Search Results (1,679)

Background: Type 1 diabetes mellitus (T1DM) is associated with an increased risk of fragility fractures that cannot be fully explained by reduced bone mineral density (BMD), highlighting a potential role for bone quality impairment. The purpose of this study was to evaluate the prevalence of altered bone density and microarchitecture and to identify their main clinical correlates in adults with T1DM and seemingly adequate glycemic control at the time of assessment. Methods: Sixty-eight adults aged 18–69 years with T1DM attending a diabetes technology outpatient clinic were enrolled in this single-center, cross-sectional study. BMD at the lumbar spine, femoral neck, and total hip was assessed by dual-energy X-ray absorptiometry (DXA) and classified as reduced based on age and sex: Z-score < −2.0 SD for premenopausal women and men < 50 years, and T-score ≤ −2.5 SD for postmenopausal women and men ≥ 50 years. Bone microarchitecture was evaluated using trabecular bone score (TBS). Clinical, metabolic, and lifestyle variables were collected, including glycated hemoglobin (HbA1c; good control ≈ 7.0%/53 mmol/mol), diabetes duration, microvascular complications, and physical activity (PA) assessed by the International PA Questionnaire (IPAQ; moderate–high PA defined according to combined high and moderate IPAQ categories). Results: Reduced BMD was observed in 35.3% of patients and was associated with older age (p < 0.001), longer disease duration (p = 0.044), lower body mass index (p = 0.031), poorer glycemic control (p = 0.03), microvascular complications such as diabetic peripheral neuropathy (p = 0.028) and retinopathy (p = 0.045), and low PA (p = 0.012). Altered TBS was present in 45.6% of patients and was associated with older age (p < 0.001), longer diabetes duration (p = 0.011), higher HbA1c levels (p < 0.001), diabetic peripheral neuropathy (p = 0.002), retinopathy (p = 0.007), cardiovascular risk factors (dyslipidemia p = 0.002, hypertension p = 0.002), and low PA (p < 0.001). In multivariable analyses, older age and higher HbA1c were independently associated with reduced TBS, whereas moderate–high PA was associated with a lower likelihood of impaired bone microarchitecture. Conclusions: Impaired bone density and bone quality are highly prevalent in adults with T1DM and are frequently associated with longer disease duration, poorer metabolic control, and chronic complications. Our findings support the potential value of a combined assessment of BMD and TBS in fracture risk evaluation, together with strategies aimed at preventing diabetes-related complications and promoting healthy lifestyle behaviors. Full article

Type 2 diabetes mellitus (T2DM) is a globally prevalent chronic metabolic disorder that poses severe public health risks. Synthetic hypoglycemic agents are susceptible to inducing adverse reactions, thus driving the development of natural, safe and highly effective plant-derived hypoglycemic active compounds as a research hotspot. Inhibiting the activity of α-glucosidase and α-amylase represents an effective strategy to regulate postprandial blood glucose levels. This study investigated the synergistic hypoglycemic activity of a composite (PS-PP) formed by polysaccharide (PS) and polyphenols (PP) from Ziziphus jujuba Mill. cv. Muzao and elucidated the structural basis underlying this synergistic effect. First, MPS and MPP were isolated and purified, followed by the in vitro assembly to prepare PS-PP. The hypoglycemic activities of MPS, MPP and MPS-PP were evaluated via in vitro enzyme inhibition assays, while structural characterization was conducted using GPC-MALLS, FT-IR and SEM techniques. Results demonstrated that PS-PP exerted the strongest activity under optimal conditions (0.75 mg/mL concentration, pH 4.0, 1:2 mass ratio), with IC₅₀ values of 1.14 μg/mL and 0.82 μg/mL against the two enzymes, which were superior to those of polysaccharides (15.10 and 36.06 μg/mL) and polyphenols (1.18 and 46.24 μg/mL). Structural analysis revealed that the interaction between PS and PP was primarily mediated by hydrogen bonds. PS-PP exhibited significant differences from single-component compounds in molecular weight distribution, functional group binding and surface morphology. These structural alterations were identified as the key factors contributing to its enhanced hypoglycemic efficacy. This study clarifies the synergistic hypoglycemic mechanism of MPP-PS and lays a scientific foundation for the development of natural hypoglycemic preparations and functional foods. Full article

Background: Ischemic stroke remains the most feared complication of atrial fibrillation (AF), and thromboembolic risk is commonly estimated using clinical scores that may not fully capture the cardiometabolic dimension of cerebrovascular vulnerability. The aim of this research was to assess whether additional parameters can be used, to predict ischemic stroke risk in patients with AF, in order to explore whether TG/HDL-C may complement conventional clinical risk scores for ischemic stroke risk stratification in PAF, and to better characterize a metabolically high-risk phenotype beyond the recommendations provided by the CHA₂DS₂-VA score, which is useful but still far from perfect in predicting AF-associated ischemic stroke risk. Methods: In this retrospective, single-center observational study, we evaluated whether the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLc), a simple surrogate of atherogenic dyslipidemia and insulin resistance, is associated with ischemic stroke risk in patients with paroxysmal atrial fibrillation (PAF). We screened 1111 consecutive AF admissions between 1 January 2015 and 31 December 2016 and, from these 1111 AF cases, we extracted only the patients with PAF for analysis. Patients were stratified based on TG/HDLc values into two groups, Group 1 (TG/HDLc > 2.5; n = 155) and Group 2 (TG/HDLc < 2.5; n = 194). Statistical analysis was performed with MedCalc v23.4.0 using Chi-square and unpaired/Welch’s t-tests as appropriate, Pearson correlations, Kaplan–Meier analysis with log-rank testing, Cox regression for first ischemic stroke, and multivariable logistic regression to identify independent correlates of TG/HDLc > 2.5. Results: Patients with TG/HDLc > 2.5 had a significantly higher prevalence of ischemic stroke after AF onset compared with those with TG/HDLc < 2.5 (37.4% vs. 21.1%, p = 0.0008), despite similar CHA₂DS₂-VA and HAS-BLED scores, and also exhibited a higher burden of cerebrovascular and neurodegenerative findings, including cortical atrophy and cerebral lacunarism. Ischemic stroke-free survival curves diverged significantly over time (log-rank p = 0.0186), and an elevated TG/HDLc ratio was associated with a 68% higher hazard of first ischemic stroke (HR 1.68; 95% CI 1.09–2.60). In multivariable analysis, type 2 diabetes mellitus (OR 4.53), hyperuricemia (OR 3.83), dyslipidemia (OR 1.94), stroke (OR 1.77), and cortical atrophy (OR 4.48) were independently associated with TG/HDLc > 2.5. Conclusions: These findings suggest that TG/HDLc identifies a metabolically high-risk PAF phenotype associated with greater cerebrovascular burden and reduced ischemic stroke-free survival, providing an inexpensive and broadly available marker that may complement conventional clinical risk scores. Full article

Background: Melioidosis, caused by Burkholderia pseudomallei, is a severe and often underdiagnosed infection endemic to South Asia, Southeast Asia, and northern Australia. While pneumonia and sepsis are the classical presentations, the disease is increasingly recognized for its diverse and atypical clinical manifestations. Objective: The objective is to improve diagnostic accuracy and increase clinical awareness in both endemic and non-endemic settings by reviewing and classifying atypical presentations of melioidosis that have been documented in the literature. Methods: A narrative, case-based review was conducted using 238 published case reports and series from endemic and transitional regions during the period from 2000 to 2025. Cases with non-respiratory presentations or anatomical locations not commonly linked to melioidosis were classified as atypical. Clinical syndromes were used to classify the extracted cases, and common patterns in presentation, diagnosis, and outcome were examined. Results: One hundred and sixty published articles were included after a full text review. The most frequent atypical presentations included neurological involvement (e.g., brain abscess, encephalomyelitis), musculoskeletal infections (osteomyelitis, myositis), thyroid abscess, tubo-ovarian abscess, and dermatologic manifestations such as erythema nodosum. Imported and pediatric cases were also found. Numerous cases were misidentified as cancer, fungal infections, or tuberculosis. Among risk factors, diabetes mellitus was the most prevalent. Non-specific symptoms, a lack of laboratory capacity, and incorrect pathogen identification frequently resulted in delays in diagnosis. Conclusions: In endemic areas, melioidosis should be taken into account when making a differential diagnosis of a variety of clinical syndromes, especially in patients who have diabetes or have had relevant environmental exposure. Poor outcomes and diagnostic delays are greatly exacerbated by atypical presentations. Improving diagnostic capabilities and raising awareness are crucial to lessening the worldwide burden of this often ignored but potentially deadly infection. Full article

Background: Atrial fibrillation (AF) is frequently associated with cardiometabolic comorbidities, and increasing evidence suggests a close relationship between AF and liver disease, particularly metabolic dysfunction-associated steatotic liver disease (MASLD); however, the clinical patterns, hepatic phenotypes, and clinical implications of this association remain insufficiently characterized. Therefore, the aim of the present study was to characterize hepatic involvement in patients with paroxysmal AF by integrating a structured literature review with original clinical data. Methods: We performed a retrospective analysis of 253 patients admitted with paroxysmal AF between 2015 and 2025. Demographic data and associated diagnoses were collected with a specific focus on hepatic pathology. Patients were stratified according to the presence and type of liver disease, and descriptive statistics, bivariate analyses, and multivariate logistic regression were used to identify associations and independent predictors. Results: Liver disease was identified in 65.2% of patients, most commonly hepatic steatosis (46.2%), followed by liver cirrhosis or advanced liver disease (19.0%). Patients with liver disease had higher prevalences of type 2 diabetes mellitus, dyslipidemia, obesity, and alcohol consumption. Dyslipidemia (OR 4.51) and obesity (OR 2.54) were independent predictors of hepatic steatosis, whereas liver cirrhosis was inversely associated with age and serum lipid levels. Conclusions: Liver pathology is highly prevalent among patients with paroxysmal AF and is closely associated with adverse metabolic and clinical profiles. Recognition of distinct hepatic phenotypes may support improved risk stratification and multidisciplinary management in patients with AF. Full article

In recent decades, the rate of kidney transplantation has risen significantly, leading to better outcomes in terms of cardiovascular and overall mortality for patients with kidney failure. Although kidney transplantation represents the most effective therapeutic option, it is not devoid of the risk of failure. Immunological and non-immunological risk factors are involved. These factors often interact and may act synergistically, ultimately influencing graft longevity and patient survival. Both contribute to long-term transplant outcomes; however, non-immunological factors, representing a significant clinical challenge, will be the focus of our review. Of the numerous non-immunological risk factors, for clarity and to avoid overextending the discussion, only those most closely associated with chronic kidney disease have been considered: hypertension, anemia, diabetes mellitus, proteinuria, electrolyte and acid–base imbalances, and impaired bone mineralization. Hypertension is reported in approximately 90% of kidney transplant recipients, often related to immunosuppressive therapy and residual renal dysfunction, and it is strongly associated with reduced graft survival. Anemia affects approximately 20–51% of these patients, contributing to cardiovascular morbidity and a more rapid decline in graft function, as does pre-existing diabetes mellitus. Proteinuria has a prevalence ranging from 7.5% to 45%, depending on the established target, and is a significant negative prognostic factor. Metabolic complications are also frequent; for example, hyperkalemia has an incidence of 25–44%, and metabolic acidosis has a prevalence of 12–58%. In our review, each of these factors is analyzed in terms of clinical impact, etiopathogenic mechanism, and available therapeutic management. Full article

Introduction: Diabetes mellitus (DM) is a prevalent metabolic disorder frequently leading to serious renal complications, particularly diabetic nephropathy. This retrospective case–control study investigated the levels and associations of commonly used enzymatic (serum creatinine and urea) and physiological (glomerular filtration rate [GFR]) markers of kidney function in diabetic patients compared to non-diabetic controls. Methodology: A total of 237 participants were enrolled, comprising 81 diabetic cases and 156 non-diabetic controls. Creatinine and urea levels were determined using enzymatic methods, measuring optical density, whereas GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, based on creatinine, age, and sex. Statistical comparisons include p-value, Pearson correlation, etc. Results: The diabetic group exhibited significantly higher mean levels of serum creatinine (2.08 ± 2.26 mg/dL) and urea (57.71 ± 38.75 mg/dL) and a significantly lower mean GFR (59.59 ± 34.16 mL/min/1.73 m²) compared to the non-diabetic control group (0.95 ± 0.69 mg/dL, 31.79 ± 20.49 mg/dL, and 96.72 ± 23.77 mL/min/1.73 m², respectively; all comparisons with p < 0.005). Correlation analysis revealed a more scattered positive association between creatinine and urea, and a pronounced inverse correlation between GFR and both creatinine and urea in the diabetic cases, suggesting a compromised renal function profile. Conclusions: Our findings demonstrate a significant association between diabetes and impaired renal function, as evidenced by elevated creatinine and urea levels and reduced GFR. These readily available biomarkers are crucial prognostic indicators for the early detection and effective management of diabetic nephropathy, emphasizing the importance of rigorous metabolic and blood pressure control to mitigate disease progression. Full article

The oral cavity harbors the second-largest and one of the most diverse microbial communities in the human body, playing a critical role in maintaining local and systemic health. Type 2 diabetes mellitus (T2DM), a chronic metabolic disease accounting for nearly 90% of all diabetes cases, has shown rapidly increasing global prevalence. Growing clinical and experimental evidence indicates a strong bidirectional relationship between oral microbiota dysbiosis and T2DM. Imbalanced oral microbial communities can contribute to systemic inflammation, insulin resistance, and metabolic dysregulation, while hyperglycemia and impaired immunity in T2DM promote oral diseases such as periodontitis, xerostomia, and mucosal infections. This review summarizes current research on the interactions between oral microbiota and T2DM, highlighting their clinical correlations, underlying mechanisms, and mutual influences on inflammation, microbial composition, and metabolic pathways. We also discuss emerging strategies for T2DM prevention and management through oral microbiota modulation. These insights may provide new perspectives for early diagnosis, targeted intervention, and integrative management of T2DM. Full article

Diabetic ketoacidosis (DKA) remains a life-threatening complication of diabetes mellitus with suboptimal outcomes despite standard management. Emerging evidence suggests that thiamine (vitamin B1) deficiency may play an under-recognized role in DKA pathophysiology and clinical course. This narrative review synthesizes current evidence regarding thiamine deficiency in diabetes and DKA, examining molecular mechanisms, clinical implications, and the rationale for thiamine supplementation as adjunctive therapy. Thiamine deficiency is highly prevalent in diabetes, with plasma concentrations reduced by approximately 75% compared to healthy controls. In DKA specifically, 25–35% of patients present with thiamine deficiency, which often worsens during insulin therapy. The primary mechanism involves hyperglycemia-induced downregulation of renal thiamine transporters (THTR-1 and THTR-2), resulting in 16–24-fold increased renal clearance and massive urinary losses. Thiamine pyrophosphate serves as an essential cofactor for three critical enzymes in glucose metabolism: pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and transketolase. Deficiency impairs these pathways, causing pyruvate accumulation with conversion to lactate (resulting in lactic acidosis), compromised TCA cycle function (reducing ATP production by 40–48%), and decreased NADPH generation (increasing oxidative stress). Clinical manifestations include persistent metabolic acidosis despite standard therapy, myocardial dysfunction with elevated cardiac biomarkers, neurological impairment, and prolonged recovery times. Cellular studies demonstrate that thiamine supplementation significantly improves mitochondrial oxygen consumption in DKA patients. The high prevalence of thiamine deficiency in DKA, compelling biochemical rationale, excellent safety profile, and preliminary mechanistic evidence support the urgent need for large-scale randomized controlled trials examining thiamine supplementation to definitively establish efficacy, optimal dosing, and patient selection criteria. Full article

Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mass, compromised microarchitecture, and increased fracture risk. Its pathogenesis extends beyond simple bone mineral density (BMD) loss and reflects complex disruptions in bone remodeling governed by osteoblast–osteoclast coupling and systemic metabolic factors. This review lays particular emphasis on diabetes mellitus-related osteoporosis (DOP) and estrogen deficiency-induced osteoporosis (EDOP), discussing bone remodeling between osteoclastogenesis and osteoblast differentiation regulated by key signaling pathways, including the RANKL/RANK/OPG, Wnt/β-catenin, BMP–Smad, Hedgehog, and inflammatory cytokine networks. This review then explores how chronic hyperglycemia, insulin deficiency or resistance, oxidative stress, ferroptosis, advanced glycation end products, and low-grade inflammation disrupt bone homeostasis in diabetes, resulting in impaired bone quality and elevated fracture risk, particularly in type 2 diabetes. In parallel, we discuss the genomic and non-genomic actions of estrogen in maintaining skeletal integrity and elucidate how estrogen deficiency accelerates bone resorption and suppresses bone formation through altered cytokine signaling, oxidative stress, and impaired mechanotransduction. Advances in diagnostic strategies beyond BMD, including trabecular bone score, high-resolution peripheral quantitative computed tomography, and emerging biomarkers, are reviewed. Finally, this review summarizes current and emerging therapeutic approaches tailored to DOP and EDOP, emphasizing the need for mechanism-based, individualized management. A deeper understanding of these shared and distinct pathways may facilitate improved risk stratification and the development of targeted interventions for osteoporosis. Full article

Background: Endocrine disturbances are increasingly recognized as components of long COVID, yet long-term data remain limited. This study evaluated the prevalence of dysglycemia and thyroid autoimmunity four years after SARS-CoV-2 infection in adults without previously known endocrine disease. Methods: We conducted a retrospective longitudinal 4-year evaluation of adults hospitalized for COVID-19 between 2020 and 2021. Of 1009 eligible patients without prior diabetes or thyroid disease, 96 completed a standardized 4-year post-infection evaluation. Acute-phase data included COVID-19 severity, admission glucose, inflammatory markers, imaging findings, and treatments. The 4-year evaluation comprised fasting plasma glucose, thyroid function tests, anti-thyroid antibodies (anti-TPO, anti-Tg), and thyroid ultrasonography. Baseline HbA1c, thyroid autoantibodies, and thyroid imaging were not available. Results: At four years post-infection, 27.1% of patients exhibited dysglycemia compatible with type 2 diabetes mellitus, 41.6% showed thyroid autoimmunity, and 15.6% presented with both conditions. Overall, 47.9% developed at least one endocrine alteration. Admission hyperglycemia strongly predicted long-term dysglycemia (OR 6.67; 95% CI: 1.45–30.58), and diabetes prevalence increased with acute disease severity. Thyroid autoimmunity was frequent but not associated with initial COVID-19 severity. Conclusions: Four years after SARS-CoV-2 infection, a substantial proportion of patients exhibited persistent metabolic and autoimmune alterations, supporting a long COVID immunometabolic phenotype. In the absence of baseline endocrine data, the reported findings reflect long-term endocrine alterations identified at the 4-year evaluation, with a potential role of SARS-CoV-2 infection. These findings highlight the importance of baseline metabolic and thyroid assessment—including HbA1c and thyroid autoantibodies—in hospitalized COVID-19 patients and underscore the need for structured long-term endocrine monitoring. Full article

Modern telemedicine requires advanced analytical solutions for efficient management of chronic diseases. This study presents the development of a comprehensive business intelligence (BI) framework using Microsoft Power BI, applied to the optimization of diabetes mellitus management. The methodology integrates Power Query transformations, 35 DAX measures organized into five functional categories, and Python 3.14.2. capabilities for advanced statistical analysis. The framework was implemented and demonstrated using a public clinical dataset of 100,000 patient records, generating five interactive dashboards covering epidemiological, demographic, clinical, geographical, and equity perspectives. A global prevalence of 8.5%, exponential growth with age, gender differences (9.75% males against 7.62% females), and substantial connections between metabolic indicators (BMI, HbA1c, and blood glucose) are all confirmed by the results. Heart disease rates are 6.2 times higher in diabetic people, according to comorbidity research. Complete methodological openness through thorough documentation, Python integration for sophisticated visualizations, and interactive multidimensional drill-down features are some of the major additions. The predictive elements are included as interpretable, exploratory components embedded in the BI environment rather than as clinically validated prediction models. This approach provides an affordable and user-friendly approach that makes advanced analytical capabilities accessible to a broader range of healthcare organizations managing chronic diseases. Full article

Background/Objectives: Migraine and diabetes mellitus are highly prevalent chronic diseases, and their comorbidity presents management challenges, particularly when wearable medical technologies are used concurrently. Remote electrical neuromodulation (REN; Nerivio^®) is an FDA-cleared non-pharmacological migraine therapy, and continuous glucose monitoring (CGM) systems are widely used in diabetes care. However, the safety and compatibility of simultaneous co-use have not yet been evaluated. This technical compatibility study aimed to assess whether REN operation affects CGM performance or interferes with glucose measurement integrity in diabetic adults. Methods: Twenty-one adults with diabetes using Dexcom G6/G7 or FreeStyle Libre 2/3 participated in a single-arm interventional study. During a 45 min session, participants operated the REN and CGM devices simultaneously on their smartphones, and the REN device was paused three times to compare CGM readings between REN ON and RED OFF conditions. The primary outcome was the mean absolute relative difference (MARD_{REN ON/OFF}), evaluated against a prespecified 5% threshold. Statistical analysis included the Wilcoxon test, with subgroup analysis by the CGM device family. Results: The median MARD_{REN ON/OFF} across all participants was 1.61% (IQR 0.84–2.44%), significantly below the 5% threshold (p < 0.001). All participants achieved MARD_{REN ON/OFF} < 5%. Subgroup analyses were consistent: the median MARD_{REN ON/OFF} was 1.70% (IQR 0.90–2.45%) for Dexcom and 1.05% (IQR 0.83–1.50%) for Abbott. No technical interference, Bluetooth disruptions, missed data transmission, or adverse events were observed. Conclusions: Simultaneous use of Nerivio^® REN and CGM systems in adults with diabetes is compatible and safe, with no evidence of interference or significant deviations in glucose readings. These findings support the integrated and reliable use of REN and CGM wearables in adults with diabetes managing comorbid conditions. Full article

Background/Objectives: Patients undergoing chronic hemodialysis are at increased risk of severe COVID-19 outcomes. This study aimed to evaluate the clinical characteristics and prognostic factors associated with mortality in hemodialysis patients infected with SARS-CoV-2. Methods: We conducted a retrospective study including 130 chronic hemodialysis patients diagnosed with COVID-19 and admitted to a nephrology unit between March 2020 and April 2021. Demographic data, comorbidities, clinical manifestations, hospitalization duration, and outcomes were analyzed using univariate and multivariate statistical methods. Results: The cohort was predominantly male (64.6%), with a mean age of 64.0 ± 13.9 years. The mean hospitalization duration was 13.6 ± 9.7 days. Cardiovascular disease, chronic respiratory disease, dyspnea at presentation, and hospital-origin admission were significantly associated with mortality. While diabetes mellitus and hypertension were highly prevalent, they did not independently predict mortality after adjustment. Overall mortality was 34.6%, particularly among older patients with multiple comorbidities. Conclusions: COVID-19 infection is associated with substantial morbidity and mortality among patients on chronic hemodialysis. Early identification of high-risk patients based on clinical presentation and comorbidity profile may support timely intervention and improved outcomes in this vulnerable population. Full article

Background/Objectives: Sugar-sweetened beverage (SSB) consumption has been linked to obesity, metabolic diseases, and rising healthcare costs. This study aimed to assess the impact of a 20% excise tax on SSBs in Brazil on obesity/overweight prevalence, seven musculoskeletal and cardiovascular diseases, and related healthcare costs, with their associated impacts on health inequalities. Methods: Using 2017/2018 Brazilian Household Budget Survey data for baseline consumption and own- and cross-price elasticities for taxed beverages, we estimated changes in caloric consumption for the entire population and for lower- and upper-income quartiles. The PRIMEtime dynamic individual-level simulation model projected body weight changes, lifetime Quality-Adjusted Life-Years (QALYs), healthcare costs (discounted at 5%), and disease cases (20-year horizon). Results: A 20% excise SSB tax was projected to reduce obesity prevalence by 1.7 percentage points in men and 1.5 percentage points in women, from baseline rates of 19.8% and 23.6%, respectively. Lifetime gains were estimated at 17,878 QALYs per million men and 12,181 per million women, alongside healthcare cost savings of Int$520 million. Impacts varied by income, with smaller health gains in the lowest quartile and higher among the wealthiest. Over 20 years, the tax could avert 1784 cases of type 2 diabetes mellitus/100,000 adults (52% in men) and 1070 cases of ischemic heart disease/100,000 adults (80% in men). Conclusions: A 20% excise SSB tax in Brazil could yield large health and cost benefits. With the recent approval of the Selective Tax under Complementary Law 214/2025, Brazil has a timely opportunity to translate these projected benefits into effective public health policy. Full article