RESUMEN
Chagas disease (CD) is a neglected disease and endemic in Brazil. In the Brazilian Northeast Region, it affects millions of people. Therefore, it is necessary to identify the spatiotemporal trends of CD mortality in the Northeast of Brazil. This ecological study was designed, in which the unit of analysis was the municipality of the Brazilian northeast. The data source was the Information System of Mortality. It was calculated relative risk from socioeconomic characteristics. Mortality rates were smoothed by the Local Empirical Bayes method. Spatial dependency was analysed by the Global and Local Moran Index. Scan spatial statistics were also used. A total of 11 287 deaths by CD were notified in the study. An expressive parcel of this number was observed among 70-year-olds or more (n = 4381; 38.8%), no schooling (n = 4381; 38.8%), mixed-race (n = 4381; 62.3%), male (n = 6875; 60.9%). It was observed positive spatial autocorrelation, mostly in municipalities of the state of Bahia, Piauí (with high-high clusters), and Maranhão (with low-low clusters). The spatial scan statistics has presented a risk of mortality in 24 purely spatial clusters (P < 0.05). The study has identified the spatial pattern of CD mortality mostly in Bahia and Piauí, highlighting priority areas in planning and control strategies of the health services.
Asunto(s)
Enfermedad de Chagas/mortalidad , Enfermedades Endémicas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Teorema de Bayes , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Análisis Espacio-Temporal , Adulto JovenRESUMEN
This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan-Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3-5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9-7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4-4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4-14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.
Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Brasil/epidemiología , COVID-19 , Enfermedades Cardiovasculares/complicaciones , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/complicaciones , Complicaciones de la Diabetes/complicaciones , Femenino , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Enfermedades Renales/complicaciones , Enfermedades Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/complicaciones , Pandemias , Neumonía Viral/complicaciones , Distribución de Poisson , Modelos de Riesgos Proporcionales , Factores de Riesgo , Factores Sexuales , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the clinical evolution of patients with implantation of ventricular assist device (VAD) and identify the intervening factors for death. METHODS: This analytical, retrospective study was carried out in a public reference hospital in cardiopulmonary diseases located in northeastern Brazil. The study population encompassed the medical records of 16 patients who underwent VAD implantation. Data collection took place from January to August 2016, through the consultation of medical records. Descriptive analysis, odds ratio, and the Fisher's Exact, Wilcoxon, Friedman and t-tests were used to analyze the data. RESULTS: All patients experienced complications during the use of the device, with bleeding being the main cause (11 [68.8%]). There was a significant decrease in noradrenaline (P = .025), milrinone (Primacor; P = .007), and dobutamine (P = .046) flow rates with the clinical evolution of patients. Regarding hematologic parameters, the use of VAD promoted a significant improvement in hemoglobin (P < .001), hematocrit (P = .003), activated partial thromboplastin time (P = .013), and fibrinogen (P = .049) values at the 3 time points analyzed. Regarding the clinical outcome of the patients, the majority (10 [62.5%]) underwent cardiac transplantation. CONCLUSIONS: This study allowed for better knowledge of the clinical evolution of patients with VAD implantation, highlighting the benefits of this type of device as a bridge for heart transplantation.
Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Corazón Auxiliar/efectos adversos , Listas de Espera/mortalidad , Adulto , Anciano , Brasil , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
ABSTRACT In order to assess the influence of an infection by the caprine arthritis-encephalitis virus (CAEV) on the physicochemical and cellular characteristics of the milk, 97 samples of milk were collected from goats of the Saanen and Oberhasli breeds. The samples were divided into 3 groups: Group 1 consisted of 36 samples collected from clinically healthy mammary glands, without bacterial growth, from females that were seronegative to the CAEV antigen; Group 2 with 49 samples collected from mammary glands with normal consistency (soft), without bacterial growth, from CAEV antigen seropositive animals; Group 3 was composed of 12 samples collected from hardened udders (indurative mastitis), without bacterial growth, from CAEV antigen seropositive animals. The samples were collected in the milking parlor immediately before the animals were milked. The pH, electrical conductivity, chloride and lactose levels, chloride/lactose ratio, fat and protein content, total solids, somatic cell count and microbiologic profile were determined. It was found that 19.68% of the seropositive animals had a diffuse hardening of the udder. The data analysis demonstrates that there is significant influence of the infection by CAEV on the physicochemical and cellular composition of the milk, as: a) the electrical conductivity, chloride level and somatic cell count were higher in CAE positive animals, regardless of the hardening of the udder; b) the lactose content was lower in CAE positive animals, regardless of the hardening of the mammary gland; c) protein, fat and total solids contents were lower only in animals with hardened udders; d) the milk pH values were not altered by the infection with CAEV.
RESUMO Com o objetivo de avaliar a influência da infecção pelo Vírus da Artrite Encefalite Caprina (VAEC) nas características físico-químicas e celulares do leite foram colhidas 97 amostras de leite de cabras das raças Saanen e Pardo Alpina, sendo as amostras divididas em 3 grupos experimentais. O Grupo 1 foi composto de 36 amostras de leite de glândulas mamárias consideradas clinicamente sadias, sem crescimento bacteriano e provenientes de fêmeas reagentes ao antígeno do VAEC (soronegativas); o Grupo 2 foi composto de 49 amostras de leite de glândulas mamárias com consistência normal da mama (macia), sem crescimento bacteriano e provenientes de fêmeas reagentes ao antígeno do VAEC (soropositivas) e o Grupo 3 foi composto de 12 amostras de leite de glândulas mamárias com endurecimento difuso da mama (Mamite Indurativa), sem crescimento bacteriano e provenientes de fêmeas reagentes ao antígeno do VAEC (soropositivas). As amostras foram colhidas na sala de ordenha, imediatamente antes da ordenha do animal, sendo as seguintes características do leite determinadas: pH, eletrocondutividade, cloretos, lactose, índice cloretos/ lactose, gordura, proteína, sólidos totais, contagem de células somáticas e exame microbiológico. Do total de 97 glândulas palpadas, observou-se que o endurecimento difuso da glândula mamária foi diagnosticado em 19,68% das cabras infectadas pelo Vírus da Artrite Encefalite Caprina (VAEC). A análise dos resultados evidenciou a significativa influência da infecção pelo vírus da Artrite Encefalite Caprina (VAEC) na composição físico-química e celular do leite de caprinos, pois: a) os valores de eletrocondutividade, os teores de cloretos e a contagem de células somáticas foram maiores nas cabras infectadas pelo VAEC com ou sem sinais de endurecimento difuso da mama; b) os valores de lactose foram menores nas cabras infectadas pelo VAEC com ou sem sinais de endurecimento difuso da mama; c) os valores de proteína, gordura e sólidos totais foram menores somente no grupo de cabras infectadas pelo VAEC com sinais de endurecimento difuso da mama; c) os valores do pH não sofreram influência da infecção pelo VAEC.