COVID-19 Mortality and Case-Fatality Rates in Sergipe State, Northeast Brazil, From April to June 2020

Information on how coronavirus disease 2019 (COVID-19) mortality is related to population characteristics in low- and middle-income countries is still limited. We described the deaths from COVID-19 in Sergipe state, Northeast Brazil, from April 2 to June 27, 2020. For this purpose, we conducted a study composed of (i) a case series study of all deaths due to COVID-19 and (ii) a population-based study to verify the behavior of the mortality and case-fatality rates (CFR) related to COVID-19. Data from 605 deaths due to COVID-19 were used to describe the characteristics of individuals with the disease, as well as the differences in gender, age, and comorbidities. Additionally, population data were extracted to estimate the mortality and CFR by population stratum. We also performed an adjusted CFR analysis including a time lag of 14 days between the onset of symptoms and reporting deaths. Of the 605 patients included in this study, 321 (53.1%) were males and the median age was 67.0 years. Most patients (n = 447, 73.9%) who died from COVID-19 had at least one pre-existing clinical condition. The mortality rate was 29.3 deaths per 100,000 inhabitants and the crude CRF was 2.6% (95% CI 2.4–2.8). CFR was higher in males (3.1%, 95% CI 2.8–3.4; p < 0.001) and people aged =60 years (14.2%, 95% CI 13.0–15.6; p = 0.042). About 25% of patients died during the first 24-h post-hospital admission. The adjusted CFR for a 14-day time lag was ~2-fold higher than the crude CFR over the study period.We dedicated this article to all health professionals who are facing COVID-19. This study was part of the EpiSERGIPE project. NM thanks the Portuguese Foundation for Science and Technology under the Horizon 2020 Program (PTDC/PSI-GER/280 76/2017)

Combinações entre cultivares, ambientes, preparo e cobertura do solo em características agronômicas de alface.

Objetivou-se identificar combinações entre cultivares, ambientes de cultivo e preparo e cobertura de solo capazes de melhorar o desempenho agronômico e aumentar a produtividade da cultura da alface em cultivo orgânico. A pesquisa foi conduzida na Universidade Federal do Acre, utilizando o delineamento experimental de blocos casualizados, com parcelas subdivididas para cada experimento (campo e casa de vegetação), com quatro repetições. Em cada experimento, três cultivares de alface (Simpson, Marisa e Vera), constituindo as sub-parcelas, foram sorteadas nas parcelas, representadas por quatro preparos e cobertura do solo (encanteiramento com cobertura de palha de arroz, polietileno prateado, solo descoberto e plantio direto). A produtividade comercial de alface foi de 12,3 t ha-1 em cultivo protegido e de 7,9 t ha-1 em campo. O cultivo protegido promoveu melhor desenvolvimento das plantas, caracterizado por maior massa da matéria fresca e seca da parte aérea, massa da matéria fresca comercial e melhor classificação comercial, além de promover bom desempenho agronômico e maior produtividade em qualquer um dos preparos de solo. As cultivares Simpson e Marisa apresentaram massa da matéria seca da parte aérea semelhante e superior à ‘Vera’, porém, o crescimento do caule da ‘Simpson’ foi elevado, caracterizando pendoamento precoce, fato que reduz sua qualidade comercial. As cultivares Marisa e Vera não alongaram o caule indicando serem tolerantes às condições ambientais de Rio Branco. A cobertura do solo com casca de arroz ou plástico prateado contribuiu para minimizar os efeitos climáticos prejudiciais ao cultivo da alface em campo. O plantio direto orgânico não diferiu do plantio em canteiro descoberto

Simultaneous CXCL12 and ESR1 CpG island hypermethylation correlates with poor prognosis in sporadic breast cancer

<p>Abstract</p> <p>Background</p> <p>CXCL12 is a chemokine that is constitutively expressed in many organs and tissues. <it>CXCL12 </it>promoter hypermethylation has been detected in primary breast tumours and contributes to their metastatic potential. It has been shown that the oestrogen receptor α (<it>ESR1</it>) gene can also be silenced by DNA methylation. In this study, we used methylation-specific PCR (MSP) to analyse the methylation status in two regions of the <it>CXCL12 </it>promoter and <it>ESR1 </it>in tumour cell lines and in primary breast tumour samples, and correlated our results with clinicopathological data.</p> <p>Methods</p> <p>First, we analysed <it>CXCL12 </it>expression in breast tumour cell lines by RT-PCR. We also used 5-aza-2'-deoxycytidine (5-aza-CdR) treatment and DNA bisulphite sequencing to study the promoter methylation for a specific region of <it>CXCL12 </it>in breast tumour cell lines. We evaluated <it>CXCL12 </it>and <it>ESR1 </it>methylation in primary tumour samples by methylation-specific PCR (MSP). Finally, promoter hypermethylation of these genes was analysed using Fisher's exact test and correlated with clinicopathological data using the Chi square test, Kaplan-Meier survival analysis and Cox regression analysis.</p> <p>Results</p> <p><it>CXCL12 </it>promoter hypermethylation in the first region (island 2) and second region (island 4) was correlated with lack of expression of the gene in tumour cell lines. In the primary tumours, island 2 was hypermethylated in 14.5% of the samples and island 4 was hypermethylated in 54% of the samples. The <it>ESR1 </it>promoter was hypermethylated in 41% of breast tumour samples. In addition, the levels of ERα protein expression diminished with increased frequency of <it>ESR1 </it>methylation (p < 0.0001). This study also demonstrated that <it>CXCL12 </it>island 4 and <it>ESR1 </it>methylation occur simultaneously at a high frequency (p = 0.0220).</p> <p>Conclusions</p> <p>This is the first study showing a simultaneous involvement of epigenetic regulation for both <it>CXCL12 </it>and <it>ESR1 </it>genes in Brazilian women. The methylation status of both genes was significantly correlated with histologically advanced disease, the presence of metastases and death. Therefore, the methylation pattern of these genes could be used as a molecular marker for the prediction of breast cancer outcome.</p

Metabolic syndrome in overweight children from the city of Botucatu - São Paulo State - Brazil: agreement among six diagnostic criteria

<p>Abstract</p> <p>Background</p> <p>The metabolic syndrome has been described in children; however, a standard criterion has not been established for its diagnosis. Also, few studies have been conducted to specifically observe the possible existence of agreement among the existing diagnostic criteria. The purpose of the study is to evaluate agreement concerning prevalence rates of the metabolic syndrome diagnosed by six different criteria in overweight schoolchildren in the city of Botucatu - SP -Brazil.</p> <p>Methods</p> <p>This is a cross-sectional study on 128 overweight schoolchildren. Clinical examination included anthropometry, pubertal staging evaluation, and blood pressure. Triacylglycerol, glycemia, HDL-cholesterol, insulin levels, and HOMA-IR were determined. The Kappa index, the Mann-Whitney test and the chi-square test were used for statistical analysis.</p> <p>Results</p> <p>The prevalence of the metabolic syndrome varied from 10 to 16.5% according to different diagnostic criteria. Results were similar for boys and girls and pubertal stage. Great agreement was observed among the six different diagnostic criteria for the metabolic syndrome.</p> <p>Conclusions</p> <p>Different diagnostic criteria, when adopted for subjects with similar demographic characteristics, generate similar and compatible prevalence. Results suggest that it is possible to adopt any of the analyzed criteria, and the choice should be according to the components available for each situation.</p

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Susceptibility of six arabic coffee cultivars to fruit flies (Diptera : Tephritoidea) under shaded and unshaded organic management in Valenca, state of Rio de Janeiro, Brazil

The infestation indices by fruit flies were determined for six cultivars of Coffea arabica L. in shaded and unshaded systems under organic management. The experiment was set in a completely randomized design with a split-split-plot arrangement and four replicates. A 250g-sample of maturing fruits per plot was harvested in May 2005. The cultivars 'Icatu Amarelo' and 'Catucai Amardo' were the least susceptible to attack by tephritids in both systems. As for lonchaeids, 'Oeiras', 'Catucai Amarelo' and 'Catuai Vermelho' were the least susceptible cultivars in the shaded system, and there was no difference among the cultivars in the unshaded system. The following tephritid species were obtained: Ceratitis capitata (Wiedemann), Anastrepha fraterculus (Wiedemann) and A. sororcula Zucchi (Tephritidae). Lonchaeids were represented by Neosilba bifida Strikis & Prado, N. certa (Walker), N. glaberrima (Wiedemann), N. pendula (Bezzi), N. pseudopendula (Korytkowski and Ojeda), Dasiops rugifrons Hennig, Neosilba n.sp. 10 and Neosilba n.sp.14.36226827