Were public interventions relevant for containing the covid-19 pandemic in Brazil in 2020?

ABSTRACT OBJECTIVE Flattening the curve was the most promoted public health strategy worldwide, during the pandemic, to slow down the spread of the SARS-CoV-2 virus, and, consequently, to avoid overloading the healthcare systems. In Brazil, a relative success of public policies was evidenced. However, the association between public policies and the "flatten the curve" objectives remain unclear, as well as the association of different policies to reach this aim. This study aims to verify if the adoption of different public policies was associated with the flattening of the infection and death curves by covid-19 first wave in 2020. METHODS Data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (Influenza Epidemiological Surveillance Information System - SIVEP-Gripe) and the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics - IBGE) were used to compute standardized incidence and mortality rates. The Oxford Covid-19 Government Response Tracker (OxCGRT) was used to obtain information about governmental responses related to the mitigation of pandemic effects, and the Human Development Index (HDI) was used as a measure of socioeconomic status. A non-linear least-square method was used to estimate parameters of the five-parameter sigmoidal curve, obtaining the time to reach the peak and the incremental rate of the curves. Additionally, ordinary least-square linear models were used to assess the correlation between the curves and the public policies adopted. RESULTS Out of 51 municipalities, 261,326 patients had SARS-CoV-2 infection. Stringency Index was associated with reducing covid-19 incremental incidence and death rates,in addition to delaying the time to reach the peak of both pandemic curves. Considering both parameters, economic support policies did not affect the incidence nor the mortality rate curves. CONCLUSION The evidence highlighted the importance and effectiveness of social distancing policies during the first year of the pandemic in Brazil, flattening the curves of mortality and incidence rates. Other policies, such as those focused on economic support, were not effective in flattening the curves but met humanitarian and social outcomes.

Homozygotes NAT2*5B slow acetylators are highly associated with hepatotoxicity induced by anti-tuberculosis drugs

BACKGROUND Distinct N-acetyltransferase 2 (NAT2) slow acetylators genotypes have been associated with a higher risk to develop anti-tuberculosis drug-induced hepatotoxicity (DIH). However, studies have not pointed the relevance of different acetylation phenotypes presented by homozygotes and compound heterozygotes slow acetylators on a clinical basis. OBJECTIVES This study aimed to investigate the association between NAT2 genotypes and the risk of developing DIH in Brazilian patients undergoing tuberculosis treatment, focusing on the discrimination of homozygotes and compound heterozygotes slow acetylators. METHODS/FINDINGS The frequency of NAT2 genotypes was analysed by DNA sequencing in 162 patients undergoing tuberculosis therapy. The mutation analyses revealed 15 variants, plus two new NAT2 mutations, that computational simulations predicted to cause structural perturbations in the protein. The multivariate statistical analysis revealed that carriers of NAT2*5/*5 slow acetylator genotype presented a higher risk of developing anti-tuberculosis DIH, on a clinical basis, when compared to the compound heterozygotes presenting NAT2*5 and any other slow acetylator haplotype [aOR 4.97, 95% confidence interval (CI) 1.47-16.82, p = 0.01]. CONCLUSION These findings suggest that patients with TB diagnosis who present the NAT2*5B/*5B genotype should be properly identified and more carefully monitored until treatment outcome in order to prevent the occurrence of anti-tuberculosis DIH.

Hepatitis of unknown etiology in children in Brazil: A new challenge or the usual scenario ?

ABSTRACT Background: An outbreak of acute hepatitis of unknown etiology in children was recently reported worldwide. We aimed to describe the burden of hospitalizations due to hepatitis of unknown etiology in children/adolescents in Brazilian public hospitals. Methods: We retrieved a database of all hospitalizations in the Brazilian Unified Health System (SUS) from January/2019 to February/2022 using the "microdatasus" R package. Hepatitis of unknown etiology was defined by the following International Classification of Diseases [ICD-10] codes: B19, B19.0, B19.9, K72.0, K72.9, K75, K75.9, R94.5, or R93.2. The incidence rates (95% confidence interval, IC) per 1,000 all-cause hospitalizations in different age strata [< 6 years; 6-11 years and 12-17 years] were estimated. Results: A total of 94,198 hospitalizations due to hepatic or infectious diseases with potential liver injury were analyzed. Of them, 1,535 children/adolescents [48.2% male sex, 41.6% aged < 6 years] were hospitalized with hepatitis with unknown etiology. The top ICD-10 codes were B19.9 [unspecified viral hepatitis without hepatic coma; 39.9% (n = 612)], K72.9 [hepatic failure, unspecified; 29.8% (n = 457)], and K72.0 [hepatic failure, not elsewhere classified; 14.5% (n = 223)]. A total of 8.5% (n = 131) of individuals required liver transplantation and 7.0% (n = 107) died during the hospital-stay. In 2021, the incidence rates (95% CI) of hospitalizations for hepatitis with unknown etiology were 7.80 (7.63-7.98), 17.96 (17.46-18.48) and 13.28 (12.95-13.62) per 1,000 all-cause hospitalizations in subjects aged < 6 years, 6-11 years and 12-17 years-old, respectively. Similarly, the incidence rates of hospitalization due to hepatitis with unknown etiology per 1,000 all-cause hospitalizations (CI95%) in January-February/2022 were 7.52 (7.11-7.94), 16.82 (15.68-18.03), and 13.96 (13.10-14.85) for children/adolescents with age < 6 years, 6-11 years, and 12-17 years, respectively. Conclusions: A non-negligible number of hospitalizations due to hepatitis with unknown etiology in children/adolescents was observed in the last years in Brazil. Up to 15% of those cases needed liver transplantation or died.

The impact of healthcare-associated infections on COVID-19 mortality: a cohort study from a Brazilian public hospital

SUMMARY OBJECTIVE: This study aims to analyze the risk factors for in-hospital mortality in a cohort of patients admitted to a newly adapted intensive care unit in a public hospital in Rio de Janeiro. METHODS: This was an observational, retrospective, and descriptive study. Data were obtained from electronic medical records. Coronavirus disease 2019 (COVID-19) was diagnosed by detecting viral ribonucleic acid using reverse transcription polymerase chain reaction. Factors associated with the risk/protection from death were determined using the odds ratio and adjusted odds ratio. RESULTS: Fifty-one patients were admitted to the hospital. The median age of the patients was 63 years, 60% were male patients, and 54% were white patients. Sixty-seven percent of the patients were diagnosed with COVID-19. Sepsis at admission increased the chance of in-hospital death by 21 times (adjusted odds ratio=21.06 [0.79-555.2]; p=0.06). The strongest risk factor for death was the development of septic shock during hospitalization (adjusted odds ratio=98.56 [2.75-352.5]; p=0.01), and one in four patients had multidrug-resistant bacteria. Mechanical ventilation, vasopressors, neuromuscular blockers, and sedatives were also the risk factors for in-hospital mortality. The in-hospital mortality rate was 41%, and the mortality rate of patients on mechanical ventilation was 60%. The diagnosis of COVID-19 was not statistically related to the adverse outcomes. CONCLUSIONS: In this cohort, the strongest risk factor for in-hospital death was the development of nosocomial septic shock. Healthcare-associated infections have a significant impact on mortality rates. Therefore, to have a better outcome, it is important to consider not only the availability of beds but also the way healthcare is delivered.

Functional Feeding Group composition and attributes: evaluation of freshwater ecosystems in Atlantic Forest, Brazil / Composição e atributos de Grupos Funcionais Alimentares: avaliação de ecossistemas de água doce na Mata Atlântica, Brasil

Abstract: Benthic macroinvertebrates Functional Feeding Group (FFG) have been used to determine aquatic assemblage dynamics and as a biomonitoring tool. The main goals of this study were to assess the effects of stream variables on the abundance and richness of FFGs and evaluate ecosystem attributes (FFG ratios) as a tool to assess ecological conditions of Atlantic Rainforest streams. We sampled 146 sites with different impairment conditions in Rio de Janeiro, Brazil. Richness was significantly different among impairment conditions for all FFGs. Mixed-effect models show that aquatic macroinvertebrate FFGs differed in their responses to abiotic variables for abundance and richness. Also, they were reduced in the impaired sites when compared to intermediate and reference sites. The FFG ratio indicated significant differences along the impairment gradient. The FFG ratio analysis was shown to be a fast and cheap tool that can be used for monitoring aquatic ecosystems in the Atlantic Forest biome. However, further studies are required to calibrate the method specifically for the Atlantic Forest region.

Resumo: Os Grupos Funcionais de Alimentação (GFA) são utilizados para determinar a dinâmica da comunidade de macroinvertebrados bentônicos e como uma ferramenta de biomonitoramento. Os principais objetivos deste estudo foram: avaliar os efeitos de variáveis de riacho na abundância e riqueza de GFAs e os atributos do ecossistema (razão GFA) como uma ferramenta para avaliar as condições ecológicas dos córregos da Mata Atlântica. Foram amostrados 146 locais com diferentes condições de impacto no Rio de Janeiro, Brasil. A riqueza foi significativamente diferente com as condições de impacto entre todos os GFA. Os modelos de efeito misto mostraram que os GFA diferiam em suas respostas às variáveis abióticas quanto à abundância e riqueza. Além disso, eles diferem nas áreas impactadas quando comparados as áreas intermediária e de referência. A razão de GFA encontrou diferenças significativas ao longo do gradiente de impacto. A análise da razão de GFA evidenciou-se uma ferramenta rápida e barata, com potencial para ser utilizada no monitoramento de ecossistemas aquáticos no bioma Mata Atlântica. No entanto, mais estudos serão necessários para calibrar o método especificamente para a região da Mata Atlântica.

Association between MBL2 haplotypes and dengue severity in children from Rio de Janeiro, Brazil

BACKGROUND Dengue is an arthropod-borne viral disease with a majority of asymptomatic individuals and clinical manifestations varying from mild fever to severe and potentially lethal forms. An increasing number of genetic studies have outlined the association between host genetic variations and dengue severity. Genes associated to viral recognition and entry, as well as those encoding mediators of the immune response against infection are strong candidates for association studies. OBJECTIVES The aim of this study was to investigate the association between MBL2, CLEC5A, ITGB3 and CCR5 genes and dengue severity in children. METHODS A matched case-control study was conducted and 19 single nucleotide polymorphisms (SNPs) were investigated. FINDINGS No associations were observed in single SNP analysis. However, when MBL2 SNPs were combined in haplotypes, the allele rs7095891G/rs1800450C/ rs1800451C/rs4935047A/rs930509G/rs2120131G/rs2099902C was significantly associated to risk of severe dengue under α = 0.05 (aOR = 4.02; p = 0.02). A second haplotype carrying rs4935047G and rs7095891G alleles was also associated to risk (aOR = 1.91; p = 0.04). MAIN CONCLUSIONS This is the first study to demonstrate the association between MBL2 haplotypes and dengue severity in Brazilians including adjustment for genetic ancestry. These results reinforce the role of mannose binding lectin in immune response to DENV.