Infiltrative Treatment of Morton's Neuroma: A Systematic Review.

BACKGROUND: Morton's neuroma (MN) is one of the most frequent neurological pathologies in feet, affecting approximately 4% of the general population. The treatment of MN can be surgical, conservative, and infiltrative, with different substances used in the injections for MN, as steroids, sclerosing solutions, and others. This review aims to evaluate the efficacy of current infiltrative therapy for Morton's neuroma and, additionally, to define adverse effects of this therapy. MATERIAL AND METHODS: A literature search was performed in PubMed, Embase, CINHAL, Epistemonikos, Web of Science (WOS), SPORTSDiscus and Cochrane Library. This search involved the application of all types of infiltrative treatment applicable to MN. The search was limited to original data describing clinical outcomes and pain using the Visual Analogue pain Scale (VAS) or the Johnson Satisfaction Scale, between February and June 2023. RESULTS: Twelve manuscripts were selected (six randomized controlled trials and six longitudinal observational studies) involving 1,438 patients. Capsaicin was reported to produce a VAS score reduction of 51.8%. Corticosteroids also reported a high level of efficacy. Alcohol and Hyaluronic Acid injections are well tolerated, but the effects of their application need further research. There were no serious adverse events. CONCLUSIONS: Corticosteroids, sclerosant injections, hyaluronic acid and capsaicin have been shown to be effective in reducing the pain related to MN.

Optimizing cone-beam computed tomography exposure for an effective radiation dose and image quality balance.

Purpose: The aim of this study was to evaluate the influence of different cone-beam computed tomography (CBCT) acquisition protocols on reducing the effective radiation dose while maintaining image quality. Materials and Methods: The effective dose emitted by a CBCT device was calculated using thermoluminescent dosimeters placed in a Rando Alderson phantom. Image quality was assessed by 3 experienced evaluators. The relationship between image quality and confidence was evaluated using the Fisher exact test, and the agreement among raters was assessed using the kappa test. Multiple linear regression analysis was performed to investigate whether the technical parameters could predict the effective dose. P-values<0.05 were considered to indicate statistical significance. Results: The optimized protocol (3 mA, 99 kVp, and 450 projection images) demonstrated good image quality and a lower effective dose for radiation-sensitive organs. Image quality and confidence had consistent values for all structures (P<0.05). Multiple linear regression analysis resulted in a statistically significant model. The milliamperage (b=0.504; t=3.406; P=0.027), kilovoltage peak (b=0.589; t=3.979; P=0.016) and number of projection images (b=0.557; t=3.762; P=0.020) were predictors of the effective dose. Conclusion: Optimized CBCT acquisition protocols can significantly reduce the effective radiation dose while maintaining acceptable image quality by adjusting the milliamperage and projection images.

Referrals for rheumatologic evaluation following a positive antinuclear antibody test result. A cross-sectional single center Brazilian study.

BACKGROUND: In general, patients are referred for rheumatological evaluation due to isolated laboratory abnormalities, especially antinuclear antibody (ANA) positivity, with the risk of more severe patients remaining on the waiting list for longer than desired. The aim of this study was to analyze the demographic, clinical, and laboratory information of patients referred to a specialized rheumatological care unit because of positive antinuclear antibody. METHODS: This is a retrospective study of 99 out of 1670 patients seen by the same rheumatologist between 01/01/2011 and 01/01/2019. Patients whose referrals were exclusively due to the ANA test result and the specialist's final diagnosis being "abnormal finding of serum immunological test" (ICD-10 R769) were included. Sociodemographic, clinical, and laboratory information were extracted from the consulting rheumatologist's chart. Descriptive statistics were used for data analysis. RESULTS: A total of 99 patients were included, most of whom were female (84.8%) with a median age of 49 years. At the moment of specialist's appointment, 97 patients (97.9%) repeated the ANA test, and 77 patients remained positive. Of these, only 35 (35.35%) were in a high titer range (greater than or equal to 1:320). Complete blood count for cytopenia's investigation was not performed in a high percentage of patients (22.2%), as well as urinalysis (31.3%). In addition, more than 70% of patients score 0 to 1 classification criteria for Systemic Lupus Erythematosus, according to SLE - ACR 1987 (American College of Rheumatology) and SLICC 2012 (Systemic Lupus International Collaborating Clinics). CONCLUSIONS: Most patients are still referred for specialized evaluation due to the misinterpretation of laboratory tests that were inappropriately requested in patients without clinical evidence of autoimmune rheumatic disease.

Morphological comparison of the larynx and trachea of Chelonia mydas (Linnaeus, 1758), Caiman yacare (Daudin, 1802) and Caiman latirostris (Daudin, 1802).

The larynx is in the lower respiratory tract and has the function of protecting the airways, controlling, and modulating breathing, assisting the circulatory system, and vocalizing. This study aims to describe the anatomy and histology of the skeleton of the larynx and trachea of the species Chelonia mydas, Caiman yacare and Caiman latirostris. The study was conducted at the Federal University of Espírito Santo (UFES), using nine specimens of Ch. mydas, 20 of Ca. yacare and four of Ca. latirostris. Samples of the larynx and trachea were collected, fixed, and sent for dissection of the structures and subsequent macroscopic analysis. For histology, samples were processed by the routine paraffin embedding method and stained with hematoxylin-eosin and Verhoeff. For the three species, two arytenoid cartilages, a cricoid cartilage, a hyoid apparatus composed of a base and two horns were found. In Ch. mydas, two structures called thyroid wings were observed, not found in crocodilians. The trachea of crocodilians presented incomplete tracheal rings and musculature, while the trachea of Ch. mydas presented complete tracheal rings. Histologically, the entire cartilaginous skeleton of the larynx of the three species, as well as the tracheal rings, are constituted by hyaline cartilage.

Respiratory and muscular effort during pre-slaughter stress affect Nile tilapia fillet quality.

Nile Tilapia (Oreochromis niloticus) management procedures are directly linked to the final quality of the product. The aim of this study was to evaluate the effect of pre-slaughter density and different stunning methods on biochemical, respiratory and muscle injury parameters associated with quality and sensory characteristics of Nile tilapia fillets. Fish with an average weight of 762±105 g were used, first collected called the control group. The experiment was conducted in a 2 × 2 factorial scheme, with two densities (50 and 300 kg of live weight m-3) and two stunning methods thus totaling four treatments, with 15 repetitions per treatment totaling 75 fish sampled. Blood gas analysis, evaluation of biochemical parameters, analysis of meat quality and sensory analysis were carried out. For blood gas, biochemical and enzymatic parameters, the highest values were obtained for the density of 300 kg m-3 and asphyxia method: partial pressures of CO2; glucose and lactate, the highest values presented were 268.98 and 11.33 mg dL-1 respectively. As well as enzymatic activities, Creatinine kinase (CPK); Creatinine kinase isoenzyme (CKMB) showed higher values (768.93 and 1078.98 mg dL-1 respectively) in the higher density and asphyxia method. Conversely, when evaluating the quality parameters, the highest values were observed for lower density and thermonarcosis. High depuration density (300 kg m-3), combined with the asphyxiation stunning method, promotes changes in respiratory dynamics and provides greater stress, less firm fillet texture and greater weight loss due to cooking, as well as changes in creatine kinase (CK) and its CK-MB isoenzyme, demonstrating greater muscle damage. On the other hand, the density of 50 kg m-3 during pre-slaughter, combined with the method of stunning by thermonarcosis, provide a longer period of permanence in pre rigor mortis, which will result in fillets with a better sensory profile.

Syringomatous tumor of the nipple: a case report.

Syringomatous tumor of the nipple is a benign, locally infiltrative tumor. There are reports in the literature of tumor recurrence in cases of incomplete excision. Clinical and mammographic findings in syringomatous tumors are like those of breast carcinoma and the pathologist has a fundamental role in final tumor diagnosis. Therefore, the aim of this study was to report a case of syringoma located in the areolar region. A 33-year-old woman reported that she had noticed a nodule in her left areolar region 4 years previously (February 2019). A breast ultrasound was performed, detecting intraparenchymatous breast cysts. Surgical resection of the nodule was indicated although it was not performed. Two years later, in August 2021, the patient underwent a mastopexy with prosthesis inclusion. Histopathology study of the surgical specimen revealed a syringomatous tumor with positive margins. Thirteen (13) months after diagnosis (September 3, 2021 - October 16, 2022), the patient is doing well and receives clinical follow-up.

A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV.

Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.

Neuronal Stability, Volumetric Changes, and Decrease in GFAP Expression of Marmoset (Callithrix jacchus) Subcortical Visual Nuclei During Aging.

The physiological aging process is well known for functional decline in visual abilities. Among the components of the visual system, the dorsal lateral geniculate nucleus (DLG) and superior colliculus (SC) provide a good model for aging investigations, as these structures constitute the main visual pathways for retinal inputs reaching the visual cortex. However, there are limited data available on quantitative morphological and neurochemical aspects in DLG and SC across lifespan. Here, we used optical density to determine immunoexpression of glial fibrillary acidic protein (GFAP) and design-based stereological probes to estimate the neuronal number, total volume, and layer volume of the DLG and SC in marmosets (Callithrix jacchus), ranging from 36 to 143 months of age. Our results revealed an age-related increase in total volume and layer volume of the DLG, with an overall stability in SC volume. Furthermore, a stable neuronal number was demonstrated in DLG and superficial layers of SC (SCv). A decrease in GFAP immunoexpression was observed in both visual centers. The results indicate region-specific variability in volumetric parameter, possibly attributed to structural plastic events in response to inflammation and compensatory mechanisms at the cellular and subcellular level. Additionally, the DLG and SCv seem to be less vulnerable to aging effects in terms of neuronal number. The neuropeptidergic data suggest that reduced GFAP expression may reflect morphological atrophy in the astroglial cells. This study contributes to updating the current understanding of aging effects in the visual system and stablishes a crucial foundation for future research on visual perception throughout the aging process.

Mapping of SINEs in the genome of Proechimys (Mammalia: Rodentia).

This study aimed to analyze the distribution of short interspersed elements (SINEs) in the chromosomes of five species of rodents of the genus Proechimys and in a variant karyotype of P. guyannensis. Molecular cytogenetic techniques were used to characterize the sequences of the B1, B4, MAR and THER SINEs, which were used as probes for hybridization in metaphase chromosomes. A wide distribution of SINEs was observed in the chromosomes of the Proechimys species examined, thus indicating differentiation of these retroelements. The signal of the B4 SINE was more evident than that of the B1 SINE, especially in P. echinothrix, P. longicaudatus, and P. cuvieri. Although the signal of the MAR SINE was more explosive than that of the THER SINE, in the species P. echinothrix, P. guyannensis (2n = 46) and P. longicaudatus, its distribution in the karyotypes was similar. The signals of these retroelements occurred at specific heterochromatic sites and were centromeric/pericentromeric and at the terminal regions in most chromosomes. This appears to be a typical distribution pattern of the SINEs and may indicate involvement with rearrangements during karyotypic diversification in Proechimys. The variation of the SINEs in the genome of Proechimys species demonstrates that these elements are distributed in a specific way in this genus and the preference for some sites, considered hotspots for chromosomal breakage, allows us to propose that these elements are related to the karyotypic evolution of Proechimys.

Allelopathic effects of cyanotoxins on the physiological responses of Chlorella vulgaris.

Contributing to the assessment of potential physiological changes in microalgae subjected to different concentrations and types of cyanotoxins, this study investigated the inhibitory effects of cyanotoxins on the growth, density, biomass, and ecotoxicity of Chlorella vulgaris. Chlorella vulgaris was exposed to crude extracts of cyanobacteria producing microcystin-LR (MC-LR), saxitoxin (SXT), anatoxin-a (ATX-A), and cylindrospermopsin (CYN) with initial concentrations of 5.0, 2.05, 0.61, and 1.42 µg.L-1, respectively. The experiments were conducted under controlled conditions, and monitoring of growth and cell inhibition occurred at 24h, 48h, 72h, and 96h. Chlorophyll-a content and ecotoxicity assessment were conducted with samples collected after 96h of exposure to cyanotoxins. The growth assays of Chlorella vulgaris, with results expressed in terms of average growth rates (doublings/day), indicated the following order for cyanotoxins: SXT (2.03) > CYN (1.66) > MC-LR (1.56) > ATX-A (0.18). This assay revealed the prominent inhibitory potential of ATX-A on Chlorella vulgaris growth compared to the other toxins evaluated. Regarding the inhibition of the photosynthetic process, expressed in terms of the percentage inhibition of Chlorophyll-a, the following order for cyanotoxins was obtained: ATX-A (82%) > MC-LR (76%) > STX (46%) > CYN (16%). These results also indicated that among the cyanotoxins, ATX-A was the most detrimental to the photosynthetic process. However, contrary to the observations in the growth study, SXT proved to be more harmful than CYN in terms of Chlorophyll-a inhibition. Finally, the results of the toxicity assay revealed that only ATX-A and MC-LR exerted a chronic influence on Chlorella vulgaris under the investigated conditions.

Gastrointestinal nematodes in Cuniculus paca (Linnaeus, 1766) from hunting fauna in the Western Amazonian region.

Cuniculus paca, commonly known as the paca, is a rodent of the Cuniculidae family that is widely distributed throughout the Americas, including all Brazilian territories, and is abundant in the Amazon region. It is one of the most hunted species and faces significant predation in the extreme western Amazon region of Brazil because it constitutes a staple in the diet of local communities, for subsistence and commercial purposes. Understanding the helminthic fauna of these animals is of paramount importance, given that some nematodes have zoonotic potential and may pose risks to consumer health. This study aimed to contribute to the records of the nemtodes of this highly consumed species in the Amazon region, highlighting the occurrence of gastrointestinal parasites in free-living pacas intended for human subsistence consumption. The study was conducted in the Paranã da Floresta community, located in the municipality of Guajará, Amazonas from 2022 to 2023. The community members hunted this rodent for consumption and voluntarily provided the viscera for analysis. Nematodes were extracted from each organ. The organs were opened, and the contents were processed using a sieve (0.15 mm) and subsequently evaluated separately. In total, 10,157 nematodes were found in the 14 pacas. Based on morphological analyses, the nematodes were identified as Heligmostrongylus sedecimradiatus (n = 10,068), Trichuris sp. (n = 85), and Physaloptera sp. (n = 4). This study provides insights into the nematodes diversity of free-living pacas in the extreme Western Amazon region, emphasizing the importance of sanitary surveillance and public awareness of the risks associated with bushmeat consumption.

BUB1B monoallelic germline variants contribute to prostate cancer predisposition by triggering chromosomal instability.

BACKGROUND: Prostate cancer (PrCa) is the most frequently diagnosed cancer in men. Variants in known moderate- to high-penetrance genes explain less than 5% of the cases arising at early-onset (< 56 years) and/or with familial aggregation of the disease. Considering that BubR1 is an essential component of the mitotic spindle assembly checkpoint, we hypothesized that monoallelic BUB1B variants could be sufficient to fuel chromosomal instability (CIN), potentially triggering (prostate) carcinogenesis. METHODS: To unveil BUB1B as a new PrCa predisposing gene, we performed targeted next-generation sequencing in germline DNA from 462 early-onset/familial PrCa patients and 1,416 cancer patients fulfilling criteria for genetic testing for other hereditary cancer syndromes. To explore the pan-cancer role of BUB1B, we used in silico BubR1 molecular modeling, in vitro gene-editing, and ex vivo patients' tumors and peripheral blood lymphocytes. RESULTS: Rare BUB1B variants were found in ~ 1.9% of the early-onset/familial PrCa cases and in ~ 0.6% of other cancer patients fulfilling criteria for hereditary disease. We further show that BUB1B variants lead to decreased BubR1 expression and/or stability, which promotes increased premature chromatid separation and, consequently, triggers CIN, driving resistance to Taxol-based therapies. CONCLUSIONS: Our study shows that different BUB1B variants may uncover a trigger for CIN-driven carcinogenesis, supporting the role of BUB1B as a (pan)-cancer predisposing gene with potential impact on genetic counseling and treatment decision-making.

Diagnostic capability of artificial intelligence tools for detecting and classifying odontogenic cysts and tumors: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the diagnostic capability of artificial intelligence (AI) for detecting and classifying odontogenic cysts and tumors, with special emphasis on odontogenic keratocyst (OKC) and ameloblastoma. STUDY DESIGN: Nine electronic databases and the gray literature were examined. Human-based studies using AI algorithms to detect or classify odontogenic cysts and tumors by using panoramic radiographs or CBCT were included. Diagnostic tests were evaluated, and a meta-analysis was performed for classifying OKCs and ameloblastomas. Heterogeneity, risk of bias, and certainty of evidence were evaluated. RESULTS: Twelve studies concluded that AI is a promising tool for the detection and/or classification of lesions, producing high diagnostic test values. Three articles assessed the sensitivity of convolutional neural networks in classifying similar lesions using panoramic radiographs, specifically OKC and ameloblastoma. The accuracy was 0.893 (95% CI 0.832-0.954). AI applied to cone beam computed tomography produced superior accuracy based on only 4 studies. The results revealed heterogeneity in the models used, variations in imaging examinations, and discrepancies in the presentation of metrics. CONCLUSION: AI tools exhibited a relatively high level of accuracy in detecting and classifying OKC and ameloblastoma. Panoramic radiography appears to be an accurate method for AI-based classification of these lesions, albeit with a low level of certainty. The accuracy of CBCT model data appears to be high and promising, although with limited available data.

Mediterranean Dietary Pattern for Healthy and Active Aging: A Narrative Review of an Integrative and Sustainable Approach.

The global population is on a trajectory of continuous growth, with estimates projecting an increase from 7.7 billion in 2019 to approximately 9.7 billion by 2050. Longevity is also expected to rise rapidly, with advancements in healthcare contributing to increased life expectancies and an increase in the maximum lifespan. The aging process is accompanied by different changes, often leading to a decline in daily life activities and an increased susceptibility to disease. Age-related changes can cause cellular damage and subsequent cellular death. Oxidative stress and inflammation play significant roles in this process contributing to molecular damage and mitochondrial dysfunction. Active aging has been associated with improved quality of life and a reduced risk of morbidity and premature mortality. In this context, the Mediterranean diet has emerged as a promising approach to promoting healthy aging and sustainability. The phytochemical compounds within the Mediterranean diet have been linked to a lower risk of developing cardiovascular disease, type 2 diabetes, obesity, cancer and neurodegenerative diseases. The findings of peer-reviewed articles regarding the use of the Mediterranean diet as a healthy and sustainable dietary pattern written in Portuguese, Spanish or English were included in this narrative literature review. This dietary pattern's emphasis on the consumption of fresh and local food aligns with both health and environmental sustainability goals. This work provides a comprehensive review of the benefits of the Mediterranean diet and its components in a healthy aging process and highlights the importance of this dietary pattern as a sustainable approach.

Fibrin Network and Platelets Densities in Platelet-Rich Fibrin (PRF) Membranes Produced from Plastic Tubes Without Additives: A New Approach to PRF Clinical Use.

Background/Purpose: The present study aimed to investigate plastic tubes without additives as alternatives to glass and silica-coated plastic tubes, in the production of PRF membranes. Materials and Methods: Nine blood samples were collected from eight volunteers (n = 8) separated into three groups, according to tube material: glass, silica-coated plastic, and plastic without additives. In each group, the samples were centrifuged using different relative centrifugation forces: L-PRF (700 g/12 min), A-PRF (200 g/14 min), and A-PRF + (200 g/8 min). The generated membranes were evaluated by histomorphometry, considering the fibrin network, platelet aggregates, and cellular morphology, by light microscopy. The ultrastructural cellular morphology integrity was evaluated by transmission electron microscopy. Results: The L-PRF (p < 0.019) and A-PRF (p < 0.001) membranes showed a significantly lower fibrin network density in plastic tubes without additives compared to glass and silica-coated plastic tubes. Plastic tubes without additives revealed a significantly higher platelet percentage, regardless of the protocol (p < 0.005). In all groups, TEM analysis showed preserved normal morphological ultrastructure, maintaining the integrity of cellular components. Conclusion: Plastic tubes without additives offer a viable alternative for producing PRF membranes. They exhibited a higher platelet density and demonstrated fibrin network and cellular morphology similar to those of glass and silica-coated plastic tubes, irrespective of the centrifugation protocol.

Anticonvulsant and anxiolytic-like potential of the essential oil from the Ocimum basilicum Linn leaves and its major constituent estragole on adult zebrafish (Danio rerio).

The Ocimum species present active compounds with the potential to develop drugs for treating chronic disease conditions, such as anxiety and seizures. The present study aims to investigate the anticonvulsant and anxiolytic-like effect of the essential oil from O. basilicum Linn (OEFOb) leaves and its major constituent estragole (ES) in vivo on adult zebrafish (aZF) and in silico. The aZF were treated with OEFOb or ES or vehicle and submitted to the tests of toxicity, open-field, anxiety, and convulsion and validated the interactions of the estragole on the involvement of GABAergic and serotonergic receptors by molecular docking assay. The results showed that the oral administration of OEFOb and ES did not have a toxic effect on the aZF and showed anxiolytic-like effects with the involvement of GABAA, 5-HT1, 5-HT2A/2C and 5-HT3A/3B as well on anxiety induced by alcohol withdrawal. The OEFOb and ES showed anticonvulsant potential attenuating the seizures induced by pentylenetetrazole (PTZ) by modulation of the GABAA system. Both anxiolytic and anticonvulsant effects were corroborated by the potential of the interaction of ES by in silico assay. These study samples demonstrate the pharmacological evidence and potential for using these compounds to develop new anxiolytic and anticonvulsant drugs.

Health education website on home care for newborns: construction, validation, and evaluation.

OBJECTIVE: to build, validate, and evaluate an educational health website on home care for newborns for use by pregnant women, postpartum women, and family members. METHOD: methodological study developed according to the Analyze, Design, Develop, Implement, and Evaluate model. After construction, the website was validated by 20 experts and evaluated by 20 individuals from the target audience, and the data wasanalyzed according to the Concordance Index with a cut-off point equal to or greater than 0.7 (70%). RESULTS: in the validation, the Concordance Index for all the items was higher than 0.7 (70%), with a variation between 0.75 (75%) and 1 (100%), reaching an overall average value of 0.91 (91%). In the evaluation, all the items got top marks, with anoverall average value of 1 (100%). CONCLUSION: the educational website was built, validated, and evaluated in a satisfactory manner. It can be considered an appropriate tool for its purpose, with benefits in the teaching-learning process for families regarding postnatal home care fornewborns through its use. It can also be used to educate students and health professionals. The website is available for free access via laptops, computers, smartphones, or tablets.

Influences on COVID-19 Vaccine Adherence among Pregnant Women: The Role of Internet Access and Pre-Vaccination Emotions.

INTRODUCTION: The onset of the COVID-19 pandemic brought about global uncertainties and fears, escalating the dissemination of fake news. This study aims to analyze the impact of fake news on COVID-19 vaccine adherence among pregnant women, providing crucial insights for effective communication strategies during the pandemic. METHODS: A cross-sectional, exploratory study was conducted with 113 pregnant women under care at a Women's Health Reference Center. Data analysis included relative frequency and odds ratio to assess the relationship between sociodemographic and behavioral variables regarding vaccination. RESULTS: In the behavioral context of vaccination, internet access shows a significant association with decision-making, influencing vaccine refusal due to online information. Nuances in the odds ratios results highlight the complexity of vaccine hesitancy, emphasizing the importance of information quality. Pre-vaccination sentiments include stress (87.61%), fear (50.44%), and anxiety (40.7%), indicating the need for sensitive communication strategies. DISCUSSION: Results revealed that pregnant women with higher education tend to adhere more to vaccination. Exposure to news about vaccine inefficacy had a subtle association with hesitancy, while finding secure sources was negatively associated with hesitancy. The behavioral complexity in the relationship between online information access and vaccination decision underscores the need for effective communication strategies. CONCLUSIONS: In the face of this challenging scenario, proactive strategies, such as developing specific campaigns for pregnant women, are essential. These should provide clear information, debunk myths, and address doubts. A user-centered approach, understanding their needs, is crucial. Furthermore, ensuring information quality and promoting secure sources are fundamental measures to strengthen trust in vaccination and enhance long-term public health.