta por 50 questões reunidas em três domínios. O questionário gera um escore percentual para cada domínio, um total e a possibilidade de risco para alteração no desenvolvimento denominada como desfecho. Os dados foram analisados de forma descritiva e analítica, considerando um nível de significância de 5% (p<0,05). Houve diferença significativa entre os grupos na pontuação total e nos domínios do APDQ, indicando que o instrumento consegue diferenciar crianças com e sem alterações do neurodesenvolvimento. No domínio de atenção, verificou-se diferença significativa entre GTDAH e GDCH, permitindo distinguir o desempenho desses grupos. Em relação aos desfechos, o APDQ conseguiu diferenciar os grupos entre si, classificando a maioria dos indivíduos do GC como “escuta normal” e os do GDCH e GTDAH como de risco para “dificuldade na linguagem, aprendizagem e escuta”. O uso do APDQ foi eficaz para distinguir as diferentes condições de neurodesenvolvimento. Destacou-se o domínio da atenção que permitiu diferenciar o GDCH e o GTDAH.
Amodiaquine-artesunate is one of the recommended options by the Angolan National Malaria Control Program for the treatment of uncomplicated malaria and for malaria seasonal chemoprevention. CYP2C8 is a critical enzyme in the metabolism of amodiaquine. The CYP2C8 gene harbors alleles coding for less active enzymes that have been linked to amodiaquine-associated adverse events. In this work, we analyzed the prevalences of the CYP2C8 main alleles in a sample of the Angolan population. We found an expected robust frequency of a very-low-activity allele, CYP2C8*2 (18.2%) but also the unusual presence of alleles CYP2C8*3 (1%) and CYP2C8*4 (0.5%). Together, these alleles were seen in a non-negligible group of Plasmodium falciparum malaria patients and children under amodiaquine-based therapies and prophylactic strategies.
Aspergillus fumigatus is the primary causative agent of aspergillosis. Cryptic species may exhibit variable pathogenic potential and antifungal resistance and, particularly those within the section Fumigati, have significant clinical and environmental relevance. However, the genomic and proteomic bases underlying these differences remain poorly understood. This study presents a comparative analysis of 42 genomes (including five newly sequenced genomes), together with their corresponding predicted proteomes, from A. fumigatus, and from four cryptic species: A. lentulus, A. udagawae, A. felis and A. hiratsukae. Notably, these represent the only genomes currently available for these cryptic species, allowing us to integrate antifungal resistance mechanisms, and virulence factors across the full existing genomic landscape. We showed that A. fumigatus retains a highly conserved core proteome, whereas A. felis and A. lentulus exhibit greater genomic plasticity. Our preliminary findings suggest that azole resistance is primarily driven by species-specific point mutations, which are not shared across the section Fumigati. Secondary metabolism pathways are the main difference observed among section Fumigati, with variations in biosynthetic gene clusters and mycotoxin production. Our findings emphasize the evolutionary balance between genomic conservation and evolutionary divergence in A. fumigatus sensu lato, determining azole resistance and pathogenicity-associated fitness.
Sporotrichosis is an emerging subcutaneous disease that occurs in outbreaks in Brazil and other South American countries. Reports of extracutaneous cases caused by Sporothrix brasiliensis have been increasing in the literature. This study describes the first case series of ocular adnexal sporotrichosis in the state of Rio Grande do Sul (RS), southern Brazil. A retrospective analysis was conducted including cases diagnosed over a three-year period at a specialized reference service in RS, Brazil. Ocular sporotrichosis accounted for 25 cases, with a marked increase observed during the last two years of the study (2024-2025), reaching the highest proportion of approximately 16 cases per 100 appointments among all sporotrichosis cases. All patients presented with ocular adnexal involvement, including granulomatous conjunctivitis (56%; 14/25), Parinaud oculoglandular syndrome (40%; 10/25), and eyelid lesions with dacryocystitis in one case (4%). All cases were associated with zoonotic transmission of S. brasiliensis. Clinical cure was achieved using itraconazole (200 mg/day) for a mean treatment duration of 120 days. Our findings highlight the emergence of ocular sporotrichosis in southern Brazil, predominantly affecting adnexal structures, and emphasize the importance of early diagnosis, continuous educational efforts, and increased awareness of extracutaneous manifestations in hyperendemic areas. We describe the first case series of ocular sporotrichosis in Rio Grande do Sul, Brazil. Our findings highlight the emergence of ocular sporotrichosis and emphasize the importance of early diagnosis, continuous educational activities, and awareness of extracutaneous manifestations in endemic areas.
Digital front doors combining symptom assessment and self-triage are increasingly used, yet real-world evidence on their clinical integration remains limited. This prospective post-market clinical follow-up evaluated a clinical decision support system embedded in routine care within a large private healthcare network. Adults completed a structured symptom assessment before consultation, and both participants and physicians completed predefined questionnaires. Treating physicians generally judged the urgency advice and assessment report to be appropriate. When the report was reviewed before the consultation, physicians reported greater preparedness and perceived efficiency gains. Participants generally reported complete symptom capture and improved preparedness. These findings provide prospective real-world evidence that a symptom assessment CDSS can generate appropriate outputs in routine care and may support both patient preparation and clinician workflow when integrated into practice.
Colorectal cancer (CRC) is a biologically heterogeneous disease in which tumor sidedness has emerged as a relevant prognostic factor. Conventional TNM staging does not incorporate several clinically and biologically meaningful variables that may influence outcomes. In this context, artificial intelligence (AI) based approaches offer an opportunity to integrate complex clinicopathological data and improve prognostic stratification. This study aimed to evaluate clinicopathological variables associated with tumor sidedness and to identify clinical predictors of high-risk disease using an AI-based decision-tree model. This retrospective cohort study included 71 adults who underwent surgical resection for colorectal adenocarcinoma at a tertiary oncology center between 2020 and 2024 and had complete clinicopathological data available for analysis. Overall and progression-free survival were estimated using the Kaplan-Meier method, and associations between categorical variables were assessed using Fisher's exact test. Decision-tree models were constructed using the J48 (C4.5) algorithm, and model performance was evaluated by leave-one-out cross-validation (LOOCV). Left-sided tumors were predominant and more frequently associated with alcohol ingestion (p = 0.04), the use of neoadjuvant chemoradiotherapy (p < 0.01), and higher mortality (p = 0.04), despite more intensive treatment strategies. Right-sided tumors were prevalent in women and were associated with angiolymphatic invasion. In prognostic modeling, positive surgical margins emerged as the strongest predictor of mortality (Full 85.18%; LOOCV 74.07%). Among patients with negative margins, tumor laterality represented the most influential prognostic factor, with right-sided tumors associated with improved survival. Interestingly, younger patients showed shorter progression-free survival (Full 89.09%; LOOCV 76.36%). Tumor sidedness constitutes a meaningful prognostic dimension in CRC when integrated with established pathological factors. AI-based decision-tree models can capture clinically coherent prognostic signatures and complement traditional staging systems, supporting their role as hypothesis-generating tools for individualized risk assessment and guiding future prospective validation.
To identify factors associated with hepatitis A infection in Curitiba, Paraná, Brazil. This is a case-control study with individuals aged ≥16 years, living in Curitiba, Paraná, selected from the municipal laboratory base. We defined as cases individuals with reactive serology for hepatitis A and as controls those with non-reactive serology, from November 1st, 2023 to May 29th, 2024. Data were collected using a self-administered questionnaire. Bivariate analysis was performed followed by hierarchical logistic regression to estimate odds ratio (OR) and respective 95% confidence intervals (95%CI). A total of 242 individuals participated (121 cases and 121 controls). The cases had a higher proportion of males (64.5% vs. 52.5%), Whites (78.5% vs. 63.8%), and men who have sex with men (MSM) (25.6% vs. 12.4%) when compared to controls. In the adjusted multivariate model, hepatitis A infection maintained a significant association with raw fish consumption (aOR 2.54; 95%CI 1.39; 4,64; p-value 0.002) and with MSM (aOR 2.38; 95%CI 1.10; 4,85; p-value 0.027). Not eating out had a protective effect (aOR 0.22; 95%CI 0.08; 0,62; p-value 0.004). In the context of the investigated outbreak, hepatitis A infection was associated with the consumption of raw fish and identification as MSM, while not eating out was a protective factor. These findings indicate the relevance of prevention measures related to both food security and specific population groups, especially in scenarios of urban outbreaks. Identificar los factores asociados a la infección por hepatitis A en Curitiba, Paraná (Brasil). Se trata de un estudio de caso-control con individuos ≥16 años de edad, residentes en Curitiba, Paraná, seleccionados de la base del laboratorio municipal. Definimos como casos a individuos con serología reactiva para hepatitis A y como controles aquellos con serología no reactiva, en el periodo del 1/11/2023 al 29/5/2024. Los datos se recopilaron mediante un cuestionario autoadministrado. Se realizó un análisis bivariado, seguido de una regresión logística jerárquica, para estimar odds ratios (OR) y los respectivos intervalos de confianza del 95% (IC 95%). Participaron 242 individuos (121 casos y 121 controles). Los casos mostraron una mayor proporción de individuos del sexo masculino (64,5% versus 52,5%), blancos (78,5% vs. 63,8%) y de hombres que tienen sexo con hombres (HSH) (25,6% vs. 12,4%) en comparación con los controles. En el modelo multivariado ajustado, la infección por hepatitis A mantuvo una significativa asociación con el consumo de pescado crudo (ORa 2,54; IC 95% 1,39; 4,64; p-valor 0,002) y con ser HSH (ORa 2,38; IC 95% 1,10; 4,85; p-valor 0,027). No comer fuera de casa tuvo un efecto protector (ORa 0,22; IC 95% 0,08; 0,62; p-valor 0,004). En el contexto del brote investigado, la infección por hepatitis A se asoció con el consumo de pescado crudo y con la identificación como HSH, mientras que no comer fuera de casa demostró ser un factor protector. Estos hallazgos indican la relevancia de las medidas de prevención relacionadas tanto con la seguridad alimentaria como con grupos poblacionales específicos, especialmente en escenarios de brotes urbanos.
The adoption of unsustainable economic development processes has contributed to the emergence of a global crisis in which the planet's biophysical limits are being exceeded, with numerous implications for natural systems, biodiversity, and human health. This crisis further restricts access - especially among historically marginalized populations in Brazil and Latin America - to basic citizenship rights such as the right to land and food, creating what can be understood as a "crisis of crises." This opinion article begins by acknowledging the significant setbacks in various public policies in Brazil and Latin America, particularly those aimed at reducing inequalities and promoting citizenship. It presents evidence that overcoming the "crisis of crises," as discussed throughout the text, requires adopting models of food production, distribution, and consumption that are simultaneously sustainable, sovereign, and inclusive. It concludes by arguing that agroecology holds immense potential to foster, across different regions of Brazil and Latin America, an economy that is ecologically regenerative and socially distributive. A adoção de processos insustentáveis de desenvolvimento econômico vem contribuindo para a conformação de uma crise global, em que os limites biofísicos do planeta têm sido extrapolados, com diversas implicações para os sistemas naturais, a biodiversidade e a saúde humana. Crise que limita ainda mais o acesso de uma imensa parcela da população brasileira e latino-americana, historicamente vulnerabilizada, a direitos cidadãos básicos, como o direito à terra e ao alimento, gerando o que pode ser considerado uma “crise de crises”. O presente artigo de opinião parte da constatação de retrocessos significativos em diversas políticas públicas, no Brasil e na América Latina, especialmente aquelas voltadas para a redução das desigualdades e a promoção da cidadania. Apresenta evidências de que a superação da “crise de crises”, discutida ao longo do texto, precisa considerar a adoção de modelos de produção, distribuição e consumo de alimentos que sejam, ao mesmo tempo, sustentáveis, soberanos e inclusivos. Conclui com a ideia de que a agroecologia tem imenso potencial de promover, nas diferentes partes do país e da América Latina, uma economia que seja regenerativa, do ponto de vista ecológico, e distributiva, do ponto de vista social. La adopción de procesos de desarrollo económico insostenibles ha contribuido a la formación de una crisis global, donde se han sobrepasado los límites biofísicos del planeta, con diversas implicaciones para los sistemas naturales, la biodiversidad y la salud humana. Esta crisis limita aún más el acceso a derechos ciudadanos básicos, como el derecho a la tierra y a la alimentación, para una vasta porción de la población brasileña y latinoamericana, históricamente vulnerable, generando lo que puede considerarse una «crisis de crisis». Este artículo de opinión parte de la observación de importantes retrocesos en diversas políticas públicas en Brasil y América Latina, especialmente aquellas dirigidas a reducir las desigualdades y promover la ciudadanía. Presenta evidencia de que superar la «crisis de crisis», abordada a lo largo del texto, requiere considerar la adopción de modelos de producción, distribución y consumo de alimentos que sean simultáneamente sostenibles, soberanos e inclusivos. Concluye con la idea de que la agroecología tiene un inmenso potencial para promover, en diferentes partes del país y de América Latina, una economía regenerativa, desde un punto de vista ecológico, y distributiva, desde un punto de vista social.
Estimate the seroprevalence of antibodies against Hepatitis A Virus (anti-HAV)-Immunoglobulin G (IgG) and Immunoglobulin M (IgM)-among adolescent students in Curitiba, Paraná, in the context of an outbreak, and identify the proportion of natural infections and vaccine immunity. A cross-sectional study based on a serological survey was conducted between July 3 and 5, 2024 in five state schools. Stratified random sampling was proportional to the total number of students per school. Adolescents aged 10-19 years were included with individual and legal guardian consent. Collection was conducted in the schools and the samples were analyzed by chemiluminescence for anti-HAV antibodies detection. Information on vaccination was obtained from the municipality's database. Statistical analyses included calculation of proportions, chi-square tests, and Fisher's exact test. Of the 216 samples, 35 (16.2%; 95%CI 11.9; 21.7) were reactive for anti-HAV IgG, indicating previous immunity; none of the samples showed reactive IgM. IgG prevalence among the unvaccinated was 4.6% and 11.6% among the vaccinated. Of the 25 previously vaccinated reactive cases, all were in the 10-14 years age group. Of the ten reactive by natural exposure, five were in the 10-14 years age group and five in the 15-19 years age group. IgG seroprevalence showed no significant difference by gender (p-value 0.685) or school (p-value 0.078). Seroprevalence of anti-HAV IgG among adolescents in Curitiba was low, predominating vaccine immunity over that acquired by natural exposure, and absence of acute infection cases. Estimar a soroprevalência de anticorpos contra o Vírus da Hepatite A (anti-HAV) - Imunoglobulina G (IgG) e Imunoglobulina M (IgM) - em adolescentes escolares de Curitiba, Paraná, no contexto de um surto, e identificar a proporção de infecções naturais e imunidade vacinal. Estudo transversal com base em inquérito sorológico realizado entre 3 e 5 de julho de 2024 em cinco escolas estaduais. A amostragem foi aleatória estratificada proporcional ao total de estudantes por escola. Foram incluídos adolescentes de 10-19 anos com consentimento individual e dos responsáveis legais. A coleta foi realizada nas escolas e as amostras analisadas por quimioluminescência para detecção de anticorpos anti-HAV. Informações sobre vacinação foram obtidas em base de dados do município. Análises estatísticas incluíram cálculo de proporções, testes qui-quadrado e Teste Exato de Fisher. Das 216 amostras, 35 (16,2%; IC95% 11,9; 21,7) foram reagentes para anti-HAV IgG, indicando imunidade prévia; nenhuma amostra apresentou IgM reagente. A prevalência de IgG entre não vacinados foi de 4,6% e de 11,6% entre os vacinados. Dos 25 casos reagentes previamente vacinados, todos estavam na faixa etária de 10-14 anos. Dos dez reagentes por exposição natural, cinco estavam na faixa de 10-14 anos e cinco na faixa de 15-19 anos. Não houve diferença significativa na soroprevalência de IgG por sexo (p-valor 0,685) ou por escola (p-valor 0,078). A soroprevalência de anti-HAV IgG em adolescentes de Curitiba foi baixa, com predominância de imunidade vacinal em relação à adquirida por infecção natural, e ausência de casos de infecção aguda. Estimar la seroprevalencia de anticuerpos contra el Virus de la Hepatitis A (anti-VHA) -Inmunoglobulina G (IgG) e Inmunoglobulina M (IgM)- en adolescentes estudiantes de Curitiba, Paraná (Brasil), en el contexto de un brote e identificar la proporción de infecciones naturales e inmunidad a la vacuna. Estudio transversal basado en una encuesta serológica realizada entre el 3 y el 5 de julio de 2024 en cinco escuelas del estado. La muestra se estratificó de manera aleatoria proporcional al número total de estudiantes por escuela. Se incluyeron a adolescentes de entre 10 y 19 años de edad, con consentimiento individual y de los tutores legales. La recolección se realizó en las escuelas, y las muestras se analizaron por quimioluminiscencia para la detección de anticuerpos anti-VHA. La información sobre la vacunación se obtuvo de la base de datos del municipio. Los análisis estadísticos incluyeron el cálculo de proporciones, pruebas de chi-cuadrado y la prueba exacta de Fisher. De las 216 muestras, 35 (16,2%; IC 95% 11,9; 21,7) fueron reactivas para anti-VHA IgG, lo que indica inmunidad previa; ninguna muestra obtuvo IgM reactivo. La prevalencia de IgG entre los no vacunados fue del 4,6%; y del 11,6% entre los vacunados. De los 25 casos de reactivos vacunados previamente, todos estaban en el grupo de edad de entre 10-14 años. De los diez reactivos por exposición natural, cinco estaban en el rango de edad de entre 10-14 años; y cinco, en el rango de edad de entre 15-19 años. No se encontraron diferencias significativas en la seroprevalencia de IgG por sexo (p-valor 0,685) o por escuela (p-valor 0,078). La seroprevalencia de anti-VHA IgG en adolescentes de Curitiba fue baja, con predominio de inmunidad vacunal con relación a la adquirida por infección natural, y ausencia de casos de infección aguda.
Neuromelanin (NM)-sensitive MRI of the substantia nigra is a biomarker of neurodegeneration in Parkinson's disease (PD), which is expected to begin years before motor symptoms emerge, and for which LRRK2 mutation asymptomatic carriers (AC) are at higher risk. To investigate NM-MRI in asymptomatic LRRK2 carriers. Asymptomatic first-degree relatives of LRRK2-PD patients were sequentially recruited. An extensive clinical evaluation and a study of NM using a specific T1-weighted MRI sequence, were performed. Targeted genetic testing for LRRK2 variants was performed after evaluation. Nineteen asymptomatic participants were included, 12 LRRK2-G2019S non-carriers (NC) and 7 AC. Demographics and motor scores, assessed using MDS-UPRS-III, did not differ between groups. NM area was smaller in AC when compared to NC (16 mm2[14.9-19.1] vs 20.6 mm2[19.3-24.0], P = 0.025). NM-MRI can be significantly decreased in LRRK2-G2019S AC. This technique may be a promising biomarker of neurodegeneration in pre-diagnostic stages of PD.
Background: Large language models (LLMs) are increasingly considered as adjuncts for differential diagnostic reasoning, yet their sensitivity to gender-attributed cues in the persona prompt-particularly for neglected tropical diseases (NTDs) and in non-English clinical settings-remains poorly characterised. Objective: The objective of this study was to compare the diagnostic accuracy of one proprietary and three open-weight LLMs for Chagas disease (CD) and visceral leishmaniasis (VL) under paired persona-prompt conditions in which the only manipulated variable was the linguistic gender of the simulated medical persona. Methods: This experimental, paired study evaluated ChatGPT-4o, LLaMA 3 70B, Meditron-70B, and Mixtral 8x7B across 12 cases per disease (n = 24) from real records at a Brazilian teaching hospital. The primary outcome was top-five diagnostic accuracy. A committee of five infectious-disease specialists assessed the biological plausibility of all differentials. Paired comparisons used Wilcoxon signed-rank tests; 95% confidence intervals were calculated using the Wilson-score method. Results: ChatGPT-4o achieved the highest accuracy (CD: 100% under both prompts; VL: 83.3-91.7%). LLaMA 3 70B and Mixtral 8x7B showed moderate performance (41.7-83.3%); the medically fine-tuned Meditron-70B exhibited paradoxically poor accuracy (16.7-25.0%) and the lowest committee-rated plausibility scores. A consistent small numerical trend favoured the female prompt across most model-disease combinations (differences of 0-16.7 percentage points), but no comparison reached statistical significance (all p > 0.05). Conclusions: Gender-attributed persona-prompt variation did not produce a systematic effect on LLM diagnostic accuracy for CD or VL. ChatGPT-4o outperformed the three evaluated open-weight alternatives, and medical-domain fine-tuning did not confer the expected advantage. Expert-validated assessment of hypothesis plausibility should complement target-disease accuracy in clinical LLM evaluation studies, particularly for NTDs.
to understand the social representations of forensic nurses regarding the feelings involved in their professional practice. a qualitative, exploratory-descriptive study, supported by the Social Representation Theory analytical framework, conducted through online semi-structured interviews between April and May 2023 with 22 nurses specializing in forensic nursing from across Brazil. The interviews were subjected to content analysis, as proposed by Bardin, with the support of the Qualitative Data Analysis Miner® software. five categories emerged from the data analysis: Fulfillment of professional ethical duty; Sensitivity to perceive what is not said; Enabling citizens to take protagonism in their own lives; Happiness in contributing to justice and society; and Personal and professional development. the social representations of forensic nurses reveal a practice anchored in ethical, humanitarian, and social justice values, strengthening professional identity and a sense of mission. Sensitivity is highlighted as a core competency, guiding humanized care and the interpretation of nonverbal signs of suffering. Forensic practice is perceived as an instrument for the reconstruction of autonomy and social transformation, integrating technical, emotional, and social dimensions, and legitimizing forensic nursing as an autonomous and socially relevant field.
Shoulder pain is common and debilitating in swimmers. This is largely attributed to the repetitive, high-intensity use of the upper limbs during swimming. While many shoulder-specific risk factors have been described, differences in muscle strength and physical performance across the upper kinetic chain between swimmers with and without shoulder pain remain unclear. Our aim was to compare isometric muscle strength and physical performance related to the upper kinetic chain between swimmers with and without shoulder pain. We included 34 swimmers (17 with shoulder pain and 17 asymptomatic) in our cross-sectional study. Participants underwent the following tests: Modified Closed Kinetic Chain Upper-Extremity Stability Test; Upper Quarter Y Balance Test; Upper Limb Rotation Test; and isometric muscle strength testing of scapular elevators, internal and external shoulder rotators, lower trapezius, serratus anterior, trunk extensors, trunk flexors and rotators, hip flexors, extensors, abductors, external rotators, and knee extensors. Swimmers with shoulder pain had lower performance in the number of touches (mean difference [MD] = -5.82; 95% confidence interval [CI] -10.15 to -1.50) and in the normalized score (MD = -3.53; 95% CI -5.94 to -1.13) of Modified Closed Kinetic Chain Upper-Extremity Stability Test, the medial direction of the Upper Quarter Y Balance Test (MD = -7.83; 95% CI -14.10 to -1.57), and the Upper Limb Rotation Test (MD = -4.49; 95% CI -7.50 to -1.48) compared with asymptomatic controls. No differences were found in the superolateral, inferolateral, or composite scores of the Upper Quarter Y Balance Test. Swimmers with shoulder pain had lower strength in trunk extensors (MD = -0.85; 95% CI -1.41 to -0.29), quadriceps (MD = -1.07; 95% CI -1.97 to -0.18), and shoulder elevators than controls (MD = -0.50; 95% CI -0.84 to -0.15), while no differences were observed in other muscle groups. Swimmers with shoulder pain had deficits in physical performance and isometric muscle strength across some components of the upper-extremity kinetic chain.
The https://ensaiosclinicos.gov.br/ identifier is RBR-4shpqhj. Some people need surgery after an elbow fracture. After surgery, the elbow may hurt and become stiff. This can make it hard to move the arm and do daily activities.Physical therapy can help people move better and feel less pain. Some physical therapists also use ultrasound. Ultrasound is a treatment that uses sound waves. However, we still do not know whether ultrasound provides additional benefits beyond physical therapy.This study will include 50 people who had surgery for an elbow fracture. Everyone will receive the same physical therapy program. One group will receive a real ultrasound. The other group will receive a sham ultrasound. The sham treatment will look like the real treatment, but the device will not send ultrasound waves.We will assess elbow range of motion, pain, hand strength, and arm function. These assessments will happen before treatment, during treatment, after treatment, and six months later.This study may help show whether ultrasound is useful after elbow fracture surgery.
PurposeTo analyze the concept risk of self-mutilation in school adolescents and to refine the nursing diagnosis, Risk for non-suicidal self-injurious behavior.MethodsWalker and Avant's theoretical framework was adopted for a concept analysis, including a scoping review. Correspondence was established between the antecedent factors identified in the concept analysis and those in the nursing diagnosis, Risk for non-suicidal self-injurious behavior. Potentially new diagnostic elements were proposed.FindingsThe scoping review identified 29 studies and synthesized 41 antecedents, 22 attributes, and 12 consequents. Risk of self-mutilation in school adolescents refers to susceptibility of individuals aged 13 to 18 years to deliberately inflict damage or injury on their own body tissue without suicidal intent. The most frequently antecedents found were substance abuse, excessive anxiety, female sex, depressive symptoms, poor academic performance, experiences of bullying, and disturbed interpersonal relationships.ConclusionsNon-suicidal self-injurious behavior in school adolescents requires a comprehensive approach, including identification of antecedent factors to implement preventive actions. The concept demonstrates conceptual convergence with the NANDA-I diagnosis.Implications for nursing practiceThis study provides evidence-based support for identifying vulnerable, as well as for the development and implementation of educational programs and campaigns in nursing practice.
Pharmacogenomic (PGx) variants can influence drug efficacy and safety, yet their prevalence in Latin American populations with cancer is underexplored. Our aim is to characterize the frequency and phenotypic distribution of actionable pharmacogenes in Brazilian patients with metastatic prostate cancer (MPC) and Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast cancer (BC). This analysis included 452 patients (259 BC, 193 MPC) from a multicenter study across 19 Brazilian sites. Exome sequencing was performed, and PGx variants were analyzed using the Pharmacogenomics Clinical Annotation Tool (PharmCAT) following the Clinical Pharmacogenetics Implementation Consortium (CPIC®) guidelines. Genotypes, star alleles, and predicted phenotypes were reported for 15 clinically relevant pharmacogenes. Actionable PGx phenotypes were detected in 99.33% of participants. The decreased-function ABCG2 rs2231142 T allele occurred at 8.96%, and the VKORC1 rs9923231 T allele at 32.63%. In SLCO1B1, normal function predominated (63.11%), with 21.11% exhibiting decreased function. Normal metabolizer phenotypes were most frequent in CYP2C19 (45.35%), CYP2C9 (70.51%), and CYP3A4 (94.62%), whereas CYP2B6 was dominated by intermediate metabolizers (43.02%) and CYP3A5 by poor/intermediate metabolizers (93.79%). Normal diplotypes predominated in thiopurine-related genes (NUDT15: 92.92%; TPMT: 88.72%), although nonfunctional alleles were observed. In UGT1A1, decreased-function alleles accounted for approximately 37% of participants. Clinically relevant DPYD and RYR1 variants were rare (<2.0%). Nearly all Brazilian patients with cancer carried at least one actionable PGx variant, highlighting the potential impact of PGx-guided therapy in oncology. These results underscore the value of integrating pharmacogenomic strategies into clinical practice in Brazil.
The aim of this article was to describe the prevalence of self-perceived discrimination and to identify associations with sociodemographic factors and the evaluation of care in health services in Brazil. This study used data from the 2013 National Health Survey, analyzing information from 44.001 adults were analyzed. The prevalence of discrimination in health services was 11.4% (95% CI 10.8-12.0). Discrimination was significantly higher in women (12.2%), in people with yellow skin color or indigenous people (13.3%), in those living with a partner (11.9%), individuals with lower economic status (13.6%), those with poor self-rated health (21,7%) and those with a shorter interval since their last medical consultation (12.2%). A higher prevalence of discrimination was also observed among respondents who rated health services as "fair, poor, or very poor" regarding medical care, reception, and waiting times. Discrimination may be associated with worse health outcomes and more negative perceptions of care quality. As such, discrimination in health services should be recognized as a public health issue requiring targeted interventions to ensure equitable and high-quality care, particularly for vulnerable populations. O objetivo do artigo foi descrever a prevalência de discriminação autopercebida e identificar associações com fatores sociodemográficos e de avaliação dos atendimentos em estabelecimentos de saúde no Brasil. O estudo utilizou dados da Pesquisa Nacional de Saúde de 2013 e foram analisados dados de 44.001 adultos. A prevalência de discriminação em serviços de saúde foi de 11,4% (IC95% 10,8-12,0). A discriminação foi significativamente maior nas mulheres (12,2%), em pessoas de raça/cor de pele amarela ou indígenas (18,2%), em quem vivia com companheiro (11,9%), em quem apresentava menor classificação econômica (13,6%), entre quem percebia sua saúde como muito ruim (21,7%) e naqueles que estiveram em consulta em um período menor de três meses (12,2%). Foram observadas maiores prevalências de discriminação nos grupos que avaliaram o atendimento como “regular, ruim ou muito ruim” quanto às características do atendimento médico, à recepção no serviço de saúde e ao tempo de espera para ser atendido. A discriminação pode estar associada a piores resultados de saúde e percepções negativas do paciente sobre a qualidade da assistência. Deve ser vista como um problema de saúde pública e necessita de ações de combate visando garantir a qualidade da atenção à saúde, principalmente de grupos vulneráveis. Este artículo tuvo como objetivo describir la prevalencia de la discriminación autopercibida e identificar su asociación con factores sociodemográficos y la evaluación de la atención en centros de salud en Brasil. El estudio utilizó datos de la Encuesta Nacional de Salud de 2013 y analizó información de 44.001 adultos. La prevalencia de discriminación en los servicios de salud fue del 11,4% (IC del 95%: 10,8-12,0). La discriminación fue significativamente mayor entre las mujeres (12,2%), las personas de ascendencia asiática o indígena (18,2%), quienes viven en pareja (11,9%), las personas con menor nivel socioeconómico (13,6%), quienes percibían su salud como muy mala (21,7%) y quienes habían acudido a consulta en los últimos tres meses (12,2%). Se observaron mayores prevalencias de discriminación en los grupos que calificaron la atención como “regular, mala o muy mala” en cuanto a las características de la atención médica, la recepción en el centro de salud y el tiempo de espera para ser atendido. La discriminación puede asociarse con peores resultados de salud y percepciones negativas de la calidad de la atención por parte de los pacientes. Debe considerarse un problema de salud pública y requiere acciones para combatirlo con el fin de garantizar la calidad de la atención sanitaria, especialmente para los grupos vulnerables.