ABSTRACT Introduction: Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher’s exact test, Kruskal-Wallis and ranksum test for comparisons. Results: We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system. Introduction . (PWH) Frailtyrelated related aged 50 years Healthrelated Health HQoL. (HQoL) Additionally COVID19 COVID 19 COVID-1 healthrelated outcomes prefrailty pre Methods Crosssectional Cross sectional 23Mar2019 Mar 23 2019 (23-Mar-201 5Mar2020 5 2020 5-Mar-2020 postCOVID19 postCOVID post post-COVID-1 23Jun2021 Jun 2021 (23-Jun-202 5May2022, 5May2022 May 2022 , 5-May-2022) INIFiocruz, INIFiocruz INI Fiocruz, Fiocruz INI-Fiocruz Janeiro Brazil domains loss selfreported self reported exhaustion weakness speed activity SF21, SF21 SF 21, SF-21 2 ChiSquare Chi Square Fishers Fisher s KruskalWallis Kruskal Wallis comparisons Results 25 10 43.6 436 43 6 (43. 14 56.4 564 56 4 (56. 60years 60 IQR (IQR 55‒64. 5564 55‒64 55 64 55‒64) selfidentified identified 15 60.8 608 (60. %, PardoBlack Pardo Black 58.4 584 58 (58. 18 72.7 727 72 7 (72. 13 52.8 528 52 (52. %. Overall 92 9 9. 95 (9 CI 8.1‒10.3 81103 1 3 616 61 61. 54.0‒69.2. 540692 54.0‒69.2 54 0 69 54.0‒69.2) posCOVID19 posCOVID pos pos-COVID-1 73 7. 106 10. p 0.66. 066 0.66 66 0.66) nonfrailty non preCOVID19 preCOVID pre-COVID-1 Conclusions system (PWH (HQoL COVID1 COVID- 23Mar201 201 (23-Mar-20 5Mar202 202 5-Mar-202 postCOVID1 post-COVID- 23Jun202 (23-Jun-20 5May202 5-May-2022 SF2 SF-2 43. (43 56. (56 556 55‒6 60. (60 58. (58 72. (72 52. (52 ( 8.1‒10. 8110 54069 54.0‒69. posCOVID1 pos-COVID- 06 0.6 preCOVID1 pre-COVID- 23Mar20 20 (23-Mar-2 5Mar20 5-Mar-20 post-COVID 23Jun20 (23-Jun-2 5May20 5-May-202 SF- (4 (5 55‒ (6 (7 8.1‒10 811 5406 54.0‒69 pos-COVID 0. pre-COVID 23Mar2 (23-Mar- 5Mar2 5-Mar-2 23Jun2 (23-Jun- 5May2 5-May-20 8.1‒1 81 540 54.0‒6 23Mar (23-Mar 5Mar 5-Mar- 23Jun (23-Jun 5May 5-May-2 8.1‒ 54.0‒ 5-Mar 5-May- 8.1 54.0 5-May 8. 54.

ABSTRACT Background: Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. Methods: We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. Results: A total of 202 PLWH with CD4 > 200 cells/μL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. Conclusions: 17DD was safe and well-tolerated in PLWH with CD4 > 200 cells/μL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination. Background DD (PLWH limited postvaccination post HIVuninfected uninfected [HIV(- . controls] Methods NCT03132311 NCT (NCT03132311 HIV(- 3 36 Janeiro Brazil obtained throughrealtime throughreal time units assays, assays , assays) neutrophils, (neutrophils AST postvaccination. Results 20 CD cellsμL cells μL 6 analyses 0 20. 22.8% 228 22 8 (22.8 vs 118 11 11. pvalue p value 0.001. 0001 0.001 001 0.001) Neutrophils Conclusions welltolerated well tolerated Postvaccination Post selflimited self [HIV( NCT0313231 (NCT0313231 HIV( 2 22.8 (22. 1 000 0.00 00 [HIV NCT031323 (NCT031323 22. (22 0.0 NCT03132 (NCT03132 (2 0. NCT0313 (NCT0313 ( NCT031 (NCT031 NCT03 (NCT03 NCT0 (NCT0 (NCT

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 Introduction: Understanding the intricate dynamics between different waves of the COVID-19 pandemic and the corresponding variations in clinical outcomes is essential for informed public health decision-making. Comprehensive insights into these fluctuations can guide resource allocation, healthcare policies, and the development of effective interventions. This study aimed to compare the characteristics and clinical outcomes of COVID-19 at peak transmission points by including all patients attended during the first four pandemic waves in a referral center in Colombia. Material and methods: In a prospective observational study of 2733 patients, clinical and demographic data were extracted from the Fundacion Valle de Lili's COVID-19 Registry, focusing on ICU admission, Invasive Mechanical Ventilation (IMV), length of hospital stay, and mortality. Results: Our analysis unveiled substantial shifts in patient care patterns. Notably, the proportion of patients receiving glucocorticoid therapy and experiencing secondary infections exhibited a pronounced decrease across waves (p < 0.001). Remarkably, there was a significant reduction in ICU admissions (62.83% vs. 51.23% vs. 58.23% vs. 46.70 %, p < 0.001), Invasive Mechanical Ventilation (IMV) usage (39.25% vs. 32.22% vs. 31.22% vs. 21.55 %, p < 0.001), and Length of Hospital Stay (LOS) (9 vs. 8 vs. 8 vs. 8 days, p < 0.001) over the successive waves. Surprisingly, hospital mortality remained stable at approximately 18-20 % (p > 0.05). Notably, vaccination coverage with one or more doses surged from 0 % during the initial waves to 66.71 % in the fourth wave. Conclusions: Our findings emphasize the critical importance of adapting healthcare strategies to the evolving dynamics of the pandemic. The reduction in ICU admissions, IMV utilization, and LOS, coupled with the rise in vaccination rates, underscores the adaptability of healthcare systems. Hospital mortality's persistence may warrant further exploration of treatment strategies. These insights can inform public health responses, helping policymakers allocate resources effectively and tailor interventions to specific phases of the pandemic. Introduction COVID19 COVID 19 COVID-1 decisionmaking. decisionmaking decision making. making decision-making allocation policies Colombia methods 273 Lilis Lili s Registry admission IMV, , stay Results patterns Notably 0.001. 0001 0.001 . 001 Remarkably 62.83% 6283 62 83 (62.83 vs 5123 51 23 51.23 5823 58 58.23 4670 46 70 46.7 0.001, (IMV 39.25% 3925 39 25 (39.25 3222 32 22 32.22 3122 31 31.22 2155 21 55 21.5 LOS (LOS 9 ( days Surprisingly 1820 18 20 18-2 0.05. 005 0.05 05 0.05) 6671 66 71 66.7 wave Conclusions utilization rates systems mortalitys responses COVID1 1 COVID- 27 000 0.00 00 62.83 628 6 (62.8 512 5 2 51.2 582 58.2 467 4 7 46. 39.25 392 3 (39.2 322 32.2 312 31.2 215 21. 182 18- 0.0 667 66. 62.8 (62. 51. 58. 39.2 (39. 32. 31. 0. 62. (62 39. (39 (6 (3

Abstract This study compares the effects of virus-cell interactions among SARS-CoV-2 variants of concern (VOCs) isolated in Brazil in 2021, hypothesizing a correlation between cellular alterations and mortality and between viral load and transmissibility. For this purpose, reference isolates of Alpha, Gamma, Zeta, and Delta variants were inoculated into monolayers of Vero-E6 cells. Viral RNA was quantified in cell supernatants by RT‒PCR, and infected cells were analyzed by Transmission Electron Microscopy (TEM) for qualitative and quantitative evaluation of cellular changes 24, 48, and 72 hours postinfection (hpi). Ultrastructural analyses showed that all variants of SARS-CoV-2 altered the structure and function of mitochondria, nucleus, and rough endoplasmic reticulum of cells. Monolayers infected with the Delta variant showed the highest number of modified cells and the greatest statistically significant differences compared to those of other variants. Viral particles were observed in the cytosol and the cell membrane in 100 % of the cells at 48 hpi. Alpha showed the highest mean particle diameter (79 nm), and Gamma and Delta were the smallest (75 nm). Alpha and Gamma had the highest particle frequency per field at 48 hpi, while the same was observed for Zeta and Delta at 72 hpi and 24 hpi, respectively. The cycle threshold of viral RNA varied among the target protein, VOC, and time of infection. The findings presented here demonstrate that all four VOCs evaluated caused ultrastructural changes in Vero-E6 cells, which were more prominent when infection occured with the Delta variant. viruscell virus SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- (VOCs 2021 transmissibility purpose VeroE6 VeroE Vero E6 E Vero-E RTPCR RT PCR RT‒PCR TEM (TEM 7 . (hpi) mitochondria nucleus 10 4 79 (7 nm, nm , nm) 75 nm. respectively protein VOC SARS-CoV 202 (hpi 1 ( 20

Abstract Invasive fungal infection (IFI) is frequent in patients with hematologic malignancies or submitted hematopoietic stem cell transplantation (HSCT). Objectives To evaluate the role of the GM (galactomannan) test in prescribing therapeutic antifungals; to determine invasive aspergillosis (IA) frequency, the factors associated with positive GM test, and the in-hospital mortality. Methods We conducted a retrospective observational study including patients aged 18 or over with hematological malignancy or submitted to HSCT. GM test was measured twice weekly. The hypothesis of IFI was considered in patients with neutropenia and persistent fever despite broad-spectrum antibiotics. Results A total of 496 patients were evaluated; the mean of GM tests performed per patient was 4.2 (+3.1), and 86 (17.3 %) had positive results. IFI was diagnosed in 166 (33.5 %) and IA in 22 (24.6 %) patients. Positive GM test was more frequent in patients with IFI (72.2 % and 25.1 %; OR 8.1; 95 % CI 4.8 - 13.8), and was associated with therapeutic antifungals prescription (52, 9 % and 20.5 %; OR 4.3, 95CI% 2.0 - 9.4), as well as lung abnormalities on HRCT (45.3% vs. 21.5 %; OR 3.0, 95 %CI 1.4 - 6.5). Mortality was 31.6 %. In the multivariate analysis, the variables associated with mortality were the hypothesis of IFI (OR 6.35; 95 % CI 3.63-11.12.0), lung abnormalities on HRCT (57.9 % and 26.9 %; OR 2 0.6; 95 % CI 1.5 - 4.4), and positive GM test (57.9 % and 26.9 %; OR 2.7 95 % CI 1.6 - 4.5). Conclusions Positive GM test was associated with lung abnormalities on HRCT and with the introduction of therapeutic antifungals. If adequate anti-mold prophylaxis is available, the GM test should not be used as screening, but to investigate IFI in high-risk patients. The diagnosis of IFI, positive GM test and lung abnormalities on HRCT were predictors of hospital mortality in patients with hematological malignancies or undergoing HSCT. (IFI HSCT . (HSCT) galactomannan (galactomannan (IA frequency inhospital 1 weekly broadspectrum broad spectrum antibiotics 49 evaluated 42 4 4. +3.1, 31 +3.1 , 3 (+3.1) 8 17.3 173 17 (17. results 16 33.5 335 33 5 (33. 24.6 246 24 6 (24. 72.2 722 72 (72. 251 25 25. 8.1 81 48 13.8, 138 13.8 13 13.8) 52, 52 (52 205 20 20. 43 4.3 95CI 0 2. 9.4, 94 9.4 9.4) 45.3% 453 45 (45.3 vs 215 21 21. 30 3.0 14 1. 6.5. 65 6.5 6.5) 316 31. analysis 6.35 635 35 3.6311.12.0, 36311120 3.63 11.12.0 63 11 12 3.63-11.12.0) 57.9 579 57 (57. 269 26 26. 0.6 06 15 4.4, 44 4.4 4.4) 27 7 4.5. 4.5 4.5) antimold anti mold available screening highrisk high risk (HSCT +3. (+3.1 17. (17 33. (33 24. (24 72. (72 8. 13. (5 9. 45.3 (45. 3. 6. 6.3 6311 3.6311.12.0 3631112 363 3.6 11120 11.12. 3.63-11.12.0 57. (57 0. +3 (+3. (1 (3 (2 (7 ( 45. (45 631 3.6311.12. 363111 36 1112 11.12 3.63-11.12. + (+3 (4 3.6311.12 36311 111 11.1 3.63-11.12 (+ 3.6311.1 3631 11. 3.63-11.1 3.6311. 3.63-11. 3.6311 3.63-11 3.631 3.63-1 3.63-

Abstract Background The COVID-19 pandemic has triggered crises in the public health sector that have complex and multifaceted interrelationships with antimicrobial resistance. It is important to evaluate the impact of COVID-19 on microbiological profile, antibiotic and alcohol gel consumption in Intensive Care Units (ICU). Methods This is a retrospective study undertaken in an infectious disease hospital located in Bahia/Brazil during three periods: from March 2019 to February 2020; from March 2020 to February 2021; and from March 2021 to February 2022. It was evaluated the incidence density of Candida spp and of multidrug-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE group) in blood, urine and tracheal secretion isolated 48 h after the patient's admission to the ICU, as well as the use of alcohol gel (in milliliters) and consumption of antibiotics in Defined Daily Dose (DDD) per 1,000 ICU patient-days in the previous year and in the first two years of COVID-19 pandemic. Results There was an increase in Candida spp. (5.81, p < 0.001, IRR = 10.47, 95 % CI 2.57‒42.62) and in carbapenem-resistant A. baumannii in clinical cultures (4.71, p < 0.001, IRR = 8.46, 95 % CI 2.07‒34.60), the latter mainly in tracheal secretions (3.18, p =0.02, IRR = 11.47, 95 % CI 1.58‒83.39). A rise in the consumption of ceftriaxone and piperacillin-tazobactam, along with an increase in the utilization of alcohol gel were observed. Conclusion The shifting microbiological profile can be attributed to both the unique characteristics of patients with COVID-19 and the adjustments made to healthcare facilities' structural and work routines. Understanding these changes is essential in addressing the accelerated impact of antimicrobial resistance during the pandemic. Therefore, conducting thorough reviews of institutional practices and routines becomes critical in mitigating the consequences of antimicrobial resistance and its implications for patient care. COVID19 COVID 19 COVID-1 ICU. . (ICU) BahiaBrazil Bahia Brazil periods 201 202 2022 multidrugresistant multidrug resistant faecium aureus pneumoniae aeruginosa ESKAPE group blood 4 s milliliters DDD (DDD 1000 1 000 1,00 patientdays days 5.81, 581 5 81 (5.81 0001 0 001 0.001 1047 10 47 10.47 9 2.57‒42.62 2574262 2 57 42 62 carbapenemresistant carbapenem 4.71, 471 71 (4.71 846 8 46 8.46 2.07‒34.60, 2073460 2.07‒34.60 , 07 34 60 2.07‒34.60) 3.18, 318 3 18 (3.18 002 02 =0.02 1147 11 11.47 1.58‒83.39. 1588339 1.58‒83.39 58 83 39 1.58‒83.39) piperacillintazobactam, piperacillintazobactam piperacillin tazobactam, tazobactam piperacillin-tazobactam observed facilities Therefore care COVID1 COVID- (ICU 20 100 00 1,0 5.81 (5.8 0.00 104 10.4 2.57‒42.6 257426 6 4.71 7 (4.7 84 8.4 207346 2.07‒34.6 3.18 31 (3.1 =0.0 114 11.4 158833 1.58‒83.3 1, 5.8 (5. 0.0 10. 2.57‒42. 25742 4.7 (4. 8. 20734 2.07‒34. 3.1 (3. =0. 11. 15883 1.58‒83. 5. (5 0. 2.57‒42 2574 4. (4 2073 2.07‒34 3. (3 =0 1588 1.58‒83 ( 2.57‒4 257 207 2.07‒3 158 1.58‒8 2.57‒ 25 2.07‒ 15 1.58‒ 2.57 2.07 1.58 2.5 2.0 1.5 2. 1.

Abstract Introduction COVID-19 remains an important threat to global health and maintains the challenge of COVID-19 hospital care. To assist decision making regarding COVID-19 hospital care many instruments to predict COVID-19 progression to critical condition were developed and validated. Objective To validate eleven COVID-19 progression prediction scores for critically ill hospitalized patients in a Brazilian population. Methodology Observational study with retrospective follow-up, including 301 adults confirmed for COVID-19 sequentially. Participants were admitted to non-critical units for treatment of the disease, between January and April 2021 and between September 2021 and February 2022. Eleven prognostic scores were applied using demographic, clinical, laboratory and imaging data collected in the first 48 of the hospital admission. The outcomes of greatest interest were as originally defined for each score. The analysis plan was to apply the instruments, estimate the outcome probability reproducing the original development/validation of each score, then to estimate performance measures (discrimination and calibration) and decision thresholds for risk classification. Results The overall outcome prevalence was 41.8 % on 301 participants. There was a greater risk of the occurrence of the outcomes in older and male patients, and a linear trend with increasing comorbidities. Most of the patients studied were not immunized against COVID-19. Presence of concomitant bacterial infection and consolidation on imaging increased the risk of outcomes. College of London COVID-19 severity score and the 4C Mortality Score were the only with reasonable discrimination (ROC AUC 0.647 and 0.798 respectively) and calibration. The risk groups (low, intermediate and high) for 4C score were updated with the following thresholds: 0.239 and 0.318 (https://pedrobrasil.shinyapps.io/INDWELL/). Conclusion The 4C score showed the best discrimination and calibration performance among the tested instruments. We suggest different limits for risk groups. 4C score use could improve decision making and early therapeutic management at hospital care. COVID19 COVID 19 COVID-1 validated population followup, followup follow up, up follow-up 30 sequentially noncritical non disease 202 2022 demographic clinical 4 admission developmentvalidation development validation classification 418 41 8 41. participants comorbidities COVID19. 19. C ROC 0647 0 647 0.64 0798 798 0.79 respectively low, low (low high 0239 239 0.23 0318 318 0.31 https//pedrobrasil.shinyapps.io/INDWELL/. httpspedrobrasilshinyappsioINDWELL https //pedrobrasil.shinyapps.io/INDWELL/ . pedrobrasil shinyapps io INDWELL (https://pedrobrasil.shinyapps.io/INDWELL/) COVID1 1 COVID- 3 20 064 64 0.6 079 79 0.7 023 23 0.2 031 31 0.3 https//pedrobrasil.shinyapps.io/INDWELL/ pedrobrasilshinyappsioINDWELL //pedrobrasil.shinyapps.io/INDWELL (https://pedrobrasil.shinyapps.io/INDWELL/ 2 06 6 0. 07 7 02 03 https//pedrobrasil.shinyapps.io/INDWELL (https://pedrobrasil.shinyapps.io/INDWELL

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) presents with fever, fatigue, elevated inflammatory markers (acute phase reactants), and a history of exposure to SARS-CoV-2 or positive antibodies to SARS-CoV-2. As the COVID-19 pandemic unfolded, the risk of MIS-C in the pediatric population increased. However, exposure to other viruses and the presence of SARS-CoV-2 positive antibodies in children hospitalized for various pathogen-associated illnesses will also remain common and may complicate differential diagnoses with diseases endemic to the region such as rickettsial diseases. The objective was to highlight the desirability of medical personnel systematically incorporating rickettsiosis as a differential diagnosis for MIS-C when studying a child with fever, non-specific symptoms, and elevated inflammatory markers. In conclusion MIS-C should be considered in children with elevated inflammatory markers when there is a history of COVID-19 and they also meet criteria that have already been established by international agencies, such as CDC and WHO MISC MIS C (MIS-C fever fatigue acute reactants, reactants , reactants) SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- SARSCoV2. 2. COVID19 COVID 19 COVID-1 unfolded increased However pathogenassociated pathogen associated nonspecific non specific symptoms agencies SARS-CoV COVID1 1 COVID-

Abstract Background The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has had a devastating impact on the global population, with an estimated 650 million people infected and more than 6.6 million lives lost. Asymptomatic individuals have been shown to play a significant role in the transmission of the virus. Therefore, this study aims to investigate and compare the prevalence of asymptomatic individuals across three waves associated with the Beta, Delta, and Omicron variants of the virus. Methods This retrospective study was conducted between December 2020 and March 2022. The study population consisted of passengers on international flights who were referred to the Gerash Clinical and Molecular Diagnosis Laboratory. Real-time PCR was employed for the diagnosis of SARS-CoV-2. Results Out of a total of 8592 foreign travelers referred to our laboratory, 139 (1.16 %) tested positive for SARS-CoV-2 infection and were asymptomatic. During the Beta surge, 35 (1.49 %) out of 2335 passengers tested positive for SARS-CoV-2. In the Delta surge, 31 (0.6 %) out of 5127 passengers tested positive. However, during the Omicron surge, a significantly higher number of passengers, specifically 73 (6.46 %) out of 1130, had a positive result for the SARS-CoV-2 test. Conclusion Considering the significant role of asymptomatic transmission in the spread of COVID-19, it is imperative to reconsider health policies when dealing with future surges of the Omicron subvariants. Additionally, we strongly recommend that the World Health Organization prioritize the development and distribution of second-generation vaccines that target not only disease but also infection prevention. COVID19 COVID 19 COVID-1 pandemic SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- virus 65 66 6 6. lost Therefore 202 2022 Laboratory Realtime Real time SARSCoV2. 2. 859 laboratory 13 1.16 116 1 16 (1.1 % surge 3 1.49 149 49 (1.4 233 0.6 06 0 (0. 512 However 7 6.46 646 46 (6.4 1130 test COVID19, 19, subvariants Additionally secondgeneration second generation prevention COVID1 COVID- SARS-CoV 20 85 1.1 11 (1. 1.4 14 4 23 0. (0 51 6.4 64 (6. 113 8 1. (1 ( 5 (6

Abstract Introduction In Brazil, though Antiretroviral Therapy (ART) is available to all, the benefits may not be experienced uniformly. We projected Life Expectancy (LE) for People Living with HIV (PLHIV) in care as currently observed and estimated the impact of guideline-concordant care. Methods Using a microsimulation model, we projected LE for a cohort of PLHIV and for four population groups: cisgender Men who have Sex with Men (MSM), cisgender Men who have Sex with Women (MSW), Cisgender Women (CGW), and Transgender Women (TGW). Cohort data from Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation (INI/Fiocruz) informed model parameters. We modeled five scenarios: 1) Current care: ART initiation, adherence, and retention in care as currently observed, 2) Guideline-concordant care: immediate ART initiation, full adherence to treatment, and consistent retention in care, 3) Immediate ART initiation with observed adherence to treatment and retention in care, 4) Full adherence to treatment with observed timing of ART initiation and retention in care, and 5) Consistent retention in care with observed timing of ART initiation and adherence. Results With current care, LE from age 15 would be 45.9, 44.4, 54.2, and 42.3 years, for MSM, MSW, CGW, and TGW. With guideline-concordant care, LE would be 54.2, 54.4, 63.1, and 53.2 years, for MSM, MSW, CGW and TGW, with TGW experiencing the greatest potential increase in LE (10.9 years). When investigating the components of care separately, MSW and CGW would gain most LE with immediate ART initiation, whereas for MSM and TGW consistent retention in care would be most impactful. Conclusions In settings like INI/Fiocruz, MSW and CGW would benefit most from interventions focused on earlier diagnosis and linkage to care, whereas TGW and MSM would benefit from interventions to sustain engagement in care. Assessment of the HIV care continuum for specific populations should inform care priorities. Brazil (ART all uniformly (LE (PLHIV guidelineconcordant guideline concordant groups , (MSM) (MSW) (CGW) . (TGW) DiseasesOswaldo Diseases Oswaldo INI/Fiocruz INIFiocruz INI Fiocruz (INI/Fiocruz parameters scenarios 1 2 Guidelineconcordant Guideline 3 4 5 459 45 9 45.9 444 44 44.4 542 54 54.2 423 42 42. years 544 54.4 631 63 63.1 532 53 53. 10.9 109 10 (10. years. years) separately impactful priorities (MSM (MSW (CGW (TGW 45. 44. 54. 6 63. 10. (10 (1 (

Abstract Background While the sexual transmissibility of HAV in MSM has been extensively described, the potential for sexual transmission of HEV has not been definitively established. Although HEV has been detected in the ejaculate of chronically infected men, studies among MSM PrEP users in France did not observe an elevated anti-HEV seroprevalence as an indicator of increased exposure risk by sexual intercourse. Patients and methods A total of 111 unselected PrEP users and 111 age- and sex-matched blood donors were tested for anti-HEV IgG, IgM and HEV (PCR). Of the participants 79/111 (71 %) responded to a questionnaire covering topics as sexual preferences, previous sexually transmitted diseases, profession, food consumption, and pet ownership. Results The anti-HEV IgG seroprevalence in PrEP users (22 %) did not differ significantly from the rate in controls (17 %). While one PrEP user and three controls tested positive for anti-HEV IgM, all PrEP users and controls tested PCR negative. Conclusion In immunocompetent individuals with frequent changes of sexual partners, the epidemiology of Hepatitis E Virus does not significantly involve the sexual transmission route. described established men antiHEV anti intercourse 11 age sexmatched sex matched PCR. . (PCR) 79111 79 79/11 71 (7 % preferences diseases profession consumption ownership 22 (2 17 (1 %. negative partners route 1 (PCR 7911 7 79/1 ( 2 791 79/

Abstract Background Understanding the epidemiology of Streptococcus pneumoniae (S. pneumoniae) isolates is important for pneumonia treatment and prevention. This research aimed to explore the epidemiological characteristics of S. pneumoniae isolated from pediatric inpatients and outpatients during the same period. Methods S. pneumoniae were isolated from unsterile samples of inpatients and outpatients younger than five years old between March 2013 and February 2014. The serotypes were determined using diagnostic pneumococcal antisera. The resistance of each strain to 13 antibiotics was tested using either the E-test or the disc diffusion method. The Sequence Types (STs) were analyzed via Multilocus Sequence Typing (MLST). Results The dominant serotypes obtained from inpatients were 19F (32.9 %), 19A (20.7 %), 23F (10.7 %), 6A (10.0 %), and 14 (8.6 %), while those from outpatients were 19F (13.6 %), 23F (12.9 %), 6A (10.0 %), 6B (10.0 %), and 19A (7.9 %). The coverage rates of 13-valent Pneumococcal Conjugate Vaccine (PCV) formulations were high in both groups. The nonsusceptibility to penicillin, cefuroxime, imipenem, erythromycin, and trimethoprim-sulfamethoxazole among the inpatient isolates was 7.1 %, 92.8 %, 65.7 %, 100 %, and 85.0 %, respectively, while that among the outpatient isolates was 0.7 %, 50.0 %, 38.6 %, 96.4 %, and 65.7 %, respectively. There were 45 and 81 STs detected from the pneumococci isolated from inpatients and outpatients, respectively. CC271 was common among both inpatients and outpatients (43.6 % and 14.3 %). Conclusions Pneumococcal vaccine-related serotypes are prevalent among both inpatients and outpatients, especially among inpatients, who exhibit more severe antibiotic resistance. Therefore, universal immunization with PCV13 would decrease the hospitalization rate due to S. pneumoniae and the antibiotic resistance rate of S. pneumoniae. S (S prevention period 201 2014 antisera 1 Etest E test method (STs MLST. MLST . (MLST) F 32.9 329 32 9 (32. , %) A 20.7 207 20 7 (20. 10.7 107 10 (10. 10.0 0 8.6 86 8 6 (8. 13.6 136 (13. 12.9 129 12 (12. B 7.9 79 (7. %. 13valent valent PCV (PCV groups penicillin cefuroxime imipenem erythromycin trimethoprimsulfamethoxazole trimethoprim sulfamethoxazole 71 7. 928 92 92. 657 65 65. 850 85 85. respectively 07 0. 500 50 50. 386 38 38. 964 96 4 96. CC CC27 43.6 436 43 (43. 143 3 14. vaccinerelated vaccine related Therefore PCV1 (MLST 32. (32 20. 2 (20 10. (10 8. (8 13. (13 12. (12 (7 5 CC2 43. (43 (3 (2 (1 ( (4

Abstract Background Patients with kidney disease on Hemodialysis (HD) are susceptible to Coronavirus Disease (COVID-19) due to multiple risk factors. Aim This study aims to report the prevalence of antibodies against SARS-CoV-2 among patients on hemodialysis before vaccination in Brazil and to compare with clinical, demographic, and laboratory data. Methods Blood samples from 398 Chronic Kidney Disease (CKD) patients treated in three different private institutions in Rio de Janeiro State, Brazil were submitted to the total anti-SARS-CoV-2 testing. Kidney, liver, and hematological markers were also determined. Respiratory samples were tested by real-time PCR for SARS-CoV-2 RNA and positive samples were subjected to high-throughput sequencing on the MinION device. Results Overall, anti-SARS-CoV-2 prevalence was 54.5 % (217/398) and two individuals had SARS-CoV-2 RNA with variant B.1.1. High anti-SARS-CoV-2 seroprevalence was found in male gender and those with hospital admission in the last 3-months before the inclusion in the study. Lower red blood cell count was observed in the anti-SARS-CoV-2 seropositive group. High levels of anti-SARS-CoV-2 were found in those who reported symptoms, had low levels of eosinophils and low hematocrit, and who practiced physical activity. Conclusion High prevalence of anti-SARS-CoV-2 was found in CKD patients before the universal immunization in Brazil suggesting that dialysis patients were highly exposed to SARS-CoV-2. HD (HD COVID19 COVID 19 (COVID-19 factors SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- clinical demographic data 39 (CKD State antiSARSCoV2 antiSARSCoV anti anti-SARS-CoV- testing liver determined realtime real time highthroughput high throughput device Overall 545 54 5 54. 217/398 217398 217 (217/398 B11 B 1 B.1.1 3months months 3 group symptoms hematocrit activity SARSCoV2. 2. COVID1 (COVID-1 SARS-CoV anti-SARS-CoV 217/39 21739 21 (217/39 B1 B.1. (COVID- 217/3 2173 (217/3 B.1 (COVID 217/ (217/ B. (217 (21 (2 (

Abstract Combination COVID-19/influenza rapid tests provide a way to quickly and accurately differentiate between the two infections. The goal of this economic evaluation was to assess the cost and health benefits of a combination COVID-19/influenza Rapid Diagnostic Test (RDT) vs. current standard-of-care in the Brazilian private healthcare setting. A dual decision tree model was developed to estimate the impact of rapid differentiation of COVID-19 and influenza in a hypothetical cohort of 1,000 adults with influenza-like illness in an ambulatory healthcare setting. The model compared the use of a combination COVID-19/influenza RDT to Brazil standard diagnostic practice of a COVID-19 RDT and presumptive influenza diagnosis. Different levels of influenza prevalence were modeled with co-infection estimated as a function of the COVID-19 prevalence. Outcomes included accuracy of diagnosis, antiviral prescriptions and healthcare resource use (hospital bed days and ICU occupancy). Depending on influenza prevalence, considering 1,000 patients with influenza-like illness, a combination RDT compared to standard practice was estimated to result in between 88 and 149 fewer missed diagnoses of influenza (including co-infection), 161 to 185 fewer cases of over-diagnosis of influenza; a 24 to 34% reduction in hospital bed days and a 16 to 26% reduction in ICU days. In the base case scenario (20% influenza, 5% COVID-19), the combination RDT was estimated to result in cohort cost savings of $99. Based upon a de novo economic model, this analysis indicates that use of a combination RDT could positively impact influenza antiviral prescriptions and lower healthcare resource use. COVID19/influenza COVID19influenza COVIDinfluenza COVID 19/influenza 19 infections (RDT vs standardofcare care setting COVID19 COVID-1 1000 1 000 1,00 influenzalike like diagnosis coinfection co infection occupancy. occupancy . occupancy) 8 14 including coinfection, , co-infection) 18 overdiagnosis over 2 34 26 20% 20 (20 5 COVID19, COVID-19) 99 $99 19influenza COVID1 COVID- 100 00 1,0 3 (2 9 $9 10 0 1, ( $