Identifying mosquito vectors is crucial for controlling diseases. Automated identification studies using Convolutional Neural Network (CNN) have been conducted for some urban mosquito vectors but not yet for sylvatic mosquito vectors that transmit the yellow fever and other arboviruses. We evaluated the ability of the AlexNet CNN to identify four mosquito species: Aedes serratus, Aedes scapularis, Haemagogus leucocelaenus and Sabethes albiprivus and whether there is variation in AlexNet's ability to classify mosquitoes based on pictures of four different body regions. The specimens were photographed using a cell phone connected to a stereoscope. Photographs were taken of the full-body, pronotum and lateral view of the thorax, which were pre-processed to train the AlexNet algorithm. The evaluation was based on the confusion matrix, the accuracy (10 pseudo-replicates) and the confidence interval for each experiment. Our study found that the AlexNet can accurately identify mosquito pictures of the genus Aedes, Sabethes and Haemagogus with over 90% accuracy. Furthermore, the algorithm performance did not change according to the body regions submitted. It is worth noting that the state of preservation of the mosquitoes, which were often damaged, may have affected the network's ability to differentiate between these species and thus accuracy rates could have been even higher. Our results support the idea of applying CNNs for AI-driven identification of mosquito vectors of tropical diseases. This approach can potentially be used in the surveillance of yellow fever vectors by health services and the population as well.

The emergence of zoonotic infectious diseases has been driven by factors such as deforestation, unplanned urbanization, climate change, and poor sanitation. Among these diseases, arboviruses such as dengue, Zika, and Chikungunya represent significant challenges to public health. Given this scenario, the implementation of entomovirological surveillance actions becomes essential to understand the dynamics of viral circulation and the determinants of arbovirus transmission. Thus, this study aimed to evaluate the circulation of arboviruses collected in two sectors (Santa Luzia and Setor Oeste) of Estrutural City - DF, a region characterized by high socioeconomic vulnerability. Mosquitoes were collected between July 2022 and May 2023. The insects were identified according to sex and species (Aedes aegypti or Culex quinquefasciatus). Female Aedes aegypti were grouped into pools and subjected to RNA extraction, followed by detection of the arboviruses DENV, ZIKV and CHIKV by RT-qPCR. The results indicated a significant increase in the number of mosquitoes captured in the Santa Luzia sector (n=4153) compared to the West Sector (n=472), suggesting the influence of the region's sanitation conditions on the proliferation of vectors. Approximately 30% of the samples analyzed were positive for DENV, ZIKV and CHIKV, regardless of the region's infrastructure. In addition, RT-qPCR revealed simultaneous amplification of these viruses, evidencing cases of co-infection in 10/86 samples analyzed, thus highlighting the complexity of the ecological and epidemiological interactions associated with arboviruses. A greater abundance of mosquitoes and a higher prevalence of viral infection were observed during months corresponding to the rainy season, due to environmental conditions favorable to the reproduction of vectors. Our study reinforces the importance of continuous monitoring of viral circulation in mosquito populations, allowing us to anticipate outbreaks and direct more effective strategies to control these diseases.

Leishmaniasis comprises a group of diseases of great public health relevance, caused by protozoa of the Leishmaniagenus and transmitted through the bite of phlebotomine sandflies. Despite advances in the study of infection immunobiology, the initial mechanisms of parasite-host interaction remain incompletely understood. While in vitro and in vivo models serve as the foundation for generating new knowledge in this field, none fully replicate human infection. Ex vivo models, such as human skin explants, represent a promising alternative, as they preserve the structural and cellular complexity of the skin tissue, including immune cells. Thus, this study aimed to standardize the use of human organotypic skin explant cultures (hOSEC) as an experimental model for studying Leishmania braziliensis infection. Skin fragment viability was assessed through metabolic evaluation (TTC salt reduction assay) and structural analysis (histological evaluation). The presence of immune cells in the skin samples was determined via immunohistochemistry. L. braziliensis infection was standardized at 3 × 10⁵ parasites per skin fragment, inoculated through three 5-µL injections. Parasite presence was confirmed by direct visualization in histological sections and scanning electron microscopy. Molecularly, the parasite load was quantified over the cultivation period using qPCR. Finally, the consequences of parasite presence were assessed through histological evaluation and cytokine quantification by flow cytometry. The results demonstrated that hOSEC culture conditions could be optimized to maintain viability for the first seven days of cultivation. Additionally, immune cells were detected in the collected and cultivated hOSEC samples. Following infection standardization, L. braziliensis presence was confirmed, with a progressive transition from promastigote to amastigote forms and a gradual decrease in parasite load over the cultivation period. Lastly, hOSEC models were shown to produce detectable levels of IL-10, IL-4, TNF-α, IFN-γ, IL-6, and IL-2 throughout the cultivation period. By the seventh day of infection, IL-2 production was modulated, with lower cytokine synthesis in infected samples. Taken together, these findings suggest that hOSEC models are immunocompetent and hold great potential for studying the early stages of L. braziliensis infection.

Introduction: Malaria, caused by protozoa of the genus Plasmodium,continues to be one of the most important infectious diseases in the world.Among the species, P. falciparum stands out for its greater clinical severity and ability to cause severe complications. Faced with growing resistance to antimalarials, it is crucial to explore new therapeutic compounds that are equally effective. Dermaseptins are antimicrobial peptides capable of forming α helixes when associated with lipid bilayers, being able to permeate and rupture the cell membrane, with described trypanocidal and leishmanicidal activity. We therefore sought to evaluate the effects of dermaseptin 01 on monocytes stimulated with red blood cells infected with P. falciparum. Methodology: To this end, THP1 monocytes were stimulated in vitro with RBCs infected with the wild-type 3D7 strain, 5% of which were parasitized, and with normal, non-parasitized RBCs. Viability was assessed using the MTT and DHL methods. Hemolytic activity was measured by hemoglobin and antioxidative capacity by ROS and ERN production. The anti-inflammatory response was also studied by evaluating the molecules of the NF-kB pathway, and the cytokines involved in the inflammatory profile were analyzed using flow cytometry. Results: Cell viability tests showed that dermaseptin 01 significantly reduced cell viability, but without inducing cell lysis. In monocytes exposedto  parasitized or normal red blood cells, the peptide showed a partial protective effect, increasing viability compared to untreated controls. In addition, dermaseptin 01 increased the production of reactive nitrogen species and decreased oxygen species, indicating a possible interference in the oxidative stress associated with the inflammatory response. Analysis of the RelA/RelB factors revealed that no NF-κB molecules were significantly activated. In addition, there was an increase in IL-8 production in the group of monocytes incubated only with the peptide, but a decrease in the cytokines IL-6 and IL-12. Final considerations: The results indicate that dermaseptin 01 can act as a modulator of the immune response in monocytes exposed to P. falciparum, especially with regard to antioxidant and anti-inflammatory activity; however, it does present a certain degree of toxicity. These findings indicate that DRS-01 has characteristics that make it a molecule with potential application in future antimalarial therapy, provided it is modified so that it does not exhibit a cytotoxic effect.

Yellow Fever (YF) is an acute, vaccine-preventable arbovirus with a high lethality rate in severe forms. In Brazil, transmission occurs in the wild by mosquitoes of the genera Haemagogus and Sabethes, and the urban cycle has been interrupted since 1942. The vaccine is safe and effective and is available from the PNI for people aged 9 months to 59 years. After the re-emergence in 2014, the country faced the largest sylvatic outbreak in history, with expansion to areas previously without vaccination recommendations, impacting public health and generating cases in international travelers. The response included innovations such as SISS-Geo and risk modeling. The aim was to describe and characterize human cases of YF, with an emphasis on travellers. A descriptive study was carried out, covering the period 2014 to 2024, based on data from reports of YF in humans and non-human primates (NHP) in Brazil. The cases were classified as residents and intrastate, interstate and international travelers. Microsoft Excel 2016®, R 4.1.2 and QGIS 3.20 were used to analyze the data. There were 2,306 records of confirmed human cases of YF, of which 441 (19.1%) were classified as travelers. The most affected were males (77.8%) aged between 20 and 59 (73.9%). There were 139 municipalities (18.5%) that recorded cases in residents and/or NHP and also in travelers. Another 27 municipalities (3.5%) reported cases only in travelers. Regarding the travel profile of the cases, 316 (71.7%) were intrastate, 107 (24%) interstate and 18 (4.1%) international, none of whom had been vaccinated. Analysis of the flow of travelers showed that São Paulo and Minas Gerais played a major role, with a median distance between origin and destination for interstate travelers of 473.2 km. The attention of national and international health authorities must be redoubled due to the wide distribution of human cases in travelers, demonstrating that the occurrence of cases and deaths from YF and its dispersion throughout the national territory and/or various continents still represent threats to international dispersion.

The introduction of antiretroviral therapy (ART) has transformed HIV infection from a fatal condition into a chronic and manageable disease. Despite advances in the development of safer and more effective regimens, adverse drug reactions (ADRs) remain a relevant challenge in the clinical management of people living with HIV (PLHIV). This study aimed to estimate the incidence of ART regimen change due to ADRs in PLHIV who had their first consultation at the University Hospital of Brasília (HUB-UnB/Ebserh) between 2018 and 2022. The specific objectives were to describe the sociodemographic and clinical data of the study population; describe the main reported complaints; classify ADRs by affected organ or system according to the Medical Dictionary for Regulatory Activities (MedDRA); describe and classify the reasons for ART regimen modification; estimate the time from the first consultation to the ART regimen change due to ADRs; and compare the incidence of regimen change due to ADRs among the ART regimens. This is a historical, retrospective, and observational cohort study, composed of 238 adult individuals who had their first consultation at the outpatient clinic between 2018 and 2022. Information was extracted from the AGHU and SICLOM systems, complemented with data from medical records. Sociodemographic, clinical, and treatment aspects and the occurrence of ADRs that led to regimen changes were analyzed. The results showed that 31.9% of patients underwent at least one ART regimen change, with 55.3% of cases motivated by an ADR. The main ADRs were related to renal disorders (29.8%), psychiatric disorders (14%), and musculoskeletal disorders (12.3%), with tenofovir, efavirenz, and dolutegravir being the most frequently implicated medications. Factors such as female sex, age, and marital status (divorced or widowed) showed a significant association with regimen change due to ADRs. Survival analysis revealed that the probability of change was higher within the first 24 months, with an incidence density of 5.6 per 100 person-years. The dolutegravir (DTG) + tenofovir (TDF) + lamivudine (3TC) regimen presented a better durability profile compared to the tenofovir (TDF) + lamivudine (3TC) + efavirenz (EFV) regimen, which was more associated with ADRs, especially psychiatric ones. It is concluded that although current regimens have a better safety profile, ADRs remain a determining factor for ART regimen change. The findings reinforce the need to strengthen active pharmacovigilance, improve the quality of clinical records, and adopt strategies for the early management of ADRs, aiming at the safety, adherence, and sustainability of treatment for PLHIV.

Introduction: Immunization Stress-Related Responses (ISRR) are physical manifestations triggered by emotional factors such as anxiety, fear, or tension related to vaccination, and do not arise from the vaccine itself. These events lack an identifiable physiological cause. Although typically benign, such reactions can negatively affect public confidence in vaccines and contribute to vaccine hesitancy, undermining coverage goals. This study aimed to identify space-time clusters of ISRR recorded after the administration of the HPV vaccine between 2014 and 2024, in order to support strategic decision-making within Brazil's health surveillance framework.
Methods: This is a retrospective observational study with a quantitative approach, based on secondary data from official surveillance systems (SI-PNI and e-SUS Notifica). Included were ISRR cases in adolescents aged 9 to 14 vaccinated with the HPV vaccine, as well as a control group composed of other AEFI cases without symptoms consistent with ISRR. The SaTScan™ software was used to apply Poisson and Bernoulli space-time models, with Monte Carlo simulation and a significance level of p ≤ 0.05, to detect clusters.
Results: During the study period, over 108 million doses of the HPV vaccine were administered to adolescents aged 9 to 14 in Brazil, resulting in 3,503 reports of Adverse Events Following Immunization (AEFI), of which 123 (0.11 per 100,000 doses) were classified as ISRR. Most cases occurred in females (78.9%) and were concentrated in the early years following vaccine introduction, especially in 2014. The space-time analysis using the retrospective Bernoulli model in SaTScan™ identified five ISRR clusters, two of which were statistically significant, lasting from 2 to 38 months and covering large geographic areas; the cluster with the highest relative risk (RR: 8.56) was located in the Southeast and South regions. The Poisson model identified seven clusters, with three reaching statistical significance, lasting from 30 to 119 days and highlighting large groupings in 2014 and 2015.
Conclusion: To the best of our knowledge, this is the first study to apply SaTScan for the detection of space-time clusters of ISRR using both the Poisson (aggregated data) and Bernoulli (individual-level data) models simultaneously. ISRR occurred predominantly in girls, peaked in the early years of vaccine introduction, and were generally mild with favorable outcomes. This pattern, consistent with international literature, reflects the influence of psychosocial factors. Identifying space-time clusters enabled the detection of temporal and geographic patterns of occurrence, enhancing surveillance responsiveness. These findings underscore the potential of spatial analysis as a strategic tool for timely public health decision-making.

Introduction: Dengue is an important health disease in Brazil. Risk factors include younger age, low schooling, presence of comorbidities and socio-environmental factors. Objective: To estimate the association between risk factors and dengue seroprevalence in a sample of the adolescent cohort of the Study of Cardiovascular Risks in Adolescents (ERICA), based on data collected in the second wave of the study, carried out in 2018. Method: This is a cross-sectional study with data from a sub-sample of adolescents from the second wave of ERICA. Absolute and relative frequencies were calculated for the analysis. The Shapiro-Wilk test was used to assess normality. The dependent variable was a positive or negative result for DENV IgG, and the independent variables assessed were gender, age, socioeconomic status and BMI classification. Poisson regression with robust variance was used. The final model was chosen on the basis of the AIC/BIC criteria and included the key variables gender and age. Results: 160 participants were assessed, 80% of whom tested positive for dengue. The average age was 20 years (min. 16/max. 23). The majority were female and more than half declared themselves to be brown or black. In terms of socio-economic status, just over half belonged to the wealthier socio-economic classes (A and B1). The majority had a normal BMI and did not report any comorbidities. In the Poisson regression with robust variance, participants belonging to the least wealthy socioeconomic class had a 14.8% higher prevalence compared to those of high socioeconomic status (PR = 1.17; 95%CI: 1.00-1.35; p = 0.044). Being overweight was significantly associated with dengue seropositivity, with a 17.8% higher prevalence than those with a normal BMI (PR = 1.20; 95%CI: 1.03-1.39; p = 0.016). The variables gender and age were included because of their theoretical/epidemiological relevance; they showed no statistically significant associations. Conclusion: The risk factors associated with dengue positivity among adolescents in the second phase of ERICA in 2018 were excess weight and socioeconomic status. In addition to the well-known socioeconomic status as an important predictor of dengue, the findings reinforce the association between nutritional status and susceptibility to infection, emphasizing that individual factors, such as excess weight, should also be considered in the formulation of disease surveillance, prevention and control strategies.

The COVID-19 pandemic significantly impacted the quality of life of patients affected by the disease. In addition to the loss of functionality caused by the acute infection, Post-COVID Conditions (PCC) have worsened this scenario. PCC are signs, symptoms, and/or conditions that persist or develop four weeks or more after COVID-19 and cannot be explained by an alternative diagnosis. This thesis assessed the prevalence of PCC, its main symptoms, associated factors, and the relationship with quality of life. A prospective cohort study was conducted with patients hospitalized at the Hospital Regional da Asa Norte (Brasília, DF), between August and November 2020. Participants were interviewed by telephone at 3 and 6 months after hospital discharge, using questionnaires on PCC symptoms and the Short-Form Health Survey 36 (SF-36). PCC was defined as the presence of at least one of the 17 symptoms assessed during the interview. The SF-36 is a quality of life questionnaire divided into 8 domains, which can be summarized into Physical Health Component (PHC) and Mental Health Component (MHC). The questionnaire scores range from 0 to 100, where 0 represents the worst and 100 the best health status. Poisson regression with robust variance was used to estimate prevalence  ratios (PR) of PCC and their associated factors, while linear regression was used to analyze SF-36 PHC and MHC scores and their respective 95% confidence intervals (95% CI). The prevalence of PCC was 81% at 3 months and 61% at 6 months. The most common symptoms at 3 months were hairloss (44%), fatigue (42%), and memory loss (39%); at 6 months, memory loss (29%) and fatigue (27%) predominated. Female sex was the main factor associated with PCC: PR 1.28 (95% CI: 1.16–1.41) at 3 months and PR 1.60 (95% CI: 1.34–1.90) at 6 months. Hypercholesterolemia was associated with PCC at 3 months (PR: 1.15; 95% CI: 1.04–1.27); at 6 months, obesity (PR: 1.22; 95% CI: 1.03–1.45) and prone positioning during hospitalization (PR: 1.12; 95% CI: 1.06–1.25) were associated. When comparing cohort data with Brazilian normative values, the scores of PHC and MHC, as well as all SF-36 dimensions (except Mental Health and Social Functioning), were significantly reduced at 3 months. At 6 months, reductions persisted in the dimensions of Role Physical, Bodily Pain, Role Emotional, General Health, and PHC. At both time points, all SF-36 domains were significantly lower among patients with PCC compared to those without PCC. Lower scores in the SF-36 components were associated with various factors. For the PHC, negative predictors at 3 months were: female sex (β: -3.0; 95% CI: -4.7 to -1.3), number of comorbidities (β: -1.1; 95% CI: -1.6 to -0.6), and number of PCC symptoms (β: -1.1; 95% CI: -1.4 to -0.9); at 6 months: female sex (β: -2.5; 95% CI: -4.2 to -0.8), number of PCC symptoms (β: -2.1; 95% CI: -2.3 to -1.8), number of comorbidities (β: -1.1; 95% CI: -1.6 to -0.6), and age (β: -0.1; 95% CI: -0.1 to -0.0).For the MHC, factors associated with lower scores were: at 3 months: female sex (β: -3.1; 95% CI: -5.8 to -0.4) and number of PCC symptoms (β: -1.6; 95% CI: -2.0 to -1.2); at 6 months: female sex (β: -4.2; 95% CI: -6.7 to -1.8), number of PCC symptoms (β: -2.7; 95% CI: -3.2 to -2.3), and number of comorbidities (β: -0.7; 95% CI: -1.4 to -0.0). On the other hand, higher scores in both components were associated with higher family income: for the PHC: 3 months (β: 0.4; 95% CI: 0.1 to 0.6) and 6 months (β: 0.2; 95% CI: 0.02 to 0.4); for the MHC: 3 months (β: 0.6; 95% CI: 0.3 to 1.0) and 6 months (β: 0.5; 95% CI: 0.2 to 0.8).In conclusion, the prevalence of persistent COVID-19 symptoms (PCC) was high, especially among women, and was associated with a significant decline in quality of life in both the physical and mental components. Female sex and the number of PCC symptoms were the main factors associated with reduced quality of life.

Chronic kidney disease (CKD) is characterized as a progressive and irreversible clinical condition that definitively compromises renal function and structure, rendering the kidneys unable to adequately perform blood filtration. This condition frequently triggers comorbidities with high lethal potential, mainly of cardiovascular origin. For patients who progress to end-stage renal failure, transplantation represents the only definitive therapeutic alternative. Renal transplant recipients begin immunosuppressive therapy before the surgical procedure. After graft implantation, induction therapy with biological agents is recommended, especially during the first months post-transplant, aiming to prevent episodes of acute rejection. A significant challenge in the clinical follow-up of these patients is the emergence of opportunistic infections and viral reactivations, a direct consequence of the therapeutic immunosuppression state. Considering the number of studies focused on investigating the blood virome of renal transplant patients in Brazil, this study proposed to investigate the circulating viral profile in this specific population. A total of 95 renal transplant recipients (54 men and 41 women) treated at the University Hospital of Brasília (Federal District, Brazil) were randomly selected for analysis of their viromes. The results demonstrated relative prevalences of 18,8% for Cytomegalovirus (CMV), 20% for HPgV, with an estimated average frequency of 3.15 for Epstein-Barr virus (EBV) and 3.8% for BKV. For HPgV, the phylogenetic analysis performed demonstrated the presence of genotypes 1, 2 and 3. The predominant genotype was 2 (78.9%), which presented with two distinct subgenotypes: 2A (5.3%) and 2B (73.6%). Interestingly, HPgV-1 genotypes reported less frequently in Brazil were also identified, for genotype 1 (10.5%) and for genotype 3 (10.5%).

Cutaneous leishmaniasis (CL) is a parasitic disease that affects approximately 1 million individuals worldwide, especially in tropical and subtropical regions. The CL polymorphism makes diagnosis difficult in health services, as the lesions can be confused with other dermatoses, such as sporotrichosis, paracocidiocomycosis and venous insufficiency. Furthermore, the diagnosis of CL depends on the experience of health professionals, such as tropical dermatologists, and laboratory procedures, making the diagnosis process slow and often late. Automated skin disease identification based on deep learning (DL) has been applied to aid diagnosis. In this study, we evaluated the performance of AlexNet, a DL algorithm, to identify images of CL lesions in patients from the Central-West region of Brazil. A set of 2458 images (up to 10 of each lesion) obtained from patients treated between 2015 and 2022 at the Dermatology Outpatient Clinic of the Hospital Universitário de Brasília were used. Of the total images, 80% were used for training, 10% for testing and 10% for validation of AlexNet in the task of identifying images of CL lesions. We performed three simulations and trained AlexNet to differentiate CL from 26 other dermatoses (e.g., chromomycosis, pyoderma, venous insufficiency). We obtained an average accuracy of 95.04% (95% Confidence Interval: 93.81–96.04), indicating excellent performance of AlexNet in identifying images of CL lesions. We conclude that automated CL identification using AlexNet has the potential to assist clinicians in diagnosing skin lesions and may contribute to the early diagnosis and timely treatment of CL. These results contribute to the development of a mobile application to assist in the diagnosis of CL in health services. Furthermore, this dissertation represents an advance in the application of DL in tropical dermatology, as a new diagnostic tool in CL.

Visceral Leishmaniasis (VL) is an important public health problem with autochthonous cases registered in 24 Brazilian states. The main vector of VL is the sandfly Lutzomyia longipalpis and dogs (Canis familiaris) are the main domestic reservoirs of the protozoan Leishmania infantum. The use of collars impregnated with 4% deltamethrin is associated with chemical control against Lu. longipalpis which may contribute to the emergence of resistance in sandflies. In this work, the susceptibility profile of different Lu. longipalpis populations to pyrethroid deltamethrin in areas where impregnated collars are used to control VL was characterized. The susceptible population of Lu. longipalpis originated from the insectarium of the Insect Biochemistry and Physiology Laboratory of the Oswaldo Cruz Institute/RJ. The field populations came from the cities of Foz do Iguaçu/PR (FOZ), Teresina/PI (TER), Fortaleza/CE (FOR), Caucáia/CE (CAU), Montes Claros/MG (MOC) and Cavalcante/GO (CAV). Sandflies were collected using CDC and/or HP- type light traps installed in peridomicile during 3 consecutive nights, between 5 pm and 8 am. Field populations were exposed to CDC bottle bioassays (Wheaton de 250 ml) impregnated with DD at 21.9 ug/bottle and 30 µg/bottle. DoseResponse (DR) experiments, using doses of 1, 3, 5, 7, 9 and 11 μg/bottle were conducted. The bottles in the control group were impregnated only with acetone. An average of 20 sandflies (♂♂ and ♀♀ mixed) per bottle were used and the exposure time was 60 minutes. Three bioassays were conducted on different days, and the mortality reading was 24 hours carried out by a single researcher. A total of 4,094 sandflies were used in the CDC bottle bioassays. Lu. longipalpis was the most frequently collected species in all localities (94%), followed by Migonemyia migonei (0.7%), Evandromyia lenti (0.5%), Evandromyia sallesi (0.3%) and Nyssomyia whitmani (0. 1%). For DD of 21.9 μg/bottle, populations from the cities of FOZ, MOC, CAV and TER were susceptible, while CAU presented a mortality rate of 87.1%, suggesting resistance and FOR demonstrated a value of 94.9%, suggesting possible resistance. For the DD of 30 μg/bottle, CAU and TER showed the possibility of resistance, but the other populations were susceptible. RR₅₀ varied between 2.27 and 0.54 and RR₉₅ between 4.18 and 0.33, indicating low resistance. The angular coefficient values of the TER, CAU, FOR and MOC sandfly populations showed less homogeneity and a higher frequency of individuals with resistance alleles. The length of time collars were implemented in each city may have influenced the susceptibility of the populations analyzed. It is suggested to use the CAV population as LRS for future studies on the susceptibility of sandflies to insecticides. The majority of populations of Lu. longipalpis were susceptible to the pyrethroid deltamethrin in areas where impregnated collars were used, except the Caucaia/CE population which was resistant to the DD of 21.9 μg/bottle. Resistance monitoring of the Lu. longipalpis should be carried out in new areas, in order to support VL control actions in Brazil.

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a serious challenge to public health, with significant morbidity and mortality, especially in Latin America. The pathogenesis is not well understood, and the immune response, as well as the clinical aspects of the disease, may be influenced by host habits such as dietary intake and physical activities. In fact, physical exercise (PE) may be a promising non-pharmacological alternative to improve host well-being and eventually for a better outcome of CD. This study aims to evaluate the long-term repercussions of a high-fat diet (HFD) and the capacity of moderate aerobic physical training in the acute phase of T. cruzi infection in female BALB/c mice. Furthermore, to verify the long-term consequences of this training conducted in the initial phase of infection. The animals were fed either a standard diet (SD) or HFD for 4 weeks, infected or not with T. cruzi, and trained or not on a treadmill for 6 weeks. Tests of maximal aerobic capacity (MAC) and strength were performed before, midway, and at the end of the training period. The dietary pattern was maintained throughout the experiment. After 90 days post-infection (dpi), the animals were euthanized. Serum cytokine levels were measured, parasite load quantified by qPCR, and histopathological analysis of different tissues was conducted. Infected mice were able to perform daily aerobic training at 60% of MAC. In the absence of training, muscle strength decreased with infection. HFD proved detrimental to muscle strength, even in uninfected mice. Likewise, this diet caused more inflammation in white adipose tissue (WAT), brown adipose tissue (BAT), and large intestine, especially in the presence of T. cruzi. HFD also increased parasite load in WAT and BAT. Physical training conducted in the acute phase of infection did not influence parasite load in the chronic phase and did not cause tissue alterations, except for BAT, which showed a higher degree of inflammation in trained mice. Given the variation in exercise adherence, the results of post-infection physical training require further investigation.

Background: Yellow fever (YF) is a mosquito-borne arboviral disease with high lethality rate. Although there is a vaccine, outbreaks of YF continue to occur in Africa and the Americas, so it is essential to know people's exposure to wild YF vectors. Here we analyze the effects of environmental, host and anthropic variables on sampling point-specific density of mosquitoes and estimate the risk of exposure of humans to yellow fever vectors in Brasilia National Park (PNB), Brazil.  Methods: We captured mosquitoes during the day at 30 sites with different levels of human use in the PNB in 2020. At each site we measured environmental variables such as distance to the edge of the forest, minimum width of the forest, proximity to watercourses, temperature, humidity, presence of non-human primates and number of birds. Density (females captured at the site) and detection (probability of capture at the site) were analyzed to estimate the risk of exposure to mosquitoes using the n-mixture model.  Results: We collected 4077 mosquitoes belonging to 24 species, mainly Sabethes albiprivus in forests with high human use. Haemagogus janthinomys was collected more in wider forests and Hg. leucocelaenus in sites far from the watercourse. Aedes albopictus, Ae. scapularis, Ae. serratus were collected more in forests with high human use, unlike Psorophora ferox. The highest exposure was observed for Sa. albiprivus, followed by Hg. leucocelaenus and Hg. janthinomys; in sites where there is a higher density of mosquitoes, a person could be bitten by up to 10 mosquitoes/hour.  Conclusions: The modeling of mosquito density considering environmental variables and capture effort allowed us to calculate the level of exposure of people per site in the BNP. Our results support the surveillance of AF vectors considering the complex interaction between the environment, mosquitoes, and humans. This information can help target more effective prevention measures in risk areas.

Introduction: The incidence of infections caused by multidrug-resistant bacteria has reached alarming levels globally. The emergence of antimicrobial resistance has become even more evident during the COVID-19 pandemic, due to the indiscriminate use of antibiotics, resurgence of neglected diseases, and increase in secondary bacterial infections, such as those caused by Pseudomonas aeruginosa. This bacterium develops resistance through genetic mutations and natural selection due to antibiotic use, resulting in multidrug-resistant strains. This phenomenon leads to therapeutic failures and unfavorable outcomes in an increasing number of cases. In this context, non-drug approaches, having a lower impact on selection and resistance, emerge as new therapeutic perspectives. Bacteria of the genus Lactobacillus are widely employed as probiotic supplements, but their colonization from the diet is limited. On the other hand, the metabolic products of Lactobacillus - postbiotics - although still little explored in medicine, have already demonstrated antimicrobial potential. This potential can be better exploited concerning the decolonization of pathogenic agents, in addition to avoiding the selection of multidrug-resistant strains. This study aimed to investigate the effect of postbiotics from Lactobacillus rhamnosus and Lactobacillus reuteri and sodium butyrate (NaBut) salt on the growth of P. aeruginosa. Materials and Methods: Growth curves for bacteria were performed following the Minimum Inhibitory Concentration (MIC) protocol, as standardized by BrCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) for broth microdilution assay, with adaptations. The Lactobacillus spp. were cultured for 48 hours at 37 ± 1°C in MRS Broth. The P. aeruginosa strain underwent pre-culture in aerobiosis for 24 hours at 37 ± 1°C in Mueller Hinton (MH) Broth. To obtain the postbiotic of Lactobacillus spp., pure and fresh cultures were used, subjected to centrifugation and then filtered with a sterile membrane filter. The media for the MIC assays were prepared with MH Broth supplemented with species-specific postbiotics (v/v) of L. rhamnosus and L. reuteri, or with initial concentrations of 50 mM of NaBut. Results: The results show a reduction in the growth of P. aeruginosa in the presence of postbiotics from L. reuteri and L. rhamnosus, varying the concentration between 50% and 0.39% (v/v). For the tests using NaBut, the data show reductions in the growth of P. aeruginosa at concentrations from 50 mM to 3.1 mM. Conclusion: Both Lactobacillus spp. postbiotics and NaBut were able to reduce the in vitro growth of P. aeruginosa in a dose-dependent manner. It is important to highlight that the data presented are preliminary and require further studies to identify the possible molecules responsible for the observation. However, the preliminary data indicate that postbiotics have an inhibitory effect on the pathogenic bacterium and, in the future, could be used as complementary approach to clinical treatments. Besides having the advantage of a lower impact on the selection of resistant strains, postbiotics stand out for their cost-effectiveness and the possibility of being offered in economically vulnerable regions.

Cryptococcus neoformans is an encapsulated fungus, with the polysaccharide capsule being one of the main virulence factors, responsible for masking pathogen-associated molecular patterns (PAMPs) in the fungal cell wall. This prevents efficient recognition by the immune system, reducing phagocytosis and other microbicidal responses. It is known that, in the absence of opsonins, antibodies or complement molecules, in vitro phagocytosis rates of C. neoformans are extremely low. However, macrophages, although crucial in the immune response to the fungus, can act as intracellular hosts, allowing pathogen replication. This study aimed to investigate whether the internalization of the fungus mediated by antibodies or complement molecules alters the interaction between C. neoformans and macrophages in vitro. Internalization pathways mediated by Fc and CR receptors were explored, and the effect of blocking these pathways with specific antibodies was evaluated by phagocytosis assays. Under the conditions tested, we observed only a partial reduction in internalization. Next, interaction assays were performed in which macrophages were exposed to C. neoformans cells previously opsonized with serum or with the anticapsular monoclonal antibody 18B7. After two hours of infection, macrophages were collected for RNA extraction and gene expression analysis by RT-qPCR to evaluate the activation of genes related to the fungal immune response, such as TNF-α, IL-10, IL-6, arg1 and iNOS. Surprisingly, our results did not demonstrate significant changes in the expression of 12 genes associated with the immune response of macrophages against fungi compared to the control, or even between the samples opsonized with serum or with the antibody. These results suggest that we need to further explore the possible differences in the immune response triggered by the internalization of the fungus by these two opsonins, possibly by exploring other genes, and also other interaction times between the cells.

Introduction: Despite acquired syphilis permeating centuries and still affecting millions of people, today it is present in a scenario with the availability of computerized social media technologies and Pre-Exposure Prophylaxis (PrEP), which prevents HIV but requires other mechanisms for preventing other Sexually Transmitted Infections (STIs). Objective: To analyze the incidence, associated factors, and predictive models of acquired syphilis among PrEP users and to explore the use of applications (APPs) for sexual encounters in individuals with syphilis. Materials and Methods: Four distinct studies were conducted. (i) A systematic review of the scientific literature, analyzing articles published between 2012 and 2023 that researched PrEP users with the outcome of acquired syphilis. Descriptive synthesis and quality analysis of the selected studies were performed. Then, (ii) a retrospective electronic cohort with data from PrEP users across Brazil from 2018 to 2020. From this cohort, we developed and tested the following machine learning models: decision tree (DT); k-nearest neighbor (kNN); generalized linear models (GLM); random forest (RF); and stochastic gradient boosting (GBM). Predictive models were analyzed (iii). Finally, (iv) a cross-sectional survey was conducted in a rapid testing and counseling service for sexually transmitted infections, located in Brasília, Federal District, Brazil, between 2020-2021, with individuals newly diagnosed with acquired syphilis. Results: In the systematic review, 35 out of 4,412 studies were selected, almost all with high or satisfactory quality. The incidence of syphilis during PrEP ranges from 7 to 14 per 100 person-years (/100-PY). Associated factors found include: age 35 years or older, men who have sex with men (MSM), history of STIs, and longer time on PrEP. In the cohort conducted in Brazil, of the 19,820 individuals effectively followed, the incidence rate of acquired syphilis was 19.1 cases/100-PY. Independently associated factors were identified. After applying the models to the cohort data, it was possible 19 to obtain and validate the predictive models, with the GBM model showing an area under the curve (AUC) = 0.706. Regarding the use of apps for sexual encounters, of the 138 individuals interviewed, 58.7% used them, mainly Grindr®️ (38.4%) or group messaging (31.2%). The use of APPs for sexual encounters was independently 5.17 times more likely (95% CI 1.99–13.46) in individuals aged 30 or younger, 5.17 times (95% CI 1.35–19.77) in bisexuals, 4.68 times more (95% CI 1.58–14.39) in homosexuals, and 11.13 times (95% CI 4.21–29.40) more likely in those who had anonymous sexual partners in the last 12 months. Conclusion: The incidence of acquired syphilis in PrEP users is quite high, with a subgroup of users more vulnerable to the infection, who could benefit from specific strategies. Using PrEP user data, it was possible to apply machine learning for predictive models of syphilis. Additionally, the use of apps for sexual encounters is common among people with recent diagnoses, and this association should be better understood in future studies.

The parasitic protozoan Giardia duodenalis (‘Giardia’ hereafter) is a leading global cause of diarrhea. As with many other intestinal pathogens, Giardia diagnosis typically involves detecting parasite presence in stool samples. However, not all stool samples drawn from infected individuals contain parasites (due to irregular parasite shedding), and no test can detect the target parasites in 100% of the samples that indeed contain those parasites (due to imperfect test sensitivity). Disentangling the effects of irregular shedding and imperfect sensitivity on parasite detection would help us better understand both transmission dynamics (which heavily depend on parasite-shedding probabilities) and diagnostic-test performance (of which sensitivity is a critical component). Here, we illustrate an approach to separately estimating, under the assumption of no false-positives, the probabilities of Giardia shedding in the stool of infected hosts (denoted θ) and of Giardia detection in Giardia-positive stool samples (true test sensitivity, denoted p). With this information, we then derive corrected estimates of host-infection frequency (Ψ). We collected 1–3 stool samples, in consecutive weeks, from 276 children (4–73 months) attending 8 kindergartens in 4 urban sectors of the Federal District, Brazil. Samples were processed by the spontaneous-sedimentation method and examined via optical microscopy by two independent observers – an expert parasitologist and a graduate student. Using these replicate test results and multi-level hierarchical models, we estimated the probability of Giardia shedding: θ=0.44. We found no evidence that shedding changed with child gender or age, or between stool sample-collection days; that test sensitivity depended on child age; or that infection frequency changed with child age or varied among urban sectors. The average probability that an expert observer, using a single test, detects Giardia in a stool sample drawn from an infected child was estimated at  0.28. Therefore, reaching upper limit of the probability requires increasing θ, which in turn requires drawing, then pooling, replicate stool samples. Our analyses suggest, in sum, that ~56% of stool samples drawn from infected children did not contain Giardia. As no specific test can (or should) detect parasites in parasite-free samples, θ =0.44 measures the upper limit of the probability of detecting Giardia in a single stool sample drawn from an infected child. The only strategy capable of taking this probability beyond this limit is to draw-and-pool replicate samples; with 4 pooled samples. By allowing estimation (and modeling) of pathogen-shedding probabilities (θ), the approach we illustrate paves the way to studying pathogen transmission cycles and performance of microscopy-based diagnostics used in routine practice in unprecedented detail. 

Amphibians of the Urodela order, salamanders and newts, comprise a rich source of molecules with bioactive properties, especially those isolated from the secretion excreted in the skin, with antimicrobial, antioxidant, vasoactive properties, modulating the immune system, among others. In 2020, the COVID19 disease pandemic began, caused by the severe acute respiratory syndrome virus coronavirus 2 (SARS-Cov-2), which resulted in thousands of deaths. This highlighted the importance of studies of new substances to guide the production of therapeutic and prophylactic drugs for infectious diseases. Considering this, this work aimed to carry out a literature review regarding molecules from urodels, with emphasis on their biological activities and to synthesize and evaluate the anti-SARS-Cov-2 activity of a peptide identified in the transcriptome of the fire salamander (Salamander salamander). The literature presents several classes of urodelar molecules, especially peptides and alkaloids. The identified and synthesized peptide, defensin SS-1, belongs to the class of defensins and the in silico 3D molecular docking experiment performed between the enzyme-linker complex with Spike WT RBD/hACE2 and the peptide linker demonstrate its interaction with the binding site active. Although further studies are needed, the preliminary impact of SS1 defensin evaluated in silico in assay illustrated its potential as a promising molecule for drug development in the treatment of COVID19 disease.

Leprosy is considered a serious public health problem worldwide. It is a disease caused by Mycobacterium leprae with high potential to induce incapacitation. Low treatment adherence is responsible for transmission outbreaks, incomplete cure, therapeutic resistance and increased patient´s irreversible damage. During Covid-19 pandemic, started on March 11 of 2020, according to the World Health Organization, several patients did avoid to seek public health services due to social isolation measures. Thus, the retrospective, observational study aimed to evaluate treatment adherence in patients with leprosy followed at the University Hospital of Brasília-DF before and during the Covid-19 pandemic. The study included 71 patients, older than 18 years old, who started and completed leprosy treatment between January 2018 and December 2021. Sociodemographic and clinical data was collected from patient´s monitoring forms and electronic medical records. Adherence to treatment was measured based on the percentage of drug refilled at the Dermatology outpatient clinic of HUB in first 6 months for PB patients and the first 12 months for MB patients. Adherent patients were considered those who used at least 80% of the total number of pills recommended for leprosy treatment. The study showed that 90.1% of the patients had adherence to the treatment, 53.5% were female, 71,8% were brown and the age mean were 44.5±12.9 years. Comparing adherent and non-adherent patient´s groups regarding sex, age, race, previous treatment, adverse reactions, polypharmacy, single treatment, and leprosy episode, we did not observe any statistical difference. But, comparing these groups regarding the presence of comorbidity, we observed a higher frequency of comorbidity in the non-adherent group (85.7%) than in the adherent group (32.8%), with p value = 0.0105. We also observe that patients that receive the leprosys treatment during the Covid-19 pandemic had higher tendency for non-adherence, in comparison with those treated without the influence of Covid-19. This study showed that patients with comorbidities are more non-adherent, and also shown that pandemic did not have significative influence on patient´s treatment for leprosy, despite the tendency of higher non-adherence in patients treated during the Covid-19 pandemic.  Those facts demonstrate that it is necessary implement public policies to help health professionals to maintain the existing care and assume co-responsibility for those patients who tend not to accept the disease and treatment, avoiding the evolution of the disease, as well as its possible complications and streaming.

ABSTRACT: Introduction: The National Immunization Program (PNI) through the vaccines of the basic schedule has been promoting the eradication, elimination, or reduction in terms of incidence, severity, and lethality of various infectious diseases. This fact can be proven with the eradication of smallpox in 1980 and the elimination of polio in the country in 1994. However, in recent years there has been a decline in vaccination coverage (VC), leading Brazil to face significant outbreaks of wild yellow fever and measles. These VC indicators are mostly based on the number of doses applied contained in the information system and do not allow the analysis of factors that lead to non-vaccination, thus, the household vaccination survey is essential for adequate monitoring of vaccination programs, identification of children who are delayed on their vaccination schedule and the factors that lead to this non-vaccination. Objective: The present study estimated vaccination coverage and analyzed the factors associated with incomplete vaccination schedules in children from six months to under five years old in Primary Health Care Units (PHCU) 01 and 04 of Riacho Fundo II in the Federal District. Method: A standardized questionnaire answered by the child's mother or guardian and photographic record of the vaccination card were used. A total of 162 probabilistically selected people were interviewed in the PHCU territories. The study estimated vaccination coverage, the proportion of incomplete vaccination schedules, and used Prevalence Ratios (PR) and their confidence intervals (CI 95%) to estimate the associations between independent variables and the outcome in question (incomplete vaccination schedules), for this purpose, a Poisson regression with robust adjustment was employed. Results: 80% (130/162) of the children evaluated had a complete vaccination schedules. However, none of the vaccines evaluated reached the vaccination coverage recommended by the Ministry of Health, considering the doses administered correctly in terms of age and interval between doses. The results ranged from 46.91% (CI 95%: 39.04%-54.90%) to 77.16% (CI 95%: 69.92%- 83.38%) for the pentavalent and rotavirus vaccines, respectively. Considering only valid doses, that is, doses applied from the recommended minimum age and with an interval equal to or greater than the recommended one, the results were more favorable, ranging from 93.29% (CI 95%: 88.80%- 96.73%) to 99.39% (CI 95% : 96.61%- 99.98%), for the varicella and pneumococcal vaccines, respectively. Factors associated with incomplete vaccination schedules were age under 2 years (adjusted PR: 2.55, CI 95% -1.53-4.24), indication of difficulties arising from the Covid-19 pandemic by those responsible (adjusted PR: 2.71, CI 95% - 1.51-4.86), and a negative response when asked if all vaccines were administered in the same location (adjusted PR: 1.97, CI 95% - 1.13-3.44). Conclusion: The results showed that vaccination coverage did not reach the goals recommended by the Ministry of Health, although it was more favorable when considering only valid doses. In addition, age under 2 years, difficulties arising from the Covid-19 pandemic, and lack of vaccination in the same location were identified as factors significantly associated with incomplete vaccination schedules. These findings highlight the importance of understanding local factors and knowing vaccination coverage to achieve the goals recommended for VC.

Introduction: The search for new molecules is important to counteract the large number of infectious agents, diseases and conditions through the mechanisms of drug resistance and tolerance. Alkaloids are a broad group of molecules whose biological activity has been increasingly explored due to their ability to interact with cell receptors and proteins. Epiisopilosin (EPIIS) obtained from the species Pilocarpus microphyllus has low cytotoxicity and anti-inflammatory effects. Considering the function of macrophages in the immune system, this study evaluated the effect of different concentrations of EPIIS on the innate function of immortalized macrophages/microglia. Material and Methods: This is an experimental, descriptive and in vitro study carried out with C20 (human microglia) and BV2 (murine microglia) cells to evaluate the effect of different concentrations of EPIIS on cell viability (MTT method and chemiluminescence), cell adherence on coverslips, and by flow cytometry, the production of reactive oxygen (EROS) and nitrogen (ERNS) species, the production of lipid corpuscles (LC) and cytokines; by morphological method, the phagocytic index (PI) and the production of the superoxide radical were assessed (O₂^º). Results: 1) the different concentrations (0.5 to 128 µg/mL) did not affect the mitochondrial metabolism of C-20 cells when incubated for 24 h (MTT test); 2) chemiluminescence showed that 1 or 4 at 32 µg/mL increased the mitochondrial activity/viability of C-20 cells, but reduced it with 128 µg/mL; 3) incubation of BV-2 cells with 0.5 µg/mL/2h or with 32, 64 or 128 µg/mL for 24 h increased the % of viable cells (MTT test), but the other concentrations did not affect the mitochondrial metabolism of the cells (2 or 24 h); 4) there was a reduction in the % of adhered C-20 cells by incubation for 24 h with 4.0 or 64.0 µg/mL; 5) the highest concentration (64.0 µg/mL) increased the stimulated or basal production of EROS and the basal production of ERNS by C-20 cells; 6) the stimulated production of ERNS (LPS or LPS + TNF) was inhibited by C-20 cells with 64.0 µg/mL; 7) the basal production of CL was higher in C-20 cells with 0.5 µg/mL, but the stimulated one (LPS) was inhibited with 64.0 µg/mL; 8) the lowest concentration (0.5 µg/mL) increased the basal production of IL-17A in C-20 cells, but was inhibited in the presence of LPS at 0.5, 4.0 or 64.0 µg/mL; 9) the three concentrations of EPIIS did not affect the basal production of the cytokines IL-2, IL-6, NTF, INF, IL-4 or IL-10 in C-20 cells; 10) 4 µg/mL/2h increased the IF of BV-2 cells by the highest % of phagocytizing cells (%cels), while 0.5 or 4.0 µg/mL for 24 h reduced the IF by the lowest %cels and the lowest number of yeasts ingested (Mlev). As for the incubation time (2 or 24 hours) with BV-2 cells, the results showed that: 11) there was a reduction in the production of the O2º radical at the three concentrations at 2 h, but not at 24 h; 12) compared to 2 h, there was an increase in Mlev at 64 µg/mL/24 h; 13) the IF was higher at 24 h in the control, than at 2 h, due to the higher %cels and Mlev; 14) the production of the O2º radical was higher at 64 µg/mL/24 h, compared to 2 h. Conclusion: All the functional tests showed that the three concentrations of EPIIS affected the mitochondrial activity of microglia, the expression of adhesion receptors, the production of EROS and ERNS, the production of lipid corpuscles/cytokines and phagocytic capacity, demonstrating the potential of EPIIS to modulate the innate immune response of microglia, thus suggesting the continuation of studies aimed at future biomedical applications in vivo.

Background & objectives: Measles is a highly contagious infectious disease with possible lethal consequences; though, it is preventable through vaccination. Vaccination/immunization has proven to be the most efficient measure in preventing and reducing incident cases and deaths caused by the measles virus amongst the population. This study aims at analyzing the seroprevalence of measles within the SCIA- Estrutural-DF community, and to identify the factors associated with the presence of the virus. Methods: Sero epidemiological survey was conducted with a sample size of 890 individuals. After seeking participants' consent, interviews were conducted, and blood samples were collected for serological testing, employing the ELISA technique, to detect IgG antibodies. The data collected were subsequently processed using the software application Jamovi version 2.3.21 and subjected to analysis through descriptive and Poisson statistical methods. Results: The estimated overall seroprevalence was 633/890 [71.1%; 95% CI: 68.0%-74.0%]. The mean age of the general population was 38.4 years (95% CI 35y-42y), standard deviation 14.5, median age 38 years. Regarding gender, 581/890 (65.3%; 95% CI 62.2-68.4) were female; of these, 417/581 (71.7%; 95% CI: 70.0-73.0) were seropositive. There was a high (83% CI 95%; 80.3-85.7) prevalence of seropositives in the 41-60, and >60 age groups (92.6% CI 95% 90.9%-94.3%)], Statistically analyzed after adjustments, the 0-19 age group had an 18% higher prevalence of antibodies [RP 1.18 CI 1.04-1.33 p= 0.009) when compared to the 20-40 age group, as well as 61% (PR 1.61 95% CI 1.19-2.19, p<0.002)) higher prevalence for the over-60years age group when compared to the 0-19years age group. Conclusion: Actions are required to enhance vaccination coverage among the population of the SCIA-Estrutural AR community and to homogenize the distribution of seropositive individuals across different age groups through proactive immunization. Subsequent studies will be necessary to evaluate the levels of measles antibodies in the studied population, as well as further studies needed to confer the level of antibody titers among the population.

Introduction: PrEP (Post Exposure Prophylaxis) consists of the use of antiretrovirals used by patients who are at increased risk of HIV infection. It is an effective epidemic control strategy, however if fully adopted.  Objective: To describe the profile of patients using PrEP and the factors associated with dropout and discontinuation rates in Brazil from 2018 to 2020. Materials and Methods: Four studies were developed.  The first, cross-sectional, evaluated the difference in profile between users of a PrEP, service and another for STI screening.  The second, case-control that investigated the factors associated with dropout rates in the first 30 days of therapy.  The third, case-control, showed the factors associated with discontinuing PrEP for reasons such as: poor adherence to the medication, adverse events, acute HIV infection.  The last, a cohort that evaluated the risk behavior of patients before and after starting PrEP.  Data came from primary databases, collected from 2020 to 2021 at a PrEP service at a tertiary hospital and at a public Testing and Counseling Center in the Federal District, Brazil. Secondary data were extracted from SICLOM, totaling 34,000 people and containing data from users of the national database from 2018 to 2020. Results: The study showed that PrEP users are homosexual or MSM (89%), with a mean age age of 33 ± 9 years;  68% with more than 12 years of study.  Before starting PrEP, 10.4% did not use condoms and after that it increased to 24.7%, showing some risk compensation.  Dropout rates in the first 30 days were 22.25% and the main factors were: sexual orientation (ORa: 0.81; 95%CI:0.71-0.91; p<0.01), race (ORa: 1.15; 95%CI: 1.08-1.22 p<0.001), education (ORa:1.54; 95%CI: 1.35-1.76 p<0.001), reason for seeking PrEP (ORa:1.21; 95%CI:1.14-1.30, p<0.001) , PEP use (ORa:0.94, 95%CI: 0.91-0.98, p<0.001), frequency of condom use more than half of the time (ORa: 0.8595%CI: 0.78-0.93, p<0.001), sex in exchange of money(ORa: 0.82CI95%: 0.73-0.91, p<0.001), use of substances, such as: poppers (ORa: 0.65, CI95%: 0.54-0.78, p<0.001), cocaine (ORa: 1.22, CI95%: 1.08-1.37p=0.002), clubs drugs (ORa: 0.79, CI95%:0.70-0.89, p<0.001) and erection stimulants (ORa: 0.64, CI95%: 0.56-0.72, p<0.001) and symptoms of acute viral infection (ORa: 0.80, 95%CI: 0.71-0.89, p<0.001) .  The interruption had the following profile: 83% were men, aged between 30-39 years (34%), motivated by: 23.3% due to changes in tests, 9.0% adverse events, 4.3% due to a positive HIV test, 3.4% due to low medication adherence and 59.8% due to their own decision.  Conclusion: The data points to inequality in the access of the most vulnerable populations regarding the risk of HIV infection, requiring policies that make this strategy more inclusive.  Even after starting PrEP, patients are still exposed to risks, neglecting effective non-pharmacological preventive measures, especially for other types of STIs.  In addition, it was found that the abandonment and interruption of patients have generated challenges in adherence, which can directly affect the good efficacy of the therapy.

INTRODUCTION: The World Health Organization estimates that in 2021, approximately 247 million people worldwide were afflicted by malaria, resulting in over 619,000 deaths. In Brazil, malaria is a serious public health issue, particularly in the Amazon region (AMZ), which accounts for 99% of the country's cases. The extra-Amazon region of Brazil registers a higher incidence of imported malaria cases compared to autochthonous cases. Therefore, one of the strategies of the National Malaria Control and Prevention Program is to eliminate the disease by 2035. To reach that the program focus on control strategies in the AMZ region and the prevention of outbreaks in the extra-Amazon region. In 2021, Brazil reported more than 137,000 autochthonous cases of malaria and 61 deaths. Despite the magnitude of malaria in Brazil, uncertainties still exist regarding the factors related to deaths in the country. OBJECTIVES: This thesis aims to describe and analyze the epidemiological scenario of malaria in Brazil from 2011 to 2022 to understand the current situation and anticipate case occurrences in the coming years. Additionally, it seeks to identify factors associated with malaria deaths in Brazil in order to prevent and eliminate such occurrences. METHODS: This thesis comprises four studies analyzing malaria case and death data from 2011 to 2022. Two of these studies have a cross-sectional design, describing and characterizing the epidemiological profiles and scenarios of the AMZ and non- AMZ regions of Brazil, including the development of predictive models (forecasting). The third study is of cross-sectional and methodological nature, reports data record linkage processes that can contribute to improving the quality of malaria death information and enhance death investigation activities. The fourth study is a case-control study, describing the epidemiological profile of malaria deaths among Brazilian residents and investigating factors associated with these deaths. Open data were used for the first two studies, while nominal data were used for the latter two. The research was approved by the Research Ethics Committee of the School of Medicine at the University of Brasília. RESULTS: In the extra-AMZ region, a predominance of imported cases from other countries and the Brazilian AMZ region was identified, mainly related to individuals' occupational activities. In the AMZ region, locally transmitted cases predominate, and the prospective scenario suggests the possibility of malaria elimination in Brazil by 2035. However, this requires overcoming challenges, especially in the states of Amazonas and Roraima, as well as in mining areas and among indigenous populations. Deaths in the country have been increasing since 2019, with higher lethality in the extra-AMZ region, mainly due to cases imported from other countries and high parasitemia infections caused by species such as P. falciparum, P. ovale, and P. malariae. In the AMZ region, deaths are predominantly due to P. vivax infections, with risk factors associated with delays in detection/diagnosis, infections in indigenous areas, infections in children under one year old and adults over 40 years old, high parasitemia, and passive case detection. CONCLUSIONS: This thesis provided a comprehensive understanding of the malaria scenario and epidemiological profile in Brazil, highlighting temporal variations over the years and future case occurrence trends. Furthermore, record linkage techniques allowed investigation of related and associated causes of malaria deaths, offering insights into how this knowledge and these techniques can strengthen public health policies and assist Brazil in its goal to eliminate malaria by 2035.

Human herpesviruses, including Cytomegalovirus (CMV), Epstein Bar virus (EBV, and human Herpesvirus type 6 (HHV-6), are considered important pathogenic agents in immunosuppressed patients, especially when it comes to kidney transplant recipients. Infection with these viruses can cause serious problems for the transplanted patient, and may lead to episodes of rejection and graft loss. There are no studies on the prevalence of human herpesviruses CMV, EBV and HHV-6 in transplanted patients in the Federal District. The study aimed to evaluate the prevalence of these herpesviruses in plasma samples from 170 kidney transplant patients monitored at the University Hospital of Brasília. Also, the prevalence found was correlated with gender, post-transplantation time and treatment regimen with immunosuppressants. After extraction of nucleic acids from the plasma, the samples were tested by means of real-time PCR for each of the studied viruses. you. The results showed a prevalence of 20% (34/170) for CMV, 1.7% (3/170) for EBV and 0.6% (1/170) for HHV-6. There was no statistical difference in the prevalence of any virus evaluated between men and women. Furthermore, it was observed that the prevalence of CMV decreases with time post-transplantation, and that the immunosuppression scheme seems to influence the appearance of the infection; while the immunosuppressants sirolimus and everolimus seem to exert a protective effect against CMV infection, the immunosuppressants mycophenolate and tacrolimus seem to favor the infection. The results of this work allow knowing the real prevalence of these herpesviruses in kidney transplant patients in the Federal District, and may serve as a basis for defining protocols aimed at preventing these infections in this population

Introduction: Cryptococcosis is an infectious disease caused by fungi of the genus Cryptococcus recognized as an important threat to the health of people with cellular immunity deficiency, with potentially fatal cases of meningitis in AIDS patients, being in this population, the third most opportunistic infectious disease prevalent. Latin America is the third global region with the most cases and deaths from cryptococcosis, with an in-hospital case fatality ranging from 30 to 60%. In Brazil, cryptococcosis is the main systemic and opportunistic mycosis associated with deaths in AIDS patients. This yeast is acquired via inhalation and can cause infection in animals and humans, with the ability to infect all organs of the body, from the skin, lungs, and CNS. Neurological involvement requires early recognition and specialized management, especially in the face of intracranial hypertension. Antifungal therapy directed at the pathogen is usually performed with amphotericin B, 5-flucytosine, or fluconazole. Medications such as corticosteroids, acetazolamide or mannitol are not suitable for the management of intracranial hypertension, and this must be controlled with CSF drainage either by lumbar puncture or CSF shunts. Methods: Observational, analytical, descriptive, and retrospective study of the historical cohort type, with the main objective of knowing the epidemiological profile of patients with cryptococcosis in the Federal District and the determinants of lethality in the federal capital from 2014 to 2019. Secondary data extracted from medical records were used. of patients with cryptococcosis in this period. The inclusion criteria established patients from the public health system of the Federal District of Brazil with any positive sample for fungi of the genus Cryptococcus. Patient screening was performed using data obtained from the Central Laboratory of Brasilia or from the laboratory of the University Hospital of Brasilia. Sociodemographic and clinical variables were evaluated. Results: 100 patients were evaluated, with a mean age of 40.1 +/- 17 years, with most patients between 19 and 60 years. Males represented 70% of patients and Cryptococcus neoformans was the most prevalent species. The CNS was affected in 89% of the cases and co-infection with HIV was identified in 66% of the patients in the study, with marked immunosuppression as shown by the median CD4 of 49 cells/mm3. The diagnosis of intracranial hypertension occurred in 41% of the participants with a median opening pressure of 33.5 cm H2O, however the opening pressure was not evaluated in 44% of the patients. Lethality at 2 and 10 weeks was 26.9% and 38.7%, respectively. Conclusion: Cryptococcosis represents a major challenge for public health, given the costs of management, the priority involvement of people of working age, lack of knowledge of professionals regarding the diagnosis and treatment of cryptococcosis and its complications.