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ABSTRACT BACKGROUND: Chronic tension-type headache (CTTH) is a prevalent primary headache disorder that significantly affects quality of life. Hyperacusis, an abnormal intolerance to everyday sounds, is frequently observed in patients with CTTH, suggesting potential shared neural mechanisms. However, the clinical characteristics of patients with CTTH and comorbid hyperacusis remain poorly characterized. OBJECTIVES: This study aimed to investigate the clinical characteristics of CTTH patients with comorbid hyperacusis, focusing on headache profiles, auditory sensitivity patterns, and psychological correlates, and to identify factors independently associated with hyperacusis in this population. DESIGN AND SETTING: A cross-sectional study was conducted at the outpatient department of the Third Affiliated Hospital of Qiqihar Medical College from January 2022 to December 2024. METHODS: We consecutively enrolled 234 patients with CTTH diagnosed according to International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were consecutively enrolled. Hyperacusis was confirmed via otolaryngological evaluation and audiometric testing (pure-tone thresholds and loudness discomfort levels [LDL]). Demographic data, headache features (frequency, intensity, and duration), hyperacusis distress severity, and psychological measures (Generalized Anxiety Disorder-7 [GAD-7], Self-rating Somatic Symptom Scale [SSS], and Pittsburgh Sleep Quality Index [PSQI]) were analyzed. Univariate analyses (Student’s t-test and Chi-squared test) and multivariate logistic regression adjusted for potential confounders were performed to compare patients with (n = 47) and without (n = 187) hyperacusis. RESULTS: Hyperacusis prevalence was 20.09% (47/234). Compared to non-hyperacusis patients, hyperacusis patients exhibited longer headache duration (13.9 ± 3.15 versus 8.11 ± 2.74 years, P = 0.01), higher weekly headache frequency (7.30 ± 1.99 versus 4.19 ± 1.2, P = 0.005), more pericranial tenderness (95.74% versus 77.54%, P = 0.008), and poorer sleep quality (PSQI: 14.01 ± 1.13 versus 9.17 ± 0.51, P = 0.004). After adjusting for age, sex, headache duration, and pain intensity in multivariate logistic regression, higher headache frequency (odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.12-1.79, P = 0.003) and higher PSQI scores (odds ratios = 1.38, 95% CI: 1.15-1.66, P = 0.001) remained independently associated with hyperacusis. Common triggering sounds included children crying (61.7%) and traffic noise (42.55%), with predominant emotional responses being irritability (76.6%) and anxiety (65.96%). LDL classification (analyzed as an ordinal variable) was correlated with headache duration (P < 0.05), while hyperacusis distress severity was linked to headache frequency and PSQI scores (P < 0.05). CONCLUSION: CTTH with hyperacusis represents a distinct subgroup characterized by a history of prolonged headaches, increased attack frequency, and significant sleep disturbances. The independent associations identified suggest that sound sensitivity is closely linked to headache burden and sleep quality; however, causal relationships require longitudinal investigation. Integrated management addressing both headache and auditory hypersensitivity is warranted.

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ABSTRACT BACKGROUND: Cisplatin is a widely used chemotherapeutic agent whose clinical utility is limited by dose-dependent hepatotoxicity, primarily driven by oxidative stress and inflammation. Agmatine, an endogenous polyamine, has demonstrated antioxidant and anti-inflammatory properties in various models; however, its hepatoprotective effects in cisplatin-induced liver injury remain underexplored. METHODS: This experimental study investigated the protective effects of agmatine against cisplatin-induced hepatotoxicity in 28 male Sprague Dawley rats. The animals were randomized into four groups: Sham, Cisplatin, Cisplatin + Agmatine (20 g/kg/day, orally), and Placebo. Biochemical markers, including ALT, AST, MDA (malondialdehyde), SOD (superoxide dismutase), GPx (glutathione peroxidase), TNF-α, IL-1β, and TGF-β, were assessed using ELISA (enzyme-linked immunosorbent assay). Histopathological evaluation was performed to assess liver architecture and injury severity. RESULTS: Cisplatin administration significantly increased serum levels of ALT, AST, MDA, and proinflammatory cytokines (IL-1β, TNF-α, and TGF-β), while reducing antioxidant enzyme activities (SOD and GPx) (p < 0.01). Agmatine co-administration significantly reversed these biochemical alterations and ameliorated histopathological damage, as evidenced by reduced inflammatory infiltration, sinusoidal dilatation, and hepatocellular degeneration. CONCLUSION: Agmatine demonstrates significant hepatoprotective effects against cisplatin-induced liver injury by attenuating oxidative stress and inflammatory responses. These findings suggest its potential role as an adjunctive agent to improve the hepatic safety profile of cisplatin chemotherapy.

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ABSTRACT BACKGROUND: Telemedicine may help advance healthcare equity, particularly in low-income communities, by reducing economic burdens and mitigating geographic barriers to specialized care, including transportation costs, time away from work, and long travel distances to referral centers. OBJECTIVES: This study aims to evaluate the impact of a remote consultation protocol on healthcare access among predominantly low-income patients with breast cancer in Brazil. DESIGN AND SETTING This prospective cohort study was conducted at a tertiary public cancer center and included 946 women with breast cancer. METHODS: Sociodemographic characteristics, teleconsultation-related data, and patient satisfaction measured using a validated Likert-based questionnaire were collected. The study was approved by the local ethics committee, and all participants provided informed consent. RESULTS The mean age was 57.3 years. Overall, 51.6% of participants identified as white, and 64.4% reported a family income below two Brazilian minimum wages. Over one-third (34.3%) had not completed elementary school. Despite this socioeconomic vulnerability, 93.5% reported internet access, 90.3% owned a mobile phone, and 52.7% had an email address. During the study period, 946 appointments were scheduled and screened for teleconsultation eligibility. Among these, 229 patients met predefined eligibility criteria and were offered teleconsultation, and 117 completed the remote visit, corresponding to an uptake of 51.1% among eligible patients. Regarding hospital visits, 57% relied on public transportation, with a mean cost of $ 4 per visit, representing a substantial financial burden. Travel time exceeded 90 minutes for 19.4% of patients. Satisfaction with teleconsultation was high, with a mean Likert score of 4.65/5 and a Net Promoter Score of 79.8. CONCLUSION: Among patients eligible for telemedicine, more than half completed teleconsultation, indicating that implementation is feasible even in socially vulnerable populations with limited digital literacy. The remote care protocol improved access, reduced financial burden, and achieved high patient satisfaction, supporting telemedicine as a strategy to promote equity in breast cancer care in Brazil.

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ABSTRACT BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disease characterized by motor and non-motor symptoms. Attention deficits are common in patients with PD, and balance can be affected by sleep quality and depression. The auditory event-related potential (ERP) P300 tool is associated with attention and discrimination processes and is a sensitive indicator of attention. OBJECTIVES: This study aimed to investigate the effects of balance, sleep quality, and depression on attention in individuals with PD using P300 latency. DESIGN AND SETTING: In this cross-sectional study, 28 individuals with PD and 27 healthy controls were assessed. METHODS: Attention was measured using the auditory ERP P300, balance with the Berg Balance Scale (BBS), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and depression with the Beck Depression Inventory (BDI). Multiple linear regression analysis was used to examine the effects of these variables on P300 latency. RESULTS: Significant differences were found between the groups in terms of attention, balance, sleep quality, and depression (all P < 0.001). Regression analysis indicated that balance (B = -4.909, P = 0.001) and sleep quality (B = 12.704, P = 0.007) were significantly associated with P300 latency, whereas depression (B = 3.472, P = 0.084) was not. CONCLUSION: PD is associated with impaired attention, balance deficits, poor sleep quality, and increased depressive symptoms. The significant association between balance performance and sleep quality with attentional processing highlights their potential relevance in clinical assessment and management. CLINICAL TRIAL REGISTRATION: The study was registered with Clinical Trials (NCT04687371 – https://clinicaltrials.gov/study/NCT04687371).

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ABSTRACT BACKGROUND: Relative energy deficiency in sport (REDs) is a syndrome that impairs physiological function because of low energy availability. Awareness and knowledge of REDs among athletes and health professionals are essential for early identification and prevention. OBJECTIVE: To translate into Brazilian Portuguese and culturally adapt a questionnaire that assesses knowledge of the signs, symptoms, and consequences of REDs, originally created by Pai et al., and to obtain evidence of content and face validity. DESIGN AND SETTING: Translation, cultural adaptation, and validation study conducted remotely using online tools and digital data collection. METHODS: The translation and cultural adaptation consisted of the following steps: two independent translations, synthesis of the translations by a committee of health professionals, two back-translations, and review by a committee of experts to determine the best version for testing. For content validity, the content validity coefficient (CVC) was calculated based on the evaluation of the experts committee on the practical pertinence, theoretical relevance, and linguistic clarity of the items of the pretest version. For face validity, the pretest version was applied to 30 individuals who assessed the items for linguistic clarity, adequacy, and comprehensibility. RESULTS: The CVC for the scale was 0.97. The CVC values for clarity, pertinence, and relevance were 0.97, 1 and 0.99, respectively. All items had a CVC > 0.8, confirming acceptable content validity. The pretest version was tested on 12 female runners, eight coaches, and 10 dietitians. Items were clear and comprehensible to 93% and adequate to 96% of respondents. No changes were needed, and the pretest version was defined as the Brazilian version of the questionnaire to assess REDs knowledge (QC-REDs). CONCLUSION: The QC-REDs obtained strong content and face validity. It provides a rigorously adapted tool for Brazil, supported by positive feedback from the target population, demonstrating its applicability and usability. This instrument fills a crucial gap and offers a valuable resource for researchers and professionals working with athletes at risk of REDs. Future research should focus on psychometric validation to further solidify its effectiveness in the Brazilian context.

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ABSTRACT BACKGROUND: The Positive Aspects of Caregiving Scale (PAC) assesses the satisfaction and psychosocial benefits perceived by caregivers in the caregiving experience. OBJECTIVE: To analyze the psychometric properties of the PAC among unpaid caregivers of people living with dementia in the Brazilian context. DESIGN AND SETTING: Validation study of the instrument conducted online with caregivers from different regions of Brazil. METHODS: The sample comprised 100 unpaid caregivers of people living with dementia. Sociodemographic characteristics, positive aspects of caregiving, burden, depressive symptoms, anxiety symptoms, and quality of life were assessed using an online form. Evidence of validity based on internal structure was examined using confirmatory factor analysis, reliability testing, and criterion validity analysis. RESULTS: Most participants were women (95%), daughters of the care recipient (85%), with an average age of 54.5 years, a high educational level, and residence in the Southeast region of Brazil. Depressive symptoms (70%), anxiety (65%), moderate to severe burden (42%), and low quality of life (62%) were prevalent. Factor analysis indicated satisfactory fit for the PAC, and the high correlation between factors supported consideration of a one-dimensional scoring structure. The scale showed high internal consistency (α = 0.89) and significant correlations with burden, anxiety symptoms, depressive symptoms, and quality of life. CONCLUSION: The PAC showed good psychometric properties in the Brazilian context, supporting its validity and reliability for assessing positive aspects of caregiving among unpaid caregivers of people living with dementia.

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ABSTRACT BACKGROUND: End-stage chronic kidney disease (CKD) requires hemodialysis, which carries significant biopsychosocial impact. OBJECTIVES: This study aimed to investigate the relationship between family functionality and social support among older individuals undergoing hemodialysis. DESIGN AND SETTING: This cross-sectional and correlational study was conducted at a renal replacement therapy unit located in São Paulo State. METHODS: A total of 118 participants aged ≥ 60 years undergoing hemodialysis were interviewed individually using the Family adaptability, partnership, growth, affection, and resolve (APGAR), and the Medical Outcomes Study Social Support Scale. All ethical principles were duly respected. RESULTS: Majority of participants were male (69.5%), aged between 60–69 years (50.8%), white ethnicity (63.6%), with a stable partner (54.2%), and had an income of one to three times the minimum wage (55.9%). Regarding the domains of social support, affective support (AS) had the highest mean score (93.44 ± 12.97), whereas informational support (IS) had the lowest (81.69 ± 24.60). Overall, 83.9% reported good family functioning, 9.3% moderate family dysfunction, and 6.8% severe dysfunction. A statistically significant positive correlation with a moderate magnitude was confirmed between APGAR with all support domains. Material support (MS, r = 0.327), AS (r = 0.425), emotional support (ES, r = 0.518), positive social interaction support (PSIS, r = 0.466), and IS (r = 0.421). CONCLUSION: Social support was positively associated with family functioning, indicating that patients with CKD undergoing hemodialysis who reported better family functioning also perceived higher levels of social support.

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ABSTRACT BACKGROUND: Melasma is one of the most common physiological hyperpigmentation disorders observed during pregnancy, and its clinical characteristics and risk factors have been extensively investigated. However, evidence regarding the relationship between pregnancy-related melasma and body perception remains limited. OBJECTIVE: This descriptive cross-sectional study aimed to determine the prevalence of melasma among pregnant women and to examine its association with body perception. METHODS: This study included 450 pregnant women in the central city center of the Central Anatolia Region of Türkiye who met the inclusion criteria. Data were collected using the Introductory Information Form, the Melasma and Skin Type Characteristics Assessment Form, and the Body Perception Scale (BPS) and analyzed using descriptive statistics, comparative analyses, and logistic regression. RESULTS: Melasma was identified in 37.8% of the participants, and the centrofacial pattern was the most common presentation (56.5%). A statistically significant association was found between pregnancy-related melasma and total BPS scores (p < 0.05). Pregnant women without melasma had significantly higher mean BPS scores than those with melasma (150.83 ± 17.18 vs. 146.15 ± 15.16; p = 0.004). Logistic regression analysis demonstrated that low educational and income levels, a personal or family history of melasma, and Fitzpatrick skin type IV were significant predictors of pregnancy-related melasma (p < 0.05), accounting for 61% of the variance. CONCLUSION: The findings indicate the need for a holistic assessment of physiological skin changes and body perception during pregnancy, as well as the integration of counseling, education, and nursing care interventions targeting risk factors into routine prenatal care.

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ABSTRACT BACKGROUND: Aphasia following stroke is primarily characterized by language impairment; however, accumulating evidence suggests that deficits in auditory and cognitive processing may also contribute to impaired language function. Auditory evoked potentials provide objective markers of neural processing across subcortical, cortical, and cognitive levels and may help clarify the neurophysiological mechanisms underlying post-stroke aphasia. OBJECTIVES: To investigate multilevel auditory processing and its relationship with language performance in individuals with post-stroke aphasia using Auditory Brainstem Responses (ABR), Late Latency Responses (LLR), and P300 potentials. DESIGN AND SETTING: Cross-sectional observational study conducted at a university hospital in Türkiye. METHODS: Twenty-nine individuals with post-stroke aphasia and 33 age-matched healthy controls were included. Language performance was assessed using the Aphasia Language Assessment Test and a standardized naming task. Auditory processing was evaluated using ABR, LLR (P1, N1, P2, N2), and P300 potentials recorded according to standard electrophysiological protocols. Group comparisons were performed for latency and amplitude measures, and correlation analyses were conducted to examine associations between electrophysiological parameters and language performance. RESULTS: Compared with healthy controls, individuals with aphasia demonstrated significantly prolonged latencies in ABR waves and interpeak intervals, as well as in all LLR and P300 components (p < 0.05). No significant group differences were observed in amplitude measures. Naming performance was significantly lower in the aphasia group. Although correlations between language performance and electrophysiological measures did not reach statistical significance, moderate negative trends were observed between naming scores and N2 and P300 latencies. CONCLUSION: Post-stroke aphasia is associated with delayed auditory processing across subcortical, cortical, and cognitive levels, reflecting generalized slowing rather than reduced neural recruitment. Latency-based auditory evoked potential measures may complement behavioral language assessments and support a multilevel auditory–cognitive framework for aphasia evaluation and rehabilitation.

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ABSTRACT BACKGROUND: Real-world data on the treatment patterns and clinical outcomes of second-line nilotinib use in chronic myeloid leukemia (CML) remain limited, particularly regarding predictors of deep molecular response (DMR). OBJECTIVES: To characterize treatment patterns and long-term clinical outcomes in patients with CML receiving second-line nilotinib and to evaluate whether early molecular milestones combined with baseline prognostic scores predict DMR. DESIGN AND SETTING: Retrospective, single-center real-world study conducted at a tertiary academic center between 2011 and 2025. METHODS: The data of 45 patients with CML receiving second-line nilotinib because of imatinib resistance or intolerance were analyzed. Treatment patterns, including duration and reasons for switching therapy, were assessed. Baseline prognostic scores (Sokal, European Treatment and Outcome Study [EUTOS], EUTOS Long-Term Survival [ELTS], Hammersmith) were calculated, and molecular responses were assessed according to the European LeukemiaNet (ELN) criteria. Predictors of DMR were examined using univariate and multivariate logistic regression, and survival outcomes were estimated using Kaplan–Meier analysis. RESULTS: The median duration of nilotinib administration was 67.3 months, with 60% of patients achieving a best response of DMR and 46.7% maintaining a sustained DMR. Univariate analysis showed that a favorable Hammersmith score (p = 0.001), low ELTS risk (p = 0.028), and attainment of ELN-defined milestones at 6 (p = 0.020) and 12 months (p = 0.006) were significantly associated with DMR. Multivariate analysis demonstrated that the 12-month ELN milestone (p = 0.008) and favorable Hammersmith score (p = 0.023) were independently associated with a DMR. Patients achieving a DMR showed a nonsignificant trend toward improved overall survival. CONCLUSION: In this real-world cohort, a DMR and favorable survival outcomes were achieved when nilotinib was administered as second-line treatment. Integrating baseline prognostic scores with molecular milestones enables individualized monitoring and supports a sustained DMR as a marker of durable disease control.

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ABSTRACT BACKGROUND: Low birth weight (LBW) is a major public health concern associated with increased neonatal morbidity and mortality. OBJECTIVE: This study was aimed to develop a predictive learning model using machine learning techniques to identify LBW from live birth data. METHODS: A retrospective population-based study was conducted using data from the Brazilian Live Birth Information System (SINASC), which includes all live births registered in the state of São Paulo between 2019 and 2023. After data curation and exclusion of records with missing or unknown information, a total of 2,548,570 live births were analyzed. Predictors included maternal sociodemographic characteristics, obstetric history, prenatal care indicators, and newborn characteristics. Logistic regression and random forest models were trained using an 80/20 train–test split, with class imbalance addressed through class weighting. Model performance was evaluated using accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC-ROC). RESULTS: The analysis showed that the balanced logistic regression model performed best in terms of sensitivity (0.688), F1-score (0.567), and AUC-ROC (0.850). A proportional analysis of the variables between the LBW and normal-weight groups revealed a higher prevalence of LBW among mothers with low education levels, without a partner, of Black or Brown ethnicity, aged ≤ 19 years or ≥ 35 years, with multiple pregnancies, with a reduced number of prenatal consultations, and with late initiation of prenatal care. CONCLUSIONS: The findings highlight the importance of large-scale data analysis supported by machine learning techniques to inform public policies aimed at preventing LBW and promoting maternal and child health.