Chemical Survey and Risk Assessment of 56 Pesticides in the Sado River Estuary (Iberian Peninsula, Portugal).

The Sado basin (~8000 km2) is an area where intensive agriculture occurs. However, this region still has few data about the water levels of priority pesticides such as fungicides, herbicides, and insecticides. Therefore, water samples were collected every two months at nine sites along the Sado River Estuary and analyzed by GC-MS/MS to determine the influx of pesticides in that ecosystem. More than 87% of the pesticides were quantified, and 42% and 72% were above the maximum totals established by the European Directives 98/83/EC and 2013/39/EU, respectively. Fungicides (91%), herbicides (87%), and insecticides (85%) attained average annual amounts of ≈3.2 µg/L, ≈1.0 µg/L, and ≈12.8 µg/L, respectively. A mathematical approach was used to evaluate the hazard of the pesticide mixture at the maximum concentrations found in this area. The assessment identified invertebrates as the most at-risk trophic level and identified two chemicals (chlorpyriphos and cyfluthrin) as the primary culprits. This assumption was supported by acute in vivo assays using Daphnia magna. These observations, and the high concentrations of phosphates, indicate that the status of the Sado waters poses environmental and potential human health risks.

TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface.

Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.

Chemical monitoring and risk assessment of 56 pesticides in the Ave River and adjoining Atlantic coastline (Iberian Peninsula, Portugal).

The Ave basin (North Atlantic Ocean Ecoregion) is highly disturbed by anthropogenic activities. The amounts and distribution patterns of 56 priority pesticides (fungicides, herbicides, and insecticides) dissolved in the aqueous phase (DAP) and suspended particle matter (SPM) were evaluated seasonally along the river, estuary and coastline. Over 83 % of the GC-MS/MS-identified pesticides were quantified in DAP and 91 % in SPM. Pesticides' average annual amounts were ≅316 ng/L and 1.3 µg/g (fungicides), ≅272 ng/L and 2.2 µg/g (herbicides) and ≅1344 ng/L and 6.6 µg/g (insecticides). Invertebrates were the most vulnerable trophic level in the theoretical assessment of pesticide mixture hazards. This hypothesis was strengthened by acute in vivo assays using Artemia salina and Daphnia magna. These data, and the fact that 38 % of pesticides showed concentrations above the maximum established by the European legislation, plus the high concentrations of nitrates, nitrites, ammonia and phosphates, request further depollution actions in this region.

Effects and Mechanisms of Action of Preussin, a Marine Fungal Metabolite, against the Triple-Negative Breast Cancer Cell Line, MDA-MB-231, in 2D and 3D Cultures.

Triple-negative breast cancer (TNBC) represents an aggressive subtype of breast cancer (BC) with a typically poorer prognosis than other subtypes of BC and limited therapeutic options. Therefore, new drugs would be particularly welcome to help treat TNBC. Preussin, isolated from the marine sponge-associated fungus, Aspergillus candidus, has shown the potential to reduce cell viability and proliferation as well as to induce cell death and cell cycle arrest in 2D cell culture models. However, studies that better mimic the tumors in vivo, such as 3D cell cultures, are needed. Here, we studied the effects of preussin in the MDA-MB-231 cell line, comparing 2D and 3D cell cultures, using ultrastructural analysis and the MTT, BrdU, annexin V-PI, comet (alkaline and FPG modified versions), and wound healing assays. Preussin was found to decrease cell viability, both in 2D and 3D cell cultures, in a dose-dependent manner, impair cell proliferation, and induce cell death, therefore excluding the hypothesis of genotoxic properties. The cellular impacts were reflected by ultrastructural alterations in both cell culture models. Preussin also significantly inhibited the migration of MDA-MB-231 cells. The new data expanded the knowledge on preussin actions while supporting other studies, highlighting its potential as a molecule or scaffold for the development of new anticancer drugs against TNBC.

Exercise Stress Test in The Assessment of Brugada Syndrome Patients

Abstract Brugada syndrome (BS) is a genetic channelopathy, clinically characterized by an increased risk of sudden cardiac death. The diagnosis requires a typical electrocardiographic pattern, and data on risk stratification are limited in the literature. The aim of this study was to conduct a review on the importance of exercise stress test (EST) in risk stratification in BS. Articles were searched in the PubMed, Scielo and Google Scholar databases. From the 200 articles retrieved, eight were included, with a total of 712 patients (95% men) aged between 35 and 60 years. Severe symptoms and ventricular arrhythmias were reported by 256 patients before the EST, with syncope being reported in 70% of cases. The reviewed articles suggest that the EST is a safe method that can help in the diagnosis and risk stratification for malignant arrhythmias in patients with BS. Potential predictors of poor prognosis were: augmentation in ST-segment elevation > 0.5 mV in V1, V2 or V3 in early recovery; J-point elevation in lead > 2mm in aVR in late recovery; heart rate reduction < 40% from maximum heart rate in late recovery and occurrence of ventricular extrasystoles in early recovery.

Observation of Communicative Behavior: an updated protocol from 0 to 72 months / Observação do Comportamento Comunicativo: protocolo atualizado de 0 a 72 meses

ABSTRACT Purpose: to describe the updating of the Observation of Communicative Behavior protocol in the age group from 0 to 72 months. Methods: the Observation of Communicative Behavior protocol was revised and updated, with the insertion of the child development milestones in its various areas, becoming a child development screening tool. Results: the protocol includes 188 items, distributed in 10 age groups from zero to 72 months. The items were organized as follows: from zero to 24 months, divided by quarter (four age groups); from 24 to 36 months per semester (two age groups); and from 36 to 72 months, divided by year (four age groups). The items covered the areas of child development and its main milestones. The score is registered in the protocol and a score of 0 - does not perform the action or behavior, 1 - performs the action in an atypical, restricted manner or it is being acquired, 2 - properly performs the action/behavior, is attributed to the response, after analysis. Few materials and a structured environment are needed to apply the protocol. Conclusion: the updating of the Observation of Communicative Behavior protocol has a direct impact on the initial assessment of children with or without suspected delay in child development and should be used by health professionals in monitoring typical child development (routine) or in cases where the child receives specific stimulation.

RESUMO Objetivo: descrever a atualização do protocolo Observação do Comportamento Comunicativo na faixa etária de 0 a 72 meses. Métodos: a Observação do Comportamento Comunicativo foi revisada e atualizada, com inserção de marcos do desenvolvimento infantil em suas diversas áreas, tornando-se um instrumento de triagem do desenvolvimento infantil. Resultados: o protocolo contempla 188 itens, distribuídos em 10 faixas etárias: de zero a 72 meses. Os itens foram organizados da seguinte forma: de zero a 12 meses, divididos por trimestre (quatro faixas etárias); de 12 a 24 meses, por semestre (duas faixas etárias); e, de 24 a 72 meses, divididos por ano (quatro faixas etárias). Os itens contemplam as áreas do desenvolvimento infantil e seus principais marcos. A pontuação é registrada no próprio protocolo, atribuindo a análise da resposta em 0 - não realiza a ação ou comportamento; 1 - realiza de maneira atípica, restrita ou está em aquisição; 2 - realiza adequadamente a ação/comportamento. São necessários poucos materiais para aplicação e ambiente estruturado. Conclusão: o protocolo Observação do Comportamento Comunicativo traz impacto direto na avaliação inicial de crianças com ou sem suspeita de atraso no desenvolvimento infantil e deve ser utilizado por profissionais da saúde, no acompanhamento do desenvolvimento infantil típico (rotina) ou em casos em que a criança recebe estimulação específica.

Reprocessamento de Marca-Passos em Países de Língua Portuguesa: Uma Reflexão Clínica / Pacemaker Reuse in Portuguese Speaking Countries: A Clinical Reflection

Resumo Há uma enorme disparidade entre os países de alta renda e outros em termos de acesso a dispositivos médicos cardíacos, como marca-passos e desfibriladores implantáveis. Os custos são uma das principais barreiras ao uso de dispositivos cardíacos nesses países. Existem iniciativas internacionais que visam reduzir essa disparidade, e o reuso de marca-passos tem sido discutido como uma possível alternativa. O conceito de reutilização de marca-passos não é novo; entretanto, estudos recentes têm se mostrado seguros, éticos e eficazes para aqueles que precisam de dispositivos eletrônicos cardíacos implantáveis e não tem como adquiri-los. Parte dos países de língua portuguesa, especialmente na África, precisam de uma resposta imediata que beneficie seus inúmeros pacientes que sofrem de arritmias tratáveis.

Abstract There is a gap between high-income countries and others in terms of access to medical cardiac devices, such as pacemakers and implantable cardioverter defibrillators. Costs are one of the main barriers to the use of cardiac devices in these countries. There are international initiatives that aim to reduce the gap. The reuse of pacemakers has been discussed as a possible alternative to this problem. The concept of reusing pacemakers is not new; however, recent studies have proven to be safe, ethical, and effective for those who need cardiac implantable electronic devices and cannot afford them. Part of the Portuguese-speaking countries, especially in Africa, need an immediate response that benefits their countless patients who suffer from treatable arrhythmias.

Cognition, functionality, and life space in older adults: the mediating role of perceived control and autonomy / Cognição, funcionalidade e espaço de vida nas pessoas idosas: o papel mediador da percepção de controle e autonomia

OBJECTIVES: To examine a model of associations between cognition, functionality, and life-space mobility, and the mediating role of perceived control and autonomy. METHODS: This is a cross-sectional study with a sample of older adults aged over 72 years, which used data from the FIBRA study. We used the structural equation modeling technique. Variables in this model were cognition, functionality, perceived control and autonomy, and life-space mobility, with sociodemographic and health covariables. Data imputation was done through the expected maximization method aiming at more effective data utilization. This study was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. RESULTS: The mediation model reached good fit indices. Cognition, functionality, and perceived control and autonomy demonstrated a predictive capacity for life space. Functionality and perceived control and autonomy mediated the relationship between cognition and life space; therefore, cognition influences life space, given its associations with the mediating variables. There was a mediating effect of perceived control and autonomy on the relationship between functionality and life space. CONCLUSIONS: Perceived control and autonomy have an adaptive role when considering changes in personal competencies. This adaptation is reflected on life spaces, indicating an adjustment between competence and environment. Studies aimed at promoting a good relationship between an individual and his or her context maintaining life space should consider perceived control and autonomy as important mechanisms in this relationship

OBJETIVOS: Examinar um modelo de associações entre cognição, funcionalidade e mobilidade em espaço de vida, e o papel mediador da percepção de controle e autonomia. METODOLOGIA: Estudo transversal, com amostra composta por idosos acima de 72 anos, utilizando dados do estudo FIBRA. Utilizou-se a técnica de Modelagem por Equações Estruturais. As variáveis do modelo foram a cognição, a funcionalidade, a percepção de controle e autonomia e a mobilidade em espaço de vida, com covariáveis sociodemográficas e de saúde. Realizou-se imputação de dados através da técnica Expected Maximization, visando o melhor aproveitamento dos dados. Estudo financiado pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. RESULTADOS: O modelo de mediação obteve bons índices de ajuste. A cognição, a funcionalidade e a percepção de controle e autonomia demonstraram capacidade preditiva do espaço de vida. A funcionalidade e a percepção de controle e autonomia mediaram a relação entre a cognição e o espaço de vida, portanto, a cognição influencia o espaço de vida, dada suas associações com as variáveis mediadoras. Houve efeito de mediação da percepção de controle e autonomia na relação entre a funcionalidade e o espaço de vida. CONCLUSÕES: A percepção de controle e autonomia exerce função adaptativa frente às alterações nas competências pessoais. Essa adaptação é refletida nos espaços de vida, indicando ajuste entre competência e meio. Estudos que visem promover uma boa relação entre o indivíduo e seu contexto, mantendo o espaço de vida, devem considerar a percepção de controle e autonomia como mecanismo importante nesta relação."

Escenario actual de la especialidad en medicina física y rehabilitación en Brasil / Current situation of the specialty of Physical Medicine and Rehablitation in Brazil

La medicina física y rehabilitación (MFR), también conocida como fisiatría, es la especialidad médica que tiene como objetivo restaurar la función de las personas, para lo cual actúa en la prevención, el diagnóstico y el tratamiento no quirúrgico de los trastornos asociados a la discapacidad física. En Brasil, la MFR como especialidad se oficializó en 1954, pero a pesar de su reconocida importancia, sigue siendo una de las especialidades más pequeñas y menos conocidas del país, encontrándose una proporción de 0,48 médicos fisiatras por cada 100.000 habitantes. Aunque actualmente hay un aumento de la inversión en rehabilitación en el país, existe una gran necesidad de incrementar los centros de formación de especialistas en MFR y llevar la especialidad a las facultades de medicina para demostrar su importancia real.

Physical medicine and rehabilitation (PM&R), also known as physiatry, is the medical specialty that aims to restore the function of the individuals, for which it acts on the prevention, diagnosis and non-surgical treatment of the disorders associated with physical disability. In Brazil, PM&R became official as a specialty in 1954, but despite its recognized importance, is still one of the smallest and least known specialties in the country, finding a proportion of 0.48 physiatrists per 100,000 inhabitants. Although there is currently an increase in investment in rehabilitation in the country, there is a great need to increase the number of training centers for specialists in PM&R and to take the specialty to the medical faculties in order to demonstrate its real importance.

Use of cannabis medicine for the treatment of spasticity-associated pain / O uso da medicina canábica para tratamento da dor associada à espasticidade

ABSTRACT BACKGROUND AND OBJECTIVES: Spasticity refers to the increase of resistance to joint passive movement according to its angular velocity. It is part of the triad of the pyramidal syndrome, along with the exacerbation of myotatic reflexes and muscle weakness, and is present in several lesions of the central nervous system, either in the spinal cord or brain. Pain associated with spasticity is caused by muscle spasms, activation of trigger points, joint deformities, interference with the position of body segments, and difficulty in movement control. For a more precise therapeutic intervention, the detailed physical examination of the locomotor system and spasticity can be completed by using specific spasticity evaluation scales. Multiple sclerosis (MS) is the clinical condition for which there are the greatest number of studies using cannabi-noids to control spasticity. The objective of this study was to perform a literature review of the possible role of cannabinoid drugs in the control of spasticity and the pain associated with it. CONTENTS: The literature shows moderate evidence that the combined use of 9-tetrahydrocannabinol and cannabidiol increases the number of people reporting improvement in spasticity. CONCLUSION: It is possible to believe that the complaint of musculoskeletal pain associated with spasticity accompanies this improvement with the use of nabiximols, but there are still gaps in the literature for this specific topic.

RESUMO JUSTIFICATIVA E OBJETIVOS: A espasticidade refere-se ao aumento da resistência ao movimento passivo articular conforme a sua velocidade angular. Ela faz parte da tríade da síndrome piramidal, junto com a exacerbação de reflexos miotáticos e fraqueza muscular, e está presente em diversas lesões do sistema nervoso central, de topografia medular ou encefálica. A dor associada à espasticidade é causada pelos espasmos musculares, ativação de pontos-gatilho, deformidades articulares, interferência na posição dos segmentos corporais e dificuldade para o controle do movimento. Para uma intervenção terapêutica mais precisa, o exame físico detalhado do aparelho locomotor e da espasticidade pode ser completado pelo uso de escalas de avaliação específicas. A esclerose múltipla é a condição clínica para a qual há maior número de estudos com uso de canabinoides para o controle da espasticidade. O objetivo deste estudo foi realizar uma revisão da literatura sobre o possível papel dos fármacos canabinoides no controle da espasticidade e da dor associada a ela. CONTEÚDO: Há na literatura evidências moderadas de que o uso combinado de 9-tetrahidrocanabinol e canabidiol aumenta o número de pessoas que relatam melhora da espasticidade. CONCLUSÃO: É possível acreditar que a queixa de dor musculoesquelética associada à espasticidade acompanhe essa melhora com uso de nabiximol, mas ainda há lacunas na literatura para esse tópico específico.

Structural and Genomic Evolution of RRNPPA Systems and Their Pheromone Signaling.

In Firmicutes, important processes such as competence development, sporulation, virulence, and biofilm formation are regulated by cytoplasmic quorum sensing (QS) receptors of the RRNPPA family using peptide-based communication. Although these systems regulate important processes in a variety of bacteria, their origin and diversification are poorly understood. Here, we integrate structural, genomic, and phylogenetic evidence to shed light on RRNPPA protein origin and diversification. The family is constituted by seven different subfamilies with different domain architectures and functions. Among these, three were found in Lactobacillales (Rgg, ComR, and PrgX) and four in Bacillales (AimR, NprR, PlcR, and Rap). The patterns of presence and the phylogeny of these proteins show that subfamilies diversified a long time ago, resulting in key structural and functional differences. The concordance between the distribution of subfamilies and the bacterial phylogeny was somewhat unexpected, since many of the subfamilies are very abundant in mobile genetic elements, such as phages, plasmids, and phage-plasmids. The existence of diverse propeptide architectures raises intriguing questions about their export and maturation. It also suggests the existence of diverse roles for the RRNPPA systems. Some systems encode multiple pheromones on the same propeptide or multiple similar propeptides, suggesting that they act as "chatterers." Many others lack pheromone genes and may be "eavesdroppers." Interestingly, AimR systems without associated propeptide genes were particularly abundant in chromosomal regions not classed as prophages, suggesting that either the bacterium or other mobile elements are eavesdropping on phage activity. IMPORTANCE Quorum sensing (QS) is a mechanism of bacterial communication, coordinating important decisions depending on bacterial population. QS regulates important processes not only in bacterial behavior but also in genetic mobile elements and host-guest interactions. In Firmicutes, the most important family of QS receptors is the RRNPPA family. Despite the importance of such systems in microbiology, we know little about RRNPPA origin and diversification. In this work, the combination of sequence analysis and structural biology allowed us to identify a very large number of novel systems but also to class of them in functional families and thereby study of their origin and functional diversification. Moreover, peptide pheromone analysis revealed new and intriguing mechanisms of communication, such as "eavesdropper" systems which only listen for the pheromone and "chatterers" that take control of the communication in their microenvironment.

Multicenter prospective validation study for international chronic ocular graft-versus-host disease consensus diagnostic criteria.

PURPOSE: To validate the international chronic ocular graft-versus-host disease (GVHD) diagnostic criteria (ICCGVHD) compared to the National Institute of Health diagnostic criteria 2014 (NIH2014) for chronic ocular GVHD. METHODS: Between 2013 and 2019, the study enrolled 233 patients with or without chronic ocular GVHD combined with the presence or absence of systemic chronic GVHD in an internationally prospective multicenter and observational cohort from 9 institutions. All patients were evaluated for four clinical parameters of ICCGVHD. RESULTS: The relation between the ICCGVHD score (0-11) and NIH2014 eye score (0-4) was relatively high (r = 0.708, 95% CI: 0.637-0.767, p < 0.001). The sensitivity and specificity of ICCGVHD for NIH 2014 for 233 patients were 94.3% (95% CI: 89.6%-98.1%) and 71.7% (95% CI: 63.0-79.5%), respectively (cutoff value of the ICCGVHD score = 6). The positive predictive value was 77.1% (95% CI: 71.1%-82.1%), and the negative predictive value was 87.0% (95% CI:81.6-92.5%). For the patients with systemic GVHD (n = 171), the sensitivity and specificity were 94.2% and 67.2%, respectively (ICCGVHD-score cutoff value = 6). By receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.903 (95% CI: 0.859-0.948). For patients without systemic GVHD (n = 62), the sensitivity and specificity were 100% and 76.7%, respectively (ICCGVHD-score cutoff value = 6). The AUC was 0.891 (95% CI 0.673-1.000). CONCLUSIONS: Good sensitivity, specificity, predictive value and correlation were found between ICCGVHD and NIH2014. ICCGVHD scores ≥6 can be useful to diagnose ocular GVHD with or without systemic GVHD for clinical research.

Acute kidney injury and renal replacement therapy: terminology standardization / Injúria renal aguda e métodos de suporte: padronização da nomenclatura

Abstract The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.

Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.

Morphometrical, Morphological, and Immunocytochemical Characterization of a Tool for Cytotoxicity Research: 3D Cultures of Breast Cell Lines Grown in Ultra-Low Attachment Plates.

Three-dimensional cell cultures may better mimic avascular tumors. Yet, they still lack characterization and standardization. Therefore, this study aimed to (a) generate multicellular aggregates (MCAs) of four breast cell lines: MCF7, MDA-MB-231, and SKBR3 (tumoral) and MCF12A (non-tumoral) using ultra-low attachment (ULA) plates, (b) detail the methodology used for their formation and analysis, providing technical tips, and (c) characterize the MCAs using morphometry, qualitative cytology (at light and electron microscopy), and quantitative immunocytochemistry (ICC) analysis. Each cell line generated uniform MCAs with structural differences among cell lines: MCF7 and MDA-MB-231 MCAs showed an ellipsoid/discoid shape and compact structure, while MCF12A and SKBR3 MCAs were loose, more flattened, and presented bigger areas. MCF7 MCAs revealed glandular breast differentiation features. ICC showed a random distribution of the proliferating and apoptotic cells throughout the MCAs, not fitting in the traditional spheroid model. ICC for cytokeratin, vimentin, and E-cadherin showed different results according to the cell lines. Estrogen (ER) and progesterone (PR) receptors were positive only in MCF7 and human epidermal growth factor receptor 2 (HER-2) in SKBR3. The presented characterization of the MCAs in non-exposed conditions provided a good baseline to evaluate the cytotoxic effects of potential anticancer compounds.

Clinical and laboratory evaluation of sicca complaints: distinctive aspects of primary, secondary and non-Sjogren syndrome.

BACKGROUND: Sjögren Syndrome (SS) is a systemic autoimmune disease with a wide spectrum of manifestations that can lead to misdiagnosis. This study describes and compares demographic, clinical, serological, and histopathological data from subjects with SS and non-Sjögren Syndrome (NSS). It also details specific features within the primary SS (pSS) and secondary SS (sSS) groups identifying sub-groups. METHODS: The sample included individuals referred to an academic medical center in Brazil for investigation of SS from 2012 to 2020. Patients were retrospectively classified as primary SS (pSS), secondary SS (sSS), or NSS, based on the American-European Consensus Group criteria (AECG-2002), after multi-professional clinical and laboratory evaluation. RESULTS: A total of 676 individuals were screened and 510 (75.4%) completed the assessments; 198 patients were classified as pSS, 149 as sSS, and 163 as NSS. Symptoms and glandular dysfunction tests were similar in the groups. Concerning pSS, extraglandular manifestations were present in 59% of patients; the elderly had more dry symptoms and peripheral neurological disorders; and 2.5% developed non-Hodgkin lymphoma. In sSS, each overlap promoted distinct clinical and laboratory variants. Several alternative diagnoses were identified as a cause of sicca complex in NSS group. CONCLUSIONS: The diagnosis of SS remains a challenge behind dryness. Up to 31% of the suspected cases had other conditions associated to the symptoms. Histopathological analysis of LSG and SSa determined the diagnostic. Aging in pSS and overlap disease in sSS were responsible for distinct phenotypes and characteristic sub-groups in SS.