Seasonal Variation of Congenital Diaphragmatic Hernia: A Review of the Literature and Database Report from the United States and Canada.

INTRODUCTION: The etiology of congenital diaphragmatic hernia (CDH) remains unknown and only 10 to 30% of patients have a genetic cause. Seasonal variation is known to contribute to the development of some congenital anomalies. Our aim was to investigate whether CDH births have seasonal variation. MATERIALS AND METHODS: A literature review was conducted for CDH and seasonality. Moreover, data from the CDH International Patient Registry Database were collected for infants with due dates between 2008 and 2014. Due dates were used to determine seasonal distribution of births. Birth rates per month in the United States and Canada were extracted from publicly available databases. Data were analyzed using analysis of variance and contingency tables. RESULTS: First, the literature review revealed 11 articles, of which 3 were eligible for inclusion. These studies reported conflicting results on seasonality of CDH. Second, we extracted due dates from the CDH International Patient Registry Database (1,259 patients) and found that there were fewer due dates in winter months (12.1 ± 4 patients/month) than in summer (16.7 ± 6 patients/month; p = 0.011) and fall months (16.3 ± 5 patients/month; p = 0.022). Although this trend was similar to that of all births in the United States and Canada, a lower incidence was observed in winter for CDH infants (20.2%) than for the general population (24.1%, p = 0.0012). CDH survival rate did not vary by season. CONCLUSION: This study provides evidence for a seasonal variation of CDH births. No causative link was established between CDH development and seasonality. Population-based studies with a focus on exposome data are needed to explain seasonal variation in CDH.

The COVID-19 infodemic in Brazil: trends in Google search data.

Background: Since the beginning of the new coronavirus pandemic, there has been much information about the disease and the virus has been in the spotlight, shared and commented upon on the Internet. However, much of this information is infodemics and can interfere with the advancement of the disease and that way that populations act. Thus, Brazil is a country that requires attention, as despite the fact that in almost two years of pandemic it has shown a devastating numbers of deaths and number of cases, and generates false, distorted and malicious news about the pandemic. This work intends to understand the attitudes of the Brazilian population using infodemic queries from the Google Trends search tool and social and income variables. Methods: Data from infodemic research carried out on Google Trends, between January 1, 2020 and June 30, 2021, with socioeconomic data, such as income and education, were unified in a single database: standardization and exploratory and multivalued techniques based on grouping were used in the study. Results: In the analysis of the search trend of infodemic terms, it is clear that the categories of Prevention and Beliefs should stand out in Brazil, where there is a diverse culture. It is followed by the COVID-19 Treatment category, with treatments that were not those recommended by the authorities. Income transfer programs and information on socioeconomic variables did not have much impact on infodemic surveys, but it was observed that states where President Bolsonaro has more supporters had researched more infodemic information. Conclusions: In a country as geographically large as Brazil, it is important that political authorities go to great lengths to disseminate reliable information and monitor the infodemic in the media and on the internet. It was concluded that the denial of the pandemic and the influence of political leaders influenced the search for infodemic information, contributing to a disorganization in the control of the disease and prevention measures.

An Analysis of the Deleterious Impact of the Infodemic during the COVID-19 Pandemic in Brazil: A Case Study Considering Possible Correlations with Socioeconomic Aspects of Brazilian Demography.

Due to COVID-19, a huge amount of incorrect information has been disseminated on the internet, which may interfere with the disease's advance. This study analyzes the behavior of the Brazilian population during the pandemic, employing queries of infodemic data searched on Google Trends and relating them to socioeconomic and political indicators in the country. The z-score technique was used to standardize the data; and for multivalued analysis, dendrograms and the Elbow method detected similar patterns among Brazilian states. The result was divided into three analyses. In the analysis of the research trend of infodemic terms, the themes "Prevention and Beliefs" and "Treatment" prevailed. In the exploratory analysis, socioeconomic indicators related to income and education, as well as government programs, showed no impact on infodemic searches; but the results suggest that the states that supported the Brazilian president in the 2018 election, where he obtained more than 50% of the votes, were the states that most searched for infodemic terms: a total of 46.58% more infodemic searches than in the other states. In the multivalued analysis, the socioeconomic indicators used showed similarities in the patterns, highlighting a cluster containing 77% of all Brazilian states. The study concludes that denial about the pandemic and the influence of political leadership can influence infodemic information searches, contributing to a disorganization in the control of disease control and prevention measures.

COVID-19 Mortality Underreporting in Brazil: Analysis of Data From Government Internet Portals.

BACKGROUND: In Brazil, a substantial number of coronavirus disease (COVID-19) cases and deaths have been reported. It has become the second most affected country worldwide, as of June 9, 2020. Official Brazilian government sources present contradictory data on the impact of the disease; thus, it is possible that the actual number of infected individuals and deaths in Brazil is far larger than those officially reported. It is very likely that the actual spread of the disease has been underestimated. OBJECTIVE: This study investigates the underreporting of cases and deaths related to COVID-19 in the most affected cities in Brazil, based on public data available from official Brazilian government internet portals, to identify the actual impact of the pandemic. METHODS: We used data from historical deaths due to respiratory problems and other natural causes from two public portals: DATASUS (Department of Informatics of the Unified Healthcare System) (2010-2018) and the Brazilian Transparency Portal of Civil Registry (2019-2020). These data were used to build time-series models (modular regressions) to predict the expected mortality patterns for 2020. The forecasts were used to estimate the possible number of deaths that were incorrectly registered during the pandemic and posted on government internet portals in the most affected cities in the country. RESULTS: Our model found a significant difference between the real and expected values. The number of deaths due to severe acute respiratory syndrome (SARS) was considerably higher in all cities, with increases between 493% and 5820%. This sudden increase may be associated with errors in reporting. An average underreporting of 40.68% (range 25.9%-62.7%) is estimated for COVID-19-related deaths. CONCLUSIONS: The significant rates of underreporting of deaths analyzed in our study demonstrate that officially released numbers are much lower than actual numbers, making it impossible for the authorities to implement a more effective pandemic response. Based on analyses carried out using different fatality rates, it can be inferred that Brazil's epidemic is worsening, and the actual number of infectees could already be between 1 to 5.4 million.

Global P wave duration on the 65-lead ECG: single-site and dual-site pacing in the structurally normal human atrium.

INTRODUCTION: Pacing is believed to prevent atrial fibrillation by reducing atrial activation time. Exact correlation between P wave duration (PWD) on surface ECG and endocardial atrial activation time is still unexplored. METHODS AND RESULTS: In 15 patients without structural heart disease (9 women, age 45 +/- 14 years), single site [high right atrium (HRA), coronary sinus ostium (CSos), distal CS (CSd), high RA septum (Bachmann's bundle, BB)] and dual-site pacing (various combinations) was performed after ablation of supraventricular tachycardia. A 65-lead surface ECG was recorded simultaneously. Endocardial atrial activation time was measured off-line (stimulus - last bipolar recording), and the respective PWD was assessed using the root mean square and 65-channel summary plots. PWD during pacing from BB was significantly shorter (96 +/- 12 msec) than during HRA (121 +/- 15 msec), CSos (108 +/- 9 msec), and CSd pacing (126 +/- 14 msec; P < 0,01, respectively). PWD during dual-site pacing (HRA+BB, 91 +/- 14 msec; HRA+CSos, 96 +/- 7 msec; HRA+CSd, 90 +/- 7 msec; BB+CSd, 96 +/- 12 msec) was not significantly shorter than during pacing from BB. Correlation between endocardial atrial activation time and PWD was 0.83. CONCLUSION: PWD during single-site and dual-site atrial pacing represents endocardial atrial activation time and can be measured precisely using the 65-lead surface ECG. The fact that high septal pacing results in the shortest PWD may have implications for preventive pacing in patients with atrial fibrillation.