Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018 / Mortalidad por enfermedades tropicales desatendidas en el estado de Piauí, Nordeste de Brasil: tendencia temporal y patrones espaciales, 2001-2018 / Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018

Objetivo: Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos: Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência espaço-temporal, regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados: Verificaram-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte no sexo masculino (RR=1,76; IC95% 1,25;2,46), idade ≥60 anos (RR=40,71; IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76; IC95% 1,09;2,84), menor porte populacional (RR=1,99; IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51; IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão: A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados.

Resumen Objetivo Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos Estudio ecológico mixto, con cálculo de razón de riesgo (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte el sexo masculino (RR=1,76; IC95% 1,25;2,46), edad ≥60 años (RR=40,71; IC95% 10,01;165,53), municipios con vulnerabilidad social mediana (RR=1,76; IC95% 1,09;2,84), con menor población (RR=1,99; IC95% 1,28;3,10) y la macrorregión de los Cerrados (RR=4,51; IC95% 2,51;8,11). Hubo tendencia al alta en las tasas de mortalidad de 2001-2008 y reducción de 2009-2018. Conclusión La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el Suroeste de la macrorregión del Semiárido, noreste y sur de los Cerrados.

Abstract Objetive To analyze temporal trends and spatial patterns of mortality due to neglected tropical diseases (NTDs) in Piauí, Brazil, 2001-2018. Methods This was a mixed ecological study, with risk ratio (RR) calculation, spatiotemporal trend analysis, Poisson joinpoint regression, using data from the Mortality Information System. Results There were 2,609 deaths due to NTDs in the period (4.60/100,000 inhabitants), 55.2% were due to Chagas' disease. There was a higher risk of death in male (RR=1.76; 95%CI 1.25;2.46), being aged ≥60 years (RR=40.71; 95%CI 10.01;165.53), municipalities with medium vulnerability social (RR=1.76; 95%CI 1.09;2.84), smaller population size (RR=1.99; 95%CI 1.28;3.10) and the Cerrados macro-region (RR=4.51; 95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a falling trend from 2009-2018. Conclusion Mortality due to NTDs in Piauí remains high, particularly due to Chagas' disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the Semiarid macro-region and the northeast and south of the Cerrados macro-region.

Envenenamientos por mordedura de serpiente en Guatemala: revisión de literatura / Snakebite envenomings in Guatemala: literature review

El accidente ofídico es una enfermedad tropical desatendida que ocasiona un problema de salud pública en el mundo, siendo una de las principales causas de morbilidad y mortalidad en las áreas empobrecidas de América Latina. En Guatemala se distribuyen 23 especies de serpientes venenosas de importancia médica. La composición de los venenos es compleja y diversa, resultando en una variedad de manifestaciones clínicas. Los departamentos con mayor incidencia de ofidismo son Petén, Alta Verapaz, Quiché, Escuintla e Izabal. Estos accidentes afectan más a hombres que a mujeres, siendo la mayoría agricultores; el rango de edad más comprometido es de 10-19 años y principalmente ocurren en miembros inferiores. El tiempo medio que tarda la víctima en llegar al hospital es de 5.6 h, siendo el retraso en la atención médica, un factor de riesgo para severidad y mortalidad. Los servicios de salud en ocasiones no cuentan con recursos idóneos para atender a las víctimas, brindando tratamiento sintomático. Simultáneamente, el tratamiento empírico tiene gran aceptación, sin embargo, los resultados de investigaciones realizadas con algunas plantas de uso común en casos de ofidismo, concluyeron que no es recomendable su uso aislado en el tratamiento del envenenamiento. Dada la falta de información se debe promover más investigación sobre el ofidismo en el país, siendo indispensable la elaboración de una ficha de reporte obligatoria. Además, deben elaborarse guías de tratamiento e identificación de serpientes para uso del personal médico, incluyendo programas de educación a nivel comunitario.

Snakebite envenoming is a neglected tropical disease that causes a public health problem in the world, being one of the main causes of morbidity and mortality in impoverished areas of Latin America. 23 species of poi-sonous snakes of medical importance are distributed in Guatemala. The composition of venoms is complex and diverse, resulting in a variety of clinical manifestations. The departments with the highest incidence of snakebites are Petén, Alta Verapaz, Quiché, Escuintla and Izabal. These accidents affect more men than women, the majo-rity being farmers; the most compromised age range is 10-19 years and they mainly occur in the lower limbs. The average time it takes for the victim to reach the hospital is 5.6 hours, with delay in medical care being a risk factor for severity and mortality. Health services sometimes do not have adequate resources to care for victims, providing symptomatic treatment. Simultaneously, empirical treatment is widely accepted, however, the results of research carried out with some plants commonly used in cases of envenoming concluded that their isolated use is not recommended in the treatment. Given the lack of information, more research on snakebite envenoming in the country should be promoted, making the preparation of a mandatory report form essential. In addition, snake identification and treatment guides should be developed for use by medical personnel, including education pro-grams at the community level.

Spatial analysis of dengue, cysticercosis and Chagas disease mortality in Ecuador, 2011-2016.

Background: Neglected tropical diseases (NTDs) continue to be an important cause of disability and mortality in the poorest tropical and subtropical areas. Methods: This is an ecological study. We included all death certificates with dengue, cysticercosis and Chagas disease in Ecuador from 2011 to 2016. The spatial autocorrelation was evaluated by GeoDa software through the Global Moran's I index and the formation of clusters by the local index of spatial association. Results: The Global Moran's I index for the study period shows a positive spatial autocorrelation for dengue, cysticercosis and Chagas disease (0.25, p=0.001; 0.07, p=0.04; 0.45, p=0.001, respectively). Conclusions: The clusters identified as higher risk in the country could be targeted by policymakers to adequately develop strategies to strengthen health promotion policies that break the cycle of these diseases.

Reprint of "Neurocysticercosis-related mortality in Brazil, 2000-2011: Epidemiology of a neglected neurologic cause of death".

Neurocysticercosis (NCC) is an important cause of severe neurological disease mainly in low- and middle-income countries, but data on NCC mortality from endemic areas are scarce. Here we analysed the epidemiological patterns of NCC-related mortality in Brazil. We included all deaths recorded in Brazil between 2000 and 2011, in which NCC was mentioned on death certificates, either as underlying or as associated cause of death. NCC was identified in 1829/12,491,280 deaths (0.015%), 1130 (61.8%) as underlying cause, and 699 (38.2%) as associated cause. Overall age-adjusted mortality rate for the period was 0.97 deaths/1,000,000 inhabitants (95% confidence interval [CI]: 0.83-1.12). The highest NCC-related mortality rates were found in males, elderly, white race/colour and residents in endemic states/regions. Age-adjusted mortality rates at national level decreased significantly over time (annual percent change [APC]: -4.7; 95% CI: -6.0 to -3.3), with a decrease in the Southeast, South and Central-West regions, and a non-significant increasing trend in the North and Northeast regions. We identified spatial and spatiotemporal high-risk mortality clusters located mainly in NCC-endemic areas. Conditions related to the nervous system were the most commonly associated causes of death when NCC was mentioned as an underlying cause, and HIV/AIDS was the main underlying cause when NCC was an associated cause. NCC is a neglected and preventable cause of severe neurologic disease and death with high public health impact in Brazil. There is a clear need to strengthen nationwide epidemiological surveillance and control for the taeniasis/cysticercosis complex.

Neurocysticercosis-related mortality in Brazil, 2000-2011: Epidemiology of a neglected neurologic cause of death.

Neurocysticercosis (NCC) is an important cause of severe neurological disease mainly in low- and middle-income countries, but data on NCC mortality from endemic areas are scarce. Here we analysed the epidemiological patterns of NCC-related mortality in Brazil. We included all deaths recorded in Brazil between 2000 and 2011, in which NCC was mentioned on death certificates, either as underlying or as associated cause of death. NCC was identified in 1829/12,491,280 deaths (0.015%), 1130 (61.8%) as underlying cause, and 699 (38.2%) as associated cause. Overall age-adjusted mortality rate for the period was 0.97 deaths/1,000,000 inhabitants (95% confidence interval [CI]: 0.83-1.12). The highest NCC-related mortality rates were found in males, elderly, white race/colour and residents in endemic states/regions. Age-adjusted mortality rates at national level decreased significantly over time (annual percent change [APC]: -4.7; 95% CI: -6.0 to -3.3), with a decrease in the Southeast, South and Central-West regions, and a non-significant increasing trend in the North and Northeast regions. We identified spatial and spatiotemporal high-risk mortality clusters located mainly in NCC-endemic areas. Conditions related to the nervous system were the most commonly associated causes of death when NCC was mentioned as an underlying cause, and HIV/AIDS was the main underlying cause when NCC was an associated cause. NCC is a neglected and preventable cause of severe neurologic disease and death with high public health impact in Brazil. There is a clear need to strengthen nationwide epidemiological surveillance and control for the taeniasis/cysticercosis complex.

[Characterization of human hydatidosis mortality: Chile, 2000-2010]. / Caracterización de la mortalidad por hidatidosis humana: Chile, 2000-2010.

BACKGROUND: Hydatidosis as a worldwide zoonosis with a high socio-economic impact in Chile and other countries for which it is a notifiable human disease in our country. OBJECTIVE: To characterize death rates by hydatidosis and whether there are differences according to the region of residence. MATERIAL: A descriptive analysis using Data System Deaths (2000-2010) was performed. RESULTS: The total number of deaths was 293 (56% male). The mortality rate changed from 0.16 in 2000 to 0.11 in 2010 per 100.000 inhabitants. The main diagnosis corresponded to B67.9 (Echinococcosis, other and unspecified). Most fatal cases had a basic level of education and the Araucanía Region had the highest mortality rate. There was a loss of life of 5022.04 years by the premature death of 293 people, with a ratio of 0.31 PYLL years lost per 1000 inhabitants. In the Araucanía Region this ratio increased to 1.03 PYLL years lost per 1000 inhabitants. CONCLUSIONS: The mortality rate tends to decrease, however this trend might mask regional differences. It should be noted that deaths caused by hydatidosis are preventable deaths and therefore unjust. Finally, the mortality analysis is important to better understand the burden of the disease and evaluate the effectiveness of public health interventions.

Caracterización de la mortalidad por hidatidosis humana: Chile, 2000-2010 / Characterization of human hydatidosis mortality: Chile, 2000-2010

Background: Hydatidosis as a worldwide zoonosis with a high socio-economic impact in Chile and other countries for which it is a notifiable human disease in our country. Objective: To characterize death rates by hydatidosis and whether there are differences according to the region of residence. Material: A descriptive analysis using Data System Deaths (2000-2010) was performed. Results: The total number of deaths was 293 (56% male). The mortality rate changed from 0.16 in 2000 to 0.11 in 2010 per 100.000 inhabitants. The main diagnosis corresponded to B67.9 (Echinococcosis, other and unspecified). Most fatal cases had a basic level of education and the Araucanía Region had the highest mortality rate. There was a loss of life of 5022.04 years by the premature death of 293 people, with a ratio of 0.31 PYLL years lost per 1000 inhabitants. In the Araucanía Region this ratio increased to 1.03 PYLL years lost per 1000 inhabitants. Conclusions: The mortality rate tends to decrease, however this trend might mask regional differences. It should be noted that deaths caused by hydatidosis are preventable deaths and therefore unjust. Finally, the mortality analysis is important to better understand the burden of the disease and evaluate the effectiveness of public health interventions.

Introducción: La hidatidosis es una zoonosis universal de alto impacto socio-económico en Chile y en otras latitudes, siendo hoy para nuestro país una afección de notificación obligatoria en humanos. Objetivo: Caracterizar las defunciones por hidatidosis y establecer si existen diferencias de acuerdo a la región de residencia. Material y Métodos: Se utilizaron datos del Sistema de Defunciones (2000-2010) realizándose un análisis descriptivo. Resultados: El total de defunciones es de 293 (56% hombres). La tasa de mortalidad se ha desplazado desde 0,16 en 2000 a 0,11 en 2010 muertes por 100 mil habitantes. El mayor diagnóstico fue B67.9 (Equinococosis, otra y la no especificada). El nivel de instrucción de los afectados fue mayoritariamente básico. La Región de La Araucanía registra la mayor tasa de mortalidad. Se produjo la pérdida de 5.022,04 años de vida por el fallecimiento prematuro de 293 personas, con una razón de AVPP de 0,31 años de pérdida por 1.000 habitantes. En la Región de La Araucanía esta razón de AVPP se incrementa a 1,03 años de pérdida por 1.000 habitantes. Conclusiones: La tasa de mortalidad tiende a disminuir en el período estudiado; sin embargo, oculta diferencias regionales. Se destaca que las muertes por hidatidosis son muertes evitables y por lo tanto injustas. Finalmente, el análisis de mortalidad es importante para comprender de mejor forma la carga de la enfermedad y evaluar la efectividad de las intervenciones de salud pública.

Overlooked issues of snakebite management: time for strategic approach.

Snakebite is a medical emergency in many parts of the world, particularly in the temperate regions. According to 2007 World Health Organization (WHO) report, there are about 5 million snakebite incidences resulting in 2.5 million envenoming, and 125,000 deaths occur annually. Most affected are the healthy individuals like children and farming populations with resource poor settings and away from health care centers in low-income countries of Africa, Asia and Latin America. In view of this, the WHO has declared snakebite as an ignored health crisis and a tropical disease. Although the death rate has reduced markedly due to anti-venom regiment, several limitations of it offer scope for better understanding of various ignored issues. Currently, snakebite therapeutics facing plethora of scientific, technological and public health challenges, including secondary/long term complications that have not been given importance so far. Because of dearth of knowledge, venom researchers and medical practitioners from affected countries worldwide should join together to accomplish this scenario. In view of this, the present review provides a broader perspective on the possible production and application of highly effective therapeutic master anti-venom, designing master diagnostic kit and also to deal with the inefficacy of anti-venom therapy against local manifestations and secondary complications of snakebite. The review demands thorough understanding of venom pharmacology, inculcating new strategies to handle and to enhance the efficacy of snakebite management and urge the governing systems of affected countries to take steps to curtail accidental debilitation and death rate of healthy individuals due to snakebite.

Morbimortalidade por paracoccidioidomicose no Brasil: 1998 -2006 / Morbidity and mortality from paracoccidioidomycosis in Brazil: 1998 -2006

Morbimortalidade por paracoccidioidomicose no Brasil. 1998-2006. INTRODUÇÃO: A paracoccidioidomicose (PCM) é micose sistêmica exclusiva do continente americano. O Brasil detém cerca de 80 por cento dos casos da doença. OBJETIVO: A presente pesquisa analisa, pela primeira vez, a morbidade hospitalar da paracoccidioidomicose no Brasil avaliando-a conjuntamente com a mortalidade pela endemia. METODOLOGIA: Realizou-se um estudo descritivo da morbidade hospitalar e mortalidade por paracoccidioidomicose, no período de janeiro de 1998 a dezembro de 2006. Analisou-se sua distribuição no tempo e no espaço e as características epidemiológicas, sociodemográficas e administrativas. As variáveis analisadas foram: frequência dos eventos segundo local de residência e de ocorrência, sexo e idade, óbito hospitalar e ocupação. A fonte dos dados para internações foi o Sistema de Informações Hospitalares (SIH/SUS), e para os óbitos, o Sistema de Informações de Mortalidade (SIM/SUS) do Sistema Único de Saúde. Selecionaram-se as internações e óbitos que tiveram como diagnóstico principal e causa básica, respectivamente, a paracoccidioidomicose (categoria B41) e a blastomicose (B40). O diagnóstico de blastomicose foi considerado equivalente a paracoccidioidomicose. RESULTADOS: No período estudado, ocorreram 6.732 internações e 1523 óbitos, representando, respectivamente, uma taxa de internação de 4,3 e uma taxa de mortalidade por paracoccidioidomicose de 1,0 por milhão de habitantes. A paracoccidioidomicose, com aproximadamente 50 por cento, das internações e dos óbitos, foi a micose sistêmica mais prevalente, figurando entre as dez principais causas de mortalidade por doença infecciosa e parasitária de natureza crônica e recorrente. A maioria dos casos era do sexo masculino, com 82 por cento das internações e 88 por cento dos óbitos. Entre as ocupações bem definidas, 60 por cento dos óbitos ocorreram em trabalhadores rurais...

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to the American continent. Brazil holds about 80% of cases of the disease.OBJECTIVE: This study aims, first, to analyze, for the first time, the hospital morbidity together with the mortality due to this endemic in Brazil.METHODS: A descriptive study of hospital morbidity and mortality due to paracoccidioidomycosis, was performed from January 1998 to December 2006. Their distribution in time and space, their epidemiological, socio-demographic and administrative characteristics were analyzed. The variables included: frequency of events by place of residence and occurrence, sex and age, in-hospital death and occupation. The source of data for admissions was the Hospital Information System (SIH / SUS), and deaths, the Information System of Mortality (SIM / SUS) of the Unified Health System. All hospital admissions and deaths were selected, respectively, either as primary diagnosis and underlying cause, paracoccidioidomycosis (Category B41) and/or blastomycosis (B40). The diagnosis of blastomycosis was considered equivalent to paracoccidioidomycosis. CONCLUSION: The study demonstrated that during the analyzed period paracoccidioidomycosis, with approximately 50 percent of all hospital admissions and deaths, was the most prevalent systemic mycosis in Brazil and showed a new spatial distribution of the disease in face of recent trends in the economic, environmental and migration that occur in the Brazilian territory...