André Luís Franco Cotia

Background: Chimeric antigen receptor T-cell (CAR-T) therapy has transformed the treatment of relapsed/refractory multiple myeloma but is associated with significant infectious complications due to prolonged immunosuppression, cytopenias, and immune dysfunction. Objective: To systematically evaluate the incidence, timing, microbiologic patterns, and risk factors of infectious complications in patients with multiple myeloma undergoing anti-BCMA CAR-T cell therapy. Study design: Systematic review following PRISMA guidelines. We searched PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar through February 2025. Eligible studies included cohorts, phase II and III trials, and case-control studies reporting infections after CAR-T therapy. Data were extracted independently and quality assessed with the Downs and Black scale. Owing to heterogeneity, results were synthesized descriptively. Etiology and temporal patterns were analyzed at the event level. Results: Nineteen studies published between 2021 and 2025, including 1,495 patients with multiple myeloma treated with CAR T-cell therapy, were included. Infection incidence ranged from approximately 33% to over 70%. Bacterial infections predominated, particularly during the first 30 days after infusion, whereas viral infections increased during later follow-up. Fungal infections were less frequent. Rates of severe infection varied widely (5% to 60%), and infection-related mortality ranged from 0% to over 5%. Key risk factors included prolonged cytopenias, low CD4 ⁺ T-cell, and hypogammaglobulinemia. Conclusions: Infectious complications following CAR-T cell therapy in multiple myeloma are frequent, with distinct early and late microbiologic profiles. Standardized infection definitions, harmonized surveillance, and risk-stratified prevention strategies are essential to reduce infection-related morbidity while preserving the benefits of this therapy.

We performed a systematic literature review and meta-analysis of studies on urinary tract infections (UTIs) and sexually transmitted infections (STIs) in symptomatic women to evaluate prevalence, patterns and clinical implications. We searched for records in PubMed, CINAHL, Scopus, Web of Science, Embase and Cochrane that evaluated the diagnosis of UTIs and STIs in women with genitourinary tract symptoms. The studies involve women >13 years with a clinical and/or laboratory diagnosis (abnormal urinalysis or urine culture) of UTI and women who underwent diagnostic testing for typical STI pathogens. The prevalence rate of STIs in symptomatic women ranged from 9% to 53% (with a pooled prevalence of 23%). The average frequency of most detected pathogens was: Trichomonas vaginalis (18.8%), Chlamydia trachomatis (13.3%) and Neisseria gonorrhoeae (4.5%). Among women with confirmed STIs, 4.7% also had a positive urine culture. Additionally, six studies described the accuracy of clinician’s diagnosis for UTIs or STIs: UTIs ranged from 34% to 95% (mean=56.9%) and for STIs, it ranged from 26% to 75% (mean=47%). Our findings emphasise the importance of comprehensive diagnostic evaluation in symptomatic women to avoid both underdiagnosis of STIs and unnecessary antibiotic exposure for UTIs.

Background: Identifying those most susceptible to COVID-19 reinfection and understanding the associated characteristics is essential for developing effective prevention and control strategies. We aimed to evaluate the influence of social determinants, regional disparities, and variant evolution on COVID-19 reinfection rates. Methods: We conducted a retrospective cohort study in São Paulo, Brazil, involving laboratory-confirmed COVID-19 patients. Reinfection was defined as a subsequent positive COVID-19 test at least 90 days after the previous confirmed infection. We assessed socioeconomic indicators, demographic factors, and spatial correlations. Reinfection rates were analyzed across different variants and subvariants. Results: Among 73 741 patients, 5626 (7.6%) experienced reinfections, with most (95.0%) having 1 reinfection. Reinfection rates increased significantly during the Omicron period, particularly with subvariants BA.1, BA.2/BA.4, BA.5, and XBB/XBB.1.5/XBB.1.16. The highest rates were seen in patients initially infected during the BA.2/BA.4 and BA.5 periods, who were later reinfected by XBB subvariants. Socioeconomic indicators, including lower Human Development Index, higher proportions of informal settlements, and lower employment rates, were significantly associated with higher reinfection rates. Geospatial analysis showed significant clustering of reinfections in areas with higher social vulnerability. Conclusions: COVID-19 reinfection rates were heavily influenced by socioeconomic disparities and variant-specific factors. Regions with lower Human Development Index and worse socioeconomic conditions experienced higher reinfection rates. These findings highlight the need for targeted public health interventions focused on vulnerable populations, particularly in areas with greater social inequality. As new variants continue to emerge, ongoing surveillance and adaptive public health strategies will be critical to reducing reinfections.

Regulatory authorities authorize the clinical use of generic drugs (GD) based on bioequivalence studies, which consist of the evaluation of pharmacokinetics after a single dose in vitro or in healthy individuals. There are few data on clinical equivalence between generic and branded antibiotics. Our aim was to synthesize and analyze the available evidence on the clinical efficacy and safety of generic antibiotics compared to their original formulations. A systematic review was performed on Medline (PubMed) and Embase and validated through Epistemonikos and Google Scholar. The last search was conducted on 30 June 2022. Meta-analyses of clinical cure and mortality outcomes were performed. One randomized clinical trial (RCT) and 10 non-randomized intervention studies were included. No differences in clinical cure were observed between groups in the meta-analysis (OR = 0.89, 95% CI [0.61–1.28]; I² = 70%, p = 0.005). No difference was observed between groups when considering the use of carbapenems for overall mortality (OR = 0.99, 95% CI [0.63–1.55]; I² = 78%) or death associated with infections (OR = 0.79, 95% CI [0.48–1.29], I² = 67%). Most of the studies were observational, and the duration of follow-up, the characteristics of the participants, and the sites of infections were heterogeneous. Due to the uncertainty of the evidence, it is not possible to contraindicate the use of generics, which is an important strategy to expand access.