ABSTRACT Trypanosomatids are an important group of parasites that predominate in tropical and subtropical areas of the planet, which cause diseases that are classified as forgotten and neglected by the world health organization. In this group of parasites, we find Trypanosoma cruzi, Trypanosoma brucei, Trypanosoma brucei rhodesiense and Leishmania spp, for which there is no vaccine available, and its control has focused mainly on pharmacological treatment. Due to the poverty situation where these diseases are found and the biological complexity of these parasites, there are multiple variables to control, including the diversity of species, the complexity of their life cycles, drug resistance, cytotoxicity, the limited use in pregnant women, the high costs of treatment and the little-known pharmacological mechanisms of action, among others. It is therefore necessary to find new strategies and approaches for the treatment of these parasitic diseases. Among these new approaches is the rational search for new targets based on the allosteric inhibition of protein kinases, which have been little studied in trypanosomatids. Among these kinases, we find Glycogen Synthase Kinase-3 (GSK-3), a kinase of great pharmacological interest, which is under intense basic and clinical research by pharmaceutical companies for the treatment of cancer. This kinase, highly studied in the PI3K/AKT/mTOR pathway signaling in humans, has an orthologous gene in these parasites (GSK-3 s), which has proven to be essential for them in response to different challenges; Therefore, it is notable to increase research in this kinase in order to achieve a broad structural and functional characterization in the different species of trypanosomatids. planet organization cruzi spp available cycles resistance cytotoxicity women littleknown known action others kinases trypanosomatids Kinase3 Kinase 3 Kinase- GSK3, GSK3 GSK , (GSK-3) interest cancer PI3KAKTmTOR PIKAKTmTOR PI3K AKT mTOR PI K humans (GSK- s, s s) challenges Therefore KAKTmTOR PIK (GSK

ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS. spp worldwide infections fatal routine fastidious weeks MALDITOF MALDI TOF explored B times14 14 times—1 2 dayscould days could matching other misidentification MALDTOF MALD MS times1 1 times—

Abstract Elephantiasis, also known as lymphatic filariasis (LF), is a debilitating condition characterized by the thickening of the skin and muscles, primarily affecting the limbs, genitalia, and female breasts. Lymphatic filariasis is a major global health concern, affecting approximately 120 million people worldwide and having a significant impact on people's quality of life, mobility, and socio-economic status. Although LF is endemic in many parts of the world, including Africa, it is a neglected issue in Southern Africa, with little information available. According to the World Health Organisation, approximately 882.5 million people in 44 countries worldwide are at risk of contracting LF, making it the second most common vector-borne disease after malaria. The primary goal of this review was to assess the prevalence of elephantiasis in the Southern African Development Community (SADC) region. Lymphatic filariasis is endemic in four of the sixteen SADC countries, three countries have administered MDA to the population that required it and they are now under post-intervention surveillance, while LF is no longer a public health problem in Malawi. Global efforts to eliminate LF have been hampered by the non-availability of MDA in some SADC countries such as Angola, Mozambique, Zambia, and Zimbabwe. Despite the implementation of mass drug administration programs, a review of the literature reveals gaps in knowledge about LF prevalence cases in SADC countries. Each country faces unique challenges and successes in combating LF due to varying levels of available data and healthcare infrastructure. Some SADC countries continue to bear the burden of LF-related diseases, necessitating ongoing disease prevention and elimination efforts. This review emphasizes the importance of ongoing research, data collection, and novel policies to combat the spread of elephantiasis disease in the SADC region and beyond. Elephantiasis , (LF) muscles limbs genitalia breasts concern 12 peoples s life mobility socioeconomic socio economic status world Africa Organisation 8825 882 5 882. 4 vectorborne vector borne malaria (SADC postintervention post intervention surveillance Malawi nonavailability non availability Angola Mozambique Zambia Zimbabwe programs infrastructure LFrelated related diseases research collection beyond (LF 1 88 8

ABSTRACT Introduction: American trypanosomiasis or Chagas diseases, caused by Trypanosoma cruzi and Human African trypanosomiasis, caused by Trypanosoma brucei, are two neglected tropical, endemic and fatal disease, that affect 20 million people and cause 95,000 deaths per year in tropical and subtropical areas of the world. Objective: The objective of this review was to show the potential of the flora of Peru, emphasizing the Asteraceae family, against Trypanosoma cruzi, comparing it with American genera and species studied in various countries. Methods: A review of scientific articles on the subject was carried out, especially taken from the Scopus, SciELO, ScienceDirect, Medline and PubMed databases of American plant species, covering a period of twelve years (2010 to 2022). Results: A wide list of genera and species of the Asteraceae family and the flora of Peru with great potential in the treatment of trypanosomiasis is presented. Most of these species belong to the families Asteraceae, Piperaceae, Annonaceae, and Lauraceae. In the Asteraceae family, 48 genera and 76 species with trypanocidal activity were recorded, corresponding to 29 genera and 57 species for the flora of Peru. In these 29 genera, 174 endemic species potentially useful in the treatment of T. cruzi have been reported. Conclusions: The flora of Peru has around 22,000 species. Some of these genera and species are found in the flora of various American countries and have been tested in the treatment of Chagas disease, so the flora of Peru offers new opportunities in its treatment.

RESUMEN Introducción: La tripanosomiasis americana o enfermedad de Chagas, causada por la Trypanosoma cruzi y la tripanosomiasis africana humana, causada por la Trypanosoma brucei, son dos enfermedades tropicales desatendidas, endémicas y fatales, que afectan a 20 millones de personas y causan 95 000 muertes por año en áreas tropicales y subtropicales del mundo. Objetivos: El objetivo de esta revisión fue mostrar el potencial de la flora del Perú, enfatizar en la familia Asteraceae contra la Trypanosoma cruzi y compararlos con géneros y especies americanas estudiadas en diversos países. Métodos: Se realizó una revisión de artículos científicos sobre el tema de especies vegetales americanas, especialmente tomados de la base de datos Scopus, SciELO, ScienceDirect, Medline and PubMed; se abarcó un período de 12 años (2010 a 2022). Resultados: Se presenta una amplia relación de géneros y especies de la familia Asteraceae y de la flora del Perú con gran potencial en el tratamiento de la tripanosomiasis. La mayoría de estas especies pertenecen a las familias Asteraceae, Piperaceae, Annonaceae y Lauraceae. En la familia Asteraceae se registraron 48 géneros y 76 especies con actividad tripanocida; correspondieron 29 géneros y 57 especies para la flora del Perú. Asimismo, en estos 29 géneros se han reportado 174 especies endémicas potencialmente útiles en el tratamiento de la T. cruzi. Conclusiones: La flora del Perú tiene alrededor de 22 000 especies. Algunos de estos géneros y especies se encuentran en la flora de varios países americanos y han sido ensayados en el tratamiento de la enfermedad de Chagas, por lo que la flora del Perú ofrece nuevas oportunidades en su tratamiento.

ABSTRACT Background: Leprosy, a neglected tropical disease, is reported in over 120 countries, with upwards of 200,000 new cases annually. This Cross-Sectional Cohort Study aimed to delineate the epidemiological profile of leprosy in a low-endemic area in southern Brazil, both before and after implementing an active search strategy. Methods: The study examined two surveillance periods in Cac ador, Santa Catarina, Brazil. The active search strategy was carried out through the application of the LSQ by the community health workers as a screening and detection tool for new cases of leprosy and this was compared with passive case detection. The first spanned from 2014 to 2020, and the second from January 2021 to August 2023. Findings: 48 leprosy cases were reported throughout the study, 83.3 % of which were diagnosed as multibacillary. The first period had an average detection rate of 0.38 cases per 10,000 inhabitants, increasing to 1.19 cases per 10,000 inhabitants in the second period. Notably, there was a substantial shift in the degree of physical disability (GD), with more Grade 0 and Grade 1 disabilities observed post-active search. Main Conclusions: The study underscores the efficacy of active search strategies in early diagnosis, highlighting a 300 % increase in the annual average of diagnosed cases. This large number of detected cases demonstrates the high sensitivity of the LSQ. This approach significantly aids in uncovering hidden cases of leprosy, enhancing disease management and control in low-endemic areas indicating that the Ministry of Health should intensify leprosy control activities in these regions. Background Leprosy 12 countries 200000 200 000 200,00 annually CrossSectional Cross Sectional lowendemic low endemic Brazil Methods ador Catarina 201 2020 202 2023 Findings 4 833 83 3 83. multibacillary 038 38 0.3 10000 10 10,00 119 19 1.1 Notably GD, GD , (GD) postactive post Conclusions diagnosis 30 regions 20000 20 00 200,0 8 03 0. 1000 10,0 11 1. (GD 2000 2 200, 100 10,

Abstract This geographic study on the epidemiology of Chagas disease (CD) highlights the importance of analyzing its spatial distribution to understand its spread. Factors such as sociodemography and the environmental and economic contexts are considered to identify high-prevalence areas. Given the transmission through triatomine insects, the study also includes entomological aspects. The study focused on the state of Yucatan, hypothesizing differences at the municipal level in the distribution of populations and the socioeconomic conditions that influence new infections with Trypanosoma cruzi. The period studied was established based on the analysis of the official statistics available about new cases of infection with T. cruzi from 2003 and the entomological indicators from 2015, both until 2022. The methodology included data by municipality loaded into a geographic information system per unit of time, followed by calculating incidence and prevalence rates. The nominal municipal marginalization index was used to assess poverty dimensions. The information was integrated with socio-demographic data from Mexico’s National Institute of Geography and Statistics (Instituto Nacional de Geografía y Estadística, INEGI) and the National Population Council (Consejo Nacional de Población, CONAPO). Finally, we conducted a correlation analysis applying a non-parametric test between entomological and socio-demographic variables, estimating the interdependence of entomological and epidemiological variables and their relationship with social factors. CD is ubiquitous in Yucatán, being more prevalent in the city of Mérida and its metropolitan area, as well as in the main urban centers and surrounding municipalities with a high population density to the south and east of the state (mainly in the municipalities of Ticul and Valladolid). The temporal distribution of the triatomine insects varied seasonally, with greater detection and collection in May 2016 and 2017. A time series analysis found no relationship between epidemiological and entomological variables. The significant correlation of epidemiological variables with the number of triatomine insects indicates the medical importance of vector transmission of the parasite in Yucatán. The evidence found suggests that living conditions - the most important socioeconomic and demographic variables at the municipal level as drivers for the vector transmission of T. cruzi and CD - were unpaved floor in houses, percentage of illiterate population aged 15 years and older, and overcrowding in households, all of them proxies of the nominal marginalization index, which was also significantly correlated with the infection rate in humans. Similarly, the correlation analysis suggests the effect of the interaction of urbanization processes, environmental modification, and the increasing human population density on the epidemiology of CD in Yucatán. In the Discussion, we argue that urbanization might influence the exposure of people to triatomine insects and affect the social vulnerability to face the threat of T. cruzi, either because it affects the household space, as well as the prevention and the availability of assets and inputs related to access to comprehensive healthcare. We also discuss the marked differences in epidemiological and entomological aspects between adjacent or similar municipalities, beyond the ecological characteristics, based on differences in the operation efficacy of monitoring programs and the urban location of technical-administrative units, and the main clinical centers and laboratories of the healthcare sector in the interior of the state. The main limitations of the study were the complexity of considering poverty as a dynamic and multidimensional process and the underreporting of CD cases due to its political and institutional neglect. This study provided a first approach to answering questions about the epidemiological situation of CD as a public health problem in Yucatán and knowing its spatial distribution. Furthermore, the present study challenges the geographically focused vision of government actions, which have addressed mainly vector control, and suggests that, due to the relationship of CD with the living conditions and socio-demographic and urbanization phenomena, this issue should be understood and approached from a broader and comprehensive perspective in public policy, including health aspects, given the complexity of the phenomenon, in parallel with the urgent need to provide access to comprehensive healthcare for those affected.

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Neglected tropical diseases (NTDs) encompass a diverse group of 20 medical conditions triggered by various pathogens, including viruses, bacteria, protozoa, and parasitic worms. Diseases caused by parasitic protozoa and parasitic worms show the highest incidence worldwide. NTDs predominantly afflict impoverished communities in tropical regions, although some exhibit a broader geographic reach. It is estimated that over 1 billion people suffer from NTDs, spanning 149 countries. Additionally, malaria is caused by protozoa of the genus Plasmodium and is highly prevalent in similar geographic regions. New drugs are urgently needed for the treatment of these diseases. In the last decades, various research groups have endeavored to develop organometallic compounds with potential applications as drugs against malaria and NTDs diseases caused by trypanosomatid parasites and parasitic helminths. This perspective highlights selected efforts from these groups in the pursuit of innovative therapeutic solutions. Relevant bioorganometallic compounds belonging to the typical classes of metallocenes, “half sandwich” M-arenes and metal carbonyls will be particularly described. (NTDs 2 pathogens viruses bacteria worldwide regions reach 14 countries Additionally decades helminths solutions metallocenes half sandwich Marenes M arenes described

ABSTRACT Visceral leishmaniasis (VL) is a neglected disease that is typical of tropical and subtropical parts of the world and is caused by the trypanosomatid Leishmania donovani complex. This disease is a multifactorial condition that involves parasitic, environmental, and immunogenetic characteristics. Genetic changes in genes encoding cytokines may be associated with changes in their expression and, consequently, with the development of clinical resistance or susceptibility to the disease. This systematic review and meta-analysis aimed to assess whether single nucleotide polymorphisms (SNPs) in interleukin genes influence the clinical consequences of visceral leishmaniasis infection. To this end, we carried out a systematic review and meta-analysis with structured searches in the EMBASE, PubMed, Scopus, SciELO, and Web of Science databases without time restrictions. Two independent reviewers examined the studies, performed data extraction, and assessed quality by assigning scores. If there were any discrepancies, a third reviewer with more experience was consulted. After the screening process, 28 articles were included in the systematic review and 9 in the final analysis of the meta-analysis. Statistical analyses were carried out using various genetic models. The odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated to estimate the associations. Overall, the main clinical outcomes were classified as not associated or associated when they presented susceptibility, resistance, risk, or protective factors for the development of the disease. Associations between IFN-γ +874T/A polymorphisms in the dominant model (OR 1.64, 95% CI 1.13-2.38, I2 = 0%, p < 0.01) and heterozygous model (OR 1.72, 95% CI 1.15-2.57, I2 = 0%, p < 0.01) and IL-18 -137G/C in the recessive model (OR 1.33, 95% CI 1.02-1.71, I2 = 9%, p = 0.03) and VL were observed. For the IL-10 gene SNPs, there was no significant association. Our findings suggest that SNPs in the IFN-γ and IL-18 genes may be associated with the risk of developing VL. (VL complex parasitic environmental characteristics consequently metaanalysis meta (SNPs infection end EMBASE PubMed Scopus SciELO restrictions studies extraction scores discrepancies consulted process 2 metaanalysis. analysis. models OR 95 CIs (CIs associations Overall IFNγ IFN γ 874TA TA 874T A T 164 1 64 1.64 1.132.38, 113238 1.13 2.38, 13 38 1.13-2.38 I 0 0% 0.01 001 01 172 72 1.72 1.152.57, 115257 1.15 2.57, 15 57 1.15-2.57 IL18 IL 18 IL-1 137G/C 137GC GC 137G C G 133 33 1.33 1.021.71, 102171 1.02 1.71, 02 71 1.02-1.71 9% 0.03 003 03 observed IL10 10 association 16 6 1.6 132 1.132.38 11323 113 1.1 238 2.38 3 1.13-2.3 0.0 00 17 7 1.7 152 1.152.57 11525 115 257 2.57 5 1.15-2.5 IL1 IL- 1.3 021 1.021.71 10217 102 1.0 171 1.71 1.02-1.7 1. 1.132.3 1132 11 23 2.3 1.13-2. 0. 1.152.5 1152 25 2.5 1.15-2. 1.021.7 1021 1.02-1. 1.132. 2. 1.13-2 1.152. 1.15-2 1.021. 1.02-1 1.132 1.13- 1.152 1.15- 1.021 1.02-

Abstract Neglected tropical diseases (NTD) are chronic infectious diseases affecting low-income populations (mainly in tropical and subtropical climates), characterized by high morbidity and low mortality. This study described the epidemiology of mortality from NTDs in the state of Maranhão, Brazil. Data from the Brazilian Mortality Information System evidenced 2,642 deaths from NTDs between 2001 and 2021; 31.13% were related to leishmaniasis (mainly the visceral form) and 20.82% to leprosy. A total of 211 municipalities in Maranhão had registered mortality due to NTDs. We identified, high-risk spatial and spatiotemporal conglomerates in the western and southern areas of Maranhão, comprising mostly municipalities with high social vulnerability and low human development. Integrated mapping of NTDs may allow the development of public intervention policies and is an important strategy to control and eliminate NTDs in the most affected populations. NTD (NTD lowincome income mainly climates, climates , climates) Brazil 2642 2 642 2,64 200 2021 3113 31 13 31.13 form 2082 20 82 20.82 leprosy 21 identified highrisk risk 264 64 2,6 202 311 3 1 31.1 208 8 20.8 26 6 2, 31. 20.

Resumo As doenças tropicais negligenciadas (DTN) são doenças infecciosas crônicas que afetam populações de baixa renda (principalmente em climas tropicais e subtropicais), causando morbidade e mortalidade. Este estudo descreveu a epidemiologia da mortalidade por DTNs no estado do Maranhão, Brasil. Dados do Sistema de Informação sobre Mortalidade do Brasil evidenciaram 2.642 mortes por DTNs entre 2001 e 2021; 31,13% estavam relacionadas à leishmaniose (principalmente a forma visceral) e 20,82% à hanseníase. Um total de 211 municípios no Maranhão apresentaram mortes por DTNs, com conglomerados espaciais e espaço-temporais de alto risco identificados nas áreas oeste e sul, compreendendo principalmente municípios com alta vulnerabilidade social e baixo desenvolvimento humano. O mapeamento integrado de DTN pode permitir o desenvolvimento de políticas de intervenção pública e é uma estratégia importante para controlar e eliminar DTN nas populações mais afetadas. (DTN subtropicais, subtropicais , subtropicais) 2642 2 642 2.64 200 2021 3113 31 13 31,13 visceral 2082 20 82 20,82 hanseníase 21 espaçotemporais espaço temporais sul humano afetadas 264 64 2.6 202 311 3 1 31,1 208 8 20,8 26 6 2. 31, 20,

BACKGROUND Undifferentiated acute febrile illness (UAFI) cause by several pathogens poses a diagnostic challenge due to the similarity on the clinical manifestations across these diseases. Precise pathogen detection is vital for appropriate medical intervention, early treatment, and timely outbreak alerts regarding emerging pathogens. In tropical regions, UAFI is predominantly linked to a wide range of viral, bacterial, and parasitic infections. Hence, confirmatory laboratory tests are essential for specific pathogen identification. OBJECTIVES Our primary goal was to develop two real-time multiplex polymerase chain reaction (PCR) assays for simultaneous detection of six neglected pathogens (Leptospira spp., Rickettsia spp., Borrelia spp., Anaplasma spp., Brucella spp., and Bartonella spp.), known for causing UAFI in tropical regions. METHODS We rigorously assessed assays parameters including: linearity, efficiency, sensitivity, and reproducibility in both singleplex and multiplex formats. FINDINGS Our results demonstrated that these multiplex assays are reliable and sensitive methods. They showed good performance with low intra- and inter-variability (< 10%) and consistently high efficiencies (> 90%). MAIN CONCLUSIONS These assays offer the alternative of streamlining work, reducing processing costs, and minimizing sample volume use. In conclusion, we present two dependable, user-friendly, rapid, and cost-effective methods for simultaneously detecting six neglected bacteria, as a significant laboratory tool in resource-limited tropical settings. (UAFI diseases intervention treatment regions viral bacterial infections Hence identification realtime real time PCR (PCR Leptospira spp spp. , spp.) including linearity efficiency sensitivity formats intra intervariability inter variability < ( 10% 10 > 90%. 90 90% . 90%) work costs use conclusion dependable userfriendly, userfriendly user friendly, friendly user-friendly rapid costeffective cost effective bacteria resourcelimited resource limited settings 1 9

ABSTRACT Background: Chagas disease is a silent illness with high mortality burden in many Latin American countries, such as Brazil. Bahia has the fourth highest mortality rate in Brazil. This study analyzed the temporal trends and regional differences in the mortality rate of Chagas disease in Bahia State from 2008 to 2018. Methods: A time-series analysis of Chagas disease-related deaths was conducted using data from the Mortality Information System of Brazil. We compared the mortality rate due to Chagas disease as the primary cause and mention of the disease in the death certificate, standardized by age and health macroregion/residence municipality, and mapped hot and coldspots. Results: The Chagas Disease Mortality Rate in Bahia during the study period revealed a stationary trend, ranging from 5.34 (2008) to 5.33 (2018) deaths per 100,000 inhabitants. However, the four health macroregions showed an upward trend in mortality rates. The mortality rate (age-adjusted) ranged from 4.3 to 5.1 deaths per 100,000 inhabitants between 2008 and 2018. We observed a upward trend in the mortality rate among individuals aged ≥70 years and a higher incidence of death among men than among women. Of the total number of deaths (8,834), 79.3% had Chagas disease as the primary cause and the death certificates of 20.7% mentioned the disease. Cardiac complications were reported in 85.1% of the deaths due to Chagas disease. Conclusions: The regional and individual differences in the mortality rate of Chagas disease highlighted in this study may support health planning that considers the peculiarities of the territory. Background countries Brazil 200 2018 Methods timeseries time series diseaserelated related certificate macroregionresidence macroregion residence municipality coldspots Results 534 5 34 5.3 (2008 533 33 (2018 100000 100 000 100,00 However rates ageadjusted adjusted (age-adjusted 43 4 3 4. 51 1 5. 70 ≥7 women 8,834, 8834 8,834 , 8 834 (8,834) 793 79 79.3 207 20 7 20.7 851 85 85.1 Conclusions territory 201 53 (200 (201 10000 10 00 100,0 ≥ 883 8,83 83 (8,834 79. 2 20. 85. (20 1000 0 100, 88 8,8 (8,83 (2 8, (8,8 ( (8, (8

Resumo O objetivo deste artigo é analisar a magnitude e o perfil das demandas judiciais por bens e serviços de saúde pública, verificando também a presença de demandas judiciais para doenças tropicais negligenciadas (DTNs) no Estado do Piauí entre 2000-2020. Estudo transversal descritivo a partir de bases de dados do Tribunal de Justiça do Piauí acerca de processos judiciais demandando bens e serviços de saúde à administração pública direta. Foram identificados inicialmente um total de 6.658 processos judiciais. Após análise de elegibilidade, 1.384 processos (20,8%) foram analisados, verificando-se aumento da demanda a partir de 2017. Ressalta-se as características: origem na capital Teresina (614; 44,4%), 40 a 59 anos de idade (372; 26,9%), sexo feminino (761; 55,0%), agricultores (123; 8,9%), assistência jurídica pública (1.063; 76,8%), julgados procedentes (594; 42,9%). Cinco (5; 0,4%) demandas judiciais para DTNs, uma leishmaniose visceral solicitando transporte, procedente; quatro para hanseníase (dois medicamentos, um concedido, outro extinto sem resolução do mérito, uma consulta e um exame, ambos concedidos). A judicialização do direito à saúde é expressiva e crescente no estado do Piauí. A baixa demanda relacionada a DTNs pode traduzir limitação de acesso não apenas à saúde, mas ao Poder Judiciário.

Abstract This article aims to analyse the magnitude and profile of legal demands for public health goods and services, also verifying the presence of legal demands for neglected tropical diseases (NTDs) in the State of Piauí between 2000-2020. Cross-sectional descriptive study based on the databases of the Court of Justice of Piauí on lawsuits demanding from the Direct Public Administration, goods and health services. A total of 6,658 lawsuits were initially identified. After eligibility analysis, 1,384 cases (20.8%) were analysed, with an increase in demand from 2017. We highlight the characteristics: origin in the capital Teresina (614; 44.4%), 40 to 59 years of age (372; 26.9%), female (761; 55.0%), farmers (123; 8.9%), public legal assistance (1,063; 76.8%), upheld (594; 42.9%). Five (5; 0.4%) lawsuits for NTDs, one visceral leishmaniasis requesting transportation, with granting, four for leprosy (two medicines, one granted, other extinguished without resolution of the merit, one consultation and one exam granted). The judicialization of the right to health is expressive and growing in the State of Piauí. The low demand related to NTDs may translate into limited access not only to health care, but also to the judiciary.

Resumo O objetivo deste artigo é analisar a magnitude e o perfil das demandas judiciais por bens e serviços de saúde pública, verificando também a presença de demandas judiciais para doenças tropicais negligenciadas (DTNs) no Estado do Piauí entre 2000-2020. Estudo transversal descritivo a partir de bases de dados do Tribunal de Justiça do Piauí acerca de processos judiciais demandando bens e serviços de saúde à administração pública direta. Foram identificados inicialmente um total de 6.658 processos judiciais. Após análise de elegibilidade, 1.384 processos (20,8%) foram analisados, verificando-se aumento da demanda a partir de 2017. Ressalta-se as características: origem na capital Teresina (614; 44,4%), 40 a 59 anos de idade (372; 26,9%), sexo feminino (761; 55,0%), agricultores (123; 8,9%), assistência jurídica pública (1.063; 76,8%), julgados procedentes (594; 42,9%). Cinco (5; 0,4%) demandas judiciais para DTNs, uma leishmaniose visceral solicitando transporte, procedente; quatro para hanseníase (dois medicamentos, um concedido, outro extinto sem resolução do mérito, uma consulta e um exame, ambos concedidos). A judicialização do direito à saúde é expressiva e crescente no estado do Piauí. A baixa demanda relacionada a DTNs pode traduzir limitação de acesso não apenas à saúde, mas ao Poder Judiciário.

Abstract This article aims to analyse the magnitude and profile of legal demands for public health goods and services, also verifying the presence of legal demands for neglected tropical diseases (NTDs) in the State of Piauí between 2000-2020. Cross-sectional descriptive study based on the databases of the Court of Justice of Piauí on lawsuits demanding from the Direct Public Administration, goods and health services. A total of 6,658 lawsuits were initially identified. After eligibility analysis, 1,384 cases (20.8%) were analysed, with an increase in demand from 2017. We highlight the characteristics: origin in the capital Teresina (614; 44.4%), 40 to 59 years of age (372; 26.9%), female (761; 55.0%), farmers (123; 8.9%), public legal assistance (1,063; 76.8%), upheld (594; 42.9%). Five (5; 0.4%) lawsuits for NTDs, one visceral leishmaniasis requesting transportation, with granting, four for leprosy (two medicines, one granted, other extinguished without resolution of the merit, one consultation and one exam granted). The judicialization of the right to health is expressive and growing in the State of Piauí. The low demand related to NTDs may translate into limited access not only to health care, but also to the judiciary.

ABSTRACT Background: This cross-sectional study compared the general impact of cutaneous leishmaniasis (CL) and patient satisfaction with treatment and health services as perceived by those undergoing different therapeutic regimens in an endemic region in South-Eastern Brazil. We also investigated the factors associated with both outcomes (general impact and satisfaction). Methods: We included 84 patients with CL treated between 2018 and 2019 with intravenous meglumine antimoniate, liposomal amphotericin B, or intralesional meglumine antimoniate therapy. Data were collected through interviews that assessed sociodemographic characteristics, comorbidity status, access and use of health services for CL diagnosis and treatment, and the items of the Cutaneous Leishmaniasis Impact Questionnaire (CLIQ). The CLIQ is a psychometric questionnaire previously validated to assess the general impact of CL on patient satisfaction with treatment and health services. Multivariate logistic regression analysis was used to identify the factors associated with high CL impact and low patient satisfaction. Results: The general impact of CL and patient satisfaction with treatment and health services were not significantly associated with the therapeutic regimen. High CL impact was associated with low family income (odds ratio [OR]:3.3; 95% confidence interval [CI]:1.0-10.3), occurrence of complications/adverse effects during treatment (OR:7.7; 95%CI:2.4-25.6), and additional costs during diagnosis and/or treatment (OR:12.1; 95% CI:2.8-52.4). Low satisfaction was associated with high disease impact (OR: 9.5; 95% CI:2.7-33.9), occurrence of complications/adverse effects (OR:4.2; 95% CI:1.3-13.0), and high family income (OR:7.1; 95%CI:1.7-28.2). Conclusions: Our data support public health policies aimed at reducing the impact of CL and its treatment as well as the use of therapy with fewer adverse effects. Background crosssectional cross sectional (CL SouthEastern South Eastern Brazil . satisfaction) Methods 8 201 B characteristics status CLIQ. (CLIQ) Results regimen odds OR3.3 OR33 OR 3.3 3 [OR]:3.3 95 CI1.010.3, CI10103 CI 1.0 10.3 , 1 0 10 [CI]:1.0-10.3) complicationsadverse complications OR7.7 OR77 7.7 7 (OR:7.7 95%CI2.425.6, 95CI24256 95%CI 2.4 25.6 2 4 25 6 95%CI:2.4-25.6) andor OR12.1 OR121 12.1 12 (OR:12.1 CI2.852.4. CI28524 2.8 52.4 52 CI:2.8-52.4) (OR 9.5 9 5 CI2.733.9, CI27339 2.7 33.9 33 CI:2.7-33.9) OR4.2 OR42 4.2 (OR:4.2 CI1.313.0, CI13130 1.3 13.0 13 CI:1.3-13.0) OR7.1 OR71 7.1 (OR:7.1 95%CI1.728.2. 95CI17282 1.7 28.2 28 95%CI:1.7-28.2) Conclusions 20 (CLIQ OR3 OR3. 3. [OR]:3. CI1 010 CI1.010.3 CI1010 1. 103 10. [CI]:1.0-10.3 OR7 OR7. 77 7. (OR:7. CI2 425 95%CI2.425.6 95CI2425 95CI 24 2. 256 25. 95%CI:2.4-25.6 OR12 OR12. 121 12. (OR:12. 852 CI2.852.4 CI2852 524 52. CI:2.8-52.4 9. 733 CI2.733.9 CI2733 27 339 33. CI:2.7-33.9 OR4 OR4. 42 4. (OR:4. 313 CI1.313.0 CI1313 130 13. CI:1.3-13.0 71 728 95%CI1.728.2 95CI1728 17 282 28. 95%CI:1.7-28.2 [OR]:3 01 CI1.010. CI101 [CI]:1.0-10. (OR:7 95%CI2.425. 95CI242 95%CI:2.4-25. OR1 (OR:12 85 CI2.852. CI285 CI:2.8-52. 73 CI2.733. CI273 CI:2.7-33. (OR:4 31 CI1.313. CI131 CI:1.3-13. 72 95%CI1.728. 95CI172 95%CI:1.7-28. [OR]: CI1.010 CI10 [CI]:1.0-10 95%CI2.425 95CI24 95%CI:2.4-25 (OR:1 CI2.852 CI28 CI:2.8-52 CI2.733 CI27 CI:2.7-33 CI1.313 CI13 CI:1.3-13 95%CI1.728 95CI17 95%CI:1.7-28 [OR] CI1.01 [CI]:1.0-1 95%CI2.42 95CI2 95%CI:2.4-2 CI2.85 CI:2.8-5 CI2.73 CI:2.7-3 CI1.31 CI:1.3-1 95%CI1.72 95CI1 95%CI:1.7-2 [OR CI1.0 [CI]:1.0- 95%CI2.4 95%CI:2.4- CI2.8 CI:2.8- CI2.7 CI:2.7- CI1.3 CI:1.3- 95%CI1.7 95%CI:1.7- CI1. [CI]:1.0 95%CI2. 95%CI:2.4 CI2. CI:2.8 CI:2.7 CI:1.3 95%CI1. 95%CI:1.7 [CI]:1. 95%CI2 95%CI:2. CI:2. CI:1. 95%CI1 95%CI:1. [CI]:1 95%CI:2 CI:2 CI:1 95%CI:1 [CI]: 95%CI: CI: [CI] [CI