Exploring the Resurgence of a Neglected Disease: Lessons From the 2023-2024 Mpox Outbreak in Rio de Janeiro, Brazil.

Following the 2022 global mpox outbreak, diagnoses decreased worldwide, even in settings with limited vaccine access. In 2023-2024, a new outbreak emerged in Rio de Janeiro, Brazil, highlighting the importance of continuous surveillance, preventive measures such as vaccination in vulnerable populations, and treatment options, emphasizing equitable global health technology distribution.

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil.

Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30-39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).

Subacute infective endocarditis caused by Bacillus cereus in a patient with Systemic Lupus Erythematosus.

A rare and difficult to diagnose case of subacute infective endocarditis caused by Bacillus cereus in a patient with systemic lupus erythematosus and Libman-Sacks endocarditis has been reported. Our aim is to highlight the importance of molecular methods such as MALDI-TOF and PCR to explain clinical and epidemiological issues about infections caused by unusual pathogen.

Trabalho de Campo Supervisionado II: uma experiência curricular de inserção na Atenção Primária à Saúde / Supervised Field Work II: a curricular experience of insertion in Primary Health Care / Trabajo de Campo Supervisado II: una experiencia curricular de inserción en la Atención Primaria para la Salud

O componente curricular Trabalho de Campo Supervisionado II (TCS II), a partir da diversificação de cenários de aprendizagem, propõe a inserção na Atenção Primária à Saúde (APS) desde os períodos iniciais do curso de Medicina da Universidade Federal Fluminense, em Niterói, Rio de Janeiro, Brasil. Este trabalho apresenta a experiência de discentes e preceptor de TCS II, em uma Unidade Básica de Saúde, nos 3º e 4º períodos. Da experiência do campo, acompanhada por meio de relatos escritos e reflexões, emergiram categorias utilizadas para descrever e analisar as contribuições da inserção sistemática na APS como dispositivo de mudança na formação médica. Conclui-se que a APS como cenário de aprendizagem é um espaço capaz de oferecer novas perspectivas de formação em saúde, com base nas necessidades de saúde da população, devendo permanecer como um espaço de prática nos períodos subsequentes do curso, o que, efetivamente, ainda não acontece.

Through the diversification of learning scenarios, the curriculum component Supervised Field Work II (SFW II) proposes to insert Primary Health Care from the early semesters of the Medical training in the Fluminense Federal University em Niterói, Rio de Janeiro, Brazil. This paper presents the experience of SFW II students and a preceptor in a Primary Care Unit (PHC) during the 3rd and 4th semesters of the medical degree. From the experience gained during the practice, and the follow-up done by written reports and reflections, several categories were used to describe and analyze the contributions of the systematic insertion in the PHC as a tool for change in medical education. It was concluded that the PHC as a learning scenario represents an environment that offers students a new perspective of health training, based on the population’s health needs, and that it must remain as a practice scenario in subsequent semesters of the training, which is not yet the case.

El componente curricular Trabajo de Campo Supervisado II (TCS II), con base en la diversificación de escenarios de aprendizaje, propone la inserción en la Atención Primaria para la Salud (APS) desde el inicio del curso de Medicina de la Universidad Federal Fluminense, en Niterói, Rio de Janeiro, Brasil. Este trabajo presenta la experiencia de los estudiantes y el preceptor de TCS II, en una Unidad Básica de Salud, durante el segundo año del curso. A partir de la experiencia, acompañada por relatos escritos y reflexiones, emergieron categorías utilizadas para describir y analizar las contribuciones de la inclusión sistemática de la APS como dispositivo de cambio en la formación médica. La APS como escenario de aprendizaje es capaz de ofrecer nuevas perspectivas de formación en salud, con bases en las necesidades de salud de la población.Concluimos que la misma debería permanecer como un espacio de práctica a lo largo del curso, lo que, efectivamente, aún no ocurre.