FUNDAMENTO: Até recentemente, o hiperaldosteronismo primário era considerado uma causa rara de hipertensão secundária. Porém, ao longo dos últimos anos, muitos estudos têm sugerido que essa doença pode afetar até 20% dos hipertensos. OBJETIVO: Determinar a prevalência do hiperaldosteronismo primário em pacientes hipertensos em tratamento na liga de hipertensão de um hospital universitário. MÉTODOS: Foram realizadas dosagens de aldosterona sérica e atividade plasmática da renina em 105 pacientes, em vigência do tratamento anti-hipertensivo usual, excetuando-se aqueles em uso de beta-bloqueadores e espironolactona, em jejum e após repouso na posição deitada por 20 minutos. Aqueles com relação aldosterona/atividade plasmática da renina maior que 25 foram submetidos ao teste de supressão com sobrecarga salina endovenosa e, após a confirmação da autonomia da secreção de aldosterona, foi realizada tomografia computadorizada das adrenais. Os resultados são apresentados como porcentagens, médias e desvios-padrão. RESULTADOS: Dos 105 pacientes, 6,54% eram hipertensos refratários. Nove apresentaram relação aldosterona/atividade plasmática da renina > 25 (8,5% do total). Destes, oito foram submetidos ao teste de supressão e um (hipertenso refratário) teve o diagnóstico confirmado de hiperaldosteronismo primário (0,96% do total). Foi realizada tomografia computadorizada de adrenais, sendo considerada normal. CONCLUSÃO: A prevalência do hiperaldosteronismo primário na amostra estudada foi de 0,96% do total. No entanto, quando avaliados apenas os portadores de hipertensão refratária, a prevalência foi de 14,3%. FUNDAMENTO: Hasta recientemente, se consideraba el hiperaldosteronismo primario como una causa rara de hipertensión secundaria. Sin embargo, a lo largo de los últimos años, muchos estudios han sugerido que esa enfermedad puede afectar hasta el 20% de los hipertensos. OBJETIVO: Determinar la prevalencia del Hiperaldosteronismo Primario en pacientes hipertensos en tratamiento en la Liga de Hipertensión de un Hospital Universitario. MÉTODOS: Se realizaron dosificaciones de aldosterona sérica y actividad plasmática de la renina en 105 pacientes, en vigencia del tratamiento antihipertensivo usual, excepto aquellos en uso de betabloqueantes y espironolactona, en ayuno y tras guardar reposo en posición acostada por 20 minutos. Aquellos con relación aldosterona/actividad plasmática de la renina mayor que 25 se sometieron a prueba de supresión con sobrecarga salina endovenosa y, luego de la confirmación de la autonomía de la secreción de aldosterona, se realizó tomografía computarizada de las adrenales. Los resultados se presentan como porcentajes, promedios y desviaciones estándar. RESULTADOS: De los 105 pacientes, el 6,54% eran hipertensos refractarios. Nueve presentaron relación aldosterona/actividad plasmática de la renina > 25 (8,5% del total). De estos, ocho se sometieron al examen de supresión y uno (hipertenso refractario) tuvo el diagnóstico confirmado de Hiperaldosteronismo Primario (el 0,96% del total). Se realizó una tomografía computarizada de adrenales, que estaba normal. CONCLUSIÓN: La prevalencia del Hiperaldosteronismo Primario en la muestra estudiada fue del 0,96% del total. Sin embargo, cuando se evaluaron sólo los portadores de hipertensión refractaria, la prevalencia fue del 14,3%. BACKGROUND: Until recently, primary hyperaldosteronism was considered a rare cause of secondary hypertension. However, in recent years, many studies have suggested that this disease can affect up to 20% of hypertensive individuals. OBJECTIVE: To determine the prevalence of primary hyperaldosteronism in hypertensive patients treated at the hypertension league of a university hospital. METHODS: Serum aldosterone and plasma renin activity levels were measured in 105 patients while they were undergoing standard antihypertensive treatment, with the exception of those using betablockers and spironolactone, in fasting condition and after rest in the supine position for 20 minutes. Those with an aldosterone/plasma renin activity ratio > 25 were submitted to the saline suppression test and, after the confirmation of the autonomy of aldosterone secretion, a computed tomography of the adrenals was performed. The results are presented as percentages and means and standard deviations. RESULTS: Of the 105 patients, 6.54% presented refractory hypertension. Nine presented an aldosterone/plasma renin activity ratio > 25 (8.5% of the total). Of these, 08 were submitted to the saline suppression test and 01 (with refractory hypertension) had the diagnosis of primary hyperaldosteronism confirmed (0.96% of the total). A computed tomography of the adrenals was performed, which showed normal results. CONCLUSION: The prevalence of primary hyperaldosteronism in the studied sample was 0.96% of the total. However, when only the patients with refractory hypertension were evaluated, the prevalence was 14.3%

Background/Objectives: Cognitive decline has been increasingly linked to cardiac autonomic regulation; however, its specific associations with cognitive domains, such as information processing speed and executive function, remain unclear. This preliminary study examined the relationship between cardiac autonomic modulation and cognitive performance in older adults. Methods: A cross-sectional study was conducted with 101 older adults (aged ≥60 years) attending a university hospital outpatient clinic. Participants were classified as without cognitive impairment (WCI) or cognitively impaired and not demented (CIND) based on neuropsychological assessments. Heart rate variability (HRV) was measured at rest, focusing on the time-domain parameters (SDNN, rMSSD, and pNN50). Trail making test parts A and B (TMT-A and TMT-B) were used to assess information processing speed and executive function, respectively. Analyses of covariance (ANCOVAs) were performed, adjusting for confounding variables including age, sex, and comorbidities. Results: Participants in the CIND group had significantly lower HRV indices than those in the WCI group (SDNN, p < 0.05, d = 0.44; rMSSD, p < 0.05, d = 0.39; pNN50, p < 0.05, d = 0.40), indicating reduced parasympathetic modulation. Higher HRV values were observed in individuals with preserved processing speed and executive function. Specifically, pNN50 was significantly associated with processing speed (p = 0.04), and SDNN was significantly correlated with executive function (p = 0.02). These associations persisted even after adjusting for confounding factors. Conclusions: Reduced cardiac autonomic modulation, especially lower parasympathetic activity, is significantly associated with cognitive impairment in older adults. Lower pNN50 values were correlated with slower information processing speed, and lower SDNN was associated with poorer executive function. These findings support the potential use of HRV as a physiological biomarker to detect cognitive changes during ageing.

Patients with type 1 diabetes (T1D) have a higher risk of developing cardiovascular disease (CVD), which is a major cause of death in this population. This study investigates early markers of CVD associated with clinical data and autosomal ancestry in T1D patients from an admixed Brazilian population. A cross-sectional study was conducted with 99 T1D patients. The mean age of the study sample was 27.6 years and the mean duration of T1D was 14.4 years. The frequencies of abnormalities of the early markers of CVD were 19.6% in the ankle-brachial index (ABI), 4.1% in the coronary artery calcium score (CACS), and 5% in the carotid Doppler. A significant percentage of agreement was observed for the comparison of the frequency of abnormalities between CACS and carotid Doppler (92.2%, p = 0.041). There was no significant association between the level of autosomal ancestry proportions and early markers of CVD. The ABI was useful in the early identification of CVD in asymptomatic young patients with T1D and with a short duration of disease. Although CACS and carotid Doppler are non-invasive tests, carotid Doppler is more cost-effective, and both have limitations in screening for CVD in young patients with a short duration of T1D. We did not find a statistically significant relationship between autosomal ancestry proportions and early CVD markers in an admixed Brazilian population.

Background: Large language models (LLMs) are increasingly considered as adjuncts for differential diagnostic reasoning, yet their sensitivity to gender-attributed cues in the persona prompt—particularly for neglected tropical diseases (NTDs) and in non-English clinical settings—remains poorly characterised. Objective: The objective of this study was to compare the diagnostic accuracy of one proprietary and three open-weight LLMs for Chagas disease (CD) and visceral leishmaniasis (VL) under paired persona-prompt conditions in which the only manipulated variable was the linguistic gender of the simulated medical persona. Methods: This experimental, paired study evaluated ChatGPT-4o, LLaMA 3 70B, Meditron-70B, and Mixtral 8x7B across 12 cases per disease (n = 24) from real records at a Brazilian teaching hospital. The primary outcome was top-five diagnostic accuracy. A committee of five infectious-disease specialists assessed the biological plausibility of all differentials. Paired comparisons used Wilcoxon signed-rank tests; 95% confidence intervals were calculated using the Wilson-score method. Results: ChatGPT-4o achieved the highest accuracy (CD: 100% under both prompts; VL: 83.3–91.7%). LLaMA 3 70B and Mixtral 8x7B showed moderate performance (41.7–83.3%); the medically fine-tuned Meditron-70B exhibited paradoxically poor accuracy (16.7–25.0%) and the lowest committee-rated plausibility scores. A consistent small numerical trend favoured the female prompt across most model–disease combinations (differences of 0–16.7 percentage points), but no comparison reached statistical significance (all p > 0.05). Conclusions: Gender-attributed persona-prompt variation did not produce a systematic effect on LLM diagnostic accuracy for CD or VL. ChatGPT-4o outperformed the three evaluated open-weight alternatives, and medical-domain fine-tuning did not confer the expected advantage. Expert-validated assessment of hypothesis plausibility should complement target-disease accuracy in clinical LLM evaluation studies, particularly for NTDs.

This study aimed to translate, cross-culturally adapt, and validate the Heart Disease Fact Questionnaire into Brazilian Portuguese. The Brazilian version of the Heart Disease Fact Questionnaire was developed through the processes of translation, back-translation, review committee, and pre-test. Test-retest reliability was measured using the intraclass correlation coefficient and the kappa coefficient. Internal consistency was measured using Cronbach's alpha. For construct validity, the total Heart Disease Fact Questionnaire score was correlated with the Diabetes Knowledge Scale and the Diabetes Attitudes Questionnaire. Ceiling and floor effects were also evaluated in this study. For construct validity and floor and ceiling effect measurements, a total of 100 participants were selected. Reliability was measured using a sub-sample of 30 participants from the total sample. We identified adequate values of reliability (kappa between 0.22 and 1.00 and ICC=0.75) and internal consistency (Cronbach's alpha=0.79). We observed adequate correlations of the Heart Disease Fact Questionnaire score with Diabetes Knowledge Scale (r=0.348) and Diabetes Attitudes Questionnaire (r=0.136). No ceiling or floor effects found. Brazilian Portuguese version of the Heart Disease Fact Questionnaire has adequate psychometric properties according to the best scientific recommendations.

Background: Large language models (LLMs) are increasingly used as diagnostic support tools. However, their sensitivity to prompt framing (especially the gender assigned to the physician persona) is poorly understood for neglected tropical diseases (NTDs). Objective: Compare the diagnostic performance of four LLMs prompted as male or female infectious disease specialists using anonymized cases of Chagas disease (CD) and visceral leishmaniasis (VL). Methods: This experimental, paired study evaluated ChatGPT-4o, LLaMA 3 70B, Meditron-70B, and Mixtral 8x7B across 12 cases per disease (n=24), from real records at a Brazilian teaching hospital. The primary outcome was top-five diagnostic accuracy. A committee of five infectious disease specialists assessed the biological plausibility of all differentials. Paired comparisons used Wilcoxon signed-rank tests; 95% confidence intervals were calculated using the Wilson score method. Results: For VL, the female prompt yielded numerically higher accuracy in all four models (gains of 8.3–16.7 percentage points), with ChatGPT-4o reaching 91.7%. For CD, ChatGPT-4o achieved 100% under both conditions; LLaMA 3 70B and Mixtral 8x7B improved by 16.7 percentage points with the female prompt, while Meditron-70B remained at 16.7%. No between-prompt differences reached statistical significance (all p>0.05). ChatGPT-4o produced the highest proportion of biologically plausible diagnoses, while Meditron-70B generated the most implausible hypotheses. Conclusion: The gender assigned to the physician persona produced subtle, nonsignificant variations in LLM diagnostic accuracy, with a consistent numerical trend favoring the female prompt in open-weight models. These findings underscore the importance of prompt standardization and systematic bias evaluation in AI-assisted diagnostics for NTDs.