Factors associated with deaths from COVID-19 in a region of northeastern Brazil.

INTRODUCTION: There is a need to improve knowledge and understanding of the factors associated with mortality from COVID-19 so that managers and decision-makers can implement strategies to mitigate and control the severe forms of the disease. This study aimed to determine the factors associated with deaths from COVID-19 in the state of Maranhão, in northeastern Brazil. METHODOLOGY: This is a cross-sectional and analytical study with patients with a confirmed diagnosis of COVID-19 who died from March 2020 to January 2022. Simple and multiple logistic regression models were used to assess the association between clinical-epidemiological characteristics and death. The odds ratios were expressed using a 95% confidence interval and a 5% significance level. RESULTS: A total of 386,567 cases of COVID-19 were registered in the period, of which 10,986 died. Risk factors associated with deaths from COVID-19 were male sex, age over 30 years, positive reverse transcriptase-polymerase chain reaction (RT-PCR) result, positive CT scan, and having one or more associated comorbidities. The three comorbidities linked to the highest propensity to die were diabetes mellitus, neurological disease, and obesity. CONCLUSIONS: The study findings support the implementation of strategic actions by health care and surveillance professionals and managers towards reducing the incidence of the risk factors for mortality by COVID-19 in Maranhão.

Spatiotemporal risk assessment and COVID-19 trend estimation in a federative unit in northeastern Brazil.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. METHODS: An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions. RESULTS: Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. CONCLUSIONS: The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.

Deaths due to COVID-19 in a state of northeastern Brazil: spatiotemporal distribution, sociodemographic and clinical and operational characteristics.

BACKGROUND: The detection of spatiotemporal clusters of deaths by coronavirus disease 2019 (COVID-19) is essential for health systems and services, as it contributes to the allocation of resources and helps in effective decision making aimed at disease control and surveillance. Thus we aim to analyse the spatiotemporal distribution and describe sociodemographic and clinical and operational characteristics of COVID-19-related deaths in a Brazilian state. METHODS: A descriptive and ecological study was carried out in the state of Maranhão. The study population consisted of deaths by COVID-19 in the period from 29 March to 31 July 2020. The detection of spatiotemporal clusters was performed by spatiotemporal scan analysis. RESULTS: A total of 3001 deaths were analysed with an average age of 69 y, predominantly in males, of brown ethnicity, with arterial hypertension and diabetes, diagnosed mainly by reverse transcription polymerase chain reaction in public laboratories. The crude mortality rates the municipalities ranged from 0.00 to 102.24 deaths per 100 000 inhabitants and three spatiotemporal clusters of high relative risk were detected, with a mortality rate ranging from 20.25 to 91.49 deaths per 100 000 inhabitants per month. The headquarters was the metropolitan region of São Luís and municipalities with better socio-economic and health development. CONCLUSIONS: The heterogeneous spatiotemporal distribution and the sociodemographic and clinical and operational characteristics of deaths by COVID-19 point to the need for interventions.

Spatial analysis of congenital syphilis in a federative unit in northeastern Brazil.

BACKGROUND: Congenital syphilis is an infectious disease that affects 1 million children a year worldwide. METHODS: The objective of this study was to describe a spatial analysis of the epidemiological characteristics of congenital syphilis in the state of Maranhão, Brazil from 2007 to 2018. This was an ecological study using data obtained in May 2020 from three Brazilian information systems. The spatial correlation was analyzed according to local and global Moran indexes. RESULTS: During the 12-y period, 1 426 177 children were born. Of these children, 3684 acquired congenital syphilis (0.26%; mean annual rate of 2.62/1000 live births) and 70 died (1.90%; mean annual rate 0.05). The clusters were statistically significant according to the global Moran index of 0.40 (p=0.01). Spearman's correlation coefficient between the rate of detection of syphilis in pregnant women and family health strategy teams was strong, positive and significant (ρ=0.73; p<0.00). Most of the variables studied showed a trend of annual increase (p<0.05). CONCLUSIONS: The use of spatial analysis tools have made it possible to detect areas with both a greater and a lesser need for intervention, and to more effectively improve and monitor those areas to change the epidemiological profile of the disease.

Epidemiological aspects and spatial patterns of human visceral leishmaniasis in Brazil.

Human visceral leishmaniasis (HVL) cases are important public health problems due to their zoonotic aspect, with high rates of morbidity and mortality in Brazil. The aim of this this study was to identify spatial patterns in both rates of HVL cases in Brazilian states during the period from 2006 to 2015. This is an ecological study, using geoprocessing tools to create choropleth maps, based on secondary data from open access platforms, to identify priority areas for control actions of the disease. Data were collected in 2017 and analysed according to the global and local Moran's I, using TerraView 4.2.2 software. Similar clusters were observed in neighbouring municipalities in thematic maps of HVL, suggesting spatial similarity in the distribution of the disease in humans mainly in the North and Northeast Regions, which concentrate the states with the highest rates of HVL. Heterogeneous spatial patterns were observed in the distribution of HVL, which show municipalities that need higher priority in the intensification of disease surveillance and control strategies.

Medicinal Plants from Northeastern Brazil against Alzheimer's Disease.

Alzheimer's disease (AD) has been linked with oxidative stress, acetylcholine deficiency in the brain, and inflammatory processes. In the northeast region of Brazil, various plants are used to treat several diseases associated with these processes; then an antioxidant test was performed with those plants in a previous work and twelve species with higher antioxidant activity were selected for AChE inhibition evaluation. The phenolic compounds content was determined by Folin-Ciocalteu test and flavonoid content with AlCl3 reagent using UV-visible spectrophotometry. The antioxidant activity was assessed analyzing the inhibitory activity against 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2-azinobis-3-ethylbenzothiazoline-6-sulfonate (ABTS) and by the ß-carotene/linoleic acid system and acetylcholinesterase inhibition using qualitative and quantitative tests. The combination of better acetylcholinesterase inhibitory and antioxidant activities pointed out six species, in descending order, as the best potential sources of therapeutic agents against AD: Hancornia speciosa > Myracrodruon urundeuva > Copaifera langsdorffii > Stryphnodendron coriaceum > Psidium guajava > Mangifera indica. Besides, the phenolic compounds in the species probably contribute to these activities. However, further pharmacological studies to assess the specific applications of these plants against AD are required to confirm these results.