Using machine learning to assess potential cases of transthyretin cardiac amyloidosis in Brazil: a retrospective database approach

INTRODUCTION: Amyloidosis is a group of protein misfolding disorders leading to organ damage due to insoluble amyloid fibril deposits • The two primary types of cardiac amyloidosis are light-chain amyloid (AL) and transthyretin (TTR) cardiac amyloidosis • TTR amyloidosis can be hereditary (hATTR) or age-related (wtATTR). It is an often-overlooked cause of heart failure in older adults • Recent studies reveal its prevalence in various patient groups: up to 13% in HFpEF, 16% in aortic stenosis patients undergoing valve replacement, 7-8% in carpal tunnel release surgery, and 17% in some other contexts • ATTR-CM is significant in the context of cardiovascular diseases, a leading global cause of death. OBJECTIVE: This study aimed to identify and describe the profile of potential transthyretin cardiac amyloidosis (ATTR-CM) cases in the Brazilian public health system (SUS), using a predictive machine learning (ML) model. MATERIALS AND METHODS: This was a retrospective descriptive database study that aimed to estimate the frequency of potential ATTR-CM cases in the Brazilian public health system (Figure 1) using a supervised machine learning (Figure 2) model, with data extracted from DATASUS outpatient and inpatient datasets from January 2015 to December 2021 • To build the model, a list of ICD-10 codes and procedures potentially related with ATTR-CM was created based on literature review and validated by experts (Figure 3). RESULTS: From 2015 to 2021, the ML model classified 262 hATTR-CM (213 reference hATTR-CIM and 49 hATTR-CM-like) and 1,581 wtATTR-CM (203 reference wtATTR-CM and 1,378 wtATTR-CM-like). Overall, the median age of hATTR-CM and wtATTR-CM patients was 66.8 and 59.9 years, respectively • The ICD-10 codes most presented as hATTR-CM and wtATTR-CM were related to heart failure and arrythmias, with similar procedures performed (Figure 4). Regarding healthcare utilization, hATTR-CM and hATTR-CM-like had similar profiles on proportion of patients with outpatient visits (hATTR-CM 98.0% vs. 92.0% hATTR-CM-like) and different profile related to proportion of hospitalized patients (hATTR-CM 94.4% vs. 32.7% hATTR-CM-like) (Figure 5) • In wtATTR-CM groups, although both proportions on outpatient visits and hospitalizations were similar, the length of stay (LOS) on hospitalizations was different in wtATTR-CM-like (wtATTR-CM median LOS 5.0 (IQR:2.0 - 10.0] vs. median LOS 7.0 [IQR:3.0 - 14.0]). CONCLUSIONS: Our findings may be useful to support decreasing the uncertainties on ATTR-CM population size in Health Technology Assessment appraisals and in the development of healthcare guidelines and policies to address patients' unmet needs and to improve early diagnosis and access to treatment for patients with ATTR-CM in Brazil This study puts a spotlight on the ATTR-CM underdiagnosis in Brazil using a machine learning approach, which can be used as an important tool to support diagnosis improvement.

Trends in Pneumococcal and Bacterial Meningitis in Brazil from 2007 to 2019.

The pneumococcal conjugate vaccination (PCV) was introduced into the Brazilian Childhood National Immunization Program in 2010; however, universal pneumococcal vaccination for older adults has not been implemented yet. Our aim is to evaluate the trends in pneumococcal meningitis incidence and case fatality rate (CFR) across all age groups from 2007 to 2019 using data from the National Surveillance System. The pre-PCV (2007-2009) and post-PCV (2011-2019) periods were compared; changes in incidence and CFR were assessed by joinpoint regression. Additional analyses of bacterial meningitis were performed to compare the patterns and trends. Over the 13-year period, 81,203 and 13,837 cases were classified as bacterial and pneumococcal meningitis, respectively. S. pneumoniae was the main etiological agent of bacterial meningitis in adults aged ≥50 years and the most lethal in all age groups. In the post-PCV period, a 56.5% reduction in the average incidence was seen in pneumococcal meningitis in the pediatric population. In contrast, there was an increasing trend among adults. The CFR for pneumococcal and bacterial meningitis remained stable in most age groups during the study period. These findings highlight the value of expanding pneumococcal vaccination policies, including vaccines that provide better indirect protection from children to adults and broadening vaccination to older adults.

Acesso equitativo a vacinas: lições aprendidas e perspectivas futuras / Equal access to vaccines: lessons learned and future perspectives

Resumo A vacinação é um componente essencial da atenção primária à saúde e do enfrentamento de emergências em saúde. No entanto, apesar do progresso ocorrido nas últimas décadas, persistem importantes barreiras que resultam na queda de coberturas e disparidades entre os países no acesso a novas vacinas. Neste cenário, a Organização Mundial da Saúde (OMS) lançou, em 2020, a Agenda de Imunização para o decênio 2021-2030 (AI2030). Este artigo tem o objetivo de debater os principais fatores que afetam o acesso às vacinas e as estratégias para promoção da equidade no acesso a elas a nível global e nacional. Tais fatores são multisetoriais e precisam ser considerados em ambos os níveis, destacando-se as barreiras financeiras e geográficas, os desafios de infraestrutura, fatores socioeconômicos e culturais, políticas públicas e governança. O texto aponta a necessidade de remodelação da arquitetura global das cadeias produtivas e dos centros de pesquisa e inovação, criando e/ou fortalecendo as existentes em países de baixa e média renda. Além disso, é necessário estabelecer novos mecanismos e modelos de produção e comercialização de vacinas. As estratégias adotadas para acesso a vacinas e outras tecnologias em saúde estão no centro do debate da agenda de saúde global.

Abstract Vaccination is an essential component of primary health care and coping with health emergencies. However, despite the progress from the last decades, important barriers persist resulting in lower access and disparities between the countries in the access to new vaccines. In this scenario, the World Health Organization (WHO) launched, in 2020, the Immunization Agenda for the 2021-2030 decade (AI2030). This article aims to discuss the main factors that affect access to vaccines and strategies to promote equity in access to them at global and national levels. These factors are multi-sectoral and need to be considered in both levels, with emphasis on financial and geographic barriers, infrastructure challenges, socioeconomic and cultural factors, public policies, and governance. The text points the need to remodel the global architecture of production chains and research and innovation centers, creating and/or strengthening existing ones in low- and middle-income countries. In addition, establishing new mechanisms and models for the production and commercialization of vaccines is necessary. The strategies adopted for accessing vaccines and other health technologies are at the center of the global health agenda debate.

Adverse events of COVID-19 vaccines in pregnant and postpartum women in Brazil: a cross-sectional study

Background By the fact that pregnant and postpartum women are currently using COVID-19 vaccines, ensure their safety is critical. So, more safety evidence is crucial to include this new technology to their vaccine’s calendar and to develop public policies regarding the support and training of Health Care Personnel. This study aims to describe the adverse events (AE) of COVID-19 vaccines in pregnant and postpartum women in the early stage of vaccination campaign in Brazil. Methods An observational cross-sectional study using data from the Brazilian surveillance information system to characterize the AE of COVID-19 vaccines (Sinovac/Butantan, Pfizer/BioNTech, AstraZeneca and Janssen) in Brazilian pregnant and postpartum women from April to August 2021. Frequency and incidence rate of AE for COVID-19 vaccines were assessed. Results 3,333 AE following immunization were reported for the study population. AE incidence was 309.4/100,000 doses (95% CI 297.23, 321.51). Within the vaccines available, Sinovac/Butantan had the lowest incidence (74.08/100,000 doses; 95% CI 63.47, 84.69). Systemic events were the most frequent notified (82.07%), followed by local (11.93%) and maternal (4.74%), being most of them classified as non-severe (90.65%). Conclusion Our results corroborate the recommendation of vaccination for these groups. Even though, further studies appraising a longer observation time are still needed to provide a broader safety aspect for the vaccines currently under use for this population.

Burden of herpes zoster among Brazilian adults: a hospital-based study / Carga da herpes zoster em adultos brasileiros: um estudo de base hospitalar

OBJECTIVE: To describe the clinical features of herpes zoster in adult patients treated at a large tertiary care hospital in Brazil over a 5-year period. METHODS: The medical records of suspected herpes zoster cases (based on ICD-10 codes) were identified for full review. Convenience sampling was used to select the medical records from a tertiary hospital in São Paulo. We collected data about co-existing medical conditions, medication use, herpes zoster-related clinical features and outcomes, and healthcare resource utilization. RESULTS: A total of 249 individuals whose first episode of herpes zoster occurred between 2010 and 2014 were included. The mean patient age was 55 years (range 18­96), and the majority were women (63.05%) and aged ≥ 50 years (63.86%). Medical comorbidities were reported in 92.77%, including diabetes (19.68%) and HIV infection (7.63%). Current/recent use of immunosuppressive agents was reported in 31.73%. A total of 65.86% of the patients were hospitalized: 102 patients (40.96%) were admitted for herpes zoster management, while 62 (24.90%) were already receiving inpatient care. The mean hospital length of stay was 16.60 days. One-third (34.14%) were managed as outpatients. Postherpetic neuralgia was reported as a complication in 18.07%. CONCLUSIONS: This retrospective descriptive study found a high frequency of herpes zoster episodes in older adults with comorbidities who sought medical care at a tertiary hospital. These results also underscore the importance of understanding the epidemiology of this disease and developing control strategies for these at-risk populations in Brazil.

OBJETIVO: Descrever as características clínicas do herpes zoster em pacientes adultos atendidos em um grande hospital terciário no Brasil por um período de cinco anos. METODOLOGIA: Os casos suspeitos de herpes zoster (com base nos códigos da CID-10) foram identificados para revisão completa dos prontuários. Foi realizada uma amostragem por conveniência para selecionar os prontuários de interesse em um hospital terciário em São Paulo. Foram coletadas informações de prontuários médicos sobre condições coexistentes, características clínicas e uso de medicamentos relacionados ao herpes zoster (como primeiro episódio ou episódio de herpes zoster recorrente) e uso de recursos de saúde. RESULTADOS: Entre 2010 e 2014, 249 indivíduos com um primeiro episódio de herpes zoster foram incluídos, com uma idade média de 55 anos (variando de 18 a 96 anos). A maioria era do sexo feminino (63,05%) e com idade ≥ 50 anos (63,86%). Comorbidades médicas foram relatadas em 92,77% dos pacientes, incluindo diabetes (19,68%) e infecção por HIV (7,63%); o uso atual / recente de agentes imunossupressores foi relatado em 31,73%. Hospitalização foi relatada em 65,86% dos casos; 102 pacientes (40,96%) foram admitidos para o tratamento do episódio de herpes zoster e 62 pacientes (24,90%) já estavam recebendo atendimento hospitalar. O tempo médio de permanência no hospital foi de 16,60 dias. Um terço (34,14%) de todos os casos foi tratado ambulatorialmente. A neuralgia pós-herpética foi relatada como complicação em 18,07% dos casos. CONCLUSÕES: Os resultados do presente estudo descritivo retrospectivo demonstram alta frequência de episódios de herpes zoster em idosos com comorbidades, buscando atendimento médico em um hospital terciário. Esses resultados também ressaltam a importância de entender a epidemiologia dessa doença e considerar as estratégias de controle nas populações de risco no Brasil.

COVID-19 in the city of Rio de Janeiro: spatial analysis of first confirmed cases and deaths. / COVID-19 no município do Rio de Janeiro: análise espacial da ocorrência dos primeiros casos e óbitos confirmados.

OBJECTIVE: to describe the spatial distribution of the first confirmed COVID-19 cases and deaths in Rio de Janeiro. METHODS: this was an ecological study of confirmed SARS-CoV-2 cases and deaths between March 6thand April 10th, 2020. Incidence, mortality, lethality, excess risk and global and local Moran rates were calculated. RESULTS: 1,808 confirmed cases and 92 confirmed deaths were recorded. The COVID-19 incidence rate was 26.8/100,000 inhab., the mortality rate was 1.36/100,000 inhab. and lethality rate 5%. The incidence rate in eight neighborhoods was 4-12 times higher than the overall rate for the municipality: Joá, in the city's Western Zone; Cosme Velho, Gávea, Ipanema, Jardim Botânico, Lagoa, Leblon and São Conrado, in its Southern Zone. CONCLUSION: high risk of COVID-19 infection and deaths was found in neighborhoods in the Southern Zone of the city of Rio de Janeiro. Neighborhoods in the Northern Zone of the city also stand out in relation to high risk of death.

Pertussis epidemiological pattern and disease burden in Brazil: an analysis of national public health surveillance data.

Objective: We described pertussis epidemiological trends in Brazil between 2010 and 2015. We also assessed tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women from 2014, the year of the introduction of Tdap maternal immunization recommendation in Brazil, to 2016.Methods: Epidemiological data for incidence, prevalence, hospitalization, mortality, and maternal vaccination coverage were calculated based on the Brazilian public surveillance databases.Results: The epidemiological data analysis results showed that the pertussis average incidence rate (IR) was 2.19/100,000 inhabitants for all ages, with a peak in 2014 (4.03/100,000 inhabitants) and highest incidence in <1-year-old children (IR = 175.20/100,000). 97.6% of pertussis deaths (405/415) were in <1-year-old children. Maternal immunization coverage was 9.2% in 2014, 40.4% in 2015, and 33.8% in 2016.Conclusions: Pertussis incidence and pertussis-related deaths increased in Brazil from 2010 to 2014 and decreased in 2015. In the two years, 2015 and 2016 that followed the NIP recommendation, Tdap vaccination coverage of pregnant women was low and varying from region to region. More efforts and national plans would help increase awareness and maternal immunization coverage.

COVID-19 no município do Rio de Janeiro: análise espacial da ocorrência dos primeiros casos e óbitos confirmados / COVID-19 en la ciudad de Rio de Janeiro: análisis espacial de la ocurrencia de los primeros casos y muertes confirmadas / COVID-19 in the city of Rio de Janeiro: spatial analysis of first confirmed cases and deaths

Resumo Objetivo descrever a distribuição espacial dos primeiros casos e óbitos confirmados de COVID-19 do Rio de Janeiro. Métodos estudo ecológico de casos e óbitos confirmados de SARS-CoV-2 entre 6 de março e 10 de abril de 2020. Calcularam-se as taxas de incidência, taxas de mortalidade, letalidade, excesso de risco e índices global e local de Moran. Resultados foram registrados 1.808 casos e 92 óbitos confirmados. A taxa de incidência de COVID-19 foi 26,8/100 mil hab., a taxa de mortalidade, 1,36/100 mil hab., e a letalidade, 5%. Oito bairros exibiram taxa de incidência de 4 a 12 vezes superior à do município: Joá, na Zona Oeste; Cosme Velho, Gávea, Ipanema, Jardim Botânico, Lagoa, Leblon e São Conrado, na Zona Sul. Conclusão observou-se alto risco de infecção e morte por COVID-19 em bairros da Zona Sul do município do Rio de Janeiro; bairros da Zona Norte também se destacam em relação ao alto risco de morte.(AU)

Resumen Objetivo describir la distribución espacial de los primeros casos y muertes confirmadas por COVID-19 en Rio de Janeiro. Métodos estudio ecológico de casos confirmados y muertes confirmadas de SARS-CoV-2 entre el 6 de marzo y el 10 de abril de 2020. Se calcularon las tasas de incidencia, mortalidad, letalidad, exceso de riesgo y los índices globales y locales de Moran. Resultados se registraron 1.808 casos y 92 muertes confirmadas. La tasa de incidencia de COVID-19 fue de 26.8, la mortalidad de 1.4 (ambos por cada 100,000 habitantes) y la letalidad de 5%. Ocho barrios tuvieron una tasa de incidencia de 4 a 12 veces mayor que la del municipio Joá, en la Zona Oeste; Cosme Velho, Gávea, Ipanema, Jardim Botânico, Lagoa, Leblon y São Conrado, en la Zona Sur. Conclusión los resultados del análisis describen alto riesgo de infección y muerte por COVID-19 en barrios de la Zona Sur de la ciudad de Rio de Janeiro. Los barrios de la Zona Norte también se destacan en relación al alto riesgo de muerte.(AU)

Abstract Objective to describe the spatial distribution of the first confirmed COVID-19 cases and deaths in Rio de Janeiro. Methods this was an ecological study of confirmed SARS-CoV-2 cases and deaths between March 6thand April 10th, 2020. Incidence, mortality, lethality, excess risk and global and local Moran rates were calculated. Results 1,808 confirmed cases and 92 confirmed deaths were recorded. The COVID-19 incidence rate was 26.8/100,000 inhab., the mortality rate was 1.36/100,000 inhab. and lethality rate 5%. The incidence rate in eight neighborhoods was 4-12 times higher than the overall rate for the municipality: Joá, in the city's Western Zone; Cosme Velho, Gávea, Ipanema, Jardim Botânico, Lagoa, Leblon and São Conrado, in its Southern Zone. Conclusion high risk of COVID-19 infection and deaths was found in neighborhoods in the Southern Zone of the city of Rio de Janeiro. Neighborhoods in the Northern Zone of the city also stand out in relation to high risk of death.(AU)