Placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with increasing cesarean delivery rates worldwide. Existing classifications, such as the World Health Organization International Statistical Classification of Diseases and Health-Related Problems and the International Federation of Gynecology and Obstetrics system, describe depth of invasion and histopathological features but do not adequately predict surgical outcomes or guide individualized management. The PAS topographic classification describes the anatomical extent of uterine wall remodeling and the presence of uterovesical adhesions, allowing surgical teams to anticipate intraoperative complexity, organ involvement, and appropriate therapeutic strategies. Although successfully applied in selected centers, its broader evaluation across diverse healthcare settings is lacking. We designed a prospective, multicenter, international cohort study enrolling patients with a high prenatal suspicion of PAS. Eligible patients are aged ≥ 18 years, undergoing surgery after 20 weeks’ gestation, and managed by multidisciplinary PAS teams familiar with the topographic classification. Standardized prenatal ultrasound staging and intraoperative surgical staging are required, with photographic and video documentation. Surgical strategies include one-step conservative surgery, total hysterectomy, and modified subtotal hysterectomy, guided by intraoperative classification. The primary outcome is intraoperative blood loss, measured using a standardized protocol. Secondary outcomes include intraoperative complications, operative time, treatment type, and usability assessments of the classification through structured surveys. Data are collected in REDCap with external review of imaging records. This study will provide the first prospective, multicenter evaluation of the PAS topographic classification, assessing its correlation with clinical outcomes and its feasibility across hospitals with varying resources and surgical expertise. Preliminary results indicate successful implementation in both high- and low-volume centers, with promising adoption of prenatal ultrasound staging and surgical protocols. The collaborative, image-based, and open-access methodology aims to strengthen the reliability of PAS research by harmonizing surgical strategies and allowing external supervision. Ultimately, this project will generate robust multicenter data to inform individualized management strategies and support the integration of the topographic classification into routine clinical practice worldwide. ClinicalTrials.gov Identifier: NCT05922397. Registered on 21 May 2023.
A inclusão educacional constitui um princípio fundamental das políticas públicas de educação, buscando garantir o acesso, a permanência e o sucesso de todos os estudantes no processo de aprendizagem. Nesse contexto, o avanço das tecnologias digitais, especialmente da Inteligência Artificial (IA), apresenta novas possibilidades para promover acessibilidade e equidade no ambiente educacional. O presente artigo tem como objetivo analisar as contribuições da Inteligência Artificial para a inclusão educacional, destacando ferramentas e estratégias que favorecem a aprendizagem de estudantes com diferentes necessidades educacionais. Trata-se de um estudo de natureza qualitativa, desenvolvido por meio de pesquisa bibliográfica em produções científicas que abordam educação inclusiva, tecnologias assistivas e inteligência artificial. Os resultados indicam que a IA pode contribuir significativamente para a personalização do ensino, adaptação de conteúdos, acessibilidade comunicacional e apoio pedagógico, ampliando as oportunidades de aprendizagem para estudantes com deficiência e dificuldades educacionais. Contudo, também se identificam desafios relacionados à formação docente, infraestrutura tecnológica e desigualdades de acesso. Conclui-se que a integração consciente e ética da Inteligência Artificial na educação pode fortalecer práticas pedagógicas inclusivas, contribuindo para a construção de sistemas educacionais mais equitativos e acessíveis.
Introduction: Leprosy is a chronic and infectious disease caused by Mycobacterium leprae that presents cutaneous and neurological manifestations. This disease mainly affects the economically active population, thus having a high impact on public health. Objectives: To analyze the incidence of leprosy cases in Brazil in the period from 2015 to 2024, highlighting occurrence by macro-regions and the influence of external factors. Methods: An ecological study was carried out with temporal and spatial distribution analysis of reported leprosy cases in Brazil using data from the Notifiable Diseases Information System (Sinan) and made available by the Ministry of Health/Health Surveillance Secretariat (SVS). The incidence of leprosy cases was analyzed according to the year of notification (aiming to observe trends and possible impacts of external factors, such as the COVID-19 pandemic) and the geographic macro-regions of residence (North, Northeast, Southeast, South and Center-West). Data were analyzed descriptively with a quantitative approach, through absolute frequency and percentage distribution of cases. Results: A total of 307,560 leprosy cases were reported in Brazil between 2015 and 2024. In the spatial analysis, the Northeast region showed the highest incidence of cases, with 129,394 notifications ‒ approximately 42% of the national total. The Center-West, North and Southeast macro-regions had relatively similar numbers of cases, with 67,448, 56,388 and 44,553 cases, respectively. The South region had the lowest incidence of notifications, approximately 3% of the total (9,777 cases). From a temporal standpoint, there was a reduction in the number of cases starting in 2020, possibly due to underreporting caused by the COVID-19 pandemic. In 2019, 36,265 cases were reported, while in 2020 there was a decrease of approximately 35%, with 23,511 cases. This reduction persisted until 2022, with a slight increase in 2023 (30,229 cases). Conclusion: The analysis revealed important regional disparities, with a very significant difference between the Northeast and South regions, with the highest and lowest incidence, respectively. In addition, an important trend of reduced notifications over the years was noted, especially after 2020.
Introdução: Segundo a Organização Mundial da Saúde, cerca de 1 bilhão de indivíduos convivem com algum transtorno mental no mundo, excedendo os gastos globais em US$1 trilhão, sendo a depressão e a ansiedade as doenças mais prevalentes. Objetivo:Foi realizado um estudo de delineamento ecológico com o objetivo de investigar o perfil epidemiológico e a tendência temporal das taxas de internações hospitalares por transtornos de humor no Brasil entre 2010 e 2024. Método: Para o estudo de série temporal, analisaram-se as taxas por meio de regressão linear simples a partir das internações no Brasil e suas regiões, conforme sexo e faixas etárias por sexo. Já no estudo do perfil, foi realizada a análise descritiva por faixa etária, sexo, cor da pele e custos hospitalares. Resultados: Foram registradas 779.671 internações por transtornos de humor no período, com maior prevalência em mulheres brancas de 20 a 39 anos. O custo total foi de R$ 781 milhões, com média de 20,1 dias de internação, sendo os maiores gastos associados a atendimentos de urgência e ao regime privado. As taxas permaneceram estáveis no Brasil, porém apresentaram crescimento nas regiões Norte e Nordeste e entre homens. Tendências crescentes foram observadas em faixas etárias específicas de ambos os sexos, enquanto o grupo de 40 a 59 anos mostrou redução nas internações. Conclusão: Embora as taxas nacionais de internação por transtornos de humor se mantenham estáveis, o crescimento observado em regiões e grupos etários específicos, associado ao elevado impacto econômico, evidencia a necessidade de ações em saúde mental mais direcionadas, preventivas e eficientes, capazes de reduzir hospitalizações evitáveis e desigualdades regionais.
PURPOSE OF THE RESEARCH:Post-stroke fatigue (PSF) is a common and disabling condition that limits rehabilitation and quality of life, yet no pharmacological treatment is well established. Modafinil, a wakefulness-promoting agent, has been proposed as a potential therapy. This systematic review and meta-analysis evaluated its efficacy and safety in PSF. PRINCIPAL RESULTS:Four studies (two RCTs, two observational) comprising 1001 met inclusion criteria. Modafinil did not significantly improve overall fatigue severity on the MFI or FSS. A domain-specific benefit was observed for mental fatigue (MD -2.51; p = 0.0005), with no significant effects on physical, general, or activity-related fatigue. No improvements were found in quality of life (SSQoL) or cognition (MoCA). Modafinil was generally well tolerated with few mild adverse events. MAJOR CONCLUSIONS:Current evidence does not support modafinil as a routine treatment for PSF. Its effect on mental fatigue is of very low certainty, limiting the strength of this finding. Clinicians should interpret these findings cautiously, and use modafinil only on a case-by-case basis. Larger, high-quality trials with standardized fatigue measures are needed to identify responders and clarify its clinical role.
