Effect of piplartine and cinnamides on Leishmania amazonensis, Plasmodium falciparum and on peritoneal cells of Swiss mice.

CONTEXT: Plants of the Piperaceae family produce piplartine that was used to synthesize the cinnamides. OBJECTIVE: To assess the effects of piplartine (1) and cinnamides (2-5) against the protozoa responsible for malaria and leishmaniasis, and peritoneal cells of Swiss mice. MATERIALS AND METHODS: Cultures of Leishmania amazonensis, Plasmodium falciparum-infected erythrocytes, and peritoneal cells were incubated, in triplicate, with different concentrations of the compounds (0 to 256 µg/mL). The inhibitory concentration (IC50) in L. amazonensis and cytotoxic concentration (CC50) in peritoneal cell were assessed by the MTT method after 6 h of incubation, while the IC50 for P. falciparum-infected erythrocytes was determined by optical microscopy after 48 or 72 h of incubation; the Selectivity Index (SI) was calculated by CC50/IC50. RESULTS: All compounds inhibited the growth of microorganisms, being more effective against P. falciparum after 72 h of incubation, especially for the compounds 1 (IC50 = 3.2 µg/mL) and 5 (IC50 = 6.6 µg/mL), than to L. amazonensis (compound 1 = 179.0 µg/mL; compound 5 = 106.0 µg/mL). Despite all compounds reducing the viability of peritoneal cells, the SI were <10 to L. amazonensis, whereas in the cultures of P. falciparum the SI >10 for the piplartine (>37.4) and cinnamides 4 (>10.7) and 5 (= 38.4). DISCUSSION AND CONCLUSION: The potential of piplartine and cinnamides 4 and 5 in the treatment of malaria suggest further pre-clinical studies to evaluate their effects in murine malaria and to determine their mechanisms in cells of the immune system.

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare.

Despite the drastic decrease in the incidence of Chagas disease in Brazil, past cases still greatly impact health services in the country. Thus, this study aimed to characterize Chagas disease cases regarding their cardiac staging and death prognosis and, based on that, to propose primary healthcare (PHC) case follow-ups. This is a cross-sectional study based on secondary data from the medical records of patients with chronic Chagas cardiomyopathy (CCC). A logistic regression was applied to estimate crude and adjusted odds ratios (OR). A total of 433 medical records were evaluated. More severe CCC cases were associated with a greater number of hospitalizations (OR = 3.41; 95%CI: 1.59-7.30) and longer hospitalization (OR = 3.15; 95%CI: 1.79-5.53). Cases with a higher risk of death were associated with a higher number of hospitalizations (OR = 1.92; 95%CI: 1.09-3.37), longer hospital stays (OR = 2.04; 95%CI: 1.30-3.18), and visits to the outpatient clinic (OR = 2.18; 95%CI: 1.39-3.41) and the emergency department of the assessed hospital (OR = 3.12; 95%CI: 1.27-7.66). Analyzing the medical records at two moments, 72.9% of the cases remained in the stages in which they were initially evaluated. Overall, 44.4% of cases were classified as mild to moderate risk of death and 68.3% as low ones. The cases classified in the most severe stages of CCC and with high or intermediate risk of death were associated with greater hospital dependence. However, most cases were classified as milder forms of the disease, with a low risk of death and clinical stability. These findings aim to promote the role of PHC as a protagonist in the longitudinal follow-up of CCC cases in Brazil.

A new focus of spotted fever caused by Rickettsia parkeri in Brazil.

Spotted fever (SF) is a tick-borne zoonosis caused by bacteria of the genus Rickettsia . The disease varies in severity from mild clinical forms to severe cases. In Brazil, Rickettsia rickettsii SF is the most serious rickettsiosis and can result in death if not diagnosed and treated at the onset of symptoms. The SF mild form is caused by Rickettsia parkeri strain Atlantic Rainforest, and this etiological agent has been reported in the South, Southeast and Northeast regions of the country, in areas of preserved or little antropized Atlantic Rainforest. Amblyomma ovale is the proven vector and dogs are the hosts associated with the bioagent cycle. During a SF case investigation in Paraty municipality, Rio de Janeiro State, an Atlantic Rainforest biome area in Southeastern Brazil, the human pathogen R. parkeri strain Atlantic Rainforest was detected by PCR in a sample of human skin inoculation eschar and in a female A. ovale tick collected from a dog. These results expand the known area of occurrence of this mild form rickettsiosis in Brazil. In addition, the results of the present study indicate the importance of implementing programs to control canine ectoparasites and to raise awareness of the risks of infection, signs and symptoms of SF caused by R. parkeri strain Atlantic Rainforest.

Records of Human Deaths from Echinococcosis in Brazil, 1995-2016.

Echinococcosis is a zoonotic disease relevant to public health in many countries, on all continents except Antarctica. The objective of the study is to describe the registered cases and mortality from echinococcosis in Brazil, from 1995 to 2016. The records of two national databases, the Hospital Information System (HIS) and the Mortality Information System (MIS), were accessed during the period of 1995-2016. Demographic, epidemiological, and health care data related to the occurrence of disease and deaths attributed to echinococcosis in Brazil are described. The results showed that 7955 records of hospitalizations were documented in the HIS, during the study period, with 185 deaths from echinococcosis, and 113 records of deaths were documented in the MIS Deaths in every state of Brazil in the period. When comparing between states, the HIS showed great variability in mortality rates, possibly indicating heterogeneity in diagnosis and in the quality of health care received by patients. Less severe cases that do not require specialized care are not recorded by the information systems, thus the true burden of the disease could be underrepresented in the country. A change in the coding of disease records in the HIS in the late 1990s, (the integration of echinococcosis cases with other pathologies), led to the loss of specificity of the records. The records showed a wide geographic distribution of deaths from echinococcosis, reinforcing the need to expand the notification of the disease in Brazil. Currently, notification of cases is compulsory in the state of Rio Grande do Sul.

Amblyomma aureolatum Genetic Diversity and Population Dynamics Are Not Related to Spotted Fever Epidemiological Scenarios in Brazil.

Regional differences in tick-borne disease epidemiology may be related to biological variations between vector populations. Amblyomma aureolatum (Ixodida: Ixodidae), a neotropical tick, is known from several regions in Brazil. However, only in the metropolitan area of São Paulo (SP) state are there studies that establish its role as a vector of a pathogenic rickettsia (Rickettsia rickettsii). The aim of the study was to analyze the genetic diversity, population dynamics, and rickettsia infection in A. aureolatum populations from different spotted fever scenarios in Brazil. Samples were subjected to DNA extraction, amplification and sequencing of 12S rDNA, cytochrome oxidase subunit II and D-loop mitochondrial markers for tick population analyses, and gltA, htrA, ompA, and ompB genes for rickettsia researches. Of the 7-17 tick haplotypes identified, 5-13 were exclusive to each population and 2-12 for each epidemiological scenario, as well as three haplotypes shared by all populations. Amblyomma aureolatum populations are expanding, and do not appear to be genetically structured vis-a-vis the different epidemiological scenarios studied. Rickettsia bellii (in SP) and Rickettsia felis (in Santa Catarina) were identified as infecting A. aureolatum. No relationship between tick haplotypes and rickettsia types were observed.

Spatiotemporal Dynamics of Hantavirus Cardiopulmonary Syndrome Transmission Risk in Brazil.

BACKGROUND: Hantavirus disease in humans is rare but frequently lethal in the Neotropics. Several abundant and widely distributed Sigmodontinae rodents are the primary hosts of Orthohantavirus and, in combination with other factors, these rodents can shape hantavirus disease. Here, we assessed the influence of host diversity, climate, social vulnerability and land use change on the risk of hantavirus disease in Brazil over 24 years. METHODS: Landscape variables (native forest, forestry, sugarcane, maize and pasture), climate (temperature and precipitation), and host biodiversity (derived through niche models) were used in spatiotemporal models, using the 5570 Brazilian municipalities as units of analysis. RESULTS: Amounts of native forest and sugarcane, combined with temperature, were the most important factors influencing the increase of disease risk. Population at risk (rural workers) and rodent host diversity also had a positive effect on disease risk. CONCLUSIONS: Land use change-especially the conversion of native areas to sugarcane fields-can have a significant impact on hantavirus disease risk, likely by promoting the interaction between the people and the infected rodents. Our results demonstrate the importance of understanding the interactions between landscape change, rodent diversity, and hantavirus disease incidence, and suggest that land use policy should consider disease risk. Meanwhile, our risk map can be used to help allocate preventive measures to avoid disease.

Magnitude and distribution of deaths due to hantavirus in Brazil, 2007-2015. / Magnitude e distribuição dos óbitos por hantavirose no Brasil, 2007-2015.

OBJECTIVE: to describe the magnitude and temporal and spatial distribution of hantavirus cases and deaths in Brazil between 2007 and 2015. METHODS: descriptive study with data from the Notifiable Diseases Information System (SINAN). RESULTS: 1,060 cases and 410 deaths were reported in the period; hantavirus lethality was 39.0%, varying according to month (from 28.6% in November to 50.7% in December), sex (37.4% in males and 42.6% in females), age (higher lethality in the elderly and children) and Brazilian regions (46.2% in the North, 32.9% in the South); most of the individuals who died lived in urban areas (58.3%) and were infected in rural area (70.2%). CONCLUSION: high lethality in certain population groups, months of the year and regions of Brazil point to low clinical suspicion of the disease in groups with low exposure, which may compromise proper case management.

Estudo descritivo de casos notificados de febre maculosa em São Paulo, Rio de Janeiro e Minas Gerais entre 2007 e 2016 / Descriptive study of reported cases of spotted fever in São Paulo, Rio de Janeiro and Minas Gerais between 2007 and 2016

Resumo Introdução A febre maculosa é uma doença infecciosa aguda causada por bactérias do gênero Rickettsia e transmitida por carrapatos que pode levar à hospitalização e, eventualmente, a óbito por causa de quadros mais graves. Objetivo O objetivo deste artigo foi descrever o cenário epidemiológico da doença nas três unidades federativas de maior número de notificações e óbitos pela doença no Brasil entre 2007 e 2016. Método Estudo epidemiológico descritivo com base nos dados das fichas de investigação para a doença, sendo analisados dados demográficos, geográficos, ambientais e de hospitalização, diagnóstico e desfecho dos casos na área de estudo. Resultados Foram confirmados 953 casos da doença, em sua maioria por critérios laboratoriais, sendo observada maior prevalência entre homens com idade média de 35 anos, pouco relacionados ao ambiente de trabalho, mas amplamente relacionados ao meio urbano. Do total de casos confirmados, 64% pacientes afirmaram ter tido algum contato com carrapato, assim como com cães (36%), capivaras (20%) e equinos (19%). Conclusão Existem questionamentos a respeito da doença que não foram elucidados neste artigo, entretanto abordagens criativas, validadas e ancoradas na associação de áreas de conhecimento distintas poderão dar bons resultados se objetivamente aplicadas em ações estratégicas da gestão da saúde.

Abstract Background Spotted fever is an acute infectious disease caused by bacteria of the genus Rickettsia and transmitted by ticks, which can lead to hospitalization and, eventually, death due to more severe conditions. Objective The purpose of this article was to describe the epidemiological scenario of the disease in the three federal states with the highest number of notifications and deaths due to the disease in Brazil between 2007 and 2016. Method A descriptive epidemiological study was carried out based on data from the investigation forms for the disease, with data being analyzed on demographic, geographic, environmental, and hospitalization, diagnosis, and outcome of cases in the study area. Results 953 cases of the disease were confirmed, mostly by laboratory criteria, with a higher prevalence being observed among men with an average age of 35 years, little related to the work environment, but largely related to the urban environment. Of the total confirmed cases, 64% of patients said that they had had some contact with ticks, as well as with dogs (36%), capybaras (20%), and horses (19%). Conclusion We believe that there are questions about the disease that were not elucidated in this article, however, creative approaches, validated and anchored in the association of different areas of knowledge can give good results if objectively applied in strategic health management actions.

Fatal case of spotted fever in a patient from Northeastern Brazil.

Spotted fevers are diseases caused by bacterial agents belonging to the spotted-fever (SF) group of the genus Rickettsia. The first documented case of SF in Pernambuco State, Northeast Brazil, was reported here. Also, it is the first case described of fatal SF in Northeast region of Brazil. The patient was a resident of Arcoverde municipality and the probable site of infection lies in Sertania municipality, both in Pernambuco State, a semi-arid region of Brazil. The patient had not visited other areas where SF is endemic. The patient showed clinical manifestations and epidemiological exposure compatible with SF, and the infection was confirmed by molecular biology techniques.

Amblyomma ticks and future climate: Range contraction due to climate warming.

Ticks of the Amblyomma cajennense species complex are important vectors of spotted fever in Latin America. Environmental conditions determine the geographic distribution of ticks, such that climate change could influence the distribution of tick-borne diseases. This study aimed to analyze the potential geographic distribution of A. cajennense complex ticks in a Brazil region under present-day and future climate models, assuming dispersal limitations and non-evolutionary adaptation of these tick populations to climate warming. Records of A. cajennense sensu stricto (s.s.) and Amblyomma sculptum were analyzed. Niche models were calibrated using Maxent considering climate variables for 1950-2000 and projecting models to conditions anticipated for 2050 and 2070 under two models of future climate (CCSM4 and HadGEM2-AO). Broad suitable areas for A. cajennense s.s. and A. sculptum were found in present-day climate models, but suitability was reduced when models were projected to future conditions. Our exploration of future climates showed that broad areas had novel climates not existing currently in the study region, including novel extremely high temperatures. Indeed, predicted suitability in these novel conditions would lead to biologically unrealistic results and therefore incorrect forecasts of future tick-distribution. Previous studies anticipating expansions of vectors populations due to climate change should be considered with caution as they assume that model extrapolation anticipates that species would evolve rapidly for adaptation to novel climatic conditions.

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare / Cardiomiopatia chagásica crônica: caracterização de casos e possibilidades para ação na atenção primária à saúde / Miocardiopatía chagásica crónica: caracterización de los casos y posibilidades de actuación de la atención primaria de salud

Despite the drastic decrease in the incidence of Chagas disease in Brazil, past cases still greatly impact health services in the country. Thus, this study aimed to characterize Chagas disease cases regarding their cardiac staging and death prognosis and, based on that, to propose primary healthcare (PHC) case follow-ups. This is a cross-sectional study based on secondary data from the medical records of patients with chronic Chagas cardiomyopathy (CCC). A logistic regression was applied to estimate crude and adjusted odds ratios (OR). A total of 433 medical records were evaluated. More severe CCC cases were associated with a greater number of hospitalizations (OR = 3.41; 95%CI: 1.59-7.30) and longer hospitalization (OR = 3.15; 95%CI: 1.79-5.53). Cases with a higher risk of death were associated with a higher number of hospitalizations (OR = 1.92; 95%CI: 1.09-3.37), longer hospital stays (OR = 2.04; 95%CI: 1.30-3.18), and visits to the outpatient clinic (OR = 2.18; 95%CI: 1.39-3.41) and the emergency department of the assessed hospital (OR = 3.12; 95%CI: 1.27-7.66). Analyzing the medical records at two moments, 72.9% of the cases remained in the stages in which they were initially evaluated. Overall, 44.4% of cases were classified as mild to moderate risk of death and 68.3% as low ones. The cases classified in the most severe stages of CCC and with high or intermediate risk of death were associated with greater hospital dependence. However, most cases were classified as milder forms of the disease, with a low risk of death and clinical stability. These findings aim to promote the role of PHC as a protagonist in the longitudinal follow-up of CCC cases in Brazil.

Apesar da diminuição importante na incidência da doença de Chagas no Brasil, as infecções ocorridas no passado ainda têm um impacto grande sobre os serviços de saúde no país. Portanto, o estudo buscou caracterizar os casos de doença de Chagas quanto ao estadiamento cardíaco e prognóstico de morte, e com base nisso, propor o seguimento dos casos na atenção primária à saúde (APS). O estudo transversal usou dados secundários dos prontuários de pacientes com cardiomiopatia chagásica crônica (CCC). Foi aplicada a regressão logística para estimar os odds ratios (OR) brutos e ajustados. Foram avaliados 433 prontuários médicos. Casos mais graves de CCC estavam associados com número maior de hospitalizações (OR = 3,41; IC95%: 1,59-7,30) e tempo de internação (OR = 3,15; IC95%: 1,79-5,53). Os casos com risco maior de morte estavam associados com número maior de hospitalizações (OR = 1,92; IC95%: 1,09-3,37), tempo de internação (OR = 2,04; IC95%: 1,30-3,18) e visitas aos ambulatórios (OR = 2,18; IC95%: 1,39-3,41) e serviços de emergência (OR = 3,12; IC95%: 1,27-7,66). Ao analisar os prontuários em dois momentos, 72,9% dos casos permaneceram nos estágios inicialmente avaliados. No total, 44,4% dos casos foram classificados como formas leves a moderadas e 68,3% como risco baixo de morte. Os casos classificados nos estágios mais graves de CCC e com risco de morte alto ou intermediário estavam associados com maior dependência hospitalar. Entretanto, a maioria dos casos foram classificados como formas mais leves da doença, clinicamente estáveis e com baixo risco de morte. Os achados apoiam a promoção do papel da APS como protagonista no seguimento longitudinal dos casos de CCC no Brasil.

A pesar de la drástica disminución de la incidencia de la enfermedad de Chagas en Brasil, los casos infectados en el pasado siguen teniendo un gran impacto en los servicios de salud del país. Por lo tanto, este estudio tuvo como objetivo caracterizar los casos de enfermedad de Chagas en lo que se refiere al estadio cardíaco y al pronóstico de muerte y, con base en eso, proponer el seguimiento de los casos por parte de la atención primaria de salud (APS). Se trata de un estudio transversal basado en datos secundarios de las historias clínicas de los pacientes con miocardiopatía chagásica crónica (MCC). Se aplicó la regresión logística para estimar las odds ratio (OR) crudas y ajustadas. Se evaluaron 433 historias clínicas. Los casos de MCC más graves se asociaron a un mayor número de hospitalizaciones (OR = 3,41; IC95%: 1,59-7,30) y días de hospitalización (OR = 3,15; IC95%: 1,79-5,53). Los casos con mayor riesgo de muerte se asociaron a un mayor número de hospitalizaciones (OR = 1,92; IC95%: 1,09-3,37), días de hospitalización (OR = 2,04; IC95%: 1,30-3,18), y las visitas a los ambulatorios (OR = 2,18; IC95%: 1,39-3,41) y al servicio de urgencias (OR = 3,12; IC95%: 1,27-7,66). Analizando las historias clínicas en dos momentos, el 72,9% de los casos permanecieron en los estadios en los que fueron evaluados inicialmente. En general, el 44,4% de los casos fueron clasificados como formas leves o moderadas y el 68,3% como de bajo riesgo de muerte. Los casos clasificados en los estadios más graves de la MCC y con riesgo de muerte alto o intermedio se asociaron a una mayor dependencia hospitalaria. Sin embargo, la mayoría de los casos fueron clasificados como formas más leves de la enfermedad, con bajo riesgo de muerte y clínicamente estables. Estos resultados pretenden promover el papel de la APS como protagonista en el seguimiento longitudinal de los casos de MCC en Brasil.

A new focus of spotted fever caused by Rickettsia parkeri in Brazil

ABSTRACT Spotted fever (SF) is a tick-borne zoonosis caused by bacteria of the genus Rickettsia . The disease varies in severity from mild clinical forms to severe cases. In Brazil, Rickettsia rickettsii SF is the most serious rickettsiosis and can result in death if not diagnosed and treated at the onset of symptoms. The SF mild form is caused by Rickettsia parkeri strain Atlantic Rainforest, and this etiological agent has been reported in the South, Southeast and Northeast regions of the country, in areas of preserved or little antropized Atlantic Rainforest. Amblyomma ovale is the proven vector and dogs are the hosts associated with the bioagent cycle. During a SF case investigation in Paraty municipality, Rio de Janeiro State, an Atlantic Rainforest biome area in Southeastern Brazil, the human pathogen R. parkeri strain Atlantic Rainforest was detected by PCR in a sample of human skin inoculation eschar and in a female A. ovale tick collected from a dog. These results expand the known area of occurrence of this mild form rickettsiosis in Brazil. In addition, the results of the present study indicate the importance of implementing programs to control canine ectoparasites and to raise awareness of the risks of infection, signs and symptoms of SF caused by R. parkeri strain Atlantic Rainforest.

Perfil epidemiológico dos acidentes com motocicletas durante a pandemia da COVID-19 nos municípios de Minas Gerais, Brasil / Epidemiological profile of motorcycle accidents during the COVID-19 pandemic in the municipalities of Minas Gerais, Brazil

Introdução: As motocicletas têm importante papel como instrumento de trabalho, em função da rapidez de mobilidade e do baixo custo de aquisição no Brasil. Os acidentes de trânsito envolvendo as motocicletas respondem em mais da metade dos óbitos por ano. Nesse sentido, é essencial entender mudanças no perfil dos acidentes com motocicletas, considerando a influência das medidas de isolamento social e o aumento da realização do transporte de mercadorias encomendadas por aplicativo, por meio de motos, no contexto da pandemia da COVID-19. Objetivo: Analisar o perfil epidemiológico das internações e dos óbitos por acidentes com motociclistas, nos municípios de Minas Gerais, comparando-se 2020, ano da pandemia da COVID-19, ao período de 2017-2019. Material e Métodos: Tratou-se de um estudo epidemiológico ecológico descritivo e quantitativo, com informações sobre Morbidade Hospitalar obtida no Departamento de Informática do Sistema Único de Saúde (DATASUS), a partir do Tabulador de Dados (TABNET) e dados populacionais, a partir do Instituto Brasileiro de Geografia e Estatística (IBGE). Calcularam-se número de óbitos e taxas de incidências das internações. Resultados: Na pandemia, as médias de incidências de internações para o sexo masculino nos municípios de pequeno e grande porte decresceram 5,40% e 2,96%, e nos de médio porte aumentaram 6,37%. Ademais, na faixa etária de 20 a 29 anos, as internações nos municípios de pequeno, médio e grande portes tiveram frequências de 34,96%, 39,72% e 39,21% e os óbitos de 27,08%, 23,64% e 25, 93%, respectivamente, no ano de 2020. Conclusão: Apesar dos declínios na pandemia, o estudo mostrou que o sexo masculino ainda predomina nas internações por acidentes com motocicleta, possivelmente, causados pelo aumento de velocidade e desvio da atenção ao utilizar o celular durante serviços de delivery.

Introduction: Motorcycles play an important role as a working tool, due to the speed of mobility and the low cost of acquisition in Brasil. However, the use of these vehicles implies in more than half of the deaths per year caused by traffic accidents. In this sense, it is essential to understand changes in the profile of motorcycle accidents, considering the influence of social isolation measures and the increase in the transport of goods ordered by application, through motorcycles, in the context of the COVID-19 pandemic. Objective: To analyze the epidemiological profile of hospitalizations and deaths from accidents involving motorcyclists in the municipalities of Minas Gerais, comparing 2020, the year of the COVID-19 pandemic, to the 2017-2019 period. Material and Methods: This was a descriptive and quantitative ecological epidemiological study, with information on Hospital Morbidity obtained from the Department of Informatics of the Unified Health System (DATASUS), from Data Tabulator (TABNET) and population data, from the Brazilian Institute of Geography and Statistics (IBGE). The number of deaths and incidence rates of hospitalizations were calculated. Results: In the pandemic, the average incidence of hospitalizations for males in small and large municipalities decreased 5.40% and 2.96%, and in medium-sized ones it increased 6.37%. Furthermore, in the age group from 20 to 29 years, hospitalizations in small, medium and large municipalities had frequencies of 34.96%, 39.72% and 39.21% and deaths of 27.08%, 23.64% and 25, 93% in 2020. Conclusion: Despite the declines in the pandemic, the study showed that males still predominate in hospitalizations due to motorcycle accidents, possibly caused by increased speed and attention diversion when using cell phones during delivery services.

Temáticas de atividades de educação em saúde mais acessadas pelos brasileiros durante a pandemia da COVID-19 / Themes of health education activities most accessed by Brazilians during the COVID-19 pandemic

Introdução: Durante a pandemia, o acesso às informações digitais sobre cuidados com a saúde se ampliou. Objetivo: Evidenciar as temáticas de atividades de educação em saúde mais acessadas pelos brasileiros no período pandêmico. Método: Estudo descritivo, exploratório, retrospectivo e misto, realizado em janeiro de 2021. Os dados foram coletados através de questionário remoto com os enfermeiros, e posteriormente aplicados no Google Trends (GT), referente ao período de abril a agosto de 2020. Os temas foram distribuídos em três dimensões, medidas de prevenção, sinais e sintomas, e cuidados pós testagem positiva. A análise ocorreu conforme a metodologia GT, baseado na distribuição geográfica. Resultados: Sobre as medidas de prevenção, houve maior tendência de acesso ao tema máscaras, com destaque para o estado do Amazonas. Quanto aos sinais e sintomas, o tema febre foi o mais acessado, especialmente na Bahia. E sobre os cuidados pós testagem positiva para COVID-19, prevaleceu quarentena, concentrando no estado de São Paulo. Conclusão: A identificação dos temas de educação em saúde mais acessados pelos brasileiros durante a pandemia fornece subsídios para pensar planos estratégicos. Além disso, os profissionais devem dialogar com as diversas tecnologias digitais disponíveis da sociedade contemporânea, para que tais temas repercutam positivamente na saúde da população.

Introducción: Durante la pandemia, se amplió el acceso a información digital sobre los cuidados de la salud. Objetivo: Destacar los temas de las actividades de educación en salud más accedidos por la población brasileña en el período de la pandemia. Metodo: Estudio descriptivo, exploratorio, retrospectivo y mixto, realizado en enero de 2021. Los datos fueron recolectados a través de cuestionario a distancia con profesionales en enfermería, y posteriormente, aplicados a Google Trends (GT), para el período de abril a agosto de 2020. Los temas fueron distribuidos en tres dimensiones: medidas de prevención, signos y síntomas, y atención posprueba positiva. El análisis se realizó según la metodología GT, basada en la distribución geográfica. Resultados: En cuanto a las medidas de prevención, hubo una mayor tendencia a acceder al tema de las mascarillas, especialmente en el estado de Amazonas. En cuanto a signos y síntomas, el tema de la fiebre fue el más visitado, especialmente en Bahía. Finalmente, con respecto a la atención después de la prueba positiva de COVID-19, predominó la cuarentena, concentrándose en el estado de São Paulo. Conclusión: La identificación de los temas de educación para la salud a los que más ha accedido la población brasileña brasileños durante la pandemia proporciona información para pensar en planes estratégicos. Además, las personas profesionales deben dialogar con las distintas tecnologías digitales disponibles en la sociedad contemporánea, para que estos temas tengan un impacto positivo en la salud de la población.

Introduction: During the pandemic, access to digital healthcare information expanded. Objective: To evidence the themes related to health education activities most accessed by Brazilians during the pandemic. Method: This was a descriptive, exploratory, retrospective, and mixed study carried out in January 2021. The data were collected through a remote questionnaire with nurses and later applied via Google Trends (GT) for the April to August 2020 time period. The themes were distributed in three dimensions: prevention measures, signs and symptoms, and post-positive testing care. The analysis took place according to the GT methodology based on geographic distribution. Results: Regarding prevention measures, there was a greater tendency to access the masks' theme, especially in the state of Amazonas. As for signs and symptoms, the topic of fever was the most accessed, especially in Bahia. Regarding care after COVID-19 positive testing, the theme of quarantine prevailed, concentrating on the state of São Paulo. Conclusion: The identification of the health education themes most accessed by Brazilians during the pandemic provides subsidies to think about strategic plans. In addition, professionals must dialogue with the various digital technologies available in contemporary society, so that such themes have a positive impact on the population's health.

Impactos da COVID-19 nos pacientes oncológicos: uma revisão sistemática / Impacts of COVID-19 on cancer patients: a systematic review

Introdução: Com a pandemia de coronavírus os pacientes oncológicos, que estão em tratamentos, nos quais a maioria são imunossupressores, se tornaram um grupo muito suscetível a formas graves da infecção. Logo, como forma de proteção e prevenção, a realização de exames de rastreio no ambiente hospitalar foi restringida, atrasando diversos diagnósticos e comprometendo a eficácia de tratamentos. Objetivos: Analisar a produção científica acerca do tema câncer e COVID-19, a fim de contribuir com informações sobre o assunto. Métodos: Revisão sistemática da literatura nas bases de dados SciELO, LILACS e PubMed. Os descritores utilizados foram "câncer" AND "COVID-19" de acordo com o Medical Subject Headings (MeSH) e seus equivalentes para a língua portuguesa, conforme os descritores de Ciências da Saúde (DeCS). Foram incluídos artigos originais em inglês e português, sem delimitação temporal. Resultados: Foram encontrados 1.606 artigos e, após utilizar os critérios de inclusão e exclusão, nove foram incluídos para análise na revisão. Dentre os temas centrais abordados pelos estudos selecionados estão o impacto da pandemia em algumas áreas de acompanhamento do paciente oncológico, como: tratamento, telemedicina, diminuição de funcionários no atendimento ao paciente com câncer, diminuição dos ensaios clínicos, redução dos recursos financeiros e apoio psicológico a essa população. Conclusão: A pandemia afetou diretamente o modo de vida desse grupo, que sofreu com uma redução no atendimento médico e nos recursos dispostos a eles. Portanto, nota-se a necessidade de prestar um cuidado mais específico a esses pacientes em situação tão delicada durante a pandemia.

Introduction: During the coronavirus pandemic, oncological patients, who are undergoing treatments in which the majority are immunosuppressant, have become a group very susceptible to severe forms of the infection. Therefore, as a form of protection, their going to hospital environments were restricted, delaying diagnosis and compromising the effectiveness of treatments. Objectives: This study aims to analyze the scientific about the production of the theme cancer and COVID-19 in order to contribute with informations on the subject. Methods: Systematic review of literature using the SciELO, LILACS and PubMed. The following keywords were used: "cancer" AND "COVID-19" according to the Medical Subject Headings (MeSH) and their translation to the Portuguese. Studies in English and Portuguese from inception were included. Results: 1,606 studies were screened and 9 were included in the systematic review after using the inclusion and exclusion criterias. Among the central themes addressed by the selected studies are the pandemic impacts in areas of monitoring oncological patients, such as: treatment, telemedicine, reduction of employees in the care of cancer patients, reduction of clinical trials, reduction of financial resources, and psychological support to that population. Conclusion: The pandemic directly affected the way of life of this group, which suffered from a reduction in medical care and the resources available to them. Therefore, there is a need to provide more specific care to these patients in such a delicate situation during the pandemic.

The impact of mastectomy on body image and sexuality in women with breast cancer: a systematic review / El impacto de la mastectomía en la imagen corporal y en la sexualidad de mujeres con cáncer de mama: una revisión sistemática

Objective: The study aims to evaluate the impact of mastectomy on body image and sexuality of women with breast cancer, as well as to provide a general understanding of their quality of life. Method: This review followed the PRISMA guidelines. The expression “Mastectomy AND (sexuality OR “body image”)” was searched in Lilacs, Scielo, Pubmed and Scopus databases. Articles published in English, Portuguese and Spanish between 2010 and 2020 were selected. The text analysis was carried out by peers. Results: 69.3% (43) of the studies presented mastectomy as a technique that worsens body image, sexual functioning and quality of life of women. Less radical procedures, such as breast-conserving surgery, showed lower impact on these indicators. Breast reconstruction is an alternative to mitigate breast surgery impacts. Conclusion: Mastectomy caused the major impacts on body image, sexual functioning and quality of life. These implications need to be considered during therapeutic choice (AU)

Objetivo: Evaluar el impacto de la mastectomía en la imagen corporal y sexualidad de mujeres con cáncer de mama, y proporcionar una comprensión general de su calidad de vida. Método: Esta revisión siguió las directrices PRISMA. Se buscó la expresión “Mastectomy AND (sexuality OR “body image”)” en las bases de datos Lilacs, Scielo, Pubmed y Scopus. Se seleccionaron artículos publicados en inglés, portugués y español entre 2010 y 2020. Los textos fueron analizados por parejas. Resultados: El 69,3% (43) de los estudios muestran que la mastectomía empeora la imagen corporal, el funcionamiento sexual y la calidad de vida de las mujeres. Procedimientos menos radicales, como la cirugía conservadora de la mama, mostraron menor impacto. La reconstrucción mamaria puede mitigar los impactos de las cirugías. Conclusión: La mastectomía causó mayores impactos con respecto a imagen corporal, funcionamiento sexual y calidad de vida. Estas implicaciones deben considerarse durante la elección terapéutica (AU)

Ten years of a hantavirus disease emergency in the Federal District, Brazil.

INTRODUCTION: Hantavirus diseases are emerging human diseases caused by Hantavirus spp. of the Bunnyaviridae family. Hantavirus pulmonary syndrome (HPS) has been detected in the Federal District (DF) of Brazil since 2004. Among the 27 Brazilian Federal Units, DF has the highest fatality rate. More than 10 years have already passed since then, with confirmation of cases caused by the Araraquara and Paranoa species. The reservoir is Necromys lasiurus. METHODS: Local surveillance data of the confirmed cases were analyzed, including age, sex, month and year of occurrence, clinical symptoms, syndromes and outcomes, and probable transmission place (PTP). The cases were mainly confirmed by IgM detection with a capture enzyme immunoassay. The cases were classified as autochthonous if PTPs were in the DF area. RESULTS: From 2004 to 2013, in the DF, 126 cases of hantavirus were confirmed, and the cumulative incidence was 5.0 per 100,000 inhabitants. The occurrence of cases was predominantly from April to August. At least 75% of the cases were autochthonous. Acute respiratory failure was reported in 47.5% of cases, and the fatality rate was 40%. CONCLUSIONS: In the DF, the cumulative incidence of HPS was one of the highest worldwide. A seasonal pattern of hantavirus disease in the dry season is clear. There was a high frequency of severe clinical signals and symptoms as well as a high fatality rate. For the near future, visitors and inhabitants of DF rural areas, particularly male adults, should receive continuous education about hantavirus transmission and prevention.

A fatal case of Brazilian spotted fever in a non-endemic area in Brazil: the importance of having health professionals who understand the disease and its areas of transmission.

Brazilian spotted fever (BSF) is caused by the bacterium Rickettsia rickettsii. Because of its high case-fatality rate and apparent increase in areas of transmission, it is considered to be the rickettsial illness of primary public health interest. Cases of this disease have historically occurred in Southeastern Brazil. This article reports the first fatal case of BSF in Southern Brazil. This case high lights the importance of BSF to be considered as a differential diagnosis for acute hemorrhagic fever in areas where cases of BSF may not be expected.

Analysis of the spatio-temporal dynamics of incidence, mortality and test rates (rapid and RT-PCR) of COVID-19 in the state of Minas Gerais, Brazil / Análise da dinâmica espaço-temporal da incidência, mortalidade e taxas de testes (rápidos e moleculares) da COVID-19 no estado de Minas Gerais, Brasil / Análisis de la dinámica espacio-temporal de la incidencia, mortalidad y tasas de prueba (rápida e RT-PCR) de COVID-19 en el estado de Minas Gerais, Brasil

Background and Objectives: A novel type of coronavirus, SARS-CoV-2, is responsible for an unprecedented pandemic with profound socioeconomic consequences. Owing to its recent discovery still represents a great unknown to researchers. Thus, this study aims to establish the spatio-temporal associations of the incidence, mortality, and the rate of both rapid and RT-PCR tests in Minas Gerais. Methods: This is a quantitative analysis of secondary data based on a cross-sectional research design. Incidence, mortality, date of the first notification of COVID-19 and number of rapid and RT-PCR tests were obtained from the sources: "GAL", "e-SUS VE" and "SES-MG". Pearson coefficient for correlation was calculated to establish the level of association between the relevant data. Descriptive statistical procedures were used to provide a comprehensive understanding of the distribution of incidence, mortality and test rates in the territory. Results: Positive correlations were found between the rate of rapid tests and incidence; rate of RT-PCR tests and incidence/mortality. At the municipal level, incidence, mortality, rate of rapid tests and RT-PCR revealed a negative correlation with days elapsed since the First Notified Case. The same effect occurs at the level of health macro-regions. Conclusion: The heterogeneity of the incidence and mortality of COVID-19 in the territory of Minas Gerais, as well as the rate of tests may be caused, in part, due to the different dates of introduction of the virus in the municipalities/macro-regions. It is speculated that this phenomenon occurs due to the dynamics of regional and inter-regional flows of people.(AU)

Justificativa e Objetivos: Um novo tipo de coronavírus, SARS-CoV-2, é responsável por uma pandemia sem precedentes com profundas consequências socioeconômicas. Devido à sua recente descoberta, o vírus surgido na cidade chinesa de Wuhan, em dezembro de 2019, ainda lança grandes incógnitas. Este estudo objetiva estabelecer as associações espaço-temporais da incidência; mortalidade; e taxas de testes rápidos e RT-PCR em Minas Gerais. Métodos: Trata-se de uma análise quantitativa de dados secundários a partir de um desenho de pesquisa transversal. Incidência, mortalidade, data da(s) primeira(s) notificações da doença, número de testes rápidos e de RT-PCR foram obtidos nas fontes: "Gerenciador de Ambiente Laboratorial", "e-sus VE" e SES-MG. O coeficiente de Pearson para correlação foi calculado para estabelecer o nível de associação entre os dados relevantes. Técnicas estatísticas descritivas foram empregadas para compreender a distribuição da incidência, mortalidade e taxas de testes no território. Resultados: Correlações positivas foram encontradas entre taxa de testes rápidos e incidência; taxa de testes RT-PCR e incidência/mortalidade. A nível municipal, incidência, mortalidade, taxa de testes rápidos e de RT-PCR têm correlação negativa com dias transcorridos desde o Primeiro Caso Notificado. O mesmo efeito ocorre, em diferentes intensidades, a nível das macrorregiões de saúde. Conclusão: A heterogeneidade da incidência e mortalidade da COVID-19 no território mineiro, assim como, das taxas de testes (rápidos e RT-PCR) pode ser causada, em parte, devido às diferentes datas de introdução do vírus nos municípios/macrorregiões de saúde. Especula-se que esse fenômeno se deve às dinâmicas dos fluxos regionais e inter-regionais de pessoas.(AU)

Justificación y Objetivos: El SARS-CoV-2 es responsable por una pandemia sin precedentes con profundas consecuencias socioeconómicas. Debido a su reciente descubrimiento, este vírus representa una gran incógnita para los investigadores. Así, este estudio tiene como objetivo establecer las asociaciones espacio-temporales de la incidencia, la mortalidad y la tasa de pruebas rápidas y RT-PCR en Minas Gerais. Métodos: Trata-se de un análisis cuantitativo de datos secundarios basado en un diseño de investigación transversal. Incidencia, mortalidad, fecha de la primera notificación de COVID-19 y número de pruebas rápidas y RT-PCR se obtuvieron de las fuentes: "GAL", "e-SUS VE" y "SES-MG". Se calculó el coeficiente de correlación de Pearson para establecer el nivel de asociación entre los datos relevantes. Se utilizaron procedimientos estadísticos descriptivos para proporcionar una comprensión integral de la distribución de la incidencia, la mortalidad y las tasas de prueba en el territorio. Resultados: Se encontraron correlaciones positivas entre la tasa de pruebas rápidas y la incidencia; tasa de pruebas de RT-PCR y incidencia/mortalidad. A nivel municipal, la incidencia, mortalidad, tasa de pruebas rápidas y RT-PCR revelaron una correlación negativa con los días transcurridos desde el Primer Caso Notificado. El mismo efecto ocorre a nivel de macrorregiones de salud. Conclusiones: La heterogeneidad de la incidencia y mortalidad de COVID-19 en el territorio de Minas Gerais, así como la tasa de pruebas puede deberse, en parte, a las diferentes fechas de introducción de la virus en los territorios. Se especula que este fenómeno ocurre debido a la dinámica de los flujos regionales e interregionales de personas.(AU)