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Syphilis is a chronic infectious disease with its prevalence being described since the 15 th century. Although its etiological agent and also the treatment measures are widely known, syphilis is still a great public health problem worldwide, mainly in countries with limited resources associated to low investments in health primary care. The aim of the present study was to analyze the trend and regional distribution of syphilis in Brazil between 2007 and 2017. This is an ecological study using secondary data from the Brazilian notification system. The Ministry of Health selected 100 municipalities which presented the worse outcomes related to syphilis from the 5,570 Brazilian municipalities as a target for a comprehensive project in order to tackle the prevalence of syphilis, called the "No Syphilis Project". These priority municipalities represent 57.7% of syphilis cases and about one third of the Brazilian population. They were compared with other 189 non-priority municipalities with more than 100 thousand inhabitants among the Brazilian regions (North, Northeast, Southeast, South and Center-West). Polynomial regression methods and Joinpoint analyses were used to analyze the trend, from which the Annual Average Percent Change (AACP) for each time period was calculated. There was a significant growth trend in all regions for the main three forms of syphilis (in pregnancy, congenital and acquired), especially in the South. The ratio between syphilis in pregnancy and congenital syphilis increased in both priority (AAPC: 8.54%; p<0.001) and non-priority municipalities (AAPC: 2.61%; p = 0.005), as well as in the regions, except the Center-West. High growth trends in syphilis prevalence were found in all municipalities, as well as all five regions between 2007 and 2017, showing that the challenge to reduce or even eliminate syphilis in Brazil is still difficult.

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BackgroundInfections by Staphylococcus spp. are often associated with wounds, especially in hospitalized patients. Wounds may be the source of bacteria causing cross-contamination, and are a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) infection. The aim of this study was to investigate the prevalence of wound colonization by Staphylococcus spp., especially S. aureus and MRSA, in hospitalized patients, and to identify the factors associated with such colonization.MethodsThis cross-sectional study enrolled patients with wounds who were hospitalized in a remote and underdeveloped inland region of northeastern Brazil with extreme poverty. Samples were collected using sterile swabs with 0.85% saline solution, and coagulase-negative Staphylococcus spp., S. aureus, and MRSA were identified using standard laboratory procedures. Data regarding the sociodemographic characteristics, antibiotic use, and comorbidities of the patients were collected using the medical records and a questionnaire.ResultsA total of 125 wounds were analyzed. The patients had a mean age of 63.88 years and a mean 3.84 years of school education. Eighty-one wounds (64.80%) were colonized by Staphylococcus spp. Twenty-five wounds (20%) were colonized by S. aureus, 32% of which were colonized by MRSA. Wound colonization by Staphylococcus spp. was associated with pneumonia or other respiratory disease (p = 0.03). Wound colonization by S. aureus was associated with nasal colonization by S. aureus (p < 0.001), fewer days of prior antibiotic use (p = 0.04), admission to a medical ward (p = 0.02), and age >65 years (p = 0.05). Among patients with wound colonization by MRSA, 37.50% had a history of prior antibiotic use, 75% had two or more comorbidities, 25% had cancer or diabetes, 50% had cardiovascular disease, and 50% died.ConclusionsWounds can be the source of Staphylococcus spp. infection, and high proportions of wounds are colonized by S. aureus and MRSA. Nasal colonization by S. aureus may be a source for wound colonization by S. aureus, illustrating the importance of preventing cross-contamination in hospital environments, especially among elderly patients. Wounds should be carefully managed to prevent microbial spread, thereby assisting patient recovery and reducing healthcare costs.

RESUMO: Objetivo: Analisar as tendências das taxas de incidência da intoxicação por agrotóxicos nas regiões brasileiras, de acordo com sexo e circunstância da intoxicação, no período de 2001 a 2014. Método: Estudo de séries temporais, com dados do Sistema de Informação de Agravos de Notificação (SINAN). As taxas de incidência foram calculadas por meio da razão entre o número de casos novos confirmados de intoxicações por agrotóxicos e a população residente no mesmo período e local. Foram realizados análise de regressão polinomial e testes de Mann-Whitney e Kruskal-Wallis. Quando encontradas diferenças significativas, os testes foram seguidos pela penalização de Bonferroni com a finalidade de identificar onde residia a diferença. Resultados: No Brasil, foram registrados 80.069 casos de intoxicação nesse período. Houve um crescimento linear de notificações de intoxicação por agrotóxico, cuja taxa de tendência de crescimento encontrada foi de 0,377 por 100 mil habitantes/ano. As regiões Sul e Centro-Oeste apresentam as maiores taxas de intoxicação. Em relação ao sexo, não foram encontradas diferenças significativas (p < 0,347), sendo a tentativa de suicídio a circunstância de intoxicação mais significativa (p < 0,001). Conclusão: A incidência de intoxicação por agrotóxico no Brasil segue em aumento no século XXI.

Objective: Conduct a survival analysis of elderly patients hospitalized in an intensive care unit (ICU), identifying the predictors of mortality among this age group. Methods: A retrospective cohort study was performed with data from the medical records of 457 elderly patients hospitalized in an ICU located in the city of Natal in Brazil. Survival functions were estimated using the Kaplan-Meier estimator, and the Log-rank test was used for comparisons. In addition, a multiple Cox proportional hazards model was constructed to identify the independent effects of the predictors of survival. Results: It was found that the survival of elderly ICU patients declined due to factors such as increased hospitalization time, advancing years, unmarried (including common-lawmarriage) status, the presence of shock, pneumonia, septicaemia, fractures, a reduced state of consciousness, hospitalization for clinical reasons, being bedridden prior to hospitalization, fever, bradycardia, hypotension, cardiac arrest and the need for mechanical ventilation. The multiple Cox proportional hazards model revealed that variables such as shock, longevity, bradycardia, fractures, fever, hospitalization in the public healthcare system and admission for clinical reasons remained significant as predictors of reduced survival in intensive care units. Conclusions: The survival rates of elderly persons in an ICU in the city of Natal in Brazil were affected by demographic and clinical predictors, and those related to the type of hospitalization and the health care network. This shows that any initiative aimed at increasing the survival of elderly ICU patients must look at individual and social issues and factors related to the health care network.

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