Resumo A sífilis gestacional (SG) em adolescentes é um desafio para a saúde pública brasileira, com elevadas taxas de incidência. A testagem, diagnóstico e tratamento dos parceiros sexuais é indispensável para interromper a cadeia de transmissão, mas desde 2017 deixou de ser critério para o tratamento adequado da gestante. Buscamos analisar e sintetizar o conhecimento produzido sobre a atenção à saúde de parceiros sexuais de adolescentes com SG no Brasil. Realizamos uma revisão integrativa nas bases de dados BVS, SciELO e PubMed, selecionando artigos que abordavam SG e/ou sífilis congênita (SC) em adolescentes de 15 a 19 anos e que incluíam informações sobre os parceiros sexuais. Quarenta e um artigos foram analisados compreensivamente com auxílio do software WebQDA e classificados em duas categorias: (a) Abordagem dos parceiros sexuais no pré-natal, e (b) Papel dos parceiros sexuais no ciclo de transmissão da SG e da SC. Os estudos evidenciam que a abordagem do parceiro é deficitária, com ausência de dados sobre o perfil sociodemográfico e informações sobre testagem e tratamento. No âmbito da atenção primária à saúde não se encontram estudos que abordem fatores inerentes ao contexto de vulnerabilidade dos parceiros sexuais em relação ao enfrentamento da sífilis.

Abstract Gestational syphilis (GS) in adolescents is a challenge for Brazilian public health, with high incidence rates. Testing, diagnosis and treatment of sexual partners is essential to interrupt the chain of transmission, but since 2017 it is no longer a criterion for the proper treatment of pregnant women. We sought to analyze and synthesize the knowledge produced about the health care of sexual partners of adolescents with GS in Brazil. We carried out a systematic review in the BVS, SciELO and PubMed databases, selecting articles that addressed GS and/or congenital syphilis (CS) in adolescents aged 15 to 19 years and that included information about sexual partners. Forty-one articles were comprehensively analyzed using the WebQDA software and classified into two categories: a) Approach to sexual partners during prenatal care, and b) The role of sexual partners in the transmission cycle of GS and CS. The studies show that the partner’s approach is deficient, with a lack of data on the sociodemographic profile and information on testing and treatment. In the context of Primary Health Care, there are no studies that address factors inherent to the context of vulnerability of sexual partners in relation to coping with syphilis.

ABSTRACT. Citrus tristeza virus (CTV) can be transmitted by several aphid species in a semi-persistent mode, with Toxoptera citricida being the most efficient vector. In Brazil, mild CTV isolates are used for pre-immunization of citrus trees against severe isolates. We aimed to determine the capacity and efficiency of T. citricida in separating the viral complex into haplotypes from three well-characterized CTV isolates (PIAC, CS1, and Forte Rolândia). Single-aphid transmission assays were conducted to determine CTV transmission efficiency. The results showed that T. citricida transmitted only haplotypes from the PIAC and CS1 isolates, with efficiencies of 8 and 4%, respectively. Both isolates caused mild CTV symptoms in Brazil. However, isolate Forte Rolândia, which causes severe symptoms in citrus trees, was not transmitted by T. citricida. The detection of CTV haplotypes from PIAC and CS1 isolates in sweet orange (Citrus sinensis) plants after a single aphid transmission occurred at different time points. The first haplotype observed was from PIAC 150 days after citrus was challenged by a single aphid, followed by CS1 at day 210 after transmission. In addition, differences in the single-strand conformation polymorphism patterns between the CTV isolates and CTV haplotypes were determined, suggesting that an aphid can acquire and transmit only one CTV haplotype to citrus plants during phloem feeding. The study of the mechanism of transmission by the vector can increase our knowledge of the interactions among hosts, vectors, and pathogens, which are often neglected. ABSTRACT (CTV semipersistent semi persistent mode Brazil preimmunization pre immunization T wellcharacterized well characterized PIAC, (PIAC CS Rolândia. Rolândia . Rolândia) Singleaphid Single 4 4% respectively However sinensis points 15 21 addition singlestrand strand determined feeding hosts vectors pathogens neglected 1 2

RESUMO O míldio é umas das principais doenças foliares que acomete o meloeiro durante o período chuvoso na região Nordeste do Brasil. O silício (Si) tem se destacado como um método alternativo para o controle de patógenos tanto por constituir barreira físicas, como na ativação de mecanismos de defesa da planta. Assim, objetivou-se com este trabalho avaliar a severidade de míldio em meloeiro durante período chuvoso com aplicações foliares de Si. Durante as chuvas, nos meses de maio a julho de 2022 realizaram-se duas pulverizações de silicato de potássio (12% de Si e 15% de potássio) nas doses de 0; 0,25; 0,50; 1,0 e 2,0 L ha-1, com quatro repetições por dose. Realizaram-se avaliações da severidade do míldio em escalas de notas, índices de clorofila e fluorescência transiente da clorofila a (OJIP). A dose de 2,0 L ha-1 proporcionou melhores resultados retardando o desenvolvimento do patógeno em folhas com incidência da doença. Houve diminuição na severidade da doença de até 68,27%, além do aumento nos índices de clorofila a, b e total, em 8,21%, 13,86% e 9,72%, respectivamente. Além disso, o Si promoveu alterações benéficas nos parâmetros do teste OJIP: ABS/RC; TR0/RC; ET0/RC; ABS/CS0 e TR0/CS0. Durante períodos de alta intensidade de chuvas e temperaturas amenas, a aplicação de Si em meloeiro reduz a severidade do míldio e protege as clorofilas, resultando em maior absorção (ABS), armazenamento (TR0) e transporte de elétrons (ET0). Brasil (Si físicas planta Assim objetivouse objetivou 202 realizaramse realizaram 12% 12 (12 15 0 0,25 025 25 0,50 050 50 10 1 1, 20 2 2, ha1, ha1 ha Realizaramse Realizaram notas OJIP. OJIP . (OJIP) ha- 6827 68 27 68,27% total 821 8 21 8,21% 1386 13 86 13,86 972 9 72 9,72% respectivamente disso ABS/RC ABSRC ABS RC TR0/RC TR0RC TRRC TR0 TR ET0/RC ET0RC ETRC ET0 ET ABSCS0 ABSCS CS0 CS ABS/CS TR0CS0 TRCS TR0/CS0 amenas clorofilas ABS, , (ABS) (TR0 ET0. (ET0) (1 0,2 02 0,5 05 5 (OJIP 682 6 68,27 82 8,21 138 13,8 97 7 9,72 TR0CS TR0/CS (ABS (TR (ET0 ( 0, 68,2 8,2 13, 9,7 (ET 68, 8, 9,

ABSTRACT Downy mildew is one of the main foliar diseases affecting melon plants during the rainy season in the Northeast region of Brazil. Silicon (Si) application has emerged as an alternative method for pathogen control, forming physical barriers and activating defense mechanisms in plants. The objective of this study was to reduce the severity of downy mildew in melon plants during the rainy season through foliar application of Si. The treatments consisted of five rates (0, 0.25, 0.5, 1, and 2 L ha-1) of potassium silicate (12% Si and 15% potassium) applied from May to July 2022, with four replications. Disease severity was assessed using rating scales, chlorophyll contents, and transient chlorophyll a fluorescence (OJIP). The rate of 2 L ha-1 resulted in the best results by delaying pathogen development in leaves with disease incidence. Disease severity decreased to 68.27% and chlorophyll a, b, and total increased by 8.21%, 13.86%, and 9.72%, respectively. Si application resulted in beneficial changes in the following OJIP test parameters: ABS/RC, TR0/RC, ET0/RC, ABS/CS0, and TR0/CS0. During periods of high rainfall intensity and mild temperatures, Si application to melon plants reduces downy mildew severity and protects chlorophylls, enhancing the absorption flux (ABS) and electron storage (TR0) and transport (ET0). Brazil (Si control 0, 0 (0 025 25 0.25 05 5 0.5 1 ha1 ha 12% 12 (12 15 2022 replications scales contents OJIP. . (OJIP) ha- incidence 6827 68 27 68.27 b 821 8 21 8.21% 1386 13 86 13.86% 972 9 72 9.72% respectively parameters ABSRC ABS RC ABS/RC TR0RC TRRC TR0 TR TR0/RC ET0RC ETRC ET0 ET ET0/RC ABSCS0 ABSCS CS0 CS ABS/CS0 TR0CS0 TRCS TR0/CS0 temperatures chlorophylls (ABS (TR0 ET0. (ET0) ( 02 0.2 0. (1 202 (OJIP 682 6 68.2 82 8.21 138 13.86 97 7 9.72 ABS/CS TR0CS TR0/CS (TR (ET0 20 68. 8.2 13.8 9.7 (ET 8. 13. 9.

ABSTRACT Introduction Instruments to manage adverse effects of endocrine therapy with Aromatase inhibitors (AI) may improve adherence and persistence to treatment and Health-Related Quality of Life (HRQL). The 31-item Cervantes Scale (CS-31) is an HRQL questionnaire with particularities of the perimenopausal and postmenopausal period that could be an appropriate instrument to assess HRQL in Breast Cancer (BC) survivors. Objective This study aimed to perform additional validation of the CS-31 for BC survivors undergoing adjuvant endocrine therapy. Methods This prospective study was performed at three time points named T0, T1, and T2: initial, intermediate, and final follow-up period, respectively, totaling 24 months of follow-up. At each time point, the participants completed the CS-31, Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F), and Hospital Anxiety and Depression Scale (HADS). The internal consistency, construct validity, responsiveness analyses, and known-group validity of CS-31 were evaluated. Results This study included 89 postmenopausal women diagnosed with hormone receptor-positive early BC in adjuvant endocrine therapy with AI. The internal consistency was good (Cronbach's alpha = 0.89). Construct validity received a positive rating, with 100% of results consistent with prior hypotheses. A prospective improvement in HRQL was identified for the CS-31 Global Score and FACIT-F Total Score and for most of their domains. Furthermore, women with anxiety and depression by HADS presented worse HRQL by CS-31. Conclusion The authors identified that the CS-31 seems to be appropriate for use in oncology medical routine and may help to monitor adverse effects and HRQL of BC survivors during adjuvant endocrine therapy. AI (AI HealthRelated Health Related HRQL. . (HRQL) 31item item 31 CS31 CS (CS-31 (BC CS-3 T0 T T1 T2 initial intermediate followup follow up respectively 2 followup. up. point CS31, 31, FACITF, FACITF FACIT F , (FACIT-F) HADS. (HADS) analyses knowngroup known group evaluated 8 receptorpositive receptor Cronbachs Cronbach s 0.89. 089 0.89 0 0.89) rating 100 hypotheses domains Furthermore CS31. 31. (HRQL 3 CS3 (CS-3 CS- (FACIT-F (HADS 08 0.8 10 (CS- 0. 1 (CS

Resumo O mero do Atlântico Epinephelus itajara é a maior espécie de garoupa no Oceano Atlântico. Apesar do seu status de conservação Vulnerável (VU) globalmente e Criticamente em Perigo (CR) no Brasil, a espécie continua enfrentando ameaças da sobrepesca em toda a sua área de distribuição. Utilizamos o sequenciamento de DNA por código de barras, empregando o gene mitocondrial da Citocromo c oxidase subunidade I (COI), para identificar a comercialização ilegal de E. itajara em mercados de peixe nas costas norte (CN) e sul (CS) do Brasil. A coleta de amostras foi realizada em mercados de peixe e teve como objetivo confirmar a identificação de peixes descaracterizados e vendidos como E. itajara na CN, bem como identificar filés de peixe vendidos como garoupa verdadeira na CS. O sequenciamento de DNA por código de barras permitiu a identificação inequívoca de 22 (84,6%) das 26 amostras de mercado de peixe analisadas. Ambas as áreas amostradas tiveram confirmação da comercialização ilegal de E. itajara, e das 22 amostras analisadas, 17 (77,3%) foram confirmadas como E. itajara. Nós relatamos aqui dois crimes, a venda ilegal de E. itajara e a fraude comercial por substituição de espécies. Este estudo ressaltou que a legislação existente que protege E. itajara em águas brasileiras requer a adoção de melhores políticas públicas para a conservação da espécie. VU (VU CR (CR Brasil distribuição COI, COI , (COI) E CN (CN CS (CS 2 84,6% 846 84 6 (84,6% analisadas 1 77,3% 773 77 3 (77,3% crimes espécies (COI 84,6 8 (84,6 77,3 7 (77,3 84, (84, 77, (77, (84 (77 (8 (7 (

Abstract The Atlantic goliath grouper Epinephelus itajara is the largest grouper species in the Atlantic Ocean. Despite the conservation status being Vulnerable (VU) globally and Critically Endangered (CR) in Brazil, the species continues to face threats from overfishing throughout its range. We used DNA barcoding employing the mitochondrial Cytochrome c oxidase subunit I (COI) gene to identify the illegal commercialization of E. itajara in fish markets from the northern (NC) and southern (SC) Brazilian coasts. Sampling was conducted in fish markets and aimed to confirm the identification of mischaracterized fish sold as E. itajara in the NC, as well as identifying fish fillets sold as the Dusky grouper in the SC. DNA barcoding allowed the unambiguous identification of 22 (84.6%) of the 26 analyzed fish market samples. Both sampled areas had confirmation of E. itajara illegal commercialization and from the 22 analyzed samples, 17 (77.3%) were confirmed to be E. itajara. Here we report two crimes, the illegal sale of E. itajara and commercial fraud by species substitution. This study has highlighted that the existing legislation that protects E. itajara in Brazilian waters requires the adoption of better public policies for the conservation of the species. Ocean VU (VU CR (CR Brazil range COI (COI E NC (NC SC (SC coasts 2 84.6% 846 84 6 (84.6% samples 1 77.3% 773 77 3 (77.3% crimes substitution 84.6 8 (84.6 77.3 7 (77.3 84. (84. 77. (77. (84 (77 (8 (7 (

In this work, babassu FAME samples were synthesized by transesterification reaction under alkaline catalysis with sodium glyceroxide and by two steps process with KOH followed by H2SO4 as catalysts. A sequential multi-element method for determination of Zn, Fe, Mg, Ca, Na and K in synthesized babassu FAME by high resolution continuum source flame atomic absorption spectrometry (HR CS FAAS) was developed. The proposed method is based on a microemulsion formation by mixing the babassu FAME samples with 1-propanol and aqueous phase. The mass proportion of the added components was evaluated through a ternary diagram. External and matrix-matching calibration techniques with inorganic and organic standard were investigated. In the five-level spike-recovery test, satisfactory results were obtained by performing the matrix-matching calibration along with inorganic standard solutions. By using the optimized conditions, limits of detection in the range of 0.002-0.12 mg kg-1 were obtained. Accuracy was attested by the agreement of the results obtained in the analysis of three certified reference materials. By applying the microemulsion system and HR-CS FAAS, the sequential determination of six elements was achieved. Therefore, the proposed method was a suitable alternative for metal determination in babassu FAME samples, with good sensitivities, accuracy, and a wide linear working range. work HSO H SO H2SO catalysts multielement multi element Zn Fe Mg Ca HR FAAS developed 1propanol propanol 1 phase diagram matrixmatching matrix matching investigated fivelevel five level spikerecovery spike recovery test solutions conditions 0.0020.12 0002012 0.002 0.12 0 002 12 0.002-0.1 kg1 kg kg- materials HRCS achieved Therefore sensitivities accuracy 0020 0.0020.1 000201 0002 0.00 012 0.1 00 0.002-0. 0.0020. 00020 000 0.0 01 0. 0.002-0 0.0020 0.002-

Resumo Objetivo Analisar os fatores associados à hesitação vacinal entre os profissionais de saúde de um hospital universitário. Métodos Estudo transversal, descritivo e analítico, desenvolvido em um hospital universitário federal de Pernambuco, entre os meses de junho e novembro de 2022, com trabalhadores de saúde da instituição com formação de nível médio e superior. Foram analisadas as variáveis preditoras aspectos socioeconômicos, ocupacionais, histórico de reação vacinal, medos relativos às vacinas e aspectos das dimensões do modelo dos 3Cs (confiança, conveniência e complacência) com o desfecho hesitação vacinal, definido como atraso ou recusa da vacinação, apesar da disponibilidade desse serviço. Utilizou-se a regressão logística binária, segundo o método stepwise backward, para verificar as associações (p < 0,05). Resultados Participaram 283 trabalhadores de saúde, sendo estatisticamente associados à hesitação vacinal o medo de eventos supostamente atribuíveis à vacinação ou imunização (OR: 2,047; IC:1,165-3,595; p = 0,013), ter acontecido algo que os fizesse desacreditar na eficácia das vacinas (OR: 2,964; IC: 1,265-6,944; p = 0,012) e disponibilidade do imunobiológico na unidade de saúde no momento da atualização do cartão (OR: 0,314; IC: 0,136-0,723; p = 0,006). Conclusão Observou-se que o medo de eventos supostamente atribuíveis à vacinação ou imunização aumenta em duas vezes a chance de hesitação vacinal; que ter acontecido algo que fizesse desacreditar na eficácia das vacinas eleva em quase três vezes; e que a disponibilidade do imunobiológico na unidade de saúde no momento da atualização do cartão diminui a ocorrência desse fenômeno. transversal analítico Pernambuco 2022 superior socioeconômicos ocupacionais Cs confiança, confiança (confiança complacência serviço Utilizouse Utilizou se binária backward 0,05. 005 0,05 . 0 05 0,05) 28 OR (OR 2,047 2047 2 047 IC1,1653,595 IC11653595 IC 1,165 3,595 1 165 3 595 IC:1,165-3,595 0,013, 0013 0,013 , 013 0,013) 2,964 2964 964 1,2656,944 12656944 1,265 6,944 265 6 944 1,265-6,944 0,012 0012 012 0,314 0314 314 0,1360,723 01360723 0,136 0,723 136 723 0,136-0,723 0,006. 0006 0,006 006 0,006) Observouse Observou fenômeno 202 00 0,0 2,04 204 04 IC1 1653 IC1,1653,59 IC1165359 1165 1,16 3595 3,59 16 59 IC:1,165-3,59 001 0,01 01 2,96 296 96 2656 1,2656,94 1265694 1265 1,26 6944 6,94 26 94 1,265-6,94 0,31 031 31 1360 0,1360,72 0136072 0136 0,13 0723 0,72 13 72 0,136-0,72 000 0,00 20 0, 2,0 IC1,1653,5 IC116535 116 1,1 359 3,5 5 IC:1,165-3,5 2,9 29 9 1,2656,9 126569 126 1,2 694 6,9 1,265-6,9 0,3 03 0,1360,7 013607 0,1 072 0,7 7 0,136-0,7 2, IC1,1653, IC11653 11 1, 35 3, IC:1,165-3, 1,2656, 12656 12 69 6, 1,265-6, 0,1360, 01360 07 0,136-0, IC1,1653 IC1165 IC:1,165-3 1,2656 1,265-6 0,1360 0,136-0 IC1,165 IC116 IC:1,165- 1,265- 0,136- IC1,16 IC11 IC:1,165 IC1,1 IC:1,16 IC1, IC:1,1 IC:1, IC:1

Abstract Objective To analyze the factors associated with vaccine hesitancy among healthcare professionals at a university hospital. Methods This is a cross-sectional, descriptive and analytical study, developed at a federal university hospital in Pernambuco, between June and November 2022, with institution healthcare workers with high school and higher education. The predictor variables socioeconomic and occupational aspects, history of vaccine reactions, fears related to vaccines and aspects of 3Cs model (confidence, compliance, convenience) dimensions with the outcome vaccine hesitancy, defined as delay or refusal of vaccination, despite the availability of this service, were analyzed. Binary logistic regression was used, according to the stepwise backward method, to verify associations (p < 0.05). Results A total of 283 healthcare workers participated, with vaccine hesitancy being statistically associated with fear of Events Supposedly Attributable to Vaccination or Immunization (OR: 2.047; CI: 1.165-3.595; p = 0.013), having something happen that made them disbelieve in vaccine effectiveness (OR: 2.964; CI: 1.265-6.944; p = 0.012) and immunobiological agent availability in the health unit to update the card (OR: 0.314; CI: 0.136-0.723; p = 0.006). Conclusion It was observed that: fear of Events Supposedly Attributable to Vaccination or Immunization increases the chance of vaccine hesitancy by two times; the fact that something happened that led to disbelief in vaccine effectiveness increases it by almost three times; and immunobiological agent availability in the health unit to update the card reduces the occurrence of this phenomenon. crosssectional, crosssectional cross sectional, sectional cross-sectional study Pernambuco 2022 education reactions Cs confidence, confidence (confidence compliance convenience vaccination service analyzed used method 0.05. 005 0.05 . 0 05 0.05) 28 participated OR (OR 2.047 2047 2 047 CI 1.1653.595 11653595 1.165 3.595 1 165 3 595 1.165-3.595 0.013, 0013 0.013 , 013 0.013) 2.964 2964 964 1.2656.944 12656944 1.265 6.944 265 6 944 1.265-6.944 0.012 0012 012 0.314 0314 314 0.1360.723 01360723 0.136 0.723 136 723 0.136-0.723 0.006. 0006 0.006 006 0.006) times phenomenon 202 00 0.0 2.04 204 04 1653 1.1653.59 1165359 1165 1.16 3595 3.59 16 59 1.165-3.59 001 0.01 01 2.96 296 96 2656 1.2656.94 1265694 1265 1.26 6944 6.94 26 94 1.265-6.94 0.31 031 31 1360 0.1360.72 0136072 0136 0.13 0723 0.72 13 72 0.136-0.72 000 0.00 20 0. 2.0 1.1653.5 116535 116 1.1 359 3.5 5 1.165-3.5 2.9 29 9 1.2656.9 126569 126 1.2 694 6.9 1.265-6.9 0.3 03 0.1360.7 013607 0.1 072 0.7 7 0.136-0.7 2. 1.1653. 11653 11 1. 35 3. 1.165-3. 1.2656. 12656 12 69 6. 1.265-6. 0.1360. 01360 07 0.136-0. 1.1653 1.165-3 1.2656 1.265-6 0.1360 0.136-0 1.165- 1.265- 0.136-

Resumen Objetivo Analizar los factores asociados a la indecisión a las vacunas entre profesionales de la salud de un hospital universitario. Métodos Estudio transversal, descriptivo y analítico, llevado a cabo en un hospital universitario federal del estado de Pernambuco, entre los meses de junio y noviembre de 2022, con trabajadores de la salud de la institución, cuya formación era de nivel medio y superior. Se analizaron las variables predictoras aspectos socioeconómicos, ocupacionales, antecedentes de reacciones a vacunas, miedos relacionados con las vacunas y aspectos de las dimensiones del modelo de las 3C (confianza, conveniencia y complacencia) con el resultado indecisión a las vacunas, definido como retraso o rechazo a la vacunación, a pesar de la disponibilidad del servicio. Se utilizó la regresión logística binaria, de acuerdo con el método stepwise backward, para verificar las relaciones (p<0,05). Resultados Participaron 283 trabajadores de la salud. La indecisión a las vacunas se relacionó estadísticamente con el miedo de eventos supuestamente atribuibles a la vacunación o inmunización (OR: 2,047; IC:1,165-3,595; p = 0,013), con algún hecho que los hiciera desacreditar de la eficacia de las vacunas (OR: 2,964; IC: 1,265-6,944; p = 0,012) y con la disponibilidad del inmunobiológico en la unidad de salud en el momento da la actualización del carnet (OR: 0,314; IC: 0,136-0,723; p = 0,006). Conclusión Se observó que el miedo de eventos supuestamente atribuibles a la vacunación o inmunización aumenta dos veces la probabilidad de indecisión a las vacunas, que la existencia de algún hecho que los hiciera desacreditar de la eficacia de las vacunas eleva casi tres veces la indecisión y que la disponibilidad del inmunobiológico en la unidad de salud en el momento da la actualización del carnet disminuye la incidencia de este fenómeno. transversal analítico Pernambuco 2022 institución superior socioeconómicos ocupacionales C confianza, confianza (confianza complacencia servicio binaria backward p<0,05. p005 p<0,05 . 0 05 (p<0,05) 28 OR (OR 2,047 2047 2 047 IC1,1653,595 IC11653595 IC 1,165 3,595 1 165 3 595 IC:1,165-3,595 0,013, 0013 0,013 , 013 0,013) 2,964 2964 964 1,2656,944 12656944 1,265 6,944 265 6 944 1,265-6,944 0,012 0012 012 0,314 0314 314 0,1360,723 01360723 0,136 0,723 136 723 0,136-0,723 0,006. 0006 0,006 006 0,006) fenómeno 202 p00 p<0,0 (p<0,05 2,04 204 04 IC1 1653 IC1,1653,59 IC1165359 1165 1,16 3595 3,59 16 59 IC:1,165-3,59 001 0,01 01 2,96 296 96 2656 1,2656,94 1265694 1265 1,26 6944 6,94 26 94 1,265-6,94 0,31 031 31 1360 0,1360,72 0136072 0136 0,13 0723 0,72 13 72 0,136-0,72 000 0,00 00 20 p0 p<0, (p<0,0 2,0 IC1,1653,5 IC116535 116 1,1 359 3,5 5 IC:1,165-3,5 0,0 2,9 29 9 1,2656,9 126569 126 1,2 694 6,9 1,265-6,9 0,3 03 0,1360,7 013607 0,1 072 0,7 7 0,136-0,7 p<0 (p<0, 2, IC1,1653, IC11653 11 1, 35 3, IC:1,165-3, 0, 1,2656, 12656 12 69 6, 1,265-6, 0,1360, 01360 07 0,136-0, p< (p<0 IC1,1653 IC1165 IC:1,165-3 1,2656 1,265-6 0,1360 0,136-0 (p< IC1,165 IC116 IC:1,165- 1,265- 0,136- (p IC1,16 IC11 IC:1,165 IC1,1 IC:1,16 IC1, IC:1,1 IC:1, IC:1

Resumo A sífilis gestacional (SG) em adolescentes é um desafio para a saúde pública brasileira, com elevadas taxas de incidência. A testagem, diagnóstico e tratamento dos parceiros sexuais é indispensável para interromper a cadeia de transmissão, mas desde 2017 deixou de ser critério para o tratamento adequado da gestante. Buscamos analisar e sintetizar o conhecimento produzido sobre a atenção à saúde de parceiros sexuais de adolescentes com SG no Brasil. Realizamos uma revisão integrativa nas bases de dados BVS, SciELO e PubMed, selecionando artigos que abordavam SG e/ou sífilis congênita (SC) em adolescentes de 15 a 19 anos e que incluíam informações sobre os parceiros sexuais. Quarenta e um artigos foram analisados compreensivamente com auxílio do software WebQDA e classificados em duas categorias: (a) Abordagem dos parceiros sexuais no pré-natal, e (b) Papel dos parceiros sexuais no ciclo de transmissão da SG e da SC. Os estudos evidenciam que a abordagem do parceiro é deficitária, com ausência de dados sobre o perfil sociodemográfico e informações sobre testagem e tratamento. No âmbito da atenção primária à saúde não se encontram estudos que abordem fatores inerentes ao contexto de vulnerabilidade dos parceiros sexuais em relação ao enfrentamento da sífilis. (SG brasileira incidência 201 gestante Brasil BVS PubMed eou ou SC (SC 1 categorias (a prénatal, prénatal pré natal, natal pré-natal b (b deficitária 20 2

Abstract Gestational syphilis (GS) in adolescents is a challenge for Brazilian public health, with high incidence rates. Testing, diagnosis and treatment of sexual partners is essential to interrupt the chain of transmission, but since 2017 it is no longer a criterion for the proper treatment of pregnant women. We sought to analyze and synthesize the knowledge produced about the health care of sexual partners of adolescents with GS in Brazil. We carried out a systematic review in the BVS, SciELO and PubMed databases, selecting articles that addressed GS and/or congenital syphilis (CS) in adolescents aged 15 to 19 years and that included information about sexual partners. Forty-one articles were comprehensively analyzed using the WebQDA software and classified into two categories: a) Approach to sexual partners during prenatal care, and b) The role of sexual partners in the transmission cycle of GS and CS. The studies show that the partner’s approach is deficient, with a lack of data on the sociodemographic profile and information on testing and treatment. In the context of Primary Health Care, there are no studies that address factors inherent to the context of vulnerability of sexual partners in relation to coping with syphilis. (GS rates Testing 201 women Brazil BVS databases andor or CS (CS 1 Fortyone Forty one categories b partner s deficient Care 20 2

The coinfection between malaria (ML) and arboviral diseases represents a major global public health problem, particularly in tropical and subtropical countries. Despite its relevance, this topic is still insufficiently discussed in the current literature. Here, we aimed to investigate the worldwide distribution, symptoms, and diagnosis during coinfection between ML and arboviral diseases. We conducted a systematic review following the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and assessed the selection and eligibility criteria, created and diagrammed maps, and analysed major symptoms with 95% confidence intervals (CI) using prevalence ratio and effect size, also performing latent class analysis. A total of 85,485 studies were retrieved, of which 56 were included: 57.14% in Asia, 25% in Africa, 14.30% in South America, and 3.56% in Europe. A total of 746 individuals were reported to be coinfected with Plasmodium and arbovirus. Concurrent ML, Dengue (DEN), Chikungunya (CHIK), and Zika (ZIK) patients are more likely to present headache and skin rash. Regarding diagnosis, 58,253 were made, of which 38,176 were positive (ML and at least one arboviral disease). The magnitude of these pathogens’ coexistence points out the pressing need for improvements in public health policies towards diagnosis and prevention of both diseases, especially in endemic areas. problem countries relevance literature Here distribution metaanalyses meta analyses PRISMA (PRISMA criteria maps 95 CI (CI size analysis 85485 85 485 85,48 retrieved 5 included 5714 57 14 57.14 Asia 25 Africa 1430 30 14.30 America 356 3 3.56 Europe 74 arbovirus DEN, DEN , (DEN) CHIK, CHIK (CHIK) ZIK (ZIK rash 58253 58 253 58,25 made 38176 38 176 38,17 disease. disease . disease) pathogens areas 9 8548 8 48 85,4 571 1 57.1 2 143 14.3 35 3.5 7 (DEN (CHIK 5825 58,2 3817 17 38,1 854 4 85, 57. 14. 3. 582 58, 381 38,

Abstract Objective To evaluate the mode of delivery according to Robson classification (RC) and the perinatal outcomes in fetal growth restriction (FGR) and small for gestational age (SGA) fetuses. Methods Retrospective cohort study by analyzing medical records of singleton pregnancies from two consecutive years (2018 and 2019). FGR was defined according to Delphi Consensus. The Robson groups were divided into two intervals (1–5.1 and 5.2–10). Results Total of 852 cases were included: FGR (n = 85), SGA (n = 20) and control (n=747). FGR showed higher percentages of newborns < 1,500 grams (p<0.001) and higher overall cesarean section (CS) rates (p<0.001). FGR had the highest rates of neonatal resuscitation and neonatal intensive care unit admission (p<0.001). SGA and control presented higher percentage of patients classified in 1 - 5.1 RC groups, while FGR had higher percentage in 5.2 - 10 RC groups (p<0.001). FGR, SGA and control did not differ in the mode of delivery in the 1-5.1 RC groups as all groups showed a higher percentage of vaginal deliveries (p=0.476). Conclusion Fetuses with FGR had higher CS rates and worse perinatal outcomes than SGA and control fetuses. Most FGR fetuses were delivered by cesarean section and were allocated in 5.2 to 10 RC groups, while most SGA and control fetuses were allocated in 1 to 5.1 RC groups. Vaginal delivery occurred in nearly 60% of FGR allocated in 1-5.1 RC groups without a significant increase in perinatal morbidity. Therefore, the vaginal route should be considered in FGR fetuses. (RC (FGR (SGA 2018 (201 2019. 2019 . 2019) Consensus 1–5.1 151 5 (1–5. 5.2–10. 5210 5.2–10 2 5.2–10) 85 included n 85, , 85) 20 n=747. n747 n=747 747 (n=747) 1500 500 1,50 p<0.001 p0001 p 0 001 (p<0.001 (CS p<0.001. 51 5. 52 15.1 1-5. p=0.476. p0476 p=0.476 476 (p=0.476) 60 morbidity Therefore 201 (20 1–5. 15 (1–5 521 5.2–1 8 n74 n=74 74 (n=747 150 50 1,5 p<0.00 p000 00 (p<0.00 15. 1-5 p047 p=0.47 47 (p=0.476 6 (2 1–5 (1– 5.2– n7 n=7 7 (n=74 1, p<0.0 p00 (p<0.0 1- p04 p=0.4 4 (p=0.47 ( 1– (1 n= (n=7 p<0. p0 (p<0. p=0. (p=0.4 (n= p<0 (p<0 p=0 (p=0. p< (p< p= (p=0 (p (p=

RESUMO O objetivo deste trabalho foi avaliar o crescimento e a micorrização de mudas de angico (Anadenanthera peregrina (Vell.) Brenan) e braúna (Melanoxylon brauna Schott) em casa de vegetação a partir de inoculante com comunidade de fungos micorrízicos arbusculares (FMAs) selecionados ou coletada em campo, em substrato formulado e comercial. Cada espécie fez parte de um experimento, instalado em delineamento inteiramente casualizado em esquema fatorial 2x4, sendo dois tratamentos de substratos, quatro de inoculação e quatro repetições de 12 mudas cada, totalizando 384 mudas por experimento. Os substratos utilizados foram: RAD - composto pela mistura de 30% de composto orgânico, 30% de subsolo (argiloso), 30% de solo arenoso e 10% de fosfato de rocha; e SC - substrato comercial composto pela mistura de vermiculita expandida, turfa, carvão, macro e micronutrientes; e quatro tratamentos: T1 - controle; T2 - controle adubado; T3 - mistura de fungos selecionados; e T4 - mistura de fungos nativos. Aos 100 dias após a semeadura para angico e 180 dias para braúna, foram realizadas medições de altura e diâmetro do coleto das mudas e determinados: área foliar (AF), matéria seca da parte aérea (MSPA) e sistema radicular (MSSR), número esporos de FMAs e colonização micorrízica. Para o angico, as mudas produzidas no substrato RAD proporcionaram maiores valores de altura, diâmetro, MSPA, AF, MSSR, além de maior eficiência da inoculação e esporulação no substrato. As mudas de angico inoculadas apresentaram maior altura e AF quando comparadas às não inoculadas, em ambos os substratos. Para braúna, o tipo de substrato influenciou apenas o diâmetro, cujo RAD promoveu maior crescimento. No substrato RAD, a inoculação com FMAs selecionados (T3) proporcionou maiores incrementos em altura e diâmetro. No substrato SC todas as mudas produzidas no tratamento T2 (adubado e não inoculado) morreram, enquanto os tratamentos de inoculação promoveram aumentos na produção de AF, MSPA, e MSSR. Recomenda-se a produção de mudas de angico com substrato RAD inoculadas com comunidade de FMAs nativos coletada em campo. Para braúna, sugerem-se estudos utilizando outras técnicas de produção aliadas à inoculação com FMAs. Anadenanthera Vell. Vell (Vell. Brenan Melanoxylon Schott (FMAs campo experimento 2x4 x 1 cada 38 30 orgânico argiloso, argiloso , (argiloso) 10 rocha expandida turfa carvão micronutrientes T adubado 18 determinados (AF) MSPA (MSPA MSSR (MSSR) micorrízica (T3 inoculado morreram Recomendase Recomenda se sugeremse sugerem (Vell 2x 3 (argiloso (AF (MSSR (T

ABSTRACT This study aimed to assess the growth and mycorrhization of greenhouse-grown angico (Anadenanthera peregrina (Vell.) Brenan) and brauna (Melanoxylon brauna Schott) seedlings based on inoculation with a community of selected or field-collected arbuscular mycorrhizal fungi (AMF), in formulated and commercial substrate. Each species corresponded to one experiment, conducted in a completely randomized design and 2x4 factorial scheme, consisting of two substrates, four inoculation treatments and four repetitions of 12 seedlings each, totaling 384 seedlings per experiment. The substrates used were: DAR – mixture of 30% organic compost, 30% subsoil (clay), 30% sandy soil and 10% rock phosphate; and CS - commercial substrate consisting of expanded vermiculite, peat, charcoal, macro and micronutrients; and four treatments: T1 - control; T2 – fertilized control; T3 – mixture of selected fungi; and T4 – mixture of native fungi. At 100 days after sowing (DAS) for angico and 180 DAS for brauna, seedling height and diameter were measured and leaf area (LA), shoot (SDW) and root dry weight (RDW), number of AMF spores and mycorrhizal colonization were determined. Angico seedlings grown in DAR obtained the highest diameter, height, SDW, RDW and LA values, as well as greater inoculation efficiency, LA, RDW, as well as greater inoculation efficiency and sporulation in this substrate. In both substrates, inoculated angico seedlings were taller and had a larger LA than their noninoculated counterparts. In brauna, the type of substrate only influenced seedling diameter, with DAR promoting greater growth. In DAR substrate, inoculation with selected AMF (T3) resulted in greater seedling height and diameter. In CS, all the seedlings produced in T2 (fertilized and noninoculated) died, whereas the inoculation treatments increased LA, SDW and RDW. It is recommended that angico seedlings grown in DAR be inoculated with native AMF collected in the field. For brauna, further research is needed using other production techniques combined with AMF inoculation. greenhousegrown greenhouse Anadenanthera Vell. Vell (Vell. Brenan Melanoxylon Schott fieldcollected field AMF, , (AMF) experiment x 2x scheme 1 each 38 30 compost clay, clay (clay) 10 phosphate vermiculite peat charcoal micronutrients T control (DAS 18 (LA) (SDW (RDW) determined values counterparts (T3 died (Vell (AMF 3 (clay (LA (RDW (T

Abstract Periodontal regeneration is a challenge, and tissue engineering based on periodontal ligament stem cells (PDLSCs) has been shown to be a promising alternative to this process. However, the need for scaffolds has limited the therapeutic use of PDLSCs. In this context, scaffold-free tissue engineering using the cell sheet (CS) technique has been developed as an alternative approach to improve tissue regeneration. Previously, we showed that Protease-activated receptor-1 (PAR1) can regulate PDLSCs. Herein, we evaluate whether PAR1 influences osteogenesis in CSs produced from PDLSCs, without the use of scaffolds. PDLSCs were isolated and immunophenotyped. Then, CSs were obtained by supplementing the culture medium with ascorbic acid (50 µg/mL), and PAR1 was activated through its agonist peptide (100 nM). Scaffold-free 3D CSs were successfully produced from PDLSCs, and they showed higher proliferation potential than isolated PDLSCs. Also, PAR1 activation decreased senescence and improved osteogenic differentiation of CSs by increasing mineralized nodule deposition and alkaline phosphatase concentration; PAR1 also modulated osteogenic markers at the gene and protein levels. We further demonstrated that this effect was regulated by Wnt, TGF-βI, MEK, p38 MAPK, and FGF/VEGF signaling pathways in PDLSCs (p < 0.05%). Overall, PAR1 activation increased osteogenic activity in CSs, emerging as a promising scaffold-free therapeutic approach for periodontal regeneration. challenge (PDLSCs process However context scaffoldfree scaffold free CS (CS Previously Proteaseactivated Protease receptor1 receptor 1 receptor- PAR (PAR1 Herein immunophenotyped Then 50 (5 µg/mL, µgmL µg/mL , µg mL µg/mL) 100 (10 nM. nM . nM) Scaffoldfree Scaffold D Also concentration levels Wnt TGFβI, TGFβI TGF βI, βI TGF-βI MEK p p3 MAPK FGFVEGF FGF VEGF 0.05%. 005 0.05% 0 05 0.05%) Overall (PAR 5 ( 10 (1 00 0.05 0.0 0.

Resumo Objetivo Este artigo teve como objetivo propor uma bateria para mensurar o modelo teórico dos 5Cs do desenvolvimento positivo de jovens no esporte e investigar suas propriedades psicométricas. Método A amostra foi composta por 305 atletas, entre 14 e 24 anos (M = 18,4±2,38, 58,9% sexo feminino). As análises empregadas foram análise fatorial confirmatória, consistência interna e modelagem de equações estruturais. Resultados Os resultados referentes a estrutura fatorial demonstraram a adequação do modelo de cinco fatores oblíquos (χ²/gl = 1,61, TLI = 0,95, CFI = 0,95, RMSEA = 0,05), com cargas fatoriais variando de 0,32 a 0,84. A Modelagem de Equações Estruturais sugeriu efeito positivo da paixão harmoniosa e do clima orientado à tarefa sobre os 5Cs. Conclusão Tais resultados corroboram a literatura ao demonstrar o papel facilitador de variáveis individuais (paixão harmoniosa) e contextuais (clima orientado à tarefa) sobre desenvolvimento positivo de jovens no esporte. Cs psicométricas 30 atletas 1 2 M 184238 18 4 38 18,4±2,38 589 58 9 58,9 feminino. feminino . feminino) confirmatória estruturais χ²/gl χ²gl χgl χ² gl χ 161 61 1,61 095 0 95 0,95 0,05, 005 0,05 , 05 0,05) 032 32 0,3 084 84 0,84 3 18423 18,4±2,3 5 58, 16 6 1,6 09 0,9 00 0,0 03 0, 08 8 0,8 1842 18,4±2, 1, 184 18,4±2 18,4± 18,4 18,

Abstract Objective This article aimed to propose a battery to measure the theoretical model of the 5Cs of the positive development of young people in sport and investigate its psychometric properties. Method The sample consisted of 305 athletes, between 14 and 24 years old (M = 18.4±2.38, 58.9% female). The analyzes used were confirmatory factor analysis, internal consistency and structural equation modeling. Results The results regarding the factorial structure demonstrated the adequacy of the five oblique factor model (χ²/gl = 1.61, TLI = 0.95, CFI = 0.95, RMSEA = 0.05), with factor loadings varying from 0.32 to 0.84. Structural Equation Modeling suggested a positive effect of harmonious passion and task-oriented climate on the 5Cs. Conclusion These results corroborate the literature by demonstrating the facilitating role of individual (harmonious passion) and contextual (task-oriented climate) variables on the positive development of young people in sport. Cs properties 30 athletes 1 2 M 184238 18 4 38 18.4±2.38 589 58 9 58.9 female. female . female) analysis modeling χ²/gl χ²gl χgl χ² gl χ 161 61 1.61 095 0 95 0.95 0.05, 005 0.05 , 05 0.05) 032 32 0.3 084 84 0.84 taskoriented task oriented 3 18423 18.4±2.3 5 58. 16 6 1.6 09 0.9 00 0.0 03 0. 08 8 0.8 1842 18.4±2. 1. 184 18.4±2 18.4± 18.4 18.

Resumo Introdução O comportamento sedentário (CS) tem sido apontado como fator de risco para doenças crônicas e mortalidade por todas as causas. Objetivo Estimar a prevalência de CS e fatores associados em universitários da área da saúde de uma universidade da região Centro-Oeste brasileira. Método Estudo transversal com acadêmicos da saúde, de ambos os sexos, de 18 a 59 anos. Coletaram-se os dados por meio de questionário e o CS foi estabelecido pelo tempo assistindo à televisão, usando computador, jogando videogame e utilizando transporte. O ponto de corte considerado como elevado CS foi de seis horas ou mais por dia. A análise ajustada foi realizada por meio de Regressão de Poisson. Resultados Entre os 2.287 participantes, a prevalência de CS foi de 50,4% (IC 95% 48,3 - 52,5), sendo que ser do sexo masculino (RP=1,18; IC95% 1,04-1,35; p<0,010), cursar medicina (RP=1,16; IC95% 1,00-1,34; p<0,047) e não praticar atividade física (RP=1,55; IC95% 1,28-1,87; p<0,001) estiveram associados ao desfecho. Conclusão Cerca de metade dos acadêmicos apresentou CS, estando essa condição associada a sexo masculino, curso de medicina e baixo nível de atividade física. Ressalta-se a importância de políticas públicas para redução do CS com recomendações a universitários a fim de se evitarem prejuízos futuros à saúde. (CS causas CentroOeste Centro Oeste brasileira sexos 1 5 anos Coletaramse Coletaram televisão computador transporte dia Poisson 2287 2 287 2.28 participantes 504 50 4 50,4 IC 95 483 48 3 48, 52,5, 525 52,5 , 52 52,5) RP=1,18 RP118 RP (RP=1,18 IC95 1,041,35 104135 1,04 1,35 04 35 1,04-1,35 p<0,010, p0010 p p<0,010 0 010 p<0,010) RP=1,16 RP116 16 (RP=1,16 1,001,34 100134 1,00 1,34 00 34 1,00-1,34 p<0,047 p0047 047 RP=1,55 RP155 55 (RP=1,55 1,281,87 128187 1,28 1,87 28 87 1,28-1,87 p<0,001 p0001 001 desfecho Ressaltase Ressalta 228 2.2 50, 9 52, RP=1,1 RP11 (RP=1,1 IC9 041 1,041,3 10413 104 1,0 135 1,3 1,04-1,3 p001 p<0,01 01 1,001,3 10013 100 134 1,00-1,3 p<0,04 p004 RP=1,5 RP15 (RP=1,5 281 1,281,8 12818 128 1,2 187 1,8 8 1,28-1,8 p<0,00 p000 22 2. RP=1, RP1 (RP=1, 1,041, 1041 10 1, 13 1,04-1, p00 p<0,0 1,001, 1001 1,00-1, 1,281, 1281 12 1,28-1, RP=1 (RP=1 1,041 1,04-1 p0 p<0, 1,001 1,00-1 1,281 1,28-1 RP= (RP= 1,04- p<0 1,00- 1,28- (RP p<

Abstract Background Sedentary behaviour (SC) has been identified as a risk factor for chronic diseases and all-cause mortality. Objective To estimate the prevalence of SC and associated factors in university students in the health area of a university in the Brazilian Midwest. Method Cross-sectional study with health academics, of both sexes, aged between 18 and 59 years. Data were collected through a questionnaire and the SC was established by time watching television, using a computer, playing video games and using transportation. The cut-off point considered as high SC was 6 hours or more per day. The adjusted analysis was performed using Poisson regression. Results Among the 2,287 participants, the prevalence of SC was 50.4% (95%CI 48.3 - 52.5), being male (PR=1.18; 95%CI 1.04-1, 35; p < 0.010), studying medicine (PR=1.16; 95%CI 1.00-1.34; p< 0.047) and not practicing physical activity (PR=1.55; 95%CI 1.28-1, 87; p<0.001), were associated with the outcome. Conclusion About half of the students had SC, this condition being associated with being male, having a medical course and having a low level of physical activity. It was emphasized the importance of public policies to reduce the SC with recommendations to university students to avoid future damage to health. (SC allcause all cause mortality Midwest Crosssectional Cross sectional academics sexes 1 5 years television computer transportation cutoff cut off day regression 2287 2 287 2,28 participants 504 50 4 50.4 95CI CI 95 483 48 3 48. 52.5, 525 52.5 , 52 52.5) PR=1.18 PR118 PR (PR=1.18 1.041, 1041 1.04 1, 04 1.04-1 35 0.010, 0010 0.010 0 010 0.010) PR=1.16 PR116 16 (PR=1.16 1.001.34 100134 1.00 1.34 00 34 1.00-1.34 0.047 0047 047 PR=1.55 PR155 55 (PR=1.55 1.281, 1281 1.28 28 1.28-1 87 p<0.001, p0001 p<0.001 001 p<0.001) outcome 228 2,2 50. 9 52. PR=1.1 PR11 (PR=1.1 041 1.041 104 1.0 1.04- 0.01 01 1.001.3 10013 100 134 1.3 1.00-1.3 0.04 004 PR=1.5 PR15 (PR=1.5 281 1.281 128 1.2 1.28- 8 p000 p<0.00 22 2, PR=1. PR1 (PR=1. 10 1. 0.0 1.001. 1001 13 1.00-1. 12 p00 p<0.0 PR=1 (PR=1 0. 1.001 1.00-1 p0 p<0. PR= (PR= 1.00- p<0 (PR

RESUMO A Síndrome de Crouzon é uma doença genética rara que afeta o desenvolvimento craniofacial resultando em diversas manifestações na região de cabeça e pescoço. Esse artigo teve como objetivo relatar um caso clínico de um paciente com a Síndrome de Crouzon, destacando as implicações relevantes para o atendimento odontológico. Foram avaliados os aspectos clínicos, radiológicos e tratamento odontológicos realizados. O cirurgião-dentista desempenha um papel fundamental na reabilitação bucal desses pacientes, promovendo melhorias na estética e qualidade de vida. Esse estudo forneceu insights sobre o manejo da condição no contexto odontológico, considerando aspectos clínicos, radiográficos e tratamentos indicados. A compreensão dessas manifestações bucais e suas implicações parece ser essencial para oferecer um atendimento adequado e melhorar a qualidade de vida dos pacientes com SC. pescoço odontológico clínicos realizados cirurgiãodentista cirurgião dentista indicados SC

ABSTRACT Crouzon Syndrome is a rare genetic disease that affects craniofacial development resulting in various manifestations in the head and neck region. This article aimed to report a clinical case of a patient with Crouzon Syndrome, highlighting the relevant implications for dental care. The clinical, radiological aspects and dental treatment performed were evaluated. The dentist plays a fundamental role in the oral rehabilitation of these patients, promoting improvements in aesthetics and quality of life. This study provided insights into the management of the condition in the dental context, considering clinical, radiographic aspects and recommended treatments. Understanding these oral manifestations and their implications seems to be essential to offering adequate care and improving the quality of life of patients with CS. region evaluated context treatments CS