Clinical decision support systems for diabetic foot ulcers: a scoping review.

OBJECTIVE: Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. METHOD: A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. RESULTS: A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. CONCLUSION: Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.

Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis.

BACKGROUND: The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE: To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS: We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS: Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION: Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.

Relación entre indicadores de desarrollo social y mortalidad por Diabetes Mellitus en Brasil: análisis espacial y temporal / Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis / Relação indicadores de desenvolvimento social e mortalidade por diabetes mellitus no Brasil: análise espacial e temporal

Objetivo: identificar el patrón espacial y temporal de la mortalidad por Diabetes Mellitus en Brasil y su relación con los indicadores de desarrollo social. Método: estudio ecológico y de series temporales, a nivel nacional, con base en datos secundarios del Departamento de Informática del Sistema Único de Salud, con análisis espacial y temporal e inserción de indicadores en modelos de regresión no espacial y espacial. Se realizaron: cálculo de la tasa de mortalidad general; caracterización del perfil sociodemográfico y regional de las muertes mediante análisis descriptivo y temporal; y elaboración de mapas temáticos. Resultados: en Brasil se registraron 601.521 muertes relacionadas con la Diabetes Mellitus, lo que representa una mortalidad media de 29,5/100.000 habitantes. Los estados de Rio Grande do Norte, Paraíba, Pernambuco, Alagoas y Sergipe, Río de Janeiro, Paraná y Rio Grande do Sul presentaron conglomerados alto-alto. Mediante el uso de modelos de regresión, se comprobó que el índice de Gini (β=11,7) y la cobertura de la Estrategia Salud de la Familia (β=3,9) fueron los indicadores que más influyeron en la mortalidad por Diabetes Mellitus en Brasil. Conclusión: la mortalidad por diabetes en Brasil tiene una tendencia general alcista, está fuertemente asociada a los lugares con peores indicadores sociales.

Objective: to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators. Method: an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps. Results: a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (β=11.7) and the Family Health Strategy coverage (β=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil. Conclusion: in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators.

Objetivo: identificar o padrão espacial e temporal da mortalidade por diabetes mellitus, no Brasil, e sua relação com indicadores de desenvolvimento social. Método: estudo ecológico e de séries temporais, de abrangência nacional, com base em dados secundários do Departamento de Informática do Sistema Único de Saúde, com análise espacial e temporal e inserção de indicadores em modelos de regressão não espacial e espacial. Realizaram-se: cálculo da taxa de mortalidade geral; caracterização do perfil sociodemográfico e regional dos óbitos mediante análise descritiva e temporal; e construção de mapas temáticos. Resultados: foram registrados 601.521 óbitos relacionados ao diabetes mellitus no Brasil, representando mortalidade média de 29,5/100.000 habitantes. Os estados do Rio Grande do Norte, Paraíba, Pernambuco, Alagoas e Sergipe, Rio de Janeiro, Paraná e Rio Grande do Sul apresentaram aglomerados alto-alto. Por meio do uso de modelos de regressão, verificou-se que o índice Gini (β=11,7) e a cobertura da Estratégia de Saúde da Família (β=3,9) foram os indicadores que mais influenciaram a mortalidade por diabetes mellitus no Brasil. Conclusão: a mortalidade por diabetes, no Brasil, exibe tendência geral ascendente, revelando-se fortemente associada a locais com piores indicadores sociais.

Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis. / Relación entre indicadores de desarrollo social y mortalidad por Diabetes Mellitus en Brasil: análisis espacial y temporal.

OBJECTIVE: to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators. METHOD: an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps. RESULTS: a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (ß=11.7) and the Family Health Strategy coverage (ß=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil. CONCLUSION: in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators. HIGHLIGHTS: (1) The time-space pattern of mortality due to Diabetes presents an increasing trend. (2) The Northeast and South regions present high rates of mortality due to Diabetes. (3) Mortality due to Diabetes is associated with worse sociodemographic indicators. (4) A relationship is observed between income, access to health and mortality due to Diabetes.

Clinical decision support systems for diabetic foot ulcers: a scoping review / Sistemas de apoyo a decisiones clínicas para las úlceras del pie diabético: una revisión de alcance / Sistemas de apoio à decisão clínica em úlceras de pé diabético: revisão de escopo

ABSTRACT Objective: Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. Method: A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. Results: A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. Conclusion: Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.

RESUMEN Objetivo: Mapeo de la evidencia científica sobre el uso de sistemas de apoyo a la toma de decisiones clínicas en el cuidado del pie diabético. Método: Revisión de alcance basada en el Manual de Síntesis de la Evidencia del JBI y registrada en la plataforma Open Science Framework. Se realizaron búsquedas en fuentes primarias y secundarias sobre prototipos y herramientas informatizadas dirigidas a la asistencia de pacientes con pie diabético o en riesgo de padecerlo, publicadas en cualquier idioma o periodo, en once bases de datos y literatura gris. Resultados: Se identificaron 710 estudios y, tras cumplir los criterios de elegibilidad, se seleccionaron 23, que retrataban el uso de sistemas de apoyo a la toma de decisiones en el diagnóstico del pie diabético, la predicción del riesgo de úlceras y amputaciones, la clasificación del estadio de gravedad, la decisión sobre el plan de tratamiento y la evaluación de la eficacia de las intervenciones, mediante el procesamiento de datos relativos a la información clínica y sociodemográfica. Conclusión: Los sistemas expertos destacan por sus resultados satisfactorios, con gran precisión y sensibilidad a la hora de orientar y cualificar el proceso de toma de decisiones en la prevención y el cuidado del pie diabético.

RESUMO Objetivo: Mapear as evidências científicas sobre uso de Sistemas de Apoio à Decisão Clínica no pé diabético. Método: Revisão de escopo fundamentada no JBI Manual for Evidence Synthesis e registrada na plataforma Open Science Framework. Realizaram-se buscas, em fontes primárias e secundárias, sobre protótipos e ferramentas informatizadas direcionadas à assistência ao paciente com pé diabético ou em risco de tê-lo, publicados em qualquer idioma ou período, em onze bases de dados e literatura cinza. Resultados: Foram identificados 710 estudos e, após critérios de elegibilidade, foram selecionados 23 que retratam o uso de sistemas de apoio à decisão no rastreio do pé diabético, predição do risco de úlceras e amputações, classificação do estágio de gravidade, decisão quanto ao plano de tratamento e avaliação da efetividade das intervenções, por meio do processamento de dados referentes a informações clínicas e sociodemográficas. Conclusão: Os sistemas especialistas destacam-se por resultados satisfatórios, com alta precisão e sensibilidade no que tange à orientação e qualificação do processo de tomada de decisão na prevenção e no cuidado ao pé diabético.

Diabetes as a factor associated with hospital deaths due to COVID-19 in Brazil, 2020. / Diabetes como um fator associado ao óbito hospitalar por COVID-19 no Brasil, 2020.

OBJECTIVE: To analyze the association between diabetes mellitus and hospital deaths due to Covid-19 in Brazil, from February to August 2020. METHODS: This was a cross-sectional study on hospitalized flu-like syndrome cases, with a positive test result for COVID-19, reported on the Influenza Epidemiological Surveillance Information System. Poisson regression with robust variance was used to estimate the magnitude of the association between diabetes and deaths. RESULTS: Data from 397,600 hospitalized cases were analyzed, of which 32.0% (n = 127,231) died. The prevalence of death among people with diabetes was 40.8% (PR = 1.41; 95%CI 1.39;1.42). After adjustments for the variables sociodemographic and comorbidities, it could be seen that those with diabetes (95%CI 1.14;1.16) were 1.15 time more likely to die. CONCLUSION: 3 out of every 20 deaths due to COVID-19 occurred among individuals with diabetes mellitus, highlighting this population susceptibility and the need to control this chronic disease.

Spatial Distribution of Mortality for Heart Failure in Brazil, 1996 - 2017. / Distribuição Espacial de Mortalidade por Insuficiência Cardíaca no Brasil, 1996-2017.

BACKGROUND: Heart failure (HF) is a leading cause of mortality and morbidity worldwide, and is associated with the high use of resources and healthcare costs. In Brazil, the HF prevalence is around 2 million patients, and its incidence is of approximately 240,000 new cases per year. OBJECTIVE: The present investigation aimed to analyze the spatiotemporal trend of mortality caused by HF in Brazil, from 1996 to 2017. METHODS: This is an ecological study developed with secondary data on HF mortality in Brazil. During the period, 1,242,014 cases of death caused by heart failure were analyzed. The existence of spatial autocorrelation of cases was calculated using the Global Moran Index (GMI) and, when significant, the Local Moran Index, considering p<0.05. The relative risk of the clusters was calculated. RESULTS: The mortality rate due to HF was diversified in all Brazilian regions, with an emphasis in the South, Southeast, and Northeast. The GMI indicated positive spatial autocorrelation (p=0.01) in all periods. Municipalities located in the South, Southeast, Northeast, and Midwest showed a higher Relative Risk for mortality from HF, and most municipalities in the North were classified as a protective factor against this cause of death. CONCLUSIONS: The study showed a decline in mortality rates across the national territory. The highest concentration of mortality rates is in the North and Northeast regions, highlighting priority vulnerable areas in the planning and controlling strategies of health services.

FUNDAMENTO: Insuficiência cardíaca (IC) é uma das principais causas de mortalidade e morbidade no mundo, e está associada ao alto uso de recursos e custos com saúde. No Brasil, a prevalência de IC é de aproximadamente 2 milhões de pacientes, e sua incidência é de aproximadamente 240.000 novos casos por ano. OBJETIVO: A investigação objetivou analisar a tendência espaço-temporal da mortalidade causada por IC no Brasil, de 1996 a 2017. MÉTODOS: Este é um estudo ecológico desenvolvido com dados secundários sobre mortalidade por IC no Brasil. Durante o período, 1.242.014 casos de morte causada por IC foram analisados. A existência da autocorrelação espacial de casos foi calculada utilizando o Índice de Moran Global (IMG) e, quando significativo, o Índice de Moran Local, considerando p <0,05. O risco relativo dos grupos foi calculado. RESULTADOS: A taxa de mortalidade causada por IC foi diversificada em regiões brasileiras, com ênfase no sul, sudeste e nordeste. O IMG indicou autocorrelação espacial positiva (p=0,01) em todos os períodos. Cidades localizadas no sul, sudeste, nordeste e centro-oeste mostraram maior risco relativo para mortalidade causada por IC, e a maioria das cidades do norte foi classificada como um fator protetivo contra esta causa de morte. CONCLUSÕES: O estudo demonstrou declínio nas taxas de mortalidade no território nacional. A maior concentração de taxas de mortalidade está nas regiões norte e nordeste, enfatizando as áreas prioritárias de vulnerabilidade no planejamento e estratégias de controle de serviços de saúde.

Distribuição Espacial de Mortalidade por Insuficiência Cardíaca no Brasil, 1996-2017 / Spatial Distribution of Mortality for Heart Failure in Brazil, 1996 - 2017

Resumo Fundamento Insuficiência cardíaca (IC) é uma das principais causas de mortalidade e morbidade no mundo, e está associada ao alto uso de recursos e custos com saúde. No Brasil, a prevalência de IC é de aproximadamente 2 milhões de pacientes, e sua incidência é de aproximadamente 240.000 novos casos por ano. Objetivo A investigação objetivou analisar a tendência espaço-temporal da mortalidade causada por IC no Brasil, de 1996 a 2017. Métodos Este é um estudo ecológico desenvolvido com dados secundários sobre mortalidade por IC no Brasil. Durante o período, 1.242.014 casos de morte causada por IC foram analisados. A existência da autocorrelação espacial de casos foi calculada utilizando o Índice de Moran Global (IMG) e, quando significativo, o Índice de Moran Local, considerando p <0,05. O risco relativo dos grupos foi calculado. Resultados A taxa de mortalidade causada por IC foi diversificada em regiões brasileiras, com ênfase no sul, sudeste e nordeste. O IMG indicou autocorrelação espacial positiva (p=0,01) em todos os períodos. Cidades localizadas no sul, sudeste, nordeste e centro-oeste mostraram maior risco relativo para mortalidade causada por IC, e a maioria das cidades do norte foi classificada como um fator protetivo contra esta causa de morte. Conclusões O estudo demonstrou declínio nas taxas de mortalidade no território nacional. A maior concentração de taxas de mortalidade está nas regiões norte e nordeste, enfatizando as áreas prioritárias de vulnerabilidade no planejamento e estratégias de controle de serviços de saúde.

Abstract Background Heart failure (HF) is a leading cause of mortality and morbidity worldwide, and is associated with the high use of resources and healthcare costs. In Brazil, the HF prevalence is around 2 million patients, and its incidence is of approximately 240,000 new cases per year. Objective The present investigation aimed to analyze the spatiotemporal trend of mortality caused by HF in Brazil, from 1996 to 2017. Methods This is an ecological study developed with secondary data on HF mortality in Brazil. During the period, 1,242,014 cases of death caused by heart failure were analyzed. The existence of spatial autocorrelation of cases was calculated using the Global Moran Index (GMI) and, when significant, the Local Moran Index, considering p<0.05. The relative risk of the clusters was calculated. Results The mortality rate due to HF was diversified in all Brazilian regions, with an emphasis in the South, Southeast, and Northeast. The GMI indicated positive spatial autocorrelation (p=0.01) in all periods. Municipalities located in the South, Southeast, Northeast, and Midwest showed a higher Relative Risk for mortality from HF, and most municipalities in the North were classified as a protective factor against this cause of death. Conclusions The study showed a decline in mortality rates across the national territory. The highest concentration of mortality rates is in the North and Northeast regions, highlighting priority vulnerable areas in the planning and controlling strategies of health services.

Diabetes como um fator associado ao óbito hospitalar por COVID-19 no Brasil, 2020 / La diabetes como factor asociado a la muerte hospitalaria por COVID-19 en Brasil, 2020 / Diabetes as a factor associated with hospital deaths due to COVID-19 in Brazil, 2020

Objetivo: Analisar a associação entre diabetes mellitus e óbito hospitalar por COVID-19 no Brasil, de fevereiro a agosto de 2020. Métodos: Estudo transversal, sobre casos notificados como síndrome gripal no Sistema de Informação de Vigilância da Gripe, positivos para COVID-19 e hospitalizados. A magnitude da associação do diabetes com o óbito foi estimada por regressão de Poisson com variância robusta. Resultados: Foram analisados dados de 397.600 casos hospitalizados, dos quais 32,0% (n = 127.231) evoluíram a óbito. A prevalência de óbito entre pessoas com diabetes foi de 40,8% (RP = 1,41; IC95% 1,39;1,42). Após ajustes por variáveis sociodemográficas e comorbidades, observou-se que o óbito foi 1,15 vez mais frequente entre aqueles com diabetes (IC95% 1,14;1,16). Conclusão: 3 a cada 20 óbitos por COVID-19 ocorreram em indivíduos com diabetes mellitus, destacando-se a suscetibilidade dessa população e a necessidade de controle dessa doença crônica.

Objetivo: Analizar la asociación entre la diabetes mellitus y la muerte hospitalaria por COVID-19 en Brasil, de febrero a agosto de 2020. Métodos: Estudio transversal con casos notificados como síndrome gripal en el Sistema de Información de Vigilancia de Influenza, positivos para COVID-19 y hospitalizados. La magnitud de la asociación entre diabetes y muerte se estimó mediante la regresión de Poisson con varianza robusta. Resultados: Se analizaron datos de 397.600 casos hospitalizados, de los cuales 32,0% (n = 127.231) fallecieron. La prevalencia de muerte entre las personas con diabetes fue de 40,8% (RP = 1,41; IC95% 1,39;1,42). Después de ajustar por variables sociodemográficasy comorbilidades, se observó que la muerte era 1,15 vez más frecuente entre los diabéticos (IC95% 1,14;1,15). Conclusión: 3 de cada 20 muertes por COVID-19 ocurrieron en individuos con diabetes mellitus, destacando la susceptibilidad de esta población y la necesidad de control de esta enfermedad crónica.

Objective: To analyze the association between diabetes mellitus and hospital deaths due to Covid-19 in Brazil, from February to August 2020. Methods: This was a cross-sectional study on hospitalized flu-like syndrome cases, with a positive test result for COVID-19, reported on the Influenza Epidemiological Surveillance Information System. Poisson regression with robust variance was used to estimate the magnitude of the association between diabetes and deaths. Results: Data from 397,600 hospitalized cases were analyzed, of which 32.0% (n = 127,231) died. The prevalence of death among people with diabetes was 40.8% (PR = 1.41; 95%CI 1.39;1.42). After adjustments for the variables sociodemographic and comorbidities, it could be seen that those with diabetes (95%CI 1.14;1.16) were 1.15 time more likely to die. Conclusion: 3 out of every 20 deaths due to COVID-19 occurred among individuals with diabetes mellitus, highlighting this population susceptibility and the need to control this chronic disease.

Social vulnerability and COVID-19 incidence in a Brazilian metropolis. / Vulnerabilidade social e incidência de COVID-19 em uma metrópole brasileira.

Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (ß=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (ß=1.40), and maximum per capita household income of the poorest fifth (ß=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.

A vulnerabilidade é um fator chave no enfrentamento da COVID-19 tendo em vista que pode influenciar no agravamento da doença. Desse modo, ela deve ser considerada no controle da COVID-19, prevenção e promoção da saúde. O objetivo deste artigo é analisar a distribuição espacial da incidência de casos de COVID-19 em uma metrópole brasileira e sua associação com indicadores de vulnerabilidade social. Estudo ecológico. Foi utilizada a análise de varredura espacial (scan) para identificar aglomerados de COVID-19. As variáveis para identificação da vulnerabilidade foram inseridas em um modelo de Regressão Espacial Geograficamente Ponderado (GWR) para identificar sua relação espacial com os casos de COVID-19. A incidência de COVID-19 em Fortaleza foi de 74,52/10 mil habitantes, com notificação de 3.554 casos, sendo pelo menos um caso registrado em cada bairro. A regressão espacial GWR mostrou relação negativa entre incidência de COVID-19 e densidade demográfica (ß=-0,0002) e relação positiva entre incidência de COVID-19 e percentual de ocupados >18 anos trabalhadores autônomos (ß=1,40), assim como, renda domiciliar per capita máxima do quinto mais pobre (ß=0,04). A influência dos indicadores de vulnerabilidade sobre a incidência evidenciou áreas que podem ser alvo de políticas públicas a fim de impactar na incidência de COVID-19.

Vulnerabilidade social e incidência de COVID-19 em uma metrópole brasileira / Social vulnerability and COVID-19 incidence in a Brazilian metropolis

Resumo A vulnerabilidade é um fator chave no enfrentamento da COVID-19 tendo em vista que pode influenciar no agravamento da doença. Desse modo, ela deve ser considerada no controle da COVID-19, prevenção e promoção da saúde. O objetivo deste artigo é analisar a distribuição espacial da incidência de casos de COVID-19 em uma metrópole brasileira e sua associação com indicadores de vulnerabilidade social. Estudo ecológico. Foi utilizada a análise de varredura espacial (scan) para identificar aglomerados de COVID-19. As variáveis para identificação da vulnerabilidade foram inseridas em um modelo de Regressão Espacial Geograficamente Ponderado (GWR) para identificar sua relação espacial com os casos de COVID-19. A incidência de COVID-19 em Fortaleza foi de 74,52/10 mil habitantes, com notificação de 3.554 casos, sendo pelo menos um caso registrado em cada bairro. A regressão espacial GWR mostrou relação negativa entre incidência de COVID-19 e densidade demográfica (β=-0,0002) e relação positiva entre incidência de COVID-19 e percentual de ocupados >18 anos trabalhadores autônomos (β=1,40), assim como, renda domiciliar per capita máxima do quinto mais pobre (β=0,04). A influência dos indicadores de vulnerabilidade sobre a incidência evidenciou áreas que podem ser alvo de políticas públicas a fim de impactar na incidência de COVID-19.

Abstract Vulnerability is a crucial factor in addressing COVID-19 as it can aggravate the disease. Thus, it should be considered in COVID-19 control and health prevention and promotion. This ecological study aimed to analyze the spatial distribution of the incidence of COVID-19 cases in a Brazilian metropolis and its association with social vulnerability indicators. Spatial scan analysis was used to identify COVID-19 clusters. The variables for identifying the vulnerability were inserted in a Geographically Weighted Regression (GWR) model to identify their spatial relationship with COVID-19 cases. The incidence of COVID-19 in Fortaleza was 74.52/10,000 inhabitants, with 3,554 reported cases and at least one case registered in each neighborhood. The spatial GWR showed a negative relationship between the incidence of COVID-19 and demographic density (β=-0,0002) and a positive relationship between the incidence of COVID-19 and the percentage of self-employed >18 years (β=1.40), and maximum per capita household income of the poorest fifth (β=0.04). The influence of vulnerability indicators on incidence showed areas that can be the target of public policies to impact the incidence of COVID-19.

MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation.

OBJECTIVE: We tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI. METHODS: Patients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses. RESULTS: We recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval [CI] 1.1-7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6-20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66-0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62-7.4). CONCLUSION: Patients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke. CLINICALTRIALSGOV IDENTIFIER: NCT02238470.

Statins do not increase Markers of Cerebral Angiopathies in patients with Cardioembolic Stroke.

We investigated whether pre-treatment with statins is associated with surrogate markers of amyloid and hypertensive angiopathies in patients who need to start long-term oral anticoagulation therapy. A prospective multicenter study of patients naive for oral anticoagulants, who had an acute cardioembolic stroke. MRI was performed at admission to evaluate microbleeds, leukoaraiosis and superficial siderosis. We collected data on the specific statin compound, the dose and the statin intensity. We performed bivariate analyses and a logistic regression to investigate variables associated with microbleeds. We studied 470 patients (age 77.5 ± 6.4 years, 43.7% were men), and 193 (41.1%) of them received prior treatment with a statin. Microbleeds were detected in 140 (29.8%), leukoaraiosis in 388 (82.5%) and superficial siderosis in 20 (4.3%) patients. The presence of microbleeds, leukoaraiosis or superficial siderosis was not related to pre-treatment with statins. Microbleeds were more frequent in patients with prior intracerebral hemorrhage (OR 9.7, 95% CI 1.06-90.9) and in those pre-treated antiplatelets (OR 1.66, 95% CI 1.09-2.53). Prior treatment with statins was not associated with markers of bleeding-prone cerebral angiopathies in patients with cardioembolic stroke. Therefore, previous statin treatment should not influence the decision to initiate or withhold oral anticoagulation if these neuroimaging markers are detected.

Bacteria with Phosphate Solubilizing Capacity Alter Mycorrhizal Fungal Growth Both Inside and Outside the Root and in the Presence of Native Microbial Communities.

Arbuscular mycorrhizal fungi (AMF) and phosphate solubilizing Pseudomonas bacteria (PSB) could potentially interact synergistically because PSB solubilize phosphate into a form that AMF can absorb and transport to the plant. However, very little is known about the interactions between these two groups of microorganisms and how they influence the growth of each other. We tested whether different strains of bacteria, that have the capacity to solubilize phosphate, are able to grow along AMF hyphae and differentially influence the growth of AMF both outside the roots of carrot in in vitro conditions and inside the roots of potato in the presence of a microbial community. We found strong effects of AMF on the growth of the different bacterial strains. Different bacterial strains also had very strong effects on the growth of AMF extraradical hyphae outside the roots of carrot and on colonization of potato roots by AMF. The differential effects on colonization occurred in the presence of a microbial community. Our results show that these two important groups of rhizosphere microorganisms indeed interact with each other. Such interactions could potentially lead to synergistic effects between the two groups but this could depend on whether the bacteria truly solubilize phosphate in the rhizosphere in the presence of microbial communities.