Universidade Salvador

BACKGROUND:Approximately 95% of people infected with Mycobacterium tuberculosis do not progress to tuberculosis (TB) disease. Identifying key determinants of TB progression could focus prevention efforts. METHODS:Contacts of pulmonary TB patients were enrolled in a prospective multi-center cohort study (Regional Prospective Observational Research in Tuberculosis [RePORT]-Brazil) from 2015 to 2019 and followed for 24 months. Empirical review and least absolute shrinkage and selection operator (LASSO) regression, using baseline clinical and laboratory information, were used as dimension reduction techniques to determine factors for inclusion in prediction models. Models were created for: (1) all contacts, (2) contacts interferon-gamma release assay (IGRA)-positive at baseline, and (3) IGRA-positive contacts who did not receive TB preventive therapy (TPT; <30 days isoniazid). Internal validation was performed using bootstrapping. RESULTS:Among 1846 contacts of 619 TB index patients, 25 (1.4%) progressed to TB. No TPT was a risk factor for progression to TB among all contacts (mixed-effects adjusted hazard ratio [aHR] = 16.55, 95% confidence interval [CI]: 2.22-124.45). Internal validation with all contacts yielded an area under the receiver operating characteristic curve of 0.80 (95% CI: .72-.86]. Body mass index (BMI) was inversely associated with increased risk of progressing to active TB among IGRA-positive contacts who did not receive TPT (aHR = 0.89, 95% CI: .80-.99). Interferon-gamma release assay-positive contacts with BMI <25 kg/m2 had a 4.14-fold (95% CI: 1.17-14.67) higher risk of progression to TB than IGRA-positive contacts with BMI ≥25 kg/m2: 8.4% versus 2.1%, respectively. CONCLUSIONS:Body mass index <25 kg/m2, a readily available biomarker, identified IGRA-positive close TB contacts at high risk of progressing to TB disease. Prioritizing this high-risk group for TB preventive therapy could improve TB prevention efforts. BMI <25 kg/m², a readily available biomarker, identified IGRA-positive close contacts at high risk for progression to TB in a large observational Brazilian cohort. Prioritizing this high-risk group for TB preventive therapy could significantly improve TB prevention efforts.

O envelhecimento feminino, particularmente durante a transição menopausal, está associado a alterações hormonais que intensificam processos inflamatórios e desfechos cardiometabólicos. Esta revisão objetiva analisar a relação entre a terapia hormonal, a menopausa, o estilo de vida e o risco cardiometabólico em ensaios comunitários controlados. Consiste em uma revisão integrativa da literatura, desenvolvida a partir de buscas realizadas em dezembro de 2025 nas bases de dados LILACS, MEDLINE e PubMed.Os estudos mostram que a combinação entre terapia hormonal e mudanças no estilo de vida reduz o risco cardiometabólico em mulheres na menopausa. Os melhores resultados ocorrem com indicação adequada, início oportuno e abordagem multiprofissional, favorecendo adesão e melhores desfechos em saúde. Assim, a combinação entre a terapia de reposição hormonal e intervenções no estilo de vida promove benefícios consistentes na redução do risco cardiometabólico em mulheres na menopausa, sobretudo quando a terapia é indicada de forma adequada e iniciada precocemente. Essa estratégia integrada mostra-se viável em contextos comunitários e reforça a importância de abordagens individualizadas e multiprofissionais para a promoção do envelhecimento saudável.

Current B-cell depletion strategies in lupus nephritis (LN) may encounter a mechanistic “glass ceiling.” While rituximab remains an important therapeutic option, its activity can be constrained by CD20 internalization, antigenic modulation, and greater reliance on complement-dependent mechanisms, which may be less efficient in complement-consuming inflammatory states. Type II anti-CD20 antibodies, particularly obinutuzumab, offer a biologically distinct approach by favoring stronger effector-cell recruitment and direct cell-death programs while reducing target internalization. In this perspective, we examine whether these properties may support deeper B-cell depletion in proliferative LN. Drawing conceptually from hematologic oncology, we propose that minimal residual disease (MRD) may serve as a useful analogue for thinking about depletion depth in nephrology; however, MRD-like peripheral depletion should not be interpreted as a validated renal endpoint or as direct proof of intrarenal immune quiescence. High-sensitivity flow cytometry may refine quantification of residual circulating B cells, whereas biomarkers such as uCD163 may provide complementary information on ongoing intrarenal inflammatory activity rather than tissue B-cell depletion per se. At present, surveillance-based retreatment and fixed peripheral thresholds remain investigational. Overall, obinutuzumab expands the mechanistic and clinical horizon of LN therapy, while underscoring the need for studies linking depletion depth, tissue biology, safety, and durability of response.

A solidão percebida é um dos principais fatores de risco para declínio cognitivo e desfechos adversos à saúde na terceira idade. Este estudo objetivou analisar a literatura atual sobre a correlação entre a solidão autorrelatada e a microestrutura da substância branca cerebral em idosos. Através de uma revisão sistemática, observou-se que indivíduos com níveis elevados de solidão apresentam reduções significativas na anisotropia fracionada (AF) em tratos de associação e projeção, indicando desintegração microestrutural. Esses achados sugerem que a solidão não é apenas um estado emocional, mas um estressor biológico capaz de impactar a conectividade cerebral. Conclui-se que intervenções para reduzir a solidão podem ser estratégias essenciais para a neuroproteção no envelhecimento.