Extracts and Terpenoids from Stevia Species as Potential Anthelmintics for Neglected Tropical Diseases Caused by Cestode Parasites.

Cestodes are etiological agents of neglected diseases such as echinococcosis and cysticercosis, which are major public health problems. Antiparasitic treatment relies on a small number of approved drugs, which are often only partially effective, poorly tolerated and require prolonged administration. Thus, the discovery of novel potential treatments is critical. The Stevia genus (Asteraceae) includes species that are recognized as a source of bioactive compounds, with many species associated with medicinal uses. In this study, the cestocidal activity of four South American Stevia species that previously showed antiprotozoal activity was analyzed using a motility assay on the laboratory cestode model, Mesocestoides vogae. The four Stevia extracts showed cestocidal activity, with S. alpina var. alpina as the most active. The sesquiterpene lactones estafietin and eupatoriopicrin were purified from S. alpina var. alpina and S. maimarensis, respectively, and tested on M. vogae. Estafietin showed cestocidal activity, inhibiting parasite viability in a dose-dependent manner, even from the first day of incubation. Consistent with the motility effects, the extract of S. alpina var. alpina and estafietin induced marked alterations in the morphology of the parasite. The results of this report show that Stevia species represent a source of new molecules with potential for the treatment of neglected tropical diseases caused by cestodes.

Breaking the silence of female genital schistosomiasis in Ghana's health system: A case of health workers within the FAST project.

BACKGROUND: Female Genital Schistosomiasis (FGS) remains a critical and yet neglected topics in Neglected Tropical Diseases (NTDs), significantly affecting the health of women and girls worldwide. Health workers' knowledge of FGS is vital to the prevention and management of the disease. This study adopted an implementation research approach to identify and address the existing knowledge gap regarding FGS among healthcare workers in Ghana. METHODS: This study was a 3-year (2020-2022) implementation research applying a pragmatic uncontrolled quasi-experimental study design. The study involved a baseline assessment, FGS training intervention for health workers and student nurses, distribution of FGS educational materials, and an endline assessment. A mixed-method approach was applied to data collection involving health workers from two schistosomiasis endemic districts and across the country. NVIVO 12 and STATA 14 were used for qualitative and quantitative data analysis, respectively. RESULTS: Prior to the intervention, the level of awareness about FGS among health workers was less than 8%, and most participants only understood FGS as merely urogenital schistosomiasis in females. In response to this gap, an FGS education intervention in the form of training of health workers, student nurses alongside the distribution of FGS educational materials were carried out. The intervention enhanced health workers' awareness of FGS to more than 61%, encompassing an enhanced understanding of the disease's signs and symptoms to more than 60%, as well as its management strategies. However, access to praziquantel, the primary treatment, remained a significant challenge. CONCLUSIONS: The FGS intervention effectively raised healthcare workers' awareness and knowledge. Expanding training and improving praziquantel access are essential for optimal FGS management. A multi-faceted approach involving individuals, communities, and the healthcare system is necessary for comprehensive FGS prevention and control.

Un caso de Chagas agudo en edad pediátrica / Acute Vector-transmitted Chagas in Pediatric Age. A Case Reportt

Presentación del caso. Se trata una niña de siete años de edad, originaria de una zona rural del departamento de San Miguel, quién consultó por presentar fiebre y edema bipalpebral derecho indoloro, de seis semanas de evolución, sin otros síntomas acompañantes. El estudio para el diagnóstico de enfermedad de Chagas fue realizado en una clínica privada; la Inmunoglobulina M para Chagas tuvo un resultado positivo, luego, se realizó la microscopía directa mediante gota al fresco y técnica de Strout con resultado negativo. En las intervenciones comunitarias se identificó la presencia del vector y la positividad del mismo, así como el diagnóstico de un caso crónico en otro miembro de la familia. Intervención terapéutica. Se indicó tratamiento con nifurtimox 150 mg cada ocho horas por 60 días y se realizó el seguimiento clínico de la evolución y control de efectos secundarios del tratamiento y exámenes de laboratorio. Evolución clínica. Evolucionó con leve disminución del apetito, se manejó con protectores gástricos. El concentrado de Strout y la gota al fresco resultaron negativos y los demás exámenes de laboratorio se mantenían en los rangos normales.

Case presentation. A seven-year-old female patient, with no previous medical history, originally from a rural area of the department of San Miguel, who presented febrile process plus long-term right bipalpebral edema of six weeks of evolution, without accompanying symptoms. Immunoglobulin M for Chagas was positive, direct microscopy by fresh drop and Strout technique was performed with negative results. In community interventions, the presence of the vector and its positivity were identified, as well as the diagnosis of a chronic case in another family member. Treatment. The patient was treated with nifurtimox 150 mg every eight hours for 60 days, subsequent controls were performed to investigate side effects of the treatment, and control tests. Outcome. With the treatment, the patient evolved with a slight decrease in appetite, and was managed with gastric protectors. Strout's concentrate and fresh gout were negative and the other laboratory tests were within normal ranges.

Paciente con leishmaniasis cutánea tratada con miltefosina en un área endémica de Brasil / Patient with cutaneous leishmaniasis treated with miltefosine in an endemic area in Brazil

Presentación del caso. Se trata de una mujer de 45 años con úlcera en el muslo izquierdo, con forma ovalada, bordes bien definidos y elevados, sin secreción, sin costra, e indolora, que presentó una lesión de 60 días de evolución, que inició como una pápula puntiforme de aumento progresivo en tamaño y profundidad hasta generar una úlcera, después de cuatro semanas de haber realizado un viaje de tres días a un área rural endémica para leishmaniasis tegumentaria americana. Intervención terapéutica. Se confirmó el diagnóstico de leishmaniasis cutánea localizada, en consecuencia, recibió tratamiento ambulatorio con miltefosina de 50 mg por vía oral cada ocho horas por un total de 28 días, acompañado de seguimiento clínico y de laboratorio. Evolución clínica. Se presentaron efectos secundarios leves, entre ellos, las náuseas que cedieron con el tratamiento con ondansetrón y omeprazol, luego presentó hiporexia, que persistió hasta el final del tratamiento. No hubo alteraciones laboratoriales significativas. La paciente fue evaluada periódicamente según las recomendaciones del Ministerio de Salud de Brasil y se observó una mejoría clínica gradual de la lesión, hasta que en la evaluación del día noventa fue determinada la cura clínica.

Case presentation. The patient is a 45-year-old woman with an oval-shaped ulcer on the left thigh, with well-defined and raised borders, no discharge, no crust, and painless; she presented a lesion of 60 days of evolution, which started as a punctate papule of progressive increase in size and depth until it became an ulcer, four weeks after a three-day trip to a rural area endemic for American tegumentary leishmaniasis. Treatment. The diagnosis of localized cutaneous leishmaniasis was confirmed; consequently, the patient received outpatient treatment with miltefosine 50 mg orally every eight hours for 28 days, accompanied by clinical and laboratory follow-up. Clinical outcome. There were mild side effects, including nausea that subsided with treatment with ondansetron and omeprazole, and later hyporexia, which persisted until the end of treatment. There were no significant laboratory alterations. The patient was periodically evaluated according to the recommendations of the Brazilian Ministry of Health, and the lesion improved gradually, reaching a clinical cure on the 90th day.

Assessing the integration of skin screening into a mass drug administration campaign against neglected tropical diseases: A cross-sectional observational study from two districts in Côte d'Ivoire, 2023.

BACKGROUND: The World Health Organization advocates integrating neglected tropical diseases (NTDs) into common delivery platforms to combat them in resource-constrained settings. However, limited literature exists on the benefits of integration. This study examines the feasibility and impact of adding skin screening to a mass drug administration (MDA) campaign in Côte d'Ivoire. METHODS: In June 2023, the Ministry of Health and Public Hygiene of Côte d'Ivoire piloted screening for skin-related NTDs alongside a national MDA campaign targeting soil-transmitted helminthiases and schistosomiasis. Two districts, Fresco and Koro, were selected for the pilot. The study applied both quantitative and qualitative assessments. The quantitative aspect focused on campaign costs and outputs, using an ingredient approach for costing. The qualitative evaluation employed an empirical phenomenological approach to analyze the campaign's operational feasibility and appreciation by stakeholders. FINDINGS: MDA activities cost $0·66 per treated child and skin screening $0·62 per screened person, including medical products. The MDA campaign exceeded coverage targets in both districts, whereas skin screening coverage varied by locality and age group. Both the service delivery team and the beneficiaries expressed appreciation for the integrated campaign. However, opportunities for improvement were identified. CONCLUSION: Integrating MDA and skin NTD screening proved operationally feasible in this context but had not recorded cost-saving effects. The performance of the MDA campaign was not negatively affected by additional skin screening activities, but effective integration requires thorough joint planning, strengthened training, and proper supervision.

Impact of COVID-19 on the neglected tropical diseases: a scoping review.

BACKGROUND: This study investigates the impact of the COVID-19 pandemic on the prevalence, management, and control of the neglected tropical diseases (NTDs) highlighting the current or prospective impact of COVID-19 on research and development funding for, and execution of, NTD programmes. This review was conducted to determine if, and how, NTDs were affected by COVID-19, and whether those effects will delay the elimination goals of the Sustainable Development goals. METHODS: Using open-source available data from policy and documentation from official websites of the relevant stakeholders including but not limited to World Health Organization (WHO) documents and policies, government foreign aid documents, and the Policy Cures G-Finder reports, this scoping review explored ongoing challenges to supporting research and development (R&D) for the NTDs and in maintaining NTD control programs; examined the constraints posed for NTD management by the pandemic from disruptions to healthcare services, reduction of finance and explored the potential long-term implications and consequences for those poorer, neglected populations in low and middle income-countries (LMICs). This was done by a scoping review literature search, publications were subject to an initial practical screening step to ensure the most relevant publications were selected for full screening, with the focus on scoping the designated topic of the impact of COVID-19 on NTDs. We further undertook an evaluation of the socio-economic factors exacerbating the impact of COVID-19 on NTD burden. RESULTS: Multiple disruptions and setbacks, likely to affect NTD programmes and progress towards their elimination targets were identified in this study. R&D funding for the NTDs and AIDs and TB has declined since the funding high point of 2019, and for malaria since the high point of 2018. Significant changes in allocation of R&D funding within the NTDs are observed post pandemic, likely because of prioritization among donors. Diseases for which the least R&D investment was reported in place, prior to the pandemic (mycetoma, taeniasis/cysticercosis, trachoma and Buruli ulcer) have been particularly impacted post pandemic. We identified specific NTDs including schistosomiasis, leprosy, and rabies that have been affected by the COVID-19 pandemic and disruptions caused to on ongoing NTD control and elimination programs. Pandemic restrictions disrupted essential medical supply manufacturing and distribution impacting immunization programs and hindered efforts to control the spread of infectious diseases. NTD programmes have experienced numerous setbacks including delays in mass drug administration programs (e.g. for schistosomiasis), cancelled or delayed vaccination programs (e.g. for rabies) and closure of testing facilities has resulted in reduced diagnosis, treatment, and disease elimination for all NTDs. Lockdowns and clinic closures causing disruption to essential healthcare services restricted NTD surveillance and treatment programs. Community fears around contracting COVID-19 exacerbated the constraints to service delivery. Disparities in global vaccine distribution have widened with LMICs facing limited access to vaccines and disruption to immunization programs. Finally, the pandemic has led to increased poverty with poor and marginalized communities, impacting nutrition, healthcare access and education all of which have long term implications for NTD management and control. CONCLUSIONS: The COVID-19 pandemic profoundly impacted global health research and global health equity. Attention and funding were diverted from all sectors, significantly affecting research and development efforts set out in the World Health Organization's NTD elimination Roadmaps. Ongoing changes to funding, economic crises, logistics and supply chain disruptions as well as deepening poverty has put a strain on already weak healthcare systems and exacerbated LMIC healthcare challenges. In particular, the delays and constraints to NTD management and elimination programs will have long-reaching consequences highlighting the need for global cooperation and renewed investment to put the NTD roadmap back on track. Targets and milestones are unlikely to be met without significant investment for recovery, in place.

Detection of Anti-Strongyloides Antibodies in the Serum of Liver Transplant Recipients: Need of Screening for This Neglected Helminthiasis.

Immunosuppressed patients, particularly transplant recipients, can develop severe strongyloidiasis. This study aimed to detect anti-Strongyloides IgG antibodies in a panel of sera from liver transplant patients. Two techniques were used: ELISA as the initial screening test and Western blotting as a confirmatory test. ELISA reactivity of 10.9% (32/294) was observed. The 40-30 kDa fraction was recognised in 93.7% (30/32) of the patients, resulting in a positivity rate of 10.2%. These data highlight the importance of serological screening for Strongyloides stercoralis infection in liver transplant recipients.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic, debilitating disease characterised by a wide range of symptoms that severely impact all aspects of life. Despite its significant prevalence, ME/CFS remains one of the most understudied and misunderstood conditions in modern medicine. ME/CFS lacks standardised diagnostic criteria owing to variations in both inclusion and exclusion criteria across different diagnostic guidelines, and furthermore, there are currently no effective treatments available. Moving beyond the traditional fragmented perspectives that have limited our understanding and management of the disease, our analysis of current information on ME/CFS represents a significant paradigm shift by synthesising the disease's multifactorial origins into a cohesive model. We discuss how ME/CFS emerges from an intricate web of genetic vulnerabilities and environmental triggers, notably viral infections, leading to a complex series of pathological responses including immune dysregulation, chronic inflammation, gut dysbiosis, and metabolic disturbances. This comprehensive model not only advances our understanding of ME/CFS's pathophysiology but also opens new avenues for research and potential therapeutic strategies. By integrating these disparate elements, our work emphasises the necessity of a holistic approach to diagnosing, researching, and treating ME/CFS, urging the scientific community to reconsider the disease's complexity and the multifaceted approach required for its study and management.

Leveraging wastewater-based epidemiology to monitor the spread of neglected tropical diseases in African communities.

Neglected tropical diseases continue to cause a significant burden worldwide, with Africa accounting for more than one-third of the global burden. Over the past decade, progress has been made in eliminating, controlling, and eradicating these diseases in Africa. By December 2022, 47 out of 54 African countries had eliminated at least one neglected tropical disease, and more countries were close to achieving this milestone. Between 2020 and 2021, there was an 80 million reduction in people requiring intervention. However, continued efforts are needed to manage neglected tropical diseases and address their social and economic burden, as they deepen marginalisation and stigmatisation. Wastewater-based epidemiology involves analyzing wastewater to detect and quantify biomarkers of disease-causing pathogens. This approach can complement current disease surveillance systems in Africa and provide an additional layer of information for monitoring disease spread and detecting outbreaks. This is particularly important in Africa due to limited traditional surveillance methods. Wastewater-based epidemiology also provides a tsunami-like warning system for neglected tropical disease outbreaks and can facilitate timely intervention and optimised resource allocation, providing an unbiased reflection of the community's health compared to traditional surveillance systems. In this review, we highlight the potential of wastewater-based epidemiology as an innovative approach for monitoring neglected tropical disease transmission within African communities and improving existing surveillance systems. Our analysis shows that wastewater-based epidemiology can enhance surveillance of neglected tropical diseases in Africa, improving early detection and management of Buruli ulcers, hookworm infections, ascariasis, schistosomiasis, dengue, chikungunya, echinococcosis, rabies, and cysticercosis for better disease control.

Understanding noma: WHO's recognition and the path forward in global health.

The World Health Organization's (WHO) designation of noma as a neglected tropical disease (NTD) on 15 December 2023 marks a crucial advancement in global health efforts. This move sheds light on a condition predominantly affecting undernourished children in isolated regions of sub-Saharan Africa. Recognized as the 21st NTD, noma, or cancrum oris, is a serious condition leading to orofacial gangrene. The disease largely impacts young children and those with compromised immune systems, including individuals with human immunodeficiency virus or leukaemia. Determining the exact prevalence of noma is complex, hindered by rapid disease progression, societal stigma and a lack of reporting, especially in impoverished areas. The WHO's acknowledgment is a significant step, emphasizing the need for more in-depth research and resources to address this overlooked disease. It highlights the critical role of multifaceted prevention strategies, including economic empowerment, improved nutrition and enhanced vaccination efforts. This recognition is pivotal in guiding international health initiatives towards better outcomes for some of the most at-risk populations globally.

Knowledge of female genital schistosomiasis and urinary schistosomiasis among final-year midwifery students in the Volta Region of Ghana.

BACKGROUND: Female genital schistosomiasis (FGS) is a gynaecological complication of urinary schistosomiasis (US) with an estimated burden of 20-120 million cases in endemic areas. A neglected sexual and reproductive health disease in sub-Saharan Africa, FGS increases susceptibility to sexually transmitted infections including cervical cancer and infertility among other morbidities. However, there appears to be limited FGS knowledge among practicing and pre-service health providers with implications for control. We assessed FGS awareness among final-year midwifery students who would soon be delivering primary maternal and reproductive health care. METHODS: A cross-sectional study was conducted among 193 randomly selected final-year students from all three midwifery training institutions in the Volta region of Ghana in August/September, 2022. Data on participants' demographics and knowledge of the transmission, signs and symptoms, complications, treatment and prevention of both FGS and US were collected using structured questionnaires. Summary statistics were presented as frequencies, proportions and percentages. RESULTS: Only 23.3% (44/189) of participants had heard about FGS compared to 64% (123/192) for US. Of the former, 42 (95%), 40 (91%) and 36 (81.8%) respectively identified genital itching/burning sensation, bloody vaginal discharge and pelvic pain/pain during intercourse as part of the symptoms of FGS. Less than a third (13/44) and about half (25/44) of those who indicated hearing about FGS knew it can be a risk for ectopic pregnancies and infertility respectively. Majority of these participants, 40 (91%), wrongly selected antibiotics as treatment for FGS while 9 indicated it is prevented by sleeping in insecticide-treated nets. CONCLUSION: Awareness of FGS was limited among the study participants. The high prevalence of knowledge of some FGS symptoms related to the genitalia needs cautious interpretation. Health care training institutions must make deliberate efforts to highlight FGS in the training of midwives as the condition has diagnostic and management implications for some sexual and reproductive health conditions.

HIV and childhood tuberculosis: fragmentation of the flow of information in the countryside of the state of São Paulo / HIV e tuberculose infantil: a fragmentação do fluxo de informação no interior paulista / VIH y tuberculosis infantil: la fragmentación del flujo de información en el interior del estado de São Paulo

Background and objectives: children are still affected by HIV and tuberculosis (TB). This study aimed to identify the occurrence of HIV and TB cases in children. Methods: this is an epidemiological, non-experimental, retrospective study, in which the population was made up of records of HIV and TB cases in children living in a municipality in the countryside of the state of São Paulo, from 2012 to 2022, in the age group of zero to 13 years old. After data collection, data consistency and validity was checked, followed by categorization of information for descriptive analyses and presentation in absolute and relative frequency tables. Results: during the study period, six HIV cases and seven TB cases were identified in children with a respective average annual incidence of 0.033 and 0.031 cases/1,000 inhabitants aged up to 13 years. There were 146 notifications of HIV-exposed children. There was a difference of months to years between the dates of diagnosis and notification, which deviates from the Ministry of Health recommendations. Incompatibility was found between municipal and state registration platforms, which shows a breakdown in flow of information on notifications. Conclusion: there have been HIV and childhood TB cases in the last ten years. Structural problems were identified in the fragmentation of the flow of information that subsidizes health actions according to the population's needs, which overshadows the health system's ability to respond.(AU)

Justificativa e Objetivos: crianças ainda são afetadas pelo HIV e pela tuberculose (TB). Dessa forma, o objetivo do estudo foi identificar a ocorrência de casos de HIV e TB em crianças. Métodos: trata-se de estudo epidemiológico, não experimental, retrospectivo, em que a população foi constituída pelo registro de casos infantis de HIV e TB residentes em um município do interior do estado de São Paulo, no período de 2012 a 2022, na faixa etária de zero a 13 anos de idade. Após a coleta de dados, foi realizada a verificação de consistência e validade dos dados, seguida do tratamento categorizado das informações para análises descritivas e apresentação em tabelas de frequência absoluta e relativa. Resultados: no período de estudo, foram identificados seis casos de HIV e sete de TB em crianças com média anual respectiva de 0,033 e 0,031 casos/1.000 habitantes com idade até 13 anos. Verificaram-se 146 notificações de criança exposta ao HIV. Houve diferença de meses a anos entre as datas de diagnóstico e de notificação, o que diverge do recomendado pelo Ministério da Saúde. Foi verificada a incompatibilidade entre plataformas de registro de âmbito municipal e estadual, o que evidencia uma quebra do fluxo de informação das notificações. Conclusão: houve ocorrência de casos de HIV e TB infantil nos últimos dez anos. Foram identificados problemas estruturais na fragmentação do fluxo da informação que subsidia ações de saúde de acordo com as necessidades da população, o que ofusca a capacidade de resposta do sistema de saúde.(AU)

Antecedentes y Objetivos: los niños siguen estando afectados por el VIH y la tuberculosis (TB). El objetivo de este estudio fue identificar la ocurrencia de casos de VIH y TB en niños. Métodos: se trata de un estudio epidemiológico, no experimental, retrospectivo, en el cual la población fue constituida por los registros de casos de VIH y TB en niños residentes en un municipio del interior del estado de São Paulo entre 2012 y 2022, con edad entre cero y 13 años. Después de la recolección de datos, se verificó la consistencia y validez de los mismos, seguido del tratamiento categorizado de la información para análisis descriptivos y presentación en tablas de frecuencias absolutas y relativas. Resultados: durante el periodo de estudio, se identificaron seis casos de VIH y siete de TB en niños, con una incidencia media anual respectiva de 0,033 y 0,031 casos/1.000 habitantes de hasta 13 años. Hubo 146 notificaciones de niños expuestos al VIH. Hubo una diferencia de meses a años entre las fechas de diagnóstico y notificación, lo que se desvía de lo recomendado por el Ministerio de Salud. Hubo incompatibilidad entre las plataformas de registro municipal y estatal, lo que muestra una ruptura en el flujo de información sobre las notificaciones. Conclusión: se han registrado casos de VIH y de tuberculosis infantil en los últimos diez años. Se identificaron problemas estructurales en la fragmentación del flujo de información que subvenciona las acciones sanitarias según las necesidades de la población, lo que ensombrece la capacidad de respuesta del sistema sanitario.(AU)

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

Current drug strategies for the treatment and control of schistosomiasis.

INTRODUCTION: Schistosomiasis, one of the current Neglected Tropical Diseases (NTDs) affects over 230 million people globally, with nearly 700 million at risk in more than 74 countries. Praziquantel (PZQ) has served as the primary treatment for the past four decades; however, its effectiveness is limited as it solely eliminates adult worms. In regions where infections are frequent, PZQ exhibits only temporary efficacy and has restricted potential to disrupt the prolonged transmission of the disease. AREAS COVERED: A comprehensive exploration using the PubMed database was conducted to review current pharmacotherapy approaches for schistosomiasis. This review also encompasses recent research findings related to potential novel therapeutics and the repurposing of existing drugs. EXPERT OPINION: Current schistosoma treatment strategies, primarily relying on PZQ, face challenges like temporary effectiveness and limited impact on disease transmission. Drug repurposing, due to economic constraints, is decisive for NTDs. Despite PZQ's efficacy, its failure to prevent reinfection highlights the need for complementary strategies, especially in regions with persistent environmental foci. Integrating therapies against diverse schistosome stages boosts efficacy and impedes resistance. Uncovering novel agents is essential to address resistance concerns in tackling this neglected tropical disease. Integrated strategies present a comprehensive approach to navigate the complex challenges.

The current status of neglected tropical diseases in Japan: A scoping review.

Little attention has been paid to neglected tropical diseases (NTDs) in high-income countries and no literature provides an overview of NTDs in Japan. This scoping review aims to synthesize the latest evidence and information to understand epidemiology of and public health response to NTDs in Japan. Using three academic databases, we retrieved articles that mentioned NTDs in Japan, written in English or Japanese, and published between 2010 and 2020. Websites of key public health institutions and medical societies were also explored. From these sources of information, we extracted data that were relevant to answering our research questions. Our findings revealed the transmission of alveolar echinococcosis, Buruli ulcer, Chagas disease, dengue, foodborne trematodiases, mycetoma, scabies, and soil-transmitted helminthiasis as well as occurrence of snakebites within Japan. Other NTDs, such as chikungunya, cystic echinococcosis, cysticercosis, leishmaniasis, leprosy, lymphatic filariasis, rabies, and schistosomiasis, have been imported into the country. Government agencies tend to organize surveillance and control programs only for the NTDs targeted by the Infectious Disease Control Law, namely, echinococcosis, rabies, dengue, and chikungunya. At least one laboratory offers diagnostic testing for each NTD except for dracunculiasis, human African trypanosomiasis, onchocerciasis, and yaws. No medicine is approved for treatment of Chagas disease and fascioliasis and only off-label use drugs are available for cysticercosis, opisthorchiasis, human African trypanosomiasis, onchocerciasis, schistosomiasis, and yaws. Based on these findings, we developed disease-specific recommendations. In addition, three policy issues are discussed, such as lack of legal frameworks to organize responses to some NTDs, overreliance on researchers to procure some NTD products, and unaffordability of unapproved NTD medicines. Japan should recognize the presence of NTDs within the country and need to address them as a national effort. The implications of our findings extend beyond Japan, emphasizing the need to study, recognize, and address NTDs even in high-income countries.

Estudo estrutural e comparativo entre Sirtuínas 2 de diferentes espécies de Leishmania / Structural and comparative study between Sirtuins 2 of different species of Leishmania by means of Comparative Modeling and Molecular Dynamic

As leishmanioses são doenças negligenciadas que afetam mais de um bilhão e meio de pessoas ao redor do mundo, principalmente nos países em desenvolvimento, provocando grandes impactos socioeconômicos. Os fármacos disponíveis para o tratamento dessas doenças são ineficazes e apresentam graves efeitos adversos. O processo de pesquisa de novos fármacos envolve, entre outras coisas, a seleção de alvos bioquímicos essenciais para a sobrevivência e desenvolvimento do agente causador. Neste sentido, a Sirtuína 2, uma enzima epigenética com atividade hidrolase essencial para a sobrevivência dos parasitas do gênero Leishmania se apresenta como um alvo validado na busca de novos fármacos contra essas parasitoses. O planejamento de fármacos baseado na estrutura do receptor requer o conhecimento da estrutura tridimensional da proteína alvo. Desta forma, a elucidação estrutural e um estudo minucioso das Sirtuínas das várias espécies do gênero Leishmania apresenta-se como uma importante abordagem na aplicação desta estratégia na busca por agentes quimioterápicos. Até o momento, na família Trypanosomatidae, a única estrutura tridimensional resolvida experimentalmente de uma enzima Sirtuína 2 é a da espécie L. infantum. Assim, este trabalho aplicou a abordagem de Modelagem Comparativa utilizando o software Modeller na construção de modelos da Sir2rp1 das espécies L. infantum, L. major e L. braziliensis, cujas sequências de aminoácidos foram extraídas do banco de dados UNIProt. Os modelos construídos foram validados por meio da função de escore DOPE do Modeller e dos servidores PROCHECK, MolProbity e QMEAN, avaliando sua qualidade estereoquímica e seu enovelamento. Os ligantes naturais da enzima foram sobrepostos nos modelos construídos por alinhamento estrutural utilizando o software PyMol e os complexos validados foram submetidos a simulações de Dinâmica Molecular através do pacote GROMACS. Os complexos refinados foram então analisados por meio dos softwares PyMol e LigPlotPlus e dos pacotes GROMACS e gmx_MMPBSA, e foram estudados os sítios de ligação dos substratos e os resíduos de aminoácidos relevantes envolvidos em sua ligação e reconhecimento. A Modelagem Comparativa da Sirtuína 2 humana e seus homólogos das espécies L. infantum, L. major e L. braziliensis, as simulações de Dinâmica Molecular realizadas com os modelos enzimáticos construídos e validados complexados com seus ligantes naturais, os cálculos de energia de interação entre os modelos e seus substratos e o estudo estrutural comparativo realizado entre eles nos fornecem uma base teórica para a busca de novos inibidores da Sirtuína 2 que sejam mais seletivos e potentes contra as enzimas parasitárias, abrindo caminho para o desenvolvimento de candidatos a fármacos leishmanicidas mais seguros e eficazes

Leishmaniasis are neglected diseases that affect more than one and a half billion people around the world, mainly in developing countries, causing major socioeconomic impacts. The drugs available for the treatment of these diseases are ineffective and have serious adverse effects. The process of researching new drugs involves, among other things, the selection of biochemical targets essential for the survival and development of the causative agent. In this sense, Sirtuin 2, an epigenetic enzyme with hydrolase activity essential for the survival of parasites of the Leishmania genus, presents itself as a validated target in the search for new drugs against these parasites. Structure-Based Drug Design requires knowledge of the three-dimensional structure of the target protein. In this way, structural elucidation and a detailed study of Sirtuins from various species of the genus Leishmania presents itself as an important approach in the application of this strategy in the search for chemotherapeutic agents. To date, in the Trypanosomatidae family, the only experimentally resolved three-dimensional structure of a Sirtuin 2 enzyme is that of the species L. infantum. Thus, this work applied the Comparative Modeling approach using the Modeller software in the construction of Sir2rp1 models of the species L. infantum, L. major and L. braziliensis, whose amino acid sequences were retrieved from the UNIProt database. The constructed models were validated using Modeller's DOPE score function and the PROCHECK, MolProbity and QMEAN servers, evaluating their stereochemical quality and folding. The enzyme's natural ligands were superimposed on the built models by structural alignment using the PyMol software and the validated complexes were subjected to Molecular Dynamics simulations using the GROMACS package. The refined complexes were then analyzed using the PyMol and LigPlotPlus softwares and the GROMACS and gmx_MMPBSA packages, and the substrate binding sites and relevant amino acid residues involved in their binding and recognition were studied. The Comparative Modeling of human Sirtuin 2 and its homologues from the species L. infantum, L. major and L. braziliensis, the Molecular Dynamics simulations carried out with the constructed and validated enzymatic models complexed with their natural ligands, the interaction energy calculations between the models and their substrates and the comparative structural study carried out between them provide us with a theoretical basis for the search for new Sirtuin 2 inhibitors that are more selective and potent against the parasitic enzymes, paving the way for the development of safer and more effective leishmanicidal drug candidates

Contribuições para a mobilização social, comunicação e educação em saúde sobre a doença de Chagas no YouTube ­ percurso e notas sobre o canal Falamos de Chagas / Contributions to social mobilization, communication and health education on Chagas disease on YouTube ­ route and notes on the channel Falamos de Chagas / Aportes a la movilización social, comunicación y educación en salud sobre la enfermedad de Chagas en YouTube ­ trayectoria y notas en el canal Falamos de Chagas

A doença de Chagas crônica afeta seis milhões de pessoas em regiões endêmicas, com 30 mil novos casos anuais ­ logo, espaços de divulgação científica são muito importantes para ofertar informações de qualidade à população. As iniciativas envolvendo o controle da doença de Chagas não podem se limitar às pesquisas com enfoque biológico. Este estudo objetiva apresentar um panorama sobre o processo de construção do canal Falamos de Chagas, no YouTube, sua importância para a comunicação, a informação, a educação em saúde e a mobilização social, bem como refletir sobre a qualidade de uma subamostra de vídeos do canal. Trata-se de um estudo qualitativo, dividido em duas fases: criação do canal e análise qualitativa dos vídeos sobre a doença disponíveis no YouTube. Observamos que existe potencial nas redes sociais, enquanto recurso de comunicação, contudo é preciso cautela, uma vez que se faz necessária a certificação da qualidade do material

Chronic Chagas disease affects six million people in endemic regions, with 30,000 new infected cases an-nually ­ thus, initiatives involving science diffusion are relevant to offer qualified information to the people. Chagas disease control initiatives cannot be limited to the level of biological focused research. This study aims to present an overview of the construction process of the YouTube channel Falando de Chagas, its importance for communication, information, health education and social mobilization, as well as to reflect on the quality of a subsample of videos present in the channel. Qualitative in nature, the study was divided into two stages: construction of the channel and qualitative analysis of videos about the disease available on YouTube. We observed that there is potential for social networks as communication resources, but caution is needed in their use, since the quality of the material needs certification

La enfermedad de Chagas crónica afecta seis millones de personas en regiones endémicas, con 30.000 nuevos casos anuales ­ los espacios de divulgación científica son muy importantes para ofrecer información a la población. Las iniciativas de control de la enfermedad de Chagas no pueden limitarse al nivel de investigación con enfoque biológico. El estudio tiene como objetivo presentar un panorama del proceso de construcción del canal Falando de Chagas, en YouTube, su importancia para la comunicación, información, educación en salud y movilización social, así como reflexionar sobre la calidad de una submuestra de videos presentes en la canal. De naturaleza cualitativa, el estudio se dividió en dos fases: construcción del canal y análisis cualitativo de videos sobre la enfermedad disponibles en YouTube. Observamos que existe potencial para las redes sociales como recurso de comunicación, sin embargo, se requiere cautela en su uso, ya que se requiere certificar la calidad del material

Comportamiento epidemiológico de la enfermedad de Hansen en Costa Rica, periodo 2018 a 2022 / Epidemiological Behavior of Hansen's Disease in Costa Rica, 2018-2022

Resumen Objetivos: Describir el comportamiento epidemiológico de la enfermedad de Hansen en Costa Rica durante el periodo 2018-2022 para la identificación y análisis de las tendencias de la patología con miras al desarrollo de estrategias más efectivas para su erradicación. Métodos: Estudio descriptivo observacional retrospectivo de casos con enfermedad de Hansen entre 2018 y 2022, realizado mediante el registro de la boleta de notificación individual y clasificados según la Clasificación Internacional de Enfermedades 10ma Revisión. Para determinar el número de casos nuevos del periodo de estudio, se solicitó la información anonimizada a la Unidad de Epidemiología de la Caja Costarricense de Seguro Social y a la Unidad de Epidemiología de la Dirección de Vigilancia de la Salud del Ministerio de Salud. Resultados: En Costa Rica, entre 2018-2022, se registraron 50 casos de enfermedad de Hansen (promedio anual de 10). El promedio de edad al momento del diagnóstico fue de 48,46 ± 17,88 años para el grupo en general, con un rango de edad de 15-78 años. La razón por sexos (hombre/ mujer) fue 2,33 (15/35). La provincia de Puntarenas registró 26 casos (52%). El cantón de Garabito se observó una tasa de prevalencia a nivel subnacional superior a 1 por cada 10000 habitantes. No se reportaron casos en menores de 15 años. La tasa media global de detección de enfermedad de Hansen durante el período de estudio fue de 0,2 (50/ 25 549 059) por 100000 habitantes. La tasa de detección de lepra disminuyó de 0,26 (13/ 5 003 402) a 0,249 (8 / 5213374) por 100000 habitantes entre 2018 y 2022. La proporción de casos clasificados como lepra multibacilar aumentó a 100% a partir del año 2019. La proporción de casos de lepra en mujeres disminuyó de 38,46 a 12,5%. Conclusión: A nivel nacional, la prevalencia de la enfermedad mantuvo los niveles de eliminación. No obstante, a nivel sub- nacional aún persisten cantones con niveles superiores a 1 por 10000 habitantes.

Abstract Objective: To describe the epidemiological characteristics of leprosy in Costa Rica from 2018-2022. Methods: Retrospective observational descriptive study from 2018 to 2022 of Hansen's Disease cases using individual notification records under the International Classification of Diseases 10th Revision. To determine the number of new cases, anonymized information was requested from the Epidemiology Unit of the Costa Rican Social Security Fund and the Epidemiology Unit of the Health Surveillance Directorate of the Ministry of Health. Results: In Costa Rica, between 2018-2022, 50 cases of Hansen's disease were registered (annual average of 10). The mean age at diagnosis was 48.46 ± 17.88 years for the group in general, with an age range between 15 -78 years. The sex ratio (male/ female) was 2.33 (15/35). The province of Puntarenas recorded 26 cases (52%). The canton of Garabito registered a prevalence rate at the subnational level of more than 1 per ten thousand inhabitants. No cases in children under 15 years of age were reported. The overall mean leprosy detection rate during the study period was 0.2 (50/25 549 059) per 100000 population. The leprosy detection rate decreased from 0.26 (13/5,003,402) to 0.249 (8/5213374) per 100000 population between 2018 and 2022. The proportion of cases classified as multibacillary leprosy increased by 100% in 2019. The proportion of leprosy in women decreased from 38.46% to 12.5%. Conclusion: Nationwide, the disease prevalence is maintained at elimination levels. However, at the subnational level, districts with rates higher than 1 per 10000 inhabitants still exist.