Cervical cancer (CC) is the most common type of cancer in women and is the third leading cause of death in most developing countries, causing more than 288,000 deaths in women worldwide each year. The most favourable survival rate is in developed countries, since CC mortality has recently declined in those countries. The purpose of this study was to determine the survival rate and associated factors of CC patients at a reference hospital in the Amazon region. The patient sample included records of 339 patients with cervical cancer who had been hospitalized in Belém, Pará, Brazil from January 2005 to December 2010; the socioeconomic and clinical data were collected between June and September 2016. A survival rate of approximately 84% was observed, and it was found that disease stage (p <0.01), metastasis (p <0.01) and readmission (p <0.01) had significant influences on patient outcome. The impact of these factors on the general survival rate was higher in the Amazon region compared with other regions of Brazil, and the primary survival factors were associated with earlier stages of the disease. However, more national studies are needed on this subject. Our findings may contribute to the development of regional strategies for the prevention of cervical cancer, a reduction in its incidence and mortality rate, an increase in survival time and an improvement in the quality of life of these women.

Human papillomavirus (HPV) infection is recognized as the most common sexually transmitted disease in the world, and there is a consensus on its role in the etiology of preneoplastic epithelial changes in the cervix. Through the process of lipid peroxidation, oxidative stress is found in the course of premalignant and malignant changes. Moreover, the level of physical activity can exert an influence on markers of oxidative stress, lowering the serum levels of these markers. Objective. To determine the relationship between levels of malondialdehyde (MDA) and the level of physical activity in women with squamous intraepithelial lesion (SIL) of the cervix. Methods. A cross-sectional study was conducted with 46 women participating in a cervical cancer control program. The women had been submitted to the cytopathological exam and were divided into two groups: 18 with SIL and 28 controls. MDA concentrations were determined, and the International Physical Activity Questionnaire (IPAQ) was administered on the same day as the gynecological appointment (prior to the Papanicolaou test). Results. The SIL group had higher MDA levels than the control group (mean: 47.63±9.57 vs. 9.32±4.79, respectively) and a lower IPAQ score (median: 713.5 vs. 1875, respectively). A weak correlation was found between the MDA level and IPAQ score (r2=−0.34, p=0.018). Conclusion. The women with SIL had higher levels of oxidative stress and were less physically active than the women in the control group. These findings suggest that physical exercise exerts an influence on markers of oxidative stress in the development of intraepithelial squamous lesions.

Prescribing physical exercise as part of the clinical treatment of cancer patients has become an important strategy in the therapeutic arsenal available in the main health centers specialized in neoplastic diseases, but there is still uncertainty regarding the role of regular physical activity in modifying oxidative stress markers and antioxidants, as high levels of oxidative stress can lead to the development of carcinogens. Therefore, we assessed the effect of physical activity versus absence of physical activity on markers of oxidative stress and antioxidants in cancer patients. We looked for randomized controlled trials that included adult with any type of cancer performing some physical activity and compared them to a control group of cancer patients with no physical activity. The outcomes of interest collected were markers of oxidative stress and antioxidants. Six databases were used for the search (EMBASE, The Cochrane Library (CENTRAL), US National Library of Medicine (PubMed), Physiotherapy Evidence Database (PEDro), Cumulative Index of Nursing and Allied Health (CINAHL) and SPORTDiscus via EBSCO) until January 31st, 2024. In the end, 7 randomized controlled clinical trials were included, totaling 573 participants. It was possible to conduct a meta-analysis with demonstrated that physical activity potentially increases the antioxidant marker Trolox, Taoc, Gpx, (SMD = 1.23, CI: 0.13 to 2.34). However, these findings were classified as having very low to moderate GRADE evidence. Cancer patients who participated in physical activity programs may have exhibited an increased concentration of antioxidants. Although the overall quality of the evidence in the studies was very low, these findings represent an important field of research that should be guided by studies with more participants and homogeneous methods of analysis of oxidant stress and antioxidant markers. PROSPERO CRD42021257815.

Manual therapy and therapeutic exercise are both recommended for chronic non-specific low back pain, the additional benefit of combining them is uncertain. To systematically review the effects of adding manual therapy to therapeutic exercise compared to exercise alone on pain intensity and functional disability in adults with chronic non-specific low back pain. A systematic review and meta-analysis of randomized controlled trials included adults aged 18-65 years with chronic non-specific low back pain (≥12 weeks). Interventions combined joint-based manual therapy (spinal mobilization and/or manipulation) with therapeutic exercise involving stretching, strengthening, motor control, and endurance training. Main outcomes were pain intensity and functional disability at short-, medium-, and long-term follow-up. PubMed, PEDro, Cochrane Library, CINAHL, and Web of Science were searched up to February 2025. Evidence certainty was rated using GRADE. Five trials (n = 260) were included. Low-quality evidence indicated no significant short-term pain reduction with manual therapy plus exercise versus exercise alone (SMD = -0.87, 95 % CI: -1.87 to 0.12, I² = 90 %). Moderate-to low-certainty evidence showed greater improvement in disability with combined therapy at short- (SMD = -0.73, 95 % CI: -1.05 to -0.42, I² = 0 %) and long-term follow-up (SMD = -1.13, 95 % CI: -2.06 to -0.19, I² = 80 %). Manual therapy combined with therapeutic exercise does not appear to provide substantial additional short-term improvements in pain intensity when compared to exercise alone. However, significant benefits were identified for functional disability in both short- and long-term outcomes PROSPERO REGISTRATION: CRD42023413778.

Background/Objectives: Treatment adherence challenges affect 10–20% of tuberculosis patients globally, contributing to drug resistance and continued transmission. While artificial intelligence approaches show promise for identifying patients who may benefit from additional treatment support, most models lack the interpretability necessary for clinical implementation. We aimed to develop and validate an integrated artificial intelligence framework combining traditional machine learning (interpretable algorithms like logistic regression and decision trees), explainable AI (methods showing which patient characteristics influence predictions), deep reinforcement learning (algorithms learning optimal intervention strategies), and natural language processing (clinical text analysis) to identify tuberculosis patients who would benefit from enhanced treatment support services. Methods: We analyzed 103,846 pulmonary tuberculosis cases from São Paulo state surveillance data (2006–2016). We evaluated models using precision (accuracy of positive predictions), recall (ability to identify all patients requiring support), F1-score (balanced performance measure), and AUC-ROC (overall discrimination ability) while maintaining interpretability scores above 0.90 for clinical transparency. Results: Our integrated framework demonstrated that explainable AI matched traditional machine learning performance (both F1-score: 0.77) while maintaining maximum interpretability (score: 0.95). The combined ensemble delivered superior results (F1-score: 0.82, 95% CI: 0.79–0.85), representing a 6.5% improvement over individual approaches (p < 0.001). Key predictors included substance use disorders, HIV co-infection, and treatment supervision factors rather than demographic characteristics. Conclusions: This multi-paradigm AI system provides a methodologically sound foundation for identifying tuberculosis patients who would benefit from enhanced treatment support services. The approach delivers excellent predictive accuracy while preserving full clinical transparency, demonstrating that the accuracy–interpretability trade-off in medical AI can be resolved through the systematic integration of complementary methodologies.

Background and purpose: Indigenous people in the Brazilian Amazon are exposed to mercury by eating methylmercury-contaminated fish. The lack of information on the health effects of prolonged exposure to mercury hinders the implementation of mitigation programs offered by the Brazilian government. This article aims to evaluate the studies that have investigated mercury exposure in indigenous people living in the Brazilian Amazon. Methods: A scoping review of the literature was conducted from studies published between 1995 and 2024 in Portuguese, English, and Spanish that evaluated mercury (Hg) concentrations in hair samples in indigenous people from the Brazilian Amazon. Results: Using total mercury (TotalHg) values in hair samples, we analyzed exposure levels, prevalence, and toxic effects. We found 15 epidemiological studies with a cross-sectional design and sample sizes ranging from 31 to 910 participants. Four studies involved children and mothers, four of which were associated with clinical outcomes and three of which analyzed genetic polymorphism. Most of the communities evaluated had a high prevalence of mercury exposure, showing levels ranging from 0.8 to 83.89 µg/g, and the highest average TotalHg concentration was found among the Kayabi. Mercury was associated with hypertension, cognitive disorders, worse mental health indicators and central and peripheral neurological disorders. Conclusions: It is concluded that indigenous people in the Brazilian Amazon experience exposure levels that are causing damage to their health, and control measures must be adopted to prevent the situation from worsening.