Epidemiological profile and temporal trend of exogenous intoxications in children and adolescents.

OBJECTIVE: To describe the epidemiological profile and to analyze the trend in the incidence rate of exogenous poisoning concerning children and adolescents (0-19 years old) in the city of Arapiraca, Alagoas, Brazil, in the period from 2007 to 2015. METHODS: Observational study with data extracted from the Notifiable Diseases Information System. The variables sex, age group, toxic agent, and circumstance were analyzed using descriptive statistics. For temporal analysis, cut-off rates of incidence/10,000 inhabitants were calculated and the inflection point regression model was used for analysis. RESULTS: There were 5,539 cases of exogenous intoxication in individuals aged 0-19 years in the city, of which 53.1% (n=2,944) occurred in girls and 61.5% (n=3,405) in children aged 0-9 years. Medicines consisted in the main agent responsible for intoxications (28.5%; n=1,580), mainly by accidental use (18.2%; n=1,010). There was a significant increase in the events during the study period (Average Annual Percent Change: 12.7; 95%CI 1.1-25.6; p<0.001), with rates increasing from 56.52/10,000 inhabitants in 2007 to 56.64/10,000 inhabitants in 2015. The incidence of cases in girls increased from 57.34/10,000 inhabitants in 2007 to 62.27/10,000 inhabitants in 2015. In boys, the incidence of cases was stationary: 55.69/10,000 inhabitants to 50.9 /10,000 inhabitants in the same period. CONCLUSIONS: The study showed a higher frequency of cases in girls aged 0 to 4 years and an increasing trend in the incidence rate during the study period. Implementation of actions and strategies, with emphasis on health education, is needed in order to prevent cases of exogenous intoxication.

Impact of the COVID-19 pandemic on the actions of the Schistosomiasis Control Program in an endemic area in Northeastern Brazil.

Schistosomiasis remains a serious public health concern in Brazil and the Schistosomiasis Control Program (PCE) was elaborated to assist in the control of the disease. Nevertheless, the irruption of the COVID-19 pandemic may have impacted the program. Herein, we assessed the impact of the pandemic on PCE actions in an endemic area in the region with the highest positivity rate for schistosomiasis in Brazil. We conducted an ecological, population-based study using data from the PCE of the state of Alagoas, between 2015 and 2021, to calculate the percentage of change. The temporal trend analysis was performed using the segmented log-linear regression model. To evaluate the spatial distribution of the data, choropleth maps were made showing the values of the% of change. Moran maps was elaborated to indicate the critical areas. Our analysis showed a decrease in the population surveyed in 2020 (-41.00%) and 2021 (-18.42%). Likewise, there was a reduction in the number of Kato-Katz tests performed (2020 = -43.45%; and in 2021 = -19.63%) and, consequently, a drop in the rate of positive tests (-37.98% in 2020 and -26.14% in 2021). Importantly, treatment of positive cases was lower than 80% (77.44% in 2020 and 77.38% in 2021). Additionally, spatial clusters with negative percentage values of up to -100% of the PCE indicators were identified mostly in the municipalities of the coastal areas that are historically most affected by schistosomiasis. Taken together, our analyzes corroborate that PCE actions in endemic municipalities of Alagoas were impacted by the COVID-19 pandemic.

Clinical characteristics and laboratory parameters associated with the risk of severe COVID-19 in patients from two hospitals in Northeast Brazil.

BACKGROUND: Although most coronavirus disease 2019 (COVID-19) infections are mild, some patients have severe clinical conditions requiring hospitalization. Data on the severity of COVID-19 in Brazil are scarce and are limited to public databases. This study aimed to investigate the clinical and laboratory factors associated with the severity of COVID-19 in a cohort of hospitalized adults from two hospitals in Northeast Brazil. METHODS: Patients over 18 years of age who were hospitalized between August 2020 and July 2021 with a confirmed diagnosis of COVID-19 were included. The patients were classified into two groups: moderate and severe. Clinical, laboratory and imaging parameters were collected and compared between the groups. A multivariate logistic regression model was used to determine the predictors of COVID-19 severity. RESULTS: This study included 495 patients (253 moderate and 242 severe). A total of 372 patients (75.2%) were between 18 and 65 years of age, and the majority were male (60.6%; n = 300). Patients with severe disease had higher levels of leukocytes, neutrophils, platelets, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, blood glucose, C-reactive protein, ferritin, D-dimer, aspartate aminotransferase, creatinine, and urea (p < 0.05). In multivariate logistic regression, the following variables were significant predictors of COVID-19 severity: leukocytes (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.12-5.06), international normalized ratio (INR) (OR 0.22, 95% CI 0.14-0.33), and urea (OR 4.03; 95% CI 2.21-7.35). CONCLUSIONS: The present study identified the clinical and laboratory factors associated with the severity of COVID-19 in hospitalized Brazilian individuals.

In-Hospital Mortality from Cardiovascular Diseases in Brazil during the First Year of The COVID-19 Pandemic. / Excesso de Mortalidade Hospitalar por Doenças Cardiovasculares no Brasil Durante o Primeiro Ano da Pandemia de COVID-19.

BACKGROUND: The COVID-19 pandemic has had an impact on mortality from several diseases worldwide, especially cardiovascular diseases (CVD). Brazil is a continent-sized country with significant differences in the health care structure between its federative units. OBJECTIVE: Analyze in-hospital mortality from CVDs in the Brazilian public health system during the first year of the COVID-19 pandemic (2020). METHODS: This is an ecological study analyzing the absolute number of in-hospital deaths and the rate of in-hospital mortality in Brazil, its macro-regions, and federative units. Data were obtained from the Hospital Information System of the Brazilian Ministry of Health. To analyze excess mortality, the P-score was used. It compares the events observed with those expected for a given place and period. The P-score was corrected by the joinpoint regression model, with a 95% confidence interval and 5% significance level. RESULTS: There were 93,104 in-hospital deaths due to CVD in Brazil in 2020, representing 1,495 fewer deaths (P score: -1.58) than expected. The central-west region had a positive P-score, with a 15.1% increase in the number of deaths. Ten federative units showed a greater number of deaths in 2020. There was also a 13.3% excess in-hospital mortality at the country level, and an excess in-hospital mortality in all macro-regions. CONCLUSIONS: There was a decrease in the absolute number of in-hospital deaths, as well as an increase in in-hospital mortality from CVD in Brazil, in 2020, after the COVID-19 pandemic onset.

FUNDAMENTO: A pandemia da COVID-19 tem causado um impacto sobre a mortalidade por várias doenças em todo o mundo, especialmente por doenças cardiovasculares (DCVs). O Brasil é um país de dimensões continentais com diferenças significativas na estrutura de saúde entre seus estados. OBJETIVO: Analisar a mortalidade hospitalar por DCV no sistema público de saúde durante o primeiro ano da pandemia por COVID-19 (2020) no Brasil. MÉTODOS: Este é um estudo ecológico analisando o número absoluto de mortes hospitalares e a taxa de mortalidade hospitalar no Brasil, suas macrorregiões, e unidades federativas. Os dados foram obtidos do Sistema de Informações Hospitalares (SIH) do Ministério da Saúde. O P-escore foi usado para analisar o excesso de mortalidade. O escore compara os eventos observados com os eventos esperados para um dado local e período. O escore-P foi corrigido por um modelo de regressão joinpoint, com um intervalo de confiança de 95% e nível de significância de 5%. RESULTADOS: Houve 93.104 óbitos hospitalares por DCV no Brasil em 2020, o que representa 1495 menos óbitos (escore-P: -1,58) que o esperado. A região centro-oeste apresentou um escore-P positivo, com um aumento de 15,1% no número de mortes. Dez estados apresentaram um maior número de óbitos em 2020. Ainda, observou-se um excesso de 13,3% de mortalidade hospitalar no país como um todo, e um excesso de mortalidade hospitalar em todas as macrorregiões. CONCLUSÕES: Houve uma diminuição no número absoluto de óbitos hospitalares, bem como um aumento na taxa de mortalidade por DCV no Brasil em 2020, após o início da pandemia por COVID-19.

Impact of the COVID-19 pandemic on compulsory notification of meningitis during the first wave of the pandemic in Brazil: an ecological study using P-score.

BACKGROUND: Meningitis is listed as one of the diseases requiring compulsory notification in Brazil. It can affect all age groups and also has no seasonality. Cases can be recorded in all months of the year and in all states of Brazil. Despite its importance, the obligation of immediate notification may have been compromised by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To analyze the immediate impact of the COVID-19 pandemic on compulsory notifications of meningitis in Brazil and its states during the first wave of the pandemic. DESIGN AND SETTING: This was an ecological study involving all confirmed cases of meningitis in Brazil, in its regions and in its states. METHODS: Data for the months from 2015 to 2020 were obtained from the database of the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN), in the Department of Informatics of the National Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS). The P-score was used to obtain the percentage change in the numbers of cases reported in 2020. RESULTS: A 45.7% reduction in notifications of meningitis in Brazil was observed. Regarding the regions and the states, with the exception of Roraima, all of them showed a negative P-score, with decreasing curves each month. CONCLUSION: The pandemic caused a negative impact on meningitis notifications in Brazil.

Prevalence of Systemic Arterial Hypertension and Diabetes Mellitus in Individuals with COVID-19: A Retrospective Study of Deaths in Pernambuco, Brazil. / Prevalência de Hipertensão Arterial Sistêmica e Diabetes Mellitus em Indivíduos com COVID-19: Um Estudo Retrospectivo de Óbitos em Pernambuco, Brasil.

Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM ­ 61,3% eram homens e 38,9% mulheres; HAS ­ 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

COVID-19 in Brazil: spatial risk, social vulnerability, human development, clinical manifestations and predictors of mortality - a retrospective study with data from 59 695 individuals.

Brazil ranks second in the number of confirmed cases of COVID-19 worldwide. In spite of this, coping measures differ throughout the national territory, as does the disease's impact on the population. This cross-sectional observational study, with 59 695 cases of COVID-19 registered in the state of Alagoas between March and August 2020, analysed clinical-epidemiological variables, incidence rate, mortality rate, case fatality rate (CFR) and the social indicators municipal human development index (MHDI) and social vulnerability index (SVI). Moran statistics and regression models were applied. Logistic regression analysis was applied to determine the predictors of death. The incidence rate was 1788.7/100 000 inhabitants; mortality rate was 48.0/100 000 and CFR was 2.7%. The highest incidence rates were observed in municipalities with better human development (overall MHDI (I = 0.1668; p = 0.002), education MHDI (I = 0.1649; p = 0.002) and income MHDI (I = 0.1880; p = 0.005)) and higher social vulnerability (overall SVI (I = 0.0599; p = 0.033)). CFR was associated with higher social vulnerability (SVI human capital (I = 0.0858; p = 0.004) and SVI urban infrastructure (I = 0.0985; p = 0.040)). Of the analysed cases, 55.4% were female; 2/3 were Black or Brown and the median age was 41 years. Among deaths, most were male (919; 57.4%) and elderly (1171; 73.1%). The predictors of death were male sex, advanced age and the presence of comorbidities. In Alagoas, Brazil, the disease has undergone a process of interiorisation and caused more deaths in poorer municipalities. The presence of comorbidities and advanced age were predictors of death.

Extracorporeal Membrane Oxygenation in COVID-19 Treatment: a Systematic Literature Review.

INTRODUCTION: The present study intends to systematically review the literature on the use of extracorporeal membrane oxygenation (ECMO) in patients with coronavirus disease 2019 (COVID-19). METHODS: The research was carried out according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). Studies were selected from PubMed/MEDLINE and LILACS databases between December 2019 and May 17 2020, using the descriptors "ECMO AND COVID-19", "Extracorporeal Membrane Oxygenation AND COVID-19", "ECLS AND COVID-19", and "Extracorporeal Life Support AND COVID-19". Exclusion criteria were government epidemiological bulletins, comments, literature reviews, and articles without full access to content. RESULTS: Two hundred and thirty-three scientific productions were found, however only 18 did not met the exclusion criteria and could be included in this study, amouting to a total of 911 patients - 624 (68.5%) men, 261 (28.6%) women, and 26 (2.8%) without sex information. The mean age of the patients was 53.7 years. ECMO was necessary in 274 (30.1%) people (200 [73%] submitted to veno-venous ECMO, nine [3.3%] to veno-arterial ECMO, and seven [2.5%] moved between these two types or needed a more specific ECMO according to the disease prognosis). Five studies did not specify the type of ECMO used, amounting 57 (20.8%) patients. Five patients (1.8%) were discharged, 77 (28.1%) died, 125 (45.6%) remained hospitalized until publication time of their respective studies, and 67 patients (24.4%) had no outcome information. CONCLUSION: It is evident that more research, covering larger populations, must be carried out in order to clearly elucidate the role of ECMO in the treatment of COVID-19.

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.

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.