Background: Brazil has witnessed the co-circulation of dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV), with outbreaks exacerbated by environmental factors, social determinants, and poor sanitation. The recent re-emergence of Oropouche virus (OROV) has added complexity to vector control strategies, emphasizing the need for integrated approaches to curb arboviruses spread. We aimed to analyze temporal trends and spatial distributions with national scope of these emerging arboviruses. Methods: An ecological study using data from the Brazilian Notifiable Diseases Information System the period from 2023 to 2024 was undertaken. Temporal trends were evaluated using Joinpoint regression, while spatial analysis was conducted using Moran’s I, and local indicators of spatial association. Results: Dengue fever cases increased by 322%, while Oropouche fever (OF) increased by 300%. The states of Amazonas and Espírito Santo reported increases in OF cases. Moran’s I test revealed spatial clustering of DENV and CHIKV. Two municipalities in the state of Mato Grosso do Sul showed cocirculation of DENV, CHIKV, and ZIKV. Conclusions: This study identified a surge in arbovirus cases between 2023 and 2024, with peak incidences from January to March and October to December, linked to favorable climatic conditions. Clustering patterns and co-circulation of arboviruses highlight the need for tailored control and prevention strategies and targeted interventions to mitigate their impact.

Urinary extracellular vesicles (uEVs) and immune mediators have emerged as potential minimally invasive renal biomarkers. Even though active lupus nephritis (LN) is associated with immune complex deposition, tissue inflammation, and podocyte damage, it remains unclear how these parameters are simultaneously altered in systemic lupus erythematosus (SLE). Thus, we aimed to evaluate uEVs as biomarkers in LN, in association with urinary immune mediators. In this cross-sectional study, uEVs were isolated from SLE patients and healthy donors by differential centrifugation and characterized and/or quantified by electron microscopy, nanoscale flow cytometry, and nanoparticle tracking analysis (NTA). Urinary immune mediators were assessed by a multiplex assay. We included 82 patients (42.6 ± 11.3 years-old, 91.4% female), of whom 56.1% (n = 46) had LN, and 18 healthy donors (37.5 ± 8.2 years-old, 83.3% female). No differences were found for particle size/concentration by NTA, but higher counts of total (P = 0.03) and podocyte-derived (P = 0.01) uEVs were observed in SLE patients, especially in active LN (P = 0.02; P = 0.03). We also identified higher urinary levels of cytokines such as IL-6, IL-8, and CCL-2 according to SLE activity and LN (P < 0.05). Significant correlations were observed between uEVs, immune mediators, R-SLEDAI-2K, proteinuria, and albuminuria in active LN. Lastly, the combinatory analysis of podocyte uEVs, IL-6, IFN-γ, IL-8, uCCL-2 and CCL-3 showed a good predictive power to detect active LN (AUC = 0.88, P = 0.0009). Our results suggest that urinary podocyte-derived uEVs and cytokines are associated with LN activity, which may reflect podocyte injury mediated by inflammation. Thus, the combined application of these biomarkers could help to identify patients with podocyte damage and renal inflammation.

Kidney injury is an important outcome associated with COVID-19 severity. In this regard, alterations in urinary extracellular vesicles (uEVs) could be detected in the early phases of renal injury and may be reflective of the inflammatory process. This is an observational study performed with a case series of COVID-19 hospitalized patients presenting mild-to-critical disease. Total and podocyte-derived uEVs were identified by nanoscale flow cytometry, and urinary immune mediators were assessed by a multiplex assay. We studied 36 patients, where 24 (66.7%) were considered as mild/moderate and 12 (33.3%) as severe/critical. Increased levels of total uEVs were observed (p = 0.0001). Importantly, total uEVs were significantly higher in severe/critical patients who underwent hemodialysis (p = 0.03) and were able to predict this clinical outcome (AUC 0.93, p = 0.02). Severe/critical patients also presented elevated urinary levels (p < 0.05) of IL-1β, IL-4, IL-6, IL-7, IL-16, IL-17A, LIF, CCL-2, CCL-3, CCL-11, CXCL-10, FGFb, M-CSF, and CTAcK. Lastly, we observed that total uEVs were associated with urinary immune mediators. In conclusion, our results show that early alterations in urinary EVs could identify patients at higher risk of developing renal dysfunction in COVID-19. This could also be relevant in different scenarios of systemic and/or infectious disease.

Introduction: Geographical analyses of antibiotic use identify regions with the highest consumption and help design policies for strategic patient groups. Methodology: We conducted a cross-sectional study based on official data available in July 2022 from Brazilian Health Surveillance Agency (Anvisa). Antibiotics are reported as a defined daily dose (DDD) per 1,000 patient-days, and central line-associated bloodstream infection (CLABSI) is defined according to Anvisa criteria. We also considered multi-drug resistant (MDR) as the critical pathogens the World Health Organization listed. We measured antimicrobial use and CLABSI trends per ICU bed using the compound annual growth rate (CAGR). Results: we evaluated the regional variation in CLABSI by multidrug-resistant pathogens and the antimicrobial use in 1,836 hospital intensive care units (ICUs). In 2020, the leader in use in intensive care units (ICUs) in the North was piperacillin/tazobactam (DDD = 929.7) in the Northeast. Midwest and South were meropenem (DDD = 809.4 and DDD = 688.1, respectively), and Southeast was ceftriaxone (DDD = 751.1). The North has reduced polymyxin use (91.1%), and ciprofloxacin increased (439%) in the South. There was an increase in CLABSI by carbapenem-resistant Pseudomonas aeruginosa in the North region (CAGR = 120.5%). Otherwise, CLABSI by vancomycin-resistant Enterococcus faecium (VRE) increased in all regions except the North (CAGR = -62.2%), while that carbapenem-resistant Acinetobacter baumannii increased in the Midwest (CAGR = 27.3%). Conclusions: we found heterogeneity in antimicrobial use patterns and CLABSI etiology among Brazilian ICUs. Although Gram-negative bacilli were the primary responsible agent, we observed a notable increase trend of CLABSI by VRE.

Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

Cannabidiol (CBD), a non-psychoactive cannabinoid with therapeutic potential, is increasingly used in combination with other drugs, raising concerns about potential interactions and their impact on safety and efficacy. This scoping review aimed to map the current evidence on CBD interactions across different drug classes and assess their clinical significance. The study followed the Joanna Briggs Institute guidelines, utilizing a structured protocol based on the population, concept, and context (PCC) framework. Five databases were searched, and preclinical and clinical studies on CBD pharmacokinetic and pharmacodynamic interactions were included, with publications in English, Portuguese, or Spanish. Out of 136 studies analyzed, 91.91% were published after 2011, reflecting a sharp rise in interest in this area. A total of 271 interactions were identified, with 203 related to pharmacokinetics, primarily involving metabolism mediated by cytochrome P450 (CYP) enzymes, and 68 linked to pharmacodynamics, including additive effects such as sedation. Among the most relevant findings, CBD was shown to inhibit CYP enzymes like CYP3A4 and CYP2C19, potentially increasing plasma levels of co-administered drugs. However, only 5.15% of studies evaluated the clinical relevance of these interactions, indicating a substantial gap in knowledge regarding their safety implications. This review highlights the urgent need for rigorous clinical research to determine the clinical significance of CBD-drug interactions, particularly in patients undergoing polypharmacy. Understanding these interactions is crucial for optimizing therapeutic outcomes, minimizing adverse effects, and enabling safer clinical use of CBD in diverse treatment regimens.