2025.2
1. Metabolic dysfunction-associated steatotic liver disease: update. Arq Gastroenterol. 2025 Sep 5;62:e24117. doi: 10.1590/S0004-2803.24612025-117.
Dezan MGF(1)(2)(3), Oliveira CP(4), Cotrim HP(1)(3).
Afiliação:
(1) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Gastro-Hepatologia, Salvador, BA, Brasil.
(2) Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
(3) Universidade Federal da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brasil.
(4) Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo, SP, Brasil.
Resumo: Since Ludwig proposed the term "nonalcoholic steatohepatitis" (NASH) for this liver disease in 1980, there have been many advances in understanding it, including its epidemiology, pathogenesis, diagnostic methods, and treatment. OBJECTIVE: This literature review aims to discuss the most relevant aspects of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: The review included clinical studies from the following databases: Embase, PubMed, Scopus, Web of Science, Lilacs, Ovid, and Scopus. RESULTS: MASLD is the most frequent liver disease worldwide, with increasing prevalence and incidence, and can evolve with liver cirrhosis and hepatocellular carcinoma. The diagnosis involves specific diagnostic criteria involving the presence of hepatic steatosis and other metabolic factors. Drug treatment, still in its incipient, involves pioglitazone, glucagon-like peptide-1 (GLP1) agonists, and sodium glucose cotransporter-2 (SGLT2) inhibitors, especially in diabetic patients. More recently, the Food and Drug Administration (FDA) approved Resmetiron for selected cases. CONCLUSION: MASLD is extremely common, presents complex pathophysiology, and requires an intensive multidisciplinary approach. It is hoped that future studies will provide effective and accessible pharmacological therapeutic options for the disease. It is necessary to bring the population's attention to this condition, which can be associated with significant morbidity and mortality.
2. Gene score to quantify systemic inflammation in patients with acutely decompensated cirrhosis. Gut. 2025 Jul 7;74(8):1293-1307. doi: 10.1136/gutjnl-2024-333876.
Trebicka J(#)(1)(2), Aguilar F(#)(2)(3), Queiroz Farias A(#)(4), Lozano JJ(#)(5), Sánchez-Garrido C(2), Usón-Raposo E(2), de la Peña-Ramirez C(2), Zipprich A(37), Castro-Lyra A(38)(39), Gustot T(40), et al.; PREDICT study and ACLARA study.
Collaborators: Gambino C, Marcondes C, Giovo I, Ramos JA, et al.
Afiliação:
(1) Department of Internal Medicine B, University of Münster, Munster, Germany.
(2) European Foundation for the Study of Chronic Liver Failure (EF CLIF), Barcelona, Spain.
(3) University of Barcelona (UB), Barcelona, Spain.
(4) Department of Gastroenterology, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
(5) Liver Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas
...
(37) Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
(38)Hospital Universitario Professor Edgard Santos, Salvador, Brazil.
(39)Hospital Sao Rafael, Salvador, Brazil.
(40)Hepato Gastroenterology, Erasme, Brussels, Belgium.
...
Erratum in
Gut. 2025 Aug 7;74(9):e18. doi: 10.1136/gutjnl-2024-333876corr1.
Resumo: Quantifying systemic inflammation (SI) in acutely decompensated cirrhosis (ADC) is of major importance because SI is a driver of the most severe forms of ADC, including acute-on-chronic liver failure (ACLF). Blood biomarkers of SI already evaluated in ADC failed to appropriately assess SI in ADC. We aimed to investigate whether gene expression related to circulating immune cells could quantify SI in ADC. METHODS: Standard biomarkers (white cell count, C reactive protein, cytokines) and genome-wide RNA expression (RNA-sequencing) were obtained in blood from 700 patients with ADC at the time of their hospital admission. A composite score based on standard biomarkers of SI (Chronic Liver Failure-Standard Biomarkers Composite (CLIF-SBC) score) and a gene score (CLIF-Systemic Inflammation Gene (SIG) score) composed of the 28 top differentially expressed immune cell-related genes in the comparison between high-severity and low-severity clinical phenotypes were computed. Among the 700 patients, the CLIF-SIG score was repeated once during follow-up in 375 patients, and 3 times or more in 46 patients. RESULTS: The CLIF-SIG score was more accurate in reflecting clinical severity induced by SI than the CLIF-SBC score (area under the curve 0.803 vs 0.658). A CLIF-SIG score of 0.386 (Youden Index) was the best cut-off level discriminating patients with poor outcomes from the others, in all clinical scenarios. Sequential measurement of the CLIF-SIG score showed that 78% of patients were admitted at the peak or descending part of the SI-wave. ACLF developed during hospitalisation in 80% of patients with a CLIF-SIG score >0.386 on admission. CONCLUSIONS: In patients with ADC, the CLIF-SIG score is an accurate estimator of SI, clinical course severity and prognosis.
3. The Dublin International Society of Urological Pathology (ISUP) Consensus Conference on Best Practice Recommendations on the Pathology of Urachal Neoplasms. Am J Surg Pathol. 2025 Nov 1;49(11):e18-e26. doi: 10.1097/PAS.0000000000002416.
Reis H(1), Al-Ahmadie H(2), Gaisa NT(3), Lopez-Beltran A(4), Maclean F(5), Tsuzuki T(6), Werneck da Cunha I(7), Amin MB(8), Aning J(9), Aron M(10), Athanazio D(11), Bambury RM(12), et al. heng L(13), Gopalan A(2), Gulmann C(14), Guo CC(15), Harris C(16), Iyer G(17), Jimenez RE(18), Jinzaki M(19), Kikuchi E(20), Lal P(21), Miyai K(22), Netto GJ(21), Pan CC(23), Panebianco V(24), van Rhijn BW(25), Siefker-Radtke A(26), Smith SC(27), Szarvas T(28), Wobker SE(29), Kristiansen G(30), Paner GP(31); ISUP Expert Panel on Urachal Neoplasms and Urinary Bladder Glandular Lesions.
Collaborators: Ferran A, Ciara B, Simone B, Bezerra Stephania M, et al.
Afiliação:
(1) Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt.
(2) Department of Pathology.
(3) Institute of Pathology, University Hospital, RWTH Aachen University; Institute of Pathology, University Hospital Ulm, University of Ulm.
(4) Department of Morphological Sciences, Unit of Anatomic Pathology, Cordoba University Medical School, Cordoba, Spain.
(5) Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia.
(6) Department of Surgical Pathology, Aichi Medical University, Aichi, Japan.
(7) Pathology Department, Rede D'OR-Sao Luiz, São Paulo, Brazil.
(8) Department of Pathology and Laboratory Medicine and Urology, University of Tennessee Health Science, Memphis, TN.
(9) Department of Urology, Southmead Hospital, North Bristol Hospitals Trust, Bristol, UK.
(10) Department of Pathology, University of Southern California, Los Angeles, CA.
(11) Oncoclinicas Precision Medicine, São Paulo, Brazil; Hospital Universitário Professor Edgard Santos/Federal University of Bahia, Brazil.
(12) Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
...
Resumo: This manuscript summarizes the first part of the proceedings of the 2023 Dublin ISUP Consensus Conference encompassing the best practice recommendations on the pathology of neoplasms of urachal origin. The rationale for convening this consensus conference was the lack of structured and consented histopathologic recommendations in these rare tumors. Consensus among the meeting participants (n=80) was reached on the following statements: (1) combination of gross, histologic, clinical and imaging findings with exclusion of secondary tumor metastasis are to be used in the diagnosis of urachal carcinoma; (2) the 2022 World Health Organization (WHO) separate criteria for the diagnosis of urachal adenocarcinoma and for nonglandular carcinoma should be applied; (3) specific elements are to be evaluated and recorded in the gross examination of resection specimens containing urachal tumors; (4) sampling considerations for resection specimens containing urachal tumors are advised; (5) participants are against using 5% or 10% cutoff for the extent of intraepithelial carcinoma in urachal mucinous cystic tumor of low malignant potential; (6) use of immunohistochemical markers for the differential diagnosis of urachal adenocarcinomas in transurethral resection (TUR) specimen is considered optional; (7) similar tumor classificatory (nosology) rules for carcinomas arising from bladder mucosa (eg, urothelial carcinoma, squamous cell carcinoma, and neuroendocrine carcinoma) should be applied for nonglandular urachal carcinomas; (8) a new staging approach other than the previously proposed systems should be designed for urachal carcinoma; (9) a system modifying the current Tumor-Node-Metastasis (TNM)/American Joint Committee on Cancer (AJCC) staging system for urinary bladder cancer is considered appropriate for a study in urachal carcinoma; and (10) several histologic elements are to be reported when diagnosing urachal carcinoma in TUR and resection specimens. This report from the Dublin ISUP consensus conference will serve as a practice recommendation for pathologists and as a guide for future standardized reporting protocols and research regarding urachal tumors. In addition, an international database for urachal cancers under the guidance of ISUP is being planned to be established to address pertinent issues in the pathology of urachal cancers.
4. The spatiotemporal ecology of Oropouche virus across Latin America: a multidisciplinary, laboratory-based, modelling study. Lancet Infect Dis. 2025 Sep;25(9):1020-1032. doi: 10.1016/S1473-3099(25)00110-0.
Fischer C(1), Frühauf A(1), Inchauste L(2), Cassiano MHA(1), Ramirez HA(3), Barthélémy K(2), Machicado LB(4), Bozza FA(5), Brites C(6), Cabada MM(7), et al.
Afiliação:
(1) Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Virology, Berlin, Germany.
(2) Unité des Virus Émergents, Marseille, France.
(3) Laboratorio Referencial de Salud Pública de San Martín, Tarapoto, Peru.
(4) Programa Nacional de Sangre, Ministerio de Salud y Deportes, La Paz, Bolivia.
(5) National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; CHRC, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
(6) Hospital Universitário Professor Edgard Santos, Universidade Federal de Bahia, Salvador, Brazil.
(7) Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.
...
Resumo: Latin America has been experiencing an Oropouche virus (OROV) outbreak of unprecedented magnitude and spread since 2023-24 for unknown reasons. We aimed to identify risk predictors of and areas at risk for OROV transmission. METHODS: In this multidisciplinary, laboratory-based, modelling study, we retrospectively tested anonymised serum samples collected between 2001 and 2022 for studies on virus epidemiology and medical diagnostics in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, and Peru with nucleoprotein-based commercial ELISAs for OROV-specific IgG and IgM antibodies. Serum samples positive for IgG from different ecological regions and sampling years were tested against Guaroa virus and two OROV glycoprotein reassortants (Iquitos virus and Madre de Dios virus) via plaque reduction neutralisation testing (PRNT) to validate IgG ELISA specificity and support antigenic cartography. Three OROV strains were included in the neutralisation testing, a Cuban OROV isolate from the 2023-24 outbreak, a contemporary Peruvian OROV isolate taken from a patient in 2020, and a historical OROV isolate from Brazil. We analysed the serological data alongside age, sex, cohort, and geographical residence data for the serum samples; reported OROV incidence data; and vector occurrence data to explore OROV transmission in ecologically different regions of Latin America. We used the MaxEnt machine learning methodology to spatially analyse and predict OROV infection risk across Latin America, fitting one model with presence-absence serological data (seropositive results were recorded as presence and seronegative results were recorded as absence) and one model with presence-only, reported incidence data from 2024. We computed marginal dependency plots, variable contribution, and permutation metrics to analyse the impact of socioecological predictors and fitted a generalised linear mixed-effects model with logit link and binary error structure to analyse the potential effects of age, sex, or cohort type bias and interactions between age or sex and cohort type in our serological data. We conducted antigenic cartography and evolutionary characterisations of all available genomic sequences for all three OROV genome segments from the National Center for Biotechnology Information, including branch-specific selection pressure analysis and the construction of OROV phylogenetic trees. FINDINGS: In total, 9420 serum samples were included in this study, representing 76 provinces in the six Latin American countries previously mentioned. The sex distribution across the combined cohorts was 48% female (4237 of 8910 samples with available data) and 52% male (4673 of 8910 samples) and the mean age was 29·5 years (range 0-95 years). The amples were collected from census-based cohorts, cohorts of healthy individuals, and cohorts of febrile patients receiving routine health care. The average OROV IgG antibody detection rate was 6·3% (95% CI 5·8-6·8), with substantial regional heterogeneity. The presence-absence, serology-based model predicted high-risk areas for OROV transmission in the Amazon River basin, around the coastal and southern areas of Brazil, and in parts of central America and the Caribbean islands, consistent with case data from the 2023-24 outbreak reported by the Pan American Health Organization. Areas with a high predicted risk of OROV transmission with the serology-based model showed a statistically significant positive correlation with state-level incidence rates per 100 000 people in 2024 (generalised linear model, p=0·0003). The area under the curve estimates were 0·79 (95% CI 0·78-0·80) for the serology-based model and 0·66 (95% CI 0·65-0·66) for the presence-only incidence-based model. Longitudinal diagnostic testing of serum samples from cohorts of febrile patients suggested constant circulation of OROV in endemic regions at varying intensity. Climate variables accounted for more than 60% of variable contribution in both the serology-based and incidence-based models. Antigenic cartography, evolutionary analyses, and in-vitro growth comparisons showed clear differentiation between OROV and its glycoprotein reassortants, but not between the three different OROV strains. PRNT titres of OROV-neutralising serum samples were strongly correlated between all three tested OROV isolates (r>0·83; p<0·0001) but were not correlated with the two glycoprotein reassortants. INTERPRETATION: Our data suggest that climatic factors are major drivers of OROV spread and were potentially exacerbated during 2024 by extreme weather events. OROV glycoprotein reassortants, but not individual OROV strains, probably have distinct antigenicity. Preparedness for OROV outbreaks requires enhanced diagnostics, surveillance, and vector control in current and future endemic areas, which could all be informed by the risk predictions presented in this Article.
5. Sleep Impairment and Chronic Pain in the Military: A Scoping Review. J Sleep Res. 2025 Jul 14:e70100. doi: 10.1111/jsr.7010.
Barbosa ERF(1)(2), da Veiga DR(1)(3), Ayala MG(1)(4), ... Muñoz SC(1)(15), Fuentes P(1)(19), Mello AGT(1)(20), Emiliozzi N(1)(21), Terseg A(1)(22), Peralta RAR(1), Nishizawa T(1), Chavez EBV(1), Bueno C(1)(14).
Afiliação:
(1) PPCR Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
(2) Military Police of Goiás State, Valparaíso de Goiás, Brazil.
(3) Hapvida NotreDame Intermédica, São Paulo, Brazil.
(4) Hospital Metropolitano, Quito, Ecuador.
...
(15) Hospital del Trabajador - ACHS, Santiago, Chile.
(16)University of Los Andes, Bogotá, Colombia.
(17)Mercer University, Macon, Georgia, USA.
(18)Universidad del Pacífico Privada, Asunción, Paraguay.
(19)Clinica Dávila, Santiago, Chile.
(20)Hospital Universitário Professor Edgar Santos, Federal University of Bahia, Salvador, Brazil.
(21)Hospital Central de San Isidro, Buenos Aires, Argentina.
(22)St. Lucas Catholic Hospital, Wiaga, Ghana.
Resumo: This scoping review explores the bidirectional association between chronic pain and sleep disorders in military personnel. It aims to identify gaps in existing studies, offering tools for diagnosing and treating sleep disorders, chronic pain, and their comorbidities. Observational and interventional studies up to 2024 that approached the relationship between chronic pain and sleep disorders were included. Furthermore, PTSD, anxiety, depression, alcohol consumption, suicidal ideation and drug abuse were considered covariables. Cancer-related or acute pain and studies primarily addressing sleep apnoea or traumatic brain injury were excluded. A systematic search was conducted in ScienceDirect, PubMed, Scopus, Embase, Web of Science and Google Scholar until April 2024. Articles were screened using Covidence by two independent researchers, and bias was assessed using the Newcastle Ottawa Scale, ROBINS-I and ROB-2. Sixteen articles analysed data from 15,060 active military personnel or veterans. Overall, studies endorsed the association between sleep quality and chronic pain and their influence on mental health, physical functioning and quality of life. Additionally, behavioural, mind-body and circadian misalignment therapies, along with other nonpharmacologic interventions, positively impacted outcomes related to pain, sleep quality, and psychiatric comorbidities. However, there was heterogeneity in the use of diagnostic tools, non-standardised procedures, and a lack of guidelines in the treatment of these conditions. The construct of sleep disorders, chronic pain and associated comorbidities was shown to improve with nonpharmacologic and integrative interventions that addressed at least one of these conditions.
6. The Dublin International Society of Urological Pathology (ISUP) Consensus Conference on Best Practice Recommendations on the Pathology of Glandular Lesions of the Urinary Bladder. Adv Anat Pathol. 2026 Jan 1;33(1):1-16. doi: 10.1097/PAP.0000000000000510.
Paner GP(1), Al-Ahmadie H(2), Gaisa NT(3)(4), Lopez-Beltran A(5), Maclean F(6), Tsuzuki T(7), Werneck da Cunha I(8), Amin MB(9)(10), Aning J(11), Aron M(12), Athanazio D(13)(14), Bambury RM(15), Cheng L(16), Gopalan A(2), Gulmann C(17), Guo CC(2), Harris C(18)(19), Iyer G(20)(21), Jimenez RE(22), Jinzaki M(23), Kikuchi E(24), Lal P(25), Miyai K(26), Netto GJ(25), Pan CC(27), Panebianco V(28), van Rhijn BW(29)(30)(31), Siefker-Radtke A(32), Smith SC(33), Szarvas T(34)(9)(35), Wobker SE(36), Kristiansen G(37), Reis H(38); ISUP Expert Panel On Urachal Neoplasms and Urinary Bladder Glandular Lesions.
Collaborators: Algaba F, Barrett C, Bertz S, Bezerra SM, ET AL.
Afiliação:
(1) Department of Pathology, University of Chicago, Chicago, IL.
(2) Department of Pathology.(3) Institute of Pathology, University Hospital, RWTH Aachen University.
(4) Institute of Pathology, University Hospital Ulm, University of Ulm.
(5) (5)Unit of Anatomic Pathology, Department of Morphological Sciences, Cordoba University Medical School, Cordoba, Spain.
(6) Douglass Hanly Moir Pathology, Faculty of Medicine and Health Sciences Macquarie University, North Ryde, Australia.
(7) Department of Surgical Pathology, Aichi Medical University, Aichi.
(8) Department of Pathology, Rede D'OR-Sao Luiz.
(9) Department of Urology.
(10) Department of Pathology and Laboratory Medicine, University of Tennessee Health Science, Memphis, TN.
(11) Department of Urology, Southmead Hospital, North Bristol Hospitals Trust, Bristol, UK.
(12) Department of Pathology, University of Southern California, Los Angeles, CA.
(13) Oncoclinicas Precision Medicine, São Paulo.
(14) Hospital Universitário Professor Edgard Santos/Federal University of Bahia, Brazil.
(15) Department of Medical Oncology, Cork University Hospital, Cork.
...
Resumo: The Dublin ISUP Consensus Conference covered the proceedings on the best practice recommendations on nonurachal glandular lesions of the urinary bladder, bladder diverticular cancers, and molecular features of bladder and urachal glandular lesions. The conference proceedings on urachal neoplasms (except for their molecular features) are published elsewhere. The rationale for convening this conference was the lack of structured and consented pathologic recommendations in these rare lesions. Consensus by participants was reached on the following statements: (1) intestinal metaplasia with dysplasia is considered to be a precursor to primary bladder adenocarcinoma; (2) dysplasia arising from cystitis glandularis should be reported in terms of focality (focal or nonfocal) and grade (low or high); (3) the term "adenocarcinoma" should only be used for carcinomas showing pure (nonurothelial) morphology and should not be used interchangeably in urothelial carcinoma with "glandular differentiation" because of the pathobiological differences and management implications; (4) the different histologic subtypes of bladder adenocarcinoma should be specified in the report; (5) immunohistochemistry has an ancillary role in the work up of bladder adenocarcinoma versus gastrointestinal or Müllerian-type adenocarcinomas; (6) lymphovascular invasion should be included as a parameter when reporting bladder adenocarcinoma; (7) representative or targeted sampling will be sufficient for bladder diverticulum resection specimens; and (8) molecular analysis in genomic profiling should be performed only in advanced or metastatic bladder and urachal adenocarcinomas for targetable therapy. This report on glandular (nonurachal) lesions of the bladder from the Dublin ISUP consensus conference will serve as a best practice recommendation and as a guide for future research on these relatively rare lesions.
7. Efficacy and safety of sacubitril/valsartan in Afro-descendant patients with resistant hypertension: a randomized controlled trial. J Hypertens. 2025 Sep 1;43(9):1485-1491. doi: 10.1097/HJH.0000000000004075.
Bitar YSL(1)(2)(3), Durães AR(1)(2)(3), de Macedo CRB(1)(3), Aras MG(3), Santos LC(3), de Abreu RSF(3), Dos Santos ECB(1)(2)(3), Bocchi E(4), da Silva WAP(5), Aras Junior R(1)(2)(3).
Afiliação:
(1) Federal University of Bahia, Postgraduate Program in Medicine and Health (PPgMS).
(2) General Hospital Roberto Santos (HGRS).
(3) Edgard Santos University Hospital (HUPES), Federal University of Bahia, Salvador.
(4) Heart Institute, University of São Paulo Medical School (InCor/USP), São Paulo.
(5) Tocantins Heart Hospital (HCORT), Palmas, Brazil.
Resumo: Sacubitril/valsartan (Sac-Val) has demonstrated blood pressure (BP)-lowering effects, but its role in resistant hypertension remains unclear. This study evaluated the efficacy and safety of Sac-Val compared to optimized angiotensin II receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) therapy in Brazilian patients with resistant hypertension, predominantly Afro-descendant. METHODS: In this phase III, 8-week, single-center, randomized trial, 80 adults with resistant hypertension were assigned to Sac-Val (titrated to 200 mg with an optional increase to 400 mg if BP remained >140/90 mmHg) or standard therapy (ARB/ACEI combined with other antihypertensive agents). The primary endpoint was the proportion of patients achieving BP control (<140/90 mmHg). The co-primary endpoints included mean reductions in mean sitting SBP (msSBP), mean sitting DBP (msDBP), and mean sitting pulse pressure (msPP) at week 8. Secondary outcomes assessed dose-dependent BP reduction. RESULTS: BP control was achieved in 94.9% of patients in the Sac-Val group versus 69.2% in the control group ( P = 0.03). Sac-Val significantly reduced msPP (-6.05 mmHg, P = 0.008) and showed a trend toward greater msSBP reduction ( P = 0.06). The 400 mg dose resulted in the greatest BP reduction, particularly for msPP ( P = 0.034). No deaths were reported. CONCLUSION: Sac-Val was more effective than standard therapy in achieving BP control and reducing BP in resistant hypertension, with a dose-dependent trend favoring the 400 mg regimen. These findings support Sac-Val as a potential treatment alternative for high-risk Afro-descendant patients.
8. Radiotherapy for Unresectable Locally Advanced NSCLC: A Practical Multidisciplinary Approach to Challenging Scenarios From the International Association for the Study of Lung Cancer Advanced Radiation Technology Subcommittee. J Thorac Oncol. 2025 Nov 14:103516. doi: 10.1016/j.jtho.2025.11.006.
Zhu H(1), Al Saifi S(2), Bahig H(3), Cooper A(4), Abrão FC(5), Corrales L(6), Faivre-Finn C(7), Filippi AR(8), Fitzgerald B(9), Khosla D(10), Lam VK(11), Le X(12), Menezes V(13), Newsom-Davis T(14), et al.
Afiliação:
(1) Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
(2) Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.
(3) Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
(4) Memorial Sloan Kettering Cancer Center, New York, New York.
(5) Division of Thoracic Surgery, Santa Marcelina Medical School, São Paulo, Brazil.
(6) Department of Medical Oncology, Centro de Investigacion y Manejo del Cancer - CIMCA, San Jose, Costa Rica.
(7) The Christie NHS Foundation Trust & The University of Manchester, Manchester, United Kingdom.
(8) Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy.
(9) Department of Medicine, Roswell Park Cancer Center, Buffalo, New York.
(10) Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
(11) Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
(12) Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, Texas.
(13) Division of Thoracic Surgery, Hospital Universitario Professor Edgar Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(14) Chelsea & Westminster Hospital, London, United Kingdom.
....
Resumo: Stage III NSCLC is a heterogeneous disease with multiple curative and palliative treatment options. Surgery and radiotherapy are the primary local treatment modalities, and their use is guided by the principals of tumor resectability and patient operability. Neoadjuvant and adjuvant immunotherapies have changed the patterns of multidisciplinary management of stage III NSCLC. METHODS: On behalf of the Multidisciplinary Clinical Science Committee and Advanced Radiotherapy Technology Subcommittee of the International Association for the Study of Lung Cancer, we present five cases representing challenging scenarios for discussion. RESULTS: The first is strategies for optimizing staging before curative intent, particularly the role of endobronchial ultrasound. The second focuses on the role of targeted therapies in the curative-intent chemoradiotherapy paradigm. The third evaluates treatment approaches for elderly or comorbid patients, specifically the choice between radiotherapy and systemic therapy. The fourth considers the management of patients who do not undergo surgery after neoadjuvant systemic therapy. The fifth concerns the role of adjuvant radiotherapy after neoadjuvant therapy and surgery. CONCLUSIONS: Herein, we present a review of challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.
9. 2025 Brazilian guidelines for the management of neuromyelitis optica spectrum disorder in adults and children. Arq Neuropsiquiatr. 2025 Nov;83(11):1-21. doi: 10.1055/s-0045-1812471.
Apóstolos-Pereira SLD(1), Damasceno A(2), Piccolo AC(3), Mendes MF(4), Brito ML(5), Alvarenga R(6), Costa BKD(7)(8), ..., Paolilo RB(25), Adoni T(1), Fukuda T(26), Daccach V(27), Becker J(7), Vasconcelos CCF(6).
Afiliação:
(1) Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Neurologia, São Paulo SP, Brazil.
(2) Universidade Estadual de Campinas, Campinas SP, Brazil.
(3) Universidade Municipal de São Caetano do Sul, São Paulo SP, Brazil.
(4) Santa Casa de São Paulo, Faculdade de Ciências Médicas, Disciplina de Neurologia, São Paulo SP, Brazil.
(5) Hospital da Restauração, Recife PE, Brazil.
(6) Universidade Federal do Estado do Rio de Janeiro, Pós-Graduação Stricto Sensu em Neurologia, Rio de Janeiro RJ, Brazil.
(7) Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brazil.
(8) Santa Casa de Porto Alegre, Hospital da Criança Santo Antônio, Porto Alegre RS, SP, Brazil.
...
(25) Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo SP, Brazil.(26) Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Salvador BA, Brazil.(27) Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto SP, Brazil.
Resumo: Neuromyelitis optica spectrum disorder (NMOSD) is a debilitating recurrent inflammatory disease of the central nervous system. Establishing management guidelines is essential to optimize patient care in Brazil.To combine the Delphi and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approaches to validate evidence-based guideline statements for NMOSD treatment.These guidelines focused on providing recommendations for different scenarios: general management and diagnosis of NMOSD; acute and preventive treatments (including systemic immunosuppressants and anti-B cell, anti-interleukin-6, and anti-complement monoclonal antibodies); and therapeutic approaches in special groups (such as the pediatric population and pregnant women). A literature review based on the Population, Intervention, Comparator, and Outcome (PICO) framework was performed, and studies were evaluated using the GRADE system. An initial questionnaire containing 19 statements was sent to 44 specialists from all regions of Brazil.Three voting rounds were necessary to reach consensus in all statements. After the first voting round, 17 statements reached consensus (level of agreement > 70%). Two statements failed to reach consensus and were, thus, revised. One of them was segmented into three different statements. After the second voting round, three out of the four revised statements reached consensus. Upon further revision, the last statement was again submitted to voting, reaching consensus in this third round. Overall, agreement was achieved on the 21 proposed statements.The primary objective in the management of NMOSD is to mitigate the severity of the attacks and prevent relapses, thereby minimizing the risk of irreversible neurological deficits. The statements in the current guideline offer evidence-based recommendations for such management within the Brazilian context.
10. Association Between Hip Radiographic Parameters and Osteonecrosis Severity in Sickle Cell Disease: A Pilot Study. Indian J Orthop. 2025 Aug 30;59(12):2174-2180. doi: 10.1007/s43465-025-01535-x.
Barreto ESR(1), Antunes Júnior CR(1), Teixeira TRG(2), Botelho VL(2), Daltro PB(2), Daltro GC(1)(2).
Afiliação:
(1) Federal University of Bahia, Av. Reitor Miguel Calmon, S/N - Vale Do Canela, Salvador, Bahia State 40110-100 Brazil.
(2) Humanitarian Health Outpatient Clinic, Professor Edgard Santos University Hospital, Salvador, Bahia State Brazil.
Resumo: In this pilot study, we analyzed whether there is an association between hip radiographic parameters and the severity of osteonecrosis secondary to sickle cell disease, according to the Ficat and Arlet, and Ohzono classifications. METHODS: This descriptive cross-sectional study included 20 patients aged 18 to 45 years treated at Professor Edgard Santos University Hospital (HUPES). All patients underwent an anteroposterior pelvic radiograph at HUPES. Clinical and radiographic data were collected, including the classification of osteonecrosis according to Ficat and Arlet, and Ohzono, as well as the following radiographic parameters: position of the hip center, femoral head extrusion index, Wilberg angle, Tönnis acetabular roof angle, and cervicodiaphyseal angle. RESULTS: Seven hips were excluded because they had already undergone surgical treatment. Of the 33 hips evaluated, most were in advanced stages of osteonecrosis. The cervicodiaphyseal angle showed a significant difference between advanced stages (III and IV) and early stages (IIA and IIB) in the Ficat & Arlet classification, while other parameters did not present statistically significant differences. CONCLUSION: The study identified significant variations in the cervicodiaphyseal angle between different stages of osteonecrosis. Despite being limited by the small sample size and excluding post-surgical cases, the study provides an initial basis for the radiographic characterization of osteonecrosis associated with Sickle Cell Disease. It indicates the need for future research with larger samples.
11. Arketamine: a scoping review of its use in humans. Eur Arch Psychiatry Clin Neurosci. 2025 Aug;275(5):1317-1332. doi: 10.1007/s00406-024-01945-2.
Leal GC(1)(2), Lima-Araújo I(1), Roiter DG(1), Caliman-Fontes AT(1)(2), Mello RP(1)(2), Kapczinski F(3), Lacerda ALT(4), Quarantini LC(5)(6).
Afiliação:
(1) Laboratório de Neuropsicofarmacologia (LANP), Psychiatry Service, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Universidade Federal da Bahia, Rua Dr. Augusto Viana, s/n-Canela, Salvador, Bahia, 40110-060, Brazil.
(2) Faculdade de Medicina da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(3) Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
(4) Programa de Transtornos Afetivos (Mood Disorders Unit), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, State of São Paulo, Brazil.
(5) Laboratório de Neuropsicofarmacologia (LANP), Psychiatry Service, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Universidade Federal da Bahia, Rua Dr. Augusto Viana, s/n-Canela, Salvador, Bahia, 40110-060, Brazil.
(6) Faculdade de Medicina da Bahia, Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, Bahia, Brazil. lcq@ufba.br.
Resumo: Arketamine (R-ketamine), an enantiomer of ketamine, has historically been less studied than esketamine (S-ketamine) and the racemic mixture. Recent preclinical studies suggest that arketamine may offer prolonged antidepressant effects and a superior safety profile. This scoping review aims to assess and synthesise existing literature on the clinical use of arketamine in humans. This review follows the PRISMA for Scoping Reviews guidelines, with a comprehensive search conducted in PubMed, Embase, ClinicalTrials.gov, and the WHO International Clinical Trials Registry. Eligible studies included those reporting the administration of arketamine to humans. Data were extracted and synthesised descriptively. A total of 20 studies involving 410 subjects were included. Arketamine was primarily investigated for pain management and depression. While early evidence suggests arketamine may be effective in reducing pain, most studies were small and conducted in non-clinical settings. In psychiatry, trials indicate potential antidepressant effects, but results are inconsistent, and some studies remain unpublished. A consistent observation across most studies is arketamine's favourable safety profile, showing lower incidences of dissociative and psychotomimetic effects compared to esketamine and racemic ketamine. Arketamine may have a role in pain management and psychiatry, with a favourable safety profile compared to other forms of ketamine. However, the small scale of many studies limits the generalizability of findings, and results in depression trials are mixed. Larger, well-designed studies, possibly with higher doses, are needed to determine its therapeutic potential and establish its place in clinical practice.
12. Phase 2 trial of daratumumab, cyclophosphamide, thalidomide, and dexamethasone in newly diagnosed multiple myeloma. Blood Neoplasia. 2025 Mar 3;2(3):100081. doi: 10.1016/j.bneo.2025.100081.
de Queiroz Crusoé E(1)(2), Leal Ribeiro Dos Santos JS(2), de Andrade Santos J(1)(2), de Melo Santos HH(1)(3), de Souza Santos A(3), Lucas LF(2), Requião de Pinna CA(1)(2), Caldas Freire PN(2), Araujo de Jesus A(2), de Moura Almeida A(1), Dutra DD(1), Chaves MF(1), Nicanor JS(1), Salvino MA(1), Bomfim Arruda MDG(2), Hungria V(4); GBRAM.
Afiliação:
(1) Hospital Universitário Professor Edgar Santos, Federal University of Bahia, Hematology and Hemotherapy Department, Salvador, Brazil.
(2) Rede D'or Oncologia, Hematology Division, Salvador, Brazil.
(3) Immunology, Molecular and Cytometry Laboratory, Instituto de Ciências da Saúde, Federal University of Bahia, Salvador, Brazil.
(4) Department of Hematology and Oncology, Clínica São Germano, São Paulo, Brazil.
Resumo: Anti-CD38 monoclonal antibodies have been successfully combined with immunomodulatory agents, proteasome inhibitors (PIs), alkylators, and corticosteroids in newly diagnosed multiple myeloma (NDMM). We assessed a regimen of daratumumab, cyclophosphamide, thalidomide, and dexamethasone (Dara-CTD) for patients with NDMM eligible to autologous stem cell transplantation (ASCT). Patients received 4 28-day cycles of induction therapy with Dara-CTD followed by ASCT, 4 cycles of consolidation Dara-TD, and single-agent daratumumab maintenance until progression or limiting toxicity. The primary end point was the percentage of patients achieving at least a very good partial response (VGPR) after the second cycle of consolidation. A key secondary end point was progression-free survival (PFS). We enrolled 24 patients, with a median age of 59.5 years, 62.5% of whom were female. Patients received a median of 28 treatment cycles. The rate of VGPR or better was 75.0% (95% confidence interval, 68.3-98.7); of 18 responding patients, 3 had a complete and 15 had a VGPR. The response duration varied between 9.5 and 41.9 months (median not reached). The estimated PFS rate at 36 months was 65%, and the overall survival rate at 48 months was 70%. The most frequent toxicity was constipation, febrile neutropenia, lymphopenia, neutropenia, peripheral neuropathy, and stomatitis. There were 7 documented cases of coronavirus disease 2019, 2 of which fatal. Two patients had permanent treatment discontinuation due to toxicity, 1 case each attributed to cyclophosphamide and daratumumab. Dara-CTD is an active, PI-free, quadruplet regimen with an acceptable safety profile for patients with ASCT-eligible NDMM.
13. Getting into host's skin: initial immune response to Schistosoma mansoni infection. Front Immunol. 2025 Dec 17;16:1661465. doi: 10.3389/fimmu.2025.1661465.
Orrico-Ferreira CM(#)(1)(2)(3), Cruz PEO(#)(3), Rios JVB(3), da Silva Rosa W(1), Santos BS(1), Silva RC(3), Pinheiro CS(2)(3), Figueiredo BC(1)(2)(3)(4).
Afiliação:
(1) Serviço de Imunologia, Hospital Universitário Prof. Edgar Santos, Universidade Federal da Bahia, Salvador, Brazil.
(2) Programa de Pós-graduação em Imunologia, Universidade Federal da Bahia, Salvador, Brazil.
(3) Laboratório de Alergia e Acarologia, Universidade Federal da Bahia, Salvador, Brazil.
(4) Departamento de Bioquímica e Biofísica, Universidade Federal da Bahia, Salvador, Brazil. (#)Contributed equally
Resumo: Schistosoma mansoni initiates infection through active skin penetration by cercariae, triggering early immune responses that are crucial to disease establishment. In naïve hosts, parasite antigens elicit an initial Th1-type response that is rapidly modulated to a Th2 profile by parasite-derived immunomodulatory molecules, including proteases and eicosanoids. Upon reinfection, prior sensitization enhances Th2 responses, IgE production, and eosinophil recruitment, while promoting regulatory mechanisms that limit pathology and favor chronic infection. Key molecules such as cercarial elastase (SmCE) interfere with antigen presentation and antibody function, facilitating immune evasion. This review explores the early immune responses elicited at the cutaneous interface during primary S. mansoni infection and reinfection, emphasizing the dynamic interplay between host defense mechanisms and parasite-driven immunoregulation. Understanding these early skin-stage events reveals how S. mansoni balances immune activation and suppression, offering valuable targets for vaccine development and immune-based interventions.
14. One-year efficacy of Dupilumab in sense of smell, nasal polyp score and quality of life in CRSwNP patients: A real-world multicenter study in Brazil. Braz J Otorhinolaryngol. 2025 Nov-Dec;91(6):101704. doi: 10.1016/j.bjorl.2025.101704.
Mieli OM(1), Valera FCP(2), Dinarte VRP(3), de Lima CMF(4), Nakanishi M(5), Zanetti MET(2), Pires FO(2), Garcia DM(2), Murashima AAB(2), Arruda LKP(2), et al.
Afiliação:
(1) Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP, Brazil.
(2) (2)Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, São Paulo, SP, Brazil.
(3) Faculdade de Medicina de Marília (FAMEMA), Marilia, SP, Brazil.
(4) Hospital Universitário Professor Edgar Santos, Salvador, BA, Brazil.
(5) Faculdade de Medicina da Universidade de Brasília, Brasilia, DF, Brazil.
...
Resumo: To present the outcomes of dupilumab in olfactory function, Nasal Polyp Score (NPS) and quality of life in Brazilian patients with severe CRSwNP.METHODS: We selected severe type 2 CRSwNP patients from different Brazilian centers. Dupilumab was indicated after failure of optimized medical and surgical treatment. Patients were evaluated with endoscopic Nasal Polyps Score (NPS), Connecticut smell test (CCCRC) and quality of life questionnaire (SNOT-22), at baseline (T0) and at one year (T1) after dupilumab was initiated. The clinical response was classified as good or non-responsive, according to the degree of improvement at T1. Regarding disease control, patients were classified as controlled, partially controlled or uncontrolled. RESULTS: 53 patients completed one year of treatment (19-76 years-old); 51 individuals (96.2%) had asthma and 33 had Aspirin-Exacerbated Respiratory Disease (AERD) (62.3%). Dupilumab decreased mean SNOT-22 scores from 61.9 to 16.7 points (paired t-test, t = 13.4, p < 0.0001). The median CCCRC scores improved from anosmia (0-points) to mild hyposmia (5.5-points) (Wilcoxon signed rank test, p < 0.0001). Regarding NPS, we observed a decrease from a median of 6 in T0 to 1 at T1. AERD patients showed similar responses to those with only asthma as comorbid disease. Overall, most of the patients (86.8%) showed improvement in the disease control (Bowker's Test, p < 0.0001). CONCLUSIONS: Real-world data show that dupilumab improved NPS, smell function, and SNOT-22 scores in the Brazilian CRSwNP population. These results support the benefits of dupilumab in treating severe cases of CRSwNP.
15. Subcutaneous daratumumab plus carfilzomib and dexamethasone (D-Kd) versus carfilzomib and dexamethasone (Kd) in patients with relapsed/refractory multiple myeloma who received previous daratumumab treatment: LYNX study. Leuk Lymphoma. 2025 Dec;66(14):2685-2696. doi: 10.1080/10428194.2025.2561117.
Bahlis NJ(1), Zonder J(2), Karlin L(3), Plesner T(4), Paris L(5), Wrobel T(6), Hungria V(7), Besemer B(8), Crusoe E(9), Silkjaer T(10), Perrot A(11), et al.
Afiliação:
(1) Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, Canada.
(2) Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA.
(3) Department of Hematology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
(4) Vejle Hospital, University of Southern Denmark, Vejle, Denmark.
(5) Division of Hematology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
(6) Uniwersytet Medyczny we Wrocławiu, Wroclaw, Poland.
(7) Clínica Medica São Germano, São Paulo, Brazil.
(8) Abteilung für Innere Medizin II, Universitätsklinikum Tübingen der Eberhard-Karls-Universität, Tübingen, Germany.
(9) Hospital São Rafael, Instituto D'Or de Pesquisa e Ensino and Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia-HUPES-UFBA, Salvador, Brazil.
(10) Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
....
Resumo: Daratumumab-based regimens demonstrate clinical efficacy in relapsed/refractory multiple myeloma (RRMM). As more patients receive frontline daratumumab-based therapy, evaluation of daratumumab retreatment is needed. In the phase 2 LYNX study (ClinicalTrials.gov Identifier: NCT03871829), 88 patients with RRMM who received 1-3 prior lines of therapy, one of which contained daratumumab, were randomized to receive subcutaneous daratumumab plus carfilzomib/dexamethasone (D-Kd; n = 44) or carfilzomib/dexamethasone (Kd; n = 44). The primary endpoint was the very good partial response or better (≥VGPR) rate. At the interim futility analysis, no significant differences in ≥ VGPR rates were found between treatment groups; therefore, the null hypothesis of no treatment difference was accepted, leading to study termination. At the final analysis, 45.5% of D-Kd patients and 40.9% of Kd patients achieved ≥ VGPR (odds ratio, 1.2 [90% CI, 0.59-2.46]; p = 0.6757). No new safety concerns were identified. Future studies are needed to optimize daratumumab-based regimens for patients with RRMM who have prior daratumumab exposure.
16. Brazilian Atrial Fibrillation Guidelines - 2025. Arq Bras Cardiol. 2025 Nov 21;122(9):e20250618. doi: 10.36660/abc.20250618.
Cintra FD(1), Pisani CF(2), Rezende AGDS(3), Henz BD(4) ..., Magalhães LP(37), Silva LRLD(38), et al.
Afiliação:
(1) Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP - Brasil.
(2) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil.
(3) PROCAPE (Pronto Socorro Cardiológico Universitário de Pernambuco Prof. Luiz Tavares), da Universidade de Pernambuco (UPE) Recife, PE - Brasil.
(4) Instituto Brasília de Arritmia Cardíaca, Brasília, DF - Brasil.
...
(37) Hospital Universitário Professor Edgard Santos da Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA - Brasil.
(38) Grupo Santa Hospitais, Brasília, DF - Brasil.
...
Sem Resumo.
17. Jaccoud's arthropathy secondary to leprosy. Mod Rheumatol Case Rep. 2025 Jul 25;9(2):rxae077. doi: 10.1093/mrcr/rxae077.
Viana IP(1), Figueiroa MLCO(1), Argollo BP(2), Pinto GLB(1), Santiago MB(1).
Afiliação:
(1) Rheumatology, Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.
(2) Radiology, Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.
Resumo: Jaccoud's arthropathy is a deforming, nonerosive form of arthritis initially described in patients with rheumatic fever. However, it has been recently observed more frequently in those with systemic lupus erythematosus. Cases of Jaccoud's arthropathy have also been described to be associated with other conditions. Herein, we describe the case of a 64-year-old Brazilian man who exhibited Jaccoud's arthropathy associated with leprosy. To the best of our knowledge, this is the first report on this association.
18. Clinical and Prognostic Factors Associated With Inflammatory Bowel Disease in a Highly Admixed Population With Primary Sclerosing Cholangitis. J Clin Gastroenterol. 2025 Sep 24. doi: 10.1097/MCG.0000000000002253.
Nardelli MJ(1), Cançado GGL(1), Barros LL(2), Dotta DD(2), Faria LC(1), Rotman V(3), Villela-Nogueira CA(3), Ferraz MLG(4), Rocco R(5), Felga GE(5), Martins AS(6), Codes L(7), et al.
Afiliação:
(1) Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte.
(2) Hospital das Clínicas da Universidade de São Paulo.
(3) Hospital Universitário Clementino Faria Filho.
(4) Universidade Federal de São Paulo.
(5) Hospital Israelita Albert Einstein, São Paulo.
(6) Hospital Universitário Professor Edgard Santos.
(7) Hospital Português, Salvador.
...
Resumo: To investigate the prevalence of inflammatory bowel disease (IBD) in a cohort of Brazilian patients with primary sclerosing cholangitis (PSC) and evaluate clinical and prognostic factors associated with concomitant IBD. BACKGROUND: IBD is reported worldwide in 62% to 81% of patients with PSC, especially in males and north Europeans. Little is known about the association of IBD and PSC in population from multigenetic ethnic origin. STUDY: Data of PSC patients from the Brazilian Cholestasis Study Group database were retrospectively reviewed to compare demographic, clinical, laboratory, and transplant-free survival between those with and without IBD. RESULTS: After exclusion of 59 (14%) participants with overlap syndrome with autoimmune hepatitis, 359 individuals with PSC were included {56% male, median age 44 [interquartile range (IQR): 33 to 54] y}. IBD was investigated in 298 (83%) participants and diagnosed in 217 (73%), including ulcerative colitis (83%), Crohn's disease (13%), and indeterminate colitis (4%). Male sex frequency was similar in patients with and without IBD (58% vs. 47%, P=0.073). IBD was more frequently diagnosed in patients without obesity (P=0.035), positive for antinuclear antibody (P=0.006), and positive for anti-smooth muscle antibody (P=0.046). IBD diagnosis occurred before, concomitant, or after PSC diagnosis in 59%, 22%, and 19% of cases, respectively. IBD was more frequently diagnosed before PSC in participants asymptomatic for liver disease (P=0.017), without advanced liver disease (P=0.017), before liver transplantation (LT) (P<0.001), and positive for antinuclear antibody (P=0.021). In a median follow-up of 69 months (IQR 31-124), LT occurred in 27.7% and cohort mortality was 11.4%. IBD was neither associated with the combined outcome of death or LT (P=0.745) nor with transplant-free survival (P=0.902). CONCLUSIONS: In Brazilian PSC patients, IBD frequency was similar to that reported in other populations but exhibited a balanced proportion between males and females. IBD diagnosis occurred before PSC in most patients, especially those without advanced liver disease. IBD presence was not associated with worse PSC prognosis.
19. Arterial Palmar Arch Aneurysms Management: Case Series. Vasc Endovascular Surg. 2025 Oct;59(7):742-747. doi: 10.1177/15385744251343706.
Carvalho Lujan RA(1), Godeiro Fernandez M(2), Costa Sampaio Silva F(3), Azevedo Lujan G(4), de Melo Mascarenhas DA(1), Pereira de Souza Filho ML(5), Aras Junior R(3).
Afiliação:
(1) Vascular Surgery Division, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
(2) Bahiana School of Medicine and Public Health, Salvador, Brazil.
(3) Postgraduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Brazil.
(4) Brazilian Society of Anesthesia (SBA), Brazil.
(5) Pathology Division, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
Resumo: IntroductionTrue aneurysms of the upper limb, particularly in the hands, are rare and challenging to manage. We aim to report two cases of true arterial palmar arch aneurysms surgically treated.Case ReportThe first case involved a 45-year-old male professional martial artist with an ulnar artery aneurysm extending to the superficial palmar arch in the right hand. The second case was a 32-year-old female administrative assistant with a radial artery aneurysm in the left hand. Despite their respective professions, neither patient had a history of significant trauma, recent excessive training, or prolonged work hours. Clinically, both presented with local pain. Diagnostic imaging confirmed the aneurysms. The surgical interventions included proximal and distal vessel ligation and aneurysm resection under local anesthesia. Both patients were discharged on the first postoperative day without complications and showed no vascular complications during a 5-year follow-up.ConclusionAneurysms with marked rarity require individualized treatment with surgical options tailored to the clinical presentation and vascular status.
20. Hospitalizations and In-Hospital Mortality from Heart Failure in Brazil: An Updated Overview. Arq Bras Cardiol. 2025 Jul 4;122(6):e20250284. doi: 10.36660/abc.20250284.
Latado AL(1)(2).
Afiliação:
(1) Universidade Federal da Bahia - Faculdade de Medicina da Bahia, Salvador, BA - Brasil.
(2) Universidade Federal da Bahia - Hospital Universitário Professor Edgard Santos, Salvador, BA - Brasil.
Sem Resumo
21. Outcomes After Allogeneic Hematopoietic Cell Transplantation in Adults With Myelodysplastic Syndrome With 65 Years or Older Compared to Youngers. A Retrospective Analysis of the Latin America Registry. Eur J Haematol. 2025 Oct;115(4):349-357. doi: 10.1111/ejh.70001.
Duarte FB(1), Garcia YDO(2), Funke VAM(3), João A(4), Hamerschlak N(5), Villela NC(6), de Almeida Macedo MCM(7), Vigorito AC(8), de Almeida Soares RD(9), Paz AA(10), Stevenazzi M(11), Diaz L(11)(12), Neto AEH(12), Bettarello G(13), de Gusmão BM(14), Salvino MA(15), ...
Afiliação:
(1) Walter Cantídio University Hospital, Fortaleza, Brazil.
(2) Federal University of Ceará, Fortaleza, Brazil.
(3) Federal University of Paraná, Curitiba, Brazil.
(4) Amaral Carvalho Cancer Hospital, São Paulo, Brazil.
(5) Albert Einstein Israelita Hospital, São Paulo, Brazil.
(6) Barretos Children's Cancer Hospital, São Paulo, Brazil.
(7) Brazilian Institute of Cancer Control, São Paulo, Brazil.(8)State University of Campinas UNICAMP, São Paulo, Brazil.
(8) Natal Hospital Center, Natal, Brazil.
(9) Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.
(10) Center TPH-SMI Integral Medical Service, Montevideo, Uruguay.
(11) Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil.
(12) DF Star Hospital, Brasília, Brazil.
(13) Beneficência Portuguesa Hospital of São Paulo, São Paulo, Brazil.
(14) University Hospital Professor Edgard Santos, Salvador, Brazil.
(15) Real Hospital Português, Recife, Brazil.
...
Resumo: This retrospective multicenter study aimed to compare outcomes and evaluate risks associated with allogeneic hematopoietic cell transplantation (allo-HCT) in myelodysplastic syndrome patients aged ≥ 65 versus < 65 years in Latin America, across 38 transplant centers (1988-2023). Of the 441 patients, 70 (16%) were ≥ 65 years (median age 68 ± 3.7). At 5 years, overall survival (OS) was 49.3% in patients ≥ 65 vs. 56.7% in those < 65 (p = 0.49), and progression-free survival (PFS) was 48.4% vs. 56.2% (p = 0.40). The cumulative incidence of relapse was 13.6%, and non-relapse mortality (NRM) 33.8%. After propensity score matching, no significant differences were observed between the age groups in OS (HR = 1.16; 95% CI: 0.76-1.77; p = 0.488), NRM (HR = 1.03; 95% CI: 0.64-1.67; p = 0.90) or PFS (HR = 1.20; 95% CI: 0.779-1.83; p = 0.40). PFS in patients ≥ 65 years was associated with high-risk IPSS-R stratification (p = 0.0056). The age group ≥ 65 years conferred higher risk of relapse compared to patients aged < 65 years (HR = 2.77; 95% CI: 1.07-7.15; p = 0.035). In patients ≥ 65 years, prevalence risk was associated to male sex, reduced-intensity conditioning, mobilized blood cells, and prior treatment, while in those < 65 years, to complications and chronic GVHD (p < 0.05). HCT is feasible in elderly patients. However, age may influence disease progression in very high-risk elderly patients and risk of relapse after transplantation.
22. Metabolic dysfunction-associated steatotic liver disease and dietary intake characteristics in children and adolescents: A cross-sectional study. Rev Gastroenterol Mex (Engl Ed). 2025 Jul-Sep;90(3):349-356. doi: 10.1016/j.rgmxen.2024.12.005.
Santos PQ(1), Cotrim HP(2), Rocha R(3), Daltro CH(4), Andrade SCS(5), Costa APC(6), Santos AMS(6).
Afiliação:
(1) Departamento de Ciencias de la Nutrición, Escuela de Nutrición, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil.
(2) (2)Facultad de Medicina de Bahía, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil; Programa de Postgrado en Medicina y Salud, Facultad de Medicina de Bahía, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil.
(3) (3)Departamento de Ciencias de la Nutrición, Escuela de Nutrición, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil; Programa de Postgrado en Alimentos, Nutrición y Salud, Escuela de Nutrición, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil.
(4) Departamento de Ciencias de la Nutrición, Escuela de Nutrición, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil; Programa de Postgrado en Medicina y Salud, Facultad de Medicina de Bahía, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil; Programa de Postgrado en Alimentos, Nutrición y Salud, Escuela de Nutrición, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil.
(5) Servicio de Radiología, Hospital Universitário Professor Edgar Santos, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil.
(6) Facultad de Nutrición, Universidad Federal de Bahía (UFBA), Salvador, Bahía, Brazil.
Resumo: Metabolic dysfunction-associated steatotic disease (MASLD) is the most common cause of chronic liver disease in children and adolescents. The development of MASLD is associated with dietary habits, and dietary intake characteristics are a relevant risk factor. The aim of the present study was to analyze dietary intake characteristics in children and adolescents and study how diet varies in subjects with and without MASLD. METHODS: A cross-sectional study was conducted that included children and adolescents from 8 to 18 years of age. The criteria for MASLD included steatosis on abdominal ultrasound study and meeting at least one metabolic syndrome criterion. Obesity was diagnosed based on the age-appropriate body mass index. Dietary habits were evaluated utilizing a 2-day food register collected on different representative days (Tuesday and Sunday), focusing on dietary energy intake, macronutrients, polyunsaturated fatty acids, trans fats, dietary fiber, and antioxidants. RESULTS: A total of 89 children and adolescents were evaluated; 50 (56%) were females and 21 (24%) presented with MASLD. The MASLD group had lower intake of protein (median [interquartile range] 76.6 g [57.7-87.7] vs. 85.8 [71.0-114.1], p = 0.035), vitamin E (mean [standard deviation] 6.0 [2.8] vs. 8.0 [6.2], p = 0.040), zinc (7.9 [2.7] vs. 10.3 [4.9], p = 0.031), and iron (9.9 [2.5] vs. 12.2 [5.4], p = 0.009), compared with the non-MASLD group. After confounding variable adjustment, only the waist-to-height ratio was associated with MASLD. CONCLUSION: The quantity and quality of foods may be related to MASLD, and abdominal obesity should be prevented in childhood.
23. Prevalence and Risk Factors Associated with Keratoconjunctivitis Sicca in People Living with Human T-Leukemia Virus Type 1: A Systematic Review and Meta-Analysis. Ocul Immunol Inflamm. 2025 Nov;33(9):2143-2152. doi: 10.1080/09273948.2025.2532044.
Silva Marques de Souza D(1), Goulardins JB(1), Matos Almeida Câmara PC(1)(2), Cury Copello Ú(2), Araújo THA(1), Rathsam-Pinheiro RH(1)(2), Rios Grassi MF(1)(3), Galvão-Castro B(1)(3), Boa-Sorte N(1)(4).
Afiliação:
(1) Centro Integrativo e Interdisciplinar de HTLV/Neurociências, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
(2) Medical Residency Program in Ophthalmology, Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira, Salvador, Brazil.
(3) Laboratório Avançado de Saúde Pública, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
(4) Núcleo de Avaliação em Tecnologias em Saúde, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Resumo: To estimate the global prevalence of keratoconjunctivitis sicca (KCS) among Human T‑cell lymphotropic virus type 1 (HTLV‑1)-infected individuals and to evaluate diagnostic methods and research gaps within ocular immunology. A systematic review and meta‑analysis were performed per PRISMA. We searched PubMed/MEDLINE, Embase, Web of Science, Scopus, Cochrane CENTRAL, SciELO, LILACS, DOAJ, OpenGrey, and CAPES through December 2023. Eligible studies were cross‑sectional or cohort investigations reporting KCS prevalence in confirmed HTLV‑1-seropositive adults (ELISA or Western blot). Two independent reviewers screened 289 records, with discrepancies resolved by a third. Eight studies met the inclusion criteria. The random‑effects pooled prevalence of KCS in HTLV‑1 infection was 34.6% (95% CI: 19.8%-51.0%; I2 = 97.2%). Patients with HTLV‑1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) exhibited a higher prevalence (prevalence ratio [PR]: 2.01; 95% CI: 1.73-2.31). Diagnostic approaches in six studies employed Rose Bengal staining, Schirmer I test, and tear film breakup time. Approximately one in three HTLV‑1-infected patients develop KCS, with elevated risk in those with HAM/TSP. Persistent heterogeneity-driven by diagnostic variability, geographic factors, and demographic differences-underscores the need for standardized criteria, inclusion of diverse populations, and further research on proviral load, gender, and ethnicity to inform ocular practice, including immunology.
24. Annexin A1 downregulates in vitro IL-1β production in L. braziliensis-infected cells. Front Immunol. 2025 Oct 22;16:1685264. doi: 10.3389/fimmu.2025.1685264.
Santos CP(1)(2), Nascimento MT(1)(2), Santana MBR(1), Carvalho EM(3), Carvalho LP(1)(2)(3)(4).
Afiliação:
(1) Laboratório de Pesquisas Clínicas, Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil.
(2) Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.
(3) Serviço de Imunologia, Complexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(4) Instituto Nacional de Ciências e Tecnologia-Doenças Tropiais, Salvador, Brazil.
Resumo: Cutaneous leishmaniasis (CL) is an infectious disease characterized by severe local inflammatory response, predominantly mediated by cytokines such as IL-1β and TNF, and cytotoxicity, contributing to tissue damage and lesion development. Given the high rate of therapeutic failure in Leishmania braziliensis transmission areas, the investigation of molecules that regulate inflammatory response has become a promising adjuvant therapeutical strategy. In this study we investigated the effects of Annexin A1 (ANXA1) on the inflammatory response of CL patients. We initially performed in silico analyses from our previous transcriptome databases and found increased expression of ANXA1, IL1B, and IL10 genes in skin biopsies from CL patients when compared to healthy skin from healthy subjects (HS). Also, increased levels of ANXA1, IL1β, and IL10 proteins were observed in serum levels and cultures of skin biopsies in CL patients when compared to HS. Treatment of lesion biopsies with recombinant ANXA1 reduced IL-1β levels without affecting IL-10 secretion, indicating a selective anti-inflammatory effect. Additionally, monocyte-derived macrophages from HS increased ANXA1, IL-1β, and IL-10 production upon Leishmania infection. Blockade of FPR2 receptor increased ANXA1 levels. Finally, addition of recombinant ANXA1 to macrophages did not affect the ability of these cells to kill Leishmania. Our findings demonstrate that ANXA1 negatively regulates IL-1β in CL, without impairing anti-inflammatory mechanisms or macrophage microbicidal activity, highlighting its potential use as an adjuvant therapy for controlling inflammation and disease progression.
25. Dolutegravir use is related to lower HTLV-1 proviral load in people co-infected by HIV-1. Commun Med (Lond). 2025 Dec 18;6(1):54. doi: 10.1038/s43856-025-01312-9.
Fernandez T(1)(2), Arriaga MB(1), Mayoral R(1), Netto EM(1)(2), Brites C(3)(4).
Afiliação:
(1) Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(2) School of Medicine, Department of Medicine, Universidade Federal da Bahia, Salvador, Brazil.
(3) Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
(4) School of Medicine, Department of Medicine, Universidade Federal da Bahia, Salvador, Brazil. crbrites@gmail.com.
Resumo: Infection by human T-cell lymphotropic virus type 1 (HTLV-1) affects millions of people worldwide and causes severe diseases. To date, no specific treatment is available for HTLV infection. The purpose of this study was to determine the impact of Dolutegravir use in reducing HTLV-1 proviral load (PVL) in HIV-HTLV1 coinfected subjects on stable antiretroviral therapy. METHODS: In this cross-sectional study we quantified HTLV-1 PVL in HIV-HTLV1 coinfected patients and HTLV-1 mono-infected ones. We compared HTLV-1 proviral load across groups, adjusting for age and sex, antiretroviral therapy use and CD4/CD8 cells count. We used a propensity score derived from a regression model for Dolutegravir use and HTLV-1 PVL, that included covariates like age and antiretroviral therapy duration. RESULTS: Eighty-eight patients were included, 44 coinfected by HIV and HTLV-1 and 44 controls. Linear regression shows an association between Dolutegravir use and lower HTLV-1 proviral load values (p = 0.042). Participants using Dolutegravir are significantly more likely to have an HTLV-1 proviral load below the median (205 DNA copies/mm3) than those antiretroviral therapy -naïve (p = 0.003). In logistic regression, Dolutegravir use is significantly associated with undetectable HTLV-1 proviral load (<50 DNA copies/mm3, p = 0.015), and HTLV-1 proviral load lower than quartile 75 values (945 DNA copies/mm3, p = 0.021). CONCLUSIONS: Dolutegravir use is consistently associated with lower HTLV-1 proviral load in HIV-HTLV-1 coinfected patients. This indicates that Dolutegravir may be an effective treatment for HTLV-1 infection.
26. Lumbar Radiculopathy Caused by an Undetected Facet Joint Cyst: A Case Report on Diagnostic Challenges and Endoscopic Treatment. Clin Spine Surg. 2025 Nov 20. doi: 10.1097/BSD.0000000000001998.
Marques MVB(1)(2)(3), Barreto ESR(4), Pacca AM(1)(5), Barreto PSD(1)(5), Pires VAA(2), Daltro GC(4).
Afiliação:
(1) Mater Dei Hospital, Salvador, Bahia state, Brazil.
(2) Professor Edgard Santos University Hospital.
(3) Ortoped, Salvador, Bahia state, Brazil.
(4) Federal University of Bahia, Salvador, Bahia state, Brazil.
(5) Department of Pathology, Rede D'Or - São Luiz, Bahia state, Brazil.
Resumo: STUDY DESIGN: Case report. OBJECTIVE: To describe a rare case of lumbosciatalgia caused by a synovial facet joint cyst undetected on preoperative MRI, successfully diagnosed and treated with a minimally invasive endoscopic approach. SUMMARY OF BACKGROUND DATA: Low back pain with sciatica (lumbosciatalgia) is a common and disabling condition. Facet joint cysts are uncommon but may cause nerve root compression and radiculopathy. Magnetic resonance imaging (MRI) is the diagnostic gold standard, but dynamic or small cysts may remain undetected, complicating diagnosis, and delaying appropriate treatment. METHODS: A 46-year-old male presented with chronic lumbosciatalgia unresponsive to conservative management. MRI showed lumbar spondyloarthrosis, degenerative disc disease, and ligamentum flavum thickening, but no definitive cause of neural compression. Persistent symptoms and diagnostic uncertainty prompted minimally invasive endoscopic exploration. RESULTS: Intraoperatively, a synovial facet cyst measuring 1.1×1.0×0.2 cm was found compressing the descending L5 nerve root. The cyst was excised completely, resulting in immediate pain relief. Functional status, assessed using the Oswestry Disability Index (ODI), improved from 26% preoperatively (moderate disability) to 8% at 30 days (minimal disability), and further to 2% at 60 days, with stability maintained at 90, 150, and 180 days. No recurrence or complications were observed. CONCLUSIONS: This case highlights the importance of considering facet joint cysts in the differential diagnosis of lumbosciatalgia, especially when imaging is inconclusive. Minimally invasive endoscopic surgery enables both definitive diagnosis and treatment, offering minimal tissue disruption, rapid recovery, and sustained symptom resolution. Early suspicion, personalized surgical planning, and structured follow-up are key to optimizing outcomes and monitoring for recurrence.
27. Darifenacin Versus Parasacral Transcutaneous Electric Nerve stimulation for overactive bladder syndrome in patients infected with Human T-Lymphotropic Virus 1 - randomized open clinical trial. Int Braz J Urol. 2025 Jul-Aug;51(4):e20240567. doi: 10.1590/S1677-5538.IBJU.2024.0567.
de Oliveira TSS(1)(2), C JA Neto(2), Oliveira CJV(2), Castro NM(2)(3), Carvalho EM(2)(4)(5).
Afiliação:
(1) Unidade Multidisciplinar do Departamento de Fisioterapia do Complexo Hospitalar Professor Edgard Santos da Universidade Federal da Bahia (UFBA) Salvador, Bahia, Brasil.
(2) Divisão de Imunologia do Complexo Hospitalar Professor Edgard Santos da Universidade Federal da Bahia (UFBA) Salvador, Bahia, Brasil.
(3) Divisão de Urologia do Complexo Hospitalar Professor Edgard Santos da Universidade Federal da Bahia (UFBA) Salvador, Bahia, Brasil.
(4) Laboratório de Pesquisa Clínica (LAPEC), Instituto Gonçalo Moniz, Fiocruz-Bahia, Brasil.(5) Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério de Inovação Científica e Tecnológica do Brasil.
Resumo: To evaluate the efficacy of parasacral transcutaneous electric nerve stimulation (PTENS), in comparison to darifenacin for the reduction of OAB symptoms in patients infected with HTLV-1. MATERIALS AND METHODS: This proof-of-concept randomized clinical trial was carried out at the HTLV-1 Outpatient Clinic of the University Hospital. Participants included 42 HTLV-1 infected subjects with symptoms OAB. The OAB symptoms score questionnaire (OABSS) was applied before and after treatment to evaluate each group: group1-received darifenacin and group 2-treated with PTENS. Random sequences and statistical analysis were generated by SPSS statistical package, version 27 (IBM Inc™).RESULTS: There was no difference between groups regarding demographic, socio-economic and clinical characteristics. The initial median and interquartile (IQR) range of OABSS were 11.2 (9.5 - 14.0) in G1 and 10.7 (8.0 - 12.7) in G2. There was a reduction in the frequency, nocturia and urgency in both groups. However, 5 (23.8%) of the patients in the group treated with darifenacin abandoned the therapy, while only 1 patient (4,8%) stopped PTENS. CONCLUSIONS: Both protocols used in this study were effective in treating OAB syndrome and reducing OABSS. However, therapy abandonment and adverse events were more frequent in the darifenacin group compared to the PTENS group.
28. Autologous bone marrow mononuclear cell transplantation for osteonecrosis of the femoral head in post-covid-19 syndrome: A case series. Regen Ther. 2025 Nov 8;30:1062-1066. doi: 10.1016/j.reth.2025.10.014.
Franco BA(1), Garrido S(1), Faleiro T(2), Veiga D(2), Daltro P(3), Pereira B(3), Daltro G(4).
Afiliação:
(1) Department of Biotechnology, Institute of Chemistry, São Paulo State University, Brazil.
(2) Department of Orthopedics and Traumatology, Professor Edgard Santos University Hospital, Federal University of Bahia, Brazil.
(3) Institute of Health Sciences, Federal University of Bahia, Brazil.
(4) Department of Experimental Surgery and Surgical Specialties, School of Medicine of Bahia, Federal University of Bahia, Brazil.
Resumo: The emergence of femoral head osteonecrosis in post-COVID-19 patients, possibly related to corticosteroid use, prompted the search for pathophysiological understanding and minimally invasive treatments, such as autologous mesenchymal cell transplantation. METHODOLOGY: Fifteen patients with post-COVID-19 femoral head osteonecrosis between 2021 and 2023 participated. A total of 100 mL of bone marrow was aspirated and processed using the SEPAX® system. The cells were tested for viability using an anti-CD34 antibody and characterized by flow cytometry and clonogenic assays. Postoperative care involved weight-bearing restrictions and clinical monitoring. This is a case series, level of evidence IV. RESULTS: Thirteen hips of patients affected by mild to moderate COVID-19 were operated on; 40 % of hospitalized patients did not require mechanical ventilation. 66.7 % received corticosteroids. Necrosis mainly occurred in the right hip, with an average necrotic area of 40 %. CONCLUSIONS: COVID-19 infection and corticosteroid use and duration are related to an increased incidence of osteonecrosis. Patients who did not use corticosteroids also developed osteonecrosis. Treatment with autologous bone marrow progenitor cells reduced pain and improved Harris Hip Score.
29. Self-reported quality of life, impulsivity and non-adherence to Immunosuppressive medication after liver transplantation: a cohort study. Arq Gastroenterol. 2025 Sep 5;62:e25012. doi: 10.1590/S0004-2803.24612025-012.
Jesus-Nunes AP(1)(2), Moreira TM(2), Morais-DE-Jesus M(1), Paraná R(3), Lins-Kusterer L(1), Quarantini LC(1)(2).
Afiliação:
(1) Universidade Federal da Bahia, Faculdade de Medicina, Programa de Pós-graduação em Medicina e Saúde, Salvador, BA. Brasil.
(2) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Salvador, BA, Brasil.
(3) Universidade Federal da Bahia, Salvador, BA, Brasil.
Resumo: Identify psychosocial risk factors for non-adherence to medication following liver transplantation. METHODS: We used the Medication Level Variability Index (MLVI) for the assessment of adherence in 52 subjects selected for a pre-transplant liver procedure and monitored them for 6 months following transplantation. Patients were divided into exposed and non-exposed groups according to adherence, and each group was analyzed using psychosocial variables: demographic characteristics, quality of life, impulsivity, resilience, anxiety and depression. RESULTS: Patients with non-adherence had lower scores in the SF-36v2 domains and in the components of physical and mental health, with significant differences in the physical functioning (P=0.03) and physical health component (P=0.03) domains. In addition, non-adherent patients showed higher levels of impulsiveness (P=0.04) and 44.2% of the non-adherent patients being men (P=0.04). CONCLUSION: Physical functioning and summary of the physical components of quality of life, impulsivity and male gender were associated with low adherence to medication.
30. Implementation of the recommendations of the II Brazilian Consensus On Gastric Cancer in clinical practice: a multicenter study of the Brazilian Gastric Cancer Association. Arq Bras Cir Dig. 2025 Sep 1;38:e1896. doi: 10.1590/0102-67202025000027e1896.
Ramos MFKP(1), Pereira MA(1), Albuquerque AF(2), Viana EF(3), Costa Junior WL(4), Sanches SRA(5), Silva AM(6), Ribeiro Junior U(1), Oliveira APRA(7), Victer FC(8), Targa GZ(9), Assumpção PP(10), Weston AC(11), Ribeiro Neto JP(12), Moreira LF(13), Mrue F(14), Lopes LR(15), Kassab P(16), Pinto JOG(17), Barchi LC(18), Forones NM(18).
Afiliação:
(1) Universidade de São Paulo, Faculty of Medicine, Hospital das Clinicas, Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil.
(2) Hospital Aristides Maltez, Bahian League Against Cancer - Salvador (BA), Brazil.
(3) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos - Salvador (BA), Brazil.
(4) AC Camargo Cancer Center - São Paulo (SP), Brazil.
(5) Universidade Federal de Minas Gerais, Hospital Universitário - Belo Horizonte (MG), Brazil.
(6) National Cancer Institute - Rio de Janeiro (RJ), Brazil.
(7) Universidade de Brasília, Hospital Universitário de Brasília - Brasília (DF), Brazil.
(8) Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho - Rio de Janeiro (RJ), Brazil.
(9) Hospital Erasto Gaertner - Curitiba (PR), Brazil.
(10) Universidade Federal do Pará, Hospital Universitário João de Barros Barreto - Belém (PA), Brazil.
(11) Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil.
(12) Universidade Federal de Pernambuco, Hospital Universitário - Recife (PE), Brazil.
(13) Hospital Universitário de Porto Alegre - Porto Alegre (RS), Brazil.
(14) Universidade Federal de Goias, Hospital Universitário - Goiânia (GO), Brazil.
(15) Universidade Estadual de Campinas, Hospital Universitário - Campinas (SP), Brazil.
(16) Santa Casa de Misericórdia de São Paulo - São Paulo (SP), Brazil.
(17) Universidade Federal do Ceará, Hospital Universitário Walter Cantídio - Fortaleza (CE), Brazil.
(18) Brazilian Gastric Cancer Association - São Paulo (SP), Brazil.
Resumo: RACIONAL: O manejo do câncer gástrico tornou-se cada vez mais complexo, ressaltando a importância de diretrizes clínicas e consensos especializados para padronizar o cuidado. O 2º Consenso Brasileiro sobre Câncer Gástrico foi elaborado com o objetivo de orientar a prática clínica em todo o país. OBJETIVOS: Avaliar o grau de implementação das recomendações do 2o Consenso Brasileiro sobre Câncer Gástrico em centros de referência oncológica no Brasil. MÉTODOS: Estudo multicêntrico com participação de 18 centros especializados no tratamento do câncer, que coletaram dados prospectivamente ao longo de um ano. Foram analisadas 21 declarações-chave do Consenso. Considerou-se aderência quando a declaração foi seguida em mais de 80% dos casos aplicáveis. RESULTADOS: Das 21 declarações avaliadas, 11 (52,4%) atingiram o critério de adesão. O uso seletivo da ultrassonografia endoscópica e do PET-CT esteve de acordo com o Consenso. No entanto, a laparoscopia diagnóstica foi subutilizada, endo realizada em apenas 24,7% dos pacientes. A terapia nutricional pré-operatória foi oferecida em 42% dos casos. A linfadenectomia D2 foi realizada em 79,8% das cirurgias, mas apenas 63,3% das peças continham ≥25 linfonodos, número recomendado para estadiamento adequado. A cirurgia minimamente invasiva foi utilizada em cerca de 25% dos tumores distais precoces, sendo rara nos tumores proximais avançados. Apesar de não recomendadas para tumores iniciais, omentectomia e bursectomia ainda foram realizadas em número significativo de casos T1/T2. A quimioterapia pré-operatória foi utilizada em 35,4% dos tumores distais estádio ≥IB e em 54,3% dos proximais, evidenciando adesão parcial. CONCLUSÕES: Pouco mais da metade das recomendações do 2o Consenso Brasileiro foram implementadas na prática. Houve boa adesão à linfadenectomia D2 e à cirurgia minimamente invasiva para tumores distais precoces. No entanto, a laparoscopia diagnóstica, o suporte nutricional, a linfadenectomia adequada e o uso mais amplo da quimioterapia neoadjuvante ainda exigem melhorias.
31. The association between gingivitis and SARS-CoV-2 colonization of subgingival biofilm in COVID-19 individuals: a cross-sectional preliminary study. Clin Oral Investig. 2025 Nov 29;29(12):590. doi: 10.1007/s00784-025-06565-1.
da Rocha Costa Coelho T(1), Machion Shaddox L(2), Nunes de Carvalho G(1), Damião Costa D(1), Nunes Vaz S(3), Brites C(3), Nunes Dos Santos J(4), Araki Ribeiro DA(5), Ramos Cury P(6).
Afiliação:
(1) Postgraduate Program in Dentistry and Health, Federal University of Bahia, Federal University of Bahia.
(2) College of Dentistry, University of Kentucky, 1095 VA Dr. Lexington, Lexington, KY, 40536-0305, USA.
(3) Infectious Diseases Research Laboratory, Professor Edgard Santos Hospital, Federal University of Bahia.
(4) School of Dentistry, Federal University of Bahia.
(5) Department of Biosciences, Institute of Health and Society, Federal University of São Paulo, UNIFESP.
(6) School of Dentistry, Federal University of Bahia.
Resumo: To evaluate the presence of SARS-CoV-2 RNA in the subgingival biofilm of COVID-19 individuals and its association with generalized gingivitis. MATERIALS AND METHODS: A pool of subgingival biofilm samples was collected from 80 individuals, 59 with and 21 without COVID-19, after periodontal diagnosis (classified as periodontally healthy or generalized gingivitis). Samples were tested for SARS-CoV-2 RNA by qRT-PCR. Binary logistic regression and Mann-Whitney test were applied to evaluate associations between the presence and amount of SARS-CoV-2 RNA in the biofilm and the presence of gingivitis (p < 0.05). RESULTS: SARS-CoV-2 RNA was detected in the subgingival biofilm of 35.6% (n = 21) of individuals with COVID-19 but not in individuals without COVID-19. In the COVID-19 group, SARS-CoV-2 RNA was detected in periodontally healthy individuals (47.6%) and those with gingivitis (52.4%). After adjusting for covariates, SARS-CoV-2 in dental biofilm was associated with 7.25-fold higher odds of generalized gingivitis (OR = 7.25; 95% CI: 1.41-37.33; p = 0.02). CONCLUSION: SARS-CoV-2 was detected in subgingival biofilms of COVID-19-positive individuals and was associated with an increased chance of gingivitis, providing preliminary evidence of a potential role of the virus in gingival inflammation. However, a bidirectional relationship may be present, as gingival inflammation could also create a more favorable environment for viral colonization of the subgingival biofilm. CLINICAL RELEVANCE: Maintaining periodontal health during and after COVID-19 infection may be important not only for oral well-being but also for mitigating viral persistence and its inflammatory effects.
32. Tenodesis of the Iliotibial Tract in the Treatment of Lesions of the Anterolateral Knee Complex - Description of a Modified Technique. Rev Bras Ortop (Sao Paulo). 2025 Nov 10;60(4):s00451811630. doi: 10.1055/s-0045-1811630.
Azi GR(1)(2), Meirelles AV(2)(3), Freitas RRC(1)(2), Fróes Neto JF(2), Mattos ESR(2)(4), Guedes A(2)(5).
Afiliação:
(1) Knee Surgery Group, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brazil.
(2) Medical Residency Program in Orthopedics and Traumatology, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brazil.
(3) Hip Surgery Group, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brazil.
(4) Hand Surgery Group, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brazil.
(5) Knee Surgery Group, Hospital Universitário Professor Edgard Santos, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil.
Resumo: The authors describe a modified lateral extraarticular tenodesis technique for the treatment of anterolateral complex knee injuries, performed in association with anterior cruciate ligament reconstruction, using a quadruple semitendinosus and gracilis tendon graft. Femoral fixation of the graft is performed with a single interference screw, together with the central band of the iliotibial tract, from the outside in, sharing the same bone tunnel, whose entrance is positioned in the topography of the lateral epicondyle (at the level of the origin of the anterolateral ligament). The postoperative protocol includes physiotherapy during the first 4 months, followed by the initiation of muscle strengthening, with clearance for return to sports starting from the 9 th month.
33. Validation of the page-b score as a prognosis of development to hepatocellular carcinoma (HCC) in chronic hepatitis B, in the brazilian population. Arq Gastroenterol. 2025 Dec 1;62:e25009. doi: 10.1590/S0004-2803.24612025-009.
Silva ILV(1), Lins-Kusterer L(2)(3), Silva Júnior WD(3), Fernandes JDC(3), Pacheco SR(2), Cunha SMCFD(2)(3), Salcedo JMV(4), Darzé LFM(3), Paraná R(2)(3), Schinoni MI(1)(2)(3).
Afiliação:
(1) Programa de Pós-Graduação em Processos Interativos de Órgãos e Sistemas - PPGPIOS-UFBA, Salvador, BA, Brasil.
(2) Hospital Universitário Professor Edgard Santos - HUPES, Salvador, BA, Brasil.
(3) Universidade Federal da Bahia - UFBA, Salvador, BA, Brasil.
(4) Centro de Medicina Tropical de Rondônia - CEMETRON, Porto Velho, RO, Brasil.
Resumo: Due to the potential risk for chronic and severe progression, hepatitis B virus (HBV) infection requires antiviral medications, such as Tenofovir (TDF) and Entecavir (ETV), to reduce the HBV viral load and prevent the risk of liver cirrhosis and hepatocellular carcinoma (HCC). The PAGE-B score is a simple and reliable tool for assessing the risk of developing HCC, although it has not yet been validated in Brazil. OBJECTIVE: To validate the PAGE-B risk score for predicting HCC development in HBV carriers in Brazil. To analyze the association between the PAGE-B score and demographic, laboratory, and HBV treatment variables. METHODS: An observational cohort. retrospective study. Study sample - 659 individuals with chronic HBV mono-infection treated with antivirals for at least 3 years at two reference centers in Brazil's Northeast and Amazon regions. The PAGE-B score was used to analyze its association with sex, age, and platelet count, classifying each patient's HCC risk as low, moderate, or high. RESULTS: The mean PAGE-B score was 12.77±5.63. PAGE-B scores were classified as low, moderate, and high in 206 (31.2%), 287 (43.5%), and 166 (25.3%) individuals, respectively. Among the 659 patients, 31 (4.7%) developed HCC, a higher frequency than reported in PAGE-B score validation studies from other countries. Of these patients, 29 were male, with a mean age of 57.4±12.6 years and lower platelet levels (<200,000 10³/mL). Patients who developed HCC had fibrosis stages: F0-F1:6 (19.3%); F2:2 (6.4%); F3:2 (6.4%); and F4:21 (67.7%). High-risk patients were treated with ETV (n=129, 32%) versus TDF (n=37, 14,4%), P<0.00. CONCLUSION: The PAGE-B score demonstrated, in the Brazilian population, a performance similar to that observed in studies with European and Asian populations in terms of sensitivity, specificity, and predictive values for HCC prediction. Based on these results, the PAGE-B score can be used in the Brazilian population to predict the risk of HCC.
34. Bovine pericardial patch with reduced crosslinking time preserves matrix integrity and mitigates calcification in rat subcutaneous tissue Cell Tissue Bank. 2025 Aug 27;26(3):37. doi: 10.1007/s10561-025-10188-x.
Dourado RC(1), de Fátima Giglioti A(2), de Goissis G(3), Araujo RGO(4), Dos Santos SH(4), Morbeck DL(5), Barreto IC(1), Aguiar MC(6)(7).
Afiliação:
(1) Laboratory of Tissue Bioengineering and Biomaterials, Federal University of Bahia, Salvador, Brazil.
(2) Braile Biomedical Industry, Commerce and Representations Ltd., São José do Rio Preto, Brazil.
(3) Biotech Biomedical Ltd., São José do Rio Preto, Brazil.
(4) Laboratory of Analytical Chemistry and Environmental, Federal University of Bahia, Salvador, Brazil.
(5) Department of Anatomic Pathology, University Hospital Professor Edgard Santos, Salvador, Brazil.
(6) Laboratory of Histotechnology, Federal University of Bahia, Salvador, Brazil.
(7) Department of Biomorphology, Institute of Health Sciences, Federal University of Bahia, Salvador, BA.
Resumo: Prosthetic valves derived from bovine pericardium (BP) are crucial for heart valve replacement, yet current crosslinking methods with glutaraldehyde can lead to immune responses and calcification. This study evaluated the effects of reducing the glutaraldehyde crosslinking time from 10 to 5 days in bovine pericardial patches for use as heart valve substitutes. In addition to examining the physical properties of the BP, the study analyzed the biocompatibility, tissue structure, and calcification of the pericardial tissue. BPs were processed using two protocols based on the fixation time with glutaraldehyde: BP10d (10 days) and BP5d (5 days). All samples were treated with glutamic acid to neutralize residual aldehyde groups from the glutaraldehyde. Subsequently, the resulting material was assessed for mechanical and thermal properties and histologically using light and scanning electron microscopy. Post-implantation histological evaluation and calcium content determination were conducted after 7, 14, 30, 60 and 120 days. The calcification was a rare occurrence. However, some samples from the BP10d group displayed positive Von Kossa staining, indicating mineral deposition. Chemical analysis using ICP-OES revealed low calcium concentrations in the explants of both groups, with higher concentrations observed in the BP10d group during the later analysis periods. Mechanical and thermal stability assessments showed no significant differences between experimental groups. Histological examination revealed more collagen and elastic fibers deformation, and inflammation in the BP10d group compared to the BP5d group. The revised manufacturing protocol, with a 5-day fixation time, showed promising anti-calcifying activity, biocompatibility, and tissue preservation.
35. Machine Learning-Based Diagnostic Prediction Model Using T1-Weighted Striatal Magnetic Resonance Imaging for Early-Stage Parkinson's Disease Detection. Acad Radiol.2025 Jul;32(7):4177-4187. doi: 10.1016/j.acra.2025.04.001.
Accioly ARM(1), Menezes VO(2), Calixto LH(3), Bispo DPCF(3), Lachmann M(4), Mourato FA(2), Machado MAD(5), Diniz PRB(6).
Afiliação:
(1) Medical Science Center, Federal University of Pernambuco, Recife, Brazil (A.R.M.A., L.H.C., D.P.C.F.B.).
(2) Nuclear Medicine, Clinical Hospital of Federal University of Pernambuco, Recife, Brazil (V.O.M., F.A.M.).
(3) Medical Science Center, Federal University of Pernambuco, Recife, Brazil (A.R.M.A., L.H.C., D.P.C.F.B.).
(4) Center for Exact and Natural Sciences, Federal University of Pernambuco, Recife, Brazil (M.L.).
(5) Radiology Department, Hospital Universitário Prof. Edgard Santos, Bahia, Brazil (M.A.D.M.).
(6) Telehealth Unit, Medical Science Center, Federal University of Pernambuco, Recife, Brazil (P.R.B.D.).
Resumo: Diagnosing Parkinson's disease (PD) typically relies on clinical evaluations, often detecting it in advanced stages. Recently, artificial intelligence has increasingly been applied to imaging for neurodegenerative disorders. This study aims to develop a diagnostic prediction model using T1-weighted magnetic resonance imaging (T1-MRI) data from the caudate and putamen in individuals with early-stage PD. MATERIALS AND METHODS: This retrospective case-control study included 69 early-stage PD patients and 22 controls, recruited through the Parkinson's Progression Markers Initiative. T1-MRI scans were acquired using a 3-tesla system. 432 radiomic features were extracted from images of the segmented caudate and putâmen in an automated way. Feature selection was performed using Pearson's correlation and recursive feature elimination to identify the most relevant variables. Three machine learning algorithms-random forest (RF), support vector machine and logistic regression-were evaluated for diagnostic prediction effectiveness using a cross-validation method. The Shapley Additive Explanations technique identified the most significant features distinguishing between the groups. The metrics used to evaluate the performance were discrimination, expressed in area under the ROC curve (AUC), sensitivity and specificity; and calibration, expressed as accuracy. RESULTS: The RF algorithm showed superior performance with an average accuracy of 92.85%, precision of 100.00%, sensitivity of 86.66%, specificity of 96.65% and AUC of 0.93. The three most influential features were contrast, elongation, and gray-level non-uniformity, all from the putamen. CONCLUSION: Machine learning-based models can differentiate early-stage PD from controls using T1-weighted MRI radiomic features.
36. Multiple Sclerosis diagnostic delay in a public reference center in Brazil: Related factors and functional impact. Mult Scler Relat Disord. 2025 Jul;99:106503. doi: 10.1016/j.msard.2025.106503.
de Cerqueira Silveira Figueiredo A(1), Eduarda Messias Vassoler M(2), Souza Medrado Nunes G(3), ..., de Jesus PAP(12), Bacellar Pedreira B(13), Oliveira Filho J(14), Gonçalves Fukuda T(15).
Afiliação:
(1) Biomorphology Department, Health Sciences Institute, Federal University of Bahia, Salvador.BA, 40110-100, Brazil.
(2) Biomorphology Department, Health Sciences Institute, Federal University of Bahia, Salvador.BA, 40110-100, Brazil.
(3) Biomorphology Department, Health Sciences Institute, Federal University of Bahia, Salvador.BA, 40110-100, Brazil.
...
(12) Biomorphology Department, Health Sciences Institute, Federal University of Bahia, Salvador.BA, 40110-100, Brazil; Professor Edgard Santos University Hospital (HUPES), Salvador.BA.
(13) Professor Edgard Santos University Hospital (HUPES), Salvador.BA, 40110-060, Brazil.
(14) Biomorphology Department, Health Sciences Institute, Federal University of Bahia, Salvador.BA, 40110-100, Brazil; Professor Edgard Santos University Hospital (HUPES), Salvador.BA, 40110-060, Brazil.
(15) Professor Edgard Santos University Hospital (HUPES), Salvador.BA, 40110-060, Brazil.
Resumo: Early and accurate MS diagnosis followed by prompt intervention is crucial in modifying the disease's natural history. This study aimed to assess the factors related to diagnostic delay in relapsing-remitting MS (RRMS) and its association with functional status. METHODS: A cross-sectional study at a reference center in Bahia, Brazil, carried out from July/2021 to April/2024. Late MS diagnosis was defined as >3 months since the disease's clinical onset. EDSS assessed functional status. RESULTS: A total of 265 patients were included. The median time from symptoms' onset until diagnosis was 7 (IQR, 2-29) months, and 159 patients (60 %) had a late diagnosis. Multivariate logistic regression showed that living outside the metropolitan region, comorbidities, prior misdiagnosis, and disease onset before the McDonald 2017 criteria update were associated with late diagnosis. Meanwhile, disease onset with visual symptoms was related to early diagnosis. Finally, late diagnosis was related to worse functional status in RRMS patients.CONCLUSION: Diagnostic delays in our population are significant, driven by living in cities outside the metropolitan region, comorbidities, previous misdiagnosis, and the use of McDonald's diagnostic criteria before the 2017 update. Understanding this reality is crucial, as timely diagnosis and treatment are essential for a favorable prognosis in RRMS.
37. Comparison between the characteristics and outcomes of patients hospitalized for COVID-19 in three waves of the pandemic: a retrospective analysis. Infect Dis Poverty. 2025 Nov 26;14(1):119. doi: 10.1186/s40249-025-01389-3.
Porto BM(1), Pereira DN(2), Kopittke L(3), Asevedo AA(4), Dos Reis Gomes AG(5), Bhering AR(6), Lima BF(7), da Silva CTCA(8), Marinho CS(9), Pereira EC(10), et al.
Afiliação:
(1) Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, Minas Gerais, CEP 30130-100, Brazil.
(2) Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte, Minas Gerais.
(3) (3)Hospital Nossa Senhora da Conceição, Av. Francisco Trein, 596, Cristo Redentor, Porto Alegre, Rio Grande Do Sul, Brazil.
(4) Hospital Santa Rosália, R. Dr. Onofre, 575, Centro, Teófilo Otoni, Minas Gerais, Brazil.
(5) Hospitais da Rede Mater Dei, Av. Do Contorno, 9000, Barro Preto, Belo Horizonte, Minas Gerias, Brazil.
(6) Hospitais da Rede UNIMED-BH, Av. Do Contorno, 3097, Santa Efigênia, Belo Horizonte, Minas Gerais, CEP 30110-017, Brazil
(7) Orizonti - Instituto de Saúde E Longevidade, Av. José Do Patrocínio Pontes, 1355, Mangabeiras, Belo Horizonte, Minas Gerias, Brazil.
(8) Hospital Santo Antônio, Praça Dr. Márcio Carvalho Lopes Filho, 501, Centro, Curvelo, Minas Gerais, Brazil.
(9) Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, R. Dr. Augusto Viana, S/N, Canela, Salvador, Bahia, Brazil.
(10) Hospital SOS Cárdio, Rodovia, SC-401, 121, Itacorubi, Florianópolis, Santa Catarina, Brazil.
...
Resumo: COVID-19 occurred in successive waves driven by different SARS-CoV-2 variants and shaped by vaccine availability and public health measures. This study analyzes differences in clinical characteristics and outcomes of hospitalized patients across three waves in Brazil. METHODS: This retrospective cohort study included adult COVID-19 patients admitted to 41 hospitals across six Brazilian states from March 2020 to August 2022. Data on demographics, clinical characteristics, and outcomes were collected from medical records and compared across three pandemic waves. Categorical variables were analyzed using Chi-square or Fisher's exact tests, with post hoc Z tests and Bonferroni correction. Continuous variables were analyzed using Analysis of Variance (ANOVA) with Tukey's test or Kruskal-Wallis with Dunn's test and Bonferroni correction. RESULTS: Among 18,632 patients, 37% were hospitalized during the first wave, 55% in the second, and 8% in the third. The median age decreased during the second wave but increased in the third (60 vs 58 vs 66 years; P < 0.001). A higher proportion of patients with three or more comorbidities were admitted during the third wave (15.9% vs 11.9% vs 20.6%; P < 0.001). Anosmia, ageusia, and fever were less frequently reported in the third wave (P < 0.001). Intensive care unit admissions (38.7% vs 37.1% vs 25.5%; P < 0.001) and in-hospital mortality (21.3% vs 23.7% vs 18.2%; P < 0.001) declined throughout the pandemic. CONCLUSION: Clinical manifestations and outcomes evolved across the pandemic waves. The third wave demonstrated fewer chemosensory symptoms, lower severity at admission, and reduced mortality, despite an older and more comorbid patient population.
38. Hip Arthroplasty in Brazil (2014-2024): An Ecological Study of Temporal Trends and Regional Distribution in the Public Health System (SUS). Indian J Orthop. 2025 Oct 10;60(2):438-446. doi: 10.1007/s43465-025-01590-4. eCollection 2026 Feb.
Silva JHV(1)(2), Meyer KA(1).
Afiliação:
(1) Professor Edgard Santos University Hospital, Salvador, Bahia State Brazil.
(2) Av. Reitor Miguel Calmon, S/N-Vale do Canela, Salvador, Bahia State, Brazil.
Resumo: OBJECTIVE: To analyze the temporal trend and regional distribution of hip arthroplasty procedures performed within Brazil's Unified Health System (SUS) between 2014 and 2024, as well as associated costs, hospital stay, and in-hospital mortality.METHODS: This ecological time series study used SIH/SUS data on hip arthroplasties performed between 2014 and 2024. Surgical subgroups were classified according to SIGTAP codes. Annual rates standardized per 100,000 inhabitants were calculated and stratified by regions and states. Temporal trends were assessed using Pearson's correlation. Mean hospital length of stay, annual costs, and in-hospital mortality were also analyzed. RESULTS: There was a progressive increase in national hip arthroplasty rates, from 1.85 to 28.23 per 100,000 inhabitants between 2014 and 2024. A significant upward trend was observed in most regions, notably in the Northeast (r = 0.68; p = 0.02). Marked inequalities were found, with higher rates in the South and Southeast and lower rates in the North and Northeast. Partial hip arthroplasty was the most frequent subgroup, accounting for most emergency procedures and the largest share of financial resources. Mean hospital stay varied among subgroups, with an overall average of 8.46 days. A significant reduction in in-hospital mortality was observed for partial arthroplasty. CONCLUSION: Between 2014 and 2024, there was a substantial increase in hip arthroplasties performed in the SUS, with important regional inequalities and variations in costs and outcomes. These findings underscore the need for public policies to expand equitable access and optimize healthcare resource use.
39. Magnetic resonance imaging in the diagnosis of HTLV-1-associated myelopathy. Arq Neuropsiquiatr. 2025 Jul;83(7):1-8. doi: 10.1055/s-0045-1809935.
Carvalho JM(1)(2), Ferraz SN(1)(2), Abraão Neto J(1)(2), Schnitman S(3), Carvalho AM(1)(2)(4)(5), Carvalho EM(1)(2)(4)(5).
Afiliação:
(1) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Imunologia, Salvador BA, Brazil.
(2) Universidade Federal da Bahia, Programa de Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
(3) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Neurologia, Salvador BA, Brazil.
(4) Instituto Nacional de Ciência e Tecnologia de Doenças Tropicais (INCT-DT), Salvador BA, Brazil.
(5) Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador BA, Brazil.
Resumo: The main neurologic manifestation of definitive human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) is spastic paraparesis, but it only occurs in 5% of the patients. In contrast, about 40% of HTLV-1-infected subjects present symptoms of urologic dysfunction, including nocturia, urgency, and incontinence, which may progress to an inability to void urine. As these patients do not present motor dysfunction, they are classified as probable HAM. Atrophy of the thoracic spinal cord (SC) is the main abnormality found on magnetic resonance image (MRI) scans of patients with definitive HAM, but damage to the SC has not been reported in patients with probable HAM.To determine if, through an evaluation of the metrics of conventional MRI, we can detect a decrease in the area of the SC in patients with probable HAM.Infection by HTLV-1 was herein diagnosed by a Western blot, and the MRI scan was performed using a 1.5-T scanner. Atrophy was considered when the SC area was less than 25% of the intrathecal area.We observed a progressive reduction in all segments of the SC area among HTLV-1 carriers, patients with probable and definitive HAM. Significantly, 48.3% of patients with probable HAM presented atrophy of the lumbar area.Using MRI metrics, the present study shows the atrophy of lumbar segments of the SC area in patients who present urinary symptoms associated with HTLV-1 but without motor dysfunction.
40. Pilot randomized controlled trial of acetylsalicylic acid to reduce cerebral microembolism in Chagas heart failure. Arq Neuropsiquiatr. 2025 Oct;83(10):1-7. doi: 10.1055/s-0045-1812028.
Castello-Branco RC(1), Santana CVC(1), Botelho VLPP(1), deSousa PRSP(1), Nunes MCP(2), Furie KL(3), Oliveira-Filho J(1).
Afiliação:
(1) Universidade Federal da Bahia, Hospital Universitario Professor Edgard Santos, Pós-Graduação em Ciências da Saúde, Salvador BA, Brazil.
(2) Universidade Federal de Minas Gerais, Faculdade de Medicina, Ambulatório de Insuficiência Cardíaca, Belo Horizonte MG, Brazil.
(3) Brown University, Neurology Service, Providence RI, United States.
Resumo: Chagas disease is an important cause of heart failure (HF) and stroke, affecting over 6 million people. High-intensity transient signals (HITS) are detected on transcranial Doppler (TCD) in patients with Chagas disease, but the effect of antithrombotic treatment on HITS is unknown.To evaluate whether acetylsalicylic acid (ASA) reduces the frequency and number of HITS in patients with Chagasic HF.Proof-of-principle pilot prospective, randomized, open, blinded endpoint (PROBE) clinical trial, in which patients with both Chagas and HITS were randomized 2:1 to ASA 300 mg for 7 days and standard HF treatment or standard HF treatment alone (control group). The primary outcome was the proportion of HITS after one week, analyzed using the Chi-squared test.A total of 373 patients with HF were evaluated, with HITS occurring in 22/190 (12%) Chagasic patients and in 16/183 (8%) non-Chagasic patients (p = 0.531). Twelve of the 22 (54%) Chagasic patients were randomized to treatment with (n = 8) or without ASA (n = 4). Two patients in the control group (50%) persisted with HITS after 7 days of treatment, compared to none in the ASA group, p = 0.028. The median number of HITS decreased from 3.5 to 0 with ASA (p = 0.012) and 4.0 to 0.5 in the control group (p = 0.095), with no significant between-group difference (p = 0.262). No adverse events were reported.In the present pilot clinical trial, ASA reduced the proportion of HITS in patients with Chagas disease HF.
41. Effects of immunonutrition on serum albumin, IL-6, and TNF-α levels in patients with COVID-19: a randomized controlled double-blind clinical trial. Nutr Hosp. 2025 Jul 7. doi: 10.20960/nh.05747.
Gomes LC(1), Pimentel RMW(2), Silva AP(3), Santana AIC(4), Ribas Filho D(5), et al.
Afiliação:
(1) Graduate Program in Health Sciences (PPgCs). Faculdade de Medicina. Universidade Federal da Bahia (UFBA). Interprofessional Epidemiology and Health Research Group (GPIES). Universidade do Estado da Bahia (UNEB).
(2) Graduate Program in Health Sciences (PPgCs). Faculdade de Medicina. Universidade Federal da Bahia (UFBA). Interprofessional Epidemiology and Health Research Group (GPIES). Universidade do Estado da Bahia (UNEB). Centro Universitário UNIDOMPEDRO Afya. Hosp.
(3) Interprofessional Epidemiology and Health Research Group (GPIES). Universidade do Estado da Bahia (UNEB).
(4) Interprofessional Epidemiology and Health Research Group (GPIES). Universidade do Estado da Bahia (UNEB). Hospital das Clínicas Professor Edgard Santos. UFBA.
(5) Associação Brasileira de Nutrologia (ABRAN).
...
Resumo: BACKGROUND AND OBJECTIVES: many specialized immunonutrient formulas are available, with an emphasis on combining arginine, omega 3 fatty acids, and nucleotides. These nutrients can reduce the inflammatory pattern, with an increased contribution to resolving infections. Considering the inflammatory catharsis resulting from COVID-19, this study aimed to evaluate the effect of immunonutrition on serum albumin, IL-6, and TNF-α levels in patients with COVID-19. MATERIALS AND METHODS: a randomized double-blind clinical trial conducted in 2020 in Salvador, Bahia, Brazil. Adult patients diagnosed with COVID-19 were randomized to receive a standard hyperproteic normocaloric supplement (control) or a supplement enriched with immunonutrients (experiment) for a period of 07 days. The participants were monitored for a period of 08 days, including the assessment of risk and nutritional status, and collection of blood samples to evaluate albumin, IL-6, and TNF-α. RESULTS: 70 patients were included in the study. 64 were randomly allocated to receive an immunonutrient diet or a standard control diet. The nutritional diagnosis was 27.6 (± 0.8) kg/m² and the nutritional risk was 41.9 %. In the experiment group, there was an average increase in albumin to 0.84 (± 0.65) mg/dL, while in the control group this increase was of 0.21 (± 0.52) mg/dL. Regarding the IL-6 doses, there was a reduction both in the experiment group (-257.27 ± 448.89 pg/ml) and in the control group (-142.75 ± 253.29 pg/ml). When comparing the difference in TNF-α levels, a reduction was observed in the experiment group (-3.72 ± 5.98 pg/ml), while an increase in the control group (5.33 ± 10.48 pg/ml) was observed. CONCLUSIONS: the use of an oral supplement enriched with immunonutrients seems to be able to reduce the IL-6 and TNF-α serum levels and increase serum albumin levels.
42. Obstructive Mullerian Anomaly: Uterus Didelphys with Cervical And Vaginal Agenesis. J Minim Invasive Gynecol. 2025 Jul 18:S1553-4650(25)00249-3. doi: 10.1016/j.jmig.2025.07.009.
Passos I(1), Chagas E(2), Britto R(3).
Afiliação:
(1) University Hospital Professor Edgard Santos, Federal University of Bahia (Drs. Passos, Chagas, Britto), Salvador, Bahia, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (Drs. Passos, Chagas, Britto), Salvador, Bahia, Brazil.
(2) University Hospital Professor Edgard Santos, Federal University of Bahia (Drs. Passos, Chagas, Britto), Salvador, Bahia, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (Drs. Passos, Chagas, Britto), Salvador, Bahia, Brazil.
(3) University Hospital Professor Edgard Santos, Federal University of Bahia (Drs. Passos, Chagas, Britto), Salvador, Bahia, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (Drs. Passos, Chagas, Britto), Salvador, Bahia, Brazil; Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Bahia (Dr. Britto), Salvador, Bahia, Brazil.
Sem Resumo.
43. Brazilian Guideline for the Evaluation and Diagnosis of Chest Pain in the Emergency Department - 2025. Arq Bras Cardiol. 2025 Dec 1;122(9):e20250620. doi: 10.36660/abc.20250620.
Silva PGMBE(1)(2)(3), Soeiro AM(4), ..., Rochitte CE(4), Serrano CV Jr(4), Virgens CMBD(17), Mesquita CT(18), et al.
Afiliação:
(1) Hospital do Coração (Hcor), São Paulo, SP - Brasil.
(2) Brazilian Clinical Research Institute, São Paulo, SP - Brasil.
(3) Centro Universitário São Camilo, São Paulo, SP - Brasil.
(4) Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil.
...
(17) Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, BA - Brasil.
(18) Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil.(19)Hospital Churruca, Buenos Aires - Argentina.
...
Sem Resumo.
44. Invertebrate-Derived DNA (iDNA) to Identify Sand Flies' Bloodmeal: A Molecular Approach to Identifying Hosts in Blood-Feeding Vectors of Leishmaniasis. Microorganisms. 2025 Nov 21;13(12):2650. doi: 10.3390/microorganisms13122650.
Cova BO(1)(2), Saranholi BH(3)(4), Gestich CC(4), Machado PR(1)(2), Monte-Alegre AF(1)(2)(5), Schriefer A(1)(2)(5).
Afiliação:
(1) Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
(2) Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
(3) Instituto Tecnológico Vale, Belém, PA, Brazil.
(4) Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
(5) Departamento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
Resumo: DNA metabarcoding data obtained by next generation sequencing (NGS) has been used to identify species in mixed biological samples, such as DNA from the gut content of invertebrates that feed on vertebrates (invertebrate-derived DNA, iDNA). This investigation employed DNA metabarcoding approach to determine vertebrate hosts of female phlebotomine sand flies, blood-feeding leishmaniasis vectors. We evaluated performance across three mitochondrial markers: a mammal-specific mini-barcode (16S rRNA), a pan-vertebrate mini-barcode (12S rRNA), and a standard CytB barcode region. Phlebotomine sand flies collections occurred in the Cacao Region of Southeastern Bahia, Brazil, an American Tegumentary Leishmaniasis (ATL) endemic zone. Our analysis examined iDNA from forty female specimens pooled in thirteen samples of seven sand fly species, including confirmed ATL vectors. Metabarcoding-derived operational taxonomic units (OTUs) underwent taxonomic assignment through comparison with GenBank NCBI® reference databases. Results identified twenty vertebrate OTUs: primates (four OTUs), rodents (four), ungulates (five), marsupials (one), plus a domestic dog and a chicken. Notably, non-mammalian taxa, including reptiles (one OTU) and amphibians (three), were detected. The iDNA metabarcoding approach allowed us to accurately sample the diversity of phlebotomine sandflies' bloodmeals in a single specimen of a non-engorged female sand fly with mixed feeding.
45. Case Report: Atypical Form of Jaccoud's Arthropathy With Distal Interphalangeal Joints Dislocation. Int J Rheum Dis. 2025 Jul;28(7):e70333. doi: 10.1111/1756-185X.70333.
Figueiroa MLCO(1), Viana IP(2), Sousa APMD(2), Pedreira ALS(1), Santiago MB(1)(2).
Afiliação:
(1) Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
(2) Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.
Sem Resumo.
46. Corrigendum to "Epidemiological and Molecular Analysis of a Rabies Outbreak in the State of Bahia, Brazil" [Acta Tropica, volume 265 (2025) 107617]. Acta Trop. 2025 Sep;269:107739. doi: 10.1016/j.actatropica.2025.107739.
Carneiro AJB(1), Ungar de Sá JE(2), Drexler JF(3), Stöcker A(4), Dos Santos F(5), et al.
Afiliação:
(1) Universidade Federal da Bahia, Escola de Medicina Veterinária e Zootecnia, Salvador, Bahia, Brazil; Ministério da Saúde, Secretaria de Vigilância em Saúde e Ambiente, Departamento de Emergências em Saúde Pública, Brasília, Distrito Federal, Brazil.
(2) Laboratório Central de Saúde Pública (LACEN/BA), Salvador, Bahia, Brazil.
(3) Institute of Virology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
(4) Laboratório de Pesquisa em Infectologia, Hospital Prof. Edgar Santos (HUPES/UFBA), Salvador, Bahia, Brazil.
(5) Universidade Federal da Bahia, Escola de Medicina Veterinária e Zootecnia, Salvador, Bahia, Brazil; Universidade Federal do Oeste da Bahia, Centro Multidisciplinar da Barra, Hospital Veterinário Universitário, Laboratório de GIS e One Health, Barra, Bahia, Brazil.
Erratum for
Acta Trop. 2025 May;265:107617. doi: 10.1016/j.actatropica.2025.107617.
47. Staggered use of sodium nitroprusside and levosimendan in a patient with refractory cardiogenic shock: a case report. Eur Heart J Case Rep. 2025 Aug 29;9(9):ytaf430. doi: 10.1093/ehjcr/ytaf430. eCollection 2025 Sep.
Duraes AR(1)(2), de Souza Lima Bitar Y(1)(2), Gonçalves Oliveira GM(1), Franklin LRV(1),Junior JBVL(1).
Afiliação:
(1) UTI3/Hospital Tereza de Lisieux-Hapvida NotreDame, Av. Antônio Carlos Magalhães, 2408 - Itaigara, Salvador, BA 41825-000, Brazil.
(2) Departamento de Cardiologia/Hospital Universitário Prof Edgar Santos (HUPES)/Universidade Federal da Bahia (UFBa), Salvador, BA, Brazil.
Resumo: Cardiogenic shock (CS) is a complex syndrome characterized by inadequate tissue perfusion due to reduced cardiac output resulting from a wide array of underlying causes. It is generally an acute and devastating condition with short-term mortality ranging from 30% to 40% and 1-year mortality around 50%. CASE SUMMARY: A 31-year-old previously healthy male presented with progressive dyspnoea, fatigue, and signs of low perfusion, ultimately developing CS requiring ICU admission. Transthoracic echocardiography revealed severe left ventricular dysfunction (left ventricular ejection fraction 18%) with diffuse hypokinesia and moderate functional mitral regurgitation (Type IIIb). Despite high-dose inotropic support (dobutamine, milrinone) and vasopressors, the patient remained in refractory shock. A therapeutic trial with sodium nitroprusside led to transient haemodynamic improvement, followed by a secondary deterioration. Due to unavailability of immediate mechanical circulatory support (MCS), levosimendan was initiated at 0.1 μg/kg/min (without loading dose), resulting in rapid and sustained clinical improvement and weaning from vasoactive agents. DISCUSSION: Given the heterogeneous nature of CS and the various physiological derangements, several vasoactive medications may be attempted to try to stabilize or reverse the haemodynamic picture with or without the installation of MCS. These devices have evolved as novel treatment strategies to restore systemic perfusion to allow cardiac recovery in the short-term. But, this case demonstrates the potential of combining vasodilator and inotropic therapies-specifically dobutamine and milrinone with sodium nitroprusside and levosimendan-as a bridge strategy in severe CS when MCS is not feasible.
48. [Tenodesis of the Iliotibial Tract in the Treatment of Lesions of the Anterolateral Knee Complex - Description of a Modified Technique]. Rev Bras Ortop (Sao Paulo). 2025 Nov 10;60(4):s00451811631. doi: 10.1055/s-0045-1811631. eCollection 2025 Aug.
Azi GR(1)(2), Meirelles AV(2)(3), Freitas RRC(1)(2), Fróes Neto JF(2), Mattos ESR(2)(4), Guedes A(2)(5).
Afiliação:
(1) Grupo de Cirurgia do Joelho, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brasil.
(2) Programa de Residência Médica em Ortopedia e Traumatologia, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brasil.
(3) Grupo de Cirurgia do Quadril, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brasil.
(4) Grupo de Cirurgia da Mão, Hospital Santo Antônio, Obras Sociais Irmã Dulce, Salvador, BA, Brasil.
(5) Grupo de Cirurgia do Joelho, Hospital Universitário Professor Edgard Santos, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brasil.
Resumo: Os autores descrevem uma técnica modificada de tenodese extrarticular lateral para o tratamento das lesões do complexo anterolateral do joelho, realizada em associação à reconstrução do ligamento cruzado anterior, utilizando enxerto tendíneo quádruplo de semitendíneo e grácil. A fixação femoral do enxerto é realizada com um único parafuso de interferência, de fora para dentro, compartilhando o mesmo túnel ósseo com a banda central do trato iliotibial. A entrada do túnel é posicionada na topografia do epicôndilo lateral, ao nível da origem do ligamento anterolateral. O protocolo pós-operatório inclui fisioterapia nos primeiros 4 meses, seguida pelo início do reforço muscular, com liberação para a prática esportiva a partir do 9° mês.
49. Treatment of Cutaneous Leishmaniasis with Liposomal Amphotericin B in the Elderly: A Randomized Clinical Trial. Am J Trop Med Hyg. 2025 Nov 4;114(1):105-107. doi: 10.4269/ajtmh.24-0812.
Azouz SF(1)(2)(3), Lago EL(2), Guimarães LH(2)(4)(5), Nolasco S(1)(2)(5), Suprien C(1)(2)(5), Carvalho EM(1)(2)(5), Machado PRL(1)(2)(5).
Afiliação:
(1) Federal University of Bahia-Professor Edgard Santos University Hospital-Immunology Service, Salvador, Brazil.
(2) Reference Center for Cutaneous Leishmaniasis Dr. Jackson Maurício Lopes Costa, President Tancredo Neves, Brazil.
(3) Federal University of Paraíba Medical Sciences Center, João Pessoa, Brazil.
(4) Federal University of Recôncavo Bahia, Santo Antonio de Jesus, Brazil.
(5) National Institute of Science and Technology in Tropical Diseases (INCT-DT), National Council for Scientific and Technological Development (CNPq), Salvador, Brazil.
Resumo: The efficacy, best dosage, and safety of liposomal amphotericin B (LAB) in the treatment of cutaneous leishmaniasis (CL) caused by Leishmania braziliensis in elderly patients was determined by a randomized, controlled trial. We selected 28 patients of both sexes age 60 years old or older with CL diagnosis confirmed by detection of L. braziliensis DNA. The groups were treated with different total doses of LAB (group 1: 12 mg/kg; group 2: 18 mg/kg; and group 3: 24 mg/kg). Clinical and laboratory evaluations were carried out during a period of 180 days (day 0, day 15, day 30, day 60, day 90, and day 180). The highest cure rate (89%) was in group 3 (differences were not statistically significant) along with the lowest incidence of side effects (11%), suggesting that 24 mg/kg is the best dose of LAB to treat CL in elderly patients.
50. Evidence of Spinal Cord Damage in Human T Cell Lymphotropic Virus Type 1-Infected Subjects Without Motor Disability. Am J Trop Med Hyg. 2025 Dec 2;114(2):328-333. doi: 10.4269/ajtmh.25-0126. Print 2026 Feb 4.
Neto JAC(1), Ferraz SN(1), Ladeia-Rocha G(2), de Oliveira CJV(1), Passos L(1), Sá RG(1), Castro N(3), Batista LT(3), Neto CA(2), Oliveira-Filho J(4), Carvalho EM(1)(5).
Afiliação:
(1) Immunology Service, Federal University of Bahia Post-Graduate Program in Health Sciences, Professor Edgard Santos University Hospital, Salvador, Brazil.
(2) Image Memorial/DASA, Salvador, Brazil.
(3) Urology Service, Professor Edgard Santos University Hospital, Salvador, Brazil.
(4) Neurology Service, Professor Edgard Santos University Hospital, Salvador, Brazil.
(5) Gonçalo Moniz Institute, Fiocruz, Brazil.
Resumo: Spinal cord (SC) narrowing has been documented in patients with human T cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM). However, it remains uncertain whether individuals who present with lower urinary tract symptoms (LUTSs) without motor disability (probable HAM) exhibit damage to the central nervous system. These patients typically experience nocturia, urgency, incontinence, and, less frequently, an arreflexic bladder, which requires intermittent catheterization for voiding. The aim for the present study was to investigate the effectiveness of magnetic resonance imaging with tractography in detecting abnormalities in HTLV-1-infected individuals with LUTS. The study participants included those with probable HAM (n = 39), HTLV-1 carriers (HCs; n = 41), and seronegative (SN) controls (n = 12). Magnetic resonance imaging with diffusion tensor imaging and tractography was performed, with two regions of interest positioned side-by-side at T5 and T12-L1. Measurements included the SC area, mean diffusivity, and fractional anisotropy (FA). No significant differences were found between groups regarding age or sex (P >0.05). The medians and interquartile ranges for the thoracic SC area were 0.41 (0.39-0.45), 0.36 (0.30-0.40), and 0.33 (0.27-0.36) in SN controls, HCs, and those with probable HAM, respectively (P <0.05). The lumbar SC area was smaller in patients with probable HAM compared with HCs and SN controls. Furthermore, the median FA in the lumbar region was significantly lower in patients with probable HAM (P <0.05). Urinary dysfunction is the most common manifestation in probable HAM, and the present study reveals SC narrowing in these patients, despite the absence of motor disability.