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Projected to impact 310 million children by the next decade, childhood obesity is linked to serious health issues like metabolic disturbance and cardiovascular diseases. This study introduces a novel approach for the integrated assessment of inflammatory, glycemic and lipid disorders in obese children in resources-limited settings and also identifies key factors contributing to these changes. Conducting a cross-sectional analysis of 231 children aged 5–12 years from public schools in Brazil's semi-arid region, the research involved collecting medical history, anthropometric measurements, and blood samples to analyze glycemic and lipid profiles, along with C-reactive protein levels. We used an adapted the Molecular Degree of Perturbation model to analyze deviations in metabolic markers from a healthy control group. Statistical analyses included Mann–Whitney and Fisher exact tests, backward logistic regression, and hierarchical cluster analysis. The study identified a direct and independent association between elevated Metabolic Disturbance Degree and both overweight and obesity in children, with significant differences in CRP, Triglycerides, and HDL levels noted between obese and healthy-weight groups. The findings highlight the critical need for early detection and comprehensive understanding of obesity-related changes to mitigate the severe health risks associated with childhood obesity.

The rapid and predominantly for-profit expansion of medical schools in Brazil over the past decade has raised widespread concerns about the erosion of academic standards in medical education. This nationwide, retrospective study analyzed academic performance indicators from all Brazilian medical schools participating in the 2013, 2016, 2019, and 2023 cycles of the National Student Performance Exam ( - ENADE), a standardized national exam used to assess students' knowledge at the end of undergraduate programs. We also included the Indicator of Difference between Observed and Expected Performance ( IDD), which estimates the value added by institutions by comparing student performance at graduation with their academic background at entry. Data were sourced from publicly available datasets provided by the Brazilian Ministry of Education. We compared trends across public, non-profit private, and for-profit private institutions, using descriptive statistics, non-parametric tests, correlation analysis, and Bayesian mixed-effects regression models to assess the impact of institutional category and class size on academic performance. The number of for-profit medical schools in Brazil nearly doubled between 2013 and 2023. These institutions consistently demonstrated lower ENADE scores compared to public and non-profit peers. Although IDD scores showed some early gains, they declined significantly in 2023, particularly among new medical schools taking the ENADE for the first time, most of which were for-profit. Larger class sizes were negatively correlated with both ENADE and IDD scores. Regression models showed that public institutions outperformed for-profit schools by an average margin of more than 21 ENADE points, while class size emerged as a modest but statistically significant negative predictor of IDD. Our findings reveal that the unregulated expansion of for-profit medical schools in Brazil has been accompanied by a decline in academic performance, as measured by national benchmarks. These patterns suggest a structural misalignment between the commercial logic of expansion and the core educational mission of medical training. Regulatory reforms are urgently needed to realign the growth of medical education with principles of academic quality and social accountability.

After nearly a decade since the promulgation of Brazil’s National Curricular Guidelines (DCNs) for Medicine, the Ministry of Education of Brazil approved a revised regulatory framework for medical training. The new DCNs preserve central structures from 2014 while explicitly aligning training to digital transformation, programmatic assessment, simulation-based safety, and student wellbeing. This study conducts a comparative documentary analysis of the 2014 and 2025 DCNs, analyzes what changed and why it matters, and map these shifts onto prevailing trends in the Global South and North. We propose a practical roadmap for schools in Brazil to adapt quickly and credibly. Our analysis may be relevant to other systems seeking to reconcile social accountability with rapidly evolving clinical, technological, and educational demands.

This study aimed to assess the performance of a commonly used ICU severity score (SAPS3) and determine whether an alternative scoring system may be more accurate across all age strata. Retrospective cohort study in a general ICU in Brazil. A secondary analysis was performed with clinical and epidemiological data, present in the first 24 hours of unit admission. Then, a binary logistic regression, followed by cross-validation, was made to develop a novel prognostic tool. ICU mortality was the primary outcome evaluated. A total of 3042 patients were included over the study period between August 2015 and July 2018 with a median age of 67 ± 18.4 years. SAPS3 performed fairly in prediction of ICU mortality, particularly in the 80 years or older subset. Multivariable regression identified variables independently associated with mortality that were used to develop the Age Calibrated ICU Score (ACIS) tool that performed similarly to SAPS3 across age categories, being slightly superior in the very elderly population (AUC 0.80 vs 0.72). The ACIS offers a robust and simple tool to predict ICU mortality, particularly in an increasingly elderly critical care population.

In emergency care, inexperience and case complexity can generate uncertainty and stress among physicians, impairing decision-making and impacting patients and the healthcare system. Despite its relevance, little is known about uncertainty among Emergency Medicine residents (EMRs). To investigate decision-making uncertainty among EMRs, identifying the most affected dimensions and the influence of sociodemographic and academic profiles. This cross-sectional study included EMRs in Brazil, regardless of residency year. Data were collected via snowball sampling using an anonymous electronic form distributed through virtual groups and email. Information on sociodemographic/academic characteristics, as well as the Physicians' Reactions to Uncertainty (PRU) questionnaire, was obtained. A total of 124 EMRs participated (median age 28 years; 52% female). The majority of the participants were first-year residents (49%), with no prior residency experience (92%) or other healthcare degrees (94%). The Southeast region was most represented (38%). The median PRU score was 49.0 (IQR: 41.0-57.0), with the highest scores observed in anxiety due to uncertainty (21.0) and reluctance to disclose uncertainty to patients (13.0). Cluster analysis identified three groups: high (43%), moderate (35%), and low (22%) uncertainty. Male and third-year residents had significantly lower total PRU scores, especially in anxiety (  = 0.023 and  = 0.017). Previous healthcare training or residency did not significantly affect uncertainty levels. EMRs show substantial uncertainty in decision-making, particularly in anxiety and reluctance to disclose uncertainty to patients. First-year residents and those without prior healthcare training or residency are more affected. Male and more experienced residents report lower uncertainty, especially regarding anxiety. These findings suggest that targeted interventions-such as enhanced training and structured support-could help EMRs manage uncertainty, improving both decision-making and well-being in emergency settings.

Objectives Education holds transformative power in society, driving economic and social development. In medical education, training quality leads to well-prepared physicians and directly impacts patient care. In Brazil, a key measure of medical training quality is the National Student Performance Exam (Enade). This study aims to analyze the institutional, social, and economic determinants of the quality of medical education in Brazil through Enade scores. Methods An ecological study was conducted with all Brazilian higher education institutions participating in the Enade for the Medicine undergraduate course in the last 5 editions. Group comparisons and a multivariable logistic regression model were conducted to examine the associations between institutional, social, and economic aspects with the Enade score, categorizing institutions into high and low/medium score groups. Results Considering all editions, the average Enade score of medical schools in Brazil was 2.8. Geographic location was a determining factor of Enade results. The highest proportion of high scores was observed in South (62.4%) and Central-West (57.3%) regions, and low scores in the North (76.4%), Southeast (64.1%), and Northeast (52.6%). The proportion of medical schools with high Enade scores increased over time (P < .001), and they demonstrated significantly higher performance in general knowledge tests (+10.6%; 64.4 vs 58.20) and specific knowledge tests (+16.0%; 65.4 vs 56.4). Institutional factors associated with better student performance in Enade included a well-rated didactic-pedagogical organization (odds ratio [OR]: 1.62 [confidence interval (CI): 1.10-2.40]), a more qualified faculty (OR: 1.81 [CI: 1.27-2.59]), and being publicly administered (OR: 5.74 [CI: 3.44-9.95]). Conclusion This study highlights significant variations in training quality among medical schools nationwide, with the Center-South region showing a higher proportion of institutions achieving high Enade scores compared to more socioeconomically vulnerable regions in Brazil. Institutional characteristics such as well-rated didactic-pedagogical organization, a highly qualified faculty, and public administration are associated with better exam performance.

The widespread adoption of large language models is increasingly shaping clinical decision-making by altering how physicians engage with data and reasoning. While these tools enhance diagnostic capacity, streamline workflows, and support learning, their misuse may diminish critical, contextual, and humanized thinking, reducing physicians to passive validators of algorithmic outputs. This paper explores the evolution of medical cognition and proposes strategies for integrating artificial intelligence in ways that preserve cognitive autonomy, such as structuring information, reducing bias, and strengthening metacognition. We argue that artificial intelligence should serve as a “cognitive stethoscope,” a tool that refines reasoning without compromising its essence.

Visceral leishmaniasis (VL) is a parasitic infectious disease that causes significant morbidity and mortality in the tropical and subtropical regions of the world. Although infections with visceralizing Leishmania may be asymptomatic, factors such as undernutrition increase the likelihood of progressing to clinical disease. Protein malnutrition, the most deleterious cause of malnutrition in developing countries, has been considered as a primary risk factor for the development of clinical VL. However, data regarding the immunological basis of this association are scarce. With the aim to analyze the effects of protein malnutrition on Leishmania infantum infection, we used BALB/c mice subjected to control or low protein isocaloric diets. Each animal group was divided into two subgroups and one was infected with L. infantum resulting in four study groups: animals fed 14% protein diet (CP), animals fed 4% protein diet (LP), animals fed 14% protein diet and infected (CPi), and animals fed 4% protein diet and infected (LPi).The susceptibility to L. infantum infection and immune responses were assessed in terms of body and lymphoid organ weight, parasite load, lymphocyte subpopulations, and cytokine expression. LPi mice had a significant reduction of body and lymphoid organ weight and exhibited a severe decrease of lymphoid follicles in the spleen. Moreover, LPi animals showed a significant decrease in CD4+CD8+ T cells in the thymus, whereas there was an increase of CD4+ and CD8+ T cells percentages in the spleen. Notably, the cytokine mRNA levels in the thymus and spleen of protein malnourished-infected animals were altered compared to the CP mice. Protein malnutrition results in a drastic dysregulation of T cells and cytokine expression in the thymus and spleen of L. infantum-infected BALB/c mice, which may lead to defective regulation of the thymocyte population and an impaired splenic immune response, accelerating the events of a normal course of infection.

To identify the challenges for the development and mentorship of physician-scientists in Latin America, outline the key barriers to integrating research training into medical education and post-graduate pathways, and propose recommendations to foster structured mentorship, improve institutional support, and strengthen the research ecosystem for future physician-scientists. Narrative review. A narrative review of relevant literature, institutional reports, and existing educational models was undertaken. The authors synthesized information on current educational pathways, funding opportunities, institutional infrastructures, and mentorship practices for physician-scientists in Latin America and derived practical recommendations for improving mentorship and training structures. Latin America's aspiring physician-scientists face fragmented educational programs, limited or inconsistent research integration in medical curricula, and inadequate mentorship support. These issues are exacerbated by overburdened healthcare systems, insufficient funding, low stipends, and a scarcity of dual-degree training programs. Institutional and funding barriers frequently force trainees and established researchers to choose between clinical practice and research, stifling the growth of a skilled physician-scientist workforce. Proposed solutions include developing integrated dual-degree and research residency programs, reforming medical curricula to include foundational research skills, strengthening mentorship networks through structured support and incentives, increasing research fellowship funding and removing exclusivity clauses, and creating regional consortia to standardize training and foster cross-border collaboration. Addressing the systemic barriers to mentoring and training physician-scientists in Latin America is essential for building a robust, research-oriented medical community. The recommended structural reforms, with increasing funding, enhanced mentorship frameworks, and promoting regional partnerships, can help Latin America cultivate a sustainable environment for the development of physician-scientists.