Background Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the ...trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic. Methods A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use. Results With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission. Conclusions The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil.
The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine ...the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment.
To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period.
The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required.
•There was a 16.7% increase in the number of hospital deaths in 2020 compared with 2019 in Brazil.•More than 19% of hospital deaths in 2020 were related to coronavirus disease 2019 (COVID-19), which ...was the leading cause of hospital death.•Forty percent of COVID-19 deaths were in individuals of black/brown ethnicity and 75% were among adults aged ≥60 years.•Brazil experienced a high death toll due to the COVID-19 pandemic in 2020.
Objectives: To describe the profile of hospital deaths in Brazil according to cause of admission during the pre-pandemic (2019) and pandemic periods (2020).
Methods: Descriptive study based on individual-level records of all hospital admissions with death outcomes reimbursed by the Brazilian National Health System in 2019 and 2020.
Results: The number of hospital deaths increased by 16.7% in 2020 compared with 2019 (522,686 vs 609,755). Coronavirus disease 2019 (COVID-19) was associated with 19.5% (118,879) of all hospital deaths in 2020, surpassing diseases of the circulatory system (15.4%, 93,735) and diseases of the respiratory system (14.9%, 91,035).
Conclusions: COVID-19 was the main cause of death in public hospitals in Brazil in 2020.
Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In ...the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner.
The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities.
The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists.
The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.
To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil.
This was a population-based survey with ...probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained.
The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%.
The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.
Background. The management of diseases in soybean crops demands a great economic cost with fungicide applications. Therefore, unnecessary or excessive applications can promote negative environmental ...results. Therefore, understanding the weather conditions and the development of diseases in the crop is essential to avoid the unnecessary use of fungicides, consequently reducing costs and ensuring the sustainability of the activity. Aim. The aim is to identify which yield components are quantitatively affected, and which aspects of the chemical composition of the grains are qualitatively influenced by fungicide management, in addition to relating the cost-benefit rate of sequential applications or previously stipulated management in the soybean crop, as well as their economic effects under water deficit conditions. Methodology. The trial was carried out using a randomized block design composed of 4 replications. The trial consisted of 5 kinds of fungicide management, defined by the time and number of applications, during the development cycle of the Lança cultivar, in the 2019/2020 crop season. Soybean agronomic traits and nutritional attributes were evaluated. Results. Unfavorable climate conditions contributed to the low rate of Asian rust infection during the soybean development cycle. The different kinds of fungicide management influenced soybean performance for the main agronomic variables studied. For the chemical composition of the grains, there was no statistical difference in relation to the different kinds of fungicide management. Implications. The results indicate that the management of fungicides must be carried out according to the meteorological conditions of the year of cultivation. Conclusion. Management without fungicide application maximized grain yield and promoted the highest economic return.
The aim of this study is to assess the efficacy of withdrawing biologics from patients with rheumatoid arthritis in sustained remission or low disease activity. This is a systematic review of ...clinical trials that randomized withdrawal or continuation of biologics. We searched MEDLINE, Embase, and other databases. Three authors independently selected and extracted the data from the studies. The GRADE approach was employed to assess the quality of the evidence. We calculated meta-analyses of random effects model and estimated the heterogeneity by
I
2
. The number needed to treat (NNT) was calculated for significant outcomes. We included six trials (
N
= 1927 patients), most were industry-sponsored. Compared to withdrawing, continuing biologics increased the probability of low disease activity (relative risk RR = 0.66, 95 % CI 0.51–0.84,
I
2
= 91 %, NNT = 4, low quality), remission (0.57, 0.44–0.74,
I
2
= 82 %, NNT = 3, low quality), and radiographic progression (RR = 0.91, 95 % CI 0.85–0.98,
I
2
= 13 %, NNT = 12, moderate quality). No significant difference was detected in the incidence of serious adverse events, serious infection, malignancy, and scores of improvement of tender and swollen joints between these strategies (low quality). A worse profile of outcomes was experienced by those patients when compared to the ones that continued biologics, but almost half of patients maintained low disease activity after withdrawal. As the quality of evidence was low, the conclusions may change as new results become available. The potential harms and benefits of this decision must be discussed with patients.
To characterize associated factors and overall survival of women with metastatic breast cancer treated with trastuzumab after its incorporation into the SUS, and additionally to present the direct ...costs of this technology.
This is a retrospective cohort, based on data from computerized medical records from one of the units of the National Cancer Institute (INCA), in Rio de Janeiro-RJ, Brazil. Women with HER-2 positive metastatic breast cancer undergoing trastuzumab treatment from September 2017 to August 2018 were included. Overall survival was estimated using the Kaplan-Meier method and compared between groups using the log-rank test.
136 women were selected, whose median age at diagnosis was 51 years (range: 21-81 years). The median OS was 43.63 months (95%CI 33.92-53.34). It is observed that the median OS for the population already diagnosed with metastatic disease (stage IV) was significantly lower than for patients diagnosed in stages I-III (37.43 months vs. 48.6 months, p<0, 01). Women without previous use of trastuzumab had a higher median OS than patients pretreated with trastuzumab (45.16 months vs. 40.73 months, p<0.01).
Trastuzumab improves survival in HER-2 positive metastatic breast cancer. Brain and multiple metastases are associated with a worse prognosis. It is essential to avoid advanced staging and perform surgical treatment, with emphasis on radical mastectomy. The SUS must adopt policies and strategies for early diagnosis and guarantee access to trastuzumab, considering its high cost.
Resumo Objetivo: estimar o impacto orçamentário incremental da terapia-alvo para tratamento de primeira linha do melanoma avançado não cirúrgico e metastático, em comparação à dacarbazina. Métodos: ...análise de impacto orçamentário na perspectiva do Sistema Único de Saúde (SUS) do Brasil; a partir de dados demográficos e estimativas da incidência, foi delimitada a população no horizonte temporal de três anos (2018-2020) e estimados os custos diretos médicos; foi considerado cenário de referência o tratamento com dacarbazina, e como cenários alternativos a terapia-alvo com vemurafenibe, dabrafenibe, vemurafenibe + cobimetinibe e dabrafenibe + trametinibe; a avaliação das incertezas foi conduzida mediante análise por cenários. Resultados: o impacto orçamentário incremental variou de R$ 451.867.881,00 a R$ 768.860.968,00, representando 0,70 a 1,53% dos gastos anuais totais com medicamentos ambulatoriais no SUS; no melhor e no pior cenário, os resultados variaram de R$ 289.160.835,00 a R$ 1.107.081.926,00. Conclusão: a terapia-alvo, comparada à dacarbazina, implica impacto excessivo no orçamento, desfavorecendo eventual incorporação.
Biofortification and bioactive compounds enrichment of maize genotypes is a great alternative for mitigating micronutrients deficiency in human and animal diet, and also for improving the benefits of ...maize for human health. This work aimed to estimate variance components and genetic parameters of bioactive compounds and micronutrients to predict superior maize hybrids from different genetic bases, and to apply the RELM/BLUP methodology to multivariate techniques. The inbreed lines were crossed and the F1 hybrids were grown for evaluations in 2014/2015 and 2015/2016 growing seasons, respectively. Then, micronutrients and bioactive compounds related traits were evaluated. The variance components and genetic parameters were estimated by REML methodology. The BLUP methodology was employed to predict genetic values and to verify the percentages of genetic gain with selection. The predicted genetic values were applied to estimate genetic distances by the Mean Euclidean Distance. The relative contribution of each trait to genetic divergence was evaluated and the principal components analysis determined, proposing the genotypes that are potentially capable to increase a given trait. The presence of genetic variability was evidenced among genotypes, while some of them presented potential for increasing specific traits. The top cross hybrid L64XAS1590 showed the highest estimates for increasing antioxidant-responsible traits, and micronutrients contents such as manganese, cooper, iron and zinc. In general, there was the possibility of achieving genetic gains with selection under application of biofortified and bioactive compounds to enhance maize hybrids through conventional breeding. However, it does not applicable for iron content due to its low estimate of broad sense heritability.
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