Complicações da comunicação buco-sinusal em cirurgias bucais: fatores de riscos, complicações e intervenções / Complications of oral-sinusal communication in oral surgery: risk factors and interventions

A comunicação buco-sinusal, uma conexão direta entre boca e seios maxilares, ocorre comumente pela extração de dentes próximos ao seio maxilar e outros procedimentos. O diagnóstico precoce é crucial para prevenir complicações graves. A abordagem terapêutica varia conforme o tamanho do defeito, presença de infecção e localização específica. Realizou-se uma breve revisão de literatura qualitativa abordando as principais complicações da comunicação buco sinusal na cirurgia bucal e como intervi-las. Buscou-se artigos científicos indexados nas seguintes bases de dados: Google Scholar, Pubmed e Biblioteca Scielo com lapso temporal de 2013 a 2023. Foram utilizados para esta busca os seguintes descritores: Comunicação buco-sinusal; Complicações; Seio maxilar. Os critérios de inclusão desta pesquisa foram artigos em inglês, português e espanhol, sendo selecionados 26 trabalhos. Os principais critérios de exclusão foram artigos com mais de 10 anos de publicação. A prevenção e gestão eficaz das complicações na comunicação oral em cirurgias são essenciais. Identificar fatores de risco, usar técnicas cirúrgicas precisas e agir imediatamente diante de sinais de comunicação com os seios da face são medidas cruciais para garantir a segurança do paciente e aprimorar os resultados cirúrgicos.

Oral-sinusal communication, a direct connection between the mouth and maxillary sinuses, commonly occurs due to the extraction of teeth close to the maxillary sinus and other procedures. Early diagnosis is crucial to prevent serious complications. The therapeutic approach varies according to the size of the defect, presence of infection and specific location. A brief qualitative literature review was carried out looking at the main complications of oral sinus communication in oral surgery and how to intervene. We searched for scientific articles indexed in the following databases: Google Scholar, Pubmed and Scielo Library with a time span from 2013 to 2023. The following descriptors were used for this search: Oral-sinus communication; Complications; Maxillary sinus. The inclusion criteria for this study were articles in English, Portuguese and Spanish, and 26 papers were selected. The main exclusion criteria were articles published more than 10 years ago. The prevention and effective management of oral communication complications during surgery are essential. Identifying risk factors, using precise surgical techniques and acting immediately in the event of signs of communication with the sinuses are crucial measures to ensure patient safety and improve surgical outcomes.

Aplicabilidade das estratégias para prevenção e diagnóstico precoce do câncer de boca: uma revisão guarda-chuva / Applicability of strategies for prevention and early diagnosis of oral cancer: an umbrella review

O câncer de boca é o sexto câncer mais comum em todo o mundo e representa um problema global crescente. Apesar disso, 70% desses cânceres são diagnosticados em estágios avançados, reforçando a importância de estratégias para prevenção e detecção precoce do câncer. Este trabalho tem como objetivo investigar a aplicabilidade de estratégias para detecção precoce do câncer de boca. Como existem diversas revisões sistemáticas já publicadas sobre o tema, a proposta é realizar uma revisão guarda-chuva das revisões sistemáticas. As buscas realizadas nas bases de dados resultaram em 2145 artigos, e outras fontes de informações acrescentaram mais 114 artigos. Após a detecção de artigos duplicados eletrônica e manualmente, em conjunto com a primeira fase da revisão, 83 artigos foram selecionados para a segunda fase da revisão. Por fim, 46 revisões sistemáticas foram incluídas neste estudo, tendo 9 artigos sido considerados confiáveis para sumarização da evidência atual. Artigos cuja estratégia foi de exame clínico convencional realizado por profissionais treinados e estudos em que houve um maior acesso dos indivíduos à saúde bucal, apresentaram um resultado mais preciso, confiável e custo-efetivo na avaliação dos grupos de indivíduos de alto risco. Em geral, os métodos auxiliares que apresentaram resultados promissores foram aqueles à base de autofluorescência e citopatologia. As estratégias de rastreamento não devem ser descartadas, uma vez que ainda há uma carência de estudos de alta qualidade nesse tema.

Role of histopathological, serological and molecular findings for the early diagnosis of treatment failure in leprosy.

BACKGROUND: Treatment failure (TF) in leprosy following multidrug therapy (MDT) presents a significant challenge. The current World Health Organization (WHO) fixed-duration MDT regimen, based on lesion count, might not be adequate. Leprosy lacks clear-cut objective cure criteria, and the predictive value of post-MDT histopathological findings remains uncertain. This study aims to identify predictive factors for TF among leprosy patients who have completed the WHO-recommended MDT. METHODS: An analysis was conducted on 80 individuals from a national leprosy reference center, comprising 40 TF cases (with a mean relapse at 13.0 months) and 40 controls (with a mean of 113.1 months without disease signs). Various epidemiological and clinical-laboratory parameters were assessed post-MDT. RESULTS: In skin samples, the presence of foamy granuloma (OR = 7.36; 95%CI2.20-24.60; p = 0.0012) and histological bacillary index (hBI) ≥ 1+ (OR = 1.55; 95%CI1. 22-1.99; p = 0.0004) were significantly associated with TF, with odds ratios of 7.36 and 1.55, respectively. Individuals who experienced TF had a mean hBI of 3.02+ (SD ± 2.02), while the control group exhibited a mean hBI of 1.8+ (SD ± 1.88). An hBI ≥ 3 + showed a sensitivity of 73% and a specificity of 78% for TF detection (AUC: 0.75; p = 0.0001). Other histopathological features like epithelioid granulomas, and skin changes did not show significant associations (p > 0.05). Additionally, higher anti-phenolic glycolipid-I (anti-PGL-I) ELISA index (EI) levels were linked to a 1.4-fold increased likelihood for TF (OR = 1.4; 95%CI1.13-1.74; p = 0.0019). A mean EI of 4.48 (SD ± 2.80) was observed, with an EI ≥ 3.95 showing a sensitivity of 79% and a specificity of 59% for TF detection (AUC: 0.74; p = 0.0001). Moreover, the presence of Mycobacterium leprae (M. leprae) DNA in real-time polymerase chain reaction (qPCR) was associated with a 3.43-fold higher likelihood of TF. Multivariate regression analysis indicated that concurrent presentation of neural/perineural lymphocytic infiltrate, foamy granuloma, hBI ≥ 1+, and EI ≥ 1 markedly increased the likelihood of TF by up to 95.41%. CONCLUSION: Persistence of nerve-selective lymphocytic infiltrate, foamy granulomas, and bacilli in skin biopsies, and elevated EI post-MDT, may serve as predictive factors for identifying individuals at higher probability of TF.

Plan of action to strengthen the surveillance and control of leishmaniasis in the Americas 2023–2030

In order to update, systematize and monitor the leishmaniasis actions at the operational level, this new version of the Plan of Action for the period of 2023-2030 has been developed, which contains actions for the surveillance, assistance and control of leishmaniases in the Region. The main elements discussed include evidence, cost, cost-effectiveness of available interventions, access to and analysis of epidemiological and process data, as well as the organization of health services in the countries of the Americas. In addition, the goals and indicators of the Plan were developed based on technical discussions, consensus, orientations and suggestions made by experts, researchers and professionals responsible for actions to fight the disease in endemic countries. The proposed targets for leishmaniases control in the Region are ambitious and will require countries and partners interested in providing support to work hard and achieve them. The actions proposed in this Plan were developed based on the diagnosis of the disease situation in the Region, where leishmaniasis was initially divided into two groups according to its clinical form: cutaneous and mucosal leishmaniasis and visceral leishmaniasis. Both differ in the species of Leishmania, vectors, reservoirs, and clinical presentation, as well as in the socioeconomic and environmental characteristics that determine the risks and different transmission cycles, leading to different surveillance and control actions. These actions are focused on early diagnosis, adequate treatment and follow-up of affected people, surveillance, prevention, and control of human cases, vector, and reservoirs, when required, along with education and communication efforts.

Comparative analysis of classical artificial intelligence and deep learning models for atrial fibrillation detection in electrocardiograms

BACKGROUND/INTRODUCTION: Early diagnosis of atrial fibrillation (AF) presents a challenging yet critical task for appropriate interventions aimed at reducing disease-related burden. In this context, strategies employing classical artificial intelligence (CAI) and deep learning (DL) have emerged as promising approaches to optimize cardiac disorder screening and detection. PURPOSE: This study aimed to compare a CAI model and a DL model for the detection of AF in patients undergoing electrocardiographic (ECG) examinations in tertiary healthcare centers. METHODS: Between December 2022 and November 2023, a total of 135,476 ECGs were performed, comprising 5,067 with AF and 130,409 without AF. The ECGs were analyzed using both artificial intelligence models. The obtained results were then compared to the gold standard (cardiologist's report). In the CAI model, signals were extracted from ECG images, analyzing five key parameters: cardiac rhythm, atrial depolarization, atrioventricular conduction, ventricular depolarization, and ventricular repolarization (figure 1A). These parameters were benchmarked against the standard values from the Brazilian Society of Cardiology guidelines for detecting cardiac anomalies. Conversely, the DL model utilized a one-dimensional ResNet-based Convolutional Neural Network (CNN). This model was trained using ADAM optimization and binary cross-entropy loss, enabling the learning of complex patterns in the data (figure 1B). RESULTS: The mean age was 54.6 years (71.9 years with AF and 53.9 without AF). In the AF population, 52.2% were male (46% were male in the overall sample). In the analysis conducted, the CAI model showed a sensitivity and specificity of 90% and 62%, respectively, while the DL model had 90% and 69%, respectively. ROC curves were generated for both models, demonstrating the superior performance of the DL model (figure 2A). CONCLUSIONS: Although the sensitivity remained similar between the models, the DL model distinguished itself with higher specificity. These results suggest that artificial intelligence, particularly the deep learning approach, holds promise as a supportive resource in AF diagnosis. However, further studies are needed to evaluate the models more thoroughly and determine their clinical applicability in a broader context.

Recomendaciones para el manejo de la enfermedad pulmonar post tuberculosis / Recommendations for the Management of Post Tuberculosis Lung Disease

Introducción: Los esfuerzos de la lucha contra la tuberculosis (TB) se centran habitualmente en un diagnóstico precoz y un tratamiento eficaz y oportuno para romper la cadena de transmisión de Mycobacterium tuberculosis. Sin embargo, en los últimos años, coincidiendo con la asociación sindémica TB/COVID-19, han aparecido cada vez más evidencias sobre las graves secuelas clínicas, funcionales y psicosociales que puede ocasionar la TB, condición que se ha definido como enfermedad pulmonar post-tuberculosis (PTLD). Aproximadamente, un tercio de los pacientes que sobreviven a la TB se enfrentan a esto, incluyendo síntomas respiratorios persistentes con exacerbaciones episódicas, insuficiencia respiratoria crónica, trastornos emocionales y desafíos psico-sociales que impactan negativamente en la calidad de vida y enfrentan un alto costo catastrófico. Objetivo: Proporcionar un modelo compartido, orientador y científicamente válido para diagnosticar, evaluar y tratar en forma oportuna a los pacientes con PTLD (prevención, diagnóstico, tratamiento y posible rehabilitación). Metodología: Es una investigación documental que incluye revisiones sistemáticas, meta-análisis, estudios observacionales y de las directrices existentes en los últimos años al respecto, sumado a una evaluación por expertos en el tema, con el propósito de adaptarlas a las condiciones locales de cada país latinoamericano. Conclusiones: Considerando la carga mundial, particularmente, latinoamericana de TB, y la carga estimada de la PTLD, se considera urgente el desarrollo de un consenso sobre este tema. Creemos que las recomendaciones de ALAT proporcionarán la base para la formulación y adopción de directrices nacionales para el manejo del PTLD en Amé- rica Latina.

Introduction: Efforts to combat tuberculosis (TB) usually focus on early, rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, coinciding with the syndemic TB/COVID-19 association, more and more evidence has proved the serious clinical, functional and psycho-social sequelae that TB can cause. This condition has been defined as Post-Pulmonary Disease Tuberculosis (PTLD) and it affects approximately one-third of the patients who survive TB, facing persistent respiratory symptoms with episodic exacerbations, chronic respiratory failure, emotional disorders and psychosocial challenges that negatively impact their life quality, meaning a high catastrophic cost. Objective: Provide a shared, guiding and scientifically valid model to promptly diagnose, evaluate and treat patients with PTLD (prevention, diagnosis, treatment and possible rehabilitation). Methodology: It is documentary research that includes systematic reviews, meta-analysis, observational studies and the guidelines that have existed in recent years in this regard, added to an evaluation by experts, with the purpose of adapting them to local conditions of each Latin American country. Conclusions: Considering the global and, particularly, the Latin American burden of TB, and the estimated burden of PTLD, the development of a consensus document on this topic is urgent. Therefore, we think ALAT recommendations will provide the basis for the formulation and adoption of national specific guidelines for the management of PTLD in Latin America.

Plano de ação para fortalecer a vigilância e o controle das leishmanioses nas Américas, 2023-2030

Com o objetivo de atualizar, sistematizar e monitorar as ações de leishmaniose em nível operacional, foi desenvolvida esta nova versão do Plano de Ação para o período de 2023-2030, que contém ações de vigilância, assistência e controle das leishmanioses na Região. Os principais elementos discutidos incluem evidências, custo, custo-efetividade das intervenções disponíveis, acesso e análise de dados epidemiológicos e de processo, assim como a organização dos serviços de saúde nos países das Américas. Além disso, as metas e indicadores do Plano foram desenvolvidos com base em discussões técnicas, consensos, orientações e sugestões feitas por especialistas, pesquisadores e profissionais responsáveis pelas ações de combate à doença em países endêmicos. As metas propostas para o controle das leishmanioses na Região são ambiciosas e exigirão que os países e parceiros interessados em fornecer apoio trabalhem arduamente para alcançá-las. As ações propostas foram formuladas com base no diagnóstico da situação da Região, que envolveu a definição de indicadores de processo, epidemiológicos e operacionais, para avaliar a evolução e monitorar a doença com vistas a melhorias palpáveis. Essas ações têm como foco o diagnóstico precoce, o tratamento e acompanhamento adequado das pessoas afetadas, a vigilância, a prevenção e o controle de casos humanos, vetores e reservatórios, quando necessário, e tudo isso deve ser agregado ao trabalho de educação e comunicação.

Plan nacional para las personas con trastorno por déficit de atención e hiperactividad, en el marco de la Ley N° 30956, Ley de protección de las personas con trastorno de déficit de atención e hiperactividad (TDHA) 2024-2027 / National plan for people with attention deficit and hyperactivity disorder, within the framework of Law No. 30956, Law for the Protection of People with Attention Deficit and Hyperactivity Disorder (TDHA) 2024-2027

El plan contiene los objetivos y las actividades a desarrollar durante el periodo 2024-2027 para ofrecer servicios de detección y diagnóstico precoz, atención y tratamiento a las personas con TDAH, atención y orientación sobre el TDAH a los familiares y cuidadores de las personas que lo presentan, e inclusión social y educativa que integre la cultura, el deporte, la recreación, en el marco del modelo de atención comunitaria en salud mental

Revolutionizing early Alzheimer's disease and mild cognitive impairment diagnosis: a deep learning MRI meta-analysis.

BACKGROUND: The early diagnosis of Alzheimer's disease (AD) and mild cognitive impairment (MCI) remains a significant challenge in neurology, with conventional methods often limited by subjectivity and variability in interpretation. Integrating deep learning with artificial intelligence (AI) in magnetic resonance imaging (MRI) analysis emerges as a transformative approach, offering the potential for unbiased, highly accurate diagnostic insights. OBJECTIVE: A meta-analysis was designed to analyze the diagnostic accuracy of deep learning of MRI images on AD and MCI models. METHODS: A meta-analysis was performed across PubMed, Embase, and Cochrane library databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, focusing on the diagnostic accuracy of deep learning. Subsequently, methodological quality was assessed using the QUADAS-2 checklist. Diagnostic measures, including sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and area under the receiver operating characteristic curve (AUROC) were analyzed, alongside subgroup analyses for T1-weighted and non-T1-weighted MRI. RESULTS: A total of 18 eligible studies were identified. The Spearman correlation coefficient was -0.6506. Meta-analysis showed that the combined sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.84, 0.86, 6.0, 0.19, and 32, respectively. The AUROC was 0.92. The quiescent point of hierarchical summary of receiver operating characteristic (HSROC) was 3.463. Notably, the images of 12 studies were acquired by T1-weighted MRI alone, and those of the other 6 were gathered by non-T1-weighted MRI alone. CONCLUSION: Overall, deep learning of MRI for the diagnosis of AD and MCI showed good sensitivity and specificity and contributed to improving diagnostic accuracy.

ANTECEDENTES: O diagnóstico precoce da doença de Alzheimer (DA) e do comprometimento cognitivo leve (CCL) continua sendo um desafio significativo na neurologia, com métodos convencionais frequentemente limitados pela subjetividade e variabilidade na interpretação. A integração da aprendizagem profunda com a inteligência artificial (IA) na análise de imagens de ressonância magnética surge como uma abordagem transformadora, oferecendo o potencial para insights diagnósticos imparciais e altamente precisos. OBJETIVO: Uma metanálise foi projetada para analisar a precisão diagnóstica do aprendizado profundo de imagens de ressonância magnética em modelos de DA e CCL. MéTODOS: Uma metanálise foi realizada nos bancos de dados das bibliotecas PubMed, Embase e Cochrane seguindo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), com foco na precisão diagnóstica do aprendizado profundo. Posteriormente, a qualidade metodológica foi avaliada por meio do checklist QUADAS-2. Medidas diagnósticas, incluindo sensibilidade, especificidade, razões de verossimilhança, razão de chances diagnósticas e área sob a curva característica de operação do receptor (area under the receiver operating characteristic curve [AUROC]) foram analisadas, juntamente com análises de subgrupo para ressonância magnética ponderada em T1 e não ponderada em T1. RESULTADOS: Um total de 18 estudos elegíveis foram identificados. O coeficiente de correlação de Spearman foi de -0,6506. A metanálise mostrou que a sensibilidade e a especificidade combinadas, a razão de verossimilhança positiva, a razão de verossimilhança negativa e a razão de chances de diagnóstico foram 0,84, 0,86, 6,0, 0,19 e 32, respectivamente. A AUROC foi de 0,92. O ponto quiescente do resumo hierárquico da característica de operação do receptor (hierarchical summary of receiver operating characteristic [HSROC]) foi 3,463. Notavelmente, as imagens de 12 estudos foram adquiridas apenas por ressonância magnética ponderada em T1, e as dos outros 6 foram obtidas apenas por ressonância magnética não ponderada em T1. CONCLUSãO: Em geral, a aprendizagem profunda da ressonância magnética para o diagnóstico de DA e CCL mostrou boa sensibilidade e especificidade e contribuiu para melhorar a precisão diagnóstica.

Suplementação de ácidos graxos ômega-3 na saúde cognitiva de idosos: revisão integrativa / Omega-3 Fatty Acid Supplementation in Cognitive Health of Older Adults: Integrative Review / Suplementación de ácidos grasos ômega-3 em la salud cognitiva de adultos mayores: revisión integradora

Introdução:O envelhecimento da população está associado ao aumento da prevalência de demências, incluindo a doença de Alzheimer. O diagnóstico precoce é crucial para intervenções terapêuticas eficazes. Estudos recentes investigam o impacto da suplementação de ácidosgraxos ômega-3 na função cognitiva de idosos, devido à falta de tratamentos farmacológicos conhecidos para prevenir ou retardar o início da demência. Objetivo:Analisar os resultados de diversos estudos sobre a suplementação de ácidos graxos ômega-3 na função cognitiva de idosos. Metodologia:Revisão integrativa da literatura a partir das bases de dados BVS, PubMed e Scielo nos últimos dez anos (2013-2023), a partir dos descritores: (Fatty Acids, Omega-3) AND (Cognitive Aging) sem restrição quanto ao idioma e de acesso livre. Foram identificados 107 artigos, dos quais, 32 foram analisados e 14 utilizados nesta revisão. Resultados:O ômega-3, encontrado em peixes e oleaginosas, está associado à saúdecognitiva, especialmente os componentes EPA e DHA. Fatoresgenéticos, como o gene APO E4, podem influenciar sua eficácia na prevenção de doenças como Alzheimer. Estudos variam sobre seus benefícios na cognição em idosos, com resultados mistos. Conclusões:Os estudos revisados apresentam achados divergentes sobre os efeitos da suplementação de ácidos graxos ômega-3 na função cognitiva de idosos. Enquanto alguns sugerem benefícios, outros não identificam diferenças significativas (AU).

Introduction:The aging population is associated with an increased prevalence of dementia, including Alzheimer's disease. Early diagnosis is crucial for effective therapeutic interventions. Recent studies are investigating the impact of omega-3 fatty acid supplementation on the cognitive function of older adults, due to the lack of known pharmacological treatments to prevent or delay dementia onset. Objective:To analyze the results of various studies on omega-3 fatty acid supplementation in the cognitive function of older adults. Methodology:Integrative literature review from the databases BVS, PubMed, and Scielo in the last ten years (2013-2023), using the descriptors: (Fatty Acids, Omega-3) AND (Cognitive Aging) with no language restrictions and open access. A total of 107 articles were identified, of which 32 were analyzed, and 14 were used in this review. Results:Omega-3, found in fish and nuts, is associated with cognitive health, especially the EPA and DHA components. Genetic factors, such as the APO E4 gene, may influence its effectiveness in preventing diseases like Alzheimer's. Studies vary on its benefits in cognition in older adults, with mixed results. Conclusions:The reviewed studies present conflicting findings on the effects of omega-3 fatty acid supplementation on the cognitive function of older adults. While some suggest benefits, others do not identify significant differences (AU).

Introducción: El envejecimiento de la población está asociado con un aumento en la prevalencia de demencia, incluida la enfermedad de Alzheimer. El diagnóstico temprano es crucial para intervenciones terapéuticas efectivas. Estudios recientes investigan el impacto de la suplementación de ácidos grasos omega-3 en la función cognitiva de adultos mayores, debido a la falta de tratamientos farmacológicos conocidos para prevenir o retrasar el inicio de la demencia. Objetivo:Analizar los resultados de diversos estudios sobre lasuplementación de ácidos grasos omega-3 en la función cognitiva de adultos mayores. Metodología: Revisión integrativa de la literatura en las bases de datos BVS, PubMed y Scielo en los últimos diez años (2013-2023), utilizando los descriptores: (Ácidos Grasos Omega-3) Y (Envejecimiento Cognitivo) sin restricciones de idioma y de acceso abierto. Se identificaron un total de 107 artículos, de los cuales se analizaron 32 y se utilizaron 14 en esta revisión. Resultados: El omega-3, presente en pescados y frutos secos, está asociado con la salud cognitiva, especialmente los componentes EPA y DHA. Factores genéticos, como el gen APO E4, pueden influir en su eficacia para prevenir enfermedades como el Alzheimer. Los estudios varían en cuanto a sus beneficios en la cognición en adultos mayores, con resultados mixtos. Conclusiones:Los estudios revisados presentan hallazgos contradictorios sobre los efectos de la suplementación con ácidos grasos omega-3 en la función cognitiva de adultos mayores. Mientras que algunos sugieren beneficios, otros no identifican diferencias significativas (AU).

Patients Journey Before Early Rheumatoid Arthritis Diagnosis Contributes to disease's Activity Level: A Real-Life Study.

INTRODUCTION: The help-seeking process in rheumatoid arthritis (RA) patients is challenging, and its study is limited in Latin America. The study describes the real-life journey before patients' incorporation into an early arthritis clinic (EAC) and its impact on baseline and 1-year cumulative disease activity levels. PATIENTS AND METHODS: The patient's journey was assessed through a questionnaire that captured the patient's path from the first disease-related symptom to the initial assessment in the EAC. A disease activity (28 joints evaluated)-erythrocyte sedimentation rate (DAS28-ESR) score >5.1 defined a high-disease activity level. The mean of individual consecutive DAS28-ESR scores summarized cumulative DAS28-ESR. Multiple logistic regression analysis identified factors associated with a DAS28-ESR score >5.1 at the first assessment. Linear regression analysis assessed the impact of general practitioner (GP)-first consultant and time on disease-modifying antirheumatic drugs (DMARDs) on baseline and cumulative DAS28-ESR scores. RESULTS: Through January 2023, the EAC had 241 RA patients, among whom 209 (86.7%) completed the patients' journey questionnaire (PJQ) and 176 (84.2%) at least 1 year of follow-up. A GP was the first consultant in 76.6% of the patients, and only 12.4% were prescribed DMARDs. Patients had additional evaluations with either rheumatologists (38.6%) or other specialists (31.6%), and half of them were initiated DMARDs. GP-first consultant (adjusted odds ratio: 2.314, 95% confidence interval: 1.190-4.500, p = 0.013) and time on DMARDs (adjusted odds ratio: 0.738, 95% confidence interval: 0.585-0.929, p = 0.010) were associated with baseline DAS28-ESR score >5.1. The B coefficient magnitudes for GP-first consultant and time on DMARDs to predict cumulative DAS28 progressively decreased during the first year of follow-up. CONCLUSIONS: Patients' journey before recent-onset RA diagnosis predicts first-year disease activity levels.

Metal Nanoparticle-Based Biosensors for the Early Diagnosis of Infectious Diseases Caused by ESKAPE Pathogens in the Fight against the Antimicrobial-Resistance Crisis.

The species included in the ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and the genus Enterobacter) have a high capacity to develop antimicrobial resistance (AMR), a health problem that is already among the leading causes of death and could kill 10 million people a year by 2050. The generation of new potentially therapeutic molecules has been insufficient to combat the AMR "crisis", and the World Health Organization (WHO) has stated that it will seek to promote the development of rapid diagnostic strategies. The physicochemical properties of metallic nanoparticles (MNPs) have made it possible to design biosensors capable of identifying low concentrations of ESKAPE bacteria in the short term; other systems identify antimicrobial susceptibility, and some have been designed with dual activity in situ (bacterial detection and antimicrobial activity), which suggests that, in the near future, multifunctional biosensors could exist based on MNPs capable of quickly identifying bacterial pathogens in clinical niches might become commercially available. This review focuses on the use of MNP-based systems for the rapid and accurate identification of clinically important bacterial pathogens, exhibiting the necessity for exhaustive research to achieve these objectives. This review focuses on the use of metal nanoparticle-based systems for the rapid and accurate identification of clinically important bacterial pathogens.

Integrated Approaches and Practical Recommendations in Patient Care Identified with 5q Spinal Muscular Atrophy through Newborn Screening.

In recent years, significant progress has been made in 5q Spinal Muscular Atrophy therapeutics, emphasizing the importance of early diagnosis and intervention for better clinical outcomes. Characterized by spinal cord motor neuron degeneration, 5q-SMA leads to muscle weakness, swallowing difficulties, respiratory insufficiency, and skeletal deformities. Recognizing the pre-symptomatic phases supported by screening and confirmatory genetic tests is crucial for early diagnosis. This work addresses key considerations in implementing 5q-SMA screening within the Brazilian National Newborn Screening Program and explores Brazil's unique challenges and opportunities, including genetic tests, time-to-patient referral to specialized centers, program follow-up, and treatment algorithms. We aim to guide healthcare professionals and policymakers, facilitating global discussions, including Latin American countries, and knowledge-sharing on this critical subject to improve the care for newborns identified with 5q SMA.

Hidden leprosy in a low-endemic area in southern Brazil: changes in endemicity following an active search.

BACKGROUND: Leprosy, a neglected tropical disease, is reported in over 120 countries, with upwards of 200,000 new cases annually. This Cross-Sectional Cohort Study aimed to delineate the epidemiological profile of leprosy in a low-endemic area in southern Brazil, both before and after implementing an active search strategy. METHODS: The study examined two surveillance periods in Caçador, Santa Catarina, Brazil. The active search strategy was carried out through the application of the LSQ by the community health workers as a screening and detection tool for new cases of leprosy and this was compared with passive case detection. The first spanned from 2014 to 2020, and the second from January 2021 to August 2023. FINDINGS: 48 leprosy cases were reported throughout the study, 83.3 % of which were diagnosed as multibacillary. The first period had an average detection rate of 0.38 cases per 10,000 inhabitants, increasing to 1.19 cases per 10,000 inhabitants in the second period. Notably, there was a substantial shift in the degree of physical disability (GD), with more Grade 0 and Grade 1 disabilities observed post-active search. MAIN CONCLUSIONS: The study underscores the efficacy of active search strategies in early diagnosis, highlighting a 300 % increase in the annual average of diagnosed cases. This large number of detected cases demonstrates the high sensitivity of the LSQ. This approach significantly aids in uncovering hidden cases of leprosy, enhancing disease management and control in low-endemic areas indicating that the Ministry of Health should intensify leprosy control activities in these regions.

Expanding access to malaria diagnosis and treatment

All malaria-endemic countries in the Region of the Americas have taken on the challenge of eliminating the disease and have focused their health programs and strategies on that goal. This technical note provides guidance on actions to expand access to malaria diagnosis and treatment. Access to diagnosis is the foundation of the entire response to the disease. Despite repeated calls and efforts emphasizing the importance of early diagnosis and treatment for malaria elimination in the Americas, significant gaps remain. Lack of detection and/or late detection of cases undoubtedly continue to be factors that perpetuate malaria transmission in the Region. In areas with malaria transmission, diagnosis and treatment need to be available as close to people as possible: at the first point of contact with the health system, and in hard-to-reach areas, within the community itself. The Pan American Health Organization (PAHO) proposes a framework for action to improve access to malaria diagnosis and treatment based on expanded access to diagnosis, including expanded use of rapid diagnostic tests (RDTs) and immediate comprehensive treatment. This framework considers diagnostic methods and antimalarial drugs to be public goods. To achieve this change in malaria operations, it will be necessary to involve many more actors from the health system, affected communities, and society in general in malaria diagnosis and treatment. This strategy calls for an expansion of the diagnosis-treatment (DT) component of the Diagnosis, Treatment, Investigation, and Response (DT-IR) strategy that PAHO and partners in the Region have been promoting for malaria elimination in the Americas.

Early diagnosis and aggressive surgical resection matters to cure rhinocerebral mucormycosis: Six case reports.

Rhino-cerebral mucormycosis (RM) is a rare and opportunistic fungal infection observed in immune-compromised patients and metabolic imbalances such as Diabetes Mellitus. RM rapidly infiltrates blood vessels, leading to vascular thrombosis, subsequent tissue necrosis, and high mortality rates (23.6-60%). Due to its fast advancement, RM is a life-threatening condition requiring accurate clinical decisions by the medical and surgical teams. Based on the report of six cases, we emphasize the need for an early diagnosis and starting antifungal pharmacological therapy at the slightest suspicion of RM. Moreover, the restitution of metabolic balance and aggressive surgical debridement are vital steps to control RM, reducing the possibility of fatal outcomes.

Early Detection and Intervention for Children with High Risk of Cerebral Palsy: A Survey of Physical Therapists and Occupational Therapists in Brazil.

AIMS: The purpose of this study was to assess the current clinical practice of physiotherapists and occupational therapists on early detection and early intervention for children with cerebral palsy (CP) in Brazil. METHODS: This was a cross-sectional study. A purpose-developed electronic survey was disseminated across the country to physiotherapists and occupational therapists working with young children with or at risk of CP. RESULTS: A total of 205 anonymous respondents were included. Most participants (64.4%) agree that the diagnosis of CP can be made before 6 months of age. General Movements Assessment (26.8%) and Hammersmith Infant Neurological Examination (37.1%) were used infrequently. Infants at risk for CP receive therapy twice a week or more by 58.5% of therapists, 93.2% identified parents' goals as the most important factor in customizing the early intervention program. The most frequent intervention strategies for this age group were active stimulation of the child (n = 182), family training (n = 161), strategies to optimize the environment (n = 143), and neurodevelopmental treatment/Bobath (n = 99). CONCLUSIONS: Currently, pediatric physiotherapists and occupational therapists in Brazil do not fully incorporate best practice tools for early identification of children with CP, nor sufficient best evidence-based interventions.

Improving Accessibility to Patients with Interstitial Lung Disease (ILD): Barriers to Early Diagnosis and Timely Treatment in Latin America.

Delayed initiation of effective antifibrotic therapy in patients with interstitial lung diseases (ILD) may influence the progression and outcome of the disease. This study analyzes the differences in the journey of patients with ILD in the Brazilian and Mexican health systems. An evaluative study was conducted in reference centers for interstitial lung diseases in Brazil and Mexico with a panel of four specialists. The patient's journey in both countries begins when the patient seeks medical care after observing a chronic respiratory symptom. In both countries, due to diagnostic complexity, these patients arrive at ILD referral centers at an advanced stage of the disease. Once diagnosis is established, the treatment onset differs between Mexico and Brazil. In Brazil, access to antifibrotic drugs through the public health system has been a significant challenge, and their cost makes them unaffordable for most people. This situation forces medical specialists to provide only supportive care to patients until these drugs can be accessed. In Mexico, antifibrotics have been available in health sectors since 2018. Brazil and Mexico have several similarities regarding the initial journey of the patient due to diagnosis difficulties. Still, the outcome tends to be different due to a difference in access to treatment with antifibrotics. For this reason, advancing health policies that ensure proper treatment for patients with ILD is crucial for the sustainability and reliability of the health system.