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Sandes ILL, Almeida IB, Menezes-Silva L, Bomfim LGS, Gomes IA, Dos Santos PL, Oliveira PD, Dos Santos MRV, Quintans-Júnior LJ, Martins-Filho PR, de Souza Araujo AA, Nunes PS, de Moura TR. Evaluation of serum levels of soluble triggering receptor expressed on myeloid cells-1 in patients with vitiligo using Luminex-based assay. Arch Dermatol Res 2023; 315:2951-2954. [PMID: 37620587 DOI: 10.1007/s00403-023-02716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/05/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Isis Lustosa Lacrose Sandes
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
| | - Isabella Barros Almeida
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
| | - Lucas Menezes-Silva
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
| | - Lays Gisele Santos Bomfim
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
| | - Isla Alcântara Gomes
- Pharmaceutical Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Priscila Lima Dos Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
| | - Pedro Dantas Oliveira
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
| | | | - Lucindo José Quintans-Júnior
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
- Pharmaceutical Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, SE, Brazil
- Laboratory of Neuroscience and Pharmacological Assays, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Paulo Ricardo Martins-Filho
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, SE, Brazil
| | - Adriano Antunes de Souza Araujo
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
- Pharmaceutical Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, SE, Brazil
- Laboratory of Pharmaceutical Assays and Toxicity, Federal University of Sergipe, São Cristóvão, SE, Brazil
| | - Paula Santos Nunes
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil.
- Laboratory of Pharmaceutical Assays and Toxicity, Federal University of Sergipe, São Cristóvão, SE, Brazil.
| | - Tatiana Rodrigues de Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Cláudio Batista St, S/N, Aracaju, SE, 49060-100, Brazil
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Rocha Da Silva R, de Santana Fontes Vasconcelos F, Nunes de Santana Campos R, Dos Santos Tavares D, Lima Dos Santos P. Matrix metalloproteinases -2 and -9 expression in dogs with visceral leishmaniasis: A systematic review. Cytokine 2023; 168:156236. [PMID: 37257306 DOI: 10.1016/j.cyto.2023.156236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/06/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
The matrix metalloproteinases (MMPs) are engaged in the degradation and remodeling of the extracellular matrix and vessels, allowing the progression of pathological processes. Recent studies pointed that MMP -2 and -9 are promising visceral leishmaniasis biomarkers. Thus, the present studystudy aimed to review published scientific literature related to MMP-2 and -9 activity on canine visceral leishmaniasis (CVL). The review followed the PRISMA method, searching for articles in ScienceDirect, PubMed, Scopus, Lilacs, Medline and Google Scholar from inception until 20 March 2022 by employing the following terms: "dog", "matrix metalloproteinases" and "Visceral Leishmaniasis" or "Kala Azar". The selected articles were read in full and only those consistent with the eligibility criteria were included in the review. Of 238 articles from the initial search, only five were deemed eligible, which were conducted between 2010 and 2018. All studies were performed in Brazil. It was observed that there was a higher expression of proMMP-2 in cerebrospinal (CS) fluid and serum and active MMP-2 in different skin areas, mainly in high parasite load areas. As for MMP-9, the pro and active forms were both expressed in CS fluid, serum and different skin areas. The MMP-2 can be considered a biomarker of bad prognostic as it plays an inflammatory role with a greater release in the initial phase of the disease, where MMP-9 is perceived in the chronic phase of CVL. Future research on the subject with greater methodological rigor and bigger sample sizes are mandatory to clarify the role of MMPs on disease progression.
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Affiliation(s)
- Renata Rocha Da Silva
- Universidade Federal de Sergipe, Programa de Pós-graduação Stricto Sensu em Ciências da Saúde, Aracaju, Sergipe, Brasil.
| | | | - Roseane Nunes de Santana Campos
- Universidade Federal de Sergipe, Programa de Pós-graduação Stricto Sensu em Ciências Aplicadas a Saúde,Lagarto, Sergipe, Brasil; Universidade Federal de Sergipe, Núcleo de Medicina Veterinária, Nossa Senhora da Glória, Sergipe, Brasil.
| | | | - Priscila Lima Dos Santos
- Universidade Federal de Sergipe, Programa de Pós-graduação Stricto Sensu em Ciências da Saúde, Aracaju, Sergipe, Brasil; Universidade Federal de Sergipe, Programa de Pós-graduação Stricto Sensu em Ciências Aplicadas a Saúde,Lagarto, Sergipe, Brasil; Universidade Federal de Sergipe Departamento de Educação em Saúde, Lagarto, Sergipe, Brasil.
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3
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de Oliveira Rekowsky LL, de Oliveira DT, Cazzaniga RA, Magalhães LS, Albuquerque LF, Araujo JMS, Tenório MDL, Machado TC, Lipscomb MW, Dos Santos PL, Ribeiro de Jesus A, Bezerra-Santos M, da Silva RLL. Influence of Testosterone in Neglected Tropical Diseases: Clinical Aspects in Leprosy and In Vitro Experiments in Leishmaniasis. Trop Med Infect Dis 2023; 8:357. [PMID: 37505653 PMCID: PMC10385189 DOI: 10.3390/tropicalmed8070357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
Neglected tropical diseases encompass a group of chronic and debilitating infectious diseases that primarily affect marginalized populations. Among these diseases, leprosy and leishmaniasis are endemic in numerous countries and can result in severe and disfiguring manifestations. Although there have been reports indicating a higher incidence of leprosy and leishmaniasis in males, the underlying factors contributing to this observation remain unclear. Therefore, the objective of this study was to examine both clinical and experimental evidence regarding the role of testosterone in leprosy and leishmaniasis. A prospective clinical study was conducted to compare the clinical forms of leprosy and assess circulating testosterone levels. Additionally, the impact of testosterone on Leishmania amazonensis-infected macrophages was evaluated in vitro. The findings demonstrated that serum testosterone levels were higher in women with leprosy than in the control group, irrespective of the multi- or pauci-bacillary form of the disease. However, no differences in testosterone levels were observed in men when comparing leprosy patients and controls. Interestingly, increasing doses of testosterone in macrophages infected with L. amazonensis resulted in a higher proportion of infected cells, decreased CD40 expression on the cell surface, elevated expression of SOCS1, and decreased expression of IRF5. These findings provide biological evidence to support the influence of testosterone on intracellular infections, though the interpretation of clinical evidence remains limited.
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Affiliation(s)
- Laís Lima de Oliveira Rekowsky
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Posgraduate Program of Health Science, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Daniela Teles de Oliveira
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Rodrigo Anselmo Cazzaniga
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Lucas Sousa Magalhães
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Posgraduate Program of Health Science, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Lenise Franco Albuquerque
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Dermatology Division of Medical Hospital, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Jonnia Maria Sherlock Araujo
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Dermatology Division of Medical Hospital, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Martha Débora Lira Tenório
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Dermatology Division of Medical Hospital, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Tiziane Cotta Machado
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Michael W Lipscomb
- Department of Pharmacology, Center for Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Priscila Lima Dos Santos
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Posgraduate Program of Health Science, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Amelia Ribeiro de Jesus
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Posgraduate Program of Health Science, Federal University of Sergipe, Aracaju 49060676, Brazil
- Instituto de Investigação em Imunologia (iii), Institutos Nacionais de Ciência e Tecnologia (INCT), CNPq, São Paulo 05403-900, Brazil
| | - Márcio Bezerra-Santos
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Posgraduate Program of Health Science, Federal University of Sergipe, Aracaju 49060676, Brazil
| | - Ricardo Luís Louzada da Silva
- Laboratory of Immunology and Molecular Biology, Federal University of Sergipe, Aracaju 49060676, Brazil
- Health Education Department, Federal University of Sergipe, Lagarto 49400000, Brazil
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Tavares DDS, Santos PLD, Bezerra Santos M, Oliveira DCDRRD, Pereira NEB. Association of socioeconomic status and oral cancer mortality in Brazil: temporal trends and spatial distribution. Med Princ Pract 2023:000529155. [PMID: 36646048 DOI: 10.1159/000529155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
The objective of this observational study was to evaluate the relationship between the oral cancer mortality rate and socioeconomic indicators throughout the Brazilian territory, between 2010 and 2019. The variables used in this study were oral cancer mortality rate from the Mortality Information System (SIM), population data from the Brazilian Institute of Geography and Statistics (IBGE), to calculate oral cancer mortality rates, along with the Human Development Index (HDI) and Social Vulnerability Index (SVI). The analysis was performed in tertile stratifications (Microsoft Excel 16.0), while temporal trends were examined by segmented linear regression (JoinPoint 4.9.0). High mortality rates were observed in more developed regions (South and Southeast), whereas temporal analysis showed significant increasing trends in the North (APC=+3.9%; p<0.05) and Northeast (APC=+2.4%; p<0.05) regions. The greater HDI (APC=+1.7%; p<0.05) and SVI (APC=+2.2%; p<0.05) tertiles had the lowest annual percentage increase, showing an inverse relationship between the temporal trend of mortality and socioeconomic indicators. Despite the higher number of oral cancer deaths located in regions with higher social indices, increasing temporal trends are more accentuated in regions with lower socioeconomic levels.
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Melo MBG, Cunha LCS, Barreto CSP, de Oliveira Mendonça FA, Santos MLB, Sacramento D, de Jesus AR, Almeida RP, Dos Santos PL. Leishmania infantum (syn. L. chagasi) parasites affect the release of soluble CD14 by infected macrophages. Parasitol Res 2021; 120:3325-3330. [PMID: 34351491 DOI: 10.1007/s00436-021-07258-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
Functionally, cluster of differentiation 14 (CD14) is a co-receptor of the complex formed by lipopolysaccharide (LPS) and LPS-binding protein expressed on the membrane of a variety of cells. However, CD14 can be shed from the cell membrane into the circulation as soluble CD14 (sCD14) upon cell activation. Previously, our group reported that elevated sCD14 serum levels were associated with the clinical and laboratory findings in the context of visceral leishmaniasis (VL), but not in the context of LPS stimulation or bacterial infection. In the present study, we investigated the secretion dynamics of sCD14 in the context of Leishmania infantum (syn. L. chagasi) in vitro infection. Macrophages from treated VL patients and delayed-type hypersensitivity positive (DTH+) subjects were infected with L. infantum (syn. L. chagasi) promastigotes, and the infection index was evaluated (number of amastigotes per 100 infected macrophages). Additionally, the levels of sCD14, Inteleukin (IL)10, IL-6 and tumour necrosis factor alpha (TNF-α) were measured in the culture supernatants using the Luminex assay. Interestingly, the release of sCD14 was inversely correlated with the L. infantum (syn. L. chagasi) infection index. Of note, the release of sCD14 was upregulated and downregulated in the context of infected macrophages from DTH+ subjects and treated VL patients, respectively. Additionally, we also observed that the levels of sCD14 in the culture supernatants were positively correlated with the levels of TNF-α, IL-6 and IL-10. Therefore, our data suggest that macrophages from treated VL patients and DTH+ subjects respond differently to L. infantum (syn. L. chagasi) infection in the context of the release of sCD14; therefore, the release of sCD14 may be associated with the outcome of VL.
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Affiliation(s)
- Michelle Barreto Gomes Melo
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Luana Celina Seraphim Cunha
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Cárcia Santana Passos Barreto
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | | | - Micheli Luize Barbosa Santos
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Danielle Sacramento
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil
| | - Amélia Ribeiro de Jesus
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil.,Instituto de Investigação Em Imunologia, 05403-900, São Paulo, São Paulo, Brasil
| | - Roque Pacheco Almeida
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil.,Instituto de Investigação Em Imunologia, 05403-900, São Paulo, São Paulo, Brasil
| | - Priscila Lima Dos Santos
- Programa de Pós-Graduação Em Ciências da Saúde, Universidade Federal de Sergipe, 49060-100, Aracaju, Sergipe, Brasil.
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Magalhães LS, Bomfim LGS, Santos CNO, Dos Santos PL, Tanajura DM, Lipscomb MW, de Jesus AR, de Almeida RP, de Moura TR. Antimony resistance associated with persistence of Leishmania (Leishmania) infantum infection in macrophages. Parasitol Res 2021; 120:2959-2964. [PMID: 34272999 DOI: 10.1007/s00436-021-07231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Visceral leishmaniasis is a severe disease caused by protozoan parasites that include Leishmania (L.) infantum. The disease is established when parasites subvert the immune response of the host. Notably, chemotherapy-based use of antimonial compounds can partially alleviate disease burden. Unfortunately, the resistance to drug treatments is increasing in areas endemic to the disease. In this report, we investigated immune responses within macrophages infected with antimony-resistant L. infantum isolates from patients with a relapse in the disease. Results revealed that antimony-resistant parasites persist in the first 24 h of infection. Activation of macrophage or blocking of thiol production during infection shows enhanced clearance of parasites, which is coordinately associated with increased production of pro-inflammatory cytokines. Taken together, these results suggest that the mechanism of antimony resistance in L. infantum isolates may be related to a decrease in macrophage microbicidal functions.
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Affiliation(s)
- Lucas Sousa Magalhães
- Laboratory of Molecular Biology and Immunology, Federal University of Sergipe, Aracaju, Brazil
| | | | | | - Priscila Lima Dos Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil.,Department of Health Education, Federal University of Sergipe, Lagarto, Brazil
| | | | | | - Amélia Ribeiro de Jesus
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil.,Instituto de Investigação Em Imunologia, São Paulo, Brazil
| | - Roque Pacheco de Almeida
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil.,Instituto de Investigação Em Imunologia, São Paulo, Brazil
| | - Tatiana Rodrigues de Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil. .,Department of Morphology, Federal University of Sergipe, São Cristóvão, Brazil.
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Almeida ÂS, Ribeiro CJN, Carlini CC, Santos RS, Dos Santos AD, Tavares DS, De Araújo KCGM, Moura TRD, Santos PLD. Spatial and spatiotemporal dynamics of visceral leishmaniasis in an endemic North-eastern region of Brazil. Geospat Health 2021; 15. [PMID: 33461273 DOI: 10.4081/gh.2020.885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/02/2020] [Indexed: 06/12/2023]
Abstract
Visceral Leishmaniasis (VL) is a neglected disease with increasing incidence in Brazil, particularly in the North-eastern. The aim of this study was to analyze the spatial and spatiotemporal dynamics of VL in an endemic region of North-eastern Brazil, between 2009 and 2017. Using spatial analysis techniques, an ecological and time series study was made regarding VL cases in Sergipe filed as notifiable disease events. With data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), a digital population and cartographic baseline was established. Segmented linear regression was used to examine the temporal trends. The statistical analysis methods of Global and Local Moran' I, local Bayesian empirical methodology and spatial-temporal scanning were used to produce thematic maps. High instances were found among adults, males, urban residents, non-Whites and persons with low levels of education. A decrease in the recovery rate and an increase in the proportion of urban cases and lethality was found. A heterogeneous VL distribution with spatiotemporal agglomeration on the seaside of the state was seen in Sergipe. To better manage the disease, new research is encouraged together with development of public health strategies. Further, improving health care networks, especially primary care, is suggested as this approach has a key role in health promotion, prevention and monitoring of the most prevalent diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Tatiana Rodrigues de Moura
- Postgraduate in Health Sciences, Federal University of Sergipe, São Cristóvão; Department of Pharmacy, Federal University of Sergipe, Lagarto.
| | - Priscila Lima Dos Santos
- Postgraduate in Applied Health Sciences, Federal University of Sergipe, Lagarto; Postgraduate in Health Sciences, Federal University of Sergipe, São Cristóvão; Department of Health Education, Federal University of Sergipe, Lagarto, Sergipe.
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Silva RRD, Santos MBD, Santos ADD, Tavares DDS, Santos PLD. Coronavirus disease and basic sanitation: too early to be worried? Rev Soc Bras Med Trop 2020; 53:e20200345. [PMID: 32696810 PMCID: PMC7375797 DOI: 10.1590/0037-8682-0345-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/03/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION: Considering that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in feces, this study aimed to verify a possible relationship between basic sanitation indices and coronavirus disease (COVID-19) numbers/rates. METHODS: Data of COVID-19 cases registered in Brazil until May 28, 2020, and independent variables associated with basic sanitation were analyzed. RESULTS: A significant correlation between the number of cases and sewage treatment index/population density was observed. In addition, COVID-19 incidence and mortality rates were significantly associated with the total water service index and lethality rate was significantly associated with the sewage treatment index. CONCLUSIONS: Precarious basic sanitation infrastructure may potentially increase the SARS-CoV-2 transmission in Brazil.
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Affiliation(s)
- Renata Rocha da Silva
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brasil
| | | | | | | | - Priscila Lima Dos Santos
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Brasil
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