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This study analyzed a total of 260 confirmed scorpion stings reported in the city of Manaus, in the Brazilian Amazon, from 1990 to 2020. Cases were mapped according to the GPS location of their occurrence and plotted on a satellite image of the city. The stings generally occurred close to green areas, and the hotspots of stings moved north as city grew into that direction over time. Spatial analysis shows that scorpion stings mostly occur in poor, recently urbanized areas. The rapid and unplanned urbanization of originally forested areas, without offering adequate infrastructure and services, creates favorable conditions for infestation by scorpions and increases the risk of scorpion stings.

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OBJECTIVE: To determine whether a combination of a single intramuscular (IM) dose of pentamidine (7 mg/kg) followed by oral tamoxifen 40 mg/day for 20 days is non-inferior to three IM doses of pentamidine 7 mg/kg in the treatment of cutaneous leishmaniasis with a margin of 15%. METHODS: Phase II, randomised, controlled, open-label, non-inferiority clinical trial. Primary outcome was the complete healing of the lesions 6 months after starting treatment. Secondary outcomes were healing 3 months after starting treatment and determining the presence and severity of adverse effects (AE). RESULTS: The research was concluded with 49 patients; Leishmania (Viannia) guyanensis was the most frequent species isolated. In the primary outcome, 18 (72%) (95% CI: 52.4%-85.7%) of the 25 patients allocated to the intervention group and 24 (100%) (95% CI: 86.2%-100%) of the control group (p = 0.015) met the established criteria of cure. There was no AE with tamoxifen. CONCLUSION: Although a 72% cure rate presented by the combination of tamoxifen and pentamidine was lower than in the control group that achieved a 100% cure, it is still a safe and is a clinically relevant result. It indicates that the therapeutic scheme evaluated may be a promising option for populations in remote areas, however it should be further studied, in order to include a larger number of patients.

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OBJECTIVE: To describe clinical, epidemiological and management information on cases of acute Chagas disease (ACD) by oral transmission in the state of Amazonas in western Amazon. METHODS: Manual and electronic medical records of patients diagnosed with ACD at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) were included. RESULTS: There were 147 cases of acute CD registered from 10 outbreaks that occurred in the state of Amazonas between 2004 and 2022. The transmission pathway was through oral route, with probable contaminated palm fruit juice (açaí and/or papatuá), and involved people from the same family, friends or neighbours. Of 147 identified cases, 87 (59%) were males; cases were aged 10 months to 82 years. The most common symptom was the febrile syndrome (123/147; 91.8%); cardiac alterations were present in 33/100 (33%), (2/147; 1.4%) had severe ACD with meningoencephalitis, and 12 (8.2%) were asymptomatic. Most cases were diagnosed through thick blood smear (132/147; 89.8%), a few (14/147; 9.5%) were diagnosed by serology and (1/147; 0.7%) by polymerase chain reaction (PCR) and blood culture. In all these outbreaks, 74.1% of the patients were analysed by PCR, and Trypanosoma cruzi TcIV was detected in all of them. No deaths were recorded. The incidence of these foci coincided with the fruit harvest period in the state of Amazonas. CONCLUSION: The occurrence of ACD outbreaks in the Amazon affected individuals of both sexes, young adults, living in rural and peri-urban areas and related to the consumption of regional foods. Early diagnosis is an important factor in surveillance. There was a low frequency of cardiac alterations. Continuous follow-up of most patients was not carried out due to difficulty in getting to specialised centres; therefore, little is known about post-treatment.

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INTRODUCTION: Immunogenicity has emerged as a challenge in the development of vaccines against coronavirus disease of 2019 (COVID-19). Immunogenicity is a determinant of the efficacy and safety of vaccines. This systematic review and associated meta-analysis summarized and characterized the immunogenicity of COVID-19 vaccines in randomized controlled trials (RCTs). METHODS: Relevant RCTs were systematically sourced from different medical databases in August 2021. The risk ratios and mean differences with 95% confidence intervals were calculated. RESULTS: Of 2,310 papers, 16 RCTs were eligible for review. These RCTs involved a total of 26,698 participants (15,292 males and 11,231 females). The pooled results showed a significant difference in the geometric mean titer between the vaccinated and control groups in favor of the vaccine group after 1 and 2 months of follow-up, for the young age group (18 - < 55y), and with different doses (P < 0.001). The difference in the older age group (>55y) was insignificant (P = 0.24). The seroconversion rate of spike neutralizing antibodies favored the vaccine groups 1 or 2 months after vaccination (P < 0.001). The seroconversion rate of the vaccine group was significantly different (P < 0.001) from that of the control group. CONCLUSIONS: Vaccination elicits immunogenicity in the follow-up period for all age groups and at low and large doses. Therefore, people should be encouraged to receive vaccines currently being offered. A boost dose has been asserted for the elderly.

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Introduction: Human fascioliasis is a plant-borne and water-borne infection caused by the trematodes Fasciola hepatica and Fasciola gigantica. It is one of the main neglected tropical diseases, and infections in humans occur via the ingestion of contaminated water and food. This study reviews all the recorded cases of human fascioliasis in Brazil under different climatic conditions in the national territory. Methodology:A survey of human fascioliasis cases in Brazil was carried out using the Google Scholar, Lilacs and PubMed databases. The climatic variables such as temperature, precipitation, moisture and altitude were obtained from the database of the Instituto Nacional de Meteorologia (INMET). Results: Between the years 1958 and 2022, sixty-six cases of human fascioliasis were recorded in places with temperature levels between 22 °C to 33 °C, humidity 78% to 86%, precipitation 90 mm to 167 mm, and at an altitude of 16 to 935 meters above sea level. Conclusion: The parasite's ability to adapt to different climatic conditions is observed in Brazil and the number of cases of human fascioliasis in the national territory may be higher due to underreporting related to the difficulty in diagnosing the infection.

Introdução: A fasciolíase humana é uma infecção de origem vegetal e hídrica, causada pelos trematódeos Fasciola hepatica e Fasciola gigantica. É uma das principais doenças tropicais negligenciadas, e as infecções em humanos ocorrem através da ingestão de água e alimentos contaminados. Este estudo revisa todos os casos registrados de fasciolíase humana no Brasil sob diferentes condições climáticas no território nacional. Metodologia: Um levantamento dos casos de fasciolíase humana no Brasil foi realizado nas bases de dados Google Scholar, Lilacs e PubMed. As variáveis climáticas como temperatura, precipitação, umidade e altitude foram obtidas do banco de dados do Instituto Nacional de Meteorologia (INMET). Resultados: Entre os anos de 1958 e 2022, sessenta e seis casos de fasciolíase humana foram registrados em locais com níveis de temperatura entre 22 °C a 33 °C, umidade de 78% a 86%, precipitação de 90 mm a 167 mm e altitude de 16 a 935 metros acima do nível do mar. Conclusão: A capacidade de adaptação do parasito a diferentes condições climáticas é observada no Brasil e o número de casos de fasciolíase humana no território nacional pode ser maior devido à subnotificação relacionada à dificuldade de diagnóstico da infecção.

Introducción: La fascioliasis humana es una infección de origen vegetal y acuático, causada por los trematodos Fasciola hepatica y Fasciola gigantica. Es una de las principales enfermedades tropicales desatendidas, y las infecciones en humanos ocurren a través de la ingestión de agua y alimentos contaminados. Este estudio revisa todos los casos registrados de fascioliasis humana en Brasil bajo diferentes condiciones climáticas en el territorio nacional. Metodología: Se realizó una encuesta de casos de fascioliasis humana en Brasil utilizando las bases de datos Google Scholar, Lilacs y PubMed. Las variables climáticas como temperatura, precipitación, humedad y altitud se obtuvieron de la base de datos del Instituto Nacional de Meteorología (INMET). Resultados: Entre los años 1958 y 2022 se registraron sesenta y seis casos de fascioliasis humana en lugares con temperatura entre 22 °C a 33 °C, humedad entre 78% y 86%, precipitación entre 90 mm y 167 mm y una altitud de 16 a 935 metros sobre el nivel del mar. Conclusión: La capacidad de adaptación del parásito a diferentes condiciones climáticas se observa en Brasil y el número de casos de fascioliasis humana en el territorio nacional puede ser mayor debido al subregistro relacionado con la dificultad en el diagnóstico de la infección.

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ABSTRACT Introduction: Immunogenicity has emerged as a challenge in the development of vaccines against coronavirus disease of 2019 (COVID-19). Immunogenicity is a determinant of the efficacy and safety of vaccines. This systematic review and associated meta-analysis summarized and characterized the immunogenicity of COVID-19 vaccines in randomized controlled trials (RCTs). Methods: Relevant RCTs were systematically sourced from different medical databases in August 2021. The risk ratios and mean differences with 95% confidence intervals were calculated. Results: Of 2,310 papers, 16 RCTs were eligible for review. These RCTs involved a total of 26,698 participants (15,292 males and 11,231 females). The pooled results showed a significant difference in the geometric mean titer between the vaccinated and control groups in favor of the vaccine group after 1 and 2 months of follow-up, for the young age group (18 - < 55y), and with different doses (P < 0.001). The difference in the older age group (>55y) was insignificant (P = 0.24). The seroconversion rate of spike neutralizing antibodies favored the vaccine groups 1 or 2 months after vaccination (P < 0.001). The seroconversion rate of the vaccine group was significantly different (P < 0.001) from that of the control group. Conclusions: Vaccination elicits immunogenicity in the follow-up period for all age groups and at low and large doses. Therefore, people should be encouraged to receive vaccines currently being offered. A boost dose has been asserted for the elderly.

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BACKGROUND: This study is the first report of the species Panstrongylus rufotuberculatus in Roraima, a state in northern Brazil. METHODS: We collected specimens from a residence in the municipality of Rorainópolis. RESULTS: Our findings confirmed the occurrence of this species in Roraima, increasing the number of registered species from six to seven. CONCLUSIONS: Future studies are required to further investigate and expand our knowledge of the occurrence of this species and its epidemiological importance for this state.

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BACKGROUND: Chagas disease is gaining importance in the Brazilian Amazon region as a differential diagnosis of febrile syndrome. The most recent microoutbreak occurred in Ipixuna, in Amazonas state. METHODS: An epidemiological survey was conducted using parasitological and serological tests, and electrocardiographic analysis. RESULTS: The patients belonged to one family and had ingested açaí acquired from Ipixuna. All patients reported fever and initially a thick blood smear test was done to identify Trypanosoma cruzi. Benznidazole treatment was administered to all patients. CONCLUSIONS: Knowledge of the epidemiological dynamics of Chagas disease allows us to improve control and management measures for this disease.

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OBJECTIVES: To compare the number of deaths that occurred in the state of Amazonas and in Brazil, from March 16th to August 20th 2020, using the variables skin color, sex, place of death, age group and association with COVID-19, and secondly, to verify whether between 2019 and 2020, in the period from March 16th to August 20th, there was a significant change in the number of deaths from diseases not associated with COVID-19. METHODS: We searched the databases of the Brazilian public agency "Transparency Portal" for the data on deaths that occurred in the state of Amazonas and Brazil in the period from March 16th to August 20th, 2019 and 2020. The absolute frequencies and percentages of the variables studied were used for statistical analysis. RESULTS: COVID-19 was responsible for an 11.01% increase in deaths in Brazil; however, this rate quadrupled in the state of Amazonas. In relation to age group, there was a similar percentage between Amazonas and the national average. The stratified analysis showed significant differences between genders and races, with higher death rates in men and people of brown/black skin. The number of deaths at home increased significantly, especially those from causes not associated with COVID-19. CONCLUSIONS: The national drop in deaths from diseases not associated with COVID between March and August 2020 in Brazil is misleading and may be due to the result of misreported causes of death.