Association between exposure to air pollutants and hospitalization for SARS-Cov-2: an ecological time-series study

ABSTRACT BACKGROUND: Exposure to air pollutants and illness by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection can cause serious pulmonary impairment. OBJECTIVE: To identify a possible association between exposure to air pollutants and hospitalizations due to SARS-Cov-2. DESIGN AND SETTING: Ecological time-series study carried out in Taubaté, Tremembé, and Pindamonhangaba in 2020 and 2021. METHODS: Study with Sars-Cov-2 hospitalizations with information on hospitalization date, sex and age of the subjects, duration of hospitalization, type of discharge, and costs of these hospitalizations. Statistical analysis was performed through a negative binomial regression, with data on pollutant concentrations, temperature, air relative humidity, and hospitalization date. Coefficients obtained by the analysis were transformed into relative risk for hospitalization, which estimated hospitalizations excess according to an increase in pollutant concentrations. RESULTS: There were 1,300 hospitalizations and 368 deaths, with a predominance of men (61.7%). These data represent an incidence rate of 250.4 per 100,000 inhabitants and 28.4% hospital lethality. Significant exposure (P value < 0.05) occurred seven days before hospital admission (lag 7) for nitrogen dioxide (NO2) (relative risk, RR = 1.0124) and two days before hospital admission for PM2.5 (RR = 1.0216). A 10 μg/m3 in NO2 concentration would decrease by 320 hospitalizations and ¼ US $ 240,000 in costs; a 5 μg/m3 in PM2.5 concentration would decrease by 278 hospitalizations and ¼ US $ 190,000 in costs. CONCLUSION: An association between exposure to air pollutants and hospital admission due to Sars-Cov-2 was observed with excess hospitalization and costs for the Brazilian public health system.

SARS-CoV-2 infection in children and adolescents: a Brazilian experience / Infecção pelo SARS-CoV-2 em crianças e adolescentes: uma experiência brasileira

Abstract Objective: To describe clinical and epidemiological aspects of children and adolescents infected with the SARS-CoV-2 in the Municipality of Taubaté, SP, from March to November 2020. Methods: Cross-sectional study with secondary data obtained from the Epidemiological Surveillance System about confirmed cases in city residents and from medical records of patients who were treated in hospitals in Taubaté, aged between 0 and 19 years. Chi-square and Student's t tests were used for comparisons. Results: 677 cases in the studied age range were reported during the study period, corresponding to 10.1% of cases reported in the municipality. The rapid antibody test was the most used to confirm infection, followed by RT-PCR and serology. Symptoms were described in 57.7% of the cases, mainly fever and cough. Diarrhea was associated with age below 4 years, while fever, cough, headache, odynophagia, ageusia, anosmia, myalgia, and dyspnea were associated with an age ranging from 10 to 19 years. In the study period, there were no deaths from COVID-19 of residents of the municipality in the age group from 0 to 19 years. Conclusions: The study was able to identify the proportion of involvement of COVID-19 in children and adolescents in the city, and the disease had a mild evolution. The main symptoms were fever and cough, but mainly diarrhea in younger children, and headache, odynophagia, anosmia, ageusia, and myalgia in adolescents.

RESUMO Objetivo: Descrever aspectos clínicos e epidemiológicos de crianças e adolescentes infectados pelo SARS-CoV-2 no município de Taubaté (SP) de março a novembro de 2020. Métodos: Estudo transversal com dados secundários obtidos no Setor de Vigilância Epidemiológica de casos confirmados em residentes do município e consulta de prontuários de pacientes que foram atendidos em hospitais de Taubaté, com idade entre 0 e 19 anos. Realizaram-se os testes de qui-quadrado, comparação de proporções e t de Student, sendo considerados nível de significância alfa <5%. Resultados: Notificaram-se 677 casos no período estudado, correspondendo a 10,1% do total de casos notificados no município. O teste rápido de anticorpos foi o teste mais utilizado, seguido de RT-PCR e sorologia. Sintomas foram descritos em 57,7% dos casos, sendo febre e tosse os mais frequentes. Diarreia apresentou associação com faixa etária < 4 anos, e febre, tosse, cefaleia, odinofagia, ageusia, anosmia, mialgia e dispneia tiveram associação com faixa etária de 10 a 19 anos. No período estudado, não ocorreu nenhum óbito por COVID-19 na faixa etária de 0 a 19 anos de residentes do município. Conclusões: O estudo conseguiu identificar a proporção de acometimento da COVID-19 em crianças e adolescentes no município, e a doença teve comportamento leve e boa evolução. Os principais sintomas foram febre e tosse, destacando-se diarreia nas crianças mais jovens e cefaleia, odinofagia, anosmia, ageusia e mialgia nos adolescentes.

American cutaneous leishmaniasis triggered by electrocoagulation

Abstract Cutaneous leishmaniasis is usually transmitted by infected phlebotomine sand fly bites that initiate local cutaneous lesions. Few reports in the literature describe other modes of transmission. We report a case of a previously healthy 59-year-old woman who underwent electrocoagulation to remove seborrheic keratosis confirmed by dermatoscopy. Three months later, a skin fragment tested positive for Leishmania culture; the parasite was identified as L. (V.) braziliensis. Trauma may generate inflammatory cascades that favor Leishmania growth and lesion formation in previously infected patients. American cutaneous leishmaniasis is a dynamic disease with unclear pathophysiology because of continually changing environments, demographics, and human behaviors.

Accuracy of mucocutaneous leishmaniasis diagnosis using polymerase chain reaction: systematic literature review and meta-analysis

The diagnosis of mucocutaneous leishmaniasis (MCL) is hampered by the absence of a gold standard. An accurate diagnosis is essential because of the high toxicity of the medications for the disease. This study aimed to assess the ability of polymerase chain reaction (PCR) to identify MCL and to compare these results with clinical research recently published by the authors. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement was performed using comprehensive search criteria and communication with the authors. A meta-analysis considering the estimates of the univariate and bivariate models was performed. Specificity near 100% was common among the papers. The primary reason for accuracy differences was sensitivity. The meta-analysis, which was only possible for PCR samples of lesion fragments, revealed a sensitivity of 71% [95% confidence interval (CI) = 0.59; 0.81] and a specificity of 93% (95% CI = 0.83; 0.98) in the bivariate model. The search for measures that could increase the sensitivity of PCR should be encouraged. The quality of the collected material and the optimisation of the amplification of genetic material should be prioritised.

Qualidade das hortaliças comercializadas no Distrito Federal / Quality of the vegetables commercialized in the Distrito Federal

Este estudo investigou a contaminação por enteroparasitas em 206 amostras de hortaliças, alface, rúcula e agrião, das regiões do Distrito Federal, Brasil, as quais foram colhidas de restaurantes self-service, feiras, mercados e da CEASA com o intuito de verificar as condições higiênico-sanitárias desses produtos consumidos in natura. Dentre as amostras obtiveram-se 189 negativas (91,8%) e 17 positivas para alguma contaminação parasitária (8,2%). Para a detecção destes parasitas foi utilizado o método de centrífugo-flutuação com Dicromato de Sódio (Diluição=1:35). Diante dos achados, concluiu-se que as hortaliças oferecidas à população do Distrito Federal estão fora dos padrões de higiene preconizados para o consumo conforme legislação vigente.