The endemisation of schistosomiasis in Porto de Galinhas, Pernambuco, Brazil, 10 years after the first epidemic outbreak.

In 2000, after heavy rains and floods in Porto de Galinhas, Pernambuco, Brazil, an outbreak of schistosomiasis was recorded, of which 62.2% (412 cases) were of the acute clinical form. Between 2001-2009, occasional findings of Biomphalaria snails parasitised by Schistosoma mansoni indicated that disease transmission was still occurring. This motivated a new epidemiological survey between August-December 2010 to provide an update of the occurrence of this health hazard and to investigate the process of disease endemisation at this locality. This survey gathered parasitological, clinical and malacological data. The results of this survey, compared with data from the year 2000 survey, showed the following: (i) over these 10 years, there were declines in the total percentage of cases and the percentage of acute forms, (ii) the acute clinical form now represents 23.3% in contrast with the 62.2% detected in 2000 and (iii) the current prevalence of schistosomiasis is 15.7%, while in 2000 32.1% of the individuals were diagnosed as parasitised. Today, the chronic clinical form represents 76.7% of the total number of cases diagnosed, thus showing that over the 10-year period the occurrences of clinical forms became inverted. These findings, together with visual observation of insalubrious environmental conditions, indicate that schistosomiasis has become endemic in Porto de Galinhas.

Construction and validation of an instrument for assessing the functionality of individuals with schistosomiasis.

OBJECTIVES: to construct and validate an instrument for assessing the functionality of individuals with schistosomiasis. METHODS: methodological study, developed in three stages: 1) construction of the instrument and its association with categories of the International Classification of Functionality, which the study used to elaborate the questions; 2) validation of content, performed by judges experts in the subject; 3) application of the instrument by the test-retest technique in the population with schistosomiasis in 14 days. The study used the correlation coefficient kappa to calculate the degree of agreement between the judges kappa. RESULTS: in its final version, the instrument consists of 27 items, 9 of which are from the Body functions component, 6 from Body structures, 4 from Activity and participation, and 8 from Environmental factors. CONCLUSIONS: the constructed instrument has a biopsychosocial approach, considering four components of the ICF, besides presenting good validity and interobserver reliability.

COVID-19 infection in pregnant women, preterm delivery, birth weight, and vertical transmission: a systematic review and meta-analysis.

In less than four months, the total of confirmed cases of COVID-19 was 1,684,833 worldwide. Outcomes among the public of pregnant women with COVID-19 are still unclear. We performed a systematic review and meta-analysis to analyze whether COVID-19 in pregnant women is related to premature birth and birth weight, and to summarize the diagnostic results of neonates born to mothers with COVID-19 for investigating the possibility of vertical transmission. Searches were performed in PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv, and medRxiv. We used the odds ratio (OR) and mean difference (MD) as measure of analysis. Summary estimates were calculated using random effects models. 38 studies were included; data from 279 women were analyzed; 60 patients were diagnosed with COVID-19. The meta-analysis showed no significant association between COVID-19 and preterm delivery (OR = 2.25; 95%CI: 0.96, 5.31; p = 0.06; I² = 0%). No significant relationship was found between birth weight and COVID-19 (MD = -124.16; 95%CI: -260.54, 12.22; p = 0.07; I² = 0%). Among 432 newborns, 10 were reported with positive results for early SARS-CoV-2. Due to the characteristics of the studies, the level of evidence of this meta-analysis was considered very low. COVID-19 in pregnant women may not be associated with the occurrence of preterm deliveries or the birth weight of the newborn children, however the evidence to date is very uncertain. A few reports suggest vertical transmission of SARS-CoV-2 to newborn is possible, but evidence is still uncertain.

Prediction of cumulative rate of COVID-19 deaths in Brazil: a modeling study.

OBJECTIVE: Estimating the potential number of COVID-19 deaths in Brazil for the coming months. METHODS: The study included all confirmed cases of COVID-19 deaths, from the first confirmed death on March 17th to May 15th, 2020. These data were collected from an official Brazilian website of the Ministry of Health. The Boltzmann function was applied to a data simulation for each set of data regarding all states of the country. RESULTS: The model data were well-fitted, with R2 values close to 0.999. Up to May 15th, 14,817 COVID-19 deaths have been confirmed in the country. Amazonas has the highest rate of accumulated cases per 1,000,000 inhabitants (321.14), followed by Ceará (161.63). Rio de Janeiro, Roraima, Amazonas, Pará, and Pernambuco are estimated to experience a substantial increase in the rate of cumulative cases until July 15th. Mato Grosso do Sul, Paraná, Minas Gerais, Rio Grande do Sul, and Santa Catarina will show lower rates per 1,000,000 inhabitants. CONCLUSION: We estimate a substantial increase in the rate of cumulative cases in Brazil over the next months. The Boltzmann function proved to be a simple tool for epidemiological forecasting that can assist in the planning of measures to contain COVID-19.

Forecasting the rate of cumulative cases of COVID-19 infection in Northeast Brazil: a Boltzmann function-based modeling study.

The COVID-19 death rate in Northeast Brazil is much higher when compared to the national average, demanding a study into the prognosis of the region for planning control measures and preventing the collapse of the health care system. We estimated the potential total cumulative cases of COVID-19 in the region for the next three months. Our study included all confirmed cases, from March 8 until April 28, 2020, collected from the official website that reports the situation of COVID-19 infections in Brazil. The Boltzmann function was applied to a data simulation for each set of data regarding different states. The model data were well fitted, with R2 values close to 0.999. Up to April 28, 20,665 cases were confirmed in the region. The state of Ceará has the highest rate of accumulated cases per 100,000 inhabitants (75.75), followed by Pernambuco. We estimated that the states of Ceará, Sergipe and Paraíba will experience a dramatic increase in the rate of cumulative cases until July 31. Maranhão, Pernambuco, Rio Grande do Norte and Piauí showed a more discreet increase in the model. For Bahia and Alagoas, a 4.7 and 6.6-fold increase in the rate was estimated, respectively. We estimate a substantial increase in the rate of cumulative cases per 100,000 inhabitants in the region within three months, especially for Ceará, Sergipe and Paraíba. The Boltzmann function proved to be a simple tool for epidemiological forecasting that can help planning the measures to contain COVID-19.

[Tuberculosis among children and adolescents: an epidemiological and spatial analysis in the state of Sergipe, Brazil, 2001-2017]. / Tuberculose em crianças e adolescentes: uma análise epidemiológica e espacial no estado de Sergipe, Brasil, 2001-2017.

Tuberculosis continues to be of the most frequent diseases in the world and one of the main causes of morbidity and mortality. Data from the World Health Organization indicate that Brazil accounts for 75% of global cases involving children. The study aims to analyze the epidemiological and spatial pattern of tuberculosis in children and adolescents in the state of Sergipe during the period from 2001 to 2017. This is an ecological, temporal series study using secondary data. The categorical variables were summarized in simple and absolute frequency. In the spatial analysis the Bayesian method for rate smoothing and the Moran index were used to evaluate spatial autocorrelation. Trend analysis was performed using the Joinpoint regression model. The mean incidence rate was 5.9, with a predominance of 15 to 19 years of age (76.4%) and a steady trend, but with a positive annual variation in both sexes. Tuberculosis in children and adolescents has significant spatial dependence in the north and northeast regions. The knowledge of the epidemiological situation of tuberculosis over the years provides subsidies for the targeting of resources in risk areas and new strategies for prevention and control of the disease among children and adolescents.

A tuberculose continua como uma das doenças mais frequentes no mundo e uma das principais causas de morbimortalidade. Dados da Organização Mundial de Saúde indicam que o Brasil responde por 75% dos casos mundiais envolvendo crianças. O estudo objetiva analisar o padrão epidemiológico e espacial da tuberculose em crianças e adolescentes no estado de Sergipe durante o período de 2001 a 2017. Trata-se de um estudo ecológico, de serie temporal, com uso de dados secundários. As variáveis categóricas foram sumarizadas em frequência simples e absoluta. Na análise espacial foi utilizado o método bayesiano para suavização de taxas e o índice de Moran para avaliar a autocorrelação espacial. A análise de tendência foi realizada por meio do modelo de regressão Joinpoint. Verificou que a taxa média de incidência foi de 5,9 com predomínio na faixa etária 15 a 19 anos (76,4%) e tendência estacionaria, porém com variação anual positiva em ambos os sexos. A tuberculose em crianças e adolescentes apresenta dependência espacial significante nas regiões norte e nordeste. O conhecimento da situação epidemiológica da tuberculose ao longo dos anos fornece subsídios para o direcionamento de recursos em áreas de risco e às novas estratégias de prevenção e controle da doença em crianças e adolescentes.

Quality of tuberculosis information systems after record linkage.

OBJECTIVE: to analyze the quality of a tuberculosis notification information system after record linkage and spatial and temporal distribution of tuberculosis in a Brazilian state. METHOD: an ecological study carried between 2006 and 2016 in Sergipe, Brazil. A deterministic linkage was performed with Notifiable Diseases Information System and Mortality Information System, recording 7,873 cases and 483 deaths. The temporal trend of tuberculosis incidence was calculated. RESULTS: there was an increase among men (2.75%), > 60 years (6.29%), higher education (4.34%) and indigenous (4.76%). A total of 190 new cases (2.9%) was found. There was an increasing trend in tuberculosis incidence with a concentration of deaths in the metropolitan region. CONCLUSION: the quality of the information system showed fragility in identifying cases and deaths in Sergipe. Temporal distribution showed an increasing trend in tuberculosis incidence, and spatial distribution identified higher incidences in southeastern Brazil.

Surveillance of the first cases of COVID-19 in Sergipe using a prospective spatiotemporal analysis: the spatial dispersion and its public health implications.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has become a global public health emergency with lethality ranging from 1% to 5%. This study aimed to identify active high-risk transmission clusters of COVID-19 in Sergipe. METHODS: We performed a prospective space-time analysis using confirmed cases of COVID-19 during the first 7 weeks of the outbreak in Sergipe. RESULTS: The prospective space-time statistic detected "active" and emerging spatio-temporal clusters comprising six municipalities in the south-central region of the state. CONCLUSIONS: The Geographic Information System (GIS) associated with spatio-temporal scan statistics can provide timely support for surveillance and assist in decision-making.

Spatial and temporal analysis of the human immunodeficiency virus in an area of social vulnerability in Northeast Brazil.

Human Immunodeficiency Virus (HIV) infection still represents an important public health problem, because it involves clinical, epidemiological, social, economic and political issues. We analyzed the temporal and spatial pattern of the HIV incidence in an area of social inequality in northeast Brazil and its association with socioeconomic indicators. An ecological study was carried out with a focus on all HIV cases reported in Alagoas State, Northeast Brazil from 2007 to 2016 using its 102 municipalities as the units of our analysis. Data from the Brazilian information systems were used. Georeferenced data were analyzed using TerraView 4.2.2 software, QGis 2.18.2 and GeoDa 1.14.0. Time trend analyses were performed by the Joinpoint Regression software and the spatial analyses included the empirical Bayesian model and Moran autocorrelation. Spatial regression was used to determine the influence of space on HIV incidence rate and socioeconomic inequalities. There was an increasing trend of HIV rates, especially in the municipalities of the interior. Significant spatial correlations were observed with the formation of clusters with emphasis on the coast of the state and in tourist regions. Spatial regression explained 46% of the dependent variable. The HIV incidence rate was positively influenced by rate of primary health care units (P=0.00), and negatively by Gini index (P=0.00) and proportion of heads of household without or low education (P=0.02). We conclude that the relationship found between indicators of better socioeconomic conditions and HIV infection suggests unequal access to the diagnosis of infection. Prevention and control strategies can be established according to each epidemiological reality.

Elevated prevalence of high-risk HPV in healthy oral mucosa of users and nonusers of drugs in Northeastern Brazil.

Variable rates of HPV infection have been reported in healthy oral mucosa worldwide. The main objective of this study was to detect and genotype HPV infection in users and nonusers of drugs with clinically healthy mucosa from the Northeast Brazil. Samples from 105 patients were amplified using the primers MY09/MY11 and GP5+/GP6+, and genotyping was performed by multiplex-PCR for HPV-6/11, 16 and 18. A total of 81.9% samples were positive. Among drug users, 84.5% presented the virus and 20.4% showed multiple infections. Among non-drug users, 78.7% were positive and 13.5% had multiple infections. Limited information is available on oral HPV in Brazilian population, especially for drug users, and our results showed higher HPV infection rates in both users and nonusers of drugs. More studies and researches focused on drug users including factors like sexual behavior, nutrition and cultural habits are necessary to enhance the comprehension of this relationship, and develop preventive strategies.

Spatial analysis and temporal trends of suicide mortality in Sergipe, Brazil, 2000-2015.

BACKGROUND: The World Health Organization defines suicide as the act of deliberately killing oneself. It is the second leading cause of death among 15-29 year olds globally. OBJECTIVE: To analyze the epidemiological profile and the spatial distribution of suicide deaths in the state of Sergipe. METHODS: We performed an ecological time-series study with data from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) about deaths by suicide occurring between 2000 and 2015. We considered as suicide deaths cases recorded as voluntary self-inflicted injuries. Suicide rates were estimated and age-adjusted in the population above 9 years. We analyzed temporal trends by sex and age groups using the simple linear regression model. For the spatial analysis, we performed Kernel density estimation with the software TerraView version 4.2.2. RESULTS: We identified 1,560 suicide cases in the state of Sergipe between 2000 and 2015, with a mean of 97.5 cases per year. We also observed that suicide rates in the state increased 102.3% (from 2.69/100,000 population in 2000 to 5.44 in 2015). Suicides occurred predominantly among males (1,160 cases; 74.35%), single people (1,010 cases; 64.7%), and brown-skinned people (1,039 cases; 66.6%). We observed significantly growing temporal trends in the general population, especially among male adults. Spatial analysis allowed us to draw a map that showed the regions with the highest occurrence of suicide. CONCLUSION: We observed growing suicide trends in the state of Sergipe and the spatial analysis was an important tool that showed the areas with higher incidences of suicide.

Space-time risk clusters of Covid-19 in a tourism area in the northeastern Brazil: an epidemiological overview after two years of pandemic

The world is facing a serious viral infection caused by the new Severe Acute Respiratory Syndrome Coronavirus 2. We aimed to evaluate and map the high-risk clusters of COVID-19 in the State of Alagoas, a touristic area in northeastern Brazil, after two years of pandemic by a population-based ecological study, using COVID-19 cases reported in the State of Alagoas, between March, 2020 and April, 2022. We performed a descriptive and statistical analysis of epidemiological data. We then map high-risk areas for COVID-19, using spatial analysis, considering the incidence rate by municipality. 297,972 positive cases were registered; 56.9% were female and 42.7% aged between 20 and 39 years old. Men (OR = 1.59) and older than 60 years old (OR = 29.64) had a higher risk of death, while the highest incidence rates of the disease occurred in the metropolitan region. Our data demonstrate the impact of COVID-19 in the State of Alagoas, through the two years of pandemic. Although the number of cases were greater among women and young adults, the chance of death was greater among men and older adults. High-risk clusters of the disease initially occur in metropolitan cities and tourist areas.

Evaluation of the schistosomiasis control program (PCE) in an endemic area, northeastern Brazil: a population-based and 10-year time series study

Schistosomiasis is an endemic disease in Brazil and the State with the highest positive rate in the country is Sergipe. Herein, we assessed data from the Brazilian Schistosomiasis Control Program (PCE) in the State of Sergipe between the period 2008 and 2017. We evaluated data about schistosomiasis and snails of the genus Biomphalaria. We used the log-linear regression model (joinpoint) to assess temporal trends and the Kernel estimator for spatial statistics analysis. According to the PCE, Sergipe has 51 endemic municipalities for schistosomiasis. Nevertheless, information about the disease and that collected by the PCE has not been recorded regularly in all endemic municipalities. Additionally, only nine municipalities (17.6%) carried out the malacological survey. The average of positive rate from schistosomiasis in Sergipe was 8.4%. However, our data suggest that it may be underestimated. The spatial analysis maps (Kernel maps) showed areas of high transmission of the disease in municipalities close to the São Francisco River and in the metropolitan region of the State. Altogether, our findings suggest that schistosomiasis has been underreported and it is still a serious public health concern in Sergipe. In addition, there are significant failures in the conduction of PCE's activities by the municipalities.

Construction and validation of an instrument for assessing the functionality of individuals with schistosomiasis / Construcción y validación de instrumento de evaluación del funcionamiento de individuos con esquistosomiasis / Construção e validação de instrumento de avaliação da funcionalidade de indivíduos com esquistossomose

ABSTRACT Objectives: to construct and validate an instrument for assessing the functionality of individuals with schistosomiasis. Methods: methodological study, developed in three stages: 1) construction of the instrument and its association with categories of the International Classification of Functionality, which the study used to elaborate the questions; 2) validation of content, performed by judges experts in the subject; 3) application of the instrument by the test-retest technique in the population with schistosomiasis in 14 days. The study used the correlation coefficient kappa to calculate the degree of agreement between the judges kappa. Results: in its final version, the instrument consists of 27 items, 9 of which are from the Body functions component, 6 from Body structures, 4 from Activity and participation, and 8 from Environmental factors. Conclusions: the constructed instrument has a biopsychosocial approach, considering four components of the ICF, besides presenting good validity and interobserver reliability.

RESUMEN Objetivos: construir y validar instrumento de evaluación del funcionamiento de individuos con esquistosomiasis. Métodos: estudio metodológico, desarrollado en tres etapas: 1) Construcción del instrumento y su asociación con categorías de la Clasificación Internacional del Funcionamiento, que fueron usadas para elaborar las preguntas; 2) Validez de contenido, realizada por jueces especialistas en la temática; 3) Aplicación del instrumento por la técnica de test-retest en la población con esquistosomiasis en el intervalo de 14 días. Para cálculo del grado de concordancia entre los jueces, se utilizó el coeficiente de correlación kappa. Resultados: en su versión final, el instrumento se constituyó por 27 ítems, siendo 9 del componente de Funciones del cuerpo, 6 de Estructuras del cuerpo, 4 de Actividad y participación y 8 de Factores ambientales. Fue considerado válido y confiable. Conclusiones: el instrumento construido tiene abordaje biopsicosocial, considerando cuatro componentes de la CIF, además de presentar buena validez y confiabilidad interobservador.

RESUMO Objetivos: construir e validar um instrumento de avaliação da funcionalidade de indivíduos com esquistossomose. Métodos: estudo metodológico, desenvolvido em três etapas: 1) Construção do instrumento e associação deste com categorias da Classificação Internacional de Funcionalidade, que foram usadas para elaborar as perguntas; 2) Validação de conteúdo, realizada por juízes especialistas na temática; 3) Aplicação do instrumento pela técnica de teste-reteste na população com esquistossomose no intervalo de 14 dias. Para o cálculo do grau de concordância entre os juízes, utilizou-se o coeficiente de correlação kappa. Resultados: em sua versão final, o instrumento constitui-se por 27 itens, sendo 9 do componente de Funções do corpo, 6 de Estruturas do corpo, 4 de Atividade e participação e 8 de Fatores ambientais. Foi considerado válido e confiável. Conclusões: o instrumento construído tem abordagem biopsicossocial, considerando quatro componentes da CIF, além de apresentar boa validade e confiabilidade interobservador.

Spatial analysis of viral hepatitis and schistosomiasis coinfection in an endemic area in Northeastern Brazil.

INTRODUCTION:: This cross-sectional study analyzed the spatial distribution of hepatitis B or C virus (HBV/HBC) and schistosomiasis coinfection. METHODS:: Serum samples were collected from patients with Schistosoma mansoni infection. These were tested for serological markers of HBV/HCV infection. The spatial distribution of coinfection was analyzed using intensity kernel estimation. RESULTS:: Overall, 9.4% of individuals had contact with HBV and 1.7% of samples tested positive for anti-HCV antibodies. We identified clusters of risk located in the central region. CONCLUSIONS:: Spatial analysis allowed visualization of high-risk areas, leading to a definition of priority areas to be targeted for intensification of control interventions.

Spatial analysis for the identification of risk areas for schistosomiasis mansoni in the State of Sergipe, Brazil, 2005-2014.

INTRODUCTION:: Schistosomiasis is a parasitic infectious disease with a worldwide prevalence. The objective of this work is to identify risk areas for schistosomiasis mansoni transmission in the State of Sergipe, Brazil, during the period from 2005 to 2014. METHODS:: We conducted an epidemiological study with secondary data from the Information System Control Program of Schistosomiasis [Sistema de Informação do Programa de Controle da Esquistossomose (SISPCE)]. Temporal trends were analyzed to obtain the annual percentage change (APC) in the rates of annual prevalence. In addition to the description of general indicators of the disease, the spatial analysis was descriptive, by means of the estimator of intensity kernel, and showed spatial dependence by indicators of global Moran (I) and Local Index of Spatial Association (LISA). Thematic maps of spatial distribution were made, identifying priority intervention areas in need of healthcare. RESULTS:: There were 78,663 cases of schistosomiasis, with an average of 8.7% positivity recorded; 79.8% of the cases were treated, and Sergipe showed a decreasing positive trend (APC: -2.78). There was the presence of spatial autocorrelation and a significant global Moran index (I = 0.19; p-value = 0.03). We identified clusters of high-risk areas, mainly located in the northeast and southcentral of the state, which each had equally high infection rates. CONCLUSIONS:: There was a decreasing positive trend of schistosomiasis in Sergipe. Spatial analysis identified the geographic distribution of risk and allowed the definition of priority areas for the maintenance and intensification of control interventions.

Desenvolvimento de um instrumento de avaliação para o método Pilates baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde / Development of an evaluation instrument for the Pilates method based on the International Classification of Functioning, Disability and Health

Há uma escassez em evidências científicas acerca de instrumentos de avaliação validados e padronizados aplicados ao Pilates. Diante da importância de uma análise individualizada e holística de cada paciente/cliente para melhor aplicação do método, faz-se necessário a construção de instrumentos que possuam uma abordagem biopsicossocial. Objetivo: Desenvolver um instrumento de avaliação para o Pilates, baseado na da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Métodos: A pesquisa foi realizada em quatro etapas. Levantamentos de informações sobre a avaliação no método Pilates, associação das informações com categorias da CIF, estudo Delphi, construção do instrumento. As informações foram obtidas por meio de um a scoping review e entrevistas com fisioterapeutas que trabalham com o Pilates, para construção as informações obtidas foram vinculadas com as categorias da CIF por dois pesquisadores de forma independente, em caso de discordância um terceiro julgaria a mais pertinente. Em seguida, foi realizado um estudo Delphi, para selecionar as categorias mais relevantes para compor o instrumento. Por fim, a construção do instrumento por três pesquisadores com conhecimento em Pilates e CIF. Resultados: O instrumento foi constituído por 49 categorias da CIF, distribuídas em 33 questões, sendo, 10 de funções do corpo, duas de estruturas do corpo, 16 de atividade e participação e, cinco dos fatores ambientais. Conclusão: O estudo possibilitou a construção de um instrumento que visa facilitar a compreensão do estado de saúde do paciente a partir de uma avaliação já realizada em cada serviço e, ao final será proporcionado uma linguagem comum.

There is a lack of scientific evidence on validated and standardized evaluation instruments applied to Pilates. Given the importance of an individualized and holistic analysis of each patient/client for a better application of the method, it is necessary to build instruments that have a bio-psychosocial approach. Objective: To develop an evaluation instrument for Pilates, based on the International Classification of Functioning, Disability and Health (ICF). Methods: The research was carried out in four stages. This is a survey of information about the assessment in the Pilates method, association of information with ICF categories, Delphi study, construction of the instrument. The information was obtained through a scoping review and interviews with physical therapists who work with Pilates. For the construction of the instrument, the information obtained was independently linked to the ICF categories by two researchers, and in case of disagreement a third party would judge the most pertinent. Next, a Delphi study was carried out to select the most relevant categories to compose the instrument; finally, the construction of the instrument by three researchers with knowledge about Pilates and ICF. Results: The instrument was made up of 49 ICF categories, distributed among 33 questions, being ten of body functions, two of body structures, 16 of activity and participation, and five of environmental factors. Conclusion: The study allowed the construction of an instrument that aims to facilitate the understanding of the patient's health status from an evaluation already performed in each service and, at the end, will provide a common language.

COVID-19 infection in pregnant women, preterm delivery, birth weight, and vertical transmission: a systematic review and meta-analysis / COVID-19 em gestantes, parto prematuro, peso ao nascer e transmissão vertical: uma revisão sistemática e metanálise / Infección por COVID-19 en mujeres embarazadas, parto pretérmino, peso al nacer y transmisión vertical: una revisión sistemática y metaanálisis

In less than four months, the total of confirmed cases of COVID-19 was 1,684,833 worldwide. Outcomes among the public of pregnant women with COVID-19 are still unclear. We performed a systematic review and meta-analysis to analyze whether COVID-19 in pregnant women is related to premature birth and birth weight, and to summarize the diagnostic results of neonates born to mothers with COVID-19 for investigating the possibility of vertical transmission. Searches were performed in PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv, and medRxiv. We used the odds ratio (OR) and mean difference (MD) as measure of analysis. Summary estimates were calculated using random effects models. 38 studies were included; data from 279 women were analyzed; 60 patients were diagnosed with COVID-19. The meta-analysis showed no significant association between COVID-19 and preterm delivery (OR = 2.25; 95%CI: 0.96, 5.31; p = 0.06; I² = 0%). No significant relationship was found between birth weight and COVID-19 (MD = -124.16; 95%CI: -260.54, 12.22; p = 0.07; I² = 0%). Among 432 newborns, 10 were reported with positive results for early SARS-CoV-2. Due to the characteristics of the studies, the level of evidence of this meta-analysis was considered very low. COVID-19 in pregnant women may not be associated with the occurrence of preterm deliveries or the birth weight of the newborn children, however the evidence to date is very uncertain. A few reports suggest vertical transmission of SARS-CoV-2 to newborn is possible, but evidence is still uncertain.

O número de casos confirmados de COVID-19 no mundo ultrapassou 1.684.833 em apenas quatro meses. Ainda não há evidências claras sobre os efeitos da COVID-19 em gestantes. Realizamos uma revisão sistemática e meta-análise em gestantes para esclarecer se a COVID-19 tem relação com a prematuridade e o peso ao nascer, além de resumir os resultados diagnósticos em recém-nascidos de mães com COVID-19 para investigar a possibilidade de transmissão vertical. Foram realizadas buscas em PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv e medRxiv. Como medidas de análise, utilizamos a razão de chances (OR) e a diferença média (DM). Foram calculadas estimativas sintéticas com o uso de modelos de efeitos randômicos. Trinta e oito estudos foram incluídos, com análise de dados de 279 mulheres, 60 das quais diagnosticadas com COVID-19. A meta-análise não mostrou associação significativa entre COVID-19 e parto prematuro (OR = 2,25; IC95%: 0,96, 5,31; p = 0,06; I² = 0%). Não houve relação significativa entre peso ao nascer e COVID-19 (DM = -124,16; IC95%: -260,54, 12,22; p = 0,07; I² = 0%). Entre 432 recém-nascidos, 10 testaram positivos para SARS-CoV-2. Devido às características dos estudos, o nível de evidências do estudo foi considerado muito baixo. A COVID-19 em gestantes pode não estar associada à ocorrência de prematuridade ou peso ao nascer, mas as evidências acumuladas até o momento não são conclusivas. Alguns relatos sugerem que a transmissão vertical do SARS-CoV-2 para o feto seja possível, mas as evidências ainda são incompletas.

En menos de cuatro meses, el total de casos confirmados de COVID-19 fue 1.684.833 en todo el mundo. Los resultados entre el colectivo de mujeres embarazadas con COVID-19 son todavía poco claros. Realizamos una revisión sistemática y metaanálisis para analizar si el COVID-19 en mujeres embarazadas está relacionado con el parto prematuro y peso al nacer, así como para resumir los resultados diagnósticos de los neonatos nacidos de madres con COVID-19, con el fin de investigar la posibilidad de una transmisión vertical. Las búsquedas se realizaron en PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv y medRxiv. Usamos odds ratio (OR) y la diferencia media (MD por sus siglas en inglés) como medida de análisis. El resumen estima que se calcularon usando modelos de efectos aleatorios. Se incluyeron 38 estudios; se analizaron datos de 279 mujeres; 60 pacientes fueron diagnosticados con COVID-19. El metaanálisis mostró que no hubo una asociación significativa entre la COVID-19 y el parto pretérmino (OR = 2,25; 95%CI: 0,96, 5,31; p = 0,06; I² = 0%). No se encontró una relación significativa entre el peso al nacer y el COVID-19 (MD = -124,16; IC95%: -260,54, 12,22; p = 0,07; I² = 0%). Entre 432 recién nacidos, 10 fueron diagnosticados como positivos tempranamente en SARS-CoV-2. Debido a las características de los estudios, el nivel de evidencia de este metaanálisis fue considerado como muy bajo. La COVID-19 en mujeres embarazadas, tal vez no está asociada con la ocurrencia de partos prematuros, o peso al nacer en niños recién nacidos, no obstante, la evidencia hasta la fecha es muy dudosa. Algunos informes sugieren que la transmisión vertical del SARS-CoV-2 al recién nacido es posible, pero la evidencia todavía no está clara.

Forecasting the rate of cumulative cases of COVID-19 infection in Northeast Brazil: a Boltzmann function-based modeling study / Projeção da taxa de casos acumulados de COVID-19 no Nordeste brasileiro: um estudo de modelagem com base na função de Boltzmann / Previsión de la tasa de incidencia acumulada por infección de COVID-19 en la región nordeste de Brasil: un estudio de modelado basado en funciones de Boltzmann

Abstract: The COVID-19 death rate in Northeast Brazil is much higher when compared to the national average, demanding a study into the prognosis of the region for planning control measures and preventing the collapse of the health care system. We estimated the potential total cumulative cases of COVID-19 in the region for the next three months. Our study included all confirmed cases, from March 8 until April 28, 2020, collected from the official website that reports the situation of COVID-19 infections in Brazil. The Boltzmann function was applied to a data simulation for each set of data regarding different states. The model data were well fitted, with R2 values close to 0.999. Up to April 28, 20,665 cases were confirmed in the region. The state of Ceará has the highest rate of accumulated cases per 100,000 inhabitants (75.75), followed by Pernambuco. We estimated that the states of Ceará, Sergipe and Paraíba will experience a dramatic increase in the rate of cumulative cases until July 31. Maranhão, Pernambuco, Rio Grande do Norte and Piauí showed a more discreet increase in the model. For Bahia and Alagoas, a 4.7 and 6.6-fold increase in the rate was estimated, respectively. We estimate a substantial increase in the rate of cumulative cases per 100,000 inhabitants in the region within three months, especially for Ceará, Sergipe and Paraíba. The Boltzmann function proved to be a simple tool for epidemiological forecasting that can help planning the measures to contain COVID-19.

Resumo: A Região Nordeste do Brasil tem uma taxa de letalidade muito mais elevada por COVID-19, comparado com a média nacional, o que exige uma investigação do prognóstico da região para o planejamento de medidas de controle e para prevenir o colapso do sistema de saúde. Estimamos o total potencial de casos acumulados de COVID-19 na região nos próximos três meses. O estudo incluiu todos os casos confirmados de COVID-19, desde o primeiro caso confirmado, em 8 de março, até 28 de abril de 2020, coletados no site oficial que relata a situação das infecções por COVID-19 no Brasil. A função de Boltzmann foi aplicada a uma simulação de dados para cada conjunto de dados dos diversos estados do Nordeste. Os dados do modelo mostraram bom ajuste, com valores de R2 próximos a 0,999. Até 28 de abril, haviam sido confirmados 20.665 casos na Região Nordeste. O estado do Ceará apresenta a maior taxa de casos acumulados por 100.000 habitantes (75,75), seguido pelo estado de Pernambuco. Estimamos que Ceará, Sergipe e Paraíba apresentarão um aumento dramático na taxa de casos acumulados até 31 de julho. Maranhão, Pernambuco, Rio Grande do Norte e Piauí mostraram aumentos mais discretos de acordo com o modelo. Para Bahia e Alagoas, foram estimados aumentos de 4,7 e 6,6 vezes nas taxas, respectivamente. Estimamos um aumento substancial na taxa de casos acumulados por 100.000 habitantes na Região Nordeste ao longo dos próximos três meses, especialmente no Ceará, Sergipe e Paraíba. A função de Boltzmann mostrou ser uma ferramenta simples para projeções epidemiológicas, podendo auxiliar no planejamento de medidas para conter a COVID-19.

Resumen: La región del nordeste brasileño cuenta con una tasa de mortalidad mucho más alta debido a la COVID-19, si se compara con la media nacional, por lo que es necesario un estudio en la prognosis de la región para planificar medidas de control y prevenir el colapso del sistema de salud. Estimamos el potencial total acumulativo de casos de COVID-19 en esta región durante los próximos tres meses. El estudio incluyó todos los casos confirmados de COVID-19, desde el primer caso, confirmado el 8 de marzo, hasta el 28 de abril de 2020, recogido del sitio web oficial que informa la situación de las infecciones por COVID-19 en Brasil. La función de Boltzmann se aplicó a la simulación de datos para cada conjunto de datos, referentes a diferentes estados. El modelo de datos estuvo bien ajustado, con valores R2 cercanos a 0,999. Hasta el 28 de abril, se confirmaron 20.665 casos en la región. Ceará contó con la tasa más alta de incidencia acumulada por 100.000 habitantes (75,75), seguida de Pernambuco. Estimamos que Ceará, Sergipe y Paraíba sufrirán un dramático aumento en la tasa de incidencia acumulada de casos hasta el 31 de julio. Maranhão, Pernambuco, Rio Grande do Norte y Piauí mostraron un incremento más discreto en este modelo. En el caso de Bahía y Alagoas, se estimó un incremento de un 4,7 y 6,6, respectivamente. Estimamos un aumento sustancial en la tasa de incidencia acumulada de casos por 100.000 habitantes dentro de esta región, respecto a los tres próximos meses, especialmente en Ceará, Sergipe y Paraíba. La función de Boltzmann probó ser una herramienta simple para la previsión epidemiológica que puede ser de ayuda en la planificación de medidas para contener a la COVID-19.