Introduction: Traffic accidents are a critical global public health problem, and cell phone use while driving has been identified as a major contributing factor. Despite legislative measures, distracted driving persists, requiring additional educational interventions. Objective: To evaluate the effectiveness of a Theory of Planned Behavior (TPB)-based educational program in reducing mobile phone use while driving among agency drivers in Rasht, Iran. Methods: A quasi-experimental study was conducted with 151 agency drivers, divided into intervention (n=76) and control (n=75) groups. The intervention consisted of three TPB-based educational sessions targeting awareness, attitudes, subjective norms, and perceived behavioral control. Data was collected pre- and two months post-intervention using a validated questionnaire. Statistical analyses included chi-square, Mann-Whitney U, and Wilcoxon signed-rank tests. Results: Post-intervention, significant improvements were observed in the intervention group across TPB constructs. Knowledge scores increased from 0.92±0.11 to 0.99±0.3 (p=0.001), attitude scores rose from 23.48±2.75 to 24.66±1.78 (p=0.001), and perceived behavioral control improved from 21.42±4.88 to 24.72±2.92 (p=0.001). Similarly, behavioral intention increased from 22.59±3.81 to 25.12±1.21 (p=0.001), and subjective norm scores rose from 22.43±3.56 to 25.19±1.51 (p=0.001). In contrast, the control group showed no significant changes in these constructs. However, no significant reduction in actual mobile phone use behavior was observed in the intervention group (15.55±3.72 to 15.58±3.77; p=0.31). Conclusion: The TPB-based educational intervention improved psychological determinants of mobile phone use while driving but did not significantly change behavior. These findings highlight the need to combine educational programs with stricter regulations and technological measures to achieve meaningful reductions in distracted driving.
INTRODUCTION Insomnia and obstructive sleep apnea (OSA) are the most prevalent sleep disorders in adults, yet with distinct pathophysiology: insomnia involves central hyperarousal and cognitive-functional impairment, while OSA results from upper airway collapse with intermittent hypoxia and elevated sympathetic tone. In oncology patients, the coexistence of these conditions may intensify fatigue and compromise treatment adherence. In the Greater ABC region of São Paulo, data on prevalence and determinants of these disorders in women with breast cancer remain scarce. METHOD Analytical crosssectional study with 211 women in outpatient breast cancer treatment at state hospitals in the São Paulo metropolitan region. The Insomnia Severity Index (ISI; score 0–28) was used for insomnia screening and the STOP-Bang Questionnaire (score 0–8) for OSA risk, both validated for Brazilian Portuguese, alongside a structured clinical-sociodemographic form. Sample size by Wald method (n=208; 95% CI). Analyses in Stata 17.0: descriptive statistics, Wilsonmethod prevalences, Pearson correlation and logistic regression. CEP-FMABC: CAAE 90818825.2.0000.0082. RESULT Clinically significant insomnia (ISI≥15): 28.9% (95% CI: 22.7–35.6). Intermediate/high OSA risk (STOP-Bang≥3): 47.9% (95% CI: 41.0–54.8). ISI × STOP-Bang correlation was weak and non-significant (r=0.075; p=0.280), confirming independent phenomena. BMI was associated with both outcomes (p<0.05); age only with OSA risk (p<0.001). Nocturnal pain and lack of marital support were associated with insomnia. DISCUSSION Insomnia and OSA showed distinct determinants: insomnia linked to socioeconomic and clinical factors; OSA to metabolic-anatomical variables and aging, reinforcing the need for independent assessment of each condition. CONCLUSION Insomnia and OSA are prevalent and independent in women with breast cancer, with specific determinants, requiring differentiated and complementary screening in outpatient oncological care.
INTRODUCTION: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia, commonly associated with obesity, physical inactivity, and unhealthy dietary patterns. Among its complications, Diabetic Kidney Disease (DKD) stands out due to its high prevalence and significant contribution to cardiovascular morbidity and mortality. Emerging biomarkers, such as serum uric acid (SUA) and its ratios with HDL cholesterol and creatinine, have been investigated as potential indicators of metabolic and renal risk. METHODS: This retrospective descriptive study analyzed secondary data from 1,232 patients with T2DM (HbA1c ≥7.0%), aged 40–70 years, of both sexes. Laboratory parameters included fasting glucose, HbA1c, creatinine, lipid profile, and SUA. The uric acid-to-HDL ratio (UHR) and uric acid-to-creatinine ratio (UCR) were calculated. Statistical analysis involved Spearman correlation and multiple linear regression models. RESULTS: Median HbA1c was 8.6%, with an estimated mean glucose of 200 mg/dL. Both UHR (ρ = -0.150; p < 0.001) and UCR (ρ = -0.202; p < 0.001) showed weak but significant inverse correlations with HbA1c. In adjusted models, HbA1c remained negatively associated with both ratios. Male sex was associated with higher UHR and lower UCR values. Age showed a negative association only with UCR. The regression models demonstrated limited explanatory power (R² < 0.10). DISCUSSION: The inverse relationship between glycemic control and the evaluated ratios suggests their potential as complementary metabolic markers. UCR demonstrated greater sensitivity to HbA1c variations and was influenced by age, whereas UHR appeared to be sex-dependent. These findings reinforce the complex interplay between glucose metabolism, lipid profile, and renal function in T2DM.
INTRODUCTION: Physical activity contributes to the motor and cognitive development of children aged 0 to 5 years and is also associated with the prevention of chronic diseases in adulthood. However, the persistent gap in conceptual definitions, assessment instruments, and analytical methods compromises data comparability and the effectiveness of interventions, limiting scientific findings. Within the Brazilian Unified Health System (SUS), the formulation of public policies and the integration of health promotion strategies depend on the identification of assessment instruments that ensure validity and reliability in data measurement. METHOD: A systematic review was conducted based on PRISMA guidelines, with searches performed in the PubMed, Scielo, and UpToDate databases using indexed terms. The scope included studies analyzing the association between development and physical activity measured through assessment instruments and scales in children aged 0–5 years. Findings were structured according to the socioecological model. Studies evaluating children with morbidities and other age groups were excluded. A critical analysis and synthesis of the main available scientific evidence were performed. RESULTS: Twenty-three articles published within the last 10 years were included, classified at the individual, interpersonal, and environmental levels. Results indicate that parental support and safe environments act as cross-cutting determinants of physical activity. However, the lack of standardization in measurement instruments still limits results and correlations, highlighting an important methodological gap. DISCUSSION: The identification of 23 studies demonstrates that physical activity in childhood is a phenomenon influenced by multifactorial aspects. The presented data corroborate existing literature, reinforcing the need for intersectoral interventions, while also emphasizing the necessity of robust assessment instruments. Within the SUS context, results indicate that the promotion of physical activity should be integrated into Primary Health Care. CONCLUSION: The findings represent a preliminary stage of a broader study aimed at testing instruments and scales to assess the impact of physical activity on child development. The topic may contribute to public policies and guide health promotion actions within the School Health Program (PSE–SUS).
INTRODUCTION: Diabetic foot is among the most frequent complications of diabetes mellitus (DM), with potentially dramatic consequences such as lower limb amputations. The Tardivo Algorithm is a simple prognostic scoring system designed to support risk stratification and structured longitudinal reassessment in routine clinical care. METHOD: This prospective observational cohort study was conducted in a routine outpatient clinic for complex wounds. Adult patients with diabetic foot were classified according to the Tardivo Algorithm at baseline and underwent structured serial reassessments at each follow-up visit as part of routine multidisciplinary care. No comparison group was included. Patients were followed for 6 to 18 months, and outcomes were descriptively recorded as minor amputation, major amputation, wound healing, or complete healing. RESULT: A total of 42 patients were followed for up to 18 months. The mean baseline Tardivo score was 7.6 ± 4.8, with 19% classified as high risk (≥12 points). Limb preservation was observed in 94.3% of participants, and complete healing occurred in 57%, with a mean healing time of 5.05 ± 1.95 months. Higher baseline Tardivo scores were positively associated with peripheral arterial disease (r = 0.740; p < 0.001), while healing time was correlated with both PAD (r = 0.547; p = 0.006) and previous amputations (r = 0.523; p = 0.009). These correlations were not independent in multivariate models. The findings reflect the associations observed in a structured, real-world outpatient care model. DISCUSSION: The 94.3% member retention rate corroborates the importance of using the Algorithm to guide routine clinical care. CONCLUSION: In this prospective, real-world cohort, the structured application of the Tardivo Algorithm was feasible and allowed for dynamic clinical monitoring. The clinical outcomes observed during follow-up are described within the context of this uncontrolled design and should be interpreted as observational associations and not as indicators of therapeutic effect. Controlled studies are needed to determine the impact.
INTRODUCTION: Migraine is a primary headache disorder caused by the activation of brain mechanisms that lead to the release of inflammatory substances, resulting in pain around cranial nerves and blood vessels. Recent studies have suggested the use of endocannabinoids in the treatment of neurological disorders; however, the potential adverse effects of these substances require further investigation. OBJECTIVE: This study aimed to investigate possible morphological alterations in the myocardium following cannabidiol administration following headache induction. METHODS: A total of 28 Wistar rats were subjected to headache induction using nitroglycerin and divided into four groups: G1-sham, G2-cannabidiol, G3-sumatriptan, and G4-caffeine-containing analgesic. Additionally, 7 rats were used as controls. After the experimental procedures, the hearts were collected, fixed, and processed. Histological sections were stained with hematoxylin and eosin for morphological analysis, picrosirius-hematoxylin for collagen evaluation, Weigert’s resorcin-fuchsin for elastic fibers analysis, and immunohistochemistry for laminin detection. RESULTS: The myocardium of rats treated with cannabidiol showed morphological alterations compared to controls, including muscle fibers with eosinophilic cytoplasm and peripheral nuclei, as well as dilated and congested blood vessels within the connective tissue. No qualitative differences in collagen were observed among groups using picrosirius staining. However, an accumulation of elastic fibers surrounding altered muscle fibers was identified in the treated group, a finding absent in controls. CONCLUSION: The findings suggest that cannabidiol may induce structural changes in the myocardium, possibly associated with modulation of inflammatory responses and oxidative stress. The accumulation of elastic fibers indicates extracellular matrix remodeling, while vascular dilation may reflect changes in cardiac microcirculation. These results highlight the importance of further studies to evaluate the cardiovascular safety of cannabidiol.
INTRODUCTION: Substance Use Disorders (SUD) are a major public health challenge with high morbidity and mortality. Diagnostic complexity increases with the coexistence of additional mental disorders, known as Dual Diagnosis (DD). DD is often underdiagnosed, compromising prognosis and increasing relapse rates. The FMABC Psychoactive Substance Didactic Outpatient Clinic (FMABC-PSDOC) provides specialized psychiatric care for individuals at the Desafio Jovem Therapeutic Community (TC), integrating clinical care with psychosocial rehabilitation. This study aims to identify the clinical profile and DD prevalence among patients at FMABC-PSDOC over 43 months. METHODS: A 3 retrospective observational study analyzed 135 medical records of male patients. Data included sociodemographic variables, SUD diagnoses (ICD-10 F10-F19), and comorbid psychiatric disorders. Analysis was performed using descriptive statistics (absolute and relative frequencies). RESULTS: DD prevalence was 26%, predominantly mood disorders (96%): Depressive (50%), Bipolar (25%), and Anxiety (19%). Regarding consumption, 60% exhibited polysubstance use (ICD-10 F19). The median age of onset was 14.5 years; alcohol (44%) and cannabis (18%) were the primary gateway drugs. Notably, 52% of those who started with alcohol transitioned to cocaine, which became the primary drug of choice at admission (66%), followed by alcohol (28%). DISCUSSION: The 26% DD prevalence reinforces that specialized psychiatric support is essential for diagnosing underlying pathologies in SUD. This integrated approach allows treatment to transcend isolated abstinence, which is critical for effective rehabilitation in TCs. Early onset and the transition to illicit substances suggest that easy access to alcohol makes it a significant entry point. CONCLUSION: By quantifying DD prevalence and characterizing the clinical profile of 135 patients, this study demonstrates that integrated psychiatric support is vital for individualized management and treatment efficacy for SUD patients in therapeutic communities.
INTRODUCTION: Cardiovascular diseases remain the leading cause of global mortality, with atherosclerosis as a central mechanism. Lipoprotein(a) [Lp(a)] is an independent and highly atherogenic risk factor associated with vascular inflammation and thrombosis. Statins do not reduce Lp(a) levels and may even increase them, contributing to residual cardiovascular risk. Novel therapies targeting Lp(a) have emerged as promising strategies. METHODS: A systematic review was conducted according to PRISMA guidelines using PubMed (2016–2026). Clinical trials (phases I–IV) in humans with ≥50 participants and quantitative Lp(a) reduction data were included. Search terms addressed Lp(a), gene silencing, and lipid-lowering therapies. Twelve studies met inclusion criteria. RESULTS: Gene-silencing therapies showed the greatest reductions in Lp(a), with olpasiran, lepodisiran, and zerlasiran achieving reductions above 80–95%. Pelacarsen reduced Lp(a) by up to 80% in a dose-dependent manner. Muvalaplin reduced Lp(a) by up to 85% by inhibiting particle formation. PCSK9 inhibitors such as alirocumab and recaticimab showed moderate reductions (~28–36%), while inclisiran had modest effects (≈15–26%). Treatments were generally well tolerated. DISCUSSION: RNA-based therapies, particularly siRNA and antisense oligonucleotides, demonstrate superior efficacy by directly targeting apolipoprotein(a) synthesis. Alternative approaches such as muvalaplin expand therapeutic options by interfering with particle assembly. CONCLUSION: Emerging Lp(a)-targeted therapies represent a major advance in addressing residual cardiovascular risk, though outcome trials are still needed.
INTRODUCTION: Adolescence is marked by intense physical, psychological, and social changes, making individuals more vulnerable to psychosocial factors. In this context, factors such as academic pressure, the need for social acceptance, bullying, and low self-esteem can negatively impact mental health, contributing to the development of anxiety and depression. These factors, combined with weaknesses in social and family support, may intensify psychological distress and compromise healthy development during this stage of life. METHOD: The present study follows an interpretative qualitative research design, conducted through an interactive group activity conducted with a group of 169 adolescents from 15 to 17 years. Data collection was structured in two phases: (1) The use of an anonymous digital tool (Mentimeter) to generate initial data that served as prompts for the second dynamic; and (2) a facilitated discussion circle with the adolescents, focused on the participants previous reported experiences. RESULTS: The qualitative analysis identified adolescence as a stage marked by change, uncertainty, and emotional ambivalence, with anxiety linked to factors such as pressure, mistrust, and loneliness. Group activities provided a supportive environment that promoted active listening and emotional sharing among participants. Additionally, coping strategies such as relaxation techniques and sensory exercises were well accepted and contributed to emotional regulation. DISCUSSION: The findings suggest that adolescence is experienced as a complex period marked by emotional vulnerability and interpersonal difficulties, particularly involving mistrust toward adults and feelings of isolation. In this context, group settings emerged as important facilitators of emotional expression and peer support, helping adolescents reinterpret their experiences and reduce psychological distress. Despite methodological limitations, the results reinforce the relevance of integrating psychoeducational strategies into youth-centered environments to promote emotional regulation and coping skills. CONCLUSION: These results underscore the importance of incorporating structured psychoeducational practices into educational and vocational programs serving young people.
INTRODUCTION: Brazil has the second highest absolute number of leprosy cases worldwide, making it a priority endemic area for epidemiological surveillance. The analysis of temporal trends and clinical profiles is essential to identify diagnostic gaps and support public health policies. METHODS: Ecological time-series study using secondary data from SINAN/DATASUS (2001–2024). The following variables were analyzed: overall detection rate, clinical forms (indeterminate, tuberculoid, borderline, and lepromatous), operational classification (paucibacillary/multibacillary), number of skin lesions at diagnosis, and degree of physical disability across the five Brazilian macroregions. Temporal trends were estimated using Prais–Winsten regression, with annual percent change and 95% confidence intervals. RESULTS: A significant decreasing trend in the overall detection rate was observed (β = −0.877; p < 0.001), with a more pronounced decline between 2003 and 2015, followed by stabilization and a slight increase from 2020 onward. The Midwest region showed the highest rates per 100,000 inhabitants. Multibacillary forms predominated, particularly borderline and lepromatous forms. Most patients presented with 2 to 5 skin lesions at diagnosis, with a considerable proportion presenting more than 5 lesions. A decreasing trend was observed for the lepromatous form and for multibacillary classification in all macroregions (p < 0.001). Rates of grade 2 physical disability at diagnosis remained stationary (p > 0.05). DISCUSSION: The coexistence of declining incidence with predominance of multibacillary forms and multiple lesions indicates persistent late diagnosis. Regional disparities reflect the influence of social determinants and structural inequalities in access to primary health care. CONCLUSION: Leprosy remains epidemiologically relevant in Brazil. The stability of disability rates and the predominance of advanced clinical forms at diagnosis reinforce the urgency of strengthening active surveillance, expanding diagnostic coverage, and addressing regional health inequities.
INTRODUCTION: Glioblastoma is the most aggressive brain tumor, requiring new biomarkers to support diagnosis and prognosis. Heparan sulfate proteoglycans, such as Glypicans and Syndecans, participate in essential pathways of tumor biology. Their alterations may influence GBM progression, and bioinformatic analyses help define their expression patterns and clinical relevance. METHODS: An exploratory, retrospective study was conducted using bioinformatic analysis of public TCGA and GTEx data via GEPIA, evaluating HSPG expression in glioblastoma and its relationship with survival. Protein interactions (STRING), functional enrichment (Enrichr), and a narrative literature review were also performed to contextualize the findings. The study was approved by the Ethics Committee for using only public and anonymized data. RESULTS: Analysis of TCGA and GTEx data in GEPIA showed overexpression of GPC2, GPC4, GPC6, SDC1, SDC2, and SDC3, while GPC5 was reduced and SDC4 remained similar to normal tissue. Only GPC5 and SDC1 were associated with poorer prognosis. In STRING, SDC1 interacted directly with FN1, TNC, MMP9, and ITGAV, whereas GPC5 showed no connections. Functional enrichment highlighted pathways related to extracellular matrix, integrins, cell migration, and tumor progression. DISCUSSION: Integrated analysis revealed heterogeneous expression of HSPGs in glioblastoma, highlighting only SDC1 and GPC5 as relevant biomarkers. SDC1 demonstrated overexpression, worse prognosis, and involvement in adhesion and invasion pathways. GPC5 showed a contextdependent effect: although reduced in tumors, higher intratumoral levels were associated with lower survival and pro-proliferative pathways. These findings suggest SDC1 as a regulator of the tumor microenvironment and GPC5 as a modulator in specific disease subgroups. CONCLUSION: The results identify SDC1 and GPC5 as the most relevant HSPGs in glioblastoma, with consistent impacts on expression and prognosis. SDC1 integrates networks associated with adhesion and invasion, while GPC5 acts in a context-dependent manner, linked to poorer survival in patient subgroups. These findings reinforce their potential as functional targets and biomarkers.
INTRODUCTION: Type II endoleak (EL2) is the most frequent complication after endovascular abdominal aortic aneurysm repair (EVAR), resulting from retrograde flow through collateral branches. Although often self-limited, persistent EL2 may lead to aneurysm sac expansion and require reintervention. Recurrent cases remain a therapeutic challenge, with no clear consensus on optimal management. CASE REPORT: A 70-year-old male with hypertension and dyslipidemia, previously submitted to EVAR in 2016, presented in 2022 with a late EL2 associated with aneurysm sac enlargement (8.5 × 6.8 cm). The patient underwent three transarterial embolizations between 2022 and 2025 due to persistent recurrence. The first procedure used metallic coils, achieving initial exclusion. However, follow-up imaging demonstrated recanalization. A second embolization with coils and microspheres was performed, again with temporary resolution. In 2025, significant sac growth (9.9 × 8.7 cm) and recurrent symptoms were observed. A third embolization using Onyx 18 was performed via femoral access, achieving complete angiographic exclusion. Postoperative Doppler confirmed sac thrombosis without residual flow. DISCUSSION: EL2 accounts for up to 50% of endoleaks, with approximately half resolving spontaneously upon being detected during the procedure. However, persistent or recurrent EL2 is associated with sac enlargement and increased risk of rupture, requiring intervention. Endovascular embolization is widely used as a therapeutic option, although recurrence rates remain high, especially in large aneurysms or in the presence of multiple collateral vessels. Different embolic agents may be used, with Onyx showing potential advantages in complex cases due to better penetration of collateral networks. This case highlights the challenges of managing recurrent EL2 and reinforces the importance of long-term surveillance and individualized treatment strategies.
INTRODUCTION: Diabetes mellitus (DM) is a highly prevalent metabolic disease associated with vascular and neuropathic complications that impair wound healing. Among these, diabetic foot stands out as a frequent and severe condition, associated with infections, amputations, and reduced quality of life. Chronic ulcers directly impact physical, emotional, and social aspects, making it essential to assess the effect of treatment on patients’ quality of life. METHOD: Observational, longitudinal study conducted with 31 patients with diabetic foot ulcers treated at a vascular surgery outpatient clinic. Participants were evaluated at three time points (D1, D60, and D120) using the WoundQoL questionnaire. Data were analyzed using descriptive statistics. RESULTS: The sample consisted predominantly of male, elderly patients with low educational level; all were diabetic, most were hypertensive and non-smokers. Most lesions were recent and classified as Wagner grade 3. A progressive and statistically significant improvement in quality of life was observed over 120 days. The total Wound-QoL score decreased from 30.50±13.01 at D1 to 14.14±10.32 at D120 (p<0.001), with improvement in physical, psychological, and daily life domains. DISCUSSION: The findings demonstrate that specialized outpatient treatment has a positive impact on quality of life in patients with diabetic foot. The observed improvement highlights the importance of a multidisciplinary approach and continuous follow-up, including clinical control and proper wound management. CONCLUSION: Structured management of diabetic foot is associated with significant improvement in quality of life. Early and multidisciplinary therapeutic strategies are essential to reduce complications and promote functional and overall recovery.
INTRODUCTION The bidirectional relationship between mental health and sleep represents a central clinical challenge in oncological care. In women with breast cancer, hypothalamic-pituitary-adrenal axis hyperactivation and increased pro-inflammatory cytokines from treatment impair sleep architecture and amplify anxiety and depressive symptoms. In Brazil, poor sleep quality prevalence ranges from 16.1% to 35.1% in the general population, while international oncology studies report rates of 67–90%. Despite this, national data on the joint prevalence of sleep disorders and mental health symptoms in outpatients remain scarce. METHOD Analytical cross-sectional study with 211 women in outpatient breast cancer treatment at state hospitals in the São Paulo metropolitan region. Three validated instruments were applied: PSQI-BR (sleep quality), Epworth Sleepiness Scale (daytime sleepiness) and HADS (anxiety and depression), alongside a clinical-sociodemographic form. Sample size by Wald method (n=208; 95% CI). Analyses in Stata 17.0: Pearson correlation, chi-square, multiple linear and logistic regression. CEP-FMABC: CAAE 90818825.2.0000.0082. RESULT Poor sleep quality (PSQI≥5): 78.7% (95% CI: 72.5–84.1). Excessive daytime sleepiness (ESS≥10): 23.2%. Anxiety symptoms in 38.9%; depressive in 25.6%. Anxiety was associated with poor sleep quality (χ²=10.70; p=0.001); depression with sleepiness (χ²=4.16; p=0.041). Logistic regression: anxiety was the only independent predictor of poor sleep quality (OR=1.157; 95% CI: 1.042–1.285; p=0.006; AUC=0.734). DISCUSSION Prevalence far exceeded that of the Brazilian general population, consistent with international oncology literature. Anxiety emerged as the main determinant, supporting the cognitive-emotional hyperarousal model. CONCLUSION Sleep disorders are strongly associated with anxiety in women with breast cancer, highlighting the need for systematic screening and integrated psychological management in outpatient oncological care.
INTRODUCTION: Mothers of children with suspected Autism Spectrum Disorder (ASD) frequently face long journeys through public health services until diagnostic confirmation. Lack of knowledge among health professionals and limited access to the Brazilian Unified Health System (SUS) significantly contribute to diagnostic delays. This process, marked by uncertainties and bureaucracy, has a substantial impact on the lives of these families. Therefore, the present study aimed to analyze the barriers faced by mothers seeking an ASD diagnosis for their children. METHOD: This is a qualitative study conducted with mothers affiliated with the Notea NGO, an organization that supports autistic children. Data was collected through semi-structured interviews and analyzed using content analysis. The project was approved by the Research Ethics Committee (CEP) under opinion No. 8.010.760 and carried out at the FMABC University Center during a university extension social action for the group through semi-structured interviews. RESULTS: Of the 12 interviewed mothers, approximately 64% reported that health professionals attributed suggestive signs of ASD to “normal” behaviors, “spoiled” or “whining behavior.” Additionally, obtaining a diagnosis through the SUS was described as exhausting due to long waiting lists and limitations of the public service. Access to rights, such as the Continuous Cash Benefit (BPC), was also reported as slow and highly bureaucratic. DISCUSSION: These results demonstrate the social and structural vulnerability experienced by atypical families, forcing many to resort to the private healthcare network - an unfeasible option for a large portion of the Brazilian population. Moreover, the lack of professional training for ASD screening not only contributes to family overload but also reveals limitations in the country’s Primary Health Care. CONCLUSION: The study shows that barriers to ASD diagnosis amplify the overload and vulnerability of atypical families. The findings suggest the need to strengthen Primary Health Care services through professional training and reduction of SUS bureaucracy. Although the proposed Line of Care for ASD signals an institutional advance, its practical implementation has not yet been achieved, and access inequalities persist.
INTRODUCTION: Glaucoma is the leading cause of irreversible blindness worldwide, and early diagnosis is essential to prevent significant visual loss. However, its often asymptomatic progression, combined with limited access to ophthalmologic evaluation in the Brazilian Unified Health System (SUS), contributes to delayed diagnosis. In this context, emerging technologies associated with artificial intelligence enable automated analysis of fundus images, expanding screening potential and improving public health outcomes. OBJECTIVE: To develop and evaluate the effectiveness of an artificial intelligence and machine learning–based system for automated analysis of fundus images, aiming to improve glaucoma screening and early diagnosis in primary care, with a focus on implementation in Basic Health Units within the SUS. METHODS: Fundus images from the public Kaggle database were used to train and test a machine learning model developed on the Teachable Machine platform. The training set included 520 images (134 positive and 386 negative), and the test set included 130 images (34 positive and 96 negative). Model performance was evaluated using accuracy, sensitivity, and specificity. RESULTS: The model achieved a sensitivity of 41.2%, specificity of 72.9%, accuracy of 64.6%, and a negative predictive value of 77.8%. DISCUSSION: In screening strategies, a high negative predictive value represents a relevant finding, indicating the model’s potential to exclude unlikely cases and optimize referrals in primary care. However, the low sensitivity limits its safety, as it implies failure to detect a portion of positive cases. Thus, the system shows potential as a complementary tool. CONCLUSION: The use of machine learning demonstrates promising potential for glaucoma screening in the context of the SUS, particularly due to its ability to exclude negative cases. However, low sensitivity limits its standalone applicability. Further improvements, including expansion and balancing of datasets, incorporation of advanced deep learning techniques, and rigorous clinical validation, are necessary to enable its use as a reliable tool for early glaucoma detection.
BACKGROUND: Acute appendicitis is one of the most common surgical emergencies worldwide. Although appendectomy remains the current gold standard, emerging evidence suggests that conservative management with antibiotics is a viable alternative for uncomplicated cases, despite its underutilization in Brazil. This approach may reduce hospital length of stay and surgical complications, albeit carrying a risk of recurrence. METHODS: This systematic review was registered in PROSPERO (CRD420261345149) and conducted in accordance with the PRISMA 2020 guidelines. A comprehensive search was performed across PubMed, SciELO, LILACS, and the Cochrane Library for studies published between 2006 and 2026. Study selection, managed via the Rayyan platform, was restricted to randomized controlled trials (RCTs) comparing both therapeutic approaches. Studies involving specific populations (pregnant women, immunocompromised patients, the elderly > 60 years, and children < 5 years) or complicated appendicitis (abscesses and perforations) were excluded. RESULTS: A total of 18 RCTs were included from 3,684 retrieved records. The initial success rate of pharmacological treatment ranged from 72.7% to 90.8%. However, recurrence rates were 27.3% at one year and reached 39.1% at five years. The presence of an appendicolith increased the risk of therapeutic failure to 41%. Overall hospital length of stay was comparable between groups (mean of 3 days), although outpatient antibiotic protocols demonstrated a significant reduction to approximately 16 hours. DISCUSSION: The pharmacological approach significantly reduces immediate complications (6.5% vs. 24.4% for surgery) and direct hospital costs. Nevertheless, the high recurrence rate - particularly in pediatric populations, where failure rates can exceed 33% - raises concerns regarding the long-term efficacy of conservative management as a definitive treatment. While surgery provides a higher rate of definitive resolution, the risk of recurrence associated with clinical treatment introduces the potential for hospital readmissions. CONCLUSION: Non-operative management demonstrates efficacy in achieving initial symptom resolution and reducing immediate complications. Nonetheless, the substantial long-term risk of recurrence necessitates a shared decision-making process between physician and patient, grounded in an individualized assessment of risks and benefits.
INTRODUCTION: Helicobacter pylori infection is highly prevalent and associated with relevant outcomes such as peptic ulcer disease and gastric cancer. Vonoprazan-based triple therapy has shown high efficacy; however, the optimal treatment duration remains uncertain. Therefore, this study aimed to evaluate the efficacy and adverse event profile of different durations (7, 10, and 14 days) of vonoprazan-based triple therapy. METHODS: A systematic review was conducted according to PRISMA 2020 guidelines, with searches in PubMed/MEDLINE, LILACS, and SciELO (2020–2025). A total of 15 studies (n=5,091) were included, of which 13 were analyzed (n=4,467). Eradication rates (ITT and PP) and adverse events were calculated using weighted proportions. RESULTS: ITT eradication rates were 85.6%, 84.9%, and 85.9% for 7-, 10-, and 14-day regimens, respectively, and PP rates were 90%, 87.5%, and 90%. Comparable efficacy was observed between 7 and 14 days. The 10-day regimen showed similar performance, with limited evidence. Adverse events varied (17.4%, 44.1%, and 26.0%) and were predominantly mild, mainly dysgeusia, diarrhea and abdominal discomfort. DISCUSSION: The comparable efficacy between 7- and 14-day regimens may be related to the potent acid suppression provided by vonoprazan, enhancing antibiotic activity. The lower incidence of adverse events in shorter regimens suggests better tolerability and adherence. Study heterogeneity and limited data for the 10-day regimen should be considered. CONCLUSION: Vonoprazan-based triple therapy shows comparable efficacy between 7- and 14-day regimens. The 7-day regimen may be an effective alternative with fewer adverse events. Evidence for the 10-day regimen remains limited.
INTRODUCTION: Hypothalamic hamartomas (HH) are rare congenital lesions located in the ventral portion of the hypothalamus. They clinically manifest through a triad including central precocious puberty, cognitive-behavioral decline, and drug-resistant epilepsy, typically characterized by gelastic seizures (unmotivated laughter). Due to the deep location and proximity to vital structures such as the optic chiasm and mammillary bodies, surgical intervention is a technical challenge. This study aims to establish the efficacy and side effects of surgical approaches through a systematic review. METHOD: A systematic review was conducted following PRISMA criteria and Ministry of Health guidelines. Searches were performed in MEDLINE/PubMed, EMBASE, and Cochrane Library databases using descriptors such as "Hypothalamic hamartomas" and "gelastic seizures". Pediatric studies on microsurgery, radiosurgery, and thermocoagulation published between 1990 and 2024 were included. Quality was assessed via RoB-2, ROBINS-I, and the JBI checklist. RESULTS: A transition toward minimally invasive methods was observed. Laser therapy (MRgLITT) showed seizure freedom in up to 72.3%. SEEG-guided radiofrequency thermocoagulation (RFTC) achieved 90% seizure absence in specific series. Gamma Knife radiosurgery (GKS) was effective in 40% to 75% of cases, with a response latency of up to 3 years. Major complications included hemiparesis, hypothyroidism, and memory deficits. Minor effects such as transient edema and weight gain were frequent. DISCUSSION: Technical choice correlates with the Delalande classification. Types I and II lesions allow less invasive methods, while giant hamartomas (type IV) may require direct resection. The efficacy of thermal ablation depends on the disconnection of the epileptogenic circuitry rather than total lesion elimination. Seizure control (Engel Scale) is associated with behavioral and cognitive improvement. CONCLUSION: Management must be individualized according to the lesion's anatomy. Minimally invasive strategies (MRgLITT and RFTC) are first-line due to high efficacy and lower morbidity. Technical selection is vital to optimize outcomes and reduce permanent risks.
INTRODUCTION: Urticaria is an inflammatory skin disease characterized by wheals, intense pruritus and impairment of quality of life. Chronic Urticaria (CU) is classified into Chronic Spontaneous Urticaria (CSU), when there is no identifiable etiology, and Chronic Inducible Urticaria (ClndU), triggered by specific agents, such as increase in core body temperature in Cholinergic Urticaria (CholU). In CSU, environmental heat may act as a nonspecific stressor, facilitating mast cell degranulation and histamine release, promoting vasodilation and increased vascular permeability, with consequent worsening of skin lesions. Therefore, this study aims to evaluate whether there is a worsening of CSU cases upon exposure to heat and whether this aggravation may be related to the presence of underdiagnosed CholU. METHODS: This study consisted of a self-administered questionnaire via Google Forms, made available through a QR code at the dermatology outpatient clinic of the Faculdade de Medicina do ABC, between December 2025 and April 2026. Individuals over 18 years of age with diagnosis of CU participated. RESULTS: The sample consisted of 48 patients, of whom 87.5% (42) were female and 12.5% (6) were male. Among them, 45.8% (22) reported a diagnosis of CSU, and of these, 72.7% (16) perceived symptom exacerbation with heat exposure. Condition worsening occurred in 54.5% (12) of participants with CSU during sun exposure; 59% (13) during summer, and 45.4% (10) on muggy, cloudy days. Furthermore, among individuals with CSU who reported worsening with heat, 12.5% (2) did not present characteristics suggestive of CholU. DISCUSSION: The higher female prevalence observed is consistent with the literature, which identifies this group as the most affected by CU. The data indicate that the majority of participants with CSU reported clinical worsening with heat exposure, frequently presenting features suggestive of CholU, such as wheals smaller than 1 cm and exacerbation after hot baths or physical exercise. Considering that, according to previous studies, 30 to 40% of patients with CSU have some type of associated ClndU, these findings suggest that a possible association between both conditions may be present. CONCLUSION: Most patients with CSU report worsening with heat exposure. Among these patients, the majority present features suggestive of undiagnosed CholU.
