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Much remains to be understood about COVID-19, but the protective role of antibodies (Igs) is widely accepted in SARS-CoV-2 infection. Igs’ functions are mainly carried out by receptors that bind to their Fc portion (FcR), and less attention has been dedicated to the cytoplasmic members of this family. In this work, we used single-cell RNA sequencing (scRNA-seq) data to discern cell populations in bronchoalveolar lavage fluid obtained from healthy individuals and patients with mild or severe COVID-19. Then, we evaluated the transcription of neonatal FcR (FcRn, FCGRT gene) and tripartite motif-containing protein 21 (TRIM21) and its downstream signaling components. The TRIM21 pathway is vital for virus infections as it has a dual function, leading opsonized viruses to degradation by proteasomes and the activation of innate inflammatory anti-virus response. The transcriptional level of FCGRT showed no statistical differences in any cell population comparing the three groups of patients. On the other hand, TRIM21 transcription was significantly higher in myeloid cells collected from patients with mild COVID-19. When comparing mild with severe cases, there was no statistical difference in TRIM21 transcription in lung adaptive lymphoid cells and innate lymphoid cells (ILC). Yet, we analyzed the transcription of all downstream signaling molecules in myeloid and, as most cells expressed the receptor, in adaptive lymphoid cells. Moreover, ILCs from mild cases and all cell populations from severe cases were missing most downstream components of the pathway. We observed that members of the ubiquitin–proteasome system (UPS) and other components associated with TRIM21 proteasomal degradation were transcribed in mild cases. Despite the transcription of the danger sensors DDX58 and IFIH1, the transcriptional level of inflammatory IL1B and IL18 was generally very low, along with the NLRP3 danger sensor, members of the NF-κB pathway, and TNF. Therefore, our data suggest that TRIM21 may contribute to SARS-CoV-2 protection by reducing the viral load, while the inflammatory branch of the pathway would be silenced, leading to no pathogenic cytokine production.

The creation of protected areas (Protected Areas—CA and Indigenous Lands—IL) is one of the effective strategies to contain deforestation, and landscape fragmentation and conserve biodiversity. However, several such areas in the Amazon suffer from anthropogenic pressures which prevent the fulfilment of their purpose. The objective of this study is to analyze the use and vegetation cover in four protected areas in the Amazon in the state of Maranhão by showing the threats to biodiversity by means of digital processing of satellite images in 1984, 1996, 2008 and 2017. Images from the Landsat satellites 5 and 8 were used for supervised classification and identification of deforestation in these areas. The results obtained in 1984 show a predominance of the forest class in the studied area, where the ILs Caru and Alto Turiaçu stand out for presenting excellent preservation in that year. As of 2008, changes related to deforestation and the presence of secondary vegetation and occurrence of fires in the area studied were observed. In this case, the changes resulting from urban and farming expansion, and infrastructure projects (roads, highways, dams and land division), mining, illegal logging, cattle raising, among others, are easily identified by satellite images. The Indigenous Lands and Strict Nature Reserve of Gurupi are connected, representing the best and the most homogeneous Amazonian biome in Maranhão. The study concludes that of the remaining vegetation, 76.41% is within the protected areas, represented mainly in the analyzed indigenous lands. So, this study highlights that although protected areas are being constantly deforested, invaded and criminally burned, these are still the best way of preserving the biodiversity of the last remnant of the Biome in the region, and its protection is necessary for the conservation of its biological resources and vegetation cover.

In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.

We identified hepatitis E virus (HEV) 3ra, a potentially zoonotic subtype, in rabbits in Ukraine, which highlights their potential role as reservoirs. Screening of rabbit fecal samples identified HEV-3ra. Public health services in this country should improve HEV surveillance and expand HEV sampling.

Among healthcare workers, nurses are at exceptionally considerable risk for contracting COVID-19. Regardless of professionals’ level of education, Brazilian nursing is one of the healthcare occupations shouldering the highest levels of responsibility and workload. Social support networks to health and nursing can be a strategy to reduce workload and stress and may contribute to implementing the activities and protecting workers’ health. This study aimed to map and analyze social support networks at workplaces as informed by frontline nursing professionals working in healthcare units in the Brazilian cities of Rio de Janeiro and Fortaleza, capitals of the States of Rio de Janeiro and Ceará, respectively. This observational and cross-sectional study used an online data collection instrument based on social network analysis methodology. We recruited 163 participants in two reference services for health professionals suspected or with COVID-19 symptoms. The research question was: “Which category or categories of health professionals have supported you or other colleagues the most in the event of diagnosis or suspicion of COVID-19 among nursing categories? Data were organized by nursing category and city and analyzed through social network analysis using Ucinet©, generating graphs and centrality metrics. Results point to the central relevance of nursing categories in the workplace social support in the pandemic, followed by other health professional categories.

Background Bacillus thuringiensis svar . israelensis (Bti) is an effective and safe biolarvicide to control Aedes aegypti . Its mode of action based on four protoxins disfavors resistance; however, control in endemic areas that display high mosquito infestation throughout the year requires continuous larvicide applications, which imposes a strong selection pressure. Therefore, this study aimed to investigate the effects of an intensive Bti exposure on an Ae. aegypti strain (RecBti), regarding its susceptibility to Bti and two of its protoxins tested individually, to other control agents temephos and diflubenzuron, and its profile of detoxifying enzymes. Methods The RecBti strain was established using a large egg sample (10,000) from Recife city (Brazil) and more than 290,000 larvae were subjected to Bti throughout 30 generations. Larvae susceptibility to larvicides and the activity of detoxifying enzymes were determined by bioassays and catalytic assays, respectively. The Rockefeller strain was the reference used for these evaluations. Results Bti exposure yielded an average of 74% mortality at each generation. Larvae assessed in seven time points throughout the 30 generations were susceptible to Bti crystal (resistance ratio RR ≤ 2.8) and to its individual toxins Cry11Aa and Cry4Ba (RR ≤ 4.1). Early signs of altered susceptibility to Cry11Aa were detected in the last evaluations, suggesting that this toxin was a marker of the selection pressure imposed. RecBti larvae were also susceptible (RR ≤ 1.6) to the other control agents, temephos and diflubenzuron. The activity of the detoxifying enzymes α- and β-esterases, glutathione-S-transferases and mixed-function oxidases was classified as unaltered in larvae from two generations (F 19 and F 25 ), except for a β-esterases increase in F 25 . Conclusions Prolonged exposure of Ae. aegypti larvae to Bti did not evolve into resistance to the crystal, and no cross-resistance with temephos and diflubenzuron were recorded, which supports their sustainable use with Bti for integrated control practices. The unaltered activity of most detoxifying enzymes suggests that they might not play a major role in the metabolism of Bti toxins, therefore resistance by this mechanism is unlikely to occur. This study also highlights the need to establish suitable criteria to classify the status of larval susceptibility/resistance.

The goal of the present study was to analyze Acinetobacter baumannii strains isolated from hospitalized patients in the period of the COVID-19 pandemic by phenotypic and molecular methods and evaluate their antimicrobial resistance patterns and biofilm production. Forty-seven strains were isolated in 2021–2022 from a hospital in Brazil, and were identified by VITEK®2, MALDI-TOF/MS (VITEK MS® and MALDI Biotyper®), and 16S rRNA sequencing. Fourier-transform infrared (FTIR) spectroscopy was applied for typing and antimicrobial susceptibility testing (AST). In addition, biofilm formation and disinfectant tolerance tests were used. All methods accurately identified all the A. baumannii strains. FTIR typing identified 23 different profiles and 11 clusters, as well as differentiated between the strains from patients with and without COVID-19. Most strains exhibited resistance to the drugs tested, 91.5% of the strains were classified as XDR, 6.4% of the strains were MDR and only 1 strain was classified as non-MDR. Over half of the strains (n = 27, 57.4%) produced biofilms on polystyrene. Sodium hypochlorite (1.0%/15 min) was the best option for effective disinfection. Overall, this study will lay the foundation for further research on effective cleaning protocols for the eradication of A. baumannii biofilms, as well as the use of FTIR for pathogen surveillance in healthcare settings.

Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26·8 per 100 000 people and traffic-related mortality was 23·5 per 100 000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport system that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.

Berardinelli-Seip Congenital Lipodystrophy (BSCL) is a rare autosomal recessive disease that affects the development of adipocytes and leads to an inability to store fat in adipocytes. This study aimed to evaluate the life expectancy and the causes of death of patients with BSCL. We analyzed death certificates, and medical records of BSCL patients who died between 1997 and 2017. If the death certificate was incomplete or unavailable, we reviewed the medical records, and if they were not available too, we collected information from the patient's relatives to understand how the death happened. We calculated the potential years of life lost as a result of premature death. Twenty patients (12 female and 8 male) died between 1997 and 2017. The mean age at the time of death was 27.1±12.4 years (women 25.2±12.5 vs. men 29.9±12.6 years, p = 0.41). Life expectancy for the study population was 62.9±4.8 years. The potential number of years of life lost was 35.6±16.6 years. The causes of deaths were divided into three major groups: infections (7 patients, 35%), liver disease (7 patients, 35%), and other causes (acute pancreatitis, one patient; renal failure, three patients; sudden death/myocardial infarction, two patients). Three patients had pulmonary fibrosis. BSCL led to premature death, cutting the patients' lifespan by 30 or more years. The majority of these young patients died of liver disease or infection. Other studies are needed to understand better the mechanisms that predispose to infections, as well as to assess whether new therapies can alter the natural history of this disease.