Skeletal muscle mass increases after viral eradication with direct-acting antivirals in patients with chronic hepatitis C: A longitudinal study.

BACKGROUND: Results of studies evaluating the effect of viral eradication following direct-acting antiviral (DDA) therapy on skeletal muscle mass of patients with chronic hepatitis C (CHC) are scarce. AIM: To assess the components of sarcopenia (low muscle mass, low muscle strength and low physical performance) in a cohort of CHC individuals before and after DAA therapy. METHODS: We performed a longitudinal study of patients with CHC who underwent body composition assessment before (T0), and at 12 (T1) and 48 (T2) weeks after DDA therapy. Bioelectrical Impedance Analysis was used to assess skeletal mass muscle (SM) and phase angle (PhA). SM index (SMI) was calculated by dividing the SM by squared height. Muscle function was evaluated by hand grip strength (HGS) and timed up-and-go (TUG) test. Mixed-effects linear regression models were fitted to SMI, HGS and physical performance and were used to test the effect of HCV eradication by DAA. RESULTS: 62 outpatients (mean age, 58.6 ± 10.8 years; 58% with compensated cirrhosis) were included. Significant decreases in liver fibrosis markers and an increase of 0.20 and 0.22 kg/m2 in the SMI were observed at T1 and T2. Following DAA therapy, an increase of one unit of PhA was associated with a reduction of 0.38 min in TUG. CONCLUSION: HCV eradication with DAA therapy was associated with a dynamic reduction of non-invasive markers of liver fibrosis and increased muscle mass in 62 patients with CHC who had an undetectable HCV load at 12 weeks after completion of antiviral treatment.

Clinical-epidemiological aspects and prognostic factors associated with death from visceral leishmaniasis between the years 2010 to 2019 in the Central-West region of Brazil.

In Brazil, the fatality rate for visceral leishmaniasis is high, and it is important to investigate its associated factors. The aim of this study was to analyze the clinical-epidemiological profile and prognostic factors associated with death from visceral leishmaniasis (VL) in the Central-West region of Brazil, between 2010 and 2019. A study of series of VL cases was carried out using data obtained from the Sistema de Informação de Agravos de Notificação (SINAN). Multivariate logistic regression was performed to identify variables associated with deaths. Male (64.96%); age group ≤5 years (28.51%); mixed race/color (59.20%); and level of education incomplete primary education (45.16%) were the most affected. The most frequent symptoms were fever (87.65%), weakness (77.56%), enlarged spleen (70.22%) and liver (67.33%), weight loss (67.22%) and pallor (63.41%). Co-infection with HIV was observed in 15.84% of patients. The parasitological diagnosis was positive in 74.17% and the Indirect Immunofluorescence (IIF) in 82.80%. The drug most used for treatment was pentavalent antimony (41.96%). Regarding the evolution of VL, cure was recorded for 82.90% of patients and death from VL in 8.30%. Factors associated with death from VL were: age group ≥20 and <60 (OR 2.95; 95% CI 1.98-4.38) and ≥60 (OR 5.84; 95% CI 3.63-9.38), edema (OR 2.27; 95% CI 1.64-3.13), pallor (OR 1.53; 95% CI 1.06-2.20), infectious condition (OR 1.56; 95% CI 1.12-2.15) and hemorrhagic phenomena (OR 2.87; 95% CI 2.02-4.08). New studies are needed in order to better manage VL control, monitoring, prevention and primary care strategies.

What is the Role of SNORA42 in Carcinogenesis? A Systematic Review.

OBJECTIVE: Perform a systematic literature review on SNORA42 in carcinogenesis in order to elucidate its importance, its potential use as a biomarker and as a therapeutic target. METHODS: Using PubMed, SciELO and Science Direct databases as search means, articles that are in line with the scope of the study, written in English, that were published between 2012 and 2022, were selected using the following keywords: "small nucleolar RNA 42", "snoRNA 42" and "SNORA42", as well as searches for the synonyms of this snoRNA (SNORA80E, box H/ACA 42 and ACA42). RESULT: From a total of 131 studies, seven were selected, in which it was possible to identify that SNORA42 interferes in several biological processes, such as proliferation, migration, invasion, metastasis, apoptosis, and signaling pathways. Among the signaling pathways, the p53 and NF-KappaB pathways stand out. Moreover, it is a potential biomarker for diagnosis, prognosis, and treatment of cancer. CONCLUSION: The summary of the main information about SNORA42 in the process of carcinogenesis and cancer progression shows that the use of this snoRNA is ideal for future applications in the field of oncology, in which it can be used as a biomarker and therapeutic target. Thus, it is of fundamental importance to carry out new studies to consolidate the applicability of this molecule.

Sarcopenia in chronic viral hepatitis: From concept to clinical relevance.

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Prevalence and epidemiological aspects of Chikungunya fever in states of the Northeast region of Brazil: A systematic review.

Chikungunya fever is a disease caused by the Chikungunya virus (CHIKV), which is transmitted through the bite of infected female hematophagous mosquitoes of the genus Aedes (Diptera: Culicidae). In the Americas, the first autochthonous cases of the disease were recorded in 2013. A year later, in 2014, the first records of the disease were acquired locally in Brazil, in the states of Bahia and Amapá. The present study aimed to carry out a systematic review of the literature on the prevalence and epidemiological aspects of Chikungunya fever in states of the Northeast region of Brazil, between the years 2018 to 2022. This study was registered in the Open Science Framework (OSF) and in the International Prospective Register of Systemactic Reviews (PROSPERO) and followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The searches were carried out in the scientific electronic databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), U. S. National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO), using descriptors cataloged in Descritores em Ciências da Saúde (DeCS) and Medical Subject Headings (MeSH) in Portuguese, English and Spanish. Gray literature was also searched by accessing Google Scholar to search for additional publications not captured in the selected electronic databases. Of the 19 studies included in the present systematic review, seven referred to the state of Ceará. Most cases of Chikungunya fever corresponded to the female gender (ranging from 7.5% to 100.0%), to the age group younger than 60 years (84.2%), to literate individuals (93.3%), belonging to the non-white race/color (95.21%) and blacks (100.0%), and residents of the urban area (range from 51.95% to 100.0%). As for laboratory characteristics, most notifications were diagnosed using clinical-epidemiological criteria (ranging from 71.21% to 90.35%). The epidemiological information about Chikungunya fever in the Northeast region of Brazil presented in this systematic review is useful to better understand the characteristics of the disease introduction process in the country. To this end, prevention and control strategies must be adopted, especially in the Northeast, as this region is most responsible for the number of cases of the disease in the country.

Epidemiological profile, spatial patterns and priority areas for surveillance and control of leishmaniasis in Brazilian border strip, 2009-2017.

Leishmaniasis represents a major neglected public health problem and the control measures have not been successful in Brazil. Recent studies have shown leishmaniasis importance to Brazilian border zones which reinforces the need to investigate its spread in those regions. This study aimed to analyze epidemiologic profile and its spatial distribution or aggregation process in both tegumentary and visceral leishmaniasis in the Brazilian border strip from 2009 to 2017. This is an ecological study of the epidemiological profile and spatial patterns encompassing municipalities in the Brazilian border strip. The presence of spatial autocorrelation and determination of priority areas for disease control were performed using global (Moran I) and local (LISA) Moran spatial techniques. The annual mean coefficients of tegumentary and visceral leishmaniasis were 29.8 and 0.6 by 100,000 inhabitants in the border strip, respectively. The indigenous population rates of leishmaniasis in the border zone appears to be higher than in the rest of the country (cutaneous changed from 33.2% to 6.6% and visceral rising from 1.0% to 17.5%) in the period. The most affected municipalities were located in the North and Central arches of the border zone. The results can subsidize the development of more targeted and effective strategies that can contribute to the surveillance and control of leishmaniasis in border zones, as the provision of epidemiological and spatial data on the disease. For better control of the disease, we recommend and emphasize the need to integrate public health policies of neighboring countries.

Occurrence of human visceral leishmaniasis in the Central-West region of Brazil: A systematic review.

Since the first case of visceral leishmaniasis (VL) recorded in Brazil, in 1913, referring to a patient from Boa Esperança, state of Mato Grosso, Central-West region, epidemics have been observed, with intensified expansion and urbanization from 1980. For a better understanding of the factors associated with VL in the Brazilian Central-West region, the present study aimed to carry out a systematic review on aspects related to the occurrence of VL in this region, which includes the states of Goiás, Mato Grosso, Mato Grosso do Sul and the Distrito Federal. Three thousand and nineteen studies were evaluated, of which twenty published between the years of 2002 and 2020 were included in this systematic review. In the states of Central-West region, it was possible to verify the occurrence of VL related to epidemiological characteristics that included: climatic variables (temperature and precipitation); socioeconomic factors (male gender; age group from zero to 14 years old; deaths from 40 years old, with emphasis from the 60 years and residents of the urban area); urban infrastructure vulnerability indicators (areas with environmental degradation, occupied by low-income population, with precarious hygienic-sanitary conditions; anthropic disturbances and population agglomerations; densely vegetated and vacant lots containing rubble and material decaying organic matter); presence of the vector (Lutzomyia longipalpis and Lu. cruzi), dogs and other animals; in addition to the migratory process. Studies related to regional aspects of VL epidemiology can help in the adoption of strategies for better effectiveness in its control.

Epidemiological aspects of pediculosis by Pediculus humanus capitis (Phthiraptera: Pediculidae) in Minas Gerais: a systematic review / Aspectos epidemiológicos da pediculose por Pediculus humanus capitis (Phthiraptera: Pediculidae) em Minas Gerais: uma revisão sistemática

Abstract Background Head lice, or head pediculosis, is a parasitosis considered a serious public health problem that affects mainly resource-limited countries. Objective To describe epidemiological aspects of the pediculosis capitis in Minas Gerais, in Brazil. Method This systematic review was conducted through the standards established by the Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). PubMed, LILACS, and SciELO databases, as well as the gray literature, were searched. Results Nine of 1,167 studies were included, published between 1988 and 2019. These studies reported a total prevalence of parasitosis that ranged from 1.4% to 57.4%. The prevalence of head lice ranged from 0.0% to 66.7% for males and 2.3% to 57.4% for females, thus being higher in black-skinned people (1.4% to 40.3%). Regarding age, the highest prevalence was 10-12 years old (45.3%). As for the characteristics of the hair, there was a greater infestation in people with long (16.0% to 79.5%), wavy (0.0% to 44.7%), dark (0.0% to 36.6%), with low capillary density (35.4%), and thick hair (39.2%). Conclusion Head pediculosis affects both sexes, different ages, and races, representing an important health problem in Minas Gerais, not only due to the presence of ectoparasite but also to the secondary complications that can be generated from this parasitism.

Resumo Introdução A pediculose de cabeça é uma parasitose considerada um sério problema de saúde pública, afetando principalmente países com recursos limitados. Objetivo Descrever os aspectos epidemiológicos da pediculose de cabeça em Minas Gerais, Brasil. Método Revisão sistemática conduzida por meio dos padrões estabelecidos pelo Preferred Reporting Items in Systematic Reviews and Metanalyses (PRISMA). Foram pesquisadas as bases de dados PubMed, LILACS e SciELO, bem como a literatura cinza. Resultados Nove de 1.167 estudos foram incluídos, publicados entre 1988 e 2019. Relatou-se uma prevalência total da parasitose que variou de 1,4% a 57,4%. Ela variou de 0,0% a 66,7% para homens e 2,3% a 57,4% para mulheres, sendo maior em pessoas de cor negra (1,4% a 40,3%). Em relação à idade, a maior prevalência foi de 10 a 12 anos (45,3%). Quanto às características dos cabelos, houve maior infestação em pessoas com cabelos longos (16,0% a 79,5%), ondulados (0,0% a 44,7%), escuros (0,0% a 36,6%), com baixa densidade capilar (35,4%) e fios grossos (39,2%). Conclusão A pediculose atinge ambos os sexos, diferentes idades e raças, representando um importante problema de saúde em Minas Gerais, não só pela presença do ectoparasita, mas também pelas complicações secundárias que podem ser geradas desse parasitismo.

Aspects of the epidemiological dynamics of acquired syphilis and gestational syphilis between 2010 and 2021 in a state of the northeast region of Brazil / Aspectos da dinâmica epidemiológica da sífilis adquirida e da sífilis gestacional entre 2010 e 2021 em um estado da região nordeste do Brasil / Aspectos de la dinámica epidemiológica de la sífilis adquirida y la sífilis gestacional entre 2010 y 2021 en un estado de la región noreste de Brasil

To characterize the epidemiological dynamics of acquired syphilis and gestational syphilis in the state of Maranhão, between 2010 and 2021. Methods: Confirmed cases of acquired syphilis between 2010 and 2021 and of gestational syphilis between 2010 and 2020, in the state of Maranhão, available by the Sistema de Informação de Agravos de Notificação (SINAN) were analyzed. Results: The year 2018 had the highest number of reports of acquired syphilis (1.787 cases; p < 0.0001). The municipality of Duque Bacelar (East Mesoregion) had the highest incidence rate (285.5 per 100,000 inhabitants), for acquired syphilis, in the triennium 2016 to 2018. Regarding gestational syphilis, the year 2018 also stood out (1,892 cases; p < 0.0001) as the one with the highest number of records. The municipality of Buriticupu (West Mesoregion) had the highest detection rate of gestational syphilis (42.4 per 1,000 live births) in the biennium 2019 and 2020. Conclusions: The data presented showed municipalities with higher rates of acquired syphilis and gestational syphilis, concentrating located respectively in the East and West Mesoregions of the state of Maranhão. The findings obtained in the present study gather useful information for monitoring areas with a high incidence of the disease, thus contributing to the discussion and implementation of effective strategies to reduce cases.

Caracterizar a dinâmica epidemiológica da sífilis adquirida e da sífilis gestacional no Maranhão, entre 2010 e 2021. Métodos: Foram analisados os casos confirmados de sífilis adquirida entre 2010 e 2021 e de sífilis gestacional entre 2010 e 2020, no Maranhão, disponíveis pelo Sistema de Informação de Agravos de Notificação (SINAN). Resultados: O ano de 2018 teve o maior número de notificações de sífilis adquirida (1.787 casos; p < 0,0001). O município de Duque Bacelar (Mesoregião Oriental) teve a maior taxa de incidência (285,5 por 100.000 habitantes), para a sífilis adquirida, no triênio 2016 a 2018. Em relação à sífilis gestacional, o ano de 2018 também se destacou (1.892 casos; p < 0,0001) como o com o maior número de registros. O município de Buriticupu (Mesoregião Ocidental) teve a maior taxa de detecção de sífilis gestacional (42,4 por mil nascidos vivos) no biênio 2019 e 2020. Conclusões: Os dados apresentados mostraram municípios com maiores taxas de sífilis adquirida e sífilis gestacional, concentrando-se localizados respectivamente nas Mesoregiões Leste e Oeste do Estado do Maranhão. Os achados obtidos no presente estudo reúnem informações úteis para o monitoramento de áreas com alta incidência da doença, contribuindo assim para a discussão e implementação de estratégias eficazes para a redução de casos.

Caracterizar la dinámica epidemiológica de la sífilis adquirida y la sífilis gestacional en el estado de Maranhão, entre 2010 y 2021. Métodos: Se analizaron casos confirmados de sífilis adquirida entre 2010 y 2021 y de sífilis gestacional entre 2010 y 2020, en el estado de Maranhão, disponibles por el Sistema de Informação de Agravos de Notificação (SINAN). Resultados: El año 2018 tuvo el mayor número de reportes de sífilis adquirida (1,787 casos; p < 0,0001). El municipio de Duque Bacelar (Mesorregión Este) tuvo la mayor tasa de incidencia (285,5 por 100.000 habitantes), por sífilis adquirida, en el trienio 2016 al 2018. En cuanto a la sífilis gestacional, también se destacó el año 2018 (1.892 casos; p < 0,0001) como el de mayor número de registros. El municipio de Buriticupu (Mesorregión Oeste) tuvo la tasa más alta de detección de sífilis gestacional (42,4 por 1.000 nacidos vivos) en el bienio 2019 y 2020. Conclusiones: Los datos presentados mostraron municipios con mayores tasas de sífilis adquirida y gestacional, concentrándose respectivamente en las Mesorregiones Este y Oeste del estado de Maranhão. Los hallazgos obtenidos en el presente estudio reúnen información útil para el seguimiento de áreas con alta incidencia de la enfermedad, contribuyendo así a la discusión e implementación de estrategias efectivas para disminuir los casos.

Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis.

INTRODUCTION: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy. METHODS: the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05. RESULTS: cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35). CONCLUSIONS: important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.

Factors associated with Leishmania infantum infection in dogs from urban areas endemic for visceral leishmaniasis in Brazil.

There are gaps in the knowledge of the factors associated with canine visceral leishmaniasis (CVL). Moreover, there is a need for studies conducted with appropriate sample selection and with standardized diagnostic methods, to assess the current infection status of animals. This study analyzed factors associated with Leishmania infantum infection in dogs from urban areas endemic for CVL in Brazil. Data from four cities in different regions of the country (Fortaleza, Brasília, Palmas, and Bauru) were included, encompassing a large and heterogeneous sample group. Dogs were considered infected if they had positive results in parasitological tests (skin lesion culture, histological or immunohistochemical analysis of skin). Data analysis consisted of logistic regression with adjustment for the effect of cities as cluster variables, using generalized estimating equations. The canine positivity for L. infantum was 9.8%. Bauru had the highest percentage (18.7%), followed by Brasília (8.4%), Fortaleza (7.9%), and Palmas (4%). Male animals were twice as likely to be infected as females (Confidence Interval (CI): 1.5-2.8). Dogs living outdoors were 1.5 times more likely to be positive (CI: 1.4-1.6). Dogs living in households rearing chickens were 40% less likely to be infected (CI: 0.5-0.8). A significant multiplicative interaction indicated that a protective association between purebred and CVL was stronger among dogs older than seven years. These findings provide evidence for the role of individual and environmental factors on L. infantum infection in dogs from endemic urban areas. They may be used for identifying groups of animals at higher risk for delivering control interventions.

Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study.

BACKGROUND: Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. METHODS: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. RESULTS: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). CONCLUSIONS: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.

Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019.

BACKGROUND: Syphilis is a chronic infectious disease that has created challenging situations for humanity for centuries. Transmission can occur sexually or vertically, with great repercussions on populations, particularly among women and children. The present study presents information on the main burden imposed by syphilis generated by the Global Burden of Disease (GBD) Study 2019 for Brazil and its 27 federated units. METHODS: We described the metrics of incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), standardized by age and per 100,000 inhabitants, from 1990 to 2019, and we compared the disease burden between the years 1990 and 2019. RESULTS: In Brazil, the disease burden increased between 2005 and 2019 for all metrics. Although a higher incidence of syphilis was found among women in 2019, DALYs [YLLs (males: 15.9%; females: 21.8%), YLDs (males: 25.0%; females: 50.0%), and DALYs (males: 16.2%; females: 22.4%)] were higher among men. In 2019, the highest DALY rate per 100,000 inhabitants was observed in individuals aged above 50 years. The State of Maranhão presented the highest values of DALYs {1990: 165.2 [95% uncertainty interval (UI) 96.2-264.4]; 2005: 43.8 [95% UI 30.3-62.4]; 2019: 29.1 [95% UI 19.8-41.1]} per 100,000 inhabitants in the three years analyzed. CONCLUSIONS: The burden of syphilis has increased in recent years. Men presented higher DALYs, although the incidence of the disease was higher in women. Syphilis affects a large number of people across all age groups, causing different degrees of disability and premature death (DALYs).

Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis / Fatores de risco pré-operatórios associados à fístula anastomótica após colectomia para câncer colorretal: revisão sistemática e metanálise

ABSTRACT Introduction: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy. Methods: the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05. Results: cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35). Conclusions: important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.

RESUMO Objetivo: fístula anastomótica (FA) após colectomia para câncer colorretal (CCR) é complicação grave. Esta revisão sistemática e meta-análise avaliou os fatores de risco pré-operatórios para FA em pacientes submetidos à colectomia. Métodos: a pesquisa bibliográfica abrangeu 15 anos e 9 meses (1 de janeiro de 2005 - 19 de outubro de 2020), sendo utilizadas as plataformas PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC e Web of Science. O critério de inclusão foram estudos transversais, coorte e caso-controle em fatores de risco pré-operatórios para FA (desfecho). A escala Newcastle-Ottawa foi usada para avaliação de viés dos estudos. A metanálise envolveu o cálculo dos efeitos de tratamento para cada estudo individualmente incluindo odds ratio (OR), risco relativo (RR) e intervalo de confiança de 95% (IC95%) com construção de modelo de efeitos aleatórios, para avaliar o impacto de cada variável (p<0,05). Resultados: foram selecionados 39 estudos transversais, 21 coortes e quatro casos-controle. A metanálise identificou 14 fatores de risco para FA em pacientes com CCR após colectomia, que são sexo masculino (RR=1,56; IC 95%=1,40-1,75), tabagismo (RR=1,48; IC 95%=1,30-1,69), alcoolismo (RR=1,35; IC 95%=1,21-1,52), diabetes mellitus (RR=1,97; IC 95%=1,44-2,70), doenças pulmonares (RR=2,14; IC 95%=1,21-3,78), doença pulmonar obstrutiva crônica (RR=1,10; IC 95%=1,04-1,16), doença coronariana (RR=1,61; IC 95%=1,07-2,41), doença renal crônica (RR=1,34; IC 95%=1,22-1,47), altas notas na escala ASA (RR=1,70; IC 95%=1,37-2,09), cirurgia abdominal prévia (RR=1,30; IC 95%=1,04-1,64), cirurgia de emergência (RR=1,61; IC 95%=1,26-2,07), quimioterapia neoadjuvante (RR=2,16; IC 95%=1,17-4,02), radioterapia (RR=2,36; IC 95%=1,33-4,19) e quimiorradioterapia (RR=1,58; IC 95%=1,06-2,35). Conclusões: importantes fatores de risco pré-operatórios para FA colorretais em pacientes com CCR foram identificados com base nas melhores pesquisas baseadas em evidências e esse conhecimento deve influenciar decisões relacionadas ao tratamento.

Factors associated with deaths from dengue in a city in a metropolitan region in Southeastern Brazil: a case-control study

ABSTRACT Background: Dengue is a public health problem in Brazil. Therefore, this study aimed to analyze factors associated with deaths from dengue in residents of the municipality of Contagem, Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil, during the 2016 epidemic. Methods: To determine the factors associated with deaths due to dengue, we used a logistic regression model (univariate and multivariable) in which the response variable (outcome) was death due to dengue. Independent variables analyzed included demographic variables and those related to symptoms, treatment, hospitalization, testing, comorbidities, and case history. Results: The factors associated with dengue deaths in the final multivariable model [p < 0.05; 95% confidence interval (CI)] were age (OR = 1.07; 95%CI 1.03-1.11) and presence of bleeding (OR = 8.55; 95%CI 1.21-59.92). Conclusions: The results showed that age and the presence of bleeding factors increased the risk of dengue death. These findings indicate that warning signs of dengue should be routinely monitored, and patients should be instructed to seek medical attention when they occur. It is also emphasized that the parameters and epidemiological conditions of dengue patients need to be continuously investigated to avoid a fatal outcome.

Prevalence of tungiasis in humans in Brazil and in its federative units: a systematic review

Tungiasis is a neglected parasitic disease caused by penetration of female Tunga penetrans under the skin, causing important health outcomes in humans. Therefore, the aim of this study was to describe the prevalence of tungiasis in Brazil and in its federative units. In November 2019, an investigation was carried out to find studies published from 1980 onwards in MEDLINE, LILACS, Cochrane, CINAHL, Scopus, Web of Science and Embase databases, and in the gray literature, using descriptors related to the prevalence of tungiasis caused by T. penetrans in Brazil. Of the 542 studies found, only 16 published between 2002 and 2010 met the eligibility criteria to be included in this systematic review. Of the 16 selected publications, 14 addressed the prevalence of tungiasis in communities in the Northeast region of the country, one in the South and one in the Southeast. The general prevalence of the parasitosis in the studies ranged from 1.6% to 54.8%, predominantly in the five to nine age group. Eight studies considered the prevalence by gender, ranging from 2.2% to 62.2% for females and 1.1% to 62.5% for males. This systematic review presents an unprecedented survey of the prevalence of tungiasis, a parasitic disease whose dissemination is facilitated by several factors, occuring mainly in low-income communities. Considering the regionalization of the findings, the scarcity of publications, as well as disease neglect, more studies are required.

Epidemiological aspects and spatial analysis of chikungunya fever cases from 2017 to 2021, in a state in the northeast region of Brazil

This study aimed to characterize the epidemiological aspects and perform a spatial analysis of Chikungunya fever cases from 2017 to 2021, in the State of Maranhão, Brazil. This is an ecological, descriptive, observational, and retrospective study, conducted by collecting data on Chikungunya fever's confirmed cases in the State of Maranhão, available on the platform of the Department of Informatics of the Unified Health System. Most cases of Chikungunya fever occurred in the year 2017 (p<0.0001), in females (p=0.54), in people between 20 and 39 years old (p=0.04), and with a high school degree (p=0.25). Regarding the evolution of the disease, most cases were cured (p=0.006). The municipalities that obtained a High/High pattern of spatial correlation for the incidence rates of Chikungunya fever per 100,000 inhabitants in the State of Maranhão were located in the West and South Mesoregions in 2017; North and East in 2018; Central, North and East in 2019; North in 2020; and North, East and South in 2021. The epidemiological situation of Chikungunya fever in the State of Maranhão needs attention from public health agencies. Greater efforts towards vector and outbreaks prevention, as well as the improvement on health education programs that educate the population about the disease are necessary. Mainly in the most affected municipalities in order to effectively involve the population in reducing domestic mosquito breeder sites

Burden of syphilis in Brazil and federated units, 1990-2016: estimates from the Global Burden of Disease Study 2019

ABSTRACT Background: Syphilis is a chronic infectious disease that has created challenging situations for humanity for centuries. Transmission can occur sexually or vertically, with great repercussions on populations, particularly among women and children. The present study presents information on the main burden imposed by syphilis generated by the Global Burden of Disease (GBD) Study 2019 for Brazil and its 27 federated units. Methods: We described the metrics of incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), standardized by age and per 100,000 inhabitants, from 1990 to 2019, and we compared the disease burden between the years 1990 and 2019. Results: In Brazil, the disease burden increased between 2005 and 2019 for all metrics. Although a higher incidence of syphilis was found among women in 2019, DALYs [YLLs (males: 15.9%; females: 21.8%), YLDs (males: 25.0%; females: 50.0%), and DALYs (males: 16.2%; females: 22.4%)] were higher among men. In 2019, the highest DALY rate per 100,000 inhabitants was observed in individuals aged above 50 years. The State of Maranhão presented the highest values of DALYs {1990: 165.2 [95% uncertainty interval (UI) 96.2-264.4]; 2005: 43.8 [95% UI 30.3-62.4]; 2019: 29.1 [95% UI 19.8-41.1]} per 100,000 inhabitants in the three years analyzed. Conclusions: The burden of syphilis has increased in recent years. Men presented higher DALYs, although the incidence of the disease was higher in women. Syphilis affects a large number of people across all age groups, causing different degrees of disability and premature death (DALYs).

Factors associated with the occurrence of dengue epidemics in Brazil: a systematic review.

OBJECTIVE: To identify and describe broadly the factors related to the occurrence of dengue epidemics in Brazil. METHODS: Systematic review of studies published in Medline, Lilacs, PubMed, Cochrane, BVS, Web of Science, Scopus, and thesis and dissertations databases using descriptors cataloged in DeCs and MeSH on dengue and factors associated with the occurrence of epidemics, published from 2008 to 2018. RESULTS: Thirty-five studies carried out in the country were selected. The epidemics recorded in Brazil were associated and/or correlated with multiple factors such as environment, socioeconomic conditions, climate, and aspects related to the vector, among others. CONCLUSIONS: Dengue epidemics are complex and multifactorial. The continuity of the vector control actions was found to be relevant to the reduction of Aedes aegypti and for disease control. To contain the spread of the disease, effective measures are needed in all sectors, including health, education, economy, population, business, and government. Actions for the early detection of cases of the disease can prevent new outbreaks of epidemics.

Factors associated with the occurrence of dengue epidemics in Brazil: a systematic review

[ABSTRACT]. Objective. To identify and describe broadly the factors related to the occurrence of dengue epidemics in Brazil.Methods. Systematic review of studies published in Medline, Lilacs, PubMed, Cochrane, BVS, Web of Sci-ence, Scopus, and thesis and dissertations databases using descriptors cataloged in DeCs and MeSH on dengue and factors associated with the occurrence of epidemics, published from 2008 to 2018.Results. Thirty-five studies carried out in the country were selected. The epidemics recorded in Brazil were associated and/or correlated with multiple factors such as environment, socioeconomic conditions, climate, and aspects related to the vector, among others.Conclusions. Dengue epidemics are complex and multifactorial. The continuity of the vector control actions was found to be relevant to the reduction of Aedes aegypti and for disease control. To contain the spread of the disease, effective measures are needed in all sectors, including health, education, economy, population, business, and government. Actions for the early detection of cases of the disease can prevent new outbreaks of epidemics.

[RESUMEN]. Objetivo. Determinar y describir de manera amplia los factores relacionados con la aparición de epidemias de dengue en Brasil.Métodos. Se llevó a cabo una revisión sistemática de los estudios publicados en MEDLINE, LILACS, PubMed, Cochrane, BVS, Web of Science, Scopus y en bases de datos de tesis y trabajos de final de grado con los descriptores catalogados en DeCS y MeSH sobre dengue y factores asociados con la aparición de epidemias publicados entre 2008 y 2018.Resultados. Se seleccionaron 35 estudios llevados a cabo en Brasil. Las epidemias registradas en el país se asociaron o se relacionaron con diversos factores, como el medioambiente, las condiciones socioeconómi-cas, el clima y aspectos relacionados con el vector, entre otros.Conclusiones. Las epidemias de dengue son complejas y multifactoriales. Se constató que la continuidad de las medidas de control de vectores es pertinente para la reducción de Aedes aegypti, así como para el control de la enfermedad. Para contener la propagación de la enfermedad son necesarias medidas eficaces en todos los sectores, como la salud, la educación, la economía, la población, las empresas y el gobierno. Las medidas de detección temprana de casos de la enfermedad pueden prevenir nuevos brotes de epidemias.

[RESUMO]. Objetivo. Identificar e descrever, de forma geral, os fatores relacionados à ocorrência de epidemias de den-gue no Brasil.Métodos. Revisão sistemática de estudos publicados entre 2008 e 2018 nas bases de dados MEDLINE, LILACS, PubMed, Cochrane, BVS, Web of Science e Scopus e em bancos de teses e dissertações, com o uso de descritores de dengue e de fatores associados à ocorrência de epidemias catalogados no portal DeCS/MeSH.Resultados. Trinta e cinco estudos realizados no Brasil foram selecionados. As epidemias registradas no país foram associadas e/ou correlacionadas a vários fatores como meio ambiente, condições socioeconômicas e climáticas, e aspectos relacionados ao vetor, entre outros.Conclusões. As epidemias de dengue são complexas e multifatoriais. Observou-se que ações contínuas de controle vetorial são essenciais para a redução da população de Aedes aegypti e o controle da doença. Para conter a propagação da dengue são necessárias medidas multissetoriais eficazes, abrangendo saúde, educação, economia, população, negócios e governo. As ações visando à detecção precoce de casos da doença contribuem para prevenir novos surtos epidêmicos.