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.

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.