ObjectivesHypertension is a major cardiovascular risk factor in Brazil and globally, requiring effective healthcare system strategies. This study examines how the health system in São Paulo manages hypertension, identifying patterns and connections that influence patient outcomes and resource use.MethodsUsing literature reviews and participatory discussions with experts, we developed a systems map, causal loop diagram, to illustrate dynamic complexity underpinning hypertension management. Thematic analysis of qualitative data informed the model, highlighting key interactions that shape screening, treatment, and long-term care.ResultsThe analysis reveals critical dynamics at individual, community, and system levels. Early diagnosis and expanded treatment access improve adherence and reduce complications. However, these improvements also increase the number of patients needing long-term care. This creates a challenge where healthcare gains today can raise future demands if prevention efforts are underfunded.ConclusionUnderstanding these interconnections is crucial for balancing treatment expansion with sustainable prevention strategies. By mapping system-wide challenges, this study offers a framework to help policymakers allocate resources more effectively and strengthen urban health systems. Future research will focus on using simulation modeling to test policy interventions and improve hypertension outcomes.
Chagas disease, a neglected tropical disease, is endemic in the Amazon region, where oral transmission predominates. Autonomic nervous system (ANS) impairment is a recognized pathophysiological mechanism contributing to disease progression, including Chagas cardiomyopathy. This study aimed to assess ANS function in patients with acute Chagas disease from the Amazon, evaluating responses pre- and post-benznidazole treatment. We included 28 acute-phase patients and 20 healthy controls. Participants underwent comprehensive cardiac evaluations, including 12-lead ECG, echocardiogram, 24-hour Holter monitoring, treadmill stress testing, and 5-minute heart rate variability (HRV) assessment. HRV was analyzed across time, frequency, and nonlinear domains, with statistical comparisons performed between groups and within the patient cohort. The study population predominantly comprised individuals from rural Amazonian municipalities (89.3%), with oral transmission accounting for 85.7% of infections. While resting ECGs were normal in 60.7%, diffuse ventricular repolarization was the most common abnormality (21.4%). Before treatment, 24-hour HRV showed significant reductions in SDANN and SDNN, indicating sympathovagal imbalance. For 5-minute HRV, significant alterations were observed across time (rMSSD, SDNN), frequency (LF, HF, LF/HF ratio), and nonlinear domains, reflecting reduced parasympathetic tone. Intragroup comparisons (pre- vs. post-treatment) further reinforced the sustained sympathovagal imbalance and parasympathetic inhibition. These findings highlight persistent autonomic modulation alterations, characterized by sympathovagal imbalance and reduced parasympathetic activity, in acute Chagas disease patients from the Amazon. Such dysfunction may predispose individuals to long-term structural cardiac changes and arrhythmias, underscoring the critical need for continued monitoring and potential targeted interventions to address autonomic imbalance in this vulnerable population.
Introduction: The 2025 International Symposium on Breast Diseases of Inland São Paulo addressed clinically relevant controversies in the management of breast cancer in special situations, including inflammatory carcinoma, axillary micrometastases after neoadjuvant chemotherapy, early luminal tumors in elderly women, and the use of vaginal estrogen therapy after breast cancer treatment. Methods: Four priority topics were presented in evidence-based lectures, followed by expert panel discussions and anonymous electronic voting. Consensus was predefined as agreement of at least 75% among panelists. Results: No consensus was reached regarding the use of sentinel lymph node biopsy in inflammatory carcinoma, although 73% of panelists voted against its performance. Likewise, no consensus was achieved on omitting axillary lymph node dissection in patients with axillary micrometastases after neoadjuvant chemotherapy, despite 61% considering this approach feasible. In elderly women with early luminal tumors, the most frequently selected option was to maintain standard treatment (29%), with no consensus supporting treatment de-escalation. In contrast, consensus was reached regarding the safety of vaginal estrogen therapy after breast cancer treatment, with 88% of panelists supporting its use in appropriately selected patients. Conclusions: These guidelines summarize expert-based recommendations for the management of breast cancer in challenging clinical scenarios and reinforce the importance of individualized, multidisciplinary decision-making. Sentinel lymph node biopsy was generally not supported in inflammatory carcinoma, and vaginal estrogen therapy was considered safe in selected breast cancer survivors. Greater caution remains warranted regarding treatment de-escalation in elderly women with early luminal tumors and omission of axillary lymph node dissection in the setting of residual micrometastatic nodal disease after neoadjuvant chemotherapy.
Background Inflammatory Bowel Diseases (IBD) are chronic conditions presenting significant diagnostic and management challenges. Current invasive methods and traditional biomarkers often lack sufficient accuracy and fail to address the disease’s heterogeneity and unpredictable therapeutic responses. This necessitates more precise, personalized clinical tools. Methods This scoping review synthesized recent findings on emerging biomarkers for IBD. We focused on technological advances in omics platforms (genomics, transcriptomics, proteomics, metabolomics, microbiomics), artificial intelligence, biosensors, and imaging techniques. Analysis identified biomarker potential for early diagnosis, disease activity monitoring, progression prognosis, and therapeutic response prediction. The review adhered to PRISMA-ScR guidelines and was registered with the Open Science Framework (OSF). The search encompassed five major databases: PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar. Results Studies demonstrate vast potential in non-invasive biomarkers for refined early diagnosis, optimized disease monitoring, and treatment response prediction. Key findings include metabolomic and gut microbiota profiles, genetic and epigenetic markers, and AI integration of complex data. These approaches promise to overcome conventional indicator limitations. From 784 initial records, 27 articles were included, published between 2021 and 2025. Conclusion Emerging biomarkers are fundamental for the transition to precision medicine in IBD. Their implementation aims to enhance pathogenesis understanding, personalize therapies, and improve patient quality of life, establishing pathways for more effective, individualized management approaches.
