In silico analysis of non-structural protein 12 sequences from SARS-COV-2 found in Manaus, Amazonas, Brazil, reveals mutations linked to higher transmissibility.

The disease coronavirus COVID-19 has been the cause of millions of deaths worldwide. Among the proteins of SARS-CoV-2, non-structural protein 12 (NSP12) plays a key role during COVID infection and is part of the RNA-dependent RNA polymerase complex. The monitoring of NSP12 polymorphisms is extremely important for the design of new antiviral drugs and monitoring of viral evolution. This study analyzed the NSP12 mutations detected in circulating SARS-CoV-2 during the years 2020 to 2022 in the population of the city of Manaus, Amazonas, Brazil. The most frequent mutations found were P323L and G671S. Reports in the literature indicate that these mutations are related to transmissibility efficiency, which may have contributed to the extremely high numbers of cases in this location. In addition, two mutations described here (E796D and R914K) are close and have RMSD that is similar to the mutations M794V and N911K, which have been described in the literature as influential on the performance of the NSP12 enzyme. These data demonstrate the need to monitor the emergence of new mutations in NSP12 in order to better understand their consequences for the treatments currently used and in the design of new drugs.

SARS-CoV-2 intra-host diversity, antibody response, and disease severity after reinfection by the variant of concern Gamma in Brazil.

The rapid spread of the SARS-CoV-2 Variant of Concern (VOC) Gamma in Amazonas during early 2021 fueled a second large COVID-19 epidemic wave and raised concern about the potential role of reinfections. Very few cases of reinfection associated with the VOC Gamma have been reported to date, and their potential impact on clinical, immunological, and virological parameters remains largely unexplored. Here we describe 25 cases of SARS-CoV-2 reinfection in Brazil. SARS-CoV-2 genomic analysis confirmed that individuals were primo-infected with distinct viral lineages between March and December 2020 (B.1.1, B.1.1.28, B.1.1.33, B.1.195, and P.2) and reinfected with the VOC Gamma between 3 to 12 months after primo-infection. We found a similar mean cycle threshold (Ct) value and limited intra-host viral diversity in both primo-infection and reinfection samples. Sera of 14 patients tested 10-75 days after reinfection displayed detectable neutralizing antibodies (NAb) titers against SARS-CoV-2 variants that circulated before (B.1.*), during (Gamma), and after (Delta and Omicron) the second epidemic wave in Brazil. All individuals had milder or no symptoms after reinfection, and none required hospitalization. These findings demonstrate that individuals reinfected with the VOC Gamma may display relatively high RNA viral loads at the upper respiratory tract after reinfection, thus contributing to onward viral transmissions. Despite this, our study points to a low overall risk of severe Gamma reinfections, supporting that the abrupt increase in hospital admissions and deaths observed in Amazonas and other Brazilian states during the Gamma wave was mostly driven by primary infections. Our findings also indicate that most individuals analyzed developed a high anti-SARS-CoV-2 NAb response after reinfection that may provide some protection against reinfection or disease by different SARS-CoV-2 variants.

Spread of Gamma (P.1) Sub-Lineages Carrying Spike Mutations Close to the Furin Cleavage Site and Deletions in the N-Terminal Domain Drives Ongoing Transmission of SARS-CoV-2 in Amazonas, Brazil.

The Amazonas was one of the most heavily affected Brazilian states by the COVID-19 epidemic. Despite a large number of infected people, particularly during the second wave associated with the spread of the Variant of Concern (VOC) Gamma (lineage P.1), SARS-CoV-2 continues to circulate in the Amazonas. To understand how SARS-CoV-2 persisted in a human population with a high immunity barrier, we generated 1,188 SARS-CoV-2 whole-genome sequences from individuals diagnosed in the Amazonas state from 1st January to 6th July 2021, of which 38 were vaccine breakthrough infections. Our study reveals a sharp increase in the relative prevalence of Gamma plus (P.1+) variants, designated Pango Lineages P.1.3 to P.1.6, harboring two types of additional Spike changes: deletions in the N-terminal (NTD) domain (particularly Δ144 or Δ141-144) associated with resistance to anti-NTD neutralizing antibodies or mutations at the S1/S2 junction (N679K or P681H) that probably enhance the binding affinity to the furin cleavage site, as suggested by our molecular dynamics simulations. As lineages P.1.4 (S:N679K) and P.1.6 (S:P681H) expanded (Re > 1) from March to July 2021, the lineage P.1 declined (Re < 1) and the median Ct value of SARS-CoV-2 positive cases in Amazonas significantly decreases. Still, we did not find an increased incidence of P.1+ variants among breakthrough cases of fully vaccinated patients (71%) in comparison to unvaccinated individuals (93%). This evidence supports that the ongoing endemic transmission of SARS-CoV-2 in the Amazonas is driven by the spread of new local Gamma/P.1 sublineages that are more transmissible, although not more efficient to evade vaccine-elicited immunity than the parental VOC. Finally, as SARS-CoV-2 continues to spread in human populations with a declining density of susceptible hosts, the risk of selecting more infectious variants or antibody evasion mutations is expected to increase. IMPORTANCE The continuous evolution of SARS-CoV-2 is an expected phenomenon that will continue to happen due to the high number of cases worldwide. The present study analyzed how a Variant of Concern (VOC) could still circulate in a population hardly affected by two COVID-19 waves and with vaccination in progress. Our results showed that the answer behind that was a new generation of Gamma-like viruses, which emerged locally carrying mutations that made it more transmissible and more capable of spreading, partially evading prior immunity triggered by natural infections or vaccines. With thousands of new cases daily, the current pandemics scenario suggests that SARS-CoV-2 will continue to evolve and efforts to reduce the number of infected subjects, including global equitable access to COVID-19 vaccines, are mandatory. Thus, until the end of pandemics, the SARS-CoV-2 genomic surveillance will be an essential tool to better understand the drivers of the viral evolutionary process.

Concepções, estratégias e usos do planejamento na gerência em Unidades de Saúde da Família / Conceptions, strategies and uses of planning management in family health units

Objetivo: discutir as concepções, estratégias e usos do planejamento pelos profissionais de saúde na gerência de Unidade de Saúde da Família (USF). Método: estudo descritivo, exploratório, de abordagem qualitativa, que utilizou a técnica de análise de conteúdo temática. Foram entrevistados nove profissionais de saúde que atuavam como gerentes de USF. Resultados: o planejamento ora é identificado como instrumento do processo de gerência das organizações, ora é desconsiderado como ferramenta do processo gerencial. Há influência dos enfoques teóricos metodológicos do Planejamento em Saúde, o Planejamento Normativo (Tradicional) e Planejamento Estratégico Situacional (PES). Destacou-se a participação de atores sociais no planejamento e influência do tempo no desenvolvimento das ações. Conclusão: articular a gerência e planejamento das ações representa um desafio e reforça a necessidade da institucionalização do planejamento das ações para a efetividade da prática gerencial.

Objective: to discuss how conceptions, strategies and uses of planning by health professionals in the Family Health Unit (FHU). Method: descriptive, exploratory study, qualitative approach, which uses a thematic content analysis technique. Nine health professionals who served as USF managers were interviewed. Results: planning is either identified as an instrument of the associations' internal process, or it is disregarded as a tool in the management process. There is an influence of the theoretical methodological approaches of Health Planning, Normative Planning (Traditional) and Situational Strategic Planning (PES). The participation of social actors in the planning and the impact of time on the development of actions were highlighted. Conclusion: articulating the planning and planning of actions poses a challenge and reinforces the need to institutionalize the planning of actions for the effectiveness of managerial practice.

Structural analysis of SARS-Cov-2 nonstructural protein 1 polymorphisms found in the Brazilian Amazon.

The coronavirus disease COVID-19 has been the cause of millions of deaths worldwide. Among the SARS-CoV-2 proteins, the non-structural protein 1 (NSP1) has great importance during the virus infection process and is present in both alpha and beta-CoVs. Therefore, monitoring of NSP1 polymorphisms is crucial in order to understand their role during infection and virus-induced pathogenicity. Herein, we analyzed how mutations detected in the circulating SARS-CoV-2 in the population of the city of Manaus, Amazonas state, Brazil could modify the tertiary structure of the NSP1 protein. Three mutations were detected in the SARS-CoV-2 NSP1 gene: deletion of the amino acids KSF from positions 141 to 143 (delKSF), SARS-CoV-2, lineage B.1.195; and two substitutions, R29H and R43C, SARS-CoV-2 lineage B.1.1.28 and B.1.1.33, respectively. The delKSF was found in 47 samples, whereas R29H and R43C were found in two samples, one for each mutation. The NSP1 structures carrying the mutations R43C and R29H on the N-terminal portion (e.g. residues 10 to 127) showed minor backbone divergence compared to the Wuhan model. However, the NSP1 C-terminal region (residues 145 to 180) was severely affected in the delKSF and R29H mutants. The intermediate variable region (residues 144 to 148) leads to changes in the C-terminal region, particularly in the delKSF structure. New investigations must be carried out to analyze how these changes affect NSP1 activity during the infection. Our results reinforce the need for continuous genomic surveillance of SARS-CoV-2 to better understand virus evolution and assess the potential impact of the viral mutations on the approved vaccines and future therapies.

COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence.

The northern state of Amazonas is among the regions in Brazil most heavily affected by the COVID-19 epidemic and has experienced two exponentially growing waves, in early and late 2020. Through a genomic epidemiology study based on 250 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from different Amazonas municipalities sampled between March 2020 and January 2021, we reveal that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195, which was gradually replaced by lineage B.1.1.28 between May and June 2020. The second wave coincides with the emergence of the variant of concern (VOC) P.1, which evolved from a local B.1.1.28 clade in late November 2020 and replaced the parental lineage in <2 months. Our findings support the conclusion that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide insights to understanding the mechanisms underlying the COVID-19 epidemic waves and the risk of dissemination of SARS-CoV-2 VOC P.1 in Brazil and, potentially, worldwide.

COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new variant of concern P.1.

Dentre as 27 Unidades Federativas brasileiras, o estado do Amazonas foi uma das mais afetadas pela presente pandemia do novo coronavírus, com a ocorrência de uma segunda onda ao final de 2020 na qual um grande número de casos graves levou a um colapso no sistema de saúde. Este pre-print, resultado da análise do genoma completo de 250 amostras do SARS-CoV-2 coletadas no Amazonas entre março de 2020 e janeiro de 2021, descreve a dinâmica de sucessões de linhagens dominantes no estado. Mais recentemente, ele foi publicado na revista Nature Medicine, após editoração e a revisão por pesquisadores independentes. A publicação apresenta dados que embasam as hipóteses de que a linhagem responsável pela maioria dos casos no primeiro momento da pandemia (entre março e maio de 2020) foi a B.1.195, de que esta foi suplantada pela B.1.1.28, que tornou-se a linhagem dominante no estado entre maio e dezembro de 2020, e de que em dezembro o surgimento de uma variante da B.1.1.28, denominada P.1 e dotada de maior transmissibilidade, foi responsável pela nova ascensão no número de casos e mortes. Desta forma, a dinâmica local de surgimento de novas genéticas virais foi uma importante força-motriz para a forma com a qual a pandemia avançou sobre o estado do Amazonas, influenciada diretamente pela circulação da população e sua relação com o espalhamento do vírus, que culminou com a substituição da B.1.1.28 pela variante de preocupação P.1 em um processo que acredita-se ter durado apenas dois meses.

Three SARS-CoV-2 reinfection cases by the new Variant of Concern (VOC) P.1/501Y.V3

Neste relatório (pre-print), são apresentados três casos de reinfecção causados pela Variante de Preocupação (VOC) P.1, também conhecida como "cepa de Manaus". As três pacientes eram mulheres adultas, e tiveram a primeira infecção durante a primeira onda da pandemia na primeira metade de 2020. Nos três casos, a linhagem detectada no primeiro diagnóstico molecular era diferente da encontrada posteriormente, evidência da reinfecção. Dois dos casos de reinfecção tiveram apresentação de sintomas leves, enquanto o terceiro foi assintomático, apesar de a quantidade de material genético viral detectado sugerir cargas virais elevadas. As evidências aqui apresentadas sugerem que a imunidade após infecção primária por linhagens anteriores à circulação daquelas contendo a mutação E484K não impede uma nova infecção pela variante P.1, e nem mesmo que pessoas reinfectadas por esta variante espalhem o vírus, embora seja possível que tenha protegido estas três pacientes do desenvolvimento de sintomas graves.

Genomic and phylogenetic characterisation of an imported case of SARS-CoV-2 in Amazonas State, Brazil.

A new coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] is currently causing a life-threatening pandemic. In this study, we report the complete genome sequencing and genetic characterisation of a SARS-CoV-2 detected in Manaus, Amazonas, Brazil, and the protocol we designed to generate high-quality SARS-CoV-2 full genome data. The isolate was obtained from an asymptomatic carrier returning from Madrid, Spain. Nucleotide sequence analysis showed a total of nine mutations in comparison with the original human case in Wuhan, China, and support this case as belonging to the recently proposed lineage A.2. Phylogeographic analysis further confirmed the likely European origin of this case. To our knowledge, this is the first SARS-CoV-2 genome obtained from the North Brazilian Region. We believe that the information generated in this study may contribute to the ongoing efforts toward the SARS-CoV-2 emergence.

Genomic and phylogenetic characterisation of an imported case of SARS-CoV-2 in Amazonas State, Brazil

A new coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] is currently causing a life-threatening pandemic. In this study, we report the complete genome sequencing and genetic characterisation of a SARS-CoV-2 detected in Manaus, Amazonas, Brazil, and the protocol we designed to generate high-quality SARS-CoV-2 full genome data. The isolate was obtained from an asymptomatic carrier returning from Madrid, Spain. Nucleotide sequence analysis showed a total of nine mutations in comparison with the original human case in Wuhan, China, and support this case as belonging to the recently proposed lineage A.2. Phylogeographic analysis further confirmed the likely European origin of this case. To our knowledge, this is the first SARS-CoV-2 genome obtained from the North Brazilian Region. We believe that the information generated in this study may contribute to the ongoing efforts toward the SARS-CoV-2 emergence.

Contexto técnico do trabalho de gerentes na atenção primária à saúde / Technical context of the manager's work in primary health care

Objetivo: analisar o contexto técnico do trabalho de gerentes de Unidades de Saúde da Atenção Primária à Saúde, no que tange à formação, à qualificação profissional e à inserção no cargo/função. Método: trata-se de um estudo qualitativo, descritivo, tipo pesquisa de campo, realizado com 18 gerentes, utilizando a entrevista semiestruturada, a observação sistemática e a técnica de Análise de Conteúdo Temática. Resultados: verificou-se que os gerentes apresentaram uma pluralidade de formações profissionais; há predominância de mulheres enfermeiras; a forma de contratação e o vínculo empregatício são incertos; a falta de experiência e de qualificação profissional no ingresso do cargo/função representa um desafio para o trabalho gerencial; as atividades de educação continuada e de educação em serviço sobrepõem-se às ações de educação permanente; as enfermeiras e gerentes da US revelam dificuldades na articulação entre a assistência e a gerência. Conclusão: deve-se investir na formação e qualificação dos indivíduos que atuam como gerentes das US, visando à valorização do SUS e, consequentemente, ao fortalecimento da APS.(AU)

Objective: to analyze the technical context of the work of managers of Health Units of Primary Health Care, regarding training, professional qualification and inclusion in the position / function. Method: this is a qualitative, descriptive, field-research study conducted with 18 managers, using the semi-structured interview, the systematic observation and the Thematic Content Analysis technique. Results: it was verified that the managers presented a plurality of professional training; there is a predominance of female nurses; the form of hiring and the employment relationship are uncertain; the lack of experience and professional qualification at the entrance of the position / function represents a challenge for managerial work; the activities of continuing education and in-service education overlap with the actions of permanent education; HU nurses and managers reveal difficulties in articulating care and management. Conclusion: it is necessary to invest in the training and qualification of the individuals who act as managers of the HU, aiming at the valorisation of the UHS and, consequently, the strengthening of PHC. (AU)

Objetivo: analizar el contexto técnico del trabajo de gerentes de Unidades de Salud de la Atención Primaria a la Salud, en lo que se refiere a la formación, a la cualificación profesional y a la inserción en el cargo / función. Método: se trata de un estudio cualitativo, descriptivo, tipo investigación de campo, realizado con 18 gerentes, utilizando la entrevista semiestructurada, la observación sistemática y la técnica de Análisis de Contenido Temático. Resultados: se verificó que los gerentes presentaron una pluralidad de formaciones profesionales; hay predominio de mujeres enfermeras; la forma de contratación y el vínculo laboral son inciertas; la falta de experiencia y de cualificación profesional en el ingreso del cargo / función representa un desafío para el trabajo gerencial; las actividades de educación continuada y de educación en servicio se superponen a las acciones de educación permanente; las enfermeras y gerentes de la US revelan dificultades en la articulación entre la asistencia y la gerencia. Conclusión: se debe invertir en la formación y calificación de los individuos que actúan como gerentes de las US, buscando la valorización del SUS y, consecuentemente, al fortalecimiento de la APS.(AU)

The Impact of the Extreme Amazonian Flood Season on the Incidence of Viral Gastroenteritis Cases.

During the Amazonian flood season in 2012, the Negro River reached its highest level in 110 years, submerging residential and commercial areas which appeared associated with an elevation in the observed gastroenteritis cases in the city of Manaus. The aim of this study was to evaluate the microbiological water quality of the Negro River basin during this extreme flood to investigate this apparent association between the illness cases and the population exposed to the contaminated waters. Forty water samples were collected and analysed for classic and emerging enteric viruses. Human adenoviruses, group A rotaviruses and genogroup II noroviruses were detected in 100, 77.5 and 27.5% of the samples, respectively, in concentrations of 103-106 GC/L. All samples were compliant with local bacteriological standards. HAdV2 and 41 and RVA G2, P[6], and P[8] were characterised. Astroviruses, sapoviruses, genogroup IV noroviruses, klasseviruses, bocaviruses and aichiviruses were not detected. Statistical analyses showed correlations between river stage level and reported gastroenteritis cases and, also, significant differences between virus concentrations during this extreme event when compared with normal dry seasons and previous flood seasons of the Negro River. These findings suggest an association between the extreme flood experienced and gastrointestinal cases in the affected areas providing circumstantial evidence of causality between the elevations in enteric viruses in surface waters and reported illness.

Seroprevalence of and risk factors for leptospirosis in the City of Manaus, State of Amazonas, Brazil.

INTRODUCTION: Leptospirosis is caused by a bacterium of the genus Leptospira. This study aimed at investigating the seroprevalence of and risk factors for leptospirosis in humans in Manaus, State of Amazonas. METHODS: Interviews were performed, and 1,000 blood serum samples were examined using a microscopic agglutination test. RESULTS: Forty-three cases were positive; there were 10 serotypes, with coagglutination in 8 cases. The most frequently occurring serotypes were Icterohaemorrhagiae (20.7%), Cynopteri (20.7%), Australis (18.8%), and Copenhageni (16.9%), and the Midwest (54.7%) and South (23.8%) had the most cases; these areas lack basic sanitation. CONCLUSIONS: Disease occurrence might be reduced through improved basic infrastructural conditions.

Viruses Surveillance Under Different Season Scenarios of the Negro River Basin, Amazonia, Brazil.

The Negro River is located in the Amazon basin, the largest hydrological catchment in the world. Its water is used for drinking, domestic activities, recreation and transportation and water quality is significantly affected by anthropogenic impacts. The goals of this study were to determine the presence and concentrations of the main viral etiological agents of acute gastroenteritis, such as group A rotavirus (RVA) and genogroup II norovirus (NoV GII), and to assess the use of human adenovirus (HAdV) and JC polyomavirus (JCPyV) as viral indicators of human faecal contamination in the aquatic environment of Manaus under different hydrological scenarios. Water samples were collected along Negro River and in small streams known as igarapés. Viruses were concentrated by an organic flocculation method and detected by quantitative PCR. From 272 samples analysed, HAdV was detected in 91.9%, followed by JCPyV (69.5%), RVA (23.9%) and NoV GII (7.4%). Viral concentrations ranged from 10(2) to 10(6) GC L(-1) and viruses were more likely to be detected during the flood season, with the exception of NoV GII, which was detected only during the dry season. Statistically significant differences on virus concentrations between dry and flood seasons were observed only for RVA. The HAdV data provides a useful complement to faecal indicator bacteria in the monitoring of aquatic environments. Overall results demonstrated that the hydrological cycle of the Negro River in the Amazon Basin affects the dynamics of viruses in aquatic environments and, consequently, the exposure of citizens to these waterborne pathogens.

Determinantes sociais e ambientais da proliferação da leptospirose em Manaus / Social and environmental determinants of leptospirosis proliferation in Manaus

As condições sociais e ambientais estão diretamente relacionadas com a qualidade de vida e saúde, o que torna importante sua avaliação na análise de fatores determinantes para a ocorrência de alguns agravos. Alterações no equilíbrio entre homem e ambiente acontecem em decorrência das transformações produtivas territoriais e espaciais geradas pela dinâmica social. Aborda a questão socioambiental na cidade de Manaus, a leptospirose na cidade de Manaus, leptospirose e vulnerabilidade social. (AU)

Cases distribution of leptospirosis in City of Manaus, State of Amazonas, Brazil, 2000-2010 / Distribuição de casos de leptospirose no Município de Manaus, Estado do Amazonas, Brasil, 2000-2010

INTRODUCTION: Leptospirosis is an infectious disease caused by microorganisms of the genus Leptospira that affects several species of animals, including the human beings. The study described the confirmed cases of leptospirosis in Manaus, from 2000 to 2010. METHODS: A descriptive study based on secondary data analysis of Secretaria Municipal de Saúde (SEMSA), Sistema de Informação de Agravos de Notificação SINAN and Sistema de Informação sobre Mortalidade (SIM) analyzing the variables: age group, gender, clinical aspects and geographic area and lethality. RESULTS: Were reported 665 cases of leptospirosis, 339 were confirmed and 35 (10.3%) died. The largest number of cases occurred in May (16.8%), March (13.3%) and April (11.4%), a period of intense rainfall. The city areas with the greatest occurrence of the disease were South (26.6%), West (23.5%) and East (19.7%), areas of the greatest precariousness socio-environment. The largest number of cases, including deaths, occurred in the age group from 14 to 44.9 years (74%), being that 291 (85.8%) were male and 48 (14.1%) females. The most frequent symptoms were fever, myalgia, headache and jaundice. In relation to the social conditions were identified low education, poor housing, absence of sanitation and low income. CONCLUSIONS: In Manaus, despite the implementation of the Social and Environmental Program of Igarapés of Manaus (PROSAMIM), there are still areas that need a proper urbanization and improvements in socio-environmental conditions, reducing the level of exposure of the human beings that living in these locations.

INTRODUÇÃO: A leptospirose é uma doença infecciosa causada por microrganismos do gênero Leptospira, que acomete várias espécies de animais, inclusive o homem. O estudo descreveu os casos confirmados de leptospirose no município de Manaus, no período de 2000 a 2010. MÉTODOS: Estudo descritivo baseado na análise de dados secundários da Secretaria Municipal de Saúde (SEMSA), Sistema de Informação de Agravos de Notificação (SINAN) e Sistema de Informação sobre Mortalidade (SIM) das variáveis: faixa etária, sexo, aspectos clínicos e área geográfica e letalidade. RESULTADOS: Foram notificados 665 casos de leptospirose, 339 foram confirmados e 35 (10,3%) evoluíram para óbito. O maior número de casos ocorreu nos meses de maio (16,8 %), março (13,3 %) e abril (11,4 %), período de intensas chuvas. As zonas da cidade de maior ocorrência da doença foram a sul (26,6%), oeste (23,5%) e leste (19,7%), áreas de maior precariedade socioambiental. O maior número de casos, inclusive com óbitos, ocorreu na faixa etária de 14 a 44,9 anos (74%), sendo que 291 (85,8%) pertenciam ao sexo masculino e 48 (14,1%) ao feminino. Os sintomas mais frequentes foram: febre, mialgia, cefaleia e icterícia. Em relação às condições sociais, identificou-se baixa escolaridade, moradia precária, falta de saneamento e baixa renda. CONCLUSÕES: Em Manaus, apesar da implantação do Programa Social e Ambiental dos Igarapés de Manaus (PROSAMIM) ainda existem áreas que necessitam de uma urbanização adequada e melhorias nas condições socioambientais, diminuindo o nível de exposição dos indivíduos que residem nestes locais.

Cases distribution of leptospirosis in City of Manaus, State of Amazonas, Brazil, 2000-2010.

INTRODUCTION: Leptospirosis is an infectious disease caused by microorganisms of the genus Leptospira that affects several species of animals, including the human beings. The study described the confirmed cases of leptospirosis in Manaus, from 2000 to 2010. METHODS: A descriptive study based on secondary data analysis of Secretaria Municipal de Saúde (SEMSA), Sistema de Informação de Agravos de Notificação SINAN and Sistema de Informação sobre Mortalidade (SIM) analyzing the variables: age group, gender, clinical aspects and geographic area and lethality. RESULTS: Were reported 665 cases of leptospirosis, 339 were confirmed and 35 (10.3%) died. The largest number of cases occurred in May (16.8%), March (13.3%) and April (11.4%), a period of intense rainfall. The city areas with the greatest occurrence of the disease were South (26.6%), West (23.5%) and East (19.7%), areas of the greatest precariousness socio-environment. The largest number of cases, including deaths, occurred in the age group from 14 to 44.9 years (74%), being that 291 (85.8%) were male and 48 (14.1%) females. The most frequent symptoms were fever, myalgia, headache and jaundice. In relation to the social conditions were identified low education, poor housing, absence of sanitation and low income. CONCLUSIONS: In Manaus, despite the implementation of the Social and Environmental Program of Igarapés of Manaus (PROSAMIM), there are still areas that need a proper urbanization and improvements in socio-environmental conditions, reducing the level of exposure of the human beings that living in these locations.

Representações sociais de adolescentes e jovens vivendo com HIV acerca da adolescência, sexualidade e AIDS / Social representations of adolescents and youth living with HIV about adolescence, sexuality and AIDS / Las representaciones socialesde los adolescentes y jóvenes que viven con el VIH sobre la adolescencia, la sexualidad y el SIDA

A adolescência é marcada por transformações biopsicossociais. A(O) adolescente soropositivo(a), além de lidar com essas transformações, tem de enfrentar limitações do HIV e exercitar práticas sexuais seguras a fim de não se re-infectar/disseminar o vírus. Os objetivos deste estudo foram: conhecer as Representações Sociais (RS) de adolescentes e jovens que vivem com HIV/AIDS sobre "adolescência" e "adolescência e aids" e identificar como estes vivenciam a sexualidade. Pesquisa de abordagem qualitativa, fundamentada na Teoria das Representações Sociais, desenvolvida com 18 sujeitos soropositivos de 11 a 20 anos que frequentam um Centro de Referência.Foi realizada a análise de conteúdo das entrevistas semi-estruturadas. Apesar de conflitos internos e restrições, estar na adolescência e/ou juventude vivendo com HIV, o processo de amadurecimento, trazido pela própria condição de soropositividade, impulsiona o(a) adolescente à busca de estratégias que propiciam melhor enfrentamento da sexualidade. Portanto, existe a necessidade de intervenções na saúde e sexualidade dessas pessoas.

The adolescence is marked by changes bio-psycho-social. The teenager seropositive, in addition to dealing with these changes is to address the limitations of seropositivity end exercise safe sex practices in order to not re-infect/spread the virus. The objectives are: to understand the Social Representations (SR) of adolescents and young living with HIV/AIDS on "adolescence" and "adolescence and AIDS" and identify how they live their sexuality. The study consists in part of a research, being qualitative type of,based on the on RS theory, developed with 18 seropositive subjects 11 to 20 years who are attending a reference center.We conducted content analysis of semi-structured interviews. That despite internal conflicts and constraints in being a person in adolescence and/or young living with HIV, the ripening process, brought even by the very condition of seropositivity drives the search for strategies that provide better coping with sexuality. Therefore, there is a need for interventions in health and sexuality of these people.

La adolescencia es marcada por transformaciones biopsicosociales. El adolescente seropositivo además dehacer frenteaestoscambios, tiene que dar frente a laslimitacionesdel VIHyla prácticadel sexomás seguroparanovolver ainfectar/transmitir el vírus.Los objetivosfueron:conocer las representaciones sociales(RS) enadolescentesy jóvenesque vivencon elVIH/SIDA en la"adolescencia" y"adolescencia ySIDA" e identificarcómo vivensu sexualidad.El estudio se constituye recorte de una pesquisa máscompleta, del tipo cualitativo, fundamentado en la Teoría de las RS, desenvuelto con 18 sujetos seropositivos de 11 a 20 años que frecuentan un Centro de Referencia.Se realizó un análisis de contenido de entrevistas semi-estructuradas. Apesar delos conflictosy dificultades internas, siendoen la adolescencia y/ojóvenes que vivencon elVIH, el proceso de maduración, provocada porla condiciónmisma delas unidades deseropositividadadolescenteaencontrarestrategiasque proporcionenmejorhacer frenteala sexualidad. Por la tanto, hay una necesidad de las intervenciones en salud y la sexualidad de estas personas.

A conservative region of the mercuric reductase gene (merA) as a molecular marker of bacterial mercury resistance / Região conservada do gene da mercúrio redutase (merA) como marcador molecular da resistência bacteriana ao mercúrio

The most common bacterial mercury resistance mechanism is based on the reduction of Hg(II) to Hg0, which is dependent of the mercuric reductase enzyme (MerA) activity. The use of a 431 bp fragment of a conservative region of the mercuric reductase (merA) gene was applied as a molecular marker of this mechanism, allowing the identification of mercury resistant bacterial strains.

O mecanismo de resistência bacteriana ao mercúrio mais comum é baseada na redução do Hg(II) a Hg0, através da atividade da enzima mercúrio redutase (MerA). O uso do fragmento de 431 pb amplificado de uma região conservada do gene merA, que codifica a enzima MerA,foi utilizado como marcador molecular deste mecanismo, permitindo a identificação de bactérias resistentes ao mercúrio.

A conservative region of the mercuric reductase gene (mera) as a molecular marker of bacterial mercury resistance.

The most common bacterial mercury resistance mechanism is based on the reduction of Hg(II) to Hg(0), which is dependent of the mercuric reductase enzyme (MerA) activity. The use of a 431 bp fragment of a conservative region of the mercuric reductase (merA) gene was applied as a molecular marker of this mechanism, allowing the identification of mercury resistant bacterial strains.