Disease In Brazil Research Articles

1393. Unveiling disease trends: a ten-year analysis of mandatory notification diseases in Brazil (2013-2022)

Abstract Background Disease surveillance is crucial for timely detection and control of diseases. In Brazil, mandatory disease notification is required through the National System of Notifiable Diseases (SINAN). This paper aims to contribute to the understanding of disease burden and patterns in Brazil, a representative region of South America and other developing countries. Methods The study utilized a retrospective observational study design to conduct surveillance of 54 mandatory notifiable diseases over a 10-year period, from January 2013 to December 2022. The data was collected from a reference public hospital located in Belo Horizonte, a city with a population of approximately 3,000,000 inhabitants, located in the Minas Gerais State of Brazil. Monthly incidence rates were calculated for each disease by using the number of cases as the numerator and the total number of patients admitted to the hospital as the denominator. To estimate endemic levels, the 90th percentile was used for both the monthly incidence rate and the mobile yearly average rate, which provided a threshold for identifying unusually high disease incidence levels. Secular time trends were evaluated using linear regression analysis. Results Over 10 years, 37,081 notifiable diseases were diagnosed from 54 different diseases. Only five diseases accounted for 87% of cases: classical dengue fever, unspecified communicable disease, assault by unspecified means, toxic effect of unspecified substance, and work-related conditions (Fig. 1). Monthly endemic levels were estimated, revealing an increase in incidence for 15 diseases including HIV, Syphilis, and assault by unspecified means (Fig. 2). Analysis of pandemic phases showed consistent increase in diseases such as visceral leishmaniasis and tuberculosis between 2018 and 2022 (Fig. 3), emphasizing the need for continued vigilance and targeted interventions.Figure 1Pareto Chart illustrating the occurrence of 54 notifiable diseases over a 10-year period (2013-2022) in a reference public hospital in Belo Horizonte, Brazil.Figure 2Trend analysis of notifiable diseases with incidence changes over a 10-year period (2013-2022) in a reference public hospital in Belo Horizonte, Brazil.Figure 3Incidence rate of visceral leishmaniasis and respiratory tuberculosis during pre-pandemic, pandemic, and late-phase pandemic periods (2018-2022) in a reference public hospital in Belo Horizonte, Brazil. Conclusion This study provides valuable insights into the epidemiology and trends of 54 mandatory notifiable diseases in Belo Horizonte, Brazil, over a 10-year period. The findings of this study contribute to our understanding of the burden of these diseases in the study population and may inform public health strategies for disease prevention and control in the future. Disclosures All Authors: No reported disclosures

Prevalence and factors associated with possible cases of familial hypercholesterolemia in Brazilian adults: a cross-sectional study

This study aimed to estimate the prevalence of possible cases of FH and analyze associated factors in the adult Brazilian population. Cross-sectional study with laboratory data from the Brazilian National Health Survey, with 8521 participants. Possible cases of FH were defined according to the Dutch Lipid Clinic Network criteria. The prevalence and 95% confidence intervals (95% CI) of possible cases of FH were estimated according to sociodemographic variables, lifestyle, diabetes, hypertension, altered tests, treatment and self-rated health. Logistic regression was used to analyze the associations. The prevalence of possible cases of FH was 0.96%, higher in women, between 45 and 59 years, white race/skin color and others, less education, people with diabetes, hypertension and total cholesterol ≥ 310 mg/dL. The presence of FH was positively associated with regular self-rated health (OR 1.96; 95% CI 0.99–3.84), poor/very poor (OR 3.02; 95% CI 1.30–7.03) and negatively with black race/skin color (OR 0.10; 95% CI 0.02–0.46) and complete elementary school, incomplete high school (OR 0.47; 95% CI 0.23–0.98) and complete high school and more (OR 0.45; 95% CI 0.21–0.95). FH affects 1:104 Brazilian adults, these findings contribute to understanding the burden of disease in Brazil. Due to the scarcity of studies on FH in low- and middle-income countries, further studies are desirable.

An emergent plant‐parasitic nematode in Brazil: Aphelenchoides besseyi. Current status and research perspectives

AbstractAphelenchoides besseyi is an emerging and yet overlooked plant parasite of many economically important crops, including cotton, soybean and common bean. It presents an economic risk to these crops in several countries, notably in Brazil. Although first reported infecting strawberries in the United States as early as 1942, it was only identified to be the causal agent of green stem and foliar retention (GSFR) disease in Brazil in 2017. Currently, there are no chemical nematicides registered in Brazil against A. besseyi, and no known sources of genetic resistance. Here, we review the biology of A. besseyi, its spread across Brazil, its relevance to the country's current and future agriculture and the limited control measures. We describe control measures that have been successfully used to manage infestations of other plant‐parasitic nematodes and could potentially be extended to use in the control of A. besseyi. We also review and discuss potential future control measures, such as RNA interference and genome editing, for the development of crops with enhanced resistance to A. besseyi.

Exploring the impact of inflammatory endotypes on olfactory function and quality of life in chronic rhinosinusitis patients

ObjectivesThe aim of this observational cross-sectional study was to determine the endotypic inflammatory pattern of a sample of patients with CRS in Brazil, correlate it with olfactory function, and evaluate the clinical severity of the disease. MethodsIn this cross-sectional study, 73 CRS patients were recruited. Patients were classified into type 2 and non-type 2 endotypic patterns based on IgE and eosinophilia levels. All subjects performed the University of Pennsylvania Smell Identification Test (UPSIT®) and responded to the Sino-Nasal Outcome Test (SNOT-22). ResultsThe majority of patients had type 2 CRS (n=57, 78.1%). Patients with type 2 CRS compared to non-type 2 CRS had a higher prevalence of nasal polyps (93% vs. 12.5%), asthma (40.3% vs. 12.5%), and non-steroidal anti-inflammatory drug exacerbated respiratory disease (NERD, 17.5% vs. 0%). Type 2 patients also had significantly lower UPSIT® and higher SNOT-22, Lund-Kennedy, and Lund-Mackay scores. ConclusionOur study provides evidence that type 2 CRS is associated with a higher prevalence of nasal polyps, asthma, and NERD, as well as decreased olfactory function and worse quality of life scores. These data will contribute to the body of knowledge on CRS and the development of treatments for this disease in Brazil. Level of evidence3.

Eating Attitudes of Patients with Celiac Disease in Brazil: A Nationwide Assessment with the EAT-26 Instrument.

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. In this sense, a gluten-free diet is the only safe treatment available. Due to the restrictions resulting from this eating pattern, this treatment may impair the relationship of the people with CD with food, increasing the risk of a disordered eating attitude, which is associated with eating disorders. The EAT-26 is a validated instrument already applied worldwide in different populations, and higher scores are suggestive of eating attitudes prone to evolve into eating disorders. Studies carried out in other countries have already shown that people with CD are prone to developing eating disorders; however, no study has been carried out with this theme in the population with CD in Brazil. We carried out a nationwide cross-sectional study in three steps: (i) study design and instrument; (ii) recruitment of participants and ethics; (iii) statistical analysis. A total of 385 participants were included in our sample, 96.36% of them being women. The internal consistency of the applied self-administered Brazilian version of the EAT-26 online questionnaire presented a satisfactory Cronbach's alpha of 0.812, and in total, 36.1% of the respondents were classified with a disordered eating attitude. No differences were found among the scores of participants when divided by categories regarding gender, average monthly income, age, and educational level. However, scores classified as a disordered eating attitude were found in respondents with a body mass index classified as overweight and obese. Our study highlights that disordered eating attitudes are present in overweight and obese women with celiac disease; thus, public health politics are needed to prevent and treat these attitudes.

Pathogenicity of Bipolaris species associated with Southern corn leaf blight disease in Brazil

The aim of the current study was to investigate the pathogenicity of Bipolaris species associated with southern corn leaf blight (SCLB) in Brazil. Fungi were isolated from leaves presenting SCLB symptoms. Morphological features were described when the cultures were grown in Potato dextrose agar (PDA) medium. The ITS and GAPDH regions were used for phylogenetic analyses. The pathogenicity of B. maydis isolates was assessed in four popcorn lines under controlled conditions. Two Bipolaris species among the collected isolates were capable of infecting corn, namely, B. maydis and B. gossypina. Previous studies reporting the infection of corn by B. gossypina were not found; therefore, the present study appears to be the first to report it. Pathological differences between isolates were observed, and there was a significant isolate x line interaction. Line L692 was susceptible in all tests, while Line L623 was resistant to three B. maydis isolates. The isolate CF/UENF 482 of B. gossypina did not generate symptoms in the tested popcorn lines. The B. maydis isolates CF/UENF 477 and CF/UENF 501 were the most virulent.

The Influence of Time on the Epidemiology and Clinical Manifestations of Behçet's Disease in Brazil.

Modifications in the severity and clinical expression of Behçet's disease (BD) have been described in some areas that are considered endemic for the disease. This study aims to evaluate the chronological changes in epidemiology and clinical characteristics of BD patients in a referral center in Brazil, which is considered a non-endemic area for the disease. A descriptive and cross-sectional study involving BD patients divided into two groups: group 1 patients were diagnosed and followed between 1988 and 2010, and group 2 were diagnosed and followed between 2011 and 2022. No significant differences were found regarding gender and age at onset of symptoms between groups. We found a significant decrease in the frequency of bilateral ocular involvement, posterior uveitis, and retinal vasculitis. The demographic dates of this group of Brazilian BD patients remained similar over the last decade. Our study supports the notion that BD is becoming lighter in some regions. BD is a severe blinding disorder, and we found a lower frequency of ocular involvement over time. These findings may be attributed to a higher level of education of patients and a growing awareness of the disease. Newer immunomodulating and biologic agents may offer an improved prognosis in patients with BD with severe manifestations.

Pathogen Pollution: Viral Diseases Associated with Poor Sanitation in Brazil

Brazil faces many types of pollution, including atmospheric CO2 pollution due to Amazon deforestation, pollution by heavy metals, microplastics, pesticides, pathogens, and other classes of environmental contaminants. Pathogen pollution refers to (I) the introduction of a pathogen to a new host species or population and (II) a concept used in the study of pathogenic organisms in water or terrestrial ecosystems. Anthropogenic activities are the leading forces of pathogen pollution in both contexts previously cited. In this Opinion article, we discuss the impacts of pathogen pollution on public health, infectious diseases emergence, and ecosystems using mosquito- and water-borne viral diseases in Brazil as case studies. Finally, we advocate improvements and expansion in sanitation systems, considering sewage treatment and soil waste management, as an umbrella factor to minimize risks and spreading of pathogen pollution in Brazil.

Clinical spectrum of myelin oligodendrocyte glycoprotein antibody-associated disease in Brazil: a single-center experience.

Anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibody-associated disease (MOGAD) is an immune-mediated neurological disorder with a broad spectrum of clinical presentation that is often difficult to distinguish from other demyelinating diseases, such as multiple sclerosis and neuromyelitis optica spectrum disorder. To describe the clinical and paraclinical characteristics of MOGAD in a Brazilian tertiary center. We retrospectively reviewed the records of adult and pediatric patients who tested positive for anti-MOG antibodies and presented with clinical and radiological diseases compatible with MOGAD. Forty-one patients (10 children) were included: 56% female, 58% Caucasian, mean age at onset 31 years (range 6-64), with a mean disease duration of 59.6 months (range 1-264 months). The most frequent onset presentation was optic neuritis (68%), acute disseminated encephalomyelitis (ADEM, 12%), and myelitis (10%). A monophasic disease course was observed in 49%. EDSS median was 2.1 at the last visit. Most patients (83%) were under continuous immunosuppressive treatment. Azathioprine was the first-line treatment in 59%. In all ADEM cases, conus, and root involvement was radiologically observed on MRI. Brazilian MOGAD patients presented with a similar spectrum of previously reported MOGAD phenotypes. Conus and spinal root involvement seems to be frequently present in MOGAD-ADEM and could serve as radiologic characteristics of this clinical entity.

Associations of RAASi Discontinuation with Mortality Among Hospitalized Patients with Cardiovascular Disease in Brazil

Associations of RAASi Discontinuation with Mortality Among Hospitalized Patients with Cardiovascular Disease in Brazil

Study of case of the profile of Covid-19 infected in Espirito Santo State in Brazil

The pandemic caused by Severe Acute Respiratory Syndrome - Related Coronavirus 2 (SARS-CoV-2) has made socio-economic inequalities between social classes more evident in the countries in development process. This scenario is also no different in Brazil and it has been demanding from the federal, state and municipal governments broad efforts to combat the consequences of the spread of the disease in Brazil. The rulers have a huge challenge to implement measures to prevent the advance of the transmission of the virus. In addition, state governments need to use the public health system to serve the main population, since the lethality rate is very high directly influenced by social inequality. To minimize the effects of the new coronavirus, the ruler needs planning to give efficient response and requires an understanding of the rich that people about free movement, controlled circulation or total blocking of population movement. In this context, our proposal was to investigate how the disease reached people of different levels of education. And how has been the response of people hospitalized in Brazilian hospitals. We analyzed the public data of reports of Severe Acute Respiratory Syndrome (SRAG). In our research, we considered the variables schooling, ethnicity, gender, time of hospitalization in the Intensive Care Unit (ICU) and use of mechanical ventilators. Our results indicate that the lethality rate is higher for those people who were admitted to the ICU. In addition, people with low schooling and no schooling are 3.6 times more likely to die than people with higher education. This discrepancy highlights the huge disparity of quality treatment in Brazilian states.

Misdiagnosis in multiple sclerosis in a Brazilian reference center: Clinical, radiological, laboratory profile and failures in the diagnostic process-Cohort study.

Multiple sclerosis misdiagnosis remains a problem despite the well-validated McDonald 2017. For proper evaluation of errors in the diagnostic process that lead to misdiagnosis, it is adequate to incorporate patients who are already under regular follow-up at reference centers of demyelinating diseases. To evaluate multiple sclerosis misdiagnosis in patients who are on follow-up at a reference center of demyelinating diseases in Brazil. We designed an observational study including patients in regular follow-up, who were diagnosed with multiple sclerosis at our specialized outpatient clinic in the Hospital of Clinics in the University of Sao Paulo, from 1996 to 2021, and were reassessed for misdiagnosis in 2022. We evaluated demographic information, clinical profile, and complementary exams and classified participants as "established multiple sclerosis," "non-multiple sclerosis, diagnosed," and "non-multiple sclerosis, undiagnosed." Failures in the diagnostic process were assessed by the modified Diagnostic Error Evaluation and Research tool. A total of 201 patients were included. After analysis, 191/201 (95.02%) participants were confirmed as "established multiple sclerosis," 5/201 (2.49%) were defined as "non-multiple sclerosis, diagnosed," and 5/201 (2.49%) were defined as "non-multiple sclerosis, undiagnosed." Multiple sclerosis misdiagnosis persists in reference centers, emphasizing the need for careful interpretation of clinical findings to prevent errors.

Diagnostic disclosure of Alzheimer's disease in Brazil: a national survey of specialized physicians.

The diagnosis of Alzheimer's disease (AD) can bring financial and emotional consequences to patients and caregivers. Whether or not the diagnosis should be disclosed to patients is a matter of debate amongst physicians and can be influenced by culture and experience. To investigate the current practice of physicians who attend and treat patients with dementia in Brazil regarding the disclosure of dementia diagnosis and compare the practice with what has been performed 15 years ago in the country. Data were evaluated using an electronic questionnaire. The questions used to carry out this research were similar to the questions of the study carried out 15 years ago 9. The form was sent to the Brazilian Academy of Neurology, the Brazilian Association of Geriatrics and Gerontology, and the Brazilian Association of Psychiatry, which forwarded it to their members. Analyses were conducted through non-parametric statistical tests, with a post-hoc assessment. 397 physicians responded to the survey, of which 231 are neurologists, 124 geriatricians, 29 psychiatrists and 13 from other specialties. The mean age was 45.2 years. The majority (66.7%) of the physicians reveal the diagnosis of AD always or usually. The youngest group of neurologists were more likely to disclose the diagnosis than the oldest group with a significant difference between them. In comparison to the 2008 Brazilian study, the percentage of physicians who always or usually disclose the diagnosis has risen by 22%. On the other hand, 12.3% of the physicians rarely or never disclose the diagnosis, in comparison to 25,3% in 2008. The main reasons for not disclosing the diagnosis concern the patients' mental health. Advances in dementia knowledge and biomarkers availability probably explain the increase in the rate of disclosure. The main challenge is to reconcile the autonomy of affected individuals, mental health issues after the diagnosis and the family member's opinion.

The Impact of COVID-19 Pandemic on Cardiovascular Diseases in Brazil

Background: The novel coronavirus pandemic is an international public health emergency due to the high contagious potential of the virus on a global scale and, similarly to what happened globally, Brazilian authorities took measures to reduce its impact on the healthcare system, including social distancing. In this context of exhaustion of the system, it is worth questioning the situation of patients who need medical care for other diseases, such as the cardiovascular ones. Objectives: Describe the changes in the epidemiological profile of hospitalizations cardiovascular diseases during the COVID-19 pandemic in Brazil. Methods: Assessment of relative variations on the number of hospitalizations, associated average time, mortality rate and financial investments. Results: After the beginning of the pandemic, there was reduction of 21.46% in hospitalizations, more accentuated in females and in the Northern region, and increase of 14.14% in mortality, of greater significance in the Midwestern region. In younger ages, mortality and permanence time presented more accentuated positive variations. In elective admissions, growth in mortality and in hospital expenses were more significant. Conclusion: The pandemic impacted on cardiovascular diseases in a multifactorial way. The number of hospitalizations decreased, and the mortality rate increased, as efforts concentrated on moderate and severe cases. Therefore, there is a need for policies that minimize mid- and long-term impacts, as well as studies that investigate possible late complications of infections by the novel coronavirus.

The association between neighborhood greenness and hospitalization for cardiorespiratory diseases in Brazil

The association between neighborhood greenness and hospitalization for cardiorespiratory diseases in Brazil

Case-Finding tool for COPD in LMIC (COLA) - translation and cross-cultural adaptation into Brazilian Portuguese language.

To translate and cross-culturally adapt the COPD in Low- and middle-income countries (LMICs) Assessment (COLA) questionnaire into Brazilian Portuguese, a case-finding instrument for chronic obstructive pulmonary disease (COPD). Translation and cross-cultural adaptation were completed in six steps: the original version was translated into Brazilian Portuguese by two native speakers of the target language; the translated versions were synthesized; back-translation was performed by two native speakers of the original language; the back-translation and the Brazilian Portuguese version of the COLA were reviewed and harmonized by an expert committee of specialists; and, then, the pre-final version was tested by 30 health professionals who were asked if the items were clear to understand. The acceptability, clarity, and understandability of the translated version were evaluated. A final review of the questionnaire was produced by the authors and approved by the author of the original questionnaire. Some idiomatic, semantic, and experiential inconsistencies were identified and properly adjusted. Item 3 was considered the most unclear item (23,3%). Items 7, 8, and 9 presented clarity above 80% (93%, 90%, and 90%, respectively). Suggestions were discussed and incorporated into the tool and COLA was found to be clear and easy to understand. The Brazilian version of the COLA was easily understood by healthcare professionals and adapted to Brazilian culture. Translation and cultural adaptation of the COLA instrument into Brazilian Portuguese can be an important case-finding instrument for chronic obstructive pulmonary disease in Brazil.

INEQUALITY AND HEALTH DURING COVID-19 IN BRAZIL: an analysis on the use of medicines in the first two years of the pandemic

This article seeks to discuss the defense of the use of drugs against COVID-19 in Brazil by former president Jair Messias Bolsonaro. The research focuses on the first two years of the pandemic, the data collected were the official speeches of the former president on the defense of the use of medicines during the first two years of infection of the disease in Brazil, we consider the defense of the use of medications during that period by the former president as an orchestrated strategy for political gain in the eyes of the population. We use discourse analysis to understand Bolsonaro's speeches with the help of Social Studies of Science and Technology and Achille Mbembe's concept of necropolitics.

Temporal trend in the incidence of human visceral leishmaniasis in Brazil.

It is an ecological study that analyzed the time trend of visceral leishmaniasis incidence rates in Brazil using segmented time regression by joinpoints. There was a decreasing incidence rate of this disease in the country with an average annual percent change (AAPC) of -5 (CI95%: -9.1; -0.6) and a reduction of 1.69 cases/100 thousand inhabitants in 2007, and 0.91/100 thousand inhabitants in 2020. The Central-West region showed the highest reduction percent (AAPC: -9.1; CI95%: -13.8; -4.3), followed by the Southeast region (AAPC: -8.7; -14.6; -2.5). The North and South regions showed the largest number of joinpoints in the time series. The highest incidences were recorded in the male population, however, stable (AAPC: 2.14; CI95%: -8.3; 0). In the age group analysis, the trend was decreasing for the groups from 0 to 4 years old (AAPC: -7.7; CI95%: -12.6; -2.4), 5 to 9 years old (AAPC: -7.3; CI95%: -13.6; -0,4) and 10 to 14 years old (AAPC: -5.5; CI95%: -10.3; -0.3). It was found that although Visceral Leishmaniasis is an endemic disease in Brazil, there was a decrease in its incidence rate from 2007 to 2020.

Initiatives to promote access to medicines after publication of the Brazilian Policy on the Comprehensive Care of People with Rare Diseases

BackgroundRare diseases affect a small number of people compared to prevalent diseases. The vast majority of these diseases are of genetic origin, have no cure, are chronic and can lead to death. Although the right to access medicines is included in the constitutionally guaranteed right to health in Brazil, problems in the supply of medicines for rare diseases are reported in the country. This study aimed to describe and analyse the initiatives to promote access to medicines for treating rare diseases in the Unified Health System, Brazil, after the publication of the Brazilian Policy on the Comprehensive Care of People with Rare Diseases. Based on the model published by the WHO Regional Office for Europe, which described access to medicines in prelaunch, perilaunch and postlaunch policies, the initiatives referring to each category were summarized based on documentary research searched in online databases from January 2014 to December 2020.ResultsDifferent actions and policy interventions were identified, which went through the expansion of resources for research and development, health regulations, incorporation of new drugs, review and publication of clinical guidelines, and expansion of the network of care facilities by the Ministry of Health. On the other hand, aspects related to care policies, pricing methods, technological development, and development of pharmaceutical service processes were not implemented.ConclusionsAlthough it is impossible to determine the explicit motivation of such actions concerning the Policy, its publication certainly was a landmark in Brazilian society, allowing greater recognition of the needs of rare disease patients and the specificities of treatment’. However, this study suggests that the steps that make up the life cycle of medicines are not linked, lacking articulation and integration of the care network, and consequently, there is no evidence that rare disease policy publication has generated a broad impact on the promotion of access to medicines to treat rare diseases in Brazil.

Temporal trends and spatial distribution of Brazilian spotted fever in Brazil.

Brazilian Spotted Fever (BSF) is a severe tick-borne disease in Brazil’s south and southeast regions. We examined temporal trends and spatial distribution of BSF cases and deaths. There were stable incidence and mortality rates, decreasing case fatality, and distinct spatial clusters, highlighting the need for ongoing surveillance and prevention efforts.