Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study / Fatores associados ao atraso no diagnóstico da hanseníase em área endêmica no Nordeste do Brasil: um estudo transversal / Factores asociados con el diagnóstico tardío de la lepra en un área endémica del Nordeste de Brasil: un estudio transversal

Abstract: This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.

Resumo: Neste estudo objetivou-se investigar os fatores relacionados ao indivíduo e ao sistema de saúde que contribuem para o atraso no diagnóstico da hanseníase em uma área endêmica no Nordeste do Brasil. Trata-se de um estudo transversal que incluiu 120 pacientes com hanseníase. Foram obtidos dados demográficos, clínicos e informações sobre fatores relacionados ao indivíduo e ao sistema de saúde que contribuem para o atraso no diagnóstico da hanseníase. O atraso do diagnóstico em meses foi estimado para cada participante por meio de entrevistas. Foi realizada uma análise multivariada por regressão de Poisson entre o resultado e as variáveis independentes. A mediana de atraso no diagnóstico da hanseníase foi de 10,5 (4,0-24,0) meses. Aproximadamente 12,6% dos participantes apresentavam grau de incapacidade física 2 (GIF 2) no momento do diagnóstico. Na análise multivariada por regressão de Poisson, homens, idosos, baixa escolaridade, residir em área urbana, hanseníase multibacilar, hanseníase tuberculóide, não procurar atendimento imediatamente após perceber os primeiros sintomas, suspeita de hanseníase, encaminhamentos excessivos e três ou mais consultas necessárias para confirmação diagnóstica associaram-se ao maior atraso diagnóstico. Este estudo encontrou um atraso significativo no diagnóstico da hanseníase em Arapiraca, Nordeste do Brasil, o que pode explicar a taxa continuamente alta de GIF 2 entre os casos novos. Fatores relacionados ao indivíduo e ao sistema de saúde foram associados ao maior atraso no diagnóstico. Intervenções para aumentar a conscientização sobre a doença entre a população geral e fortalecer a atenção primária à saúde são urgentemente necessárias.

Resumen: El objetivo de este estudio fue investigar los factores relacionados con el individuo y el sistema de salud que contribuyen al diagnóstico tardío de la lepra en un área endémica del Nordeste de Brasil. Se trata de un estudio transversal que incluyó a 120 pacientes con lepra. Se obtuvieron datos demográficos, clínicos e informaciones sobre los factores relacionados con el individuo y el sistema de salud que contribuyen al diagnóstico tardío de la lepra. Se estimó el retraso del diagnóstico en meses para cada participante a través de entrevistas. Se realizó un análisis multivariante por regresión de Poisson entre el resultado y las variables independientes. La mediana de retraso en el diagnóstico de lepra fue de 10,5 (4,0-24,0) meses. Aproximadamente el 12,6% de los participantes tenían grado de discapacidad física 2 (GIF 2) en el momento del diagnóstico. En el análisis multivariante por regresión de Poisson se encontró que los hombres, ancianos, la baja escolaridad, vivir en área urbana, la lepra multibacilar, la lepra tuberculoide, no buscar atención médica inmediatamente tras notar los primeros síntomas, la sospecha de lepra, las derivaciones excesivas y la necesidad de tres o más consultas para confirmar el diagnóstico se asociaron con un mayor retraso del diagnóstico. Este estudio encontró un retraso significativo en el diagnóstico de la lepra en Arapiraca, Nordeste de Brasil, lo que puede explicar la tasa continuamente alta de GIF 2 entre los nuevos casos. Factores relacionados con el individuo y el sistema de salud se asociaron con el mayor retraso del diagnóstico. Intervenciones para aumentar la concienciación sobre la enfermedad entre la población general y fortalecer la atención primaria de salud son urgentemente necesarias.

Analytical evaluation of thirty-two severe acute respiratory syndrome 2 lateral flow antigen tests demonstrates sensitivity remains with the SARS-CoV-2 Gamma lineage

ABSTRACT Background: The emergence of variants of concern (VOCs) requires an ongoing assessment of the performance of antigen lateral flow tests (Ag-RDTs). The limit of detection (LOD) of 32 Ag-RDTs was evaluated using the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant. Methods: Ag-RDTs were performed according to the manufacturer's instructions with a clinical isolate of the Gamma variant. Results: Twenty-eight of the 32 Ag-RDTs exceeded the World Health Organization criteria. Conclusions: This comprehensive analytical evaluation of Ag-RDTs demonstrated that the test performance was maintained with Gamma VOC.

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis

Abstract: Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Novo século, velho problema: tendência da mortalidade infantil e seus componentes no Nordeste brasileiro / New century, old problems: infant mortality trend and its components in the northeast region of Brazil

Resumo Introdução A mortalidade infantil ainda representa um desafio para os países em desenvolvimento. Objetivo Analisar a tendência da mortalidade infantil e seus componentes nos estados do Nordeste brasileiro entre 2001 e 2015. Método Estudo ecológico envolvendo quatro indicadores de mortalidade infantil: geral, neonatal precoce, neonatal tardia e pós-neonatal. Foi aplicado o modelo de regressão por pontos de inflexão (joinpoint regression). A tendência foi classificada em crescente, decrescente ou estacionária. Calculou-se o Percentual de Variação Anual (APC, Annual Percent Change), considerando Intervalo de Confiança de 95%. Resultados Foi observada tendência decrescente da mortalidade infantil geral no Nordeste (-3,9%) e em todos os estados, sendo Pernambuco com maior redução (-5,2%). Na mortalidade neonatal precoce, somente o Maranhão apresentou tendência estacionária (-0,2%). Na mortalidade neonatal tardia, Maranhão, Piauí, Paraíba e Sergipe apresentaram padrão estacionário. A mortalidade pós-neonatal foi a que apresentou maior redução, tendo destaque Alagoas (-8,6%) e Pernambuco (-7,6%). No Nordeste, esse componente apresentou variação anual de -6,1%. A partir do final da primeira década, a mortalidade pós-neonatal apresentou padrão estacionário no Nordeste, destacando-se Maranhão, Ceará, Rio Grande do Norte e Sergipe. Conclusão Embora tenha sido verificada redução da mortalidade infantil no Nordeste do Brasil, o comportamento estacionário em alguns estados configura motivo de preocupação, tendo em vista que os valores ainda são muito elevados quando comparados aos de locais desenvolvidos.

Abstract Background Infant mortality still represents a challenge for developing countries. Objective To assess the infant mortality trend and its components in the Brazilian Northeast states between 2001 and 2015. Method Ecological study consisting of four indicators of infant mortality were analyzed as following: general, early neonatal, late neonatal and post-neonatal mortalities. A regression analysis was applied to fit the inflection point (joinpoint regression). The trends were classified as increasing, decreasing or stationary. The Annual Percent Change (APC) was calculated considering a 95% confidence interval. Results Decreasing trend of overall infant mortality in the Northeast region (-3.9%) could be measured; the state of Pernambuco showed the greatest reduction (-5.2%). Regarding the early neonatal mortality, only the state of Maranhão showed stationary trends (-0.2%). With respect to the late neonatal mortality, the states of Maranhão, Piauí, Paraíba and Sergipe showed stationary pattern. The post-neonatal mortality presented the greatest reduction, being highlighted the values of this significant reduction in the states of Alagoas (-8.6) and Pernambuco (-7.6). Considering the entire region, this component showed an APC of -6.1%. At the end of the first decade, post-neonatal mortality showed a stationary pattern over the Northeast region, with the highest values in the states of Maranhão, Ceará, Rio Grande do Norte and Sergipe. Conclusion Although it has been a reduction in infant mortality in Northeastern Brazil, the stationary pattern in some states produced reasons for concern, considering that rates are still very elevated when compared to developed areas.

Telehealth actions in times of COVID-19: information with evidence

SUMMARY The coronavirus pandemic (COVID-19) brought up discussions about improvements in both primary healthcare and hospital care in Brasil. In addition, the use of information and communication technology tools has become more prominent in the transmission of health information to patients remotely. Through content dissemination actions for professionals and direct guidance to users, remote telehealth/telemedicine services offer qualified actions that can reduce unnecessary referrals and decrease the flow of patients in health units. Information and communication technologies are allies in the fight against COVID-19.

Mortality of motorcyclists due to traffic injuries in Brasil: a population-based study in Brazilian capitals

SUMMARY OBJECTIVE: To analyze the mortality trend of young men who were victims of traffic injuries involving motorcycles in all Brazilian capitals from 2001 to 2015. METHODS: A time-series study on all deaths of men aged 20-39 years old due to traffic injuries involving motorcycles in all 27 Brazilian capitals. We used the joinpoint regression model for temporal analysis and calculated the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) to verify the mortality trends. RESULTS: A total of 12,058 deaths of young men were recorded in the Brazilian capitals during the period studied. The highest mortality rates were observed in Boa Vista/Roraima (34.0/100,000 population) and Palmas/Tocantins (29.80/100,000). Twelve of the 27 capitals showed an increasing trend in mortality, with the highest percentage increase being observed in Salvador (APC: 29.0%) and São Paulo (APC: 13.1%). None of the capitals showed a decline in the trend of mortality. CONCLUSIONS: Overall, the mortality of young men from traffic injuries involving motorcycles shows an increasing trend in 12 of the 27 capitals, which represents a public health problem that requires the implementation of more effective public policies.

RESUMO OBJETIVO: Analisar a tendência temporal da mortalidade de homens jovens vítimas de acidente de trânsito envolvendo motocicletas em todas as capitais brasileiras de 2001 a 2015. MÉTODOS: Estudo de séries temporais incluindo as mortes de homens de 20 a 39 anos por lesões no trânsito envolvendo motocicletas nas 27 capitais brasileiras. Para a análise, foi utilizado o modelo de regressão do ponto de inflexão e calculada a Variação Percentual Anual (APC) e a Variação Percentual Anual Média (AAPC). RESULTADOS: Foram registradas 12.058 mortes de homens jovens nas capitais brasileiras durante o período estudado. As maiores taxas de mortalidade foram observadas em Boa Vista/Roraima (34,0/100.000 habitantes) e Palmas/Tocantins (29,80/100.000). Doze capitais apresentaram tendência crescente de mortalidade, sendo o maior aumento percentual em Salvador (APC: 29,0%) e São Paulo (APC: 13,1%). Nenhuma das capitais mostrou declínio nas taxas. CONCLUSÕES: A mortalidade de jovens por lesões no trânsito envolvendo motocicletas tem mostrado uma tendência crescente em 12 capitais, o que representa um problema de saúde pública que requer a implementação de políticas públicas mais eficazes.

Epidemiological monitoring of leprosy indicators in Sergipe (2001-2015): segmented regression analysis

Abstract This study analyzed the trend of leprosy indicators in Sergipe, between 2001 and 2015. It was a time series study that analyzed the trend for general detection coefficient, children under 15 years of age, and new cases with grade 2 disability. The joinpoint model was used. Two (2.6%) municipalities had an increasing trend in general detection coefficient, five (6.6%) had an increasing trend in detection rate in children under 15, and 19 (25.3%) had an increasing trend in detection coefficient of new leprosy cases with grade 2 disability. The findings suggest maintenance of the chain of transmission.

Biomarcadores de Lesão Miocárdica e Complicações Cardíacas Associadas à Mortalidade em Pacientes com COVID-19 / Myocardial Injury Biomarkers and Cardiac Complications Associated with Mortality in Patients with COVID-19

Resumo Fundamento O SARS-CoV-2 é um vírus de RNA emergente associado à doença respiratória aguda grave conhecida como COVID-19. Embora a COVID-19 seja predominantemente uma doença pulmonar, alguns pacientes apresentam graves danos cardiovasculares. Realizamos uma síntese de evidências quantitativas de dados clínicos, biomarcadores de lesão miocárdica e complicações cardíacas associadas ao óbito hospitalar em pacientes com COVID-19. Métodos Buscamos nas bases de dados PubMed, Embase e Google Scholar para identificar estudos que comparassem dados clínicos, biomarcadores de lesão miocárdica e complicações cardíacas entre pacientes sobreviventes e não sobreviventes da COVID-19. Os tamanhos dos efeitos foram apresentados como diferença média ou diferença média padronizada para variáveis contínuas e razão de risco para variáveis dicotômicas, com intervalos de confiança de 95%. Foi utilizado um modelo de efeitos aleatórios para agrupar os resultados. Resultados Foram incluídos seis estudos retrospectivos que relataram dados de 1.141 pacientes (832 sobreviventes e 309 não sobreviventes). Verificamos que condições cardiovasculares subjacentes; elevação de troponina cardíaca I de alta sensibilidade; N-terminal do pró-hormônio do peptídeo natriurético do tipo B e creatina quinase-MB; e complicações cardíacas foram associadas ao aumento do risco de óbito em pacientes com infecção por SARS-CoV-2. Conclusões A confirmação de que condições cardiovasculares subjacentes, elevação de biomarcadores de lesão miocárdica durante a infecção por COVID-19 e descompensação cardiovascular aguda são preditores de mortalidade na infecção por SARS-CoV-2 deve incentivar novas pesquisas para esclarecer possíveis mecanismos e testar tratamentos adequados. (Arq Bras Cardiol. 2020; 115(2):273-277)

Abstract Background SARS-CoV-2 is an emerging RNA virus associated with a severe acute respiratory disease known as COVID-19. Although COVID-19 is predominantly a pulmonary disease, some patients have severe cardiovascular damage. We performed a quantitative evidence synthesis of clinical data, myocardial injury biomarkers, and cardiac complications associated with in-hospital death in patients with COVID-19. Methods We searched the databases PubMed, Embase, and Google Scholar to identify studies comparing clinical data, myocardial injury biomarkers, and cardiac complications between non-survivors and survivors of COVID-19. Effect sizes were reported as mean difference or standardized mean difference for continuous variables and risk ratio for dichotomous variables with 95% confidence intervals. A random effects model was used to pool the results. Results Six retrospective studies reporting data from 1,141 patients (832 survivors and 309 non-survivors) were included. We found that underlying cardiovascular conditions; elevation of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and creatine kinase-MB; and cardiac complications were associated with increased risk of death for patients with SARS-CoV-2 infection. Conclusions The confirmation that underlying cardiovascular conditions, elevation of myocardial injury biomarkers during COVID-19 infection, and acute cardiovascular decompensation are predictors for mortality in SARS-CoV-2 infection must encourage new research to clarify potential mechanisms and test appropriate treatments. (Arq Bras Cardiol. 2020; 115(2):273-277)

Prevalence of coinfections in women living with human immunodeficiency virus in Northeast Brazil

Abstract INTRODUCTION: Despite the success of antiretrovirals, human immunodeficiency virus (HIV) coinfections continue to cause mortality. We investigated the prevalence of coinfections in women with HIV/acquired immunodeficiency syndrome in Sergipe, Brazil. METHODS: We conducted a cross-sectional study. The coinfections investigated were syphilis, hepatitis B and C, toxoplasmosis, rubella, tuberculosis, and cytomegalovirus. RESULTS: Among the 435 women, 85 (19.5%) had coinfections. The most prevalent was HIV/syphilis, followed by tuberculosis, toxoplasmosis, hepatitis C, hepatitis B, and rubella. Additionally, 300 (96.2%) were seropositive for cytomegalovirus immunoglobulin G. CONCLUSIONS: Despite significant progress in the treatment for people with HIV, coinfections continued to affect this population.

Social determinants of mortality due to visceral leishmaniasis in Brazil (2001-2015): an ecological study

Abstract INTRODUCTION We aimed to analyze the relationship between visceral leishmaniasis mortality and social determinants of health (SDH). METHODS This was an ecological study of all leishmaniasis-related deaths in Brazil, from 2001 to 2015. We analyzed 49 indicators of human development and social vulnerability. The association was tested using the classical and spatial regression model. RESULTS Mortality was associated with indicators that expressed low human development and high social vulnerability: lack of garbage collection, low schooling, unemployment rate, low per capita income, and income inequality (Gini index). CONCLUSIONS: There was an association between high mortality by leishmaniasis and low SDH.

Delay in head and neck cancer care during the COVID-19 pandemic and its impact on health outcomes

Abstract The coronavirus disease 2019 (COVID-19) outbreak has created unprecedent challenges for healthcare systems worldwide. Oncology services have been reorganized to decrease the risk of nosocomial acquisition of SARS-CoV-2, but changes in treatment pathways and follow-up cancer care can result in patients receiving suboptimal or delayed care. Herein, we describe a cross-sectional nested cohort study conducted to evaluate delays in care for patients with head and neck cancer (HNC) in post-treatment follow-up or palliative care during the COVID-19 pandemic in Northeast Brazil and its impact on health outcomes. Information was extracted from medical records and supplemented by telephone interviews. We compared the following health outcomes: self-perception of anxiety or sadness, fear of COVID-19 infection, cancer-related complications during social isolation, self-medication, diagnosis of COVID-19, and death between patients with and without delayed cancer care. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test was used for categorical variables. Thirty-one HNC patients were included in the study, and no case of confirmed SARS-CoV-2 was found. Delayed cancer care due to restriction in health services was reported in 58.1% of cases, and there was no report of telemedicine use during the COVID-19 outbreak. Cancer-related complications during the COVID-19 pandemic were described for most patients (67.7%) and included pain or discomfort, swelling, and dyspnea. Eight (25.8%) patients reported use of prescribed morphine or codeine to manage pain and six (19.4%) patients reported self-medication with over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs). We found an association between delayed HNC care and the use of self-medication (p = 0.028). This study indicated that patients with delayed HNC care during the COVID-19 outbreak are more likely to use self-medication with NSAIDs for pain management. Better strategies to follow HNC patients in socioeconomically disadvantaged communities need to be discussed and implemented.

The need to strengthen Primary Health Care in Brazil in the context of the COVID-19 pandemic

Abstract: The emergence of severe acute respiratory coronavirus 2 (SARS-CoV-2) and its association with severe pneumonia and deaths has exposed gaps in the health systems of several countries worldwide. Although the necessary focus has been to care for hospitalized patients, the strengthening of Primary Health Care (PHC) actions is necessary. PHC is the gateway to the health system in several countries, including Brazil and it plays a role in preventing, protecting, promoting, and treating individuals and communities. Brazil, like other countries, has faced the SARS-CoV-2 pandemic. As Brazil has a universal and decentralized health system, in which PHC has been the model of health re-organizing the health system; here we reflected the importance of strengthening PHC in Brazil in the times of coronavirus disease 2019 pandemic.

Syphilis among pregnant women in Northeast Brazil from 2008 to 2015: a trend analysis according to sociodemographic and clinical characteristics

Abstract INTRODUCTION: The number of syphilis cases among pregnant women in Brazil has increased. This study aimed to analyze the temporal trend of syphilis indicators among pregnant women in Northeast Brazil. METHODS: A time-series study was performed. RESULTS: We observed an increase in the detection rate of syphilis among pregnant women, those aged 15-19 years, and those of brown ethnicity. A strong correlation was observed between the detection rate of syphilis and family health strategy coverage. CONCLUSIONS: Despite an increase in primary care coverage, The increase in cases of syphilis among pregnant women is still considered a challenge.

Family COVID-19 cluster analysis of an infant without respiratory symptoms

Abstract Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.

Primary Health Care in Brasil in the times of COVID-19: changes, challenges and perspectives

SUMMARY The pandemic of Coronavirus Disease 2019 (COVID-19) has put pressure on countries' health systems. Although attention is mostly directed at the hospital sector, since many critically ill people will need intensive care, Primary Health Care (PHC) has also been disrupted. In Brasil, a universal and free health system has existed since the 1988 Constitution, which re-organized the PHC to attend the population. However, like other countries, the Brazilian health system is being overloaded with the increase in the large number of COVID-19 cases. It is worth reflecting on the changes and challenges in PHC during the COVID-19 pandemic in Brasil.

Recommendations for a safety dental care management during SARS-CoV-2 pandemic / Recomendaciones para una atención odontológica segura durante la pandemia por SARS-CoV-2 / Recomendações para um atendimento odontológico seguro durante a pandemia do SARS-CoV-2

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly through droplets, sneezes and aerosols, there is a high risk of transmission during dental procedures. This report describes measures that can be adopted by oral healthcare personnel to minimize the risk of cross-contamination in clinical practice during the current SARS-CoV-2 pandemic. (AU)

Dado que el SARS-CoV-2, causante de síndrome respiratorio agudo severo, se transmite principalmente por medio de gotitas, estornudos y aerosoles, existe un alto riesgo de transmisión durante los procedimientos dentales. En este informe se describen las medidas que puede adoptar el personal de salud bucodental para reducir al mínimo el riesgo de contaminación cruzada en la práctica clínica durante la actual pandemia por SARS-CoV-2.(AU)

Como o SARS-CoV-2, que causa síndrome respiratória aguda grave, é transmitido principalmente por gotícu-las, espirros e aerossóis, há um alto risco de transmissão durante os procedimentos odontológicos. Este relatório descreve os passos que podem ser tomados pelo pessoal de saúde oral para minimizar o risco de contaminação cruzada na prática clínica durante a actual pandemia do SARS-CoV-2.(AU)