Artigos - MPTS

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Development and validation of shoaib sensorimotor development tool for normal pediatric population
(2025) WAQAS, Shoaib; AHMAD, Ashfaq; GOULARDINS, Juliana Barbosa; HANIF, Asif; TARIQ, Muhammad; NIAMAT, Atiqa
Background: During the COVID-19 pandemic, concerns about developmental delays in babies were at their peak. During the COVID-19 pandemic, concerns about developmental delays in infants and young children increased substantially. However, culturally relevant, validated tools to assess sensorimotor development are scarce. Objective: This study aimed to develop and validate the Shoaib Sensorimotor Development Tool (SSDT) to evaluate developmental milestones in typically developing children. Methods: This was a cross-sectional psychometric validation study. A comprehensive tool encompassing nine domains, gross motor, fine motor, sensory, tone, balance, gait, reflexes, social interaction, and speech, was developed to assess sensorimotor development holistically. Atotal of 150 mothers of typically developing children aged 3 to 7 years participated in the exploratory factor analysis (EFA), while 300 mothers were included in the confirmatory factor analysis (CFA). In addition, the SSDT required an average of 21 ± 6.00 minutes to complete, with administration being feasible for trained therapists following a brief workshop. Data were analyzed using SPSS v26 and AMOS for factor analysis. Model fit was evaluated with regression weights and standard fit indices (p < 0.05). Results: The mean age of mothers who participated in this study was 36.16±4.73 years, and the mean age of children was 4.45±0.784 years. Of the 150 mothers (EFA) and 300 mothers (CFA) enrolled, 144 and 288 completed the full assessment, yielding a 96% completion rate. Dropouts were minimal, 6 and 12, respectively, and the reasons have been detailed in the methods. 75 constructs were analyzed using EFAand three were removed due to cross-loading, resulting in a significant Bartlett's test (p = 0.000) and a high Kaiser-Meyer-Olkin (KMO) measure of 0.992. The final 72 constructs of SSDT formed a single factor, sensorimotor development, with a cumulative variance of 84.317% and an eigenvalue of 3.897. Fit indices indicated good model fit (CFI = 0.983, GFI = 0.962, TLI = 0.989, SRMR = 0.0325, RMSEA= 0.076). The SSDTdemonstrated excellent internal consistency (Cronbach's α = 0.963). Conclusion: SSDT is a promising tool for early sensorimotor assessment, offering clinical, educational, and research utility; however, broader validation and longitudinal studies are needed for its universal adoption.
Active teaching-learning methodologies applied in implant dentistry
(2025) SILVA, Poliana Sandes da; MEDRADO, Alena Ribeiro Alves Peixoto; DANTAS, Juliana Borges de Lima; FERNANDES, Atson Carlos de Souza; FARIAS, Illa Oliveira Bitencourt
The teaching and learning methodologies in implant dentistry have been the subject of ongoing discussion due to the challenges students face in developing the skills necessary to perform both the planning and surgical-prosthetic stages of implant-supported rehabilitation. To address this, a literature review was conducted to describe the various active teaching methodologies applied in implant dentistry. An electronic search was carried out in the PubMed, Google Scholar, and SciELO databases between January 2023 and August 2024, targeting publications from 2018 to 2024 in English and Portuguese. A total of 5,650 articles were identified. Following title and abstract screening, nine studies were selected for full-text review, of which four met the established inclusion and exclusion criteria. The reviewed literature described active methodologies such as Active Learning, the Flipped Classroom model, Augmented Reality, Realistic Simulation, as well as Sensory and Hybrid Reality approaches for teaching implant dentistry. According to the findings, the integration of innovative teaching and learning methodologies in implant dentistry enhances the opportunity for practice-based learning experiences that closely replicate real-world scenarios. However, the results also highlight a persistent need for the incorporation of these active methodologies into both undergraduate and postgraduate curricula. Such implementation would improve the students’ and professionals’ training in the planning and execution of implant-supported rehabilitations, ultimately fostering greater clinical competence and readiness.
Interplay between biological & social vulnerability and poor tuberculosis treatment outcome in Brazil: a nationwide study using multivariate modelling with excess risk
(2026) DUARTE, Beatriz Barreto; SERRA, Klauss Villalva; PINTO, João P. Miguez; PEREIRA, Mariana Araújo; CAMPOS, Vanessa M. S; FERREIRA, Isabella B. B.; NOGUEIRA, Betânia M. F.; QUEIROZ, Artur T. L.; ROLLA, Valeria C.; SANTOS, Marcelo Cordeiro; KRITSKI, Afrânio L.; MARTINEZ, Leonardo; REBEIRO, Peter F.; STERLING, Timothy R; RODRIGUES, Moreno M.; ANDRADE, Bruno B.
Background: Focusing on socially vulnerable sub-populations at increased risk of tuberculosis is warranted to decrease the disease burden. In this study, we evaluated whether homelessness, living with HIV, incarceration, pregnancy, immigration, drug use, and healthcare work are inter-related risk factors for unfavorable antituberculosis treatment (ATT) outcomes in Brazil through analysis of national disease registry database (SINAN).Methods: We conducted a retrospective cohort study of tuberculosis cases ≥18 years-old reported to SINAN between 2015 and 2023. Clinical and epidemiologic variables were compared between groups (non-vulnerability, homeless, people deprived of their liberty, pregnant women, people with HIV, people who use drugs, immigrants and healthcare worker). Bivariate comparisons identified characteristics associated with a composite unfavorable ATT outcome, or specifically death or LTFU versus cure. Multivariate modelling with relative excess risk due to interactions (RERI) were calculated to estimate how co-occurring vulnerabilities further increase the risk of unfavorable outcomes. Findings: Among 679,572 cases analysed, most were males aged 18−35 years-old, with non-white ethnicity. 16% of individuals without vulnerabilities experienced unfavourable outcomes, compared to 33% among those with at least one vulnerability. Overlapping vulnerabilities further amplified risk: for instance, unfavourable outcomes occurred in more than 67% of individuals who reported both homelessness and drug use. Interaction analyses revealed both synergistic and antagonistic effects, with the strongest additive synergy observed between HIV infection and drug use, with a RERI of 225% [174–304%]. Interpretation: The superposition of interlacing social and biological vulnerabilities significantly worsened the risk of both death and LTFU in our population. Our study demonstrates that the joint effect of vulnerabilities on TB outcomes is not merely additive, but often synergistic, highlighting the importance of integrated and multisectoral interventions. These findings hallmark the need for policies that simultaneously address social and biological vulnerabilities to improve ATT success.
Biochemical, immune, and endocrine biomarkers associated with exacerbated muscular response: insights from a fieldbased operational cohort study
(2025) SOUZA, Deivide Oliveira de; GOMES, Diego Viana; PESQUERO, João Bosco; AQUINO NETO, Francisco Radler de; LUZARDO, Ricardo; DUARTE, Beatriz Barreto; ANDRADE, Bruno B.; CARNEIRO, Andréia
Muscle damage and systemic stress responses are common consequences of intense physical exertion. However, the extent to which these responses vary according to the severity of muscular strain remains unclear. We conducted a field-based study involving 24 active-duty elite military personnel who participated in five distinct operational missions in Brazil. Circulating levels of 36 plasma biomarkers were assessed and compared between individuals presenting moderate or exacerbated muscular response, defined by serum creatine kinase (CK) concentrations below or above 1000 U/L, respectively. Statistical comparisons and multivariate logistic regression were performed to evaluate associations between biomarker levels and muscular response severity. Our analysis revealed that individuals with exacerbated response exhibited distinct systemic profiles, marked by elevated tissue injury markers, reduced eosinophil and lymphocyte counts, and lower adrenal steroid hormone concentrations. Furthermore, regression models identified creatine kinase muscle-brain (CKMB) and alanine aminotransferase (ALT) as independently associated with higher CK levels, while heightened eosinophil counts showed a potential protective trend. These findings suggest that greater degrees of muscular stress are associated with broader systemic dysregulation, and that specific circulating biomarkers may serve as indicators of individual susceptibility to acute stress in high-demand physical environments.
Medicine beyond machines: viewpoint on the art of thinking in the age of al
(2025) FERREIRA, Isabella B. B.; MENEZES, Rodrigo C.; CORREIA, Luis Cláudio L.; ANDRADE, Bruno B
The widespread adoption of large language models is increasingly shaping clinical decision-making by altering how physicians engage with data and reasoning. While these tools enhance diagnostic capacity, streamline workflows, and support learning, their misuse may diminish critical, contextual, and humanized thinking, reducing physicians to passive validators of algorithmic outputs. This paper explores the evolution of medical cognition and proposes strategies for integrating artificial intelligence in ways that preserve cognitive autonomy, such as structuring information, reducing bias, and strengthening metacognition. We argue that artificial intelligence should serve as a “cognitive stethoscope,” a tool that refines reasoning without compromising its essence.
Fatores associados ao nível de atividade física de pessoas idosas robustas residentes na comunidade: estudo transversal
(2025) FURTADO, Claudia; NASCIMENTO, Carla Ferreira do; MAIA, Helena Fraga; SALLES, Cristina; DIAS, Cristiane; PINTO, Elen Beatriz
Objetivo: Investigar os fatores associados ao nível de atividade física em pessoas idosas robustas residentes na comunidade. Método: Foi realizado um estudo transversal com indivíduos com mais de 65 anos, considerados robustos de acordo com o Índice de Vulnerabilidade Clínico-Funcional 20 (IVCF-20). Os dados primários foram coletados entre setembro de 2021 e novembro de 2023. Após a aplicação do IVCF-20, os indivíduos classificados como robustos responderam a um instrumento de coleta de dados e foram submetidos a avaliações utilizando a Avaliação Cognitiva de Montreal – Versão Básica (MoCA-B), a Escala de Confiança no Equilíbrio para Atividades Específicas (ABC), a Escala de Comportamentos de Queda (FaB), o teste Timed Up and Go (TUG) e o Perfil de Atividade Humana (PAH). As associações entre as variáveis explicativas e a variável reposta (PAH) foram avaliadas por modelos de regressão linear, sendo apresentadas pelos coeficientes da regressão (β) e seus intervalos de 95% de confiança. Resultados: De acordo com o IVCF-20 preencheram os critérios de elegibilidade 101 pessoas idosas com mediana de idade de 71 anos, sendo a maioria do sexo feminino (74,3%). Na análise multivariada os dados comportamentais, como confiança no equilíbrio (ABC) (β=0,23) e comportamento de risco para queda (FaB) (β=-4,19) se mantiveram independentemente associados ao nível de atividade física. Conclusão: Os achados deste estudo sugerem que, entre idosos robustos e moderadamente ativos, uma maior confiança no equilíbrio está associada a níveis mais elevados de atividade física. Por outro lado, a adoção de comportamentos mais protetores em relação às quedas também está associada a níveis mais elevados de atividade física.
A physiotherapy protocol for stroke patients in acute hospital settings: expert consensus from the Brazilian early stroke rehabilitation task force
(2025) MASO, Iara; LUVIZUTTO, Gustavo José; MIRANDA, Jéssica Mariana de Aquino; NASCIMENTO, Carla Ferreira do; BONOME, Luana Aparecida Miranda; PINTO, Elen Beatriz; KLITZKE, Fabiane Maria; SOUZA, Ricardo Machado; MORO, Carla Heloisa Cabral; BAZAN, Rodrigo; JESUS, Pedro Antonio Pereira de; ROCHA, Eduardo de Melo Carvalho; MINELLI, Cesar; MARTINS, Sheila Ouriques; BAGGIO, Jussara Almeida de Oliveira
The present protocol provides general recommendations based on the best evidence currently available for physiotherapists to use as a guide for the care of stroke patients during hospitalization. The Brazilian Early Stroke Rehabilitation Task Force, comprising physical therapy experts and researchers from different Brazilian states, was organized to develop this care protocol based on a bibliographical survey, including meta-analyses, systematic reviews, clinical trials, and other more recent and relevant scientific publications. Professionals working in stroke units were also included in the task force to ensure the practicality of the protocol in different contexts. This protocol provides guidance on assessment strategies, safety criteria for the mobilization of patients with stroke, recommendations formobilization and proper positioning, as well as evidence-based practices for treatment during hospitalization, including preventive measures for shoulder pain and shoulder-hand syndrome. The protocol also provides information on the organization of the physiotherapy service at stroke units, guidelines for hospital discharge, and quality indicators for physiotherapy services. We have included detailed activities that can be performed during mobilization in the supplementary material, such as postural control training, sensory and perceptual stimulation, task-oriented training, and activities involving an enriched environment. The protocol was written in a user-friendly format to facilitate its application in different social and cultural contexts, utilizing resources readily available in most clinical settings.
Usability assessment of the electronic health record used in the school clinic of a higher education institution
(2025) SOUSA, João Victor; LEITE, Mariana Ferreira; RAMOS, Maria Emília Santos Pereira; DANTAS, Juliana Borges de Lima; FERNANDES, Atson Carlos de Souza
The distinctions and the value of physician-scientists: a call for sustained support and nourishment
(2025) ANDRADE, Bruno Bezerril
ABSTRACT | CONTEXT: Physician-scientists occupy a unique and critical position at the intersection of clinical practice and scientific research, yet they are becoming increasingly rare due to systemic challenges, including time constraints, financial disincentives, and insufficient institutional support. This article explores the conceptual and historical differences between physicians, researchers, scientists, and physician-scientists, highlighting their distinct contributions to global health, policy-making, and medical innovation. Historical examples, such as Robert Koch and Virchow Rudolf, exemplify the transformative impact of physician-scientists in advancing medicine. The rise of artificial intelligence (AI) presents new opportunities and challenges for these professionals, as AI can enhance their dual roles in research and patient care. CONCEPTUALIZATION: However, to sustain and grow the physicianscientist workforce, significant changes are needed, including better financial incentives, protected research time, and stronger mentorship programs. Without such support, the future of medical innovation and global health may be jeopardized. This article advocates for a renewed focus on cultivating physician-scientists, emphasizing their indispensable role in bridging the gap between bench and bedside, and ensuring that scientific discoveries translate into tangible improvements in human health and well-being.
A anatomia facial como pilar da harmonização orofacial: um estudo de revisão
(2025) FREITAS, Tathiane Dias Pinheiro de; PEREIRA, Larissa de Ávila; DANTAS, Juliana Borges de Lima; LEITE, Mariana Ferreira; FERNANDES, Atson Carlos de Souza
Os procedimentos de Harmonização Orofacial (HOF) exigem um elevado domínio da área de anatomia por parte dos profissionais, uma vez que lida com áreas nobres e desta maneira, proporciona a sua realização de forma segura e eficaz. Objetivos: Discorrer sobre os aspectos gerais que envolvem a HOF, como os procedimentos realizados e a formação profissional, bem como endossar a importância da anatomia facial dentro desse contexto. Métodos: Tratou-se de um estudo descritivo e narrativo caracterizado como revisão da literatura. Os critérios de inclusão estabelecidos foram: estudos pertinentes à temática, redigidos em qualquer idioma e sem corte temporal. O levantamento ocorreu entre janeiro a dezembro/2024, através de busca nas bases Pubmed, LILACS e SciELO, literatura cinzenta do Google Acadêmico e sites institucionais. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com os operadoradores booleanos e um total de 52 referências foram incluídas. Resultados: A Harmonização de face pode ser conduzida por diversos profissionais da saúde e engloba a realização de procedimentos com injetáveis e minimammente invasivos. Há uma necessidade de aprofundamento sobre anatomia facial nos cursos ofertados em HOF, uma vez que efeitos adversos e intercorrências não são incomuns e esse conhecimento tratá confiança e segurança aos profissionais. Conclusão: Portanto, este conhecimento determina a consolidação da confiança e da atuação em HOF, o que amplia o sucesso dos procedimentos. Diante desse contexto, compreende-se que esta revisão representa um ponto de partida para condução de cursos e de estudos que objetivem o aprofundamento da anatomia facial.
Conjunct effects of transcranial direct current stimulation with mirror therapy on motor control and muscle performance in spastic quadriplegic cerebral palsy children: a randomized clinical trial
(2025) WAQAS, Shoaib; AHMAD, Ashfaq; GOULARDINS, Juliana Barbosa; HASSAN, Zainab; HANIF, Asif; TARIQ, Muhammad
Background: Cerebral palsy (CP) is a birth-related non-progressive neuromotor brain disorder characterized by abnormalities of muscular tonicity, gross and fine motor skills, gait, and posture. It impacts motor control and muscle performance, which are emergent rehabilitation challenges in cerebral palsy children. Mirror therapy (MT) and transcranial direct current stimulation (tDCS) are novel treatment strategies to enhance muscle performance and motor control. Methods: A randomized clinical trial was conducted at Ghurki Hospital Lahore, Pakistan. One hundred and five spastic quadriplegic CP (SQCP) children aged three to seven years were included. Randomization was carried out using Version 1.0 of Randomized Allocation Software. Allocation was done to three groups (35 in each group) with a 1:1:1 ratio with a unique identity number. Group I (tDCS+MT+Routine Physical Therapy (RPT), Group II (MT+RPT), and Group III (tDCS + RPT). Each patient received ten sessions of tDCS and MT, lasting for 15 minutes per side along with 20 minutes of RPT five days a week for ten weeks. Motor control was assessed by the Fugl-Meyer assessment tool, and muscle performance was measured using an isokinetic dynamometer and assessed at baseline, the 2nd, and the 10th week of follow-up and was analyzed using SPSS version 26. Results: The results indicated a significant improvement after 10 weeks in the mean scores of motor control upper extremities, lower extremities, and trunk) with P-values of 0.04, 0.01, 0.02, 0.02, 0.03, 0.05, 0.05, and 0.02, respectively. Similarly, muscle performance (isokinetic power) for these muscle groups also demonstrated significant changes, with P-values of 0.04, 0.01, 0.04, 0.02, 0.03, 0.05, 0.05, and 0.02, respectively. Conclusion: tDCS and MT in combination significantly impacted motor control and muscle performance, enhancing elbow and knee musculature strength and power among SQCP patients.
Association of depressive symptoms and physical activity profile with cognitive function in individuals with obesity candidates for bariatric surgery
(2025) SOUSA, Ana Gabriela Terencio de; SANTANA, Tauan dos Santos; ATTA, João Gabriel Penedo Cabral; BOMFIM, Eric Simas; PINTO, Lélia Lessa Teixeira; SOUZA, Lucas Antônio Jesus de; LEITE, Josias Melo; BARROS, João Henrique Cerqueira; ALMEIDA, Luiz Alberto Bastos de; SANTOS, Clarcson Plácido Conceição dos
Introduction: Obesity is a major global health issue, associated with physical, psychological, and behavioral impacts. Sedentary lifestyles and depressive symptoms, common in individuals with obesity, may contribute to cognitive decline. Objective: To analyze the association between physical activity levels, the presence of depressive symptoms, and cognitive function performance in individuals with obesity. Materials and Methods: Cross sectional study conducted with preoperative bariatric surgery patients at the “removed for anonymized review” in “removed for anonymized review”. Assessments included the International Physical Activity Questionnaire, Center for Epidemiologic Studies Depression Scale, Mini–Mental State Examination, and a general clinical form. Data were collected via Research Electronic Data Capture and analyzed with R software (version 4.5). Results: The sample included 100 individuals (mean body mass index: 41.2 ± 5.2); 58% were physically active, 42% sedentary, and 26% had clinically significant depressive symptoms. Multiple linear regression indicated a mean cognitive function score of 28.52 in the reference group (P < 0.001), with no significant association with sedentary behavior (β = +0.24; P = 0.469) or absence of depressive symptoms (β = −0.36; P = 0.398). Higher education was associated with better cognitive performance, particularly among those with completed higher education (β = +1.67; P < 0.001) and incomplete higher education (β = +1.25; P = 0.019). The model was statistically significant (F: P =0.004). Conclusion: Educational level was shown to be the main determinant of cognitive function in individuals with obesity, whereas depressive symptoms and sedentary behavior showed no significant association.
Retrospective cohort of a decade of pediatric kidney transplant in a Brazilian state: Clinical profile, main complications, and outcomes
(2025) LORDELO, Marina da Rocha; NUNES, Claudia Andrade; PEREIRA, Mariana Araújo; DUARTE, Beatriz Barreto; ANDRADE, Bruno B.
Pediatric kidney transplant is performed globally, although unevenly, with specific challenges in low-income countries with limited resources. We aimed to describe pediatric kidney transplantation in Bahia, a state located in one of the poorest regions in Brazil, and explore possible predictors of survival. This was a single-center retro¬spective cohort, and we included 101 pediatric kidney transplants performed between 2013 and 2022. There was no predominance of sex; the median age was 12 years old. Congenital anomalies of the kidney and urinary tract were the most common etiology of renal disease. 21 transplants were preemptive. Delayed graft function occurred in just over half of transplants. Patient survival rate was 96%, 96%, 89.1%, and 89.1% respectively at 1-year, 3-years, 5-years, and 10-years post-transplant. The overall graft survival rate was 80.2%, 76.9%, 66.8%, and 45.8% at 1-year, 3-years, 5-years, and 10-years post-transplant. Multivariate analysis of outcome predictors revealed that delayed graft function was a risk factor for graft survival in 5 years (adjusted HR 3.44 (1,18–10,05)). Pediatric kidney transplantation is a regionally fea¬sible treatment, with good outcomes, although slightly inferior to those reported in the literature; efforts on reducing incidence in delayed graft function may improve graft survival.
Effects of missed anti-tuberculosis therapy doses on treatment outcome: a multi-center cohort study
(2025) FERREIRA, Isabella B. B.; MENEZES, Rodrigo C.; PEREIRA, Mariana Araújo; ROLLA, Valeria C. R; KRITSKI, Afrânio L.; SANTOS, Marcelo Cordeiro; STERLING, Timothy R.; STAATS, Cody; AMORIM, Gustavo; TRAJMAN, Anete; ANDRADE, Bruno B.
Background Tuberculosis (TB) remains a leading cause of infectious disease mortality globally. Although directly observed therapy (DOT) has been widely implemented to improve adherence, nonadherence continues to compromise treatment success rates, especially in real-world settings. Therefore, this study aims to assess the impact of missed doses on TB treatment outcomes. Methods Prospective study that followed adults with drug-sensitive TB for two years after TB treatment initiation at five clinical centers of the RePORT-Brazil cohort between June 2015 and June 2019. Participants not in DOT or followed for less than 30 days were excluded. Nonadherence was defined as the percentage of missed doses relative to the prescribed regimen, monitored daily through DOT. The primary composite outcome comprised treatment failure, disease recurrence, drug resistance, death, or loss to follow-up (LTFU) after 30 days of treatment. Associations were assessed with multivariable logistic regression. Findings Among the 578 participants analyzed, 218 (37⋅7%) experienced unfavorable outcomes. Overall, 23% of participants missed more than 10% of prescribed doses, and this group had an 81⋅2% likelihood of experiencing unfavorable outcomes, compared to only 21⋅6% among those with complete adherence. A significant association was observed between the percentage of missed doses and unfavorable outcomes (adjusted OR: 1⋅11, 95% CI: 1⋅07–1⋅14, p-value < 0⋅0001). Interpretation Even minor nonadherence in TB treatment was associated with an increased risk of unfavorable outcomes, highlighting the role of adherence in successful TB care. Funding Fundação Oswaldo Cruz, Fundação José Silveira, Departamento de Ciência e Tecnologia, US National Institute of Allergy and Infectious Diseases. Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license http://creativecommons.org/licenses/by-nc-nd/4.0/).
Comportamento mastigatório e dor após tratamento cirúrgico de fraturas mandibulares: estudo transversal
(2025) SILVEIRA, Paulo Brasil Brandão da; SANTOS, Júlia Marcela Jardim Melo dos; PINHEIRO, Eulália Silva dos Santos; SANTOS, Carlos Eduardo Pinto Buffone dos; TESCH, Ricardo de Souza; SÁ, Kátia Nunes
Introdução: O trauma maxilofacial é frequente e a mandíbula um dos ossos mais fraturados. Em muitos casos, a intervenção cirúrgica é urgente. Esse procedimento pode acarretar complicações, incluindo dor crônica ou limitações nas funções mastigatórias. Objetivo: Descrever as principais queixas após cirurgia de fraturas mandibulares. Métodos: Estudo transversal em pessoas submetidas a tratamento cirúrgico de fraturas mandibulares por origem traumática em um hospital de referência do estado da Bahia. Os questionários foram retirados do Diagnostic Criteria for Temporomandibular Disorders (DC-TMD) e aplicados por telefone, mensagem ou e-mail. Quatro grupos foram categorizados pelos meses de pós-operatório: A (1-4), B (5-7), C (8- 10) e D (>=11) para a análise de dor e mobilidade articular; a descrição dos hábitos parafuncionais, disfunção mastigatória e as associações se deu pela amostra unificada. Resultados: Um total de 289 sujeitos foram avaliados. Houve alta prevalência de hábitos parafuncionais e relatos de dor, baixa mobilidade de mandíbula e disfunção mastigatória. Na associação para dor orofacial, a sensação de abertura completa da boca se mostrou protetora, enquanto dor de cabeça fator de risco. Conclusão: O tratamento cirúrgico de fraturas mandibulares apresenta um prognóstico complicado, os profissionais devem alertar os pacientes quanto às complicações e orientar o tratamento e reabilitação.
Challenges and prospects in mentoring medical scientists in Latin America: a narrative review and recommendations
(2025) MENEZES, Rodrigo C.; VINHAES, Caian L.; RIDOLFI, Felipe; FERREIRA, Isabella B. B.; HUAMAN, Moises A.; UGARTE-GIL, Cesar; ANDRADE, Bruno B.
Objective: To identify the challenges for the development and mentorship of physician-scientists in Latin America, outline the key barriers to integrating research training into medical education and post-graduate pathways, and propose recommendations to foster structured mentorship, improve institutional support, and strengthen the research ecosystem for future physician-scientists. Study design: Narrative review. Methods: A narrative review of relevant literature, institutional reports, and existing educational models was undertaken. The authors synthesized information on current educational pathways, funding opportunities, institutional infrastructures, and mentorship practices for physician-scientists in Latin America and derived practical recommendations for improving mentorship and training structures. Results: Latin America’s aspiring physician-scientists face fragmented educational programs, limited or inconsistent research integration in medical curricula, and inadequate mentorship support. These issues are exacerbated by overburdened healthcare systems, insufficient funding, low stipends, and a scarcity of dual-degree training programs. Institutional and funding barriers frequently force trainees and established researchers to choose between clinical practice and research, stifling the growth of a skilled physician-scientist workforce. Proposed solutions include developing integrated dual-degree and research residency programs, reforming medical curricula to include foundational research skills, strengthening mentorship networks through structured support and incentives, increasing research fellowship funding and removing exclusivity clauses, and creating regional consortia to standardize training and foster cross-border collaboration. Conclusion: Addressing the systemic barriers to mentoring and training physician-scientists in Latin America is essential for building a robust, researchoriented medical community. The recommended structural reforms, with increasing funding, enhanced mentorship frameworks, and promoting regional partnerships, can help Latin America cultivate a sustainable environment for the development of physician-scientists.
The medical student of the future: redefining competencies in a transformative era
(2025) MIGUEZ-PINTO, João P.; GARCIA-ROSA, Beatriz; BEZERRIL, Mateus Maggitti; RAMALHO, Clara; GARCIA, Stefania L.; PUSTILNIK, Hugo N.; BOCZAR, Daniel; AVENA, Katia M.; ANDRADE, Bruno B.
Medical education is undergoing a profound transformation, driven by rapid technological advances, evolving pedagogical strategies, and the shifting demands of healthcare systems globally. This article explores the historical evolution of medical student competencies, evaluates the current state of medical education, and envisions the future competencies required for medical school entrants and graduates. We propose a forward-looking framework for reimagining the medical student of the future, emphasizing the integration of advanced technological literacy, humanistic values, and a global perspective. By redefining these competencies, medical schools can ensure the development of adaptable, empathetic, and innovation-driven physicians for a dynamic healthcare landscape.
Effects of transcranial direct current stimulation combined with speech therapy in two children with autism spectrum disorder: a clinical case series
(2025) OLIVEIRA, Márcia Santos de; FERRAZ, Sofia Borba de Toledo; BARBOSA, Emanuelle Lacerda Pinto; SILVA JÚNIOR, Hercílio Barbosa da; GOULARDINS, Juliana Barbosa
ABSTRACT | BACKGROUND: Transcranial direct current stimulation (tDCS) has shown promise as an adjunctive therapy for neurological and developmental conditions, including autism spectrum disorder (ASD). OBJECTIVE: To describe the preliminary effects of a tDCS protocol combined with traditional speech therapy in two children with ASD. METHODS: This case series involved two male children, aged 4-5 years, diagnosed with ASD. A total of 30 tDCS sessions (1mA, 30 minutes each) were delivered over 10 weeks (CP5–Fp2 montage), combined with language-focused speech therapy. Parents completed the Social Responsiveness Scale (SRS-2) before and after the intervention. RESULTS: Quantitative improvements were observed in social cognition, communication, and motivation, alongside reductions in restrictive behaviors. Qualitative gains included enhanced verbal intention, vocabulary, sentence construction, and emotional regulation. CONCLUSION: These findings support the feasibility and potential therapeutic benefit of combining tDCS with speech therapy in young children with ASD, warranting further investigation in controlled trials.
Evidence-based umbrella review of non-invasive neuromodulation in chronica neuropathic pain
(2025) MOREIRA, Rafael Jardim Duarte; SHIRAHIGE, Lívia; PRIETO, Indira Enith Rodriguez; ALVES, Maércio Maia; LOPES, Tiago da Silva; BAPTISTA, Rachel Fontes; HAZIME, Fuad Ahmad; ZANA, Yossi; KUBOTA, Gabriel Taricani; ANDRADE, Daniel Ciampi de; YENG, Lin Tchia; TEIXEIRA, Manoel Jacobsen; DÁQUER, Egas Caparelli Moniz de Aragão; SÁ, Katia Nunes; SILVA, Kátia Monte; BAPTISTA, Abrahão Fontes
Background and Objective: Non-invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic pain (NP), a prevalent and complex condition. However, treating NP remains challenging due to the numerous variables involved, such as different techniques, dosages and aetiologies. It is necessary to provide insights for clinicians and public healthcare managers to support clinical decision-making. This umbrella review aims to consolidate existing evidence on the effectiveness of various NIN in managing chronic NP. Databases and Data Treatment: A systematic search was conducted in the PubMed/MEDLINE database, including metaanalyses of controlled trials comparing NIN techniques with sham interventions for NP treatment. The quality of included studies was assessed using the AMSTAR-2 tool and the GRADE system, with effect sizes adjusted to the standard mean difference (SMD). Results: The review included 22 meta-analyses comprising 8151 participants from 214 controlled trials. The most investigated NIN techniques were tDCS and rTMS, with primary targets being the motor cortex and dorsolateral prefrontal cortex. The findings suggest that excitatory protocols, particularly high-frequency rTMS and anodal tDCS, are effective in reducing pain intensity in individuals with NP. However, the overall quality of evidence was rated low, primarily due to heterogeneity among studies and small sample sizes. Conclusion: NIN techniques show promise in managing NP, with potential benefits in pain reduction. However, further highquality research is needed to establish optimal protocols and long-term effects.
Non-invasive brain stimulation for stroke-related motor impairment and disability: an umbrella review of systematic review and meta-analysis
(2025) RITHIELY, Beatriz; SHIRAHIGE, Lívia; LIMA, Patrícia; SOUZA, Maíra; MARQUES, Déborah; BRITO, Rodrigo; BALTAR, Adriana; MOREIRA, Rafael J. Duarte; BARRETO, Gabriel; ANDRADE, Rodrigo; SÁ, Katia Nunes; BAPTISTA, Abrahão Fontes; PISCITELLI, Daniele; SILVA, Kátia Monte
Introduction: Non-invasive brain stimulation (NIBS) techniques, particularly repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have shown potential in stroke rehabilitation. However, systematic reviews often reach conflicting conclusions, highlighting the need for an umbrella review. Objective: To synthesize, based on the principal domains of the International Classification of Functioning, Disability and Health (ICF) framework, the best available evidence on the effectiveness and safety of NIBS for improving motor impairment and disability after stroke. Methods: We conducted an umbrella review (PROSPERO: CRD42021239577) that included meta-analyses of controlled trials investigating NIBS effects in stroke survivors, retrieved from PubMed/MEDLINE from February 2020 to July 2025. Methodological quality was appraised using AMSTAR-2 and certainty of evidence using GRADE. Outcomes were mapped to ICF body structure/function and activity domains. Results: Fifty-six studies were included (2–48 primary trials each; 54–1,654 participants per meta-analysis). All included studies evaluated only rTMS and tDCS; no meta-analyses of other NIBS modalities met inclusion criteria. Methodological quality was high or moderate in 85.7% of the meta-analyses. Certainty of evidence was low or very low for 14/50 studies; only one rTMS review provided moderate-certainty evidence for activities of daily living. rTMS showed improvement in activities of daily living (ADL; SMD = −0.82, 95% CI −1.05 to −0.59), upper-limb motor impairment (SMD = −0.32, 95% CI −0.55 to −0.09) and variable effects on mobility from small (SMD = −0.35, 95% CI −0.45 to −0.24) to large (SMD = −0.97, 95% CI −1.28 to −0.66). tDCS was supported by verylow-certainty evidence: small effects were found for motor impairment (SMD = −0.22, 95 % CI −0.32 to −0.12) and upper-limb activity (SMD = −0.31, 95% CI −0.55 to −0.01), while a much smaller subset of trials suggested a large effect (SMD = −1.54, 95% CI −2.78 to −0.29). Effects on ADL and mobility with tDCS were inconsistent and generally non-significant. Conclusion: rTMS was more frequently associated with moderate to large effect sizes for body structure/function outcomes, particularly general neurological function. In contrast, tDCS demonstrated small effects on motor recovery, though evidence certainty was very low due to heterogeneity, imprecision, and protocol variability. Within the activity domain, NIBS showed modest effects, with rTMS showing more consistent benefits for ADL. tDCS effects were generally limited and supported by low to very low certainty of evidence.

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