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SUMMARY OBJECTIVE: Low back pain is a common health problem that may lead to functional limitations and disability, restricting daily activities, reducing work productivity, and adversely affecting social participation and quality of life. This study aimed to evaluate the factors associated with functional capacity in patients with low back pain attending family medicine outpatient clinics. METHODS: This single-centre, cross-sectional study included 250 patients aged 18–65 years with chronic low back pain. Data were collected through face-to-face interviews using a structured questionnaire covering sociodemographic characteristics, chronic diseases, medication use, and low back pain characteristics. Pain intensity was assessed using the Visual Analog Scale, and functional capacity was assessed using the Back Pain Functional Scale. RESULTS: In the univariable analyses, lower Back Pain Functional Scale scores were observed in women, participants aged ≥55 years, individuals with obesity, housewives, those with lower educational attainment and income, and those with chronic diseases (all p<0.05). Back Pain Functional Scale scores were negatively correlated with pre-treatment Visual Analog Scale scores (Spearman's ρ=−0.419, p<0.001). In the multivariable analysis, male sex was independently associated with higher Back Pain Functional Scale scores, whereas higher body mass index, greater pain intensity, and reporting heavy lifting as the aggravating factor were independently associated with lower Back Pain Functional Scale scores (p<0.05). CONCLUSION: This study identified several factors associated with functional capacity in patients with low back pain. Higher body mass index, greater pain intensity, and heavy lifting as an aggravating factor were independently associated with poorer functional capacity. These findings may help clinicians identify patients at increased risk of functional impairment and support comprehensive assessment and management of low back pain.

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SUMMARY OBJECTIVE: The aim of this study was to analyze the profile of motorcycle accident victims treated at Hospital Monsenhor Walfredo Gurgel, a trauma referral center in Rio Grande do Norte, between February and October 2024. METHODS: This was an observational, retrospective, and descriptive study. Data regarding epidemiological profiles, mode of arrival, medical specialties involved, length of hospital stay, and clinical outcomes were extracted from electronic medical records. RESULTS: Among 7,176 recorded victims, there was a clear male predominance (75.52%, n=5,420), while females accounted for 24.47% (n=1,756). Analyzing victims aged 21–70 years, most cases occurred in the 21–30 age group (40.67%), followed by the 31–40 age group (28.66%). Most patients (71.27%) were admitted using specialized transport, including rural and state SAMU ambulances. General Surgery was the specialty most frequently involved in care (52.89%, n=3,178), followed by Orthopedics and Traumatology (36.98%), with Neurosurgery, Oral and Maxillofacial Surgery, Neurology, and Urology accounting for smaller proportions. CONCLUSION: Motorcycle injuries predominantly affect young, economically active men aged 21–40 years, accentuating the need for preventive strategies to reduce the burden on health services and improve pre-hospital and in-hospital care.

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SUMMARY OBJECTIVE: The aim of this study was to investigate whether serum zonulin, citrulline, and hemogram-derived inflammatory indices—the systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value—are associated with newly diagnosed pediatric celiac disease and to characterize their ability to distinguish the study groups. METHODS: A total of 82 children, comprising 48 patients with celiac disease and 34 healthy controls, were included. Serum zonulin, citrulline, and tissue transglutaminase immunoglobulin A levels and the systemic immune-inflammation index, systemic inflammation response index, and pan-immune-inflammation value were compared between groups. Receiver operating characteristic analysis was used to describe group discrimination within the selected sample, highlighting the limited standalone utility of these markers. RESULTS: Zonulin, tissue transglutaminase immunoglobulin A, the systemic immune-inflammation index, the systemic inflammation response index, and pan-immune-inflammation value were higher in the celiac group (p≤0.024), whereas citrulline did not differ between groups (p=0.982). The area under the receiver operating characteristic curves of pan-immune-inflammation value (0.644), monocyte count (0.642), the systemic immune-inflammation index (0.614), and the systemic inflammation response index (0.612) indicated poor discrimination and did not support their use as stand-alone diagnostic tests. The systemic inflammation response index and pan-immune-inflammation value were strongly correlated (ρ=0.91, p<0.001); this association should be interpreted in view of their shared blood-count components. CONCLUSION: Zonulin and hematological inflammation indices are potential markers associated with increased intestinal permeability and systemic inflammation in pediatric celiac disease. Together with tissue transglutaminase immunoglobulin A, these parameters may have an adjunctive role in reflecting disease-related pathophysiological processes; however, their low discriminatory performance precludes their use as stand-alone diagnostic tests.

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SUMMARY OBJECTIVE: The aim of this study was to analyze the incidence, spatial distribution, and temporal trend of leprosy in Piauí, Brazil, between 2013 and 2023. METHODS: This ecological study used secondary data on new leprosy cases from the Notifiable Diseases Information System, available through DATASUS/TABNET. Cases among adults aged 18 years or older living in Piauí were included. For the spatial analysis, cases were grouped by health macro-region and development region of residence, and absolute and relative frequencies were calculated to identify territories with the highest concentration of notifications. Temporal trends were assessed by simple linear regression, with a 5% significance level. RESULTS: From 2013 to 2023, Piauí recorded 12,256 new leprosy cases. The highest concentration occurred in the Meio Norte macro-region and the Entre Rios development region. A significant decreasing trend was observed in Piauí (β=-54.11; 95%CI -85.24 to -22.98; p=0.003) and Brazil (β=-1,361.24; 95%CI -2,151.01 to -571.46; p=0.004), with a marked reduction in notifications in 2020. Low educational attainment, lack of bacilloscopy testing, and dimorphic clinical form predominated. CONCLUSION: Leprosy remains a relevant public health problem in Piauí, with spatial concentration and signs compatible with delayed diagnosis and surveillance weaknesses. Strengthening early detection, active surveillance, and health education is necessary to reduce transmission.

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SUMMARY OBJECTIVE: This study aimed to investigate the factors affecting physical activity and physical function in primary Sjogren syndrome. METHODS: In total, 63 women with primary Sjogren syndrome were examined for physical activity using the International Physical Activity Questionnaire, identified barriers to activity via the Self-Perceived Barriers for Physical Activity Questionnaire, and assessed physical function with the 30-s sit-to-stand and grip strength tests. Disease activity was measured with the EULAR Sjögren's Syndrome Disease Activity Index, symptom severity with the EULAR Sjogren's Syndrome Patient Reported Index, and fatigue using the Multidimensional Fatigue Inventory. Anxiety and depression levels were evaluated with the Hospital Anxiety and Depression Scale, while health perception was assessed with the Health Perception Scale. RESULTS: A one-unit increase in the HPS_Center of control score was associated with a 23.1-point increase in the median International Physical Activity Questionnaire total score (95%CIs 0.55; 63.52). An increase in the Hospital Anxiety and Depression Scale-Anxiety, Hospital Anxiety and Depression Scale-Depression, and MFI_total scores is associated with a rise in the Self-Perceived Barriers for Physical Activity Questionnaire score (0.69 [0.42; 1.13]), (1.07 [0.58; 1.41]), and (0.25 [0.1; 0.3]), respectively. Conversely, grip strength was associated with EULAR Sjogren's Syndrome Patient Reported Index, Hospital Anxiety and Depression Scale-Depression, and MFI_Reduced Motivation (-0.44 [-0.86; -0.01]), (-0.26 [-0.41; -0.08]), and (-0.22 [-0.48; -0.08]), respectively. However, the HPS_Self-awareness score had a positive effect on the 30-s sit-to-stand (0.18 [0.11; 0.3]). CONCLUSION: In women with primary Sjogren syndrome, emotional symptoms and fatigue were negatively associated with physical activity and function. Better health perception was positively associated with both. Health education and management of emotional disorders and fatigue can improve physical activity and function in primary Sjogren syndrome.

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SUMMARY OBJECTIVE: This study aimed to evaluate the preventive effect of adding a propolis gargle to standard oral care on the development of oral mucositis in critically ill patients with chronic obstructive pulmonary disease. METHODS: This randomized controlled trial included 60 critically ill patients with chronic obstructive pulmonary disease. Both groups received the institutional standard oral care protocol with 0.2% chlorhexidine gluconate three times daily. The intervention group additionally received a propolis gargle three times daily for 15 days. Oral mucosal status was evaluated using the total oral mucosa score. RESULTS: There was no significant difference in oral mucosa scores between the groups at baseline, whereas oral mucosa scores were significantly lower in the intervention group than in the control group at the 7- and 15-day follow-ups (p<0.001). CONCLUSION: Adding propolis gargle to standard oral care significantly reduced the development of oral mucositis in critically ill patients with chronic obstructive pulmonary disease. However, because the intervention group received additional oral care exposure, the independent effect of propolis cannot be determined and requires further investigation. Clinical Trial Registration Number: ClinicalTrials.gov Identifier: NCT07426198.

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SUMMARY BACKGROUND: Multimodal interventions integrating breathing regulation and rhythmic auditory stimulation may improve trunk stability and modulate stress-related psychophysiological responses. Evidence on combined core stabilization and autonomic regulation programs in young adults remains limited. OBJECTIVE: The aim of this study was to investigate the effects of a 12-week music-accompanied program combining core stabilization, diaphragmatic breathing, and relaxation exercises on trunk muscle endurance and stress-related outcomes in university students. METHODS: In this randomized controlled trial, 80 university students were randomly assigned to an intervention (n=40) or a waitlist control group (n=40). The intervention was performed four times weekly for 12 weeks under physiotherapist supervision, including progressive core stabilization integrated with diaphragmatic breathing and slow-tempo music. Outcomes included trunk extensor endurance (Biering-Sorensen), lateral trunk endurance (lateral plank), trunk flexor endurance, perceived stress (PSS-10), and state anxiety (STAI-S). A 2×2 mixed-design analysis of variance evaluated group×time interactions. Assessors were not blinded. RESULTS: Significant group×time interactions favored the intervention group for perceived stress (η2p=0.148, d=0.82), state anxiety (η2p=0.122, d=0.74), lateral trunk endurance (left lateral plank: η2p=0.052, d=0.46;right lateral plank: η2p=0.078, d=0.57), and trunk flexor endurance (η2p=0.123, d=0.74). No significant interaction was found for trunk extensor endurance. CONCLUSION: A 12-week multimodal program combining core stabilization, breathing, relaxation, and music improved trunk endurance and reduced stress and anxiety; the waitlist design does not permit isolating music's specific contribution.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate changes in inflammatory markers after cardiac surgery with cardiopulmonary bypass and assess the discriminatory ability of aortic cross-clamp time for postoperative acute kidney injury. METHODS: This retrospective single-center study included 109 patients undergoing cardiopulmonary bypass-assisted cardiac surgery between January 2024 and March 2025. Preoperative and postoperative (30–36 h) creatinine, urea, albumin, C-reactive protein, neutrophil, and lymphocyte levels were evaluated. Acute kidney injury was defined using the serum creatinine component of KDIGO criteria. C-reactive protein/albumin ratio, C-reactive protein/lymphocyte ratio, neutrophil/lymphocyte ratio, and albumin×lymphocyte/C-reactive protein (CALLY) were calculated. Given the limited number of acute kidney injury cases, analyses were exploratory. Aortic cross-clamp time was assessed by receiver operating characteristic analysis. RESULTS: Postoperative neutrophil, lymphocyte, and albumin levels differed significantly from preoperative values (all false discovery rate-corrected p<0.001). C-reactive protein, C-reactive protein/albumin ratio, C-reactive protein/lymphocyte ratio, neutrophil/lymphocyte ratio, and CALLY levels increased significantly (all false discovery rate-corrected p<0.001). Acute kidney injury developed in 15 patients and was more common among non-survivors (10.1 vs. 50.0%; p=0.006; false discovery rate-corrected p=0.022). Postoperative creatinine levels were higher in non-survivors (false discovery rate-corrected p=0.011). Aortic cross-clamp time showed limited discrimination for Acute kidney injury (area under curve=0.621). At the 52-min cutoff, sensitivity was 66.7%, and specificity was 60.2%. CONCLUSION: Cardiopulmonary bypass-associated cardiac surgery was accompanied by significant inflammatory changes. Aortic cross-clamp time showed limited discriminatory ability and should be considered an exploratory risk indicator rather than a standalone predictor of acute kidney injury.

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SUMMARY OBJECTIVE: People with multiple sclerosis often experience muscle weakness and fatigue, which impair proprioception and gait. The effects of knee muscle fatigue on these outcomes remain unclear. This study investigated the effects of a knee muscle fatigue protocol on knee position sense and gait in people with multiple sclerosis. METHODS: A total of 36 mildly affected people with multiple sclerosis and nine healthy controls participated in this case-control study with repeated pre- and post-fatigue assessments. Gait was assessed using a G-Walk sensor, and knee position sense with an active repositioning test on an isokinetic dynamometer. Muscle strength and fatigue indexes were determined isokinetically for the knee flexors and extensors. RESULTS: During the fatigue protocol, people with multiple sclerosis produced lower total workloads than healthy control, although fatigue indexes were similar. After fatigue, both groups showed increased cadence and reduced gait cycle duration, while gait speed increased only in people with multiple sclerosis. Knee position sense deteriorated bilaterally in people with multiple sclerosis and on the non-dominant side in healthy control. CONCLUSION: Localized knee muscle fatigue altered knee position sense and gait in both groups, with no significant group×time interaction, though the small control group warrants caution. Similar fatigue indices despite lower total work warrant cautious interpretation of the Cybex fatigue index, given its dependence on baseline torque. As proprioceptive acuity declined transiently after localized knee muscle fatigue, clinicians may consider performing balance- or coordination-demanding tasks beforehand in people with multiple sclerosis.

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SUMMARY OBJECTIVE: The aim of this study was to describe the prescription of medical nutrition therapy for critically ill patients who were admitted to an intensive care unit during the first 5 days. METHODS: In an observational, longitudinal, retrospective study conducted at the intensive care unit of a tertiary hospital in Mexico City, adult patients admitted from January to December 2018 and from November 2024 to February 2025 were included. Indications for fasting, the route of medical nutrition therapy (enteral nutrition—parenteral nutrition), caloric and protein intakes, sequential organ failure assessment score and lactate levels, and vasopressor requirements during the 5 days were evaluated. Delay in initiating medical nutrition therapy was defined as initiated after 48 h of intensive care unit admission. RESULTS: 100 critically ill patients were included; aged 53±18.8, and with a median sequential organ failure assessment score of 10 (7–12). The most frequent diagnoses at admission were pulmonary disease and septic shock. On the first day, 98% of patients were fasting, and 25% received high-dose vasopressor therapy (if the norepinephrine equivalent dose >0.3 μg/kg/min). Over 5 days, medical nutrition therapy transitioned progressively, predominantly from fasting through enteral nutrition (45%) and parenteral nutrition (11%). medical nutrition therapy delay in 54 patients and in a multivariate analysis was associated with age (OR 1.04; 95%CI 1.01–1.07), sequential organ failure assessment score (OR 1.20; 95%CI 1.02–1.40), and lactate levels (OR 1.8; 95%CI 1.10–3.00). CONCLUSION: Prescription of medical nutrition therapy in critically ill patients admitted to a intensive care unit during 5 days is dynamic, and in all patients, it is not possible to initiate at 48 h, associated with higher age and illness severity.