Addition of Neuromuscular Electrical Stimulation, Based on the Level of Excitability, to an Intradialytic Twice-Weekly Cycling Protocol: A Randomized Trial Beatriz da Costa Ferreira, Clara Narcisa Silva Almeida, Daniel da Costa Torres, Rafaela Regina de Souza Torres, João Luiz Quaglioti Durigan, et al. Physiotherapy Research International, 2026 Background and Purpose Neuromuscular electrical stimulation (NMES) has shown promise as an adjunct or alternative to traditional training, but its optimal application in chronic kidney disease (CKD) population remains uncertain. This study aimed to compare the effects of the NMES intradialytic protocol combined with a traditional cycling on muscle strength and functional capacity in CKD patients. Methods Fourteen patients were randomly assigned to either the experimental group (cycling plus NMES) or the control group (cycling only). Treatments were administered twice weekly for 8 weeks. Primary outcomes included muscle strength (isometric manual dynamometry) and functional capacity (1‐min sit‐stand test). Secondary outcomes included neuromuscular excitability, respiratory muscle strength, and quality of life. Results After 8 weeks, repeated measures ANOVA showed no significant differences between the groups for any outcomes. Discussion This study demonstrated that NMES was not superior to the cycling protocol in terms of peripheral muscle strength, functional capacity, neuromuscular excitability, respiratory muscle strength, and quality of life.
Somatosensory Disturbance and Long-Term Exposure to Methylmercury: A Comprehensive Review Leonardo Breno do Nascimento de Aviz, Carolina Fonte de Aviz, Fabiana Costa Cardoso, Laura dos Santos Barros, Raphaely Cristiny Sanches Progênio, et al. Journal of Applied Toxicology, 2026 Chronic exposure to methylmercury remains a significant public health concern, particularly in populations with high fish consumption. Somatosensory disturbances are among the most frequently reported neurological manifestations, even at exposure levels below internationally established safety thresholds. This review aims to synthesize current evidence on somatosensory disturbances associated with long‐term methylmercury exposure in human populations. This comprehensive review findings from human studies investigating clinical, psychophysical, and neurophysiological aspects of somatosensory function in populations chronically exposed to methylmercury. Relevant literature was identified through searches in major scientific databases, and studies were selected based on their relevance to the topic. The reviewed studies consistently report distal, symmetrical somatosensory impairments, commonly described as a glove‐and‐stocking pattern. Psychophysical assessments demonstrate altered tactile, vibration, and thermal perception, while neurophysiological investigations reveal cortical and peripheral sensory dysfunctions. The evidence indicates that chronic methylmercury exposure is associated with clinically relevant somatosensory disturbances. These findings highlight the importance of incorporating somatosensory assessment into the clinical evaluation and surveillance of populations at risk.
Integrated Artificial Intelligence Framework for Tuberculosis Treatment Abandonment Prediction: A Multi-Paradigm Approach Frederico Guilherme Santana Da Silva Filho, Igor Wenner Silva Falcão, Tobias Moraes de Souza, Saul Rassy Carneiro, Marcos César da Rocha Seruffo, et al. Journal of Clinical Medicine, 2025 Background/Objectives: Treatment adherence challenges affect 10–20% of tuberculosis patients globally, contributing to drug resistance and continued transmission. While artificial intelligence approaches show promise for identifying patients who may benefit from additional treatment support, most models lack the interpretability necessary for clinical implementation. We aimed to develop and validate an integrated artificial intelligence framework combining traditional machine learning (interpretable algorithms like logistic regression and decision trees), explainable AI (methods showing which patient characteristics influence predictions), deep reinforcement learning (algorithms learning optimal intervention strategies), and natural language processing (clinical text analysis) to identify tuberculosis patients who would benefit from enhanced treatment support services. Methods: We analyzed 103,846 pulmonary tuberculosis cases from São Paulo state surveillance data (2006–2016). We evaluated models using precision (accuracy of positive predictions), recall (ability to identify all patients requiring support), F1-score (balanced performance measure), and AUC-ROC (overall discrimination ability) while maintaining interpretability scores above 0.90 for clinical transparency. Results: Our integrated framework demonstrated that explainable AI matched traditional machine learning performance (both F1-score: 0.77) while maintaining maximum interpretability (score: 0.95). The combined ensemble delivered superior results (F1-score: 0.82, 95% CI: 0.79–0.85), representing a 6.5% improvement over individual approaches (p < 0.001). Key predictors included substance use disorders, HIV co-infection, and treatment supervision factors rather than demographic characteristics. Conclusions: This multi-paradigm AI system provides a methodologically sound foundation for identifying tuberculosis patients who would benefit from enhanced treatment support services. The approach delivers excellent predictive accuracy while preserving full clinical transparency, demonstrating that the accuracy–interpretability trade-off in medical AI can be resolved through the systematic integration of complementary methodologies.
Mercury Exposure and Health Effects in Indigenous People from the Brazilian Amazon—Literature-Scoping Review Maria da Conceição Nascimento Pinheiro, Fabiana Costa Cardoso, Leonardo Breno do Nascimento de Aviz, José Aglair Barbosa de Freitas Junior, Márcia Cristina Freitas da Silva, et al. International Journal of Environmental Research and Public Health, 2025 Background and purpose: Indigenous people in the Brazilian Amazon are exposed to mercury by eating methylmercury-contaminated fish. The lack of information on the health effects of prolonged exposure to mercury hinders the implementation of mitigation programs offered by the Brazilian government. This article aims to evaluate the studies that have investigated mercury exposure in indigenous people living in the Brazilian Amazon. Methods: A scoping review of the literature was conducted from studies published between 1995 and 2024 in Portuguese, English, and Spanish that evaluated mercury (Hg) concentrations in hair samples in indigenous people from the Brazilian Amazon. Results: Using total mercury (TotalHg) values in hair samples, we analyzed exposure levels, prevalence, and toxic effects. We found 15 epidemiological studies with a cross-sectional design and sample sizes ranging from 31 to 910 participants. Four studies involved children and mothers, four of which were associated with clinical outcomes and three of which analyzed genetic polymorphism. Most of the communities evaluated had a high prevalence of mercury exposure, showing levels ranging from 0.8 to 83.89 µg/g, and the highest average TotalHg concentration was found among the Kayabi. Mercury was associated with hypertension, cognitive disorders, worse mental health indicators and central and peripheral neurological disorders. Conclusions: It is concluded that indigenous people in the Brazilian Amazon experience exposure levels that are causing damage to their health, and control measures must be adopted to prevent the situation from worsening.
Systematic review and meta-analysis of the impact of diabetes mellitus on chronic venous insufficiency Alex Carlos Ferreira de Castro, Anderson Veiga Barbosa, David Fonseca Lima, João Vitor Rodrigues Vidal, José Maciel Caldas Reis, et al. Jornal Vascular Brasileiro, 2025 Resumo Esta revisão sistemática com metanálise pesquisou a ocorrência de insuficiência venosa crônica (IVC) em pacientes com diabetes melito tipo 2 (DM2). A pergunta norteadora utilizou a estratégia PECOT (P: população; E: exposição; C: comparação; O: outcome [desfecho]; T: tipo de estudo), e o risco de viés foi analisado com a ferramenta ROBIS-I. A análise incluiu quatro estudos, e os resultados mostraram que a ocorrência de IVC em pacientes com DM2 foi de 55%, com uma razão de prevalência de 1,51 (IC95% 1,01-2,26). Assim, a prevalência de IVC é maior em pessoas com DM2 em comparação com a população sem a doença. No entanto, esta revisão destacou limitações, como a escassez de estudos longitudinais e a disparidade nos métodos de diagnóstico de IVC entre os estudos, evidenciando a necessidade de mais pesquisas sobre o tema.
Factors associated with smoking cessation Samires Avelino de Souza França, Ana Ligian Feitosa das Neves, Tatiane Andressa Santos de Souza, Nandara Celana Negreiros Martins, Saul Rassy Carneiro, et al. Revista De Saude Publica, 2015
