Perfil Epidemiológico Do Tétano Acidental no Nordeste Brasileiro entre os anos de 2007 e 2022

Objective: To describe the epidemiological profile of reported cases of accidental tetanus in the Northeastern region of Brazil between the years 2007 and 2022. Methods: This is an ecological study,  and as such data collection was conducted in May 2023 using the Notifiable Diseases Information System (SINAN) online platform. Results: The sample (1422 cases) majoritarily consisted of males (89.52%), with a majority of mixed-race individuals (73.41%), and the largest amount of cases (53.09%) resulted in recovery. The average fatality rate among the observed years was of 32.22 per 100 confirmed cases, with peak fatality rates occurring in 2021 and 2018 with (n=19.23) and (n=48.33) respectively. Conclusions: The study cooperates with the advancement of epidemiological knowledge regarding confirmed cases of accidental tetanus in the Northeastern Region. Thus, it is possible to successively observe the evolution of the incidence of the disease in the region in question. In addition, it is essential to invest in preventive actions in order to alleviate the problems that emerge as a result from the disease. Additionally, the research suffers from a lack of possible cases due to underreporting, outdatedness of information and lack of registration of data due to the inadequacies of the platform used to carry out the data collection.Objetivo: Describir el perfil epidemiológico de los casos notificados de tétanos accidental en el nordeste de Brasil entre los años 2007 y 2022. Métodos: Se trata de un estudio ecológico cuya recolección de datos se realizó en mayo de 2023 utilizando la plataforma en línea del Sistema de Información de Enfermedades de Declaración Obligatoria (SINAN). ). Resultados: La muestra (1422 casos) presentó una gran mayoría de sexo masculino (89,52%), con predominio de raza parda (73,41%) y con la mayoría (53,09%) de los casos progresando a la curación. La letalidad promedio entre los años evaluados fue de 32,22 por cada 100 casos confirmados, con picos de letalidad en los años 2021 y 2018 con (n=19,23) y (n=48,33) respectivamente. Consideraciones finales: El estudio coopera con el avance del conocimiento epidemiológico sobre casos confirmados de DE en la Región Nordeste. A partir de ahí se puede observar sucesivamente la evolución de la incidencia de la enfermedad en la región estudiada. Además, es fundamental invertir en acciones preventivas para paliar los problemas derivados de la enfermedad. Además, la investigación adolece de posibles casos de subregistro, desactualización y falta de registro debido a imperfecciones en la plataforma utilizada para recolectar datos.Objetivo: Descrever o perfil epidemiológico dos casos notificados de tétano acidental no nordeste brasileiro entre os anos de 2007 e 2022. Métodos: Trata-se de estudo do tipo ecológico cuja coleta de dados foi realizada no mês de maio de 2023 utilizando a plataforma online do Sistema de Informação de Agravo de Notificação (SINAN). Resultados: A amostra (1422 casos) apresentou grande maioria masculina (89,52%), com predomínio da raça parda (73,41%) e com a maioria (53,09%) dos casos tendo evoluído para cura. A letalidade média entre os anos avaliados foi de 32,22 a cada 100 casos confirmados, sendo os picos de letalidade nos anos de 2021 e 2018 com (n=19,23) e (n=48,33) respectivamente. Considerações finais: O estudo coopera com o avanço do conhecimento epidemiológico no que se diz respeito aos casos confirmados de TA na Região Nordeste. A partir dele é possível observar sucessivamente a evolução da incidência da doença na região estudada. Além disso, é essencial investir em ações preventivas no intuito de amenizar os problemas resultados da doença. Ademais, a pesquisa possui como deficiência eventuais casos de subnotificação, desatualização e falta de registro devido às imperfeições da plataforma utilizada na realização da coleta de dados

Perfil epidemiológico dos óbitos infantis por doenças do aparelho respiratório no estado de São Paulo no período de 2017 a 2021

This article aims to correlate infant mortality rates with acute respiratory diseases in the years 2017 to 2021 in the state of São Paulo. This is an ecological epidemiological study of temporal analysis with data obtained in December 2023 from the Information Technology Department of the Unified Health System (DataSus) and originating from the Disease and Notification Information System (SINAN). It was evident from the analysis of the graphs that in the state of São Paulo, the rate of infant deaths due to diseases of the respiratory system has an important relationship with the size of the population, in addition to the intrinsic relationship between these diseases and atmospheric pollutants. Although at the beginning of 2020 the state had a drop in deaths related to the respiratory system in children, the Covid-19 pandemic brought a significant increase in this figure, thus reaffirming the need to look carefully at this challenge to the system. of Brazilian health.Este artículo tiene como objetivo correlacionar las tasas de mortalidad infantil con las enfermedades respiratorias agudas en los años 2017 a 2021 en el estado de São Paulo. Se trata de un estudio epidemiológico ecológico de análisis temporal con datos obtenidos en noviembre de 2023 del Departamento de Tecnología de la Información del Sistema Único de Salud (DataSus) y provenientes del Sistema de Información de Notificación y Enfermedades (SINAN). Del análisis de los gráficos se desprende que en el estado de São Paulo, la tasa de muertes infantiles por enfermedades del sistema respiratorio tiene una relación importante con el tamaño de la población, además de la relación intrínseca entre estas enfermedades y contaminantes atmosféricos. Si bien a principios de 2020 el estado tuvo una caída en las muertes relacionadas con el sistema respiratorio en niños, la pandemia de Covid-19 trajo un aumento significativo de esa cifra, reafirmando así la necesidad de mirar con atención este desafío al sistema brasileño. salud.Este artigo tem como objetivo correlacionar as taxas de mortalidade infantil com as doenças respiratórias agudas nos anos de 2017 a 2021 no estado de São Paulo. Trata-se de um estudo epidemiológico do tipo ecológico de análise temporal com dados obtidos no mês de novembro de 2023 no Departamento de Informática do Sistema Único de Saúde (DataSus) e originárias do Sistema de Informação de Agravo e Notificações (SINAN). Foi evidenciado a partir da análise dos gráficos que no estado de São Paulo, a taxa de óbitos infantis por doenças do aparelho respiratório apresenta importante relação com o tamanho da população, além da intrínseca relação dessas enfermidades com os poluentes atmosféricos. Embora no início do ano de 2020 o estado tenha apresentado uma baixa nas mortes relacionadas ao aparelho respiratório em crianças, a pandemia da Covid-19 trouxe um aumento significativo nesse dado, reafirmando assim, a necessidade de se olhar com atenção para esse desafio do sistema de saúde brasileiro

Dinâmica da Coinfecção de TB-HIV na Região Norte antes (2017-2019) e durante a Pandemia(2020-2022)

This article aims to compare cases of co-infection between tuberculosis and HIV in the northern region of Brazil, during the pre-pandemic period (2017 to 2019) and the post-pandemic period (2020 to 2022). This is an epidemiological study of the ecological type of temporal analysis with data obtained in September 2023 from the Department of Informatics of the Unified Health System (DATASUS) and originating from the Notifiable Diseases Information System (SINAN). Analysis of the graphs showed an increase in the lethality rate in 2020 in the northern region, which was not accompanied by an increase in the incidence of TB-HIV co-infection in the same period. In addition, there was a drop in the percentage of infections in the 2020-2023 triennium in the states of Amazonas and Pará, while in the states of Tocantins, Rondônia and Roraima the result was an increase in co-infection rates. Although more studies are still needed to analyze the underreporting of cases during the pandemic, it is inferred that the COVID-19 pandemic contributed to the discrepancy in the incidence of new cases or notification of existing cases in the different states in the north of the country.Este artigo tem como objetivo comparar casos de coinfecção entre Tuberculose e HIV na região Norte do Brasil, durante o período pré-pandêmico (2017 a 2019) e período pós Pandêmico (2020 a 2022). Trata-se de um estudo epidemiológico do tipo ecológico de análise temporal com dados obtidos em setembro de 2023 no Departamento de Informática do Sistema Único de Saúde (DATASUS) e originárias do Sistema de Informação de Agravo de Notificação (SINAN). Foi evidenciado a partir das análises dos gráficos um aumento na taxa de letalidade no ano de 2020 na região norte, não sendo acompanhado pelo aumento na incidência do coinfecção entre TB-HIV no mesmo período, além disso, ocorreu uma queda no percentual de infecções no triênio 2020-2023 nos estados do Amazonas e Pará, enquanto nos estados de Tocantins, Rondônia e Roraima o resultado foi um incremento nas taxas de coinfecção. Embora, ainda sejam necessários mais estudos para analisar a subnotificação dos casos durante a pandemia, infere-se que a pandemia do covid-19 contribuiu para a discrepância na incidência dos novos casos ou notificação dos existentes nos diferentes estados do norte do país

hADSCs promote axonal regeneration.

<p>A–D) Photomontages showing the expression pattern of 5HT-positive serotonergic fibers in horizontal sections spanning the pre- and post-lesion regions in DMEM (A) and hADSC (B) treated animals one week after compression. The inset shows an example of a hogback termination in the post-lesion area. Note that the hADSC-treated cord exhibits a larger number of serotoninergic fibers crossing the injury site. C) Graph representing the total length of 5-HT fibers in each experimental group (n = 3 in each group). D–E) 5HT expression was greatly reduced in the chronic phase (8 wks) in DMEM-treated rats (D), while it was slightly reduced in hADSC (E) treated group. F) Quantification of the total length of 5-HT positive axons, eight weeks after SCI (n = 3 in each group). G–R) Progression of axonal regeneration was followed by Tuj1 (G–L) or anti-GAP-43 (M–R) immunoreactivity. Panels on the left show Tuj1 (G, J) or GAP-43 (M, P) positive fibers one week after compression at the epicenter of the lesion. Panels H, K, N, Q and rows on the right show respective rostral (left), epicenter (center), and caudal (right) regions of the same section eight weeks after SCI. Far column on the right (yellow frame) shows boxed areas in higher magnification. The dashed line indicates the border of the lesion cavity. Graphics show the quantification of the total lengths of Tuj1 (I, L) or GAP-43 (O, R) positive fibers one week (I, O) and eight weeks (L, R) after SCI in the peri-cavity region (n = 3 in each group). Tuj1 and GAP-43 positive axons in DMEM (blue) and hADSC (red) treated groups were quantified in an area of approximately 900 µm in extension along the longitudinal axis. Both white and grey matter was analyzed. The y-axes in panels F, I, L, O and R were omitted for aesthetic purpose and they represent fiber length per area (µm/µm²×10³). The values in C, F, I, L, O, R represent means ± standard errors. *P<0.05, **P<0.01, ***P<0.001. Bars: A, B = 500 µm, D–Q = 100 µm, high magnification = 50 µm.</p

hADSCs induce functional recovery and reduce cavitation and cellular inflammatory response.

<p>The locomotor performance was assessed by the BBB score. Animals were evaluated weekly, during eight weeks after spinal compression (A). Asterisks indicate statistic differences between hADSC (n = 9) and DMEM groups (n = 9) and crosses indicate differences between hADSC and sham groups (n = 3). B,C) Low-magnification photomontages showing the marked difference in distribution of macrophages in the spinal cord of rats treated with hADSC (C) and DMEM (B). Note that ED1-positive cells concentrate in the immediate surroundings of the lesion cavity in hADSC-treated animals (arrowheads), in contrast to the dispersed distribution in DMEM-treated animals. D, E) GFAP immunoreactivity delineates the cavity and reveals astrocyte activation following injury, in vehicle (DMEM) (D) and hADSC (E) treated animals. F) Graph representing the area of the lesion cavity of 5 different dorso–ventral sections (represented in the x axis) in DMEM (blue) and hADSC (red) treated animals (n = 3 per condition). Note that cavitation in hADSC-treated animals is smaller. G,H) High magnification images of the boxed areas in <i>D</i> (blue) and <i>E</i> (red) are shown in <i>G</i> and H, respectively. Note the few GFAP-positive cells at the vicinity of the lesion and that very few cells are seen at the cavity border in hADSC-treated rat (H). I) Graph representing the total area of positive staining for GFAP (see <i>Materials and Methods</i>) in the immediate surroundings of the cavity in DMEM (blue) and hADSC (red) treated animals (n = 3 per condition). Dashed line delineates the cavity borders in G and H. *P<0.05, **P<0.01, ***: p<0.001. Bars: B and C = 500 µm, D and E = 100 µm and G and H = 50 µm.</p

hADSCs led to the appearance of perivascular spaces in between endothelial and astrocytic basement membranes one week after injection.

<p>A–D) Confocal images of horizontal sections immunostained with anti-pan-laminin antibody (red) one week after injury. Note that in DMEM animals (A,B) there is no separation between the two membranes whereas in hADSCs–treated animals (C,D) these membranes are separated (arrows in D). E) Confocal images of a horizontal section immunostained with anti-pan-laminin (green) and RECA-1(red). F–F”) Confocal imagens of sequential optical sections immunostained with anti-pan-laminin (green) and DAPI (blue) showing the extravasation of cells from the blood vessels. Bars: C, F = 50 µm B, D, E = 25 µm.</p

hADSCs secrete laminin in the spinal cord independently of SCI.

<p>A–C) Horizontal section of an animal subjected to spinal compression and injected with GFP-hADSCs one week after injury/injection. Panels A and B show photomontages depicting DAPI staining (A) and immunoreactivity for anti-human laminin (B). Note that cell infiltrates and laminin are located in corresponding regions. Panel C shows confocal images demonstrating the coincident localization of GFP-positive hADSCs (green), cell infiltrates (blue) and human laminin (red). D–E) Horizontal section of an uninjured animal one week after transplantation with GFP-hADSCs. Panels D to D’’’ show photomontages depicting DAPI staining (blue, D), GFP-positive hADSCs (D’, green), immunoreactivity for anti-human laminin (D’’, white) and immunoreactivity for anti-pan laminin (D’’’, red). Panel E shows confocal images to demonstrate that while the anti-pan laminin antibody labels rat blood vessels (E’’, red), the anti-human laminin does not (E’). Bars: A, B, D = 1 mm, C = 100 µm, E = 200 µm.</p

Areas of increased cellularity induced by hADSC are mainly composed of neural precursors, but cell types differ in the vascular and parenchymal compartments.

<p>A–F) Confocal images of horizontal sections of the spinal cord showing immunostaining for nestin (A), vimentin (B), NG2 (C), smooth muscle α-actin (αSMA, D), Tuj1 (E), and Olig2 (F) in clusters of high cell density along the midline, one week after SCI. Note that cells in the clusters are positive for all of these markers, suggesting that clusters are mostly composed of neural progenitors and possibly of invading pericytes. Panels on the right correspond to high-magnification images of the boxed areas, showing the labeling for each phenotypic marker. G–M) Blood vessels immunostained with pan-laminin (red) and nestin (G), vimentin (H), NG2 (I), αSMA (J), Tuj1 (K) (green). Panels L and M show that most Olig2 positive cells (purple) are out of blood vessels (L). Panel M depicts one Olig2-labeled nucleus in close proximity with a region where the basal lamina seems to be disrupted (arrow). (N–Q) Correspondence between immunoreactivities for nestin (N) and Ki67 (O) in photomontages of horizontal sections of an injured spinal cord one week after injury/injection. Confocal images showing proliferative activity (anti-Ki67, red) in the spinal parenchyma (P) and a perivascular region (Q) of nestin positive cells. Bars: A–F = 100 µm; G–M = 50 µm; N, O = 1 mm, Q = 10 µm.</p

Laminin produced by hADSC forms reticular-like deposits independent of fractones.

<p>Photomontage of a horizontal section of the undamaged spinal cord one week after injection of hADSCs (A) immunostained with a pan-specific anti-laminin antibody (green) and (B) counterstained with DAPI (blue). The arrowheads in B delimit the region of the highest increase in cellularity, corresponding to reticular laminin in A. Boxed areas in A were amplified to show the detailed morphology of the types of laminin deposits in the spinal cord. C) The red box shows fractones characterized by the presence of thin lines (arrow) and puncta (arrowhead). D) The yellow box shows an independent reticular-like deposit. E) The blue box shows laminin around a blood vessel. Note that laminin seems to detach from the perivascular basal lamina and to spread in the spinal parenchyma (asterisks). Panels C and D were reconstructed in the z axis to provide a 3D view of the fractones (F) and of the reticular deposits (G). In F, lines (arrow) and puncta (arrowheads) presented similar shapes in 2D or 3D. Panel H shows a 3D view of laminin deposits stained with an antibody specific for the α2 chain of human laminin (red) and counterstained with DAPI (blue). The 3D structure of laminin secreted by hADSCs is similar to the one depicted in G and different from the one depicted in F. Note that DAPI-stained nuclei are nested within reticular laminin (red) and that the protein produced by GFP-transduced hADSCs (green) largely surpasses the borders of the secreting cells.</p