ABSTRACT Background: The primary aim of this study is to assess the survival rates of individuals diagnosed with Community-Acquired Pneumonia (CAP) post-hospitalization in Colombia. Additionally, explore potential risk factors associated with decreased long-term survival. Methods: A retrospective cohort study was conducted in a hospital in Colombia, evaluating survival at 3, 6 and 12 months in CAP patients, using the Kaplan-Meier method. Stratifications were made by age, sex, comorbidity, and severity. The comparison of survival curves was performed using the Log-Rank test, a multivariate analysis with Cox regression was performed to study possible risk factors that affected 12-month survival in patients with CAP. Results: 3688 subjects were admitted, with a mortality of 16.3 % per year. Survival at three, six, and twelve months was 92.9 % (95 % CI 92–93 %), 88.8 % (95 % CI 87–90 %), and 84.2 % (95 % CI 82–85 %), respectively. Analysis stratified by pneumonia severity index, 12-month survival was 98.7 % in Class I, 95.6 % in Class II, 87.41 % in Class III, 77.1 % in Class IV, and 65.8 % in class-V (p < 0.001). Cox-regression showed that being male (HR = 1.44; 95 % CI 1.22–1.70; p < 0.001), an elevated pneumonia severity index (HR = 4.22; 95 % CI 1.89–9.43; p < 0.001), a high comorbidity index (HR = 2.29; 95 % CI 1.89–2.84; p < 0.001) and vasopressor requirement (HR = 2.22; 95 % CI < 0.001) were associated with a lower survival at twelve months of follow-up. Conclusion: Survival in patients with CAP who require hospitalization decreases at 3, 6, and 12 months of follow-up, being lower in patients older than 65 years, men, high comorbidity, and in subjects with severe presentation of the disease. Background CommunityAcquired Community Acquired (CAP posthospitalization post Colombia Additionally longterm long term Methods 3 1 KaplanMeier Kaplan Meier method age sex LogRank Log Rank test 12month month Results 368 admitted 163 16 16. year three six 929 92 9 92. (9 9293 93 92–9 %, , %) 888 88 8 88. 8790 87 90 87–9 842 84 2 84. 8285 82 85 82–8 respectively 987 98 7 98. I 956 95. II 8741 41 87.4 III 771 77 77. IV 658 65. classV class V 0.001. 0001 0.001 . 0 001 Coxregression HR 1.44 144 44 1.22–1.70 122170 22 70 0.001, 4.22 422 4 1.89–9.43 189943 89 43 2.29 229 29 1.89–2.84 189284 2.22 222 followup. followup follow up. up follow-up Conclusion followup, up, years men disease 36 ( 92– 879 87– 828 82– 874 87. 000 0.00 00 1.4 14 1.22–1.7 12217 4.2 42 1.89–9.4 18994 2.2 1.89–2.8 18928 0.0 1. 1.22–1. 1221 4. 1.89–9. 1899 2. 1.89–2. 1892 0. 1.22–1 122 1.89–9 189 1.89–2 1.22– 1.89– 18 1.22 1.89 1.2 1.8

ABSTRACT In Brazil, Dengue, Zika and Chikungunya viruses constitute a major threat to the public health system. Simultaneous circulation of these arboviruses occurs in many regions of the world due to the expansion of transmission vectors. The infection by these arboviruses triggers similar symptoms during their acute phase. However, in some cases, severe symptoms may occur, leading to different types of disabilities and even death. In this context, considering the similarity of the symptoms, the problems caused by the infection of these arboviruses, and the increasing risk of coinfection in humans, the differential diagnosis of these infections is essential for clinical management and epidemiological investigation. Thus, this study aimed to identify, through diagnosis via Quantitative Polymerase Chain Reaction with Reverse Transcription, arbovirus coinfection in patients from the Tocantins state (Northern Brazil). A total of 495 samples were analyzed, three from which were determined to be a coinfection of Dengue and Chikungunya viruses. The data obtained here indicate the co-circulation and coinfection by Dengue and Chikungunya viruses in the Tocantins state. These results highlight the importance of monitoring the circulation of these arboviruses for the development of health actions that aim their prevention and combat, as well as their clinical and therapeutic management. Brazil system vectors phase However cases occur death context humans investigation Thus identify Transcription Northern Brazil. . Brazil) 49 analyzed cocirculation co combat 4

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 Background: The Amazonas state/AM and Manaus rank among the highest AIDS detection rates in Brazil. High proportion of HIV infected blood donors and transmission clusters of multidrug antiretroviral/ARV resistant viruses were described in HEMOAM blood donors, a main Amazonas public blood bank. Recent and long-term infections among previously genotyped donors are reported. Methods/materials: The recency immunoassay Lag Avidity EIA (Maxim, USA) was employed. Clinical/CD4/viral load medical file data of the main local HIV management center (FMTHVD) and ARV treatment/ART data were reviewed. Results: Among 142 HIV-blood donors, chronic infection predominated (n = 87; 61.3 %), 79 based on LAg EIA and 8 undisclosed HIV identified in FMT-HVD records, mostly young adult, single males, 4 repeat donors, all ART-naive. Recent infections represented 30.3 % (n = 43),39 identified by LAg EIA and 4 immunologic windows (antibody negative/NAT/RNA positive). The overall profile of recent and long-term infections was similar, including moderate rate of transmitted drug resistance/TDR, however with multiple resistance mutations to more than one ARV-class, suggesting ART/failure. Discussion: Recent/acute and undisclosed/long-term HIV infections represent blood safety alerts suggesting test-seeking behavior of at-risk populations. Early ART use in Brazil, can turn HIV diagnosis more challenging representing a blood transfusion risk in the highly endemic Brazilian Amazon. Background stateAM state AM Brazil antiretroviralARV antiretroviral bank longterm long term reported Methods/materials Methodsmaterials Methods materials Maxim, Maxim (Maxim USA employed ClinicalCD4viral ClinicalCDviral Clinical CD4 viral CD FMTHVD (FMTHVD treatmentART treatment reviewed Results 14 HIVblood n 87 613 61 3 61. %, , %) 7 FMT HVD records adult males ARTnaive. ARTnaive naive. naive ART-naive 303 30 30. 43,39 4339 43 ,39 39 43),3 antibody negativeNATRNA negative NAT RNA positive. positive . positive) similar resistanceTDR TDR resistance/TDR ARVclass, ARVclass class, class ARV-class ARTfailure failure ART/failure Discussion Recentacute acute undisclosed/longterm undisclosedlongterm undisclosed/long testseeking test seeking atrisk at populations Amazon ClinicalCD 1 6 43,3 433 ,3 43), undisclosedlong 43, 43)

ABSTRACT Assessment is an essential component for all educational programs and must check competence acquirement while foster and promote learning. Progress Test (PT) is well recognized to assess cognitive knowledge, clinical reasoning and decision making in the clinical context, offering important information about the individual performance and program quality. It is widely used in Brazilian and international medical schools; however, it still has little role in assessing medical residents in Brazil. We present the experience of a PT pilot implementation in an Infectious Diseases residency program over two years. The first, second and third-year residents did four serial exams with 40 multiple choice questions (item)/each. Preceptors were trained on best practices on item writing. All the items were reviewed by a panel of experts and, after approval, included in the item bank. All participants answered a survey on their perceptions about the experience. The final score was higher for the third-year residents in all exam applications. The level of satisfaction was high among the participants, who mentioned the learning opportunity with the exam and the feedback. PT can improve residents’ assessment along the training period and residents’ performance should guide review and improvement of the programs. (PT knowledge context quality schools however Brazil years first thirdyear third year 4 item/each. itemeach /each. each (item)/each writing approval bank applications feedback item/each /each

Abstract Human Immunodeficiency Virus (HIV) infection is among the most challenging issues in the healthcare system, presenting significant financial and hygiene problems with a wide range of clinical manifestations. Despite the hopeful outcomes of Antiretroviral Therapies (ARTs), the current strategies for the treatment of patients with HIV infection have not shown clinical significance for all subjects, which is mainly due to the complexity of the disease. Therefore, the need for collaborative and interdisciplinary research focused on deciphering the multifaceted cellular, and molecular immunopathogenesis of HIV remains essential in the development of innovative and more efficacious therapeutic approaches. T-regulatory (Treg) cells function as suppressors of effector T-cell responses contributing to the inhibition of autoimmune disorders and the limitation of chronic inflammatory diseases. Notably, these cells can play substantial roles in regulating immune responses, immunopathogenesis, viral persistence and disease progression, and affect therapeutic responses in HIV patients. In this review, we aim elucidating the role of T-regulatory cells (Tregs) in the immunopathogenesis of HIV, including immunological fatigue and seroconversion. In particular, the focus of the current study is exploration of novel immunotherapeutic approaches to target HIV or related co-infections. (HIV system manifestations ARTs, ARTs , (ARTs) subjects Therefore cellular Tregulatory T regulatory Treg (Treg Tcell cell diseases Notably progression review Tregs (Tregs seroconversion particular coinfections. coinfections co infections. infections co-infections (ARTs

Abstract Vancomycin is a glycopeptide antibiotic mainly excreted by glomerular filtration. Therefore, patients undergoing hemodialysis tend to accumulate its crystalline degradation product, which has been associated with cross-reaction in commercial immunoassays. The aim of this study was to assess the performance of two commercial immunoassays for measuring vancomycin levels in patients undergoing hemodialysis. This method-comparison study enrolled patients undergoing hemodialysis at two hospitals in Porto Alegre, Brazil. Vancomycin serum concentrations measured by Chemiluminescent Microparticle Assay (CMIA) and measured by Kinetic Interaction of Microparticles in Solution (KIMS) were compared with Liquid Chromatography coupled with Tandem Mass Spectrometry (LC-MS/MS). A total of 64 samples from 42 patients and 54 samples from 23 patients were included in CMIA and KIMS groups. Both measurements were highly correlated with LC-MS/MS, with Spearman rank correlation coefficient r = 0.840 (p < 0.001) and r = 0.926 (p < 0.001), respectively. No deviation of linearity was observed (p = 0.81 and p = 0.49, respectively). The mean difference between CMIA and LC-MS/MS was -1.19 μg/mL and between KIMS and LC-MS/MS was -2.28 μg/mL. LC-MS/MS measured levels were, on average, 2.64 % higher than CMIA and 8.81 % higher than KIMS. CMIA and KIMS revealed accurate commercial methods to measure vancomycin serum concentrations in patients undergoing hemodialysis. filtration Therefore product crossreaction cross reaction methodcomparison method comparison Alegre Brazil (CMIA (KIMS LCMS/MS. LCMSMS LC MS/MS . MS (LC-MS/MS) 6 4 5 2 groups LCMS/MS, MS/MS, 0840 0 840 0.84 0.001 0001 001 0926 926 0.92 0.001, , respectively 081 81 0.8 049 49 0.49 respectively) LCMS/MS 1.19 119 1 19 -1.1 μgmL μg mL 2.28 228 28 -2.2 average 264 2.6 881 8 8.8 LCMS MSMS (LC-MS/MS 084 84 0.00 000 00 092 92 0.9 08 0. 04 0.4 1.1 11 -1. 2.2 22 -2. 26 2. 88 8. 0.0 09 9 1. -1 -2 -

Abstract Leprosy is a chronic infectious disease caused by the bacilli Mycobacterium leprae and Mycobacterium lepromatosis. In addition to humans, animals such as nine-banded armadillos and red squirrels are species naturally infected. The objective of this study was to investigate the presence of M. leprae and M. lepromatosis in non-volant small mammals of the order Didelphimorphia and Rodentia through Polymerase Chain Reaction (PCR) assay. During 2015 and 2018, field expeditions were carried out in three municipalities, covering biotic elements of the Amazon and Cerrado biomes, in the Mato Grosso State, Midwest of Brazil. A specific primer for repetitive sequences of the genomic DNA of M. leprae and M. lepromatosis targeting the RLEP and RLPM gene, respectively, was used to screen for these agents. The molecular detection of M. leprae DNA in the samples was 13.8%. M. lepromatosis was not detected. The present study reports a description of M. leprae in small non-volant mammals in Brazil. humans ninebanded nine banded infected M nonvolant non volant PCR (PCR assay 201 2018 municipalities biomes State Brazil gene respectively agents 138 13 8 13.8% detected 20 1 13.8 2 13.

Abstract Infective Endocarditis (IE) is a complex, life-threatening disease. The aim of the present study was to evaluate the impact of the Endocarditis-Team on management of IE. This observational study conducted at a university hospital (2015‒22), included adult patients with IE. The study period was divided in two periods: before (pre-Endocarditis-Team; pre-ET) and after the establishment of the Endocarditis-Team (post-Endocarditis-Team; post-ET) on January 2018. Among 505 IE episodes (187 in pre-Endocarditis-Team, 318 in post-ET period), 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography was more commonly used in post-ET period (14 % vs. 28 %; p < 0.001). Overall, thirty-day and one-year mortality were 14 % and 27 %, respectively; no difference was observed between the two periods. In post-ET period, the administration of 4-weeks, rather than 6-weeks, of intravenous antimicrobial treatment was higher than in the post-ET period (15 % vs. 45 %; p < 0.001). Indication for surgery was present in 115 (61 %) patients in pre-ET and in 153 (48 %) in the post-ET period. In post-ET period, among patients with indication, valve surgery was more frequently performed (66 % vs. 78 %; p = 0.038). Such difference was due to a higher acceptance of operative indication by the cardiac surgeon (69 % vs. 94 %; p = 0.013). The observed increase in number of patients benefiting from cardiac surgery in the post-ET period led to a decrease of subsequent embolic events, since among patients with operative indication (n = 268), new embolic events after the establishment of the indication were more common in the pre-ET period compared to post-ET (23 % vs. 12 %; p = 0.033). After the implementation of the multidisciplinary Endocarditis-Team we observed several improvements in the general management of IE patients. (IE complex lifethreatening life threatening disease EndocarditisTeam Team 2015‒22, 201522 2015‒22 , 2015 22 (2015‒22) periods preEndocarditisTeam pre (pre-Endocarditis-Team preET ET postEndocarditisTeam post (post-Endocarditis-Team postET 2018 50 187 (18 preEndocarditisTeam, Team, pre-Endocarditis-Team 31 period) 18FFluorodeoxyglucose FFluorodeoxyglucose 18F Fluorodeoxyglucose F TomographyComputed Computed (1 vs 2 0.001. 0001 0.001 . 0 001 0.001) Overall thirtyday thirty day oneyear one year 1 respectively 4weeks, 4weeks weeks 4 weeks, 4-weeks 6weeks, 6weeks 6 6-weeks 15 11 61 (6 48 (4 66 7 0.038. 0038 0.038 038 0.038) 69 9 0.013. 0013 0.013 013 0.013) n 268, 268 268) 23 (2 0.033. 0033 0.033 033 0.033) 20152 2015‒2 201 (2015‒22 5 18 3 ( 000 0.00 00 003 0.03 03 0.01 01 26 2015‒ 20 (2015‒2 0.0 (2015‒ 0. (2015 (201 (20

Abstract Itraconazole (ITZ) is widely prescribed for the treatment of mycosis such as Paracoccidioidomycosis (PCM). However, it's related to toxicity and serious adverse events, such as Congestive Heart Failure (CHF). The objective is to describe a patient with PCM and CHF secondary to ITZ. Male, 50-years old, was diagnosed with chronic adult PCM and started ITZ 200 mg 12/12 h. After 2-months, acute CHF began without previous-heart disease. The electrocardiogram showed changes in ventricular repolarization and left anterior superior divisional block. Echocardiogram: slight reduction in left ventricular systolic function and ejection fraction of 51%. ITZ was replaced by trimethoprim-sulfamethoxazole. After a week, there was remission of symptoms. Despite thousands of patients around the world received ITZ, few cases of CHF were reported. It's dose dependent and improves when the drug is discontinuing. ITZ has negative inotropic effect and probably causes mitochondrial dysfunction. However, the intrinsic mechanisms are not yet completely understood. (ITZ PCM. . (PCM) However its it s events CHF. (CHF) Male 50years years 50 old 20 1212 12 12/1 h 2months, 2months months 2 months, 2-months previousheart previous heart disease block Echocardiogram 51 51% trimethoprimsulfamethoxazole. trimethoprimsulfamethoxazole trimethoprim sulfamethoxazole. sulfamethoxazole trimethoprim-sulfamethoxazole week symptoms reported Its It discontinuing dysfunction understood (PCM (CHF 5 121 1 12/

Abstract Sporotrichosis is a fungal anthropozoonosis that has become a major public health problem in tropical countries. With that in mind, this study analyzed the relationship between this disease and demographic, socioeconomic and public health issues in Belém, State of Pará, Brazil, from 2020 to 2022. This ecological and cross-sectional study used data from the Belém Zoonosis Control Center, the Brazilian Institute of Geography and Statistics and the Health Ministry. Descriptive and spatial analyses were performed employing significance statistical, kernel, buffer and Moran techniques. One hundred sporotrichosis cases in cats and 49 in humans were analyzed. The results showed that the individuals most affected were women (61.22 %), adults (87.76 %), with the cutaneous form (95.92 %), diagnosed histopathologically (38.78 %), still undergoing treatment (46.94 %) and that the form of contagion was through cat scratches or bites (73.47 %). The profile also showed quantitative significance of ignored data related to treatment (65.31 %) and cat presence at home (63.27 %). The disease had a non-homogeneous distribution with very high densities in Campina de Icoaraci, Águas Negras and Parque Guajará. Those neighborhoods presented a very low Living Conditions Index and precarious services and health centers. The spatial dependence between the environmental and socioeconomic studied variables evidenced the establishment of an active transmission circuit for sporotrichosis in peripheral areas of the city, related to health inequalities with an underlying possible epidemiological silence, suggesting the need for expanding One Health public policies, aiming the sustainable development. countries mind demographic Pará Brazil 202 2022 crosssectional cross sectional Center Ministry statistical kernel techniques 4 61.22 6122 61 22 (61.2 %, % , 87.76 8776 87 76 (87.7 95.92 9592 95 92 (95.9 38.78 3878 38 78 (38.7 46.94 4694 46 94 (46.9 73.47 7347 73 47 (73.4 %. . 65.31 6531 65 31 (65.3 63.27 6327 63 27 (63.2 nonhomogeneous non homogeneous Icoaraci Guajará centers city silence policies development 20 61.2 612 6 2 (61. 87.7 877 8 7 (87. 95.9 959 9 (95. 38.7 387 3 (38. 46.9 469 (46. 73.4 734 (73. 65.3 653 (65. 63.2 632 (63. 61. (61 87. (87 95. (95 38. (38 46. (46 73. (73 65. (65 63. (63 (6 (8 (9 (3 (4 (7 (

Abstract Bartonelloses represent a group of potentially fatal diseases associated with various clinical manifestations including endocarditis. Caused by bacteria belonging to the genus Bartonella, these microorganisms have a remarkable ability to infect mammals, and their transmission is commonly associated with hematophagous vectors such as fleas, lice, mosquitoes, and ticks. The aim of this study was to evaluate the occurrence of Bartonella sp. DNA in 81 triatomines of the species Triatoma sordida collected in the field in peri‑domiciliary areas of the Brazilian city of Seabra, located in the state of Bahia. Nested PCR was conducted targeting the ftsZ gene and real-time PCR targeting the gltA gene, both representing specific reactions for Bartonella henselae. Additionally, conventional PCR targeting kDNA was employed to evaluate the presence of Trypanosoma cruzi. Of the samples tested, 23/81 (28.39 %) bugs showed positive PCR for B. henselae. No sample showed positive PCR for T. cruzi. The high prevalence of triatomines with a positive PCR for B. henselae emphasizes the close relationship between these insects and the bacteria, indicating the need for further studies to investigate the vectorial potential of these kissing bugs. endocarditis mammals fleas lice mosquitoes ticks sp 8 peridomiciliary peri domiciliary Seabra Bahia realtime real time Additionally cruzi tested 2381 23 23/8 28.39 2839 28 39 (28.3 % B T 238 2 23/ 28.3 283 3 (28. 28. (28 (2 (

ABSTRACT Chlamydia psittaci – related community-acquired pneumonia associated to acute myocarditis was diagnosed in a young man with no medical history, and a professional exposition to birds. The diagnosis was confirmed with positive specific polymerase chain reaction in bronchoalveolar lavage. The patient was treated with spiramycin for two weeks with anti-inflammatory treatment for myocarditis for three months. Clinical and biological improvement was rapidly observed followed by normalization of electrocardiogram and chest CT scan. No relapse was reported for over a two-year follow-up. communityacquired community acquired history birds lavage antiinflammatory anti inflammatory months scan twoyear year followup. followup follow up. up follow-up