Skeletal muscle mass increases after viral eradication with direct-acting antivirals in patients with chronic hepatitis C: A longitudinal study

BACKGROUND

Results of studies evaluating the effect of viral eradication following direct-acting antiviral (DDA) therapy on skeletal muscle mass of patients with chronic hepatitis C (CHC) are scarce.

AIM

To assess the components of sarcopenia (low muscle mass, low muscle strength and low physical performance) in a cohort of CHC individuals before and after DAA therapy.

METHODS

We performed a longitudinal study of patients with CHC who underwent body composition assessment before (T0), and at 12 (T1) and 48 (T2) weeks after DDA therapy. Bioelectrical Impedance Analysis was used to assess skeletal mass muscle (SM) and phase angle (PhA). SM index (SMI) was calculated by dividing the SM by squared height. Muscle function was evaluated by hand grip strength (HGS) and timed up-and-go (TUG) test. Mixed-effects linear regression models were fitted to SMI, HGS and physical performance and were used to test the effect of HCV eradication by DAA.

RESULTS

62 outpatients (mean age, 58.6 ± 10.8 years; 58% with compensated cirrhosis) were included. Significant decreases in liver fibrosis markers and an increase of 0.20 and 0.22 kg/m2 in the SMI were observed at T1 and T2. Following DAA therapy, an increase of one unit of PhA was associated with a reduction of 0.38 min in TUG.

CONCLUSION

HCV eradication with DAA therapy was associated with a dynamic reduction of non-invasive markers of liver fibrosis and increased muscle mass in 62 patients with CHC who had an undetectable HCV load at 12 weeks after completion of antiviral treatment.

Clinical-epidemiological aspects and prognostic factors associated with death from visceral leishmaniasis between the years 2010 to 2019 in the Central-West region of Brazil

In Brazil, the fatality rate for visceral leishmaniasis is high, and it is important to investigate its associated factors. The aim of this study was to analyze the clinical-epidemiological profile and prognostic factors associated with death from visceral leishmaniasis (VL) in the Central-West region of Brazil, between 2010 and 2019. A study of series of VL cases was carried out using data obtained from the Sistema de Informação de Agravos de Notificação (SINAN). Multivariate logistic regression was performed to identify variables associated with deaths. Male (64.96%); age group ≤5 years (28.51%); mixed race/color (59.20%); and level of education incomplete primary education (45.16%) were the most affected. The most frequent symptoms were fever (87.65%), weakness (77.56%), enlarged spleen (70.22%) and liver (67.33%), weight loss (67.22%) and pallor (63.41%). Co-infection with HIV was observed in 15.84% of patients. The parasitological diagnosis was positive in 74.17% and the Indirect Immunofluorescence (IIF) in 82.80%. The drug most used for treatment was pentavalent antimony (41.96%). Regarding the evolution of VL, cure was recorded for 82.90% of patients and death from VL in 8.30%. Factors associated with death from VL were: age group ≥20 and <60 (OR 2.95; 95% CI 1.98-4.38) and ≥60 (OR 5.84; 95% CI 3.63-9.38), edema (OR 2.27; 95% CI 1.64-3.13), pallor (OR 1.53; 95% CI 1.06-2.20), infectious condition (OR 1.56; 95% CI 1.12-2.15) and hemorrhagic phenomena (OR 2.87; 95% CI 2.02-4.08). New studies are needed in order to better manage VL control, monitoring, prevention and primary care strategies.

What is the Role of SNORA42 in Carcinogenesis? A Systematic Review

OBJECTIVE

Perform a systematic literature review on SNORA42 in carcinogenesis in order to elucidate its importance, its potential use as a biomarker and as a therapeutic target.

METHODS

Using PubMed, SciELO and Science Direct databases as search means, articles that are in line with the scope of the study, written in English, that were published between 2012 and 2022, were selected using the following keywords: "small nucleolar RNA 42", "snoRNA 42" and "SNORA42", as well as searches for the synonyms of this snoRNA (SNORA80E, box H/ACA 42 and ACA42).

RESULT

From a total of 131 studies, seven were selected, in which it was possible to identify that SNORA42 interferes in several biological processes, such as proliferation, migration, invasion, metastasis, apoptosis, and signaling pathways. Among the signaling pathways, the p53 and NF-KappaB pathways stand out. Moreover, it is a potential biomarker for diagnosis, prognosis, and treatment of cancer.

CONCLUSION

The summary of the main information about SNORA42 in the process of carcinogenesis and cancer progression shows that the use of this snoRNA is ideal for future applications in the field of oncology, in which it can be used as a biomarker and therapeutic target. Thus, it is of fundamental importance to carry out new studies to consolidate the applicability of this molecule.

Sarcopenia in chronic viral hepatitis: From concept to clinical relevance

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Prevalence and epidemiological aspects of Chikungunya fever in states of the Northeast region of Brazil: A systematic review

Chikungunya fever is a disease caused by the Chikungunya virus (CHIKV), which is transmitted through the bite of infected female hematophagous mosquitoes of the genus Aedes (Diptera: Culicidae). In the Americas, the first autochthonous cases of the disease were recorded in 2013. A year later, in 2014, the first records of the disease were acquired locally in Brazil, in the states of Bahia and Amapá. The present study aimed to carry out a systematic review of the literature on the prevalence and epidemiological aspects of Chikungunya fever in states of the Northeast region of Brazil, between the years 2018 to 2022. This study was registered in the Open Science Framework (OSF) and in the International Prospective Register of Systemactic Reviews (PROSPERO) and followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The searches were carried out in the scientific electronic databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), U. S. National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO), using descriptors cataloged in Descritores em Ciências da Saúde (DeCS) and Medical Subject Headings (MeSH) in Portuguese, English and Spanish. Gray literature was also searched by accessing Google Scholar to search for additional publications not captured in the selected electronic databases. Of the 19 studies included in the present systematic review, seven referred to the state of Ceará. Most cases of Chikungunya fever corresponded to the female gender (ranging from 7.5% to 100.0%), to the age group younger than 60 years (84.2%), to literate individuals (93.3%), belonging to the non-white race/color (95.21%) and blacks (100.0%), and residents of the urban area (range from 51.95% to 100.0%). As for laboratory characteristics, most notifications were diagnosed using clinical-epidemiological criteria (ranging from 71.21% to 90.35%). The epidemiological information about Chikungunya fever in the Northeast region of Brazil presented in this systematic review is useful to better understand the characteristics of the disease introduction process in the country. To this end, prevention and control strategies must be adopted, especially in the Northeast, as this region is most responsible for the number of cases of the disease in the country.

Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis

INTRODUCTION

anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy.

METHODS

the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05.

RESULTS

cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35).

CONCLUSIONS

important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.

Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study

BACKGROUND

Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic.

METHODS

To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history.

RESULTS

The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92).

CONCLUSIONS

The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.

Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019

Background:

Syphilis is a chronic infectious disease that has created challenging situations for humanity for centuries. Transmission can occur sexually or vertically, with great repercussions on populations, particularly among women and children. The present study presents information on the main burden imposed by syphilis generated by the Global Burden of Disease (GBD) Study 2019 for Brazil and its 27 federated units.

Methods:

We described the metrics of incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), standardized by age and per 100,000 inhabitants, from 1990 to 2019, and we compared the disease burden between the years 1990 and 2019.

Results:

In Brazil, the disease burden increased between 2005 and 2019 for all metrics. Although a higher incidence of syphilis was found among women in 2019, DALYs [YLLs (males: 15.9%; females: 21.8%), YLDs (males: 25.0%; females: 50.0%), and DALYs (males: 16.2%; females: 22.4%)] were higher among men. In 2019, the highest DALY rate per 100,000 inhabitants was observed in individuals aged above 50 years. The State of Maranhão presented the highest values of DALYs {1990: 165.2 [95% uncertainty interval (UI) 96.2-264.4]; 2005: 43.8 [95% UI 30.3-62.4]; 2019: 29.1 [95% UI 19.8-41.1]} per 100,000 inhabitants in the three years analyzed.

Conclusions:

The burden of syphilis has increased in recent years. Men presented higher DALYs, although the incidence of the disease was higher in women. Syphilis affects a large number of people across all age groups, causing different degrees of disability and premature death (DALYs).

Epidemiological aspects and spatial analysis of chikungunya fever cases from 2017 to 2021, in a state in the northeast region of Brazil

This study aimed to characterize the epidemiological aspects and perform a spatial analysis of Chikungunya fever cases from 2017 to 2021, in the State of Maranhão, Brazil. This is an ecological, descriptive, observational, and retrospective study, conducted by collecting data on Chikungunya fever’s confirmed cases in the State of Maranhão, available on the platform of the Department of Informatics of the Unified Health System. Most cases of Chikungunya fever occurred in the year 2017 (p<0.0001), in females (p=0.54), in people between 20 and 39 years old (p=0.04), and with a high school degree (p=0.25). Regarding the evolution of the disease, most cases were cured (p=0.006). The municipalities that obtained a High/High pattern of spatial correlation for the incidence rates of Chikungunya fever per 100,000 inhabitants in the State of Maranhão were located in the West and South Mesoregions in 2017; North and East in 2018; Central, North and East in 2019; North in 2020; and North, East and South in 2021. The epidemiological situation of Chikungunya fever in the State of Maranhão needs attention from public health agencies. Greater efforts towards vector and outbreaks prevention, as well as the improvement on health education programs that educate the population about the disease are necessary. Mainly in the most affected municipalities in order to effectively involve the population in reducing domestic mosquito breeder sites. KEY WORDS: Chikungunya fever; epidemiology; spatial analysis.  

Prevalence of tungiasis in humans in Brazil and in its federative units: a systematic review

Tungiasis is a neglected parasitic disease caused by penetration of female Tunga penetrans under the skin, causing important health outcomes in humans. Therefore, the aim of this study was to describe the prevalence of tungiasis in Brazil and in its federative units. In November 2019, an investigation was carried out to find studies published from 1980 onwards in MEDLINE, LILACS, Cochrane, CINAHL, Scopus, Web of Science and Embase databases, and in the gray literature, using descriptors related to the prevalence of tungiasis caused by T. penetrans in Brazil. Of the 542 studies found, only 16 published between 2002 and 2010 met the eligibility criteria to be included in this systematic review. Of the 16 selected publications, 14 addressed the prevalence of tungiasis in communities in the Northeast region of the country, one in the South and one in the Southeast. The general prevalence of the parasitosis in the studies ranged from 1.6% to 54.8%, predominantly in the five to nine age group. Eight studies considered the prevalence by gender, ranging from 2.2% to 62.2% for females and 1.1% to 62.5% for males. This systematic review presents an unprecedented survey of the prevalence of tungiasis, a parasitic disease whose dissemination is facilitated by several factors, occuring mainly in low-income communities. Considering the regionalization of the findings, the scarcity of publications, as well as disease neglect, more studies are required. KEY WORDS: Tunga penetrans; occurrence; epidemiology; PRISMA; human.

Spatial dynamics of COVID-19 cases in a state in the southeast region of Brazil

This study analyzed the progression of COVID-19 in the State of Espírito Santo, identifying the areas where the disease spread furthest. Temporal and spatial analysis were performed based on confirmed cases of the disease reported in the eSUS/VS System - State Health Department, from March 2020 to February 2021. The highest incidence was noted in July (ranging from 146.1 to 2,099.5 cases per 100,000 inhabitants in the municipalities of Espírito Santo State), with the majority being females, people aged 20 to 39 years and residents in cities in the metropolitan region. A positive and complete high association (p < 0.05) was identified in all months, with clusters containing a greater number of municipalities in April, May and June 2020 in the Central region of the state. The results of the present study indicated a continuous spread of COVID-19 since its introduction, especially in the cities in the Central region of the State of Espírito Santo. These findings present an important aid for decision making regarding the most effective strategies to control the disease. Furthermore, individual and collective protection measures against the transmission of the SARS-CoV-2 must be encouraged. KEY WORDS: COVID-19; SARS-CoV-2; pandemic; spatial analysis; epidemiology; Espirito Santo.

Factors associated with the occurrence of dengue epidemics in Brazil: a systematic review

Objective

To identify and describe broadly the factors related to the occurrence of dengue epidemics in Brazil.

Methods

Systematic review of studies published in Medline, Lilacs, PubMed, Cochrane, BVS, Web of Science, Scopus, and thesis and dissertations databases using descriptors cataloged in DeCs and MeSH on dengue and factors associated with the occurrence of epidemics, published from 2008 to 2018.

Results

Thirty-five studies carried out in the country were selected. The epidemics recorded in Brazil were associated and/or correlated with multiple factors such as environment, socioeconomic conditions, climate, and aspects related to the vector, among others.

Conclusions

Dengue epidemics are complex and multifactorial. The continuity of the vector control actions was found to be relevant to the reduction of Aedes aegypti and for disease control. To contain the spread of the disease, effective measures are needed in all sectors, including health, education, economy, population, business, and government. Actions for the early detection of cases of the disease can prevent new outbreaks of epidemics.

Entry of dengue virus serotypes and their geographic distribution in Brazilian federative units: a systematic review

OBJECTIVE

To describe the entry of Dengue virus (DENV) serotypes in Brazil and its federative units.

METHODS

A systematic review of studies published between 1980 and 2018 in databases and in the gray literature was performed using descriptors related to the years of entry of the DENV serotypes. Additionally, experts and official sources of information (Brazilian Ministry of Health) were consulted.

RESULTS

From 100 publications selected for the systematic review, 26 addressed the entry of DENV serotypes in the North region of the country, 33 in the Northeast, 24 in the Southeast, 14 in the Central-West, and five in the South. DENV-1 and DENV-4 were introduced in the North region in 1981. DENV-2 was introduced in the Southeast in 1990. DENV-3 was introduced in the North in 1999.

CONCLUSION

The rapid expansion of dengue throughout the Brazilian territory was verified from the second half of the 1980s, with the gradual entry of the four serotypes, which resulted in the emergence of epidemics of arbovirus, which are currently verified in the country. Considering the epidemiology of the disease, more information should be disseminated and published in the wide-ranging scientific literature for a better understanding of the spread and circulation of DENV serotypes.

Spatiotemporal dynamics and risk estimates of COVID-19 epidemic in Minas Gerais State: analysis of an expanding process

COVID-19 is an infectious disease caused by the recently discovered coronavirus SARS-Cov-2. The disease became pandemic affecting many countries globally, including Brazil. Considering the expansion process and particularities during the initial stages of the epidemic, we aimed to analyze the spatial and spatiotemporal patterns of COVID-19 occurrence and to identify priority risk areas in Minas Gerais State, Southeast Brazil. An ecological study was performed considering all data from human cases of COVID-19 confirmed from the epidemiological week (EW) 11 (March 08, 2020) to EW 26 (June 27, 2020). Crude and smoothed incidence rates were used to analyze the distribution of disease patterns based on global and local indicators of spatial association and space-time risk assessment. Positive spatial autocorrelation and spatial dependence were found. Our results suggest that the metropolitan region of the State capital Belo Horizonte (MRBH) and Vale do Rio Doce mesoregions, as major epidemic foci in the beginning of the expansion process, have had important influence on the dispersion of SARS-CoV-2 in Minas Gerais State. Triangulo Mineiro/Alto Paranaiba region presented the highest risk of infection. In addition, six statistically significant spatiotemporal clusters were identified in the State, three at high risk and three at low risk. Our findings contribute to a greater understanding of the space-time disease dynamic and discuss strategies for identification of priority areas for COVID-19 surveillance and control.

Clinical, epidemiological and climatic factors related to the occurrence of cutaneous leishmaniasis in an endemic area in northeastern Brazil

Cutaneous leishmaniasis (CL) is a neglected tropical disease with a wide distribution in the Americas. Brazil is an endemic country and present cases in all states. This study aimed to describe the occurrence, the underlying clinical and epidemiological factors, and the correlation of climatic variables with the frequency of reported CL cases in the municipality of Caxias, state of Maranhão, Brazil. This is a retrospective and descriptive epidemiological study based on data extracted from the Brazilian Information System of Diseases Notification, from 2007 to 2017. Maximum and minimum temperature, precipitation, and relative air humidity data were provided by the Brazilian National Institute of Meteorology. A total of 201 reported autochthonous CL cases were analyzed. The predominance of cases was observed in males (70.1%). The age range between 31 and 60 years old was the most affected, with 96 cases (47.9%). Of the total number of registered cases, 38.8% of the affected individuals were engaged in agriculture-related activities. The georeferenced distribution revealed the heterogeneity of disease occurrence, with cases concentrated in the Western and Southern regions of the municipality. An association was detected between relative air humidity (monthly mean) and the number of CL cases per month (p = 0.04). CL continues to be a concerning public health issue in Caxias. In this context, there is a pressing need to strengthen measures of prevention and control of the disease through the network of health services of the municipality, considering local and regional particularities.

Changes in malaria patterns in Brazil over 28 years (1990-2017): results from the Global Burden of Disease Study 2017

Background

This study presents the malaria burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), by analyzing disease burden indicators in federated units of the Legal Amazon and Extra-Amazon regions, as well as describing malaria cases according to Plasmodium species occurring in the country.

Methods

We used estimates from the GBD 2017 to report years of life lost due to premature death (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for malaria in Brazil, grouped by gender, age group, and Brazilian federated unit, from 1990 to 2017. Results are presented as absolute numbers and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UI).

Results

At the national level, the age-standardized DALYs rate due to malaria decreased by 92.0%, from 42.5 DALYs per 100,000 inhabitants (95% UI 16.6–56.9) in 1990 to 3.4 DALYs per 100,000 inhabitants (95% UI 2.7–4.7) in 2017. The YLLs were the main component of the total DALYs rate for malaria in 1990 (67.3%), and the YLDs were the main component of the metric in 2017 (61.8%). In 2017, the highest sex–age DALYs rate was found among females in the “< 1-year-old” age group, with a 6.4 DALYs per 100,000 inhabitants (95% UI 1.8–14.7) and among males in the age group of “20 to 24 years old”, with a 4.7 DALYs per 100,000 inhabitants (95% UI 3.3–9.9). Within the Brazilian Amazon region, the three federated units with the highest age-standardized DALYs rates in 2017 were Acre [28.4 (95% UI 14.2–39.1)], Roraima [28.3 (95% UI 13.5–40.2)], and Rondônia [24.7 (95% UI 11.4–34.8)]. Concerning the parasite species that caused malaria, 73.5% of the total of cases registered in the period had Plasmodium vivax as the etiological agent.

Conclusions

The results of the GBD 2017 show that despite the considerable reduction in the DALYs rates between 1990 and 2017, malaria remains a relevant and preventable disease, which in recent years has generated more years of life lost due to disability than deaths. The states endemic for malaria in the Amazon region require constant evaluation of preventive and control measures. The present study will contribute to the direction of current health policies aimed at reducing the burden of malaria in Brazil, as knowing the geographical and temporal distribution of the risk of death and disability of this disease can facilitate the planning, implementation, and improvement of control strategies aimed at eliminating the disease.

The burden of tuberculosis and attributable risk factors in Brazil, 1990-2017: results from the Global Burden of Disease Study 2017

Background

Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017).

Methods

This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs).

Results

In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269–349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645–202,394), while 87,957 DALYs (95% UI: 50,624–146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex–age-specific TB burden was highest among males and in children under-1 year and the age groups 45–59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%.

Conclusions

GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country.

Interleukin-6-174G/C polymorphism is associated with a decreased risk of type 2 diabetes in patients with chronic hepatitis C virus

BACKGROUND

Chronic hepatitis C (CHC) is associated with type 2 diabetes mellitus. Although the pathogenesis remains to be elucidated, a growing evidence has suggested a role of pro-inflammatory immune response. Increased serum concentrations of Interleukin 6 (IL-6) have been associated with insulin resistance, type 2 diabetes mellitus as well as advanced forms of liver disease in chronic hepatitis C infection.

AIM

To investigate the frequency of IL-6-174G/C (rs1800795) single nucleotide polymorphism (SNP) in CHC patients and in healthy subjects of the same ethnicity. Associations between type 2 diabetes mellitus (dependent variable) and demographic, clinical, nutritional, virological and, IL-6 genotyping data were also investigated in CHC patients.

METHODS

Two hundred and forty-five patients with CHC and 179 healthy control subjects (blood donors) were prospectively included. Type 2 diabetes mellitus was diagnosed according to the criteria of the American Diabetes Association. Clinical, biochemical, histological and radiological methods were used for the diagnosis of the liver disease. IL-6 polymorphism was evaluated by Taqman SNP genotyping assay. The data were analysed by logistic regression models.

RESULTS

Type 2 diabetes mellitus, blood hypertension and liver cirrhosis were observed in 20.8% (51/245), 40.0% (98/245) and 38.4% (94/245) of the patients, respectively. The frequency of the studied IL-6 SNP did not differ between the CHC patients and controls (P = 0.81) and all alleles were in Hardy-Weinberg equilibrium (P = 0.38). In the multivariate analysis, type 2 diabetes mellitus was inversely associated with GC and CC genotypes of IL-6-174 (OR = 0.42; 95%CI = 0.22-0.78; P = 0.006) and positively associated with blood hypertension (OR = 5.56; 95%CI = 2.79-11.09; P < 0.001).

CONCLUSION

This study was the first to show that GC and CC genotypes of IL-6-174 SNP are associated with a decreased risk of type 2 diabetes mellitus in patients chronically infected with hepatitis C virus. The identification of potential inflammatory mediators involved in the crosstalk between hepatitis C virus and the axis pancreas-liver remains important issues that deserve further investigations.

Emergence of chikungunya and Zika in a municipality endemic to dengue, Santa Luzia, MG, Brazil, 2015-2017

INTRODUCTION

The recent circulation of arboviruses transmitted by vectors, such as dengue, chikungunya, and Zika, is concerning due to the high morbidity rates, clinical complications, and increased demand on health services. The objective of this study was to analyze the clinical and epidemiological aspects of an epidemic caused by arboviruses in the municipality of Santa Luzia, Minas Gerais, Brazil.

METHODS

Longitudinal study of patients with acute febrile disease and suspected arbovirus infection reported to Brazilian Notifiable Disease Information System (Sistema de Informação de Agravos de Notificação) from the epidemiological week 44 of 2015 to epidemiological week 52 of 2016. Patients with confirmed chikungunya were followed-up for 18 months and those with Zika for 15 months. Additionally, we analyzed and described the temporal distribution of confirmed cases of these arboviruses in this municipality.

RESULTS

Overall 3,531 arboviruses cases, including 3,481 (98.7%) cases of dengue, 38 (1.0%) cases of chikungunya, and 12 (0.3%) cases of Zika were confirmed. The highest incidence of arbovirus infection occurred in the first quarter of 2016 (epidemiological week 7 to 14). The most frequent symptoms were for dengue, which included fever, headache, retro-orbital pain, and exanthema. Chikungunya infection was associated with fever, myalgia, arthralgia, and rash while Zika infection with pruritus and rash.

CONCLUSIONS

Given the similarities in the initial clinical profiles of these arboviruses, it is important to perform a detailed clinical analysis, laboratory diagnosis, and patient follow-up.

Occurrence of Phlebotominae (Diptera: Psychodidae) in Urban Leishmaniasis Transmission Foci in North-Eastern Brazil

In this study, we analyzed species composition, richness, and monthly and seasonal abundance of sand flies in an urban area, municipality Caxias, state Maranhão, endemic for American visceral and tegumentary leishmaniasis. Sand flies were caught using Center for Disease Control (CDC) light traps in peridomicile (animal shelter) and extradomicile (forest) environments twice a month for 1 yr. A total of 16,332 specimens belonging to 20 species were captured. The predominant species identified in this study were Lutzomyia longipalpis (Diptera: Psychodidae) (Lutz and Neiva 1912) (43.08%) and Lutzomyia whitmani (Diptera: Psychodidae) (Antunes and Coutinho 1939) (43.02%), which occurred throughout the year (every month). The highest abundance of phlebotomine was recorded during the dry season (53.75%) and in the urban peridomicile environment (59.1%), wherein 17 species were found. In the study area, L. longipalpis and L. whitmani are reported to be effective visceral or tegumentary leishmaniasis vectors, respectively, due to their abundance throughout the year.

Burden of leishmaniasis in Brazil and federated units, 1990-2016: Findings from Global Burden of Disease Study 2016

BACKGROUND

The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016.

METHODOLOGY

We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change.

PRINCIPAL FINDINGS

The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate and YLD decreased by 51% and 31.8% respectively for the same period. For VL, similar profiles for male and female were observed, with YLL and DALY increasing over time; with males presenting slightly higher values. The highest YLL rates were among "under 1-year old" children, which increased 131.2% from 1990 to 2016. Regarding CML, the highest values of YLD and DALY were verified among males, and YLD values showed a similar profile, with rates increasing with age. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states.

CONCLUSION

The increase of VL burden over the study period might be associated with the difficulties in controlling the disease spread. Information regarding the weight of VL and CML, including the death and disability tolls that they cause, highlights the impact of these neglected diseases on public health and the importance of effective prevention and treatment.

Aumento da carga de dengue no Brasil e unidades federadas, 2000 e 2015: análise do Global Burden of Disease Study 2015

RESUMO: Objetivo: Descrever as principais métricas sobre dengue geradas pelo Global Burden of Disease (GBD) Study 2015, para o Brasil e suas 27 unidades federadas, nos anos de 2000 e 2015. Métodos: As métricas descritas foram: taxas de incidência e de mortalidade por dengue, padronizadas por idade, years of life lost (YLL), years lived with disability (YLD) e disability adjusted life years (DALY) (frequência absoluta e taxas padronizadas por idade). As métricas estimadas foram apresentadas com intervalos de incerteza (II 95%) para 2000 e 2015, acompanhadas da variação relativa percentual. Resultados: Verificou-se aumento de 232,7% no número de casos e de 639,0% no número de mortes entre os anos de 2000 e 2015 no país. A taxa de incidência variou 184,3% e a taxa de mortalidade mostrou-se baixa, mas com aumento de 500,0% no período avaliado. As taxas de YLL, YLD e DALY aumentaram 420,0, 187,2 e 266,1%, respectivamente. Em 2015, DALY foi semelhante entre mulheres e homens (21,9/100.000). O DALY aumentou mais que o dobro em todas as unidades da federação. Conclusão: O aumento acentuado de dengue ao longo dos anos associa-se à introdução e/ou circulação de um ou mais sorotipos do vírus e crescente proporção de pacientes acometidos pela forma grave da doença. Apesar da baixa taxa de mortalidade, a dengue contribui para considerável perda de anos saudáveis de vida no Brasil por acometer elevado número de pessoas, de todas as faixas etárias, ocasionando algum grau de incapacidade durante a infecção sintomática, e em razão dos óbitos, principalmente, em crianças.

Fatores associados à leishmaniose visceral na área endêmica de Codó, estado do Maranhão, Brasil

Justificativa e Objetivos: A leishmaniose visceral é uma endemia no município de Codó, pelo risco da gravidade e o impacto na saúde de grande parcela da comunidade. Por isso, a realização deste estudo, para levantar a situação epidemiológica da doença nos últimos anos. Investigou-se ainda o aspecto clínico, epidemiológico e o conhecimento das famílias pesquisadas sobre a leishmaniose visceral. Métodos: Foram incluídas no estudo as fichas de notificação que apresentaram o diagnóstico de LV humana no referido período, de ambos os sexos e idades. Foram investigadas variáveis sociodemográficas (sexo, faixa etária, raça, área da ocorrência da doença), dados clínicos (manifestações clínicas, coinfecção com o HIV/LV, doença relacionada ao trabalho, relação de casos autóctones e importados), dados laboratoriais e classificação dos casos (critérios de confirmação para LV, diagnósticos parasitológico e imunológico, tipo de entrada e evolução dos casos confirmados). Resultados: No período de estudo, o coeficiente de incidência da doença no município foi 86,31 casos/100.000 habitantes e o coeficiente de letalidade foi 3,68%. O sexo masculino foi o mais acometido com 56% (t=0,5023; p=0,3105), a raça parda 88% (H=17,9622; p=0,0004); os sintomas foram: febre (16,3%), esplenomegalia (15,3%) e palidez (14,4%) (H=50,8473; p

Anopheles DIVERSITY AND MALARIA INFECTION IN THE COCAIS ZONE, STATE OF MARANHÃO, BRAZIL

Realizou-se um levantamento das espécies de Anopheles no município de São Mateus, estado do Maranhão. Foram estudados os hábitos da espécie, a hematofagia, a influência da sazonalidade, assim como a infecção do vetor por Plasmodium. Os mosquitos fêmeas de Anopheles foram capturados entre fevereiro e dezembro de 2010 e em março de 2012, das 18h às 21h, no intra e peridomicílio. A PCR foi utilizada para os estudos de infecção. Um total de 615 espécimes de Anopheles foi capturado, sendo 223 (36,2%) na localidade de Piquizeiro e 392 (63,8%) na Fazenda Retiro Velho, distribuídos entre as espécies An. nuneztovari, An. darlingi, An. triannulatus, An. albitarsis e An. oswaldoi. No Piquizeiro, a maioria foi capturada na área intradomiciliar e, na Fazenda Retiro Velho, no peridomicílio. Os resultados mostram a influência da sazonalidade, o tempo de captura e frequência hematofágica dos Anopheles capturados. A análise da infecção negativa para Plasmodium demonstra a redução dos casos de malária no estado no período de estudo.

Conhecimentos de estudantes sobre Leishmaniose Visceral em escolas públicas de Caxias, Maranhão, Brasil

Trata-se de um inquérito amostral (743 questionários), realizado nos meses de abril a novembro de 2009 em dez escolas públicas municipais, previamente sorteadas e localizadas em oito bairros da cidade de Caxias. Avaliou-se por meio da aplicação de questionários fechados, o conhecimento dos estudantes sobre a Leishmaniose Visceral (LV), seu vetor e prevenção. Os resultados mostraram mudanças com maior percentual de acertos quanto às respostas sobre a transmissão da doença e quanto aos sintomas da LV no homem e no cão após as campanhas. Contudo, as campanhas educativas são necessárias como medidas para fortalecer a participação da população no combate à LV, pois antes do trabalho educativo a maioria dos estudantes disse que se prevenia da doença evitando contato com cães doentes, entretanto, após as campanhas os mesmos disseram evitar acúmulo de lixo. A pesquisa pode servir como subsídio para orientar novas ações educativas das equipes locais de controle da LV.

Variation in Aedes aegypti (Linnaeus) (Diptera, Culicidae) infestation in artificial containers in Caxias, state of Maranhão, Brazil

INTRODUCTION

Dengue is a serious public health problem worldwide, with cases reported annually in tropical and subtropical regions. Aedes aegypti (Linnaeus, 1762), the main vector of dengue, is a domiciliary species with high dispersal and survival capacities and can use various artificial containers as breeding sites. We assessed potential container breeding sites of A. aegypti in the municipality of Caxias, Maranhão, Brazil.

METHODS

In the initial phase, we analyzed 900 properties in 3 neighborhoods during the dry and rainy seasons (August-October 2005 and February-April 2006, respectively). During the second sampling period, September 2006-August 2007, we used 5 assessment cycles for 300 properties in a single neighborhood.

RESULTS

During the dry and rainy seasons, water-storage containers comprised 55.7% (n = 1,970) and 48.5% (n = 1,836) of the total containers inspected, and showed the highest productivity of immature A. aegypti; we found 23.7 and 106.1 individuals/container, respectively, in peridomicile sites. In intradomicile sites, water-storage containers were also the most important breeding sites with 86.4% (n = 973) and 85.6% (n = 900) of all containers and a mean of 7.9 and 108.3 individuals/container in the dry and rainy seaso-October 2006 (1,342). The highest number of positives (70) was recorded in May, mostly (94%) in storage containers.

CONCLUSIONS

Storage containers are the principal and most productive A. aegypti breeding sites and are a major contributing factor to the maintenance of this vector in Caxias.

Evaluation of students' knowledge as a contribution to dengue control programs

This study describes a survey (n=700) carried out in 14 elementary schools in the municipality of Caxias, State of Maranhão, Brazil. The survey was conducted between July and December 2007 in schools from seven neighborhoods on the outskirts of the western part of the municipality, where for the past three years high densities of immature Aedes aegypti mosquitoes have been recorded. The students' knowledge of dengue, its vector, and disease prevention was evaluated by targeted questionnaires. The students with the most comprehensive knowledge were found in schools in the Trizidela neighborhood, which has better social and urban conditions than the other neighborhoods. Moreover, educational campaigns are necessary to reinforce behavioral changes of the population, because the existence of breeding sites in the areas examined was mentioned, especially in the Tamarineiro neighborhood. The survey can be used to assist with new educational activities of local teams working with dengue control.