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Background: Neurological and psychiatric manifestations occur in patients with primary Sjogren's disease (SjD) with a wide-ranging clinical presentation, affecting quality of life, social participation, and prognosis. Despite this, neither central nor peripheral neurological symptoms are systematically evaluated in the context of autoimmunity or identified as manifestations of SjD. The EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) covers only part of them in the neurological domain., Methods: We performed a systematic review of the diagnosis and prevalence of central, peripheral, and autonomic nervous system manifestations in primary SjD, following the recommendations proposed by the Cochrane Collaboration Handbook. Observational studies were included when their main issue was the diagnosis and the prevalence of the manifestations individually. We employed a generalized linear mixed model (GLMM) method with a random-effects model, and the results were computed using logit transformation, implemented through the 'meta' and 'metafor' packages in the R software (version 3.6.1). To present these recommendations, agreement among experts was investigated using the Delphi method in in-person meetings., Results: We propose ten recommendations regarding the investigation and management of neurological involvement in SjD that had 100% agreement among participants., Conclusion: These recommendations add to the literature on the clinical care of patients with SjD., Competing Interests: Declarations. Ethical approval: Not applicable. Consent for publication: All authors consent to publication. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The text discusses the trajectory of the global pharmaceutical industry towards becoming what is currently called Big Pharma. Also presents the configuration of the Health Industrial Complex and exposes its economic and political dimensions. It suggests as essential determinants of the transformation of the global pharmaceutical industry into Big Pharma the processes of financialization of the global political economy and the harmonization of the intellectual property regime carried out by the World Trade Organization through the TRIPS agreement. Furthermore, it discusses the microeconomic changes that have occurred in the companies' production process. Finally, it points out that this trajectory is part of the process of weakening multilateral representation built after the Second World War during the 1990s.

This study aims to estimate the prevalence of special diets and analyze the sociodemographic profile, nutritional status, and eating habits of the Brazilian population that uses special diets. This cross-sectional study was conducted with data from the second 2017/2018 National Food Survey (n=45,689 individuals aged at least 10 years). We questioned the use of hypertension, diabetes, cholesterol, heart disease, and weight-loss diets. Dieting prevalence was estimated by sociodemographic characteristics and nutritional status, and logistic regression models were employed to assess factors associated with dieting. All analyses considered sample design and expansion factors. The prevalence of special diets was 14.3%. Weight-loss (5.2%) and hypertension (4.6%) diets were the most prevalent. Women, older adults, individuals with higher incomes, and obese individuals were more likely to follow any type of special diet than their peers.

Urban reservoirs are frequently exposed to impacts from high population density, polluting activities, and the absence of environmental control measures and monitoring. In this study, we investigated the use of satellite imagery to assess restoration measures and support decision-making in a hypereutrophic urban reservoir. Since 2016, Lake Pampulha (Brazil) has undergone restoration measures, including the application of Phoslock®, to mitigate its poor water quality conditions. Satellite images from Landsat-8 (L8) and Sentinel-2 (S2) and historical monitoring data were used to estimate total suspended matter (TSM), chlorophyll-a (Chla), and Secchi disk depth (SDD). We explored both established models from existing literature and novel alternatives, the latter employing machine learning approaches. Model performance was assessed through the coefficient of determination (R 2 ) during calibration and using the root mean square error (RMSE) and its normalization by the observed mean (nRMSE) during validation. Random forest regressor presented superior performance for the three water quality parameters and both satellites. The performance metrics for Landsat-8 were TSM (n=44) R 2 of 0.62; Chla (n=48) R 2 of 0.74; and SDD (n=23) R 2 of 0.67. For Sentinel-2, TSM (n=53) R 2 of 0.72; Chla (n=54) R 2 of 0.64; SDD (n=33) R 2 of 0.89. The selected models were then applied to cloud-free images from 2013 to 2022 to provide modeled TSM, Chla, and SDD values. These were used for spatiotemporal analysis, encompassing cluster analysis, sample comparisons, and trend analysis. Three distinct regions within Lake Pampulha were identified, with the upstream region displaying poorer conditions for TSM, Chla, and SDD. Restoration measures have contributed positively to improving water quality in Lake Pampulha; however, rainy periods pose a challenge due to water quality deterioration associated with urban runoff. Remote sensing has proven to be a robust tool for assisting managers in assessing recovery measures in urban lakes., Competing Interests: Declarations. Ethics Approval: Not applicable Conflict of Interest: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Posttraumatic stress disorder (PTSD) is a debilitating condition affecting 5.7 % of the global population in their lifetime. There is a strong association between trauma-related nightmares and insomnia with higher rates of physical illness, mental distress, and suicide among PTSD patients. Prazosin, an α1-adrenergic antagonist, has shown mixed results in treating these sleep disturbances. This study aims to evaluate the effect of prazosin compared to placebo on insomnia, nightmares, and global PTSD symptoms, and to examine variables that might influence this effect. We conducted a meta-analysis and a novel meta-regression analysis of randomized clinical trials (RCTs) comparing prazosin to placebo in samples of patients with PTSD. Data sources were MEDLINE, EMBASE, Scopus, ISI Web of Science, and PTSD Pubs. Examined variables were age, gender, military/civilian status, prazosin dose, treatment duration, baseline symptom severity, use of antidepressants, use of benzodiazepines (BDZ), prevalence of depression, and alcohol use disorder. Ten RCTs with 648 patients were included. Analysis revealed prazosin significantly improved insomnia (SMD = -0.654, p = 0.043) and nightmares (SMD = -0.641, p = 0.025), but not overall PTSD symptoms (SMD = -0.428, p = 0.077). Unexpectedly, higher BDZ use was associated with greater improvement in insomnia (β = -0.046; p = 0.01) and PTSD severity (β = -0.037; p = 0.004). These findings suggest that prazosin effectively reduces insomnia and nightmares in PTSD patients. Benzodiazepine co-administration seems to enhance prazosin's efficacy, suggesting that the addition of prazosin might allow for a reduction of BDZ doses in these patients. Further research should empirically test the efficacy of prazosin alone versus prazosin combined with BDZ to confirm these findings., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2025 Elsevier Inc. All rights reserved.)

The scope of this study was to determine the diagnostic performance of ABSI for obesity and sarcopenic obesity, compared to the results of bioimpedance analysis (BIA) and BMI, by sex and age group. It involved a cross-sectional study with 12,793 participants in the second round of ELSA-Brasil (Longitudinal Study of Adult Health in Brazil), which obtained measurements of body fat percentage using BIA and anthropometry, verifying the performance of the diagnostic tests in order to compare the indices. The results showed that for obesity in men in all three age groups, the sensitivity was below 49%. Specificity ranged from 73% to 93%, with a higher percentage in the 65 to 79 age group. The same pattern was found for women, with sensitivity lower than 42%, and specificity ranged from 85% to 92%, and was higher in older women. With respect to sarcopenic obesity, the sensitivity and specificity among men in the three age groups were 72% was 99%, respectively. Among women, sensitivity was around 95% and specificity around 70% in all age groups. ABSI, compared to BIA, showed a reduced ability to identify obesity. However, it proved to be a good marker of sarcopenic obesity.

Background: The congenital absence of the left atrial appendage (LAA) is an extremely rare anatomical anomaly, with only 23 cases documented in medical literature. The LAA plays a critical role in thrombus formation, particularly in patients with atrial fibrillation (AF), thus impacting stroke prevention strategies and the management of anticoagulation., Case Summary: We report a 48-year-old male with a 2-year history of hypertension and prior episodes of tachycardic palpitations, who presented with AF and chest pain. During catheter ablation for AF, a transoesophageal echocardiogram revealed the absence of the LAA, initially suspected to be a thrombus. The procedure was suspended until a computed tomography confirmed the congenital absence of the LAA. The patient successfully underwent pulmonary vein isolation with radiofrequency and, after a shared decision-making process, discontinued anticoagulation. He remains asymptomatic without AF recurrence., Discussion: The congenital absence of the LAA raises important considerations for managing stroke risk in AF patients, as standard thromboembolic risk scores do not account for such anatomical variations. Despite the LAA being the most common site for thrombus formation, stroke risk in AF results from multiple factors beyond a single site of thrombus formation. Left atrial appendage occlusion is a viable alternative for stroke prevention in patients contraindicated for anticoagulation. Recent guidelines recommend individualized risk assessment using scores such as CHA 2 DS 2 -VA, even in atypical cases, ensuring that management strategies are tailored to each patient's risk profile., Competing Interests: Conflict of interest. None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Neuroacanthocytosis syndromes are rare inherited neurodegenerative disorders, characterized by the presence of acanthocytes. Among them, Choreoacanthocytosis and McLeod syndrome stand out, sharing similarities with Huntington's disease, including choreic movement disorders, psychiatric symptoms, and cognitive decline. The case described involves a 36-year-old patient with cognitive deficits, involuntary movements, and ataxic gait. Cranial computed tomography revealed accentuation of cortical sulci and cisterns and atrophy of the caudate nucleus with ex-vacuo dilatation of the anterior horns of the lateral ventricles. Magnetic resonance imaging confirmed these findings and showed putamen atrophy and hypointensity in the basal nuclei. Diagnosis included peripheral blood smear, which revealed numerous acanthocytes, culminating in neuroacanthocytosis, specifically choreoacanthocytosis., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Glucocorticoids (GCs) mediate responses to energetic and psychosocial challenges and are associated with behavioral adjustments that form part of an adaptive vertebrate stress response. GCs and behavior can indirectly influence each other, leading to either an intensification or attenuation of stress responses. Exploring these GC-behavior relationships may offer insights into the beneficial aspects of behavior and help identify coping mechanisms that potentially enhance individual fitness. We conducted a systematic review of the relationship between GCs and several behavioral traits, as described in the literature on captive and wild primates, and evaluated the effect of different categorical factors on these relationships using a meta-analytic approach. According to the type of behavior, we grouped statistical measures into affiliative, agonistic, anxiety-like, and foraging domains which were further differentiated into behavioral subgroups. We also categorized measures based on setting, method, sex and age of individuals, and sample matrix involved in each primary study. Overall, we found that some affiliative and foraging behaviors are associated with lower GC levels, while agonistic and anxiety-like behaviors are linked to higher GC levels. Specifically, non-sexual affiliation and energetically inexpensive activities were negatively related to GCs. In contrast, inter- and intragroup aggression, noncommunicative and self-directed behaviors, and energetically expensive activities were positively related to GCs. By demonstrating how certain social, ecological and intrinsic factors affect the GC-behavior relationships, our study helps elucidate the contexts that may alleviate or intensify the stress responses in non-human primates., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Biological decontamination strategies using microorganisms to adsorb aflatoxins have shown promising results for reducing the dietary exposure to these contaminants. In this study, the ability of inactivated biomasses of Lacticaseibacillus rhamnosus (LRB) and Saccharomyces cerevisiae (SCB) incorporated alone or in combination into functional yogurts (FY) at 0.5-4.0% ( w / w ) to adsorb aflatoxin B 1 (AFB 1 ) was evaluated in vitro. Higher adsorption percentages (86.9-91.2%) were observed in FY containing 1.0% LR + SC or 2.0% SC ( w / w ). The survival of mouse embryonic fibroblasts increased after exposure to yogurts containing LC + SC at 1.0-4.0% ( w / w ). No significant differences were noted in the physicochemical and sensory characteristics between aflatoxin-free FY and control yogurts (no biomass) after 30 days of storage. The incorporation of combined LRB and SCB into yogurts as vehicles for these inactivated biomasses is a promising alternative for reducing the exposure to dietary AFB 1 . The results of this trial support further studies to develop practical applications aiming at the scalability of using the biomasses evaluated in functional foods to mitigate aflatoxin exposure.

Since 2009, the Municipal Health Secretariat of Rio de Janeiro (SMS-RJ) has encouraged the creation of a Master's degree in primary health care at the National Health School/Fiocruz (ENSP/Fiocruz). In the following decade, this proposal became one of the main lines of the institution's professional stricto sensu postgraduate program, which culminated in CAPES approving the first professional doctorate class in the history of Fiocruz-RJ offered in 2024. The class comprises primary health care (PHC) students from Rio's SUS and Fiocruz employees in science, technology and innovation. Regarding the profile of the PHC students, the highlights were women (61.5%), a degree in medicine (53.8%), a mean of 15 years since graduating, 10 years working in PHC, graduates of a medical or multiprofessional residency course (69.2%) and a Master's degree in primary care from ENSP/Fiocruz or UFRJ (84.6%). The SMS-RJ thus leaves a legacy for Brazilian Public Health as a leader in the promotion of Fiocruz-RJ stricto sensu professional training programs, innovating in the end-of-course work, reviving the presence of doctors in the classes and bringing the contributions of the Portuguese SNS, a source of inspiration for the PHC reform undertaken in Rio de Janeiro, to the Rio de Janeiro SUS debate.

The aim of this review is to present the state of the art regarding obstetric violence in Brazil. The most commonly used terms are "obstetric violence," "disrespect and abuse," and "mistreatment". Concerning measurement, the most widely used instrument is based on the definition of "mistreatment," still in its early stages of evaluation and lacking adaptation to Brazil. The prevalence of obstetric violence varies widely in national studies due to methodological factors and the type of postpartum women considered. Regarding risk factors, adolescent or women over 35, non-white, with low education levels, users of the public health system (SUS), those who had vaginal birth or abortion, are at higher risk. Hierarchical relationships between the healthcare team and the family are also relevant, as well as inadequate hospital structures, bed shortages, and insufficient healthcare professionals, which contribute to obstetric violence. The consequences of this violence include an increased risk of postpartum depression and PTSD, reduced likelihood of attending postpartum and childcare consultations, and difficulties in exclusive breastfeeding. Interventions to mitigate obstetric violence should consider women's empowerment, healthcare professionals' training, monitoring obstetric violence, and legal support.

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas., (© 2024. The Author(s).)

A long-term indwelling catheter may be indicated in clinical situations, such as chronic diseases of the genitourinary or neurological systems. In addition to the risks of infection, trauma, and bleeding, a catheter's permanence can affect psycho-emotional and socioeconomic dimensions. We aimed to understand how the need to use a long-term indwelling catheter affects this patient's self-perception, interrelationships, and self-care. We carried out a qualitative, descriptive study based on interviews with 17 patients, and applied thematic analysis and complex thinking. The different prognoses and expectations regarding the catheter influenced self-perception, adaptation, acceptance, or denial. The presence of a catheter, whether as a curative measure or for comfort, can affect self-image and sexuality, and generate insecurities and uncertainties, which require understanding the multidimensionality of situations that suffer interference from the personal, family, and social environment, as well as health systems' capacity to deal with it. Despite the challenges, the majority of participants reported a favorable disposition towards self-care, whether to enable catheter removal or to prevent injuries in lifelong indications.

This study aimed to analyze the role of nurses in hospital management in the face of COVID-19. The study had a qualitative, descriptive, and exploratory approach. The setting was a hospital that was completely transformed to care for patients with COVID-19. At the time of data collection, ten nurses managed the services, and all participated in the semi-structured interview. After thematic analysis, the data were presented in three categories, representing the elements of Donabedian's triad: structure, process, and result. Category 1 highlighted the hospital structure reconfiguration based on material and people management; category 2 addressed the work process restructuring to achieve goals with safety and quality; and category 3 focused on nurses' experiences in describing the results achieved and expected. The analysis highlighted the importance of teamwork, involvement, and adaptation of managers in the face of the challenges of a new and life-threatening disease, scarce resources, and the complexity of human relationships in the crisis. In transformational leadership, these nurses encouraged behavior change, professional growth, and resilience.

Sjogren's disease (SjD) is an autoimmune disease that is characterized not only by the sicca symptoms it causes but also by its systemic nature, which is capable of several and not yet fully understood extraglandular manifestations. To gain a clearer understanding of these manifestations as well as a better practical approach, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of the extraglandular manifestations present in ESSDAI (EULAR Sjogren´s syndrome disease activity index), followed by a voting panel with recommendations for clinical practice. This publication is complementary to others already published and covers cutaneous and hematological manifestations, with prevalence data generated by a meta-analysis of 13 clinical or laboratory manifestations and 6 clinical management recommendations., (© 2024. The Author(s).)

This article maps the structural, nonstructural and functional vulnerabilities of healthcare facilities to the COVID-19 pandemic. It reports on a scoping review guided by JBI recommendations and structured by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus and Web of Science Repositories and databases were consulted, as was the grey literature. The protocol was registered in the Open Science Framework. The 54 studies included summarised 36 vulnerabilities in three categories in 29 countries. Functional and non-structural vulnerabilities were the most recurrent. Limited material and human resources, service disruption, non-COVID procedures and inadequate training were the items with most impact. COVID-19 exposed nations to the need to strengthen health systems to ensure their resilience in future health crises. Prospective risk management and systematic analysis of health facility vulnerabilities are necessary to ensure greater safety, sustainability and improved standards of preparedness and response to events of this nature.

Numerous countries and regions have embraced implementing a separate sewer system, segregating sanitary and storm sewers into distinct systems. However, the functionality of these systems often needs to improve due to irregular interconnections, resulting in a mixed and malfunctioning system. Sewage collection is crucial for residential sanitation, but untreated collection significantly contributes to environmental degradation. Analyzing the simultaneous operation of both systems becomes vital for effective management. Using mathematical tools for precise and unified diagnosis and prognosis becomes imperative. However, municipal professionals and companies need more tools specifically designed to evaluate these systems in a unified way, mapping all the hydraulic connections observed in practice. This study proposes a unified simulation method for stormwater and sanitary sewer urban systems, addressing real-world scenarios and potential interferences. The primary goal is to develop a simulation method for both systems, considering system interconnections and urban layouts, involving hydrodynamic and water quality simulations. The practical application of this method, the Multilayer Hydrodynamic Simulation Method (MODCEL-MHUS), successfully identifies issues in urban water networks and suggests solutions, making it a valuable tool for urban water management and environmental engineering professionals., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

Background: Uremic stomatitis is often unfamiliar to healthcare professionals. This study presents five cases of uremic stomatitis, providing a comprehensive analysis of their demographic distribution, clinicopathological features, and management strategies based on existing literature., Methods: Data were collected from centers across Brazil, Argentina, Venezuela, and Mexico. Electronic searches were conducted in five databases supplemented by manual scrutiny and gray literature., Results: The series consisted of three men and two women with a mean age of 40.2 years. Lesions mostly appeared as white plaques, particularly on the tongue (100%). The median blood urea level was 129 mg/dL. Histopathological analysis revealed epithelial changes, including acanthosis and parakeratosis, with ballooned keratinocytes in the suprabasal region. Oral lesions resolved subsequent to hemodialysis in three cases (75%). Thirty-seven studies comprising 52 cases of uremic stomatitis have been described hitherto. Most patients were male (65.4%) with a mean age of 43.6 years. Clinically, grayish-white plaques (37.3%) and ulcers/ulcerations (28.9%) were common, particularly on the tongue (30.9%). Hemodialysis was performed on 27 individuals. The resolution rate of oral lesions was 53.3%., Conclusion: Earlier recognition of uremic stomatitis, possibly associated with long-term uremia, holds the potential to improve outcomes for patients with undiagnosed chronic kidney disease., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis in childhood. It often presents with cutaneous involvement and exhibits a predilection for the head and neck region. This article illustrates a case of congenital JXG in a 5-month-old boy, characterized by a solitary, well-circumscribed nodule above the left upper lip. Histopathologically, the lesion exhibited histiocytes with eosinophilic cytoplasm and Touton giant cells. Immunohistochemistry revealed histiocytes positive for CD68 and Factor XIIIa, while negative for S-100 protein. Clinicians should become familiar with the broad clinical spectrum of cutaneous JXG, particularly its congenital presentation, in order to ensure timely and accurate management., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The treatment for peripheral nerve sheath tumors (PNSTs) is based on surgical excision and the primary goal is to improve symptoms whilst preserving neurological function. In order to improve this technique, surgeons may use sodium fluorescein (SF) to help visualize the neoplasm and, consequently, facilitate its removal. Aiming to assess the efficacy of this emerging surgical strategy, we conducted a systematic review and single-arm meta-analysis. We conducted a systematic search on the PubMed, Embase, and Web of Science databases, following the PRISMA guidelines. Studies without outcomes of interest, case series with less than four patients, letters, comments, technical notes, editorials, reviews, and basic research papers were excluded. The outcomes considered for this study were: the number of tumors that achieved total resection, subtotal resection, or near total resection, the approach/technique utilized by the surgeon, SF-related complications, and total complications. Five studies, with a total of 175 individuals, were included in our survey. Notably, 70% of the neoplasms presented by the patients were schwannomas. Considering extracranial lesions, we found a proportion of 96% (95% CI: 88 - 100%) in total resection, 0% (95% CI: 0-1%) in near total resection, and 4% (95% CI: 0-12%) in subtotal resection, all linked to an amount of 185 analyzed PNSTs. Furthermore, a proportion of 1% (95% CI: 0 - 2%) in SF-related complications was spotted among 183 patients. Finally, total complications analysis accounted for 11% (95% CI: 0 - 25%) among 183 individuals. We concluded that SF-assisted resection of PNSTs is a suitable and relatively safe technique, linked to minimum complications, of which the majority was not associated with the chemical compound itself. Future research is necessary to increase the number of patients available in the current literature and, therefore, enhance future analyses., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: A cost of illness (COI) study aims to evaluate the socioeconomic burden that an illness imposes on society as a whole. This study aimed to describe the resources used, patterns of care, direct cost, and loss of productivity due to systemic lupus erythematosus (SLE) in Brazil., Methods: This 12-month, cross-sectional, COI study of patients with SLE (ACR 1997 Classification Criteria) collected data using patient interviews (questionnaires) and medical records, covering: SLE profile, resources used, morbidities, quality of life (12-Item Short Form Survey, SF-12), and loss of productivity. Patients were excluded if they were retired or on sick leave for another illness. Direct resources included health-related (consultations, tests, medications, hospitalization) or non-health-related (transportation, home adaptation, expenditure on caregivers) hospital resources.Costs were calculated using the unit value of each resource and the quantity consumed. A gamma regression model explored cost predictors for patients with SLE., Results: Overall, 300 patients with SLE were included (92.3% female,mean [standard deviation (SD)] disease duration 11.8 [7.9] years), of which 100 patients (33.3%) were on SLE-related sick leave and 46 patients (15.3%) had stopped schooling. Mean (SD) travel time from home to a care facility was 4.4 (12.6) hours. Antimalarials were the most commonly used drugs (222 [74.0%]). A negative correlation was observed between SF-12 physical component and SLE Disease Activity Index (- 0.117, p = 0.042), Systemic Lupus International CollaboratingClinics/AmericanCollegeofRheumatology Damage Index (- 0.115, p = 0.046), medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific drugs/day (- 0.113, p = 0.051), and lost productivity (- 0.570, p < 0.001). For the mental component, a negative correlation was observed with medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific medications/day (- 0.113, p = 0.051), and missed appointments (- 0.232, p < 0.001). Mean total SLE cost was US$3,123.53/patient/year (median [interquartile range (IQR)] US$1,618.51 [$678.66, $4,601.29]). Main expenditure was medication, with a median (IQR) cost of US$910.62 ($460, $4,033.51). Mycophenolate increased costs by 3.664 times (p < 0.001), and inflammatory monitoring (erythrocyte sedimentation rate or C-reactive protein) reduced expenditure by 0.381 times (p < 0.001)., Conclusion: These results allowed access to care patterns, the median cost for patients with SLE in Brazil, and the differences across regions driven by biological, social, and behavioral factors. The cost of SLE provides an updated setting to support the decision-making process across the country., (© 2024. The Author(s).)

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare benign neoplasm that can be mistaken for malignancies due to its unfamiliarity among clinicians and aggressive clinical appearance. We herein contributed by reporting an additional case of MNTI characterized by an extensive extraoral protrusion in a 2-month-old infant. The lesion involved the anterior maxilla, cheek, and infraorbital region, resulting the displacement of the nose to the contralateral side, and measuring approximately 10 cm in size. Surgical resection of the lesion was performed. After a 6-month follow-up, the patient has shown no evidence of recurrence. The rapid growth and aggressive behavior of MNTI emphasize the importance of an early diagnosis and prompt intervention in order to achieve favorable outcomes., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This article proposes a reflection on the imperative of antiracism in collective oral health, which, as a science, field, core, and praxis, contributes significantly to the reconstruction of an ethos that considers equity and enables citizenship and democracy. As a paradigm, we assumed the concept of "Buccality" and the guidelines of the National Comprehensive Health Policy for the Black Population, emphasizing the defense of the right to health as a prerogative of the right to life and the combat against racism and all forms of discrimination systematically. As a critical exercise, we discussed the status quo of collective oral health. We pointed to adopting a racial pro-equity perspective as an intentional, political choice socially agreed upon with all of society for social justice. Finally, we propose recommendations for dismantling systemic racism in collective oral health.

The article discusses the interface between gender, social classes, and (bio)technologies to improve body aesthetics. Dialoguing with gender studies, it investigates how these (bio)technologies act in the production of contemporary bodies and femininities in different social groups based on ethnographic research performed in circuits where these interventions occur. We analyze the uses, meanings, and moralities attributed to them, showing how they fabricate conventions simultaneously aesthetic, moral, and bodily of femininity in a process also traversed by distinctions and class belonging.

Ecosystem restoration strategies vary widely in the techniques applied and ecological contexts. We conducted a meta-analysis to evaluate how restoration success varies across socio-ecological contexts, taxonomic groups and biomes. Restoration success is quantified as the percentage of each ecological metric value attained in the restoration site compared to the reference systems. We show that restoration success is different for plants, animals, and soils and across ecological indicators. Abundance of individuals is easier to restore than carbon stocks, which are easier than species diversity. However, abundance may be a poor indicator of ecosystem recovery because there is no unidirectional trend over time, and abundance often fails to distinguish restored from degraded areas. We also found that carbon stocks in the soil and in the vegetation are restored at analogous paces, but the recovery of soil carbon stocks is less variable than plant stocks across sites. Our results demonstrate that different restoration techniques are effective in recovering diversity and carbon stocks, but assisted natural regeneration showed a slightly higher success compared to other strategies. However, there is a considerable difficulty in restoring converted and degraded areas to achieve conditions similar to the original ecosystems. It is critical and timely to investigate benefits and effectiveness of ecosystem restoration techniques to biodiversity and carbon recovery different ecosystem types to improve the restoration effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This study aims to identify the individual community strategies to avoid violence exposure most used by adolescents from public and private schools in the IX Administrative Region of Rio de Janeiro and investigate the profile of co-occurrence and its prevalence in specific population subgroups. This is a cross-sectional study with 693 individuals. A multidimensional questionnaire collected information regarding strategies to avoid community violence exposure and was self-completed in the classroom. The most used strategies were avoiding walking close to armed people (55.5%), avoiding walking alone (30.5%), and avoiding returning home at dawn (24.7%). Girls adopt more of all (concurrently) the four limiting behaviors to reduce their community violence exposure (53% vs. 32%). Notably, the adoption of such strategies differed by socioeconomic indicators and was higher among adolescents from lower-income households. These findings point to the high frequency of use of such strategies by adolescents, which may hinder and limit the full development of their social and cultural skills.

The natural outcome of dental composite restorations highly depends on the translucency of the enamel layer and fluorescence. This study aimed to evaluate the Translucency Parameter (TP) and Fluorescence Intensity (FI) of five different resin composite systems. Seven discs of each composite brand were prepared in a circular increasing thickness. For TP, a spectrophotometer measured the samples' colors. The color difference within the white/black backgrounds obtained the translucency parameter. For FI, samples were exposed to UV light, and ten photographs per group were taken. Each specimen was analyzed digitally. A mixed model analysis to a 95% confidence level analyzed groups differences. Higher values of TP were observed for ED and EL, followed by FZ. The lowest values were observed for EO and FO. FI values descending order was EL>FO>EO>ED>FZ. The composition of fillers and organic matrix influenced the behavior of fluorescence and translucency of resin composites. Key words: Resin composite, fluorescence, color, translucency parameter., Competing Interests: Conflicts of interest Non declared., (Copyright: © 2024 Medicina Oral S.L.)

Convergent evolution is defined as the independent evolution of similar phenotypes in different lineages. Its existence underscores the importance of external selection pressures in evolutionary history, revealing how functionally similar adaptations can evolve in response to persistent ecological challenges through a diversity of evolutionary routes. However, many examples of convergence, particularly among closely related species, involve parallel changes in the same genes or developmental pathways, raising the possibility that homology at deeper mechanistic levels is an important facilitator of phenotypic convergence. Using the genus Ranitomeya, a young, color-diverse radiation of Neotropical poison frogs, we set out to 1) provide a phylogenetic framework for this group, 2) leverage this framework to determine if color phenotypes are convergent, and 3) to characterize the underlying coloration mechanisms to test whether color convergence occurred through the same or different physical mechanisms. We generated a phylogeny for Ranitomeya using ultraconserved elements and investigated the physical mechanisms underlying bright coloration, focusing on skin pigments. Using phylogenetic comparative methods, we identified several instances of color convergence, involving several gains and losses of carotenoid and pterin pigments. We also found a compelling example of nonparallel convergence, where, in one lineage, red coloration evolved through the red pterin pigment drosopterin, and in another lineage through red ketocarotenoids. Additionally, in another lineage, "reddish" coloration evolved predominantly through structural color mechanisms. Our study demonstrates that, even within a radiation of closely related species, convergent evolution can occur through both parallel and nonparallel mechanisms, challenging the assumption that similar phenotypes among close relatives evolve through the same mechanisms., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Systematic Biologists.)

This study analyzed the periodontal clinical data of individuals with a history of COVID-19 treated in a dental school during the pandemic in 2021 before vaccination., Methods: This analysis included individuals older than 18 years with no history of systemic disorders other than systemic arterial hypertension. Individuals who had COVID-19 were classified according to the World Health Organization as asymptomatic, with mild, moderate, severe, or critical symptoms., Results: A total of 95 individuals were evaluated, which included 24 with a history of COVID-19. Seventeen percent had been asymptomatic, 21% had mild, 25% moderate, 21% severe, and 17% critical symptoms, including intubation. Individuals with no history of COVID-19 presented significantly lower measurements of probing depth (p=0.003; Mann-Whitney test) and clinical attachment level (p=0.002) compared to individuals with a history of COVID-19. A significant negative association was found between bleeding on probing and the severity of characteristics of COVID-19 (rho= -0.233; p=0.023). Conversely, positive associations between the values of probing depth (rho= 0.292; p=0.004) and mean clinical attachment level (rho= 0.300; p=0.003) and the characteristics of COVID-19 were found., Conclusions: The periodontal data shows that patients who had COVID-19 before vaccination may present a worse periodontal status when compared to patients in the same clinical setting with no history of COVID-19. However, a more extensive study should confirm it with more participants.

The dating of documents is crucial in forensic chemistry, particularly for verifying their authenticity. This study aimed to develop a rapid and direct method for the dating of pen ink in documents, using a combination of Fourier transform infrared spectroscopy in attenuated reflectance mode (FTIR-ATR), desorption electrospray ionization mass spectrometry (DESI-MS) and multiple ensemble data modeling. Two sets of paper document samples containing writing in blue pen ink were investigated: (I) artificially aged documents and (II) real documents dating from 1960 to 2022. The FTIR-ATR spectra of both sets of samples showed a decrease in absorbance at ∼1584 cm -1 , related to the chemical modification of the CN bond in the molecular structure of Basic Violet 3 (BV3), one of the main dyes used in blue pen ink. DESI-MS confirmed the presence of BV3 and its degradation by-products in all the samples, indicating its widespread utilization in blue pen ink production. Moreover, DESI-MS detected combinations of dyes within the ink composition. The models were built using the DESI-MS and FTIR-ATR data separately, but the error and trend were significantly reduced when both sets of data were used. The combination of DESI-MS and FTIR-ATR spectral information resulted in a final predictive model with low error for pen inks from real documents in writing from the years 1960 to 2022. These analyses proved to be effective for the dating of pen inks and are suitable for use in routine forensic analysis, providing a direct and rapid method that allows for accurate prediction.

Radiopharmaceuticals have been used to diagnose several diseases, particularly because the procedure is non-invasive. However, it is important that the correct amount of radiopharmaceutical is used to avoid inaccurate diagnostic results and suboptimal therapeutic outcomes. The amount of the radiopharmaceutical is measured when produced (by the supplier) and a second time (by the receiver), before it's use. When measured at the receiver, the result is corrected for its normal radioactivity decay. Even then, it is possible that both measurements should be considered nominal different or even statistically different when compared through various statistical tools. This research combines two innovative techniques in the field of clinical metrology. The first technique is data reconciliation, which not only enhances measurement accuracy but also reduces measurement uncertainty. The second technique involves using uncertainty information to establish specification limits for compliance assessments. In this way, our proposal aimed to minimize the risk of making incorrect decisions regarding the conformity of the concentration of radiopharmaceutical activity, that is, rejecting an item or batch that is within specification or accepting an item or batch that is outside of specification. A spreadsheet, based on these metrology fundamentals, is available to help the user with the calculations, presenting numerical and graphical results for some common radioisotopes. Reliable specification limits can be calculated and used to determine if the radiopharmaceutical is in accordance with its proposed application., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Homeless women have complex life conditions and are often exposed to violence, sexual exploitation, rape, prostitution, reproductive disorders, survival sex trading, unintended pregnancies and sexually transmitted infections (STIs). The aim was to explore the existence of sexual aggression and vulnerability to STIs among homeless Brazilian women., Methods: Fifteen interviews were conducted with homeless women who were admitted to a women's shelter in a large city in Brazil. Data were collected through semi-structured interviews, audiorecorded and complemented with notes of the researcher in field diary, subjected to inductive thematic analysis and analyzed in light of the social relations of gender., Results: Two themes were constructed: "Being a woman on the streets: a look at gender inequalities" and "Pain and the raped body: the scars of homeless women". The transgression of women's rights was observed with reports of sexual abuse interspersed with physical violence. Unprotected sexual practices were part of the daily lives of these women, with repercussions for their exposure to sexually transmitted infections. Dependence on psychoactive substances was mentioned, and transactional sex was used as a source of income to maintain such dependence, as well as to promote the women's livelihood., Conclusion: Homeless women experience complex situations on the streets involving exposure to different types of violence, the use of transactional sex as a survival strategy and unprotected sexual practices. Furthermore, the way in which women have been exposed to sexual assault and their coping mechanisms to those require attention. Interventions are need to improve the healthcare assistance of homeless women victims of sexual assault, considering the vulnerability of this population., (© 2023. The Author(s).)

Brazilian coastal areas have been exposed to various anthropic influences including physical alteration such as marina construction. To assess the impact of the pier marina construction in the Saco da Ribeira cove (Flamengo Bay, SE Brazil), sedimentological (grain size), geochemical (organic and trace elements) parameters and benthic foraminifera were analyzed on a 50-cm-long dated sediment core covering the last century. The multiproxy approach applied to a numerical hydrodynamic model shows that the circulation in the study area underwent an overall reduction (ca. 30 %) after the pier marina construction in the 1970s, promoting an increase of mud accumulation and higher concentrations of total organic carbon and trace elements (i.e., Enrichment Factor Cu from 0.80 to 1.4) as well as a shift in the benthic foraminiferal assemblages (i.e., foraminiferal density from 63 to 23.20 specimens per 10 cm 3 and dominance from 0.13 to 0.73). On the basis of these integrated data, better environmental conditions occurred before the 1970s, then an overall increase in environmental stress took place after the pier's marina construction. Our results provide a baseline for future biomonitoring projects in a stressed region and exemplify the strong capability and reliability of benthic foraminifera as bioindicators of paleoenvironmental changes in coastal environments and for understanding how human pressure might induce such changes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

We reflect on Black women's health as part of a narrative produced by the exercise of coloniality and the forces that contribute toward defining and imposing the place of a subaltern since the objectified and racialized body notion informs it. Black women are represented in the worst health indicators. We propose to look at collective health from the perspective of care as a political, social, and intersubjective technology, in whose encounters with the aesthetic-political body of Black women are traversed by unique exclusion experiences. Moving beyond suffering, we also address agency, resistance, and the construction of an agenda of struggle based on the Black people's leading roles.

Background: Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population., Methods: A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented., Results: A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively., Conclusion: Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The objective of this study was to manufacture and to evaluate the physico-mechanical properties of the Lithium disilicate (Li 2 O 5 Si 2 ) ceramic structures fabricated using additive manufacturing (3D printing)., Methods: Li 2 O 5 Si 2 samples were divided into (n = 30/group): SM (subtractively manufactured) and AR (additive/robocasting). For the AR group, Li 2 O 5 Si 2 powder was combined with ammonium polyacrylate, hydroxypropyl methylcellulose, and polyelectrolyte to create a colloidal gel, which was then used for printing. A digital CAD model of a disc was designed, and the G-code transferred to a custom built DIW 3D printer. The control group samples were prepared using pre-crystallized ceramic blocks, which were cut to obtain discs with same dimensions as the AR group. Disc-shaped specimens from both groups were crystallized at 840 °C. Mechanical properties were evaluated using biaxial flexural strength test (BFS) and Vickers hardness test. Representative fractographic images of the specimens were acquired using scanning electron microscopy (SEM) to analyze the fracture origin and crack propagation. Energy-dispersive X-ray spectroscopy (EDS) and attenuated total reflection Fourier transform infrared spectroscopy (FTIR-ATR) were used for chemical analysis, and X-ray diffractometry (XRD) was performed to analyze the crystalline phases., Results: AR group yielded lower values of BFS (120.02 MPa ±33.91) and hardness (4.07 GPa ±0.30), relative to the SM group, (325.09 MPa ±63.98) and (5.63 GPa ±0.14), respectively. For EDS analysis, AR and SM groups showed similar elemental composition. In FTIR-ATR analysis, higher peaks referring to the crystalline structure were found for SM group. XRD analysis indicated a decreased formation of Li 2 O 5 Si 2 from Lithium metasilicate (Li 2 O-SiO 2 ) in the AM group. SEM micrographs showed a more porous microstructure associated with the 3D printed samples., Significance: The viability of fabricating Li 2 O 5 Si 2 ceramic constructs using the Robocasting technique was successful. However, the samples prepared using subtractive manufacturing presented higher mechanical properties compared to the 3D printed constructs. The difference in properties between the manufacturing may be correlated to the decreased formation of Li 2 O 5 Si 2 crystals and higher degrees of porosity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Rare or orphan diseases have played an important role in the pharmaceutical industry. On the other hand, the impact of new technologies derived from genomic research has been growing in this industry, with new drugs being launched on the market at unsustainable prices for health systems and patients. This double tendency poses important and growing challenges to public policies on Health Technology Assessment, whose hegemonic rationale is based on cost-benefit analysis between therapies. The very high prices of these drugs require revisiting this rationale and the recent negotiations between the Brazilian Ministry of Health and Novartis regarding a possible risk-sharing agreement for the incorporation of the drug Zolgensma is an opportunity for this revisitation.

Background: Congenital melanotic macule of the tongue (CMMT) has been described as a distinct entity, despite its unknown etiology. However, the diagnosis and management of affected newborns may challenge clinicians and pediatric dentists., Methods: We document here the clinicopathological findings of two additional cases of CMMT. A literature review of CMMT reports identified across PubMed, Web of Science, Embase, and Scopus was also conducted., Results: The patients, 2- and 4 month-old Venezuelan boys, respectively, presented at birth with a single or multiple dark-brown-pigmented macule exclusively on the dorsum of the tongue. Histopathological features revealed increased melanin pigmentation in the basal epithelial layer with overlying hyperkeratosis and pigment-laden subepithelial macrophages with normal morphological appearance. Nine studies comprising 17 cases of CMMT have been described hitherto. Most cases were from the USA and France (n = 6 each). Twelve (70.6%) patients were males, eight (50%) were white, and median age was 2.7 months. CMMT presented as brownish to black, solitary or multiple pigmentations located in the right or left region of the dorsum of the tongue, ranging in size from 3.0 to 30.0 mm., Conclusion: An important feature for the diagnosis of CMMT is the information about the manifestation at birth and consequent proportional growth. This report intends to draw the attention of pediatricians and dentists to this apparently underdiagnosed condition for decision-making and management of affected newborns., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Leishmaniasis is a tropical disease caused by protozoan parasites of the genus Leishmania. Mucosal leishmaniasis has been described as secondary to the cutaneous form; however, isolated mucosal involvement can also occur. Specifically, mucosal leishmaniasis of the lip is poorly described and its diagnosis challenges clinicians., Methods: We herein report a case of mucosal leishmaniasis affecting the lower lip without cutaneous involvement in a 20-year-old Venezuelan man. The patient had no relevant past medical history. Clinically, a mass-like lesion with ulcerations and crusts was observed., Results: Microscopically, the lesion was composed of granulomatous inflammation along with macrophages containing intracytoplasmic inclusions similar to round-shaped Leishmania. The species Leishmania (Viannia) braziliensis was confirmed. Treatment with meglumine antimonate was effective. The lesion healed satisfactorily, and no side effects or recurrences were observed., Conclusion: Clinicians should be aware of isolated forms of mucosal leishmaniasis of the lip, even in cases where the cutaneous lesion is undetected or clinically manifests as self-limiting. Knowing the endemic areas in the scenario of the dynamics of the ecoepidemiology of leishmaniasis is also essential for surveillance and counselling of the population., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs.

This article, in an essay format, seeks to establish a dialogue between the ethics of care and pediatric palliative care, taking into consideration the fact that moral perceptions are based on a network of relationships, while care is built on intersubjectivity. Four pillars that are referred to as movements are discussed: the ethics of care, as a feminist ethic, in a dialogue with pediatric palliative care, and communication and autonomy as tools of care based on their relational aspects. The conclusion drawn is that considering these aspects from a palliative standpoint can be a way to implement a moral commitment of care.

The scope of this article was to identify the social representations of children in a municipal public school in Rio de Janeiro, with respect to the blood sampling procedure and to discuss the social representations that emerge, in the light of the performance of the family health team in carrying out this procedure. Moscovisci's method/theory of analysis of social representations based on a qualitative approach was used. For data collection, the projective technique of the esthetic production scene and the student's speech was used. The results were grouped into four categories: 1) structural dimensions involved in the blood sampling procedure; 2) dimension of the human component and its interface in the blood sampling procedure; 3) the psycho-emotional dimension portrayed in the blood sampling procedure; and 4) blood sampling: the importance for student health. With respect to the importance of blood sampling, we highlight the perception of students regarding the importance of actions aimed at prevention and health care promotion.

Background: The ecoepidemiological panorama of paracoccidioidomycosis (PCM) is dynamic and still ongoing in Brazil. In particular, data about the oral lesions of PCM are barely explored. The aim of this study was to report the clinicopathological features of individuals diagnosed with oral PCM lesions at an oral and maxillofacial pathology service in Rio de Janeiro, Brazil, in the light of a literature review., Material and Methods: A retrospective study was conducted on oral biopsies obtained from 1958 to 2021. Additionally, electronic searches were conducted in PubMed, Embase, Scopus, Web of Science, Latin American and Caribbean Center on Health Sciences Information, and Brazilian Library of Dentistry to gather information from large case series of oral PCM., Results: Ninety-five cases of oral PCM were surveyed. The manifestations were more frequent among males (n=86/90.5%), middle-aged/older adults (n=54/58.7%), and white individuals (n=40/51.9%). The most commonly affected sites were the gingiva/alveolar ridge (n=40/23.4%) and lip/labial commissure (n=33/19.3%); however, one (n=40/42.1%) or multiple sites (n=55/57.9%) could also be affected. In 90 (94.7%) patients, "mulberry-like" ulcerations/moriform appearance were observed. Data from 21 studies (1,333 cases), mostly Brazilian (90.5%), revealed that men (92.4%; male/female: 11.8:1) and individuals in the fifth and sixth decades of life were the most affected (range: 7-89 years), with the gingiva/alveolar ridge, palate, and lips/labial commissure being the sites most frequently affected., Conclusions: The features of oral PCM lesions are similar to those reported in previous studies from Latin America. Clinicians should be aware of the oral manifestations of PCM, with emphasis on the clinicodemographic aspects and differential diagnoses, especially considering the phenomenon of the emergence of reported cases in rural and/or urban areas of Brazil.