ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors. AIDSrelated expectancy nonAIDS non events CD4CD8 CDCD CD4 CD8 CD CD4+/CD8 practice death 6 80% 80 (80 males, males , males) regimens 70 groups age inclusion CD8+Tcell CD8Tcell CDTcell CD8+T T analysis CD4+Tcell CD4Tcell CD4+T p=0.004, p0004 p p=0.004 0 004 (p=0.004) infection incidence p=0.003. p0003 p=0.003 . 003 (p=0.003) contrast conclusion HIVrelated CD4CD CD4+/CD 8 (8 7 Tcell CD8T CDT CD4T p000 p=0.00 00 (p=0.004 (p=0.003 ( p00 p=0.0 (p=0.00 p0 p=0. (p=0.0 p=0 (p=0. p= (p=0 (p= (p

Abstract Background Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. Objective With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. Methods A total of 25 panelists, including adult and child neurologists, participated in the study. Results The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusion The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system. (AIE antigens symptoms complaints disorders young prognosis Academia ABN Sociedade Infantil SBNI, SBNI , SBNI) method 2 neurologists CSF (CSF tissuebased tissue based TBA (TBA cellbased cell CBA (CBA techniques antimyelin anti myelin antiMOG. antiMOG MOG . (anti-MOG) firstline line IVIG (IVIG plasmapheresis secondline second andor cyclophosphamide thirdline third tocilizumab symptomatic stage antiNmethylDaspartate N methyl D aspartate antiNMDAR NMDAR (anti-NMDAR used scales MiniMental Mini Mental MMSE, MMSE (MMSE) MoCA, MoCA (MoCA) mRS, mRS (mRS) CASE. CASE (CASE) system (anti-MOG (MMSE (MoCA (mRS (CASE

Resumo Antecedentes Encefalites autoimunes (EAIs) são um grupo de doenças inflamatórias caracterizadas pela presença de anticorpos contra antígenos neuronais e gliais, que ocasionam sintomas psiquiátricos subagudos, queixas de memória e distúrbios anormais do movimento. A maioria dos pacientes é jovem, e o atraso no tratamento está associado a pior prognóstico. Objetivo Com o apoio da Academia Brasileira de Neurologia (ABN) e da Sociedade Brasileira de Neurologia Infantil (SBNI), desenvolvemos um consenso sobre o diagnóstico e o tratamento da EAIs no Brasil utilizando a metodologia Delphi. Métodos Um total de 25 especialistas, incluindo neurologistas e neurologistas infantis, foram convidados a participar. Resultados Os especialistas concordaram que os pacientes com critérios de possíveis EAIs devem ser submetidos ao rastreio de anticorpos antineuronais no soro e no líquido cefalorraquidiano (LCR) por meio das técnicas de ensaio baseado em tecidos (tissue-based assay, TBA, em inglês) e ensaio baseado em células (cell-based assay, CBA, em inglês). As crianças também devem ser submetidas ao rastreio de de anticorpo contra a glicoproteína da mielina de oligodendrócitos (anti-myelin oligodendrocyte glycoprotein, anti-MOG, em inglês). O tratamento deve ser iniciado dentro das primeiras 4 semanas dos sintomas, sendo as opções de primeira linha metilprednisolona combinada com imunoglobulina intravenosa (IGIV) ou plasmaférese. O tratamento de segunda linha inclui rituximabe e ciclofosfamida. Bortezomib e tocilizumab são opções de tratamento de terceira linha. A maioria das crises epilépticas nas EAIs são sintomáticas, e os fármacos anticrise podem ser desmamadas após a fase aguda. Em relação à encefalite antirreceptor de N-metil-D-aspartato (anti-N-methyl-D-aspartate receptor, anti-NMDAR, em inglês), os especialistas concordaram que agentes imunossupressores orais não devem ser usados. Os pacientes devem ser avaliados na fase aguda e pós-aguda mediante escalas funcionais e cognitivas, como Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Modified Rankin Scale (mRS), e Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusão Esta pesquisa oferece evidências tangíveis do manejo efetivo de pacientes com EAIs no sistema de saúde Brasileiro. (EAIs gliais subagudos movimento jovem prognóstico ABN (ABN SBNI, SBNI , (SBNI) Delphi 2 infantis participar LCR (LCR tissuebased tissue based assay TBA inglês cellbased cell CBA inglês. . antimyelin anti myelin glycoprotein antiMOG, antiMOG MOG, MOG anti-MOG IGIV (IGIV plasmaférese ciclofosfamida sintomáticas NmetilDaspartato N metil D aspartato antiNmethylDaspartate methyl aspartate receptor antiNMDAR, antiNMDAR NMDAR, NMDAR anti-NMDAR inglês, usados pósaguda pós cognitivas MiniMental Mini Mental MMSE, MMSE (MMSE) MoCA, MoCA (MoCA) mRS, mRS (mRS) CASE. CASE (CASE) Brasileiro (SBNI (MMSE (MoCA (mRS (CASE

Abstract The aim of this study was to evaluate the effect of substituting virginiamycin with yeastbased products in high-energy diets containing monensin on the nutrient digestibility and ruminal parameters of cattle. Five crossbred Nellore × Holstein steers (initial body weight 281 kg ± 9.2 kg) were allotted to a 5 × 5 Latin square design. The diets were composed in dry matter basis of corn silage (355 g kg-1), and concentrate composed of ground corn, soybean meal, soybean hulls,mineral mix, limestone, salt and urea (645 g kg-1). The treatments were: 1 - control, 18 mg kg-1 dry matter (DM) virginiamycin (VM); 2 - enriched yeast culture (Saccharomyces cerevisiae) at 7 g animal day-1 (EYC 7); 3 - enriched yeast culture (S. cerevisiae) at 14 g animal day-1 (EYC 14); 4 - autolyzed yeast (S. cerevisiae) at 7 g animal day-1 (AY 7); and 5 - autolyzed yeast (S. cerevisiae) at 14 g animal day-1 (AY 14). Monensin (18 mg kg-1 DM) was added to the mineral mix in all treatments. No significant differences (P > 0.05) were found for DM intake (mean 8.36 kg DM), organic matter (OM) digestibility (average of 58.39%), or mean ruminal pH (mean 6.75) among treatments. Moreover, the treatment did not have a significant effect on the short-chain fatty acid or ammonia nitrogen concentrations. These results indicated the possibility of replacing virginiamycin with yeast-based products at the lowest level (7 g of enriched yeast culture or autolyzed yeast per animal day-1) in high-energy diets containing monensin. highenergy high energy cattle initial 28 92 9 9. design 355 (35 kg1, kg1 , kg-1) meal hullsmineral hulls limestone 645 (64 kg1. . control kg- (DM VM (VM) Saccharomyces cerevisiae day1 day day- EYC 7) S. S (S 14) AY 14. (1 P 0.05 005 0 05 836 8 36 8.3 DM, OM (OM average 58.39%, 5839 58.39% 58 39 58.39%) 6.75 675 6 75 Moreover shortchain short chain concentrations based ( 35 (3 64 (6 (VM 0.0 00 83 8. 583 58.39 6.7 67 0. 58.3 6. 58.

Resumo O objetivo do estudo foi avaliar a substituição de virginiamicina por produtos à base de levedura em dietas de alto grão contendo monensina, sobre a digestibilidade dos nutrientes e parâmetros ruminais. Cinco novilhos cruzados Nelore x Holandês (peso inicial 281 kg ± 9,2 kg) distribuídos em um delineamento Quadrado Latino 5 x 5. As dietas foram compostas por silagem de milho (355 g kg-1) e concentrado composto por: milho moído, farelo de soja, casca de soja, mistura mineral, calcário, sal e ureia (645 g kg-1). Os tratamentos foram: 1. Controle, 18 mg kg-1 MS de virginiamicina (VM); 2. Cultura de levedura enriquecida (Saccharomyces cerevisiae) 7g animal dia-1 (CLE 7); 3. Cultura de levedura enriquecida (Saccharomyces cerevisiae) 14g animal dia-1 (CLE 14); 4. Levedura autolisada (Saccharomyces cerevisiae) 7g animal dia-1 (LA 7) e Levedura autolisada (Saccharomyces cerevisiae) 14g animal dia-1 (LA 14). A monensina (18 mg kg-1 MS) estava presente na mistura mineral vitamínica fornecida em todos tratamentos. Não houve diferença significativa (P>0,05) para o consumo de matéria seca (média 8,36 kg MS); digestibilidade da matéria orgânica (média 58,39%) e média de pH ruminal (média 6,75). Além disso, não foram encontrados efeitos significativos de tratamentos para concentração de ácidos graxos de cadeia curta e nitrogênio amoniacal. Estes resultados indicam a possibilidade de substituir a virginiamicina por produtos à base de levedura nos menores níveis (7g animal dia-1 de cultura de levedura enriquecida ou 7g animal dia-1 de levedura autolisada) em dietas de alto grão com monensina. ruminais peso 28 92 9 2 9, 355 (35 kg1 1 moído soja calcário 645 (64 kg1. . Controle kg- VM (VM) Saccharomyces cerevisiae dia1 dia dia- CLE 7 3 14 14) 4 LA 14. (1 P>0,05 P005 P 0 05 (P>0,05 836 8 36 8,3 58,39% 5839 58 39 6,75. 675 6,75 6 75 6,75) disso amoniacal 35 (3 64 (6 (VM ( P>0,0 P00 (P>0,0 83 8, 58,39 583 67 6,7 P>0, P0 (P>0, 58,3 6, P>0 (P>0 58, P> (P> (P

Abstract Objective To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. Methods Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. Conclusions Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy. evidencebased based adults methods search citations studies inclusion Physicians Associations Association s interventions parts 1 (1 tests syndrome tumors (2 procedures grafting longterm long term nonsurgical non etiology dysfunction therapy (

SUMMARY OBJECTIVE: The aim of this study was to evaluate the prevalence and risk factors related to metabolic dysfunction-associated steatotic liver disease in inflammatory bowel disease patients. METHODS: This is a cross-sectional study conducted on adults with inflammatory bowel disease from 2019 to 2021. Metabolic dysfunction-associated steatotic liver disease encompasses patients with steatosis and at least one cardiometabolic risk factor. Patients with alcohol consumption ≥20 g/day, chronic liver diseases, or methotrexate use were excluded. RESULTS: Almost 140 patients were included: 67.1% were female, with a mean age of 49.7±13.7 years, and 63.6% had Crohn's disease. The mean duration of inflammatory bowel disease was 9.7±7.9 years. Metabolic dysfunction-associated steatotic liver disease was observed in 44.3% and advanced liver fibrosis was excluded in 63.5% by Fibrosis-4. Patients with metabolic dysfunction-associated steatotic liver disease were older (p = 0.003) and had a higher number of metabolic syndrome components (2.9±1.1 versus 1.6±1.0; p<0.001), greater abdominal circumference (p<0.001), and body mass index (p<0.001). The only factor related to inflammatory bowel disease associated with metabolic dysfunction-associated steatotic liver disease was disease duration (11.6±9.5 versus 8.3±6.2; p = 0.017). A higher number of metabolic syndrome components and obesity increase by 2.2 times and an altered waist circumference by 2.6 times the occurrence of metabolic dysfunction-associated steatotic liver disease. CONCLUSION: A high prevalence of metabolic dysfunction-associated steatotic liver disease was observed in patients with inflammatory bowel disease, with the main risk factors being associated with metabolic syndrome predicting it, but not with inflammatory bowel disease features and/or its treatment. OBJECTIVE dysfunctionassociated dysfunction METHODS crosssectional cross sectional 201 2021 20 ≥2 gday g day g/day diseases RESULTS 14 included 671 67 1 67.1 female 497137 49 7 13 49.7±13. years 636 63 6 63.6 Crohns Crohn s 9779 9 9.7±7. 443 44 3 44.3 635 5 63.5 Fibrosis4. Fibrosis4 Fibrosis 4. 4 Fibrosis-4 0.003 0003 0 003 2.9±1.1 2911 2 (2.9±1. 1.6±1.0 1610 p<0.001, p0001 p<0.001 , 001 p<0.001) (p<0.001) p<0.001. . 11.6±9.5 11695 11 (11.6±9. 8.3±6.2 8362 8 0.017. 0017 0.017 017 0.017) 22 2. 26 CONCLUSION it andor treatment 202 ≥ 67. 49713 49.7±13 63. 977 9.7±7 44. Fibrosis- 0.00 000 00 2.9±1. 291 (2.9±1 1.6±1. 161 p000 p<0.00 (p<0.001 11.6±9. 1169 (11.6±9 8.3±6. 836 0.01 01 4971 49.7±1 97 9.7± 0.0 2.9±1 29 (2.9± 1.6±1 16 p00 p<0.0 (p<0.00 11.6±9 116 (11.6± 8.3±6 83 497 49.7± 9.7 0. 2.9± (2.9 1.6± p0 p<0. (p<0.0 11.6± (11.6 8.3± 49.7 9. 2.9 (2. 1.6 p<0 (p<0. 11.6 (11. 8.3 49. (2 1. p< (p<0 11. (11 8. ( (p< (1

Abstract The article analyzed the sugarcane-derived socioenvironmental conflicts and injustice in the Acaú-Goiana Extractive Reserve, Pernambuco, Brazil. A descriptive case study was conducted with rural workers based on social cartography and documents, analyzed under the EJAtlas categories. The Global Atlas of Environmental Justice (EJAtlas) is a web inventory that gathers environmental conflicts and injustice, serving as a basis for reporting affected territories. Even with the creation of the Reserve to protect natural assets and ecosystem life, new conflicts emerged from the installation of enterprises that put pressure on the territory and added to centuries-old problems such as sugarcane cultivation. Other impacts include air pollution, contamination of soil and water resources, biodiversity loss, food and nutritional insecurity, increased violence, human rights violations, and mental health problems. sugarcanederived derived AcaúGoiana Acaú Goiana Pernambuco Brazil documents categories (EJAtlas territories life centuriesold centuries old cultivation pollution resources loss insecurity violence violations

Resumo O artigo analisou os conflitos e injustiças socioambientais decorrentes da cana-de-açúcar na Reserva Extrativista Acaú-Goiana, Pernambuco, Brasil. Foi realizado estudo de caso de caráter descritivo com trabalhadores rurais a partir da cartografia social e documentos, analisados segundo as categorias do EJAtlas. O Atlas Global de Justiça Ambiental (EJAtlas) é um inventário na web que reúne conflitos e injustiças ambientais, servindo como base para denúncias de territórios afetados. Mesmo com a criação da Reserva para proteção dos bens naturais e vida dos ecossistemas, emergiram novos conflitos decorrentes da instalação de empreendimentos que pressionam o território, e que se somam a problemas seculares como o cultivo da cana-de-açúcar. Entre outros impactos, destacam-se a poluição do ar, contaminação do solo e recursos hídricos, perda de biodiversidade, insegurança alimentar e nutricional, aumento da violência, violações de direitos humanos e problemas de saúde mental. canadeaçúcar cana açúcar AcaúGoiana, AcaúGoiana Acaú Goiana, Goiana Acaú-Goiana Pernambuco Brasil documentos EJAtlas (EJAtlas ambientais afetados ecossistemas território canadeaçúcar. açúcar. impactos destacamse destacam ar hídricos biodiversidade nutricional violência mental

Resumen Los conflictos socioambientales son la clave para entender contradicciones e injusticias del actual modelo de desarrollo. El Atlas Global de Justicia Ambiental (EJAtlas) es un inventario en Internet de los conflictos e injusticias ambientales, que sirve para las denuncias de los territorios afectados. El artículo analiza los conflictos e injusticias socioambientales derivados de la caña de azúcar en la Reserva Extractiva de Acaú-Goiana, Pernambuco, Brasil. Se realizó un estudio de caso descriptivo con trabajadores rurales basado en cartografía social y documentos, analizados según las categorías del EJAtlas. En la Reserva, creada para la protección de los bienes naturales han surgido nuevos conflictos debido a la instalación de granjas camaroneras y condominios privados que presionan el territorio. Entre otros impactos, destacan la contaminación del aire, del suelo y de los recursos hídricos, la inseguridad alimentaria y nutricional, las violaciones de los derechos humanos y los problemas de salud mental. desarrollo EJAtlas (EJAtlas ambientales afectados AcaúGoiana, AcaúGoiana Acaú Goiana, Goiana Acaú-Goiana Pernambuco Brasil documentos territorio impactos aire hídricos nutricional mental

Abstract Sjogren's syndrome (SS) is a complex autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands, resulting in sicca symptoms. Additionally, SS presents with neurological manifestations that significantly impact the nervous system. This review aims to provide a comprehensive overview of the neurological aspects of SSj, covering both the peripheral and central nervous system involvement, while emphasizing diagnosis, treatment, and prognosis. Sjogrens Sjogren s (SS glands symptoms Additionally SSj involvement diagnosis treatment prognosis

Resumo A síndrome de Sjogren (SS) é uma doença autoimune complexa caracterizada pela infiltração linfocítica das glândulas salivares e lacrimais, resultando em sintomas sicca. Além disso, a SS apresenta manifestações neurológicas que afetam significativamente o sistema nervoso. Esta revisão tem como objetivo fornecer uma visão abrangente dos aspectos neurológicos da SSj, abordando tanto o envolvimento do sistema nervoso periférico quanto do central, com ênfase no diagnóstico, tratamento e prognóstico. (SS lacrimais sicca disso SSj central diagnóstico prognóstico

Resumo Introdução: Na neoplasia de mama ocorrem inúmeras transformações na vida da pessoa acometida e de todas as pessoas próximas, sentimentos como medo, angústia e tristeza. Diante disso, a identificação dos métodos usados para enfrentar a neoplasia de mama faz-se crucial, visto que proporciona melhor vivência desse momento por parte da mulher e de todos os envolvidos. Objetivo: Compreender as formas de enfrentamento do câncer de mama por meio do discurso de participantes de um grupo de apoio. Metodologia: Pesquisa descritiva com abordagem qualitativa realizada com 10 mulheres que participam de um grupo geral de apoio, localizado em um município da Paraíba, Brasil. Para a coleta de dados, utilizou-se entrevista semiestruturada, e como processo metodológico para a análise dos dados, o Discurso do Sujeito Coletivo. Resultados: Foi possível a compreensão de três ideias centrais em relação às formas de enfrentamento do câncer de mama: ''Ancoragem na fé e espiritualidade''; ''Suporte familiar''; e ''Grupo de apoio''. Conclusão: O estudo atingiu seu objetivo de identificar as principais formas de enfrentamento do câncer de mama por mulheres mastectomizadas, podendo elucidar a importância da fé e espiritualidade, o suporte familiar e a participação em grupos de apoio por meio do discurso das participantes.

Resumen Introducción: Con el cáncer de mama se producen numerosos cambios en la vida de la persona afectada y de las personas cercanas, en los que se manifiestan sentimientos como el miedo, la angustia y la tristeza. Ante eso, la identificación de los métodos utilizados para enfrentar el cáncer de mama es crucial, ya que permite una mejor vivencia de ese momento para la mujer y los involucrados. Objetivo: Comprender las formas de afrontamiento del cáncer de mama, a través del discurso de mujeres mastectomizadas en un grupo de apoyo. Metodología: Investigación descriptiva con enfoque cualitativo realizada con 10 mujeres que participan en un grupo de apoyo, ubicado en un municipio de Paraíba, Brasil. Para la recolección de datos, se utilizaron entrevistas semiestructuradas. Además, como proceso metodológico de análisis de datos, se aplicó el Discurso Colectivo del Sujeto. Resultados: Fue posible comprender tres ideas centrales sobre las formas de enfrentamiento del cáncer de mama: ''Anclaje en la fe y la espiritualidad''; ''Apoyo familiar''y ''Grupo de apoyo''. Conclusión: El estudio alcanzó su objetivo de identificar las principales formas de enfrentamiento del cáncer de mama por parte de las mujeres con mastectomía. Se pudo dilucidar la importancia de la fe y la espiritualidad, el apoyo familiar y la participación en grupos de apoyo, a través del discurso de las participantes.

Abstract Introduction: When facing breast cancer, patients and their loving ones experiment many changes in their lives filled with feelings such as fear, anguish, and sadness. In the light of this, the identification of the coping methods used to face breast cancer is crucial to provide a better experience for all those involved. Objective: To understand the ways of coping with breast cancer through the discourse of mastectomized women in a support group. Methodology: Descriptive research with a qualitative approach carried out with 10 women who participate in a support group, located in a municipality in Paraíba, Brasil. For data collection, semi-structured interviews were conducted and as a methodological process for data analysis, the Collective Subject Discourse was used. Results: It was possible to understand three central coping mechanisms: ''Anchoring in faith and spirituality''; ''Family support'', and ''Support group''. Conclusion: The study reached its objective of identifying the main ways of coping with breast cancer by women who had mastectomies, their discourse highlighted the importance of faith and spirituality, the support of their families, and their participation in support groups.

RESUMO O objetivo deste estudo será apresentar o protocolo de um ensaio clínico randomizado em cluster a ser realizado por meio do projeto TeleUTI - Qualificação da Assistência em Terapia Intensiva por Telemedicina. O estudo consistirá em um ensaio clínico randomizado por cluster, open label, em unidades de terapia intensiva pediátricas, com proporção de alocação de 1:1, com o intuito de comparar o grupo de intervenção (apoio da telemedicina para os pacientes internados na unidade de terapia intensiva pediátrica) com um grupo controle (cuidados habituais da unidade de terapia intensiva pediátrica). O estudo se propõe a selecionar 16 unidades de terapia intensiva pediátricas, incluindo 100 participantes por local, com o total de 1.600 participantes. O grupo intervenção receberá telerounds de segunda-feira a sexta-feira e terá à disposição especialistas e atividades de educação continuada. O desfecho primário a ser avaliado será o tempo de permanência nas unidades de terapia intensiva pediátricas, definido pela diferença entre a data de alta do participante com a data de admissão na unidade de terapia intensiva. Os desfechos secundários serão: taxa de mortalidade; dias livres de ventilação mecânica, dias de uso de antibióticos, dias de uso de drogas vasoativas e dias de uso de sedoanalgesia. Este estudo será conduzido em conformidade com a resolução 466/12 do Conselho Nacional de Saúde, com aprovação pelo Comitê de Ética em Pesquisa das instituições hospitalares envolvidas. O trabalho tem o potencial de reproduzir estudos sobre Telemedicina em cuidados intensivos, podendo trazer contribuições importantes ao atendimento em unidades de terapia intensiva no Brasil e em outras realidades. Se a Telemedicina mostrar resultados clínicos assistenciais positivos em relação ao tratamento convencional, mais pacientes pediátricos poderão ser beneficiados. Registro ClinicalTrials.gov: NCT05260710 label pediátricas 11, 11 1 1, 1:1 apoio pediátrica pediátrica. . 10 local 1600 600 1.60 segundafeira segunda feira sextafeira sexta continuada serão mortalidade mecânica antibióticos sedoanalgesia 46612 466 12 466/1 Saúde envolvidas intensivos realidades convencional beneficiados ClinicalTrials.gov ClinicalTrialsgov ClinicalTrials gov NCT NCT0526071 1: 160 60 1.6 4661 46 466/ NCT052607 6 1. 4 NCT05260 NCT0526 NCT052 NCT05 NCT0

ABSTRACT The objective of this study is to present the protocol of a cluster randomized clinical trial to be conducted through the TeleICU project - Qualification of Intensive Care by Telemedicine. The study will consist of a cluster randomized clinical trial, open label, in pediatric intensive care units, with an allocation ratio of 1:1, to compare the intervention group (support of Telemedicine for patients admitted to the pediatric intensive care unit) with a control group (pediatric intensive care unit usual care). The study proposed to select 16 pediatric intensive care units, including 100 participants per site, with a total of 1,600 participants. The intervention group will receive telerounds from Monday to Friday and will have specialists and continuing education activities available. The primary outcome measure will be the length of stay in the pediatric intensive care unit, defined as the difference between the date of discharge of the participant and the date of admission to the intensive care unit. The secondary outcomes will be mortality rate, invasive mechanical ventilation-free days, days using antibiotics, days using vasoactive drugs and days using sedoanalgesia. This study will be conducted in accordance with Resolution 466/12 of the National Health Council, with approval by the Research Ethics Committee of the institutions involved. The present study has the potential to reproduce studies on Telemedicine in intensive care and may make important contributions to care in intensive care units in Brazil and other settings. If Telemedicine shows positive clinical care results compared to conventional treatment, more pediatric patients may benefit. ClinicalTrials.gov registry: NCT05260710 label 11, 11 1 1, 1:1 support care. . care) 10 site 1600 600 1,60 available rate ventilationfree ventilation free antibiotics sedoanalgesia 46612 466 12 466/1 Council involved settings treatment benefit ClinicalTrialsgov ClinicalTrials gov registry NCT NCT0526071 1: 160 60 1,6 4661 46 466/ NCT052607 6 4 NCT05260 NCT0526 NCT052 NCT05 NCT0

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis – audiologic, electrophysiologic tests, and imaging; (2) Treatment – wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team. Objective Methods methods search citations studies inclusion Physicians Associations Association s interventions Results parts 1 (1 audiologic tests imaging (2 protocols surgery radiosurgeryradiotherapy radiosurgery radiotherapy radiosurgery/radiotherapy therapy Conclusions challenging tumors families case team (

BACKGROUND Chikungunya is a mosquito-borne virus that has been causing large outbreaks in the Americas since 2014. In Brazil, Asian-Caribbean (AC) and East-Central-South-African (ECSA) genotypes have been detected and lead to large outbreaks in several Brazilian states. In Rio Grande do Sul (RS), the southernmost state of Brazil, the first cases were reported in 2016. OBJECTIVES AND METHODS We employed genome sequencing and epidemiological investigation to characterise the Chikungunya fever (CHIKF) burden in RS between 2017-2021. FINDINGS We detected an increasing CHIKF burden linked to travel associated introductions and communitary transmission of distinct lineages of the ECSA genotype during this period. MAIN CONCLUSIONS Until 2020, CHIKV introductions were most travel associated and transmission was limited. Then, in 2021, the largest outbreak occurred in the state associated with the introduction of a new ECSA lineage. CHIKV outbreaks are likely to occur in the near future due to abundant competent vectors and a susceptible population, exposing more than 11 million inhabitants to an increasing infection risk. mosquitoborne mosquito borne 2014 Brazil AsianCaribbean Asian Caribbean AC (AC EastCentralSouthAfrican East Central South African (ECSA states RS, , (RS) 2016 (CHIKF 20172021. 20172021 2017 2021. 2021 2017-2021 period 2020 limited Then lineage population 1 risk 201 (RS 2017202 202 2017-202 20 201720 2017-20 2 20172 2017-2 2017-

ABSTRACT Background: The aim of this research was to investigate the efficiency of methods to overcome primary dormancy and biochemical processes associated with germination of Erythrina falcata Benth seeds. Seeds were submitted to dormancy overcoming treatments and the water uptake pattern was analysed. We then evaluated the activity of the antioxidant enzymes SOD, CAT, and APX, and quantified lipid peroxidation levels, hydrogen peroxide content and total protein content. The experiments were performed in a completely randomized design and the statistical analysis used was Scott-Knott test at 5% probability. Results: Mechanical scarification with sandpaper leads to approximately 94% of germination in E. falcata, while control non-scarified seeds show only approximately 37% of germination. Treatments with hot water led to high mortality in E. falcata seeds. Rapid water absorption was observed in the first 18 hours of imbition when the seeds were scarified with sandpaper, and radicle emergence was observed after 36 hours. During imbibition there was an increase of antioxidant enzyme activity and a decrease in lipid peroxidation and H2O2 production, suggesting an efficient mechanism for regulating imbibition damage. A decrease in the total protein content was observed during germination of E. falcata seeds. Conclusions: Mechanical scarification is an efficient method for breaking dormancy of E. falcata seeds. During germination of E. falcata seeds there is a reduction in the production of H2O2 and lipid peroxidation, and an increase in the activity of antioxidant enzymes. The total protein content decreased along the germination time. Background analysed SOD CAT APX levels ScottKnott Scott Knott 5 probability Results 94 E nonscarified non 37 1 3 HO H O H2O damage Conclusions time 9

RESUMEN Objetivo: Describir el perfil sociodemográfico y gestacional de mujeres VIH positivas en Curitiba-PR, años 2018-2020. Método: Investigación observacional, de corte transversal, condatos obtenidos del Sistema de Información de Enfermedades de Notificación de la mujer embarazada. Los datos fueron analizados para exploración, descripción y análisis de consistencia. Resultados: La muestra estuvo compuesta en su mayoría por mujeres de 13 a 30 años, blancas y con instrucción básica incompleta. El control prenatal fue realizado por el 93,8% de las gestantes, siendo que el 66,1% conocía su estado serológico antes Del control prenatal y el 45% recibió notificación en el 1er trimestre. El acceso a la medicación antirretroviral ocurrió para el 82,4% de las mujeres embarazadas y para el 74,6% el resultado del embarazo fue nacido vivo. Las variables asociadas estadísticamente al control prenatal fueron evolución del embarazo, profilaxis antirretroviral, tipo de parto y antirretroviral al parto (p<0,001). Conclusión: Las gestantes de la muestra presentaron indicadores gestacionales deseados. Los datos recolectados permitieron describir el perfil de la muestra y evaluar El desempeño de la política de salud de las mujeres embarazadas. Objetivo CuritibaPR, CuritibaPR Curitiba PR, PR Curitiba-PR 20182020. 20182020 2018 2020. 2020 2018-2020 Método observacional transversal embarazada exploración consistencia Resultados 1 3 incompleta 938 93 8 93,8 661 66 66,1 45 er trimestre 824 82 4 82,4 746 74 6 74,6 vivo p<0,001. p0001 p p<0,001 . 0 001 (p<0,001) Conclusión deseados 2018202 201 202 2018-202 9 93, 66, 82, 7 74, p000 p<0,00 00 (p<0,001 201820 20 2018-20 p00 p<0,0 (p<0,00 20182 2 2018-2 p0 p<0, (p<0,0 2018- p<0 (p<0, p< (p<0 (p< (p

ABSTRACT Objective: To describe the sociodemographic and gestational profile of HIV-positive women in Curitiba-PR, years 2018-2020. Method: Observational, cross-sectional research, with data obtained from the Information System of Diseases of Notification of Pregnant Women. Data were analyzed for consistency exploration, description and analysis. Results: The sample consisted mostly of women aged 13-30 years, white and with incomplete elementary school. Prenatal care was performed by 93.8% of pregnant women, 66.1% of whom knew their serological status before prenatal care and 45% received notification in the first gestational trimester. Access to antiretroviral medication occurred for 82.4% of pregnant women and for 74.6% the pregnancy outcome was alive newborns. The statistical variables associated with prenatal care were pregnancy evolution, ART prophylaxis, type of delivery and ART at delivery (p<0.00). Conclusion: The pregnant women in the sample presented desired gestational indicators. The collected data allowed describing the sample's profile and evaluating the performance of the health policy for pregnant women. Objective HIVpositive HIV positive CuritibaPR, CuritibaPR Curitiba PR, PR Curitiba-PR 20182020. 20182020 2018 2020. 2020 2018-2020 Method Observational crosssectional cross sectional research Women exploration analysis Results 1330 13 30 13-3 school 938 93 8 93.8 661 66 1 66.1 45 trimester 824 82 4 82.4 746 74 6 74.6 newborns evolution prophylaxis p<0.00. p000 p p<0.00 . 0 00 (p<0.00) Conclusion indicators samples s 2018202 201 202 2018-202 133 3 13- 9 93. 66. 82. 7 74. p00 p<0.0 (p<0.00 201820 20 2018-20 p0 p<0. (p<0.0 20182 2 2018-2 p<0 (p<0. 2018- p< (p<0 (p< (p

RESUMO Objetivo: Descrever o perfil sociodemográfico e gestacional de mulheres HIV positivo de Curitiba-PR, anos 2018-2020. Método: Pesquisa observacional, transversal, com dados do Sistema de Informação de Agravos de notificação das gestantes. Os dados foram analisados para exploração de consistência, descrição e análise. Resultados: Amostra perfilou-se majoritariamente por mulheres brancas na faixa etária de 13-30 anos. Pré-natal foi realizado por 93,8% das gestantes, sendo que 66,1% sabiam sua condição sorológica antes do pré-natal e 45% receberam a notificação no 1º trimestre. O acesso à medicação antirretroviral ocorreu para 82,4% das gestantes e para 74,6% o desfecho da gestação foi bebê nascido vivo. As variáveis estatisticamente associadas ao pré-natal foram evolução da gravidez, profilaxia com antirretroviral, tipo de parto e antirretroviral no parto (p<0,001). Conclusão: As gestantes da amostra apresentaram indicadores gestacionais desejados. Os dados coletados permitiram descrever o perfil da amostra e avaliar o desempenho da política de saúde para gestantes. Objetivo CuritibaPR, CuritibaPR Curitiba PR, PR Curitiba-PR 20182020. 20182020 2018 2020. 2020 2018-2020 Método observacional transversal consistência análise Resultados perfilouse perfilou se 1330 13 30 13-3 Prénatal Pré natal 938 93 8 93,8 661 66 1 66,1 prénatal pré 45 º trimestre 824 82 4 82,4 746 74 6 74,6 vivo gravidez p<0,001. p0001 p p<0,001 . 0 001 (p<0,001) Conclusão desejados 2018202 201 202 2018-202 133 3 13- 9 93, 66, 82, 7 74, p000 p<0,00 00 (p<0,001 201820 20 2018-20 p00 p<0,0 (p<0,00 20182 2 2018-2 p0 p<0, (p<0,0 2018- p<0 (p<0, p< (p<0 (p< (p

Abstract Objective To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2. STOPBang STOP Bang polysomnography Crosssectional Cross sectional allocation interview 1839, 1839 18 39, 39 18-39 4059, 4059 40 59, 59 40-59 60 ≥6 years Disordersthird Disorders third edition tables sensitivity specificity value ratio accuracy 32 analysis 5 56%. 56 56% . (56%) 79 79% better authors 183 1 3 18-3 405 4 40-5 6 ≥ (56% 7 18- 40- (56 (5 (

ABSTRACT Background: Sexually Transmitted Infections (STIs) can be caused by viruses, bacteria, and parasites. The World Health Organization estimated more than 300 million new global cases of curable STIs among individuals of reproductive age. Infection by Trichomonas vaginalis is one of the most prevalent curable STL Despite the current treatments available, the diagnosis of T. vaginalis can be difficult, and the resistance to the treatment increased concern for the healthcare system. Objectives: The aim of this study was to determine the prevalence and factors associated with Trichomonas vaginalis infection among women of reproductive age attending community-based services for cervical screening. Patients and methods: A total of 1477 reproductive-aged women attending 18 Primary Health Care Units in Botucatu, Brazil, from September to October 2012, were enrolled. A structured questionnaire was used for individual face-to-face interviews for obtaining data on sociodemographic, gynecologic, and obstetrics history, sexual and hygiene practices, among others. Cervicovaginal samples were obtained for detection of T. vaginalis by culture using Diamond's medium and microscopic vaginal microbiota classification according to Nugent. A multivariable logistic regression analysis was carried out to estimate Odds Ratios (OR) and 95% Confidence Intervals (95% CI) for the association between participants’ sociodemographic, behavioral factors, and clinical factors with T. vaginalis infection. Results: Median age of study participants was 33 years (ranging from 18 to 50). The overall prevalence of T. vaginalis infection was 1.3% (n = 20). Several factors were independently associated with T. vaginalis infection, such as self-reporting as black or Pardo for ethnicity (OR = 2.70; 95% CI 1.03–7.08), smoking (OR=3.18; 95% CI 1.23–8.24) and having bacterial vaginosis (OR = 4.01; 95%CI = 1.55–10.38) upon enrollment. A protective effect of higher educational level (having high school degree) was observed (OR = 0.16; 95% CI 0.05–0.53). Conclusions: Our data suggest that screening programs to correctly detect T. vaginalis infection can be helpful to guide prevention strategies to the community. Our study supports an association between abnormal vaginal microbiota and T. vaginalis infection. Background (STIs viruses bacteria parasites 30 available T difficult system Objectives communitybased community based methods 147 reproductiveaged aged 1 Botucatu Brazil 2012 enrolled facetoface face sociodemographic gynecologic history practices others Diamonds Diamond s Nugent OR 95 (95 Results 3 ranging 50. 50 . 50) 13 1.3 n 20. 20 20) selfreporting self reporting 2.70 270 2 70 1.03–7.08, 103708 1.03–7.08 , 03 7 08 1.03–7.08) OR=3.18 OR318 (OR=3.18 1.23–8.24 123824 23 8 24 4.01 401 4 01 95CI 1.55–10.38 1551038 55 10 38 enrollment degree 0.16 016 0 16 0.05–0.53. 005053 0.05–0.53 05 53 0.05–0.53) Conclusions 14 201 9 (9 5 1. 2.7 27 10370 1.03–7.0 OR=3.1 OR31 (OR=3.1 1.23–8.2 12382 4.0 40 1.55–10.3 155103 0.1 00505 0.05–0.5 ( 2. 1037 1.03–7. OR=3. OR3 (OR=3. 1.23–8. 1238 4. 1.55–10. 15510 0. 0050 0.05–0. 103 1.03–7 OR=3 (OR=3 1.23–8 123 1.55–10 1551 005 0.05–0 1.03– OR= (OR= 1.23– 12 1.55–1 155 00 0.05– 1.03 1.23 1.55– 15 0.05 1.0 1.2 1.55 0.0 1.5