Análise espacial da taxa de detecção de casos suspeitos de síndrome congênita pelo vírus Zika, Maranhão, 2015 a 2018

RESUMO: Objetivo: Identificar padrões espaciais em casos de lactentes com alterações de crescimento e desenvolvimento relacionadas à infecção pelo vírus Zika e outras etiologias infecciosas (neste trabalho denominado de síndrome congênita pelo vírus Zika), notificados no Maranhão de 2015 a 2018 e sua relação com variáveis socioeconômicas e demográficas. Métodos: Estudo ecológico de casos suspeitos notificados de síndrome congênita pelo vírus Zika nos 217 municípios do Maranhão, Brasil. Calculou-se a autocorrelação espacial pelos índices de Moran local e global (I) univariado e bivariado da taxa de detecção de casos suspeitos de síndrome congênita pelo vírus Zika com índice de desenvolvimento humano municipal, densidade demográfica, índice de Gini e tempo de emancipação político-administrativa dos municípios. O índice de Moran local foi calculado para localizar clusters com autocorrelação espacial significativa. Resultados: Houve autocorrelação espacial na análise univariada da taxa municipal de detecção de casos suspeitos de síndrome congênita pelo vírus Zika (I=0,494; p=0,001) e, na análise bivariada, correlação positiva da taxa de detecção de casos suspeitos com índice de desenvolvimento humano municipal (I=0,252; p=0,001), densidade demográfica (I=0,338; p=0,001) e tempo de emancipação dos municípios (I=0,134; p=0,001). Não houve correlação significativa da taxa de detecção de casos suspeitos com o índice de Gini (I= -0,033; p=0,131). Cinco clusters de alta detecção de casos suspeitos foram encontrados em áreas distintas do estado. Conclusões: Os municípios com maior índice de desenvolvimento humano municipal, maior densidade demográfica e mais tempo de emancipação político-administrativa tiveram mais casos suspeitos notificados de síndrome congênita pelo vírus Zika.

Autoregressive spatial modeling of possible cases of dengue, chikungunya, and Zika in the capital of Northeastern Brazil

INTRODUCTION:

Dengue, chikungunya, and Zika are a growing global health problem. This study analyzed the spatial distribution of dengue, chikungunya, and Zika cases in São Luís, Maranhão, from 2015 to 2016 and investigated the association between socio-environmental and economic factors and hotspots for mosquito proliferation.

METHODS:

This was a socio-ecological study using data from the National Information System of Notifiable Diseases. The spatial units of analysis were census tracts. The incidence rates of the combined cases of the three diseases were calculated and smoothed using empirical local Bayes estimates. The spatial autocorrelation of the smoothed incidence rate was measured using Local Moran's I and Global Moran's I. Multiple linear regression and spatial autoregressive models were fitted using the log of the smoothed disease incidence rate as the dependent variable and socio-environmental factors, demographics, and mosquito hotspots as independent variables.

RESULTS:

The findings showed a significant spatial autocorrelation of the smoothed incidence rate. The model that best fit the data was the spatial lag model, revealing a positive association between disease incidence and the proportion of households with surrounding garbage accumulation.

CONCLUSIONS:

The distribution of dengue, chikungunya, and Zika cases showed a significant spatial pattern, in which the high-risk areas for the three diseases were explained by the variable "garbage accumulated in the surrounding environment,” demonstrating the need for an intersectoral approach for vector control and prevention that goes beyond health actions.

Spatial analysis of probable cases of dengue fever, chikungunya fever and zika virus infections in Maranhao State, Brazil

Dengue fever, chikungunya fever, and zika virus infections are increasing public health problems in the world, the last two diseases having recently emerged in Brazil. This ecological study employed spatial analysis of probable cases of dengue fever, chikungunya fever, and zika virus infections reported to the National Mandatory Reporting System (SINAN) in Maranhao State from 2015 to 2016. The software GeoDa version 1.10 was used for calculating global and local Moran indices. The global Moran index identified a significant autocorrelation of incidence rates of dengue (I=0.10; p=0.009) and zika (I=0.07; p=0.03). The study found a positive spatial correlation between dengue and the population density (I=0.31; p<0.001) and a negative correlation with the Performance Index of Unified Health System (PIUHS) by basic care coverage (I=-0.08; p=0.01). Regarding chikungunya fever, there were positive spatial correlations with the population density (I=0.06; p=0.03) and the Municipal Human Development Index (MHDI) (I=0.10; p=0.002), and a negative correlation with the Gini index (I=-0.01; p<0.001) and the PIUHS by basic care coverage (I=-0.18; p<0.001). Lastly, we found positive spatial correlations between Zika virus infections and the population density (I=0.13; p=0.005) and the MHDI (I=0.12; p<0.001), as well as a negative correlation with the Gini index (I=-0.11; p<0.001) and the PIUHS by basic care coverage (I=-0.05; p=0.03). Our results suggest that several socio-demographic factors influenced the occurrence of dengue fever, chikungunya fever, and zika virus infections in Maranhao State.

Musical auditory stimulus acutely influences heart rate dynamic responses to medication in subjects with well-controlled hypertension

Music can improve the efficiency of medical treatment when correctly associated with drug action, reducing risk factors involving deteriorating cardiac function. We evaluated the effect of musical auditory stimulus associated with anti-hypertensive medication on heart rate (HR) autonomic control in hypertensive subjects. We evaluated 37 well-controlled hypertensive patients designated for anti-hypertensive medication. Heart rate variability (HRV) was calculated from the HR monitor recordings of two different, randomly sorted protocols (control and music) on two separate days. Patients were examined in a resting condition 10 minutes before medication and 20 minutes, 40 minutes and 60 minutes after oral medication. Music was played throughout the 60 minutes after medication with the same intensity for all subjects in the music protocol. We noted analogous response of systolic and diastolic arterial pressure in both protocols. HR decreased 60 minutes after medication in the music protocol while it remained unchanged in the control protocol. The effects of anti-hypertensive medication on SDNN (Standard deviation of all normal RR intervals), LF (low frequency, nu), HF (high frequency, nu) and alpha-1 scale were more intense in the music protocol. In conclusion, musical auditory stimulus increased HR autonomic responses to anti-hypertensive medication in well-controlled hypertensive subjects.

Analysis of dengue cases according to clinical severity, São Luís, Maranhão, Brazil

Severe dengue cases have increased in Brazil since 2001, with the first records in Maranhão dating back to 2002. The aim of this study was to determine the prevalence of severe dengue cases by age group and the possible risk factors. This was a study of secondary data on dengue in residents of São Luís, Maranhão, Brazil, using probable cases notified to the National Mandatory Reporting System (SINAN) from 2002 to 2011. The diagnosis and classification of dengue were based on the Brazilian Ministry of Health criteria: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue fever with complications (DWC). DHF and DWC were considered severe dengue, and DF was classified as non-severe dengue. A logistic regression analysis was performed with severe dengue as the outcome. During the study period, 1,229 cases of severe dengue were reported; of these, 812 in patients under the age of 15 (66%). Among the risk factors evaluated, age under 15 years old (OR = 3.10, 95% CI = 2.69-3.57, p-value = 0.001) was associated with severe dengue. The prevalence of severe dengue in children under the age of 15 was higher, and only this age group was associated with the occurrence of severe dengue.

Spatial-temporal analysis of dengue deaths: identifying social vulnerabilities

INTRODUCTION

Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito.

METHODS:

This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level.

RESULTS:

There were 74 deaths, concentrated in areas of social vulnerability.

CONCLUSIONS:

The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

Description of the first cases of Zika virus fever investigated in municipalities of the Brazilian Northeastern Region, 2015

OBJECTIVE

to confirm Zika virus circulation and discard other etiological agents in an outbreak occurred in the states of Rio Grande do Norte, Maranhão and Paraíba, in May, 2015.

METHODS

this is a case series descriptive study with residents in Natal-RN, Barra do Corda-MA, São Luis-MA and João Pessoa-PB, with 20 cases in each state, presenting rash, absent or mild fever and one of the following signs/symptoms: conjunctival hyperemia, arthralgia or limb edema; RT-PCR/isolation tests for Zika, enterovirus and respiratory viruses, and serology tests (dengue, rubella and parvovirus B19) were performed.

RESULTS

the main symptoms were rash (n=60), pruritus (n=54), and arthralgia (n=47); 51 individuals did not present fever; Zika virus was identified in 18 cases (12 in Paraíba, four in Maranhão and two in Rio Grande do Norte), and antibodies to dengue, in 14 cases.

CONCLUSION

the symptoms were consistent with Zika virus fever; there was laboratory confirmation for Zika and dengue.

Risk factors associated with death in Brazilian children with severe dengue: a case-control study

OBJECTIVE

The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue.

METHODS

The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue.

RESULTS

Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death.

CONCLUSIONS

The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.