Leprosy is a chronic granulomatous infection caused by the etiological agent Mycobacterium
leprae. It is a contagious disease with a high infectivity rate, which facilitates its dissemination
among people. It affects the skin and peripheral nerves, and in more severe cases, lymph nodes
and bone marrow. Treatment interrupts the chain of transmission, as individuals no longer
transmit the disease once treatment begins. In this context, a clinical and epidemiological
investigation was conducted involving patients diagnosed with leprosy, referred by Primary Care
or arriving spontaneously, and subsequently treated at a Dermatological Center located in the
state of Ceará, Brazil. This descriptive, documental, and correlational cross-sectional study

applied both quantitative and qualitative approaches, based on data collected through semi-
structured questionnaires administered to participants during the study's data collection period.

The fieldwork occurred between July and December 2024 and January 2025, forming three
participant groups: the group already undergoing treatment (21 participants), the group
diagnosed during the research (7 participants), and the group of patients not diagnosed with
leprosy (89 participants), totaling 117 samples. The following tools were utilized for data
collection: (I) Sociodemographic Profile Questionnaire, (II) Leprosy Suspicion Questionnaire
(LSQ), (III) Beck Depression Inventory (BDI), and (IV) Beck Anxiety Inventory (BAI), in
addition to clinical records and laboratory test results when necessary. The completed
questionnaires were digitized into a database. Fisher's Exact Test and the Kruskal-Wallis Test
were used to verify possible associations between variables using R-Studio software version
4.3.2, adopting a significance level of p ≤ 0.05. To assess the reliability of the BAI and BDI
instruments, internal consistency was analyzed using Cronbach's Alpha Coefficient, with results
of Alpha 0.873 and 0.864, respectively. The "Excluded" group for leprosy accounted for the
highest number of participants (76.1%), followed by the "Treatment" group (17.9%) and the
"Diagnosed" group (6.0%). A significant association was observed between the data collection
sites and the groups, with the highest concentration at the Dermatology and Infectious Diseases
Center compared to the five neighborhoods. Regarding leprosy cases, male sex was statistically
significant, and most cases were reported among individuals identifying as mixed race. No
statistically significant association was found between marital status, religious beliefs, housing
conditions, and the groups of respondents, with a p-value of 0.05%. The majority of participants
had an income of up to three minimum wages and incomplete elementary education. The most
common symptoms reported by participants included numbness, tingling, numb patches on the
skin, and skin spots. Results highlight the presence of pathologies often confused with clinical
signs characteristic of leprosy. Most respondents had no history of previous illnesses, though 

hypertension was the most common condition among those who reported a medical history.
It is suggested that investments be made in screening campaigns, health education, and training
professionals for early diagnosis. The integration of public policies and health actions directed at
these populations can enhance effective leprosy control.

Cutaneous leishmaniasis (CL), a disease of the skin and mucous membranes caused by different
species of protozoa in the genus Leishmania, is contagious but not transmissible. Leishmania ssp.
is an obligatory intracellular parasite that infects the cells of the mononuclear phagocytic system.
It exists in two primary forms: a flagellate or promastigote, which is found in the digestive tube
of the insect vector, and an aflagellate or amastigote, which is observed in the tissues of
vertebrate hosts. The vectors of the CL are commonly referred to as phlebotomine sandflies,
including species such as Lutzomyia longipalpis, Lutzomyia intermedia, and Lutzomyia whitmani,
among others, which vary based on the geographical area. Bacterial coinfection frequently occurs
in CL lesions. The objective of this study is to analyze and describe the microbiological makeup
of the area surrounding skin ulcers in individuals with CL. This study is characterized by its
observational, analytical, prospective, and transversal nature. Microbiota samples were obtained
by swabbing the injuries of patients diagnosed with CL at the Clinical School of the Faculty of
Medicine of the Federal University of Cariri between January and March 2024. The study
examined the variables associated with epidemiological, clinical, and microbial data on lesions
and the corresponding area of the body for comparison. Analyzed data using absolute and relative
frequencies for categorical variables and centrality metrics for continuous variables, such as

average and standard deviation. The survey's key variables were analyzed using the Kruskal-
Wallis and Mann-Whitney tests, which involved comparing averages. The statistical analyses

were conducted at a significance threshold of α = 0.05. The study revealed that most of 

individuals affected by LC were men (61%) between the ages of 38 and 47 (20.5%), residing in
rural areas (70.7%), with incomplete elementary education (46.3%), and earning an income
between 1 to 5 minimum wages (80.5%). The lesions were most seen in the lower left limbs
(47.5%) in both males and females. Regarding the culture of ulcerative lesions, Staphylococcus
aureus was the most common (22.7%). Furthermore, it was noted that 11.3% of patients
exhibited a rise in the same bacterial species (Staphylococcus) in both the culture of the affected
area and the control culture. An assessment was conducted on the intricacy of Cutaneous
leishmaniasis with particular emphasis on the impact of bacterial coinfection. The presence of
bacteria alongside Leishmania spp. in skin lesions exacerbates the challenges associated with
identification and therapy, impeding the healing process, and potentially resulting in
consequences. The findings suggest a correlation between lesion problems and the colonization
of opportunistic bacteria, which is impacted by the inflammation caused by Leishmania. The
presence of low oxygen levels in the lesions promotes the continued existence of the infection.
Research has found a high occurrence of S. aureus infections in the periphery of skin ulcers in
individuals with Leishmania ssp. Simultaneous infection Leishmania ssp. and S. aureus
exacerbate the inflammatory response, leading to more severe lesions. CL primarily impacts
males, resulting in frequent injuries to both the upper and lower extremities. In conclusion, the
initial findings indicated that the lesions induced by CL may exhibit an opportunistic colonization
by commensal bacteria of the human epithelium, hence facilitating the emergence of subsequent
infections. Therefore, it is possible to develop novel therapeutic approaches that not only focus
on combating Leishmania but also target the opportunistic microbiota. This can help reduce the
likelihood of difficulties in the clinical condition of patients. These findings emphasize the
significance of taking secondary infections into account while treating CL. To enhance patient
outcomes and minimize difficulties, healthcare providers can effectively target both leishmania
and opportunistic microorganisms.

Visceral Leishmaniasis (VL), also known as Kala-azar, is an infectious, non-contagious disease characterized as a Neglected Tropical Disease (NTD). It has the most severe clinical form of leishmaniasis and, when left untreated, up to 90% of cases can progress to death due to parasitic involvement of several organs, especially bone marrow, spleen and liver. Given this scenario, the importance of the Death Verification Service (SVO) stands out as a surveillance service capable of determining the Cause of Death naturally with or without medical assistance, especially those under epidemiological investigation. The present study aimed to evaluate the seroprevalence of Visceral Leishmaniasis in bodies from the Death Verification Service in the city of Barbalha, Ceará, Brazil. This is an observational, descriptive, cross-sectional study with uncontrolled prevalence, carried out from January to April 2024. After the legal representative signed the informed consent form, the sociodemographic and clinical epidemiological profile of the post-mortem bodies was collected, and then the subclavian vein was punctured to obtain plasma through a centrifuge to perform the immunochromatographic test for qualitative detection of antibodies to parasites of the Leishmania donovani complex. Simultaneously, complementary immunochromatographic tests for COVID-19, Syphilis, HCV, HBV, and HIV were performed. This study was approved by the Research Ethics Committee of the Federal University of Cariri – UFCA, Barbalha, CE, Brazil, under registration CAAE 76885323.7.0000.5698. A total of 223 samples were analyzed, of which it was observed that there was no seroprevalence for VL (0%) in the UFCA SVO, however, for COVID-19, Syphilis, HCV, HBV and HIV, there was a low seroprevalence rate, with values of 5.38%, 2.69%, 0.89%, 0.44% and 0%, respectively. When associated with the positivity of the immunochromatographic test for syphilis with the sociodemographic characteristic of no professional occupation, a statistically significant value was observed (p = 0.006). According to the study, the results suggest that although the SVO coverage region brings together cities endemic for human VL, the post-mortem bodies that were admitted during the sample collection period did not present positivity in the immunochromatographic test for VL, and no confirmatory clinical history for visceral leishmaniasis was identified. It can be concluded that the cases of VL that resulted in death in the areas covered by the study were clarified as to the Cause of Death, and it was not necessary to activate the UFCA Death Verification Service.

Bacillus subtilis is a Gram-positive bacterium that produces lipopeptide antibiotics with antibacterial and antifungal functions. It is a non-pathogenic rod-shaped bacterium that forms biofilm and endospores and is used as a model microorganism for studies related to infectious diseases. This bacterium produces the nucleotide guanosine penta/tetraphosphate (p)ppGpp, which participates in several cellular processes. However, in situations of nutritional deficiency, these bacteria begin to undergo changes that activate the production of (p)ppGpp in larger quantities for metabolic regulation. The objective of this study was to understand the impact of the absence of guanosine tetraphosphate (ppGpp0) synthesis on cell growth and iron/manganese toxicity under oxidative stress in Bacillus subtilis. Bacillus subtilis PY79 and ppGpp0 strains were grown in 20 mL of liquid LB Broth (Lennox) medium with shaking or in solid LB Broth (Lennox) medium, both at 37 °C for 15 h. Bacterial growth was measured in the absence or presence of iron sulfate (FeSO4) and manganese sulfate (MnSO4) at different concentrations, every hour, for 10 h. Hydrogen peroxide (H2O2) levels were detected using AmplexRed/Horseradish peroxidase, and the activities of antioxidant enzymes (catalase and superoxide dismutase) were evaluated. Cellular respiration was measured using a Clark-type electrode. The tests demonstrated that the ppGpp0 mutants presented a growth delay compared to the PY79 control, and none of the cells grew in FeSO4 at a concentration of 4 mM. At concentrations equal to or lower than 1 mM of FeSO4, Bacillus subtilis tolerated well. However, compared to the wild type (PY79), the ppGpp0 mutant strain exhibited significantly increased sensitivity to FeSO4, showing delayed entry into the exponential phase of growth. The ppGpp0 mutant produced higher levels of H2O2 (in the stationary phase) when stimulated by FeSO4 (2 mM). MnSO4-induced stress caused a marked increase in the lag phase of cell growth in Bacillus subtilis mutants for ppGpp0. The presence of these metals induced an increase in oxygen consumption compared to strains without FeSO4 and MnSO4. Antioxidant enzymes did not show significant differences in activities. It is concluded that the comparative studies between Bacillus subtilis PY79 and ppGpp0 strains were fundamental to confirm that the absence of the ppGpp nucleotide significantly compromises bacterial growth, resulting in a notable delay throughout the exponential phase in the presence of high concentrations of Fe2+ and Mn2+.Furthermore, the limitation of cell growth by Fe2+ is through a mechanism related to the redox state.

Sepsis is characterized by an uncontrolled immune response to systemic infection, commonly triggered by bacterial endotoxins such as lipopolysaccharide (LPS) from Gram-negative bacteria, playing a central role in severe inflammation. Moreover, sepsis-induced cardiac dysfunction is a leading cause of mortality. This study aims to determine the effects of LPS-induced cardiac injury on mitochondrial damage, oxidative stress, and subsequent cardiac dysfunction in mice and rats. Mice and rats were injected with LPS for three days (1.5 mg/kg), following approval by the Animal Use Committee. Cardiac function analysis was performed using the Langendorff perfusion system. Activities of mitochondrial complexes (I, II, III, and IV), antioxidant enzymes, and hydrogen peroxide levels were measured spectrophotometrically. Statistical analysis was performed using Student's t-test in GraphPad Prism software. LPS treatment significantly reduced the activities of glutathione peroxidase, glutathione reductase, and catalase. This was accompanied by a trend towards decreased levels of mitochondrial sulfhydryl proteins in mouse cardiac samples and in rat cytosol. Additionally, LPS treatment significantly increased mitochondrial hydrogen peroxide production and lipid peroxidation in treated animals, indicating increased oxidative stress. There was also a significant increase in glutathione S- transferase, as an adaptive mechanism by the cell to control oxidative stress. These results led us to examine the influence of LPS on mitochondrial complex functionality. These analyses revealed a significant decrease in complexes I and II in cardiac mitochondria of LPS-treated animals, while activities of complexes III and IV remained unchanged. In Langendorff-perfused rat hearts, LPS infusion (0.5 µg) induced a significant increase in left ventricular end-diastolic pressure and a decrease in total developed pressure by this same ventricle. In conclusion, this study sheds light on the detrimental effects of LPS-induced cardiac injury on mitochondrial integrity and function, leading to increased oxidative stress and subsequent cardiac dysfunction. These insights may pave the way for the development of targeted therapeutic interventions aimed at mitigating the deleterious consequences of sepsis-induced cardiac dysfunction.

Cervical cancer is the fourth most common neoplasm among women worldwide and the third most frequent type in Brazil, with a mortality rate of 5.74 per 100,000 women in Ceará alone. The main risk factor is HPV infection; however, studies suggest a potential role of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) in oncogenesis. Objectives: This study investigated the association of EBV and CMV with cervical carcinoma and premalignant lesions, exploring their interaction with HPV and the human oncoprotein E-cadherin. Methodology: A total of 79 cases of cervical carcinoma and 51 outpatient biopsies, including premalignant and non- malignant lesions, were analyzed. Samples underwent PCR for the detection of HPV, CMV, and EBV, as well as HPV16 and 18 genotyping. qPCR was used to quantify EBV, in situ hybridization (ISH) for EBERs and EBV DNA, and immunohistochemistry for LMP1 and E- cadherin. The 30bp deletion in the viral LMP1 gene, EBV sequencing for target confirmation, and HPV16 integration were also assessed. Results: HPV was detected in 94.9% of carcinomas and 78.4% of biopsies. HPV16 integration was observed in 44.4% of outpatient samples and 89.4% of carcinomas, indicating a strong association with tumor progression (OR=10.6; P<0.01). EBV was identified by PCR in 30.4% of carcinomas (OR=5.1; P<0.01), with a higher viral load in squamous cell carcinomas (P=0.05) and moderately differentiated tumors (P=0.03). The 30bp deletion in the EBV LMP1 gene, present in 19% of carcinomas, was associated with virulence and HPV16 integration. CMV was found in 10.1% of carcinomas, particularly in adenocarcinomas. E-cadherin showed positive membrane expression in 55.4% of squamous cell carcinomas. Additionally, membrane E-cadherin expression increased the likelihood of HPV16 integration ninefold (OR=9.0). An inverse correlation (Rho=-0.397; P=0.041) between the membrane E-cadherin Labelling Index (LI) and EBV viral load was also observed, highlighting the interaction between E-cadherin expression and viral load in tumor progression. Conclusion: This study reinforces the association between EBV and cervical carcinoma, emphasizing the importance of EBV, alongside HPV, in disease progression. The 30bp deletion in the LMP1 gene and HPV16 integration into the host genome are indicative of greater tumor aggressiveness, while the presence of CMV requires further investigation. Regarding E-cadherin expression, the observed inverse correlation suggests that higher EBV viral loads are associated with lower E-cadherin expression levels. These findings underscore the relevance of multiple viral factors in the development of cervical cancer and suggest a possible collaboration between EBV and HPV, highlighting the need for further studies that could ultimately reshape early diagnosis, prevention, and treatment strategies.

Bacterial resistance is an important public health problem, demanding the need for investment in
research in the pharmaceutical field in the search for alternatives to combat infectious diseases.
Natural products have increasingly gained prominence in this field due to the properties they
present. Among these, Sarcomphalus joazeiro has proven action in the treatment of diseases of
the respiratory and gastrointestinal tract and treatment of bacterial infections, due to the action of
secondary metabolites, such as saponins, which are substances made up of a lipophilic fraction

and a sapogenin, molecule that has antifungal, antibacterial, antiviral, anti-cancer and anti-
inflammatory activity. The present work evaluated the Antibacterial potential and reversal of

bacterial Resistance by Ethanolic Extract of Sarcomphalus joazeiro (Mart.) Hauenschild (EESJ)
and Hecogenin Acetate. An ethanolic extract of the bark was prepared and chemically
characterized using UPLC-ESI-QToF-MSE

. To carry out microbiological tests, strains of
Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus mutans, Escherichia coli,
Pseudomonas aeruginosa and Staphylococcus aureus and strains SA-1199, SA-1199B with
overexpression of the NorA efflux pump and SA-K2068 with overexpression of MepA pump for
efflux pump inhibition assays determined by subinhibitory concentration and in microdilution
plates. The determination of the minimum inhibitory concentration (MIC) and activity modifying
the antibiotic action were carried out using the broth microdilution method. The biofilm assays
were evaluated using the crystal violet method. The results of the chemical characterization of
EESJ showed the presence of 24 peaks of constituents, with the majority presence of saponin 

derivatives. EESJ did not present significant antibacterial activity, with MIC ≥2048 μg/mL,
however, in combination with antibiotics, it potentiated the action of the drugs, promoting a
significant reduction in MIC as in the analysis against the S. epidermidis strain, where the MIC
of Gentamicin reduced from 16 μg/mL to 4 μg/mL, and had a relevant ability to inhibit biofilm
formation against bacterial strains, mainly against strains of S. aureus and P. aeruginosa. The
results for Hecogenin Acetate demonstrated the absence of relevant antibacterial activity,
however the association with antibiotics reveals the decrease in MIC being more significant
against the P. Aeruginosa strain, where a reduction was observed in all antibiotics evaluated. In
inhibiting the efflux pump, sapogenin did not show relevant activity, demonstrating an increase
in the MIC of norfloxacin against strains SA 11199-B and SA-K2068. In the evaluation of
antibiofilm capacity, it was observed that Hecogenin Acetate presented promising results for
both anti-formation activity and eradication activity. It was concluded that EESJ is mainly
composed of saponin derivatives and has important antimicrobial activity when associated with
conventional antibiotics, demonstrating enhancement of their action. It is also important to
highlight its ability to inhibit biofilm formation, especially S. aureus and Pseudomonas
aeruginosa strains. Hecogenin Acetate did not show intrinsic antimicrobial activity, however, it
showed a decrease in MIC when associated with antibiotics. In front of the efflux pumps, no
relevant reversal results were observed. Sapogenin has relevant antibiofilm activity.

At the end of 2019, the SARS-COV2 virus, which causes the disease COVID-19, was identified in China,
and quickly spread globally. Although COVID-19 is mostly a respiratory syndrome, it can affect multiple
systems. This work aims to identify the clinical and sociodemographic factors associated with the
development of the critical form and the occurrence of death due to COVID19 in adults living in
Cajazeiras, state of Paraíba (PB) admitted to the Hospital Regional de Cajazeiras (HRC). This is an
observational, descriptive, cross-sectional, time series research, in which data will be collected through
the medical records of all patients confirmed to have Covid19, who were admitted to the Hospital
Regional de Cajazeiras, PB, during the period March 21, 2020, to March 31, 2022, with the critical form
of the disease and which progressed to hospital discharge or death. The time frame refers to the period
in which the HRC was a reference unit for treating the condition. In the present study, the absolute and
relative frequencies of all variables were calculated, and the distribution of clinical and epidemiological
characteristics was verified, namely: age group, race/color, sex, comorbidities, prevalent clinical
manifestations, length of stay. Data organization and tabulation were carried out in Microsoft Excel.
Among the cases analyzed, there was a predominance of deaths among older people, brown or black,
with low levels of education and income; and comorbidities, with cardiovascular pathologies being the
most common. The advancement of vaccination in the period between age groups and throughout the
historical series contributed to the reduction in the number of deaths. With the results presented, the
study offers valuable information about the impact of COVID-19 in the Cajazeiras region, contributing to
the understanding of the social and health determinants associated with death due to COVID-19,
helping to guide public policies that can contribute to improve the response to the consequences of the
pandemic.