Jefferson Luiz Brum Marques

Thermal analyses using Quantitative Sensory Testing (QST) play a crucial role in supporting the diagnosis of diabetic peripheral neuropathy (DPN), as small thermal fibers are the first to be affected in such cases. This study presents the development of X-QST, a system designed to perform thermal QST procedures, integrated into the ubiquitous health platform Screening for Diabetes Complications (SDC-X), developed at the Institute of Biomedical Engineering of the Federal University of Santa Catarina (IEB-UFSC). The system comprises a wireless acquisition module and a data management module and performs warm and cold detection threshold tests, heat pain threshold tests, and evaluation of paradoxical heat sensations. A pilot study involving 15 healthy adults was conducted to evaluate the system, and the results were compared with normative reference values using Z-score transformation, the group-comparison t-test proposed with the reference dataset, and exact tests of the proportion of abnormal classifications. Most participants’ results fell within the normal range, and the proportion of abnormal classifications did not differ from that expected under the normative criterion for the detection thresholds and for paradoxical heat sensations. Heat pain threshold data are reported separately for the two subgroups defined by a change in the verbal instruction during the pilot and are not pooled. These findings demonstrate the technical feasibility of the X-QST subsystem and its integration into the SDC-X platform in a sample of healthy adults. Diagnostic performance for DPN was not assessed in this study; validation in individuals with diabetes mellitus, with and without peripheral neuropathy, is required before any screening use and is the planned next step.

Aims/hypothesis: The aim of this study was to determine whether cardiac autonomic neuropathy (CAN) is an independent risk factor for kidney function decline in type 1 diabetes mellitus over a 15 year follow-up period. Methods: Eighty seven participants with type 1 diabetes and eGFR >30 ml/min per 1.73 m ² underwent cardiovascular autonomic reflex testing at baseline. Renal data were retrieved at 4 year intervals over 15 years. Stratification of participants into Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease progression prognostic risk was done by using eGFR and urinary albumin/creatinine ratio (UACR). Longitudinal changes in eGFR and UACR were analysed using linear mixed-effects models with adjustment for potential confounders to determine whether CAN is an independent predictor of eGFR and UACR change over 15 years. Results: At baseline, higher KDIGO risk category was associated with increased severity of CAN ( r =0.38, p p 2 , compared with 3.1 (7.3) and 3.3 (7.4) ml/min per 1.73 m ² in the early stage and those without CAN ( p =0.004). Mean (SD) increases in UACR were 0.4 (0.9), 11.3 (30.4) and 4 (8.9) mg/mmol for no CAN, early CAN and established CAN ( p =0.03), respectively. After adjusting for potential confounders, baseline CAN was independently associated with both accelerated eGFR decline ( p =0.018) and greater increases in UACR ( p =0.002) over time. Conclusions/interpretation: CAN is an independent predictor of both accelerated eGFR decline and increased albuminuria in type 1 diabetes. The study also explored the relationship between CAN and KDIGO prognostic risk in diabetic kidney disease, demonstrating that increased severity of CAN is associated with higher KDIGO prognostic risk.

This article aims to analyze adverse events and their probable causes associated with medical devices used in homecare to identify and categorize main problems. The work aims to establish strategies in health technology management in techno-surveillance processes to mitigate risks. A quantitative study of adverse events reported in Brazilian and North American databases between 2019 and 2024 was conducted. Reports regarding glucose monitors and continuous positive airway pressure were analyzed and the Ishikawa diagram quality tool was applied to categorize the causes of adverse events. The number of techno-surveillance notifications for medical devices reported by Brazilian National Health Surveillance Agency between 2019 and 2024 was 106,900, while on the Manufacturer and User Facility Device Experience/Food and Drug Administration (MAUDE/FDA) platform, there were 12,457,700 notifications for the same period. Medical devices used in homecare are among the technologies with the highest number of notifications. The probable causes of the failures were categorized into six factors: human, technological, environmental, interconnectivity and data security, metrological, and protocol. Technological development inserted in a Living Lab ecosystem and implementing accessible guidance resources are some strategies presented to mitigate the occurrence of adverse events. The occurrence of adverse events in medical devices in homecare has a direct impact on the quality of care. These technologies are operated by the users themselves to support decision-making. Therefore, strategies to mitigate the occurrence of adverse events in medical devices in homecare should be applied in the pre- and post-marketing stages.

Traumatic brain injury (TBI) is a condition that changes the autonomic system, modulating the heart rate variability (HRV) at all levels of brain lesions. Although fluid percussion injury (FPI) model can reproduce all degrees of severity of clinical TBI, there is still a lack of comprehensive analysis of linear and non-linear HRV metrics following FPI. The present study sought to assess the influence of the FPI model on time-domain (HR, mean NN, SD1, SD2, SDNN, RMSSD, and SD1/SD2) and frequency-domain (LF, HF, and LF/HF). A non-invasive electrocardiogram recording was used in anesthetized and awake male Wistar rats, both before and for three days after moderate FPI. Although a decrease in the SD2 occurred in the anesthetized state, an increase in HFnu led to a reduction in HR during baseline evaluations. Post-TBI analyses revealed that neither the sham nor the TBI groups exhibited HR alterations under the influence of isoflurane; however, both groups showed a decrease in parasympathetic activity (RMSSD, SD1, and HFnu). Under isoflurane anesthesia, only the TBI group exhibited changes in LFnu, HFnu, and LF/HF metrics for three days. In contrast, awake animals experienced an increase in HR for three days post-injury, with a critical period at 24 hours when SD2, LFnu, HFnu, and LF/HF were altered. With few exceptions, the sham group did not exhibit significant differences in the awake state. Therefore, the effects of isoflurane predominate over TBI effects in both time- and frequency-domain metrics, while FPI in awake animals indicates a critical period of altered specific metrics at 24 hours post-injury.

Purpose: To evaluate changes in scotopic pupil diameter before and after cataract surgery performed by phacoemulsification with intraocular lens implantation. Methods: This prospective longitudinal observational study included patients who underwent cataract surgery. Scotopic pupil diameter was measured preoperatively and 30-40 days postoperatively using an automated keratometer after a standardized dark-adaptation period under controlled ambient illumination. Each eye was considered an independent unit of observation. Because some participants contributed both eyes, intraindividual correlation was accounted for using a linear mixed-effects model with random patient intercepts. Time of assessment (preoperative versus postoperative), age, sex, and eye laterality were included as fixed effects. Results: A total of 354 eyes from 251 patients were analyzed. The mean patient age was 69.3±7.2 yr. Mean scotopic pupil diameter decreased from 5.3±0.9mm preoperatively to 4.8±0.8mm postoperatively, representing a mean reduction of 0.5mm (9.4%). In the linear mixed-effects model, cataract surgery was associated with a significant reduction in pupil diameter, with an adjusted mean difference of 0.45mm (95% confidence interval [95% CI], 0.39-0.51; p<0.001). Age (p=0.061), sex (p=0.920), and eye laterality (p=0.152) were not significantly associated with the magnitude of pupil diameter change. Conclusion: Phacoemulsification with intraocular lens implantation was associated with a significant reduction in scotopic pupil diameter, independent of age, sex, and eye laterality. This finding should be considered during preoperative planning, particularly when selecting intraocular lenses whose optical performance depends on postoperative pupil size.

RESUMEN Objetivo: Analizar la evaluación de usuarios y médicos sobre el servicio de teleconsulta para la renovación de recetas de medicamentos de control especial en la Atención Primaria de Salud, Joinville (SC), Brasil. Método: Estudio transversal, descriptivo y cuantitativo. Muestra intencional, no probabilística, con 23 usuarios y tres médicos. Datos obtenidos mediante cuestionarios semiestructurados, aplicados por teléfono y correo electrónico. Análisis cuantitativo realizado con estadística descriptiva simple. Resultados: Participaron 23 usuarios, en su mayoría mujeres de entre 51 y 60 años. Entre los aspectos positivos, 15 mencionaron la practicidad (65 %), 11 la eficiencia (48 %) y seis las comodidades (26 %). Como aspectos negativos, siete (30 %) necesitaron ayuda tecnológica y cinco (22 %) tuvieron dificultades para acceder a Internet. Los médicos (n = 3) validaron la flexibilidad y el potencial del servicio para ampliar la adherencia, pero destacaron la limitación de la imposibilidad de realizar el examen físico. Conclusión: La teleconsulta para renovar recetas fue bien valorada por los usuarios y los médicos, que destacaron su practicidad, el ahorro de tiempo y la reducción de desplazamientos, a pesar de las barreras tecnológicas.

RESUMO Objetivo: Analisar a avaliação de usuários e médicos sobre o serviço de teleconsulta para a renovação de receitas de medicamentos de controle especial na Atenção Primária à Saúde, Joinville (SC), Brasil. Método: Estudo transversal, descritivo, quantitativo. Amostra intencional, não probabilística, com 23 usuários e três médicos. Dados obtidos por questionários semiestruturados, aplicados por telefone e e-mail. Análise quantitativa realizada com estatística descritiva simples. Resultados: Participaram 23 usuários, a maioria mulheres com idade entre 51 e 60 anos. Entre os aspectos positivos, 15 mencionaram praticidade (65%), 11 eficiência (48%), seis comodidades (26%). Como aspectos negativos, sete (30%) necessitaram de ajuda tecnológica, cinco (22%) tiveram dificuldade de acesso à Internet. Os médicos (n=3) validaram a flexibilidade e o potencial do serviço para ampliar a adesão, mas ressaltaram a limitação da impossibilidade de realizar o exame físico. Conclusão: A teleconsulta para renovação de receitas foi bem avaliada pelos usuários e médicos, destacando praticidade, economia de tempo e redução de deslocamentos, apesar das barreiras tecnológicas.

Objective: To analyze the evaluation of users and physicians regarding the teleconsultation service for the renewal of prescriptions for controlled medications in Primary Health Care, Joinville (SC), Brazil. Method: Cross-sectional, descriptive, quantitative study. Intentional, non-probabilistic sample, with 23 users and three physicians. Data obtained through semi-structured questionnaires, administered by telephone and email. Quantitative analysis performed using simple descriptive statistics. Results: 23 users participated, most of whom were women aged 51-60. Among the positive aspects, 15 mentioned practicality (65%), 11 mentioned efficiency (48%), and 6 mentioned convenience (26%). Negative aspects included: 7 (30%) needing technological assistance and 5 (22%) having difficulty accessing the Internet. The physicians (n=3) validated the flexibility and potential of the service to increase adherence, but emphasized the limitation of not being able to perform a physical examination. Conclusion: Teleconsultation for prescription renewals was well received by users and physicians, who highlighted its practicality, time savings, and reduced travel, despite technological barriers.

Research focused on improving the sensitivity of SPR analytical technology has led to the investigation of different electric field enhancement elements for incorporation with classic sensor structures. Over the past ten years, considerable attention has been given to ceramic, metal oxide, and 2D materials that not only improve the magnitude of the field but are also used as affinity layers for improved adsorption of molecules. However, focusing on the improvements these materials deliver can lead designers to explore only some of themultiple dependencies associated with sensitivity. When using the angular interrogation mode, the impacts of working with different wavelengths are generally disregarded, as a fixed value of λ=633 nm is commonly adopted. Choosing 633 nm is often justified for achieving near-zero reflectivity and good sensitivity. However, newer SPR designs lack the determination of optimal wavelength-dependent sensitivity points. This article numerically investigates sensitivity as a function of wavelength for SPR sensors. We systematically study the effects of operating outside λ=633 nm and show that the signature produced by bare metal sensors does not always resemble the signatures produced by field-enhanced designs. Examinations are based on Graphene and BaTiO ₃ . Furthermore, we demonstrate how imposing thresholds on optimization targets can be leveraged to sustain high-sensitivity results, and we elaborate on the pertinent tradeoffs. Our approach shows further performance improvements in designs for which highly efficient benchmarks have already been demonstrated.

A numerical investigation of a sensor for acetone monitoring using surface plasmon resonance (SPR) is proposed. We evaluate the effects of polyaniline (PANI), graphene, or chitosan acting as a chemisorption binding layer for the selective sensing of acetone. Our findings suggest that these materials present suitable responses when applied as an overlayer to the sensor. Their thicknesses, however, should be maintained close to a monolayer level to preserve performance.