Clinical-epidemiological characteristics of pregnant women with HIV/syphilis coinfection: an integrative review / Características clínico-epidemiológicas de gestantes com coinfecção HIV/sífilis: revisão integrativa / Características clínico-epidemiológicas de gestantes con coinfección VIH/sífilis: revisión integrativa

Background and Objectives: HIV/syphilis coinfection is an important problem to be considered during pregnancy due to the various negative outcomes such as abortion, stillbirth, prematurity and congenital infections. The study is justified by the need to identify scientific evidence of clinical-epidemiological characteristics and vulnerabilities related to infections, factors that influence the prevalence, and if there are related health problems. The objective was to synthesize scientific evidence about sociodemographic characteristics and clinical manifestations of associated cases of syphilis and HIV. Content: this is an integrative literature review, searching the PubMed, MEDLINE, CINAHL, LILACS, BDENF and MedCarib databases, using the descriptors "HIV", "Syphilis", "Epidemiology", "Coinfection" and "Pregnant woman", combined by Boolean operators "AND" and "OR", guided by the question: what is the scientific evidence related to the clinical-epidemiological characteristics of pregnant women co-infected with HIV/syphilis? It was held from June to September 2022, including articles published in the last eight years. Nine primary articles published between 2015 and 2020 were selected. The association of infections was present in pregnant women of young adult age, non-white race/color, married, low level of education, housewives, residents of urban areas and belonging to more economically disadvantaged social classes. Conclusion: the study highlighted the importance of improving prenatal care, with the aim of reducing the risks of vertical transmission of these diseases, especially with the implementation of public policies aimed at the clinical management of co-infected pregnant women, the allocation of resources and the development of specific intervention protocols.(AU)

Justificativa e Objetivos: A coinfecção HIV/sífilis é um problema importante a ser considerado durante a gravidez devido aos diversos desfechos negativos como aborto, natimorto, prematuridade e infecções congênitas. O estudo justifica-se pela necessidade de identificar evidências científicas de características clínico-epidemiológicas e vulnerabilidades relacionadas às infecções, fatores que influenciam a prevalência e se há problemas de saúde relacionados. O objetivo foi sintetizar evidências científicas sobre características sociodemográficas e manifestações clínicas de casos associados de sífilis e HIV. Conteúdo: trata-se de uma revisão integrativa da literatura, com busca nas bases de dados PubMed, MEDLINE, CINAHL, LILACS, BDENF e MedCarib, utilizando os descritores "HIV", "Syphilis", "Epidemiology", "Coinfection" e "Pregnant woman", combinados por Operadores booleanos "AND" e "OR", norteados pela questão: quais as evidências científicas relacionadas às características clínico-epidemiológicas de gestantes coinfectadas com HIV/sífilis? Foi realizado de junho a setembro de 2022, incluindo artigos publicados nos últimos oito anos. Foram selecionados nove artigos primários publicados entre 2015 e 2020. A associação das infecções esteve presente em gestantes em idade adulta jovem, raça/cor não branca, casadas, baixa escolaridade, donas de casa, residentes em zona urbana e pertencentes a classes sociais mais desfavorecidas economicamente. Conclusão: o estudo destacou a importância da melhoria da assistência pré-natal, com o objetivo de reduzir os riscos de transmissão vertical dessas doenças, especialmente com a implementação de políticas públicas voltadas ao manejo clínico das gestantes coinfectadas, à alocação de recursos e o desenvolvimento de protocolos de intervenção específicos.(AU)

Antecedentes y objetivos: La coinfección VIH/sífilis es un problema importante a considerar durante el embarazo debido a los diversos resultados negativos como aborto, muerte fetal, prematuridad e infecciones congénitas. El estudio se justifica por la necesidad de identificar evidencia científica de características clínico-epidemiológicas y vulnerabilidades relacionadas con las infecciones, factores que influyen en la prevalencia y si existen problemas de salud relacionados. El objetivo fue sintetizar evidencia científica sobre las características sociodemográficas y manifestaciones clínicas de los casos asociados de sífilis y VIH. Contenido: se trata de una revisión integradora de la literatura, buscando en las bases de datos PubMed, MEDLINE, CINAHL, LILACS, BDENF y MedCarib, utilizando los descriptores "VIH", "Sífilis", "Epidemiología", "Coinfección" y "Mujer embarazada", combinados por Operadores booleanos "Y" y "O", guiados por la pregunta: ¿cuál es la evidencia científica relacionada con las características clínico- -epidemiológicas de las gestantes coinfectadas con VIH/sífilis? Se realizó de junio a septiembre de 2022, incluyendo artículos publicados en los últimos ocho años. Se seleccionaron nueve artículos primarios publicados entre 2015 y 2020. La asociación de infecciones estuvo presente en mujeres embarazadas de edad adulta joven, de raza/color no blanca, casadas, de bajo nivel educativo, amas de casa, residentes de áreas urbanas y pertenecientes a clases sociales más desfavorecidas económicamente. Conclusión: el estudio destacó la importancia de mejorar la atención prenatal, con el objetivo de reducir los riesgos de transmisión vertical de estas enfermedades, especialmente con la implementación de políticas públicas orientadas al manejo clínico de las gestantes coinfectadas, la asignación de recursos y el desarrollo de protocolos de intervención específicos.(AU)

Factors associated with deaths from COVID-19 in a region of northeastern Brazil.

INTRODUCTION: There is a need to improve knowledge and understanding of the factors associated with mortality from COVID-19 so that managers and decision-makers can implement strategies to mitigate and control the severe forms of the disease. This study aimed to determine the factors associated with deaths from COVID-19 in the state of Maranhão, in northeastern Brazil. METHODOLOGY: This is a cross-sectional and analytical study with patients with a confirmed diagnosis of COVID-19 who died from March 2020 to January 2022. Simple and multiple logistic regression models were used to assess the association between clinical-epidemiological characteristics and death. The odds ratios were expressed using a 95% confidence interval and a 5% significance level. RESULTS: A total of 386,567 cases of COVID-19 were registered in the period, of which 10,986 died. Risk factors associated with deaths from COVID-19 were male sex, age over 30 years, positive reverse transcriptase-polymerase chain reaction (RT-PCR) result, positive CT scan, and having one or more associated comorbidities. The three comorbidities linked to the highest propensity to die were diabetes mellitus, neurological disease, and obesity. CONCLUSIONS: The study findings support the implementation of strategic actions by health care and surveillance professionals and managers towards reducing the incidence of the risk factors for mortality by COVID-19 in Maranhão.

Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020.

MAIN RESULTS: Out of 2,147 grade 2 disability leprosy cases, the majority were male, of mixed race/skin color, multibacillary and borderline. The São Luís regional health unit showed a falling trend. IMPLICATIONS FOR SERVICES: The results can guide strategies for the leprosy control program in the state, aiming at new approaches towards early diagnosis, treatment and prevention of disabilities. PERSPECTIVES: Further studies are needed, such as spatial distribution of cases and detection rates of leprosy in children under 15 years of age, in order to gain a better understanding of the epidemiological profile of leprosy in Maranhão. OBJECTIVE: to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. METHODS: this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. RESULTS: of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). CONCLUSION: incidence trend was stable in the state of Maranhão and falling in São Luís.

Factors associated with multibacillary leprosy in a region of northeastern Brazil.

INTRODUCTION: The analysis of factors associated with multibacillary leprosy is important for the development of strategies to mitigate the disease, which persists as a public health problem in Brazil and the world. The objective of this study was to verify the associations between sociodemographic and clinical-epidemiological variables and multibacillary leprosy in the state of northeastern Brazil. METHODOLOGY: This is a cross-sectional, analytical, and retrospective study, with a quantitative approach, carried out in 16 municipalities in the southwest of Maranhão State, northeastern Brazil. All cases of leprosy reported between January 2008 and December 2017 were considered. Sociodemographic and clinical-epidemiological variables were analyzed using descriptive statistics. The identification of the risk factors associated with multibacillary leprosy was conducted using Poisson regression models. The prevalence ratios and respective 95% confidence intervals were estimated using regression coefficients at a 5% significance level. RESULTS: A total of 3,903 leprosy cases were analyzed. Individuals older than 15 years, males, with less than 8 years of education, with level I, II, or "not evaluated" disability, and with type 1 or 2 or both reactional states were more likely to have multibacillary leprosy. Therefore, these characteristics may be considered risk factors. No protective factors were identified. CONCLUSIONS: The investigation revealed important associations between risk factors and multibacillary leprosy. The findings can be considered during the creation of strategies to control and combat the disease.

Spatiotemporal risk assessment and COVID-19 trend estimation in a federative unit in northeastern Brazil.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. METHODS: An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions. RESULTS: Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. CONCLUSIONS: The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.

Características clínico-epidemiológicas e tendência temporal de casos novos de hanseníase com grau 2 de incapacidade física, no estado do Maranhão, 2011-2020 / Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020 / Características clínico-epidemiológicas y tendencia temporal de los nuevos casos de lepra grado 2 de discapacidad en el estado de Maranhão, Brasil, 2011-2020

Objetivo: descrever as características clínico-epidemiológicas dos casos novos de hanseníase com grau 2 de incapacidade física e analisar sua tendência no estado do Maranhão, Brasil, 2011-2020. Métodos: estudo transversal descritivo e ecológico de série temporal, com dados do Sistema de Informação de Agravos de Notificação; realizou-se análise descritiva do evento segundo características sociodemográficas e clínico-laboratoriais dos casos; a tendência temporal da incidência do evento foi analisada pela regressão de Prais-Winsten. Resultados: dos 2.147 casos notificados, 71,5% foram do sexo masculino, 48,9% possuíam até 8 anos de estudo, 66,5% eram de raça/cor da pele parda, 95,5% da forma multibacilar, 58,8% da forma dimorfa e 32,3% com baciloscopia negativa no diagnóstico; observou-se estacionaridade na tendência no estado, e tendência decrescente na regional de saúde de São Luís (variação anual = -64,4%; intervalo de confiança de 95% -73,7;-51,9). Conclusão: a tendência da incidência foi estável no estado do Maranhão e decrescente em São Luís.

Objective: to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. Methods: this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. Results: of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). Conclusion: incidence trend was stable in the state of Maranhão and falling in São Luís.

Objetivo: describir las características clínicas y epidemiológicas de los nuevos casos de lepra con discapacidad física grado 2 y analizar su tendencia en el estado de Maranhão, de 2011 a 2020. Métodos: estudio transversal descriptivo y ecológico de serie temporal con datos del Sistema de Información de Agravamiento de Notificaciones. Se realizó un análisis descriptivo de características sociodemográficas y clínico-laboratoriales. La tendencia temporal de la incidencia de eventos se analizó mediante la regresión de Prais-Winsten. Resultados: de los 2.147 casos, 71,5% era masculino, 48,9% tenía hasta 8 años de escolaridad, 66,5% era de raza/piel parda, 95,5% de forma multibacilar, 58,8% dimorfa, 32,3% con baciloscopia negativa al diagnóstico. Hubo tendencia estacionaria en el estado y tendencia decreciente en la Región de Salud São Luís (variación anual = -64,4%; intervalo de confianza 95%: -73,7;-51,9). Conclusión: la tendencia de la incidencia se mantuvo estable en el estado de Maranhão y decreciente en São Luís.

Análise de aplicativos móveis voltados para controle parental: revisão narrativa / Analysis of mobile applications aimed at parental control: narrative review / Análisis de aplicaciones móviles orientadas al control parental: revisión narrativa

Crianças e adolescentes usam a tecnologia móvel para diversas finalidades, como lazer, entretenimento, estudos e comunicação. No entanto, faz-se necessário o controle e mediação parental pois o uso inadequado pode gerar danos à saúde. Existem aplicativos voltados para esta tarefa e com funcionalidades e características variadas. Diante disso, este estudo teve como objetivo analisar as aplicações móveis disponíveis para download na plataforma Google Play Store por meio de uma revisão narrativa e com auxílio do software IRAMUTEQ para revisão dos dados, analisar os comentários deixados pelos usuários. Foram investigadas as informações de 138 aplicativos, boa parte deles realizam funções essenciais, como controlar o tempo de acesso, bloquear sites e apps indesejados, porém, há muitas críticas relacionadas a problemas técnicos, aplicabilidade e prejuízos gerados pelo excessivo controle dos pais. A investigação mostrou que cinco softwares para o controle parental apresentavam as principais funções de acordo com a aplicabilidade (limite de tempo, filtros, localizador GPS, monitoramento de chamadas e mensagens), nota acima de 3,0 e ano de atualização em 2021. A análise dos comentários feita pelo software IRAMUTEQ, destacou as palavras "App" (referente à aplicativo), "filho", "celular", "bloquear", "funcionar", "criança", "instalar" e "desinstalar" como as mais importantes pelos usuários.

Children and teenagers use mobile technology for different purposes, such as leisure, entertainment, studies and communication. However, parental control and mediation is necessary, as inappropriate use can cause health damage. There are applications aimed at this task and with varied functionalities and characteristics. Therefore, this study aimed to analyze the mobile applications available for download on the Google Play Store platform through a narrative review and with the help of the IRAMUTEQ software to review the data, analyze the comments left by users. Information from 138 applications was investigated, most of which perform essential functions, such as controlling access time, blocking unwanted websites and apps, however, there are many criticisms related to technical problems, applicability and damage caused by excessive parental control. The investigation showed that five parental control software had the main functions according to applicability (time limit, filters, GPS locator, call and message monitoring), grade above 3.0 and year of update in 2021. The analysis of the comments made by the IRAMUTEQ software, highlighted the words "App" (referring to the application), "son", "cell phone", "block", "work", "child", "install" and "uninstall" as the most important for users.

Los niños y adolescentes utilizan la tecnología móvil para diferentes fines, como el ocio, el entretenimiento, los estudios y la comunicación. Sin embargo, es necesario el control y la mediación parental, ya que un uso inadecuado puede causar daños a la salud. Existen aplicaciones destinadas a esta tarea y con funcionalidades y características variadas. Por lo tanto, este estudio tuvo como objetivo analizar las aplicaciones móviles disponibles para su descarga en la plataforma Google Play Store a través de una revisión narrativa y con la ayuda del software IRAMUTEQ para revisar los datos, analizar los comentarios dejados por los usuarios. Se investigó la información de 138 aplicaciones, la mayoría de las cuales cumplen funciones esenciales, como controlar el tiempo de acceso, bloquear sitios web y apps no deseadas, sin embargo, existen muchas críticas relacionadas con problemas técnicos, de aplicabilidad y daños causados por el excesivo control parental. La investigación mostró que cinco programas de control parental tenían las funciones principales según aplicabilidad (límite de tiempo, filtros, localizador GPS, monitorización de llamadas y mensajes), grado superior a 3.0 y año de actualización en 2021. El análisis de los comentarios realizados por el software IRAMUTEQ, destacó las palabras "App" (refiriéndose a la aplicación), "hijo", "móvil", "bloquear", "trabajar", "niño", "instalar" y "desinstalar" como las más importantes para los usuarios.

Geotechnologies applied in epidemiological studies on cases of covid-19: a narrative review / Geotecnologias aplicadas em estudos epidemiológicos sobre os casos de covid-19: revisão narrativa / Geotecnologías aplicadas en estudios epidemiológicos sobre casos de covid-19: revisión narrativa

Background and objectives: the applied geotechnologies are essential in helping the development of epidemiological studies that aim to identify and distribute health events in specific populations and territories, in addition to verifying the factors that influence the occurrence of these events, intending to apply the evidence in strategies of disease planning and control as in the covid-19 pandemic. This study aimed to present the scientific evidence that has been produced on geotechnologies applied in epidemiological studies on cases of covid-19. Methods: this is a descriptive narrative literature review (NLR). To guide the study, the following research question was elaborated: what has been studied about applied geotechnologies in epidemiological research on covid-19 cases? The search was carried out in October 2021, using the descriptors Geographic Information Systems AND Covid-19 OR SARS-CoV-2 AND Epidemiology AND Spatial Analysis, in Virtual Health Library, Scopus, Web of Science, Portal CAPES. Complementarily, a search was carried out for epidemiological bulletins and booklets on the Brazilian Ministry of Health website. Results: nineteen sources of information were selected that fit the objectives for the discussion construction, with three categories of analysis being listed: Geotechnology application; Information management; Challenges of epidemiological studies that use secondary data. Conclusion: geotechnology use in epidemiological studies on covid-19 in identifying areas at risk for the infection spread was such remarkable.(AU)

Justificativa e objetivos: as geotecnologias aplicadas são essenciais para auxiliar o desenvolvimento de estudos epidemiológicos que visam identificar e distribuir eventos de saúde em populações e territórios específicos, além de verificar os fatores que influenciam a ocorrência desses eventos, pretendendo aplicar as evidências em estratégias de planejamento e controle de doenças como na pandemia de covid-19. Este estudo teve como objetivo apresentar as evidências científicas que vêm sendo produzidas sobre geotecnologias aplicadas em estudos epidemiológicos de casos de covid-19. Métodos: trata-se de uma revisão de literatura narrativa descritiva (NLR). Para nortear o estudo, elaborou-se a seguinte questão de pesquisa: o que tem sido estudado sobre as geotecnologias aplicadas na pesquisa epidemiológica dos casos de covid-19? A busca foi realizada no mês de outubro de 2021, utilizando os descritores Geographic Information Systems AND Covid-19 OR SARS-CoV-2 AND Epidemiology AND Spatial Analysis, na Biblioteca Virtual em Saúde, Scopus, Web of Science, Portal CAPES. Complementarmente, foi realizada busca de boletins e cartilhas epidemiológicas no site do Ministério da Saúde do Brasil. Resultados: foram selecionadas dezenove fontes de informação que se enquadram nos objetivos para a construção da discussão, sendo elencadas três categorias de análise: Aplicação da geotecnologia; Gestão da informação; Desafios dos estudos epidemiológicos que utilizam dados secundários. Conclusão: o uso da geotecnologia em estudos epidemiológicos da covid-19 na identificação de áreas de risco para a propagação da infecção foi notável.(AU)

Justificación y objetivos: las geotecnologías aplicadas son esenciales para ayudar al desarrollo de estudios epidemiológicos que tengan como objetivo identificar y distribuir eventos de salud en poblaciones y territorios específicos, además de verificar los factores que influyen en la ocurrencia de estos eventos, con la intención de aplicar la evidencia en estrategias de planificación y control de enfermedades como en la pandemia de covid-19. Este estudio tuvo como objetivo presentar la evidencia científica que se ha producido sobre geotecnologías aplicadas en estudios epidemiológicos sobre casos de covid-19. Métodos: se trata de una revisión descriptiva narrativa de la literatura (NLR). Para orientar el estudio se elaboró la siguiente pregunta de investigación: ¿Qué se ha estudiado sobre geotecnologías aplicadas en la investigación epidemiológica de casos de covid-19? La búsqueda se realizó en octubre de 2021, utilizando los descriptores Sistemas de Información Geográfica Y Covid-19 O SARS-CoV-2 Y Epidemiología Y Análisis Espacial, en Biblioteca Virtual en Salud, Scopus, Web of Science, Portal CAPES. Complementariamente, se realizó una búsqueda de boletines y folletos epidemiológicos en el sitio web del Ministerio de Salud de Brasil. Resultados: fueron seleccionadas diecinueve fuentes de información que se ajustan a los objetivos para la construcción de la discusión, siendo enumeradas tres categorías de análisis: aplicación de la geotecnología; Gestión de la información; Retos de los estudios epidemiológicos que utilizan datos secundarios. Conclusión: el uso de geotecnología en estudios epidemiológicos sobre covid-19 para identificar áreas en riesgo de propagación de la infección fue tan notable.(AU)

Risk factors and spatial distribution associated with deaths due to COVID-19: an integrative review / Fatores de risco e distribuição espacial associados aos óbitos por COVID-19: uma revisão integrative / Factores de riesgo y distribución espacial asociados a las muertes por COVID-19: una revisión integradora

Background and objectives: understanding the clinical-epidemiological and environmental factors related to deaths due to COVID-19 and their distribution in space can serve as subsidies to direct and implement more effective health actions for vulnerable populations. Thus, the objective was to synthesize the scientific evidence related to risk factors and spatial distribution of deaths due to COVID-19 in the world. Content: this is an integrative literature review, and the following guiding question emerged: what is the scientific evidence related to risk factors and spatial distribution of deaths due to COVID-19 in the world? Searches were carried out in the Scientific Electronic Library Online (SciELO) and the Scopus, Web of Science and National Library of Medicine (PubMed) databases in June 2021. Original studies in Portuguese, English or Spanish, without time frame, excluding studies with a specific age group or with an audience with specific comorbidity, were used. A total of 25 studies were included, with findings in different scenarios around the world. Factors such as age, sex, pre-existing diseases were associated with deaths due to COVID-19, which had a heterogeneous spatial distribution and occurred in environmental, socioeconomic and geographic conditions peculiar to these territories. Conclusion: age equal to or greater than 60 years, males, cardiovascular diseases, diabetes mellitus and geographic areas with greater environmental pollution, greater population density and precarious sanitary conditions influenced the mortality of COVID-19.(AU)

Justificativa e objetivos: compreender os fatores clínico-epidemiológicos e ambientais relacionados aos óbitos por COVID-19 e sua distribuição no espaço pode servir de subsídio para direcionar e implementar ações de saúde mais efetivas para populações vulneráveis. Assim, o objetivo foi sintetizar as evidências científicas relacionadas aos fatores de risco e distribuição espacial dos óbitos por COVID-19 no mundo. Conteúdo: trata-se de uma revisão integrativa da literatura, e emergiu a seguinte questão norteadora: quais são as evidências científicas relacionadas aos fatores de risco e distribuição espacial dos óbitos por COVID-19 no mundo? As buscas foram realizadas nas bases de dados Scientific Electronic Library Online (SciELO) e Scopus, Web of Science e National Library of Medicine (PubMed) em junho de 2021. Estudos originais em português, inglês ou espanhol, sem recorte temporal, excluindo estudos com faixa etária específica ou com um público com comorbidade específica. Um total de 25 estudos foram incluídos, com achados em diferentes cenários ao redor do mundo. Fatores como idade, sexo, doenças pré-existentes foram associados aos óbitos por COVID-19, que tiveram distribuição espacial heterogênea e ocorreram em condições ambientais, socioeconômicas e geográficas peculiares a esses territórios. Conclusão: idade igual ou superior a 60 anos, sexo masculino, doenças cardiovasculares, diabetes mellitus e áreas geográficas com maior poluição ambiental, maior densidade populacional e condições sanitárias precárias influenciaram na mortalidade por COVID-19.(AU)

Justificación y objetivos: comprender los factores clínico-epidemiológicos y ambientales relacionados con las muertes por COVID-19 y su distribución en el espacio puede servir como subsidio para orientar e implementar acciones de salud más efectivas para poblaciones vulnerables. Así, el objetivo fue sintetizar la evidencia científica relacionada con los factores de riesgo y la distribución espacial de las muertes por COVID-19 en el mundo. Contenido: se trata de una revisión integrativa de la literatura, y surgió la siguiente pregunta orientadora: ¿cuál es la evidencia científica relacionada con los factores de riesgo y la distribución espacial de las muertes por COVID-19 en el mundo? Las búsquedas se realizaron en las bases de datos Scientific Electronic Library Online (SciELO) y Scopus, Web of Science y National Library of Medicine (PubMed) en junio de 2021. Estudios originales en portugués, inglés o español, sin marco de tiempo, excluyendo estudios con se utilizó un grupo de edad específico o con un público con comorbilidad específica. Se incluyeron un total de 25 estudios, con hallazgos en diferentes escenarios alrededor del mundo. Factores como la edad, el sexo, las enfermedades preexistentes se asociaron a las muertes por COVID-19, que tuvo una distribución espacial heterogénea y se produjo en condiciones ambientales, socioeconómicas y geográficas propias de estos territorios. Conclusión: la edad igual o mayor a 60 años, la maldad, las enfermedades cardiovasculares, la diabetes mellitus y las áreas geográficas con mayor contaminación ambiental, mayor densidad poblacional y precarias condiciones sanitarias influyeron en la mortalidad por COVID-19.(AU)

Síndrome Respiratória Aguda Grave por COVID-19: Perfil Clínico- Epidemiológico e Distribuição Espacial dos Óbitos nas Unidades Federativas do Brasil / Severe Acute Respiratory Syndrome by COVID-19: Clinical- Epidemiological Profile and Spatial Distribution of Deaths in the States of Brazil

A Síndrome Respiratória Aguda Grave (SRAG) é uma manifestação grave da infeção por COVID-19 que, em alguns casos, pode resultar em morte. No cenário epidemiológico global atual, o Brasil é o segundo país em número de óbitos pela doença, assim, faz-se necessário conhecer características clínico-epidemiológicas dos óbitos e como se distribuem espacialmente pelos territórios. Desse modo, objetivou-se descrever as características clínico-epidemiológicas e a distribuição espacial dos óbitos de SRAG por COVID-19 nas unidades federativas do Brasil. Trata-se de estudo descritivo e ecológico dos óbitos de SRAG por COVID-19 nos estados brasileiros, no período de março de 2020 a junho de 2021, a partir de dados secundários disponíveis no openDataSUS. Realizou-se estatística descritiva para as variáveis clínico-epidemiológicas e determinaram-se as taxas de mortalidade mensais por unidade federada e foram confeccionados mapas temáticos no software QGIS versão 2.4.17. Foram registrados 196.109 óbitos no período investigado, sendo predominante o sexo masculino, idade avançada, cor branca e baixa escolaridade. Nas variáveis clínicas, destacaram-se tosse, desconforto respiratório, dispneia e presença de comorbidades. Observou-se distribuição espacial heterogênea dos óbitos, com taxas variando de 0,00 a 24,59 óbitos/100 mil habitantes, as maiores taxas foram nos estados do Rio de Janeiro, Amazonas, Ceará, Sergipe, São Paulo e Pernambuco. Tais achados suscitam a necessidade de investimentos por parte da gestão pública e dos sistemas e serviços de saúde dos estados mais afetados, aperfeiçoamentos da vigilância epidemiológica, educação permanente em saúde, ampliação do acesso à imunização e medidas de prevenção de saúde para controle e monitoramento da SRAG por COVID-19.

Severe Acute Respiratory Syndrome (SARS) is a severe manifestation of COVID-19 infection that, in some cases, can result in death. In the current global epidemiological scenario, Brazil is the second country with highest number of deaths from the disease; thus, it is necessary to know the clinical and epidemiological characteristics of deaths and how they are spatially distributed across territories. Therefore, the objective was to describe the clinical and epidemiological characteristics and the spatial distribution of SARS deaths due to COVID-19 in the Brazilian federative units (states). This is a descriptive and ecological study of SARS deaths due to COVID-19 in Brazilian states, from March 2020 to June 2021, based on secondary data available on the openDataSUS database. Descriptive statistics were performed for the clinical-epidemiological variables and the monthly mortality rates were determined by state and thematic maps were made in QGIS software version 2.4.17. A total of 196,109 deaths were recorded in the investigated period, predominantly male, older, white, and low-educated. Among the clinical variables, cough, respiratory distress, dyspnea, and the presence of comorbidities stood out. A heterogeneous spatial distribution of deaths was observed, with rates ranging from 0.00 to 24.59 deaths/100,000 inhabitants, the highest rates were in the states of Rio de Janeiro, Amazonas, Ceara, Sergipe, Sao Paulo, and Pernambuco. These findings raise the need for investments on the part of public management and health systems and services in the most affected states, improvements in epidemiological surveillance, permanent health education, increased access to immunization and health prevention measures to control and monitor SARS caused by COVID-19.

Spatial analysis of congenital syphilis in a federative unit in northeastern Brazil.

BACKGROUND: Congenital syphilis is an infectious disease that affects 1 million children a year worldwide. METHODS: The objective of this study was to describe a spatial analysis of the epidemiological characteristics of congenital syphilis in the state of Maranhão, Brazil from 2007 to 2018. This was an ecological study using data obtained in May 2020 from three Brazilian information systems. The spatial correlation was analyzed according to local and global Moran indexes. RESULTS: During the 12-y period, 1 426 177 children were born. Of these children, 3684 acquired congenital syphilis (0.26%; mean annual rate of 2.62/1000 live births) and 70 died (1.90%; mean annual rate 0.05). The clusters were statistically significant according to the global Moran index of 0.40 (p=0.01). Spearman's correlation coefficient between the rate of detection of syphilis in pregnant women and family health strategy teams was strong, positive and significant (ρ=0.73; p<0.00). Most of the variables studied showed a trend of annual increase (p<0.05). CONCLUSIONS: The use of spatial analysis tools have made it possible to detect areas with both a greater and a lesser need for intervention, and to more effectively improve and monitor those areas to change the epidemiological profile of the disease.

Factors Associated with Multibacillary Leprosy in a Priority Region for Disease Control in Northeastern Brazil: A Retrospective Observational Study.

BACKGROUND: Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. OBJECTIVE: To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. METHOD: This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. RESULTS: From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). CONCLUSION: Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.

Desempenho de antígenos nativo, recombinante e sintético, em testes imunoenzimáticos, para diagnóstico e prognóstico de pacientes com diferentes formas clínicas de hanseníase / Performance of native, recombinant and synthetic antigens by enzyme immunoassays for the diagnosis and prognosis of leprosy patients classified in the wide spectrum of the disease

Apesar da Organização Mundial de Saúde (OMS) ter adotado medidas de controle, a hanseníase permanece como um problema social e de saúde pública em muitos países. O diagnóstico clínico e a baciloscopia permanecem como as principais ferramentas utilizadas para a classificação dos pacientes e definição da terapêutica a ser instituída. A identificação de novos antígenos de M. leprae, o desenvolvimento de novos métodos laboratoriais e melhorar o desempenho de testes sorológicos já existentes são prioridades para tentar atingir as metas da OMS programadas para o período de 2011-2015. Neste estudo avaliamos o desempenho diagnóstico dos antígenos glicolipídeo sintético ND-O-BSA para pesquisa de anticorpos totais e recombinante LID-1, para pesquisa anticorpos IgG por ELISA; e o perfil de reatividade de anticorpos IgG contra proteínas nativas de M. leprae por Western Blotting, em amostras de soros de pacientes de área endêmica com diferentes formas clínicas da doença. Nossos resultados mostraram que os testes ELISA ND-O-BSA e LID-1 auxiliaram na detecção de 70% dos pacientes multibacilares com baciloscopia negativa. O valor preditivo negativo foi de 94% para ambos os testes. A análise do Western Blotting mostrou que pacientes multibacilares possuem anticorpos IgG para a fração de 38kDa e região de 3,5kDa, esta reatividade não foi observada no grupo controle. Nosso estudo sugere a utilização do ELISA, com antígenos recombinante e sintético, na rotina diagnóstica; e que a fração de 38kDa e região de 3,5kDa, de antígeno nativo de M. leprae, são bons marcadores no diagnóstico de hanseníase e no prognóstico de pacientes com as formas borderline e indeterminada da doença

Although several control measures have been adopted by the World Health Organization, (WHO) leprosy continues to be a social and public health problem in many countries. Clinical diagnosis and acid-fast bacilli skin smear are the main tools used to classify patients and define therapy. According to the WHO program for 2011-2015, the identification of new Mycobacterium leprae antigens, the development of new laboratory methods and improved serological tests are the priorities. In the present study, we evaluated the diagnostic performance of the synthetic glycolipid antigen, ND-O-BSA, to detect total antibodies and the recombinant antigen LID-1 to detect IgG antibodies by ELISA and the IgG reactivity profile against native M. leprae proteins by Western blot in serum samples from leprosy patients classified in the wide spectrum of the disease. Our results showed that ND-O-BSA and LID-1 ELISA are able to detect the disease in 70% of multibacillary patients with negative skin smears. The negative predictive values were 94% for both tests. The Western blot analysis revealed that most multibacillary patients had IgG antibodies against the 38 kDa and 3.5 kDa regions; this reactivity was not observed in the control group. Our study suggests the use of ELISA, with recombinant or synthetic antigens, in routine diagnosis and that the 38 kDa fraction and the 3.5 kDa region, from native M leprae antigen, are good markers for the diagnosis of leprosy and its prognosis as shown for the borderline and indeterminate forms of the disease.

A study of IgA antibody response to different mycobacterium tuberculosis antigens in the diagnosis and monitoring of pulmonary tuberculosis.

We evaluated the performance of the ELISA technique in the detection of IgA antibodies against different Mycobacterium tuberculosis antigenic preparations in serum samples from 49 patients with pulmonary tuberculosis collected before and after the start of specific treatment. The controls consisted of serum samples from healthy patients without any prior contact with the bacteria and serum samples from patients with other pneumopathies. Glycolipid antigen gave the best diagnostic performance, with a sensitivity of 88% and specificities varying from 88 to 100% in the control groups. These antigens constitute a powerful tool for the diagnosis and monitoring of patients with pulmonary tuberculosis.

A study of iga antibody response to different mycobacterium tuberculosis antigens in the diagnosis and monitoring of pulmonary tuberculosis

We evaluated the performance of the ELISA technique in the detection of IgA antibodies against different Mycobacterium tuberculosis antigenic preparations in serum samples from 49 patients with pulmonary tuberculosis collected before and after the start of specific treatment. The controls consisted of serum samples from healthy patients without any prior contact with the bacteria and serum samples from patients with other pneumopathies. Glycolipid antigen gave the best diagnostic performance, with a sensitivity of 88 percent and specificities varying from 88 to 100 percent in the control groups. These antigens constitute a powerful tool for the diagnosis and monitoring of patients with pulmonary tuberculosis.