Abstract The years 2020 and 2021 were peculiar due to the coronavirus disease 2019 (COVID-19) pandemic, which may also have had an impact on people with colorectal cancer (CRC). In the state of Bahia, Brazil, Hospital Aristides Maltez (HAM) is responsible for most of the oncological care, including malignant neoplasms of colon and rectum. Considering that most of metastatic CRC cases are no longer curable, evaluate if there was an increase in the proportion of that stage of disease can serve as a metric of the impact of this epidemic. Retrospective analysis of HAM's electronic medical records of patients with CRC that had their first consultation during the first 12 months of COVID-19 epidemic at Bahia, in comparison to those that had their first consultation during the 12 previous months. Main characteristics of both groups were similar. Median age was 63 years old, with near representation of both genders, and predominance of brown skin color and a low level of education. However, in the first year of COVID-19 epidemic, there was a 26.89% increase of subjects with already metastatic CRC in the first medical evaluation at HAM (although without statistical significance). We found a numerical increase in metastatic CRC in the COVID period cohort. In consonance with this, another Brazilian study found an increase in the proportion of new cases of advanced CRC, between March and July 2020, in comparison to the same period in 2019. Moreover, in another publication, an increase in colorectal cancer mortality in USA is projected due to delays in screening and diagnosing during the COVID-19 pandemic. These results urge attention to CRC in the following years and in the next pandemic.

ABSTRACT Although cohort studies are essential for understanding health outcomes over time, they often face challenges in participant retention, particularly in contexts of social vulnerability. The return of results to participants has emerged as an ethical and methodological strategy capable of strengthening the bond with participants and reducing loss to follow-up. This article presents the experience of the birth cohort conducted by the Brazilian Center for Early Child Development (CPAPI), in which a Satisfaction Questionnaire was administered to mothers participating in the six-month follow-up stage. The findings identify individual feedback as the primary motivating factor for participants to remain in the study. However, standardized guidelines for institutionalizing this practice are still lacking. We argue that the return of results, beyond being an ethical commitment established in regulatory frameworks, can serve as an effective tool for participant retention in longitudinal studies. Thus, it contributes to the quality and legitimacy of scientific production.

Cytomegalovirus (CMV) remains a significant challenge in kidney transplantation. Despite prophylactic and preemptive antiviral strategies, clinical practices vary widely. This study assessed CMV diagnostic and monitoring practices in Brazilian kidney transplant centers, focusing on access to diagnostic tools, therapeutic thresholds, and logistical barriers. A nationwide electronic survey was conducted between August and October 2024, targeting all kidney transplant programs (TP) registered with the Brazilian Society of Organ Transplantation (ABTO). A total of 35 TP (20.6% response rate) participated, representing 62% of kidney transplants performed in Brazil in 2023. While most centers had CMV management protocols (94.3%), significant variability was observed in the initiation of preemptive therapy (PET). Among high-risk patients (D+/R-), 41.9% followed predefined thresholds. Specific cut-off values were applied in 71.0% of R+ patients and in 45.2% of the low-risk group (D-/R-). Quantitative PCR was the primary diagnostic method (97.1%), with whole blood (60%) and plasma (34.3%) as preferred sample types. A significant proportion of CMV TP (60%) relied on outsourced laboratories for CMV diagnostics, with 82.4% experiencing turnaround times exceeding three days for results. Only 8.6% TP had access to molecular testing for CMV-resistant strains. This survey reveals substantial variability in CMV diagnosis and management among Brazilian kidney transplant centers, with limited diagnostic access and delays due to reliance on outsourced laboratories. Expanding diagnostic capacity and standardizing guidelines are essential to improving patient outcomes.

ABSTRACT We evaluated the potential of Landsat Next’s planned band configuration to discriminate among five pasture degradation classes in central Brazil. Hyperspectral data from the Environmental Mapping and Analysis Program (EnMAP) were used to simulate the spectral resolution of the innovative Landsat Next mission, planned for 2031, specifically 18 of its 21 reflective bands. Other past and current multispectral missions were also considered as part of a strategy to represent a progressive increase in the number of spectral bands and coverage across the 400–2500 nm range. Classification with the Light Gradient Boosting Machine (LightGBM) and band reflectance focused on Non-degraded pastures (NDP) and four degradation levels: Low-intensity (LID), Moderate-intensity (MID), Severe agronomic (SAD), and Severe biological (SBD). The results showed the importance of the Landsat Next red-edge and shortwave infrared (SWIR) multispectral bands, particularly those near 740 nm, 1600 nm and beyond 2000 nm, in distinguishing different levels of pasture degradation. Overall classification accuracy ranged from 0.63 for sensors limited to the visible and near-infrared (VNIR) to 0.74 for instruments covering both VNIR and SWIR regions. All simulations achieved F1-scores above 0.86 for NDP. For SAD, the highest F1-score was observed with Landsat Next (0.68). For SBD, only Landsat Next achieved good classification performance (F1-score = 0.60), attributable to its three additional narrow bands centred at 2038 nm, 2108 nm, and 2211 nm. These bands captured signs of clay mineral absorption bands linked to increased soil exposure caused by vegetation depletion through biological processes.

The thermalscapes of urban consumption: Informal shading practices in a hot Brazilian city centre

Despite advances in cardiovascular surgery, access to specialized care remains limited in low-resource regions. Telemedicine, which expanded significantly during the COVID-19 pandemic, offers a strategy to mitigate these disparities. The National Teleconference Platform (TAC) was developed to provide real-time, multidisciplinary telementoring for pediatric congenital heart surgery in remote areas. This prospective, multicenter study assessed the feasibility, usability, and effectiveness of the TAC platform. The system integrated videoconferencing with Internet of Things (IoT) technologies, enabling synchronous audiovisual communication, real-time monitoring of surgical equipment, and interactive mentorship. Three Brazilian centers from the North, Northeast, and Southeast regions participated. Telementoring encompassed the entire surgical workflow, from anesthesia induction to postoperative debriefing, with data security compliant with national and international standards. Between November 2022 and March 2025, 50 pediatric cardiac procedures were performed with complete telementoring in 93% of cases, and no technical failures occurred. Each operating room incorporated seven connected devices. User evaluations revealed high satisfaction: 76% of surgical teams reported increased confidence, 92% preserved autonomy throughout procedures, and all participants highlighted the substantial educational value of the platform. The TAC platform is feasible, effective, and well-accepted for providing multidisciplinary surgical guidance. It optimizes procedural performance, enhances surgical care, and demonstrates significant potential to expand access to specialized healthcare in resource-limited settings.

Shallow caves in karst regions pose significant hazards to engineering works, particularly to linear infrastructures such as highways, due to the risk of sudden ground collapse. Although conventional subsurface investigation methods, which are generally destructive, are widely used, they do not allow for the complete characterization of large areas, reinforcing the importance of nondestructive geophysical techniques such as Ground Penetrating Radar (GPR). Grounded in concepts of karst geomorphology and in the operation of the GPR method, this study evaluates the applicability of the technique for detecting shallow subsurface cavities. The main characteristics of karst environments and the fundamentals of GPR are presented. To support field investigations and data interpretation, a computational simulation of GPR responses was performed using the gprMax software, based on a real case identified during the construction of highway BR-414/GO, located in a limestone region in central Brazil. The results confirm the suitability of GPR as a nondestructive technique for detecting shallow cavities in limestone terrains and highlight the contribution of numerical modeling to radargram interpretation and to understanding the performance of the method in this type of environment.

Let’s talk: Conservation scientists and stakeholders joining hands for biodiversity in Central Brazil

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event without effective treatment, just recommended dose reduction, interruption, or modification of the chemotherapy regimen. We conducted a randomized controlled study to evaluate the therapeutic effects of acupuncture. Sixty patients with stage I, II, and III breast cancer who developed CIPN due to neoadjuvant or adjuvant paclitaxel were randomized 1:1 to receive true vs sham acupuncture once per week for 8weeks. The primary outcome was the response to Neuropathic Pain Symptom Inventory (NPSI), and the secondary outcomes were Visual Analog Scale (VAS) and Functional Assessment of Cancer Therapy-Taxane Version 4 (FACT-taxane) quality of life scale. The questionnaires were administered during weeks 1, 4, 6, and 8 (in person) and week 12 (by telephone). For the primary outcome, there were statistically significant differences at week 8 favoring the true acupuncture group for the subscales pressure pain (mean 0.11 vs 0.33; p = 0.01), paroxysmal pain (mean 0.13 vs 0.30; p = 0.037), paresthesia/dysesthesia (mean 0.21 vs 0.43; p = 0.007) and the total score (mean 0.14 vs 0.33; p = 0.02). Regarding secondary outcomes on the VAS scale, there was statistically significant difference favoring the true acupuncture group at visit 8 (mean 3.0 vs 6.0; p = 0.001), but without differences in FACT-taxane, either total score or subscales. There were no differences in any of the outcomes at week 12. CIPN-related symptoms in patients with breast cancer who received paclitaxel were reduced by true acupuncture compared with sham acupuncture in the eighth week (ClinicalTrials.gov ID NCT04461977).

Chronic GvHD is a major cause of non-relapse morbidity and mortality after hematopoietic cell transplantation. Its incidence has increased due to more frequent use of unrelated and/or mismatched donors, reduced intensity conditioning regimens or intensified regimens and PBSC grafts. The first-line therapy for chronic GvHD is systemic corticosteroids associated with either CNI or sirolimus, as a steroid sparing agent. Since children are more susceptible to the long-term steroid side effects, development of steroid-free strategies for front-line therapy is crucial. Sirolimus seems to be an interesting choice due to its capacity of inhibiting T-cells preserving the Tregs cells and antifibrotic, antineoplastic and antiviral activities. FAM regimen (Fluticasone, Azitromycin and Montelucaste) is recommended in combination with systemic steroids for initial treatment of bronchiolitis obliterans. For steroid-refractory chronic GvHD, ruxolitinib is the standard of care, while extracorporeal photopheresis can be combined for better results, however treatment costs are limitations. Extracorporeal photopheresis, treatment that preserves graft-versus-leukemia effect due to its steroid sparing and immunomodulatory actions, and mesenchymal stem cells, another non-pharmacological strategy that can be combined with the options mentioned above in severe chronic GvHD. Since access to novel drugs and extracorporeal photopheresis or mesenchymal stem cells is tough, other options approved for the third line and beyond are ibrutinib, belumosudil and axatilimab. Conventional agents could be used such as imatinib, low dose-MTX, rituximab, however the expected response rates are lower. We reviewed clinical studies and published recommendations on pediatric chronic GVHD that were presented in debate rounds with GvHD experts of the Pediatric group of the Sociedade Brasileira de Terapia Celular e Transplante de Medula Óssea (SBTMO). The goal of this consensus is to standardize the prophylaxis, diagnosis, grading and treatment of chronic GvHD among Brazilian pediatric HCT centers, to improve post-transplant outcomes.

Strongyloides stercoralis in type 2 diabetes mellitus: discordant stool and serologic findings in an endemic Brazilian population.

Few studies have conducted the prevalence of obesity in cat populations and the associated risk factors by assessing cats in their homes, regardless of whether they had visited a veterinary hospital. Moreover, such studies are scarce in Latin America, and, to date, few census-based, in-home epidemiological assessment of feline obesity has been conducted in Brazil. This study aimed to estimate the prevalence of obesity in owned cats in the metropolis of Goiânia, Goiás, Brazil, and to assess the presence of risk factors related to the animals, their owners, the home environment, and cat management practices. A cross-sectional study was conducted with 188 cats and their owners, using geographically stratified household sampling. The animals were categorized based on body condition score (BCS) as underweight, ideal weight, overweight, or obese, and prevalence rates were calculated. The BCS was investigated for its association with animal, owner, environmental, and management characteristics using the Kruskal-Wallis test (α = 5%). Subsequently, characteristics with p ≤ 0.05 were analyzed as potential risk factors for overweight or obesity using binary logistic regression. Kappa analysis was used to determine the agreement between the BCS determined by veterinarians and the owners’ perception of their cats’ body condition. The prevalence of overweight and obesity in cats was 28.7%. Factors related to age and activity level, type of household, as well as the owners’ education and occupation, were identified as risk factors for the development of overweight or obesity in the study cat population. Additionally, protective factors against overweight and obesity were identified, including the number of cats in the household, the location of the household, and the owners’ perception of their own diet. The agreement between the actual BCS of the animals and the owners’ perception of their cats’ body condition was considered low.

ABSTRACTIntroductionCharacterized as relatively isolated communities, many Brazilian quilombos were formed during the period of slavery in Brazil when enslaved persons (most of African descent) ran away or were abandoned by their enslavers. Quilombos in Central Brazil, whose settlement was more recent due to the relative isolation of the region, remain understudied. To address this gap, this study estimated the genetic ancestry of three quilombo communities in Central Brazil.MethodsA cross‐sectional study was performed among three Central Brazilian quilombos, Cocalinho (N = 54) and Pé do Morro (N = 58) located in the Brazilian state of Tocantins, and Kalunga (N = 132) located in the state of Goiás. Genetic ancestry was estimated from 61 Ancestry‐informative INDEL biallelic markers collected from blood samples and analyzed using STRUCTURE v 2.3. Statistical analyses were performed using SAS statistical software, v. 9.4.ResultsThe population demonstrated heterogeneous genetic admixture by quilombo. Average African admixture estimates were 36.75%, 29.82%, and 63.17% in Cocalinho (semirural), Pé do Morro (urban), and Kalunga (rural) communities, respectively. Indigenous and European ancestry contributions also varied by quilombo, with participants from the more recently populated quilombos and those living closest to urban areas having higher European and Indigenous genetic ancestry contributions.ConclusionsThis study demonstrates that quilombos comprise rich population histories shaped by culture, historical events, and sociodemographic and environmental interactions. By unraveling the genetic tapestry of Central Brazil's quilombos, this study contributes to a deeper understanding of Brazil's intricate social and historical landscape.

Few studies have conducted the prevalence of obesity in cat populations and the associated risk factors by assessing cats in their homes, regardless of whether they had visited a veterinary hospital. Moreover, such studies are scarce in Latin America, and, to date, few census-based, in-home epidemiological assessment of feline obesity has been conducted in Brazil. This study aimed to estimate the prevalence of obesity in owned cats in the metropolis of Goiânia, Goiás, Brazil, and to assess the presence of risk factors related to the animals, their owners, the home environment, and cat management practices. A cross-sectional study was conducted with 188 cats and their owners, using geographically stratified household sampling. The animals were categorized based on body condition score (BCS) as underweight, ideal weight, overweight, or obese, and prevalence rates were calculated. The BCS was investigated for its association with animal, owner, environmental, and management characteristics using the Kruskal-Wallis test (α = 5%). Subsequently, characteristics with p ≤ 0.05 were analyzed as potential risk factors for overweight or obesity using binary logistic regression. Kappa analysis was used to determine the agreement between the BCS determined by veterinarians and the owners' perception of their cats' body condition. The prevalence of overweight and obesity in cats was 28.7%. Factors related to age and activity level, type of household, as well as the owners' education and occupation, were identified as risk factors for the development of overweight or obesity in the study cat population. Additionally, protective factors against overweight and obesity were identified, including the number of cats in the household, the location of the household, and the owners' perception of their own diet. The agreement between the actual BCS of the animals and the owners' perception of their cats' body condition was considered low.

Climate extremes and the dynamic reshaping of snail habitat: implications for the spatiotemporal heterogeneity of schistosomal vulnerability in Brazil.

Speleothem-based reconstruction of Holocene changes in monsoonal patterns and environmental conditions in Central Brazil

ABSTRACTNeurological manifestations remain a significant cause of hospitalization and in-hospital mortality among people living with HIV (PLWH), even in the era of antiretroviral therapy (ART). This study aims to describe the clinical and epidemiological profile of PLWH with neurological opportunistic infections (nOIs) and to identify factors associated with in-hospital mortality. We conducted a retrospective cohort study with PLWH aged >18 years hospitalized due to nOIs between November 2017 and December 2021 at a tertiary hospital in Brazil. Demographic, clinical, and laboratory data were extracted from electronic medical records. Logistic regression was used to evaluate associations between patient characteristics and in-hospital mortality. Among 237 hospitalized PLWH, 89 (37.6%) had nOIs. The median CD4 count at admission was 55 cells/mm³ (IQR 22.5–149), and 91.7% had previously used ART (only 22.7% used it regularly). The most frequent infections were cerebral toxoplasmosis (50.6%), cryptococcal meningitis (10.1%), and progressive multifocal leukoencephalopathy (9%). A total of 19 in-hospital deaths occurred. In the multivariate analysis, undefined neurological infections (aOR: 8.67; 95%CI: 1.23–61.17) and ICU admission (aOR: 58.61; 95% CI: 10.24–335.49) were independently associated with mortality. In conclusion, severe immunosuppression and low ART adherence were common in this cohort. Cerebral toxoplasmosis was the most prevalent neurological infection. ICU admission and undefined neurological syndromes were strong predictors of in-hospital mortality. Early diagnosis, prompt treatment, and strategies to improve ART adherence are essential to reduce fatal outcomes in this population.

ABSTRACT The Giant Armadillo is considered an ecosystem engineer due to its digging activities, which promote soil aeration and create new habitats. Additionally, its burrows offer thermal refuge, shelter from predators, food sources, and resting sites for other vertebrates. In this study, we investigated which vertebrate species use Priodontes maximus burrows in the Serra da Fortaleza Wildlife Refuge and its surroundings, in southern Goiás, central Brazil. From July 2023 to February 2024, we monitored 20 Giant Armadillo burrows with camera traps, each for approximately 30 days. With a total effort of 596 trap days, we obtained 654 records belonging to 32 vertebrate species (19 mammals, 10 birds, 2 reptiles, and 1 amphibian). Momotus momota, Dasypus novemcinctus, and P. maximus regularly entered the burrows, with M. momota often being observed carrying food and leaves, digging lateral tunnels, and exhibiting behaviors indicative of possible nesting. Rhinella diptycha, Cyanocorax cyanopogon, Cabassous squamicaudis, Dasyprocta azarae, Didelphis albiventris, Dicotyles tajacu, and Tamandua tetradactyla also used the burrows. A usage‐dependent pattern was observed, with D. novemcinctus and P. maximus entering burrows in more than 50% of the observations. We highlight the ecological importance of P. maximus, demonstrating that many species benefit from its excavations.

HighlightsWhat are the main findings?In a 10-year cohort of 559 neursurgical TBI discharges at a Brazilian public tertiary center, warning sign counseling was documented in 16.1% (95% CI 13.2–19.5) and palliative care referrals were 0%.EHR documentation exposed specific, digitally fixable gaps in the discharge process that can be measured as process quality indicators.What are the implications of the main findings?EHR discharge order sets with mandatory fields, CDS prompts for palliative care screening, and QR-coded patient handouts can standardize counseling and trigger appropriate referrals.The low, precisely estimated baseline provides a pragmatic target for quality improvement and a monitorable metric for resource-constrained hospitals.Background/Objectives: Safe discharge after neurosurgical traumatic brain injury (TBI) depends on documented counseling and appropriate referrals, yet real-world fidelity is uncertain in resource-constrained settings. We quantified discharge process quality and identified digitally actionable gaps. Methods: The sample for this study was a retrospective cohort of 559 consecutive neurosurgical TBI patients discharged from a Brazilian public tertiary center (2012–2022). Data were abstracted from electronic health records. The primary outcome was documentation of warning sign counseling at discharge. Proportions are reported with exact Clopper–Pearson 95% confidence intervals. Results: The median age was 66 years (IQR 47–79.5); 78.5% were male and most received care under the public health system. Subdural hematoma predominated; hematoma drainage was the most frequent procedure. Warning sign counseling was documented in 16.1% of cases (89/559; 95% CI 13.2–19.5), and no palliative care referrals were recorded. Conclusions: A low baseline for a safety-critical discharge element exposes an immediately actionable target. Embedding discharge order sets with mandatory counseling fields in the EHR, clinical decision support prompts for palliative care screening and follow-up, and QR-coded patient handouts represent a pragmatic path to improve discharge quality and end-of-life readiness in the digital era.

Abstract Incoming surface shortwave radiation () has exhibited regionally‐variable multidecadal trends and variability over land that have variously been linked to aerosols and clouds. However, limitations in the spatiotemporal coverage of the observations, combined with apparent disagreements between climate models and observations, have precluded global analyses. Here, we first demonstrate that both the variability and trends in ERA5 agree favorably with high‐quality estimates from satellite and in situ sources, and then show evidence of substantial continental brightening from 1980 to 2024, including in places like the central United States, Brazil, and central Asia that do not show large trends in aerosol concentrations over the same period. The brightening in these regions is co‐located with reductions in total cloud cover, and trends in both are at the edge or entirely outside an ensemble of 237 CMIP6‐era climate model simulations, whose spatial pattern of trends more directly reflect the pattern of aerosol concentrations.