Hospital Moinhos de Vento

Biologic therapies have transformed psoriasis management, and their incorporation into Brazil's public healthcare system (SUS) in 2019 expanded access nationwide. However, real-world utilization and perceptions remain incompletely understood.

To evaluate perceptions, barriers, and prescription patterns regarding biologic therapy among Brazilian dermatologists and patients five years after universal incorporation, while quantifying the prevalence of undertreatment.

We conducted two independent cross-sectional online surveys throughout 2024 among dermatologists (n = 225) and patients with psoriasis or psoriatic arthritis (n = 1,001). Data on demographics, clinical characteristics, and perceived barriers were analyzed.

Overall, 64.9% of dermatologists prescribed biologics, with higher prescribing rates among younger physicians (p = 0.022), those with fewer years of practice (p = 0.013), higher patient volumes (p < 0.001), and practice in tertiary centers (p = 0.001). Only 25.5% of patients were receiving biologics, strongly associated with psoriatic arthritis (p < 0.001), with no difference between public and private care. Key barriers included perceptions that conventional therapies are sufficient (59.5%), insufficient training (38.0%), and administrative burden (45.5%), while patients mainly reported safety (45.7%) and cost (30.9%) concerns. Undertreatment was prevalent, affecting over 50% of patients with moderate-to-severe disease. While 71.3% of non-users were willing to start biologics, only 28.0% had received a medical recommendation.

Persistent educational and structural barriers continue to limit optimal biologic use despite formal availability, highlighting the need for targeted education, streamlined care pathways, and improved physician-patient communication to achieve equitable outcomes.

Depression is a leading cause of disability among adolescents, yet the biological mechanisms underlying its onset and clinical course remain poorly understood. Dysregulation of immune and metabolic pathways has been increasingly implicated in adolescent depression, but longitudinal data linking these mechanisms to clinical trajectories are still limited.

We investigated transcriptomic profiles in a three-year longitudinal study of n = 50 adolescents with major depressive disorder (MDD) and n = 50 adolescents at high sociodemographic risk (HR) for developing MDD, recruited as part of the IDEA-RiSCo cohort in Brazil. Remission (for the MDD group) or transition to depression (for the HR group) were evaluated at 3-year follow-up. Peripheral blood transcriptomics were analyzed using RNA-sequencing, and differentially expressed transcripts were subjected to pathway analysis. Baseline and 3-year follow-up transcriptomics profiles were compared between (i) adolescents with remitted versus persistent MDD, and between (ii) HR adolescents who transitioned to MDD versus those who did not.

Adolescents with MDD at baseline who later remitted showed a change in activation of inflammatory pathways between baseline and 3-year follow-up when compared with those with persistent MDD, presenting an initial stronger pro-inflammatory signature which reversed at follow-up with a recovery of adaptive immune pathways, including upregulation of IL-4 signaling and downregulation of CTLA4 and neutrophil degranulation pathways. In contrast, HR adolescents who transitioned to MDD displayed early dysregulation of immune and GABAergic and glutamatergic pathways, with subsequent downregulation of cell cycle regulation, intracellular signaling, and serotonin receptor pathways at follow-up.

This study identifies distinct transcriptomic signatures underlying divergent trajectories of adolescent depression. A dynamic regulation of inflammatory responses appears to support remission, while progressive impairment of immune, metabolic, GABAergic, glutamatergic and serotoninergic pathways characterizes both persistence of MDD and the transition from high-risk status to disorder onset. These findings highlight potential biological targets for prevention and stratified interventions in adolescent depression.

To evaluate the incidence and factors associated with oropharyngeal dysphagia (OD) three months after intensive care unit (ICU) discharge in patients who underwent invasive mechanical ventilation (IMV).

This was a post-hoc analysis of a prospective multicenter cohort study conducted across ten clinical-surgical ICUs in Brazil. Adult survivors (age > 18 years) with ICU stays ≥72 h and who needed IMV were included. The primary outcome was the incidence of OD, assessed by the Functional Oral Intake Scale (FOIS) during structured telephone interviews. Secondary outcomes included quality of life, measured by the Short Form Health Survey version 2, and rehospitalization.

Among 360 patients, the incidence of OD 3 months after ICU discharge was 24.17%. Educational attainment (adjusted risk ratio [aRR] per 1 year increase, 0.95; 95% confidence interval [CI] 0.92-0.99), risk of death at ICU admission (aRR per 1% increase, 1.99; 95% CI, 1.06-3.77), acute respiratory distress syndrome [ARDS] diagnosis at ICU admission (aRR, 0.21; 95% CI, 0.06-0.71), and length of mechanical ventilation (aRR per 1 day increase, 1.02; 95%CI, 1.01-1.03) were associated with OD. Patients with OD reported significantly worse physical and mental quality-of-life scores. The incidence of rehospitalization did not differ significantly between patients with and without OD.

OD 3 months after ICU discharge is a common condition among ICU survivors who required IMV. Educational level, severity of illness at ICU admission, ARDS diagnosis at ICU admission, and length of mechanical ventilation are key associated variables.