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Background Homeless women have complex life conditions and are often exposed to violence, sexual exploitation, rape, prostitution, reproductive disorders, survival sex trading, unintended pregnancies and sexually transmitted infections (STIs). The aim was to explore the existence of sexual aggression and vulnerability to STIs among homeless Brazilian women. Methods Fifteen interviews were conducted with homeless women who were admitted to a women’s shelter in a large city in Brazil. Data were collected through semi-structured interviews, audiorecorded and complemented with notes of the researcher in field diary, subjected to inductive thematic analysis and analyzed in light of the social relations of gender. Results Two themes were constructed: “Being a woman on the streets: a look at gender inequalities” and “Pain and the raped body: the scars of homeless women”. The transgression of women’s rights was observed with reports of sexual abuse interspersed with physical violence. Unprotected sexual practices were part of the daily lives of these women, with repercussions for their exposure to sexually transmitted infections. Dependence on psychoactive substances was mentioned, and transactional sex was used as a source of income to maintain such dependence, as well as to promote the women’s livelihood. Conclusion Homeless women experience complex situations on the streets involving exposure to different types of violence, the use of transactional sex as a survival strategy and unprotected sexual practices. Furthermore, the way in which women have been exposed to sexual assault and their coping mechanisms to those require attention. Interventions are need to improve the healthcare assistance of homeless women victims of sexual assault, considering the vulnerability of this population.

ABSTRACT Objectives: to understand women’s perception regarding the care received during labor and birth. Methods: this is a descriptive-exploratory, qualitative study carried out with 54 postpartum women from hospitals in the Metropolitan Region II of the state of Rio de Janeiro, from January to December 2018, using semi-structured interviews submitted to content analysis. Results: puerperal women’s perceptions about the childbirth care they received indicated the use of interventions, such as pressure maneuvers on the uterine fundus during the expulsion period - Kristeller maneuver, episiotomy and repeated vaginal examination and without consent. The use of institutional routines, such as zero diet, horizontal birth and disrespect. Final Considerations: despite the encouragement of public humanization policies, the technocratic model is still present in obstetric care during childbirth. The humanization of obstetric care requires changes in attitudes and care paradigms, in order to guarantee respect and the right to quality care. RESUMO Objetivos: compreender a percepção das mulheres quanto à assistência recebida durante o parto e nascimento. Métodos: estudo descritivo-exploratório, qualitativo, realizado com 54 puérperas de hospitais da Região Metropolitana II do estado do Rio de Janeiro, de janeiro a dezembro de 2018, utilizando entrevistas semiestruturadas submetidas à análise de conteúdo. Resultados: as percepções das puérperas sobre a assistência ao parto recebida apontaram a utilização de intervenções, tais como manobras de pressão sobre o fundo uterino no período expulsivo - manobra de Kristeller, episiotomia e toque vaginal repetidos e sem consentimento. A utilização de rotinas institucionais, como a dieta zero, parto horizontal e desrespeito. Considerações Finais: apesar do incentivo das políticas públicas de humanização, o modelo tecnocrático ainda se faz presente na assistência obstétrica ao parto. A humanização da assistência obstétrica requer mudanças de atitudes e paradigmas assistenciais, a fim de garantir respeito e direito à assistência de qualidade. RESUMEN Objetivos: comprender la percepción de las mujeres sobre la asistencia recibida durante el trabajo de parto y el parto. Métodos: estudio descriptivo-exploratorio, cualitativo, realizado con 54 puérperas de hospitales de la II Región Metropolitana del estado de Río de Janeiro, de enero a diciembre de 2018, mediante entrevistas semiestructuradas sometidas a análisis de contenido. Resultados: las percepciones de las puérperas sobre la atención recibida del parto indicaron el uso de intervenciones, como maniobras de presión sobre el fondo uterino en el período expulsivo - maniobra de Kristeller, episiotomía y toque vaginal repetido y sin consentimiento. El uso de rutinas institucionales, como dieta cero, parto horizontal y falta de respeto. Consideraciones Finales: a pesar del impulso de las políticas públicas de humanización, el modelo tecnocrático sigue presente en la atención obstétrica durante el parto. La humanización de la atención obstétrica requiere cambios de actitudes y paradigmas de atención, a fin de garantizar el respeto y el derecho a una atención de calidad.

Recurrent COVID-19, defined as two or more distinct episodes, may reflect an impaired immune response to SARS-CoV-2. In this case–control study, we compared three groups: individuals with recurrent COVID-19, those with a single episode, and SARS-CoV-2-naïve controls. We genotyped six immune-related SNPs, including TLR7 rs179008, and measured CD4+ and CD8+ T cell responses to SARS-CoV-2 antigens using flow cytometry. The T allele of TLR7 rs179008, previously linked to reduced receptor expression, was significantly overrepresented in the recurrent COVID-19 cohort. At baseline, frequencies of IFN-γ+, IL-2+, and TNF-α+ cells among CD4+ and CD8+ T cells did not differ between groups. However, stratification by the rs179008 genotype revealed that T allele carriers displayed diminished IFN-γ production in both CD4+ and CD8+ T cells and reduced IL-2 production in CD4+ T cells. Following vaccination, T cell responses were comparable across all genotypes. The T allele of TLR7 rs179008 is associated with recurrent COVID-19 and may contribute to impaired T cell-mediated immunity. Further studies are warranted to elucidate the mechanistic role of TLR7 variation in SARS-CoV-2 reinfection risk.

We evaluated clinical and epidemiological characteristics of Trypanosoma cruzi infection in Sergipe. In this cross-sectional study, we collected serum samples to identify serological markers of Chagas disease. A questionnaire was used, and electrocardiogram, echocardiogram, chest radiography, and contrast radiography of esophagus and colon were performed. T. cruzi infection seroprevalence was 12.1%, mean age of subjects was 55 years, 90% had an elementary school education, 78.6% were agriculture workers, and 60.5% had electrocardiographic abnormalities. A high prevalence of T. cruzi infection was observed in mostly elderly individuals.

Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi, being one of the leading causes of morbidity and mortality in the Americas with an estimated six to seven million infected people worldwide. In Brazil, the improvement in vector control and blood donor screening has evidenced the important epidemiological role of congenital transmission of Chagas disease. A serological survey for Chagas disease was performed in 3,952 newborns in the southern region of Sergipe using paper filter disks of dried blood samples. The newborns were screened using the Sergipe State Neonatal Screening Program between July 2015 and July 2016, and 3,749 and 750 blood samples were obtained for the IgG enzyme-linked immunosorbent assay and indirect immunofluorescence assay, respectively. In addition, mothers of the children who presented initial reagent serology were examined. Among 3,749 blood samples, samples of two children were positive for the enzyme-linked immunosorbent assay; however, their confirmation test results were negative, suggesting passive transfer of the mother's antibody. One puerpera was identified with Chagas disease, with a prevalence of 0.02%. Congenital Chagas disease was not observed in newborns in the Southern region of Sergipe. However, Chagas disease was observed in women of reproductive age. Therefore, effective measurements for monitoring and systematic evaluation should be conducted. The Neonatal Screening Program proved to be an effective public health strategy for the prevention and control of Chagas disease.

Visceral leishmaniasis (VL) is a severe disease caused by infection with protozoa of the genus Leishmania. Classic VL is characterized by a systemic infection of phagocytic cells and an intense activation of the inflammatory response. It is unclear why 90% of infected individuals do not develop the disease while a minority develop the classical form. Furthermore, among those that develop disease, a small group progresses to more severe form that is unresponsive to treatment. The presence of inflammatory mediators in serum could theoretically help to control the infection. However, there is also a release of anti-inflammatory mediators that could interfere with the control of parasite multiplication. In this study, we took advantage of the spectrum of outcomes to test the hypothesis that the immune profile of individuals infected with Leishmania (L.) infantum is associated with the development and severity of disease. Sera from patients with confirmed diagnosis of VL were evaluated for the presence of numerous molecules, and levels compared with healthy control and asymptomatic infected individuals. Although differences were not observed in LPS levels, higher levels of sCD14 were detected in VL patients. Our data suggest that L. infantum may activate the inflammatory response via CD14, stimulating a generalized inflammatory response with production of several cytokines and soluble molecules, including IFN-γ, IL-27, IL-10, IL-6 and sCD14. These molecules were strongly associated with hepatosplenomegaly, neutropenia and thrombocytopenia. We also observed that IL-6 levels greater than 200 pg/ml were strongly associated with death. Together our data reinforce the close relationship of IFN-γ, IL-10, IL-6, TNF-α and IL-27 in the immune dynamics of VL and suggest the direct participation of sCD14 in the activation of the immune response against L. infantum.

Knowledge of biodiversity in oligotrophic aquatic ecosystems is fundamental to plan conservation strategies for protected areas. This study assessed the diatom diversity from an urban reservoir with oligotrophic conditions. The Piraquara I reservoir is located in an Environmental Protection Area and is responsible for the public supply of Curitiba city and the metropolitan region. Samples were collected seasonally between October 2007 and August 2008. Periphytic samples were obtained by removing the biofilm attached to Polygonum hydropiperoides stems and to glass slides. The taxonomic study resulted in the identification of 87 diatom taxa. The most representative genera regarding the species richness were Pinnularia (15 species) and Eunotia (14 species). Five species were registered for the first time in Brazil and seven in the State of Paraná. Taxonomic and ecological comments of the species registered are provided. Resumo: O conhecimento da biodiversidade em ecossistemas aquáticos oligotróficos é fundamental para planejar estratégias de conservação de áreas protegidas. Este estudo teve como objetivo conhecer a diversidade de diatomáceas em um reservatório urbano com condições oligotróficas. O reservatório do Piraquara I está inserido em uma Área de Proteção Ambiental em região de manancial e é responsável pelo abastecimento público de Curitiba e região metropolitana. Foram realizadas coletas estacionais entre os meses de outubro de 2007 e agosto de 2008. As amostras perifíticas foram obtidas pela remoção do biofilme aderido a caules de Polygonum hydropiperoides e de lâminas de vidro. O estudo taxonômico resultou na identificação de 87 táxons. Os gêneros mais representativos, considerando a riqueza de espécies, foram Pinnularia (15 espécies) e Eunotia (14 espécies). Cinco espécies de diatomáceas foram registradas pela primeira vez no Brasil e sete no estado do Paraná. Comentários taxonômicos e ecológicos também são apresentados para as espécies encontradas.

Schistosomiasis is endemic in 74 countries and is considered a serious public health problem in some locations. A transverse study was performed of 13 landless settlements in southern Sergipe from February to December 2009. The study included 822 settlers, of whom 601 underwent stool testing. The prevalence of schistosomiasis in landless workers was 4.3%. The population has a low education level, and basic sanitation services are not available to all residents. The prevalence of schistosomiasis was low in the population and among different settlements, possibly because of different forms of water use by the settlers.

Prostate cancer differently affects different regions of the world, displaying higher rates in more developed areas. After the implementation of prostate-specific antigen (PSA) testing, several studies described rising rates globally, but it is possible that indolent lesions are being detected given the lack of changes in mortality data. The Brazilian government recommends against PSA screening in the male population regardless of age, but the Urology Society issued a report recommending that screening should start at 50 years old for certain men and for those aged ≥75 years with a life expectancy exceeding 10 years. In this study, we examined the incidence and mortality rates of invasive prostate cancer over time in the Sergipe state of Brazil. The databases of the Aracaju Cancer Registry and Mortality Information System were used to calculate age-standardized rates for all prostate tumors (International Classification of Diseases 10th edition: C61 and D07.5) in the following age ranges: 20–44, 45–54, and ≥65 years. We identified 3595 cases of cancer, 30 glandular intraepithelial high-grade lesions, and 3269 deaths. Using the Joinpoint Regression Program, we found that the incidence of prostate cancer dramatically increased over time until the mid-2000s for all age groups, after which the rates declined. Prostate cancer mortality rates increased until 2005, followed by a non-significant annual percent change of 22.0 in 2001–2005 and a stable rate thereafter. We noticed that the increases and decreases of the incidence rates of prostate cancer were associated with the screening recommendations. Meanwhile, the increased mortality rates did not appear to be associated with decreased PSA testing; instead, they were linked to the effects of age and improvements in identification of the cause of death. Thus, we do not believe a PSA screening program would benefit the population of this study.

No vaccine is currently licensed against human visceral leishmaniasis (VL), a fatal CD4+ T cell immunosupressive disease against which chemotherapy is reduced to a few toxic drugs. The NH36 nucleoside hydrolase is a DNA metabolism vital enzyme present in all species. A vaccine based on such a conserved antigen could protect against both VL and cutaneous leishmaniasis, whose epidemics geographically overlap. Increased frequencies of NH36-specific IL-2+TNF-α+IFN-γ+-producing CD4+ T cells were associated with VL immune protection. the sequences of HLA-Class I and Class II T cell epitopes were predicted in the NH36 peptide sequence using the Tepitope, Propred, IEDB and NetMHCpan EL 4.1 immune informatic tools. The epitopes were synthetized and used to study their reactivity with sera samples, and to stimulate the response of PBMC of human patients cured from VL, asymptomatic individuals and healthy blood donors of a non-endemic area. Cytokine production was studied intracellularly by flow cytometry (ICS) and cytokine secretion was measured in PBMC supernatants. The HLA typing of DNA patients and the analysis of epitope conservancy in the genus were obtained. Two recombinant multiepitope proteins were designed, cloned in , expressed, purified and used for stimulation of PBMC of VL cured and asymptomatic patients. We identified fifteen NH36 conserved epitopes that correspond to promiscuous binders of HLA-DR, -DQ, -DP class II molecules, as well as HLA-A, B and C class I molecules. Collectively, these epitopes provide high worldwide population coverage of both class I and II alleles, and bound to alleles associated with VL susceptibility and resistance. VL asymptomatic individuals showed maximal frequencies of CD4+ and CD8+ multifunctional IL-2+TNF-α+IFN-γ+-producing T lymphocytes in response to these epitopes, with secretion of TNF-α, IL-1β and IL-6. Two recombinant multiepitope vaccines were designed using these epitopes linked by AAA or GPGPG spacers. Both proteins promoted CD4+ and CD8+ T cell responses in PBMC of VL cured and asymptomatic individuals. Both MultiAAA and MultiGPGPG proteins could be potentially used for universal human vaccination against leishmaniasis.