-Context -The ingestion of gluten is responsible for the symptoms of Celiac disease, but other environmental factors can also influence. Strains of the Bifidobacterium genus have been shown to afford protection against the inflammatory response and mucosal damage caused by gliadin peptides in vitro. Objective -This study was designed to compare the concentration of fecal bifidobacteria and pH of patients with celiac disease on gluten-free diet and control subjects in order to identify if the imbalance on fecal microbiota still remain during the treatment of celiac disease and identify the necessity of dietary supplementation with pre-or probiotics. Methods -It was analyzed the feces of 42 healthy subjects and 14 celiac patients. The bifidobacteria count in feces was done in selective medium BIM-25. Microscopic analysis of the colonies was performed by Gram stain. The identification of the genus Bifidobacterium was performed by determination of fructose-6-phosphate phosphoketolase. Fecal pH was measured using a pH meter. Results -The concentration of bifidobacteria per gram of feces was significantly higher in healthy subjects (controls) (1.5 ± 0.63 x10 8 CFU/g) when compared to celiac patients (2.5 ± 1.5 x10 7 CFU/g). The fecal pH was not different between celiac patients (7.19 ± 0.521) and controls (7.18 ± 0.522). Conclusion -These results suggest that with lower levels of bifidobacteria, celiac patients have an imbalance in the intestinal microbiota, regardless of pH, even while on a gluten-free diet. This fact could favor the pathological process of the disorder. HEADINGS -Bifidobacterium. Microbiota. Hydrogen-Ion concentration. Celiac disease. Gluten-free diet.Declared conflict of interest of all authors: none Source of Funding: no funding has been received for the research.

This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.

prevalences were reported among 16-19 year olds for CT 13% (95% CI; 10.8-16.4), NG, 12% (95% CI; 9.7-15.1) and TV, 17%(95% CI; 13.7-21.1). There were 17,848 STI tests conducted in 2010 and among females aged 16-34; 33.3% had ≥ 1 STI (highest in 16-19 year olds: 48.9%) and 21.3% of males had ≥ 1 STI (highest in 16-19 year olds:33.4%). The most frequent co-infection was CT and NG which was found in 3.4% of females (highest in 16-19 year olds: 8.6%) and 3.9% of males (highest in 16-19 year olds:10.1%). Discussion STRIVE has provided information not previously available in regard to a comprehensive epidemiological picture of STI morbidity and health service responses in remote Aboriginal communities and highlights work required especially among young people. The results of STRIVE may be of relevance to other areas globally with STI endemic rates. Background The availability of point of care(POC) tests for infectious diseases has revolutionised the provision of health care for remote rural populations without access to laboratories. However, little attention has been given to quality assurance for POC tests. In a screening project that tested 45,226 adults of both sexes by 268 Health Care Workers(HCWs), in remote indigenous populations in the Amazon region of Brazil, where the overall prevalence of syphilis was 1.6%, and of HIV 0.1%, we evaluated the use of Dry Tube Specimens(DTS) for External Quality Assurance(EQA) for POC HIV and Syphilis tests. Methods The EQA programme was implemented from March 2010 to March 2011 using DTS panels developed by a reference laboratory, containing samples with negative and positive results at different antibody concentrations, for HIV and Syphilis infection. These were re-suspended and tested in the communities by each HCW. We also conducted stability tests for the panels at the reference laboratory. Results Results from 268 HCWs, responsible for implementing the POC tests at six Indigenous District(DSEI) participated in the EQA programme, showed a concordance rate of 90% for syphilis and 93% for HIV (Kappa coefficients of 0.74 and 0.78 respectively) with reference laboratories for a total of 1,608 determinations. The highest rate of inaccurate diagnoses occurred in positive samples of very low antibody concentration (40% for syphilis and 11.9% for HIV). The stability tests showed that titers were stable for up to one week at 30°C in dry conditions. Conclusion The results show that errors in the interpretation of POC test results were identified by the EQA programme using DTS. The use of POC tests for syphilis and HIV is now recommended as a policy by the Brazilian government. EQA/using DTS can help to improve the quality of these screening programmes and is already being implemented nationally.

Objectives Neisseria gonorrhoeae antimicrobial resistance (AMR) surveillance is imperative internationally, but only eight (22.9%) countries in the WHO Region of the Americas reported complete AMR data to the WHO Global Gonococcal Antimicrobial Surveillance Program (WHO GASP) in 2016. Genomic studies are ideal for enhanced understanding of gonococcal populations, including the spread of AMR strains. To elucidate the circulating gonococcal lineages/sublineages, including their AMR determinants, and the baseline genomic diversity among gonococcal strains in Brazil, we conducted WGS on 548 isolates obtained in 2015–16 across all five macroregions in Brazil. Methods A total of 548 gonococcal isolates cultured across Brazil in 2015–16 were genome sequenced. AMR was determined using agar dilution and/or Etest. Genome sequences of isolates from Argentina (n = 158) and the 2016 WHO reference strains (n = 14) were included in the analysis. Results We found 302, 68 and 214 different NG-MAST, MLST and NG-STAR STs, respectively. The phylogenomic analysis identified one main antimicrobial-susceptible lineage and one AMR lineage, which was divided into two sublineages with different AMR profiles. Determination of NG-STAR networks of clonal complexes was shown as a new and valuable molecular epidemiological analysis. Several novel mosaic mtrD (and mtrR and mtrE) variants associated with azithromycin resistance were identified. Conclusions We describe the first genomic baseline data to support the Brazilian GASP. The high prevalence of resistance to ciprofloxacin, tetracycline and benzylpenicillin, and the high number of isolates with mosaic penA and azithromycin resistance mutations, should prompt continued and strengthened AMR surveillance, including WGS, of N. gonorrhoeae in Brazil.

Objectives In 2012, the WHO estimated that 6 million new cases of syphilis per year would occur worldwide, including 937 000 in Brazil. Early diagnosis and treatment of syphilis are essential to reduce morbidity and prevent transmission. The availability of rapid tests (RTs) for this diagnosis means that testing can be performed more quickly, as a point-of-care test, even in non-laboratory environments and requires only simple technical training to antibodies detection. The objective of this study was to evaluate the performance and operational aspects of seven commercially available RTs for syphilis in Brazil. Methods Seven rapid treponemal tests were evaluated for sensitivity, specificity, accuracy and Kappa value, according to a panel composed of 493 members. The operational performance of the assay was also determined for these tests. results The seven RTs showed sensitivity ranging from 94.5% to 100% when compared with the reference tests and specificity of between 91.5% and 100%. All the RTs evaluated presented good operational performance, and only one failed to present the minimum specificity as defined by Brazil's Ministry of Health. conclusion All the tests presented good operational performance, and the professionals who performed them considered them to be easy to use and interpret. This evaluation is important for making informed choices of tests to be used in the Brazilian Unified Health System. IntrOductIOnSyphilis constitutes a major public health problem. In 2012, the WHO estimated that six million new cases of syphilis per year would occur worldwide.