Clinical manifestations of COVID-19 are varied in the general population. This study aimed to systematize the literature regarding clinical manifestations of patients with confirmed COVID-19. A systematic review of the literature was conducted. A total of 8070 scientific productions were found in the databases. Among the studies, 184 met the initial inclusion criteria, with a total of 114,046 patients. After complete reading, 32 studies that did not report clinical manifestations were excluded. The 152 publications finally included a total of 41,409 individuals from at least 23 countries and 26 different clinical manifestations were reported. In percentage terms, 6 symptoms had a general prevalence greater than or equal to 25%, namely, fever (58.66%), cough (54.52%), dyspnea (30.82%), malaise (29.75%), fatigue (28.16%) and sputum/secretion (25.33%). Neurological symptoms (20.82%), dermatological manifestations (20.45%), anorexia (20.26%), myalgia (16.9%), sneezing (14.71%), sore throat (14.41%), rhinitis (14.29%), goosebumps (13.49%), headache (12.17%), chest pain (11.49%) and diarrhea (9.59%) were other Electronic supplementary material The online version of this article (

Background: Coronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020. Since then, the disease has spread throughout the country, reaching the poorest areas. This study analyzes the relationship between COVID-19 and the population's living conditions. We aimed to identify social determinants related to the incidence, mortality, and case fatality rate of COVID-19 in Brazil, in 2020. Methods: This is an ecological study evaluating the relationship between COVID-19 incidence, mortality, and case fatality rates and 49 social indicators of human development and social vulnerability. For the analysis, bivariate spatial correlation and multivariate and spatial regression models (spatial lag model and spatial error models) were used, considering a 95% confidence interval and a significance level of 5%. Results: A total of 44.8% of municipalities registered confirmed cases of COVID-19 and 14.7% had deaths. We observed that 56.2% of municipalities with confirmed cases had very low human development (COVID-19 incidence rate: 59.00/100 000; mortality rate: 36.75/1 000 000), and 52.8% had very high vulnerability (COVID-19 incidence rate: 41.68/100 000; mortality rate: 27.46/1 000 000). The regression model showed 17 indicators associated with transmission of COVID-19 in Brazil. Conclusions: Although COVID-19 first arrived in the most developed and least vulnerable municipalities in Brazil, it has already reached locations that are farther from large urban centers, whose populations are exposed to a context of intense social vulnerability. Based on these findings, it is necessary to adopt measures that take local social aspects into account in order to contain the pandemic.

The emergence of severe acute respiratory coronavirus 2 (SARS-CoV-2) and its association with severe pneumonia and deaths has exposed gaps in the health systems of several countries worldwide. Although the necessary focus has been to care for hospitalized patients, the strengthening of Primary Health Care (PHC) actions is necessary. PHC is the gateway to the health system in several countries, including Brazil and it plays a role in preventing, protecting, promoting, and treating individuals and communities. Brazil, like other countries, has faced the SARS-CoV-2 pandemic. As Brazil has a universal and decentralized health system, in which PHC has been the model of health reorganizing the health system; here we reflected the importance of strengthening PHC in Brazil in the times of coronavirus disease 2019 pandemic.

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BACKGROUNDLeprosy is an infectious disease caused by Mycobacterium leprae, able to infect large numbers of people. This work is relevant to Juazeiro-BA, a hyper-endemic area for leprosy, since unravel the behavior of the disease in the area, may suggest the decision making for sectors of surveillance, establishing strategies, organizing and evaluating programs and services.OBJECTIVESTo analyze the epidemiology of leprosy in Juazeiro-BA, from 2002 to 2012.METHODSA descriptive, cross-sectional study was conducted based in data of the Diseases Notification System, assigned by the service of Epidemiology from Juazeiro-BA, between 2002 and 2012.RESULTS1,916 new cases of leprosy were detected between 2002 and 2012, of which 921 (48.07%) represented male sex, 995 (51.93%) female, and there was a reduction in the incidence rate of leprosy per 100,000 inhabitants. Most carriers were brown individuals, with low levels of education, living in the urban area, being more prevalent in the economically active age group. Through statistical analysis we found that there are more chances of developing sequelae among men, and multibacillary individuals older than 45 years.CONCLUSIONSThe work serves to direct efforts to control this disease, and highlights the importance of active search for new cases to achieve an early diagnosis, reducing the number of sequels and allowing breaking the chain of disease transmission.

(WHO) 2016-2020 Global Leprosy Strategy aims to reinvigorate efforts to control leprosy and avert leprosy disability to less than 1 per million population. OBJECTIVE To systematically identify clinical factors associated with physical disability in patients with leprosy. DATA SOURCE Searches were conducted in Scopus, PubMed, and Web of Science databases to identify studies published from January 23, 1988, to May 23, 2018, using the keywords leprosy and physical disability and related terms. STUDY SELECTION Studies that evaluated patients using the WHO leprosy disability grading system and reported the number of patients with and without disability by clinical characteristics were included. DATA EXTRACTION AND SYNTHESIS The odds ratio (OR) was used as a measure of association between the clinical features and physical disability. Summary estimates were calculated using random-effects models. MAIN OUTCOMES AND MEASURES The primary outcome was physical disability according to the WHO disability classification. The association between clinical features and physical disability was evaluated. RESULTS The search identified 2447 reports. After screening titles and abstracts, 177 full-text articles were assessed for eligibility, and 32 studies were included in the systematic review; 24 of the 32 studies included sex information (39 571 patients), of whom 24 218 (61.2%) were male. Male patients with leprosy were more likely to have physical disability than female patients with leprosy (pooled OR, 1.66; 95% CI, 1.43-1.93; I 2 , 81.3%; P < .001). Persons with multibacillary leprosy were 4-fold more likely to have physical disability than those with paucibacillary leprosy (pooled OR, 4.32; 95% CI, 3.37-5.53; I 2 , 88.9%, P < .001). Patients having leprosy reactions were more likely to have disability (pooled OR, 2.43; 95% CI, 1.35-4.36; I 2 , 92.1%; P < .001). Patients with lepromatous leprosy experienced 5-to 12-fold higher odds of disability. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis confirms the association between the presence of physical disabilities and male sex, multibacillary leprosy, leprosy reactions, and lepromatous presentation. These findings can guide the development of targeted interventions for early identification of individuals at greater risk of developing physical disabilities and education campaigns to promote early consultation to institute treatment for leprosy reactions and prevent physical disability.

Highlight This study showed a spatial association between COVID-19 and poor living conditions in a population in Northeast Brazil. The case fatality rate was 1.42 times higher in the municipalities with very high social deprivation. Priority municipalities have been identified for intervention by the public authorities.

Aim Older adults are the main risk group for coronavirus disease 2019 (COVID‐19). This study aimed to describe the clinical manifestations and factors associated with mortality from COVID‐19 among older adults in Brazil. Methods A cross‐sectional observational study was carried out with data from 9807 cases of COVID‐19 among older adults in the state of Alagoas, Brazil. We determined the case fatality rate between age groups and clinical factors associated with mortality. Results A total of 52.5% (n = 5145) were women, and with an average age of 70.21 ± 8.37 years. The fatality rate was 11.9%, with a higher rate in men (14.4%) compared with women (9.8%). The fatality rate increased with age. The most common manifestations were fever (n = 4926; 50.2%), cough (n = 5737; 58.5%), headache (n = 1980; 20.2%) and fatigue (n = 2022; 20.6%). The most prevalent comorbidities were diabetes (n = 1528; 5.6%), cardiovascular disease (n = 1528; 15.6%) and systemic arterial hypertension (n = 597; 6.1%). The factors associated with mortality were male sex (OR 1.54), age ≥75 years (OR 2.40), dyspnea (OR 2.92), diabetes (OR 2.33), hypertension (OR 1.53) and chronic kidney disease (OR 2.02). Conclusions The profile and the risk factors evidenced show the need to adopt mechanisms to protect the elderly population.