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This study aimed to analyze the self-reported clinical history of patients misdiagnosed with leprosy in the State of Mato Grosso, Brazil. This is a cross-sectional study of new leprosy cases diagnosed in the State of Mato Grosso from 2016 to 2019, with individuals who were released from multidrug therapy due to misdiagnosis after starting treatment. Data were collected via telephone interviews. Over the study period, 354 leprosy cases were released from treatment due to misdiagnosis, of which 162 (45.8%) could be interviewed. All interviewees expressed dissatisfaction with their treatment, which prompted them to seek a reevaluation of their diagnosis before they were released due to “misdiagnosis”. Among them, 35.8% received a final diagnosis of a musculoskeletal or connective tissue disease - mainly fibromyalgia and degenerative changes in the spine - followed by 13.6% with diagnoses of skin and subcutaneous tissue diseases. For 23.5% of the respondents, no alternative diagnosis was established, whereas 7.4% were later re-diagnosed with leprosy. Fibromyalgia and spinal problems were the most common alternative diagnoses for erroneous leprosy. Although the diagnosis of leprosy is usually clinical and does not require access to technical infrastructure in most cases, some more complex situations require diagnostic support via complementary tests, as well as close collaboration between primary care and reference services.

Background Leprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin. Methods Leprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016–2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes. Results Overall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01). Conclusions The disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination. Graphical Abstract

In this study, we propose an indicator of air pollution exposure to identify potential hazardous areas for human health in the Amazon and Central-West Regions of Brazil from 2010 to 2019. This indicator aggregates both concentrations and time of exposure to fine particulate matter (PM2.5), according to the current limit recommended by the World Health Organization (WHO). We used daily PM2.5 averages obtained from the Brazilian Health Integrated Environmental Information System (SISAM) to calculate the percentages of days with PM2.5 concentrations exceeding the limit of 15µg/m³ per year and per month. From 2010 to 2019, the months from August to October presented the largest areas and the highest percentages of days with unacceptable pollution concentration values, harmful to human health. These areas were concentrated in the Arc of Deforestation. Therefore, 60% of the residents of the Amazon and Central-West regions were subjected to inadequate air quality for approximately six months per year. The proposed indicator is reproducible and appropriate to monitor areas of exposure and risk for human health.

Objetivo: Analisar a tendência da mortalidade por insuficiência cardíaca (IC) em brasileiros com 50 anos ou mais, em um período de 21 anos. Métodos: Estudo ecológico com análise de série temporal da mortalidade por IC no Brasil, segundo regiões e Unidades Federativas (UF), em indivíduos com 50 anos ou mais, no período de 1998 a 2019. Foram incluídos todos os óbitos registrados que tinham por causa básica a IC, codificada na Classificação Internacional de Doenças como I50, no período de 1998 a 2019. Os dados foram obtidos no Sistema de Informação sobre Mortalidade do Ministério da Saúde. As análises estatísticas foram realizadas no programa Stata 11.1, por meio do cálculo do coeficiente de mortalidade por IC por 100 mil habitantes. Na análise de tendência, foi utilizada a regressão de Prais-Winsten. Resultados: Entre os anos de 1998 a 2019, foram registrados 567.789 óbitos por IC em adultos com idade acima de 50 anos, o que corresponde à taxa média de 75,5 a cada 100 mil habitantes. A tendência foi decrescente por sexo, regiões e em 23 UF. As maiores taxas de mortalidade observadas ocorreram nas idades mais avançadas em todas as regiões do país. Conclusão: A tendência das taxas de mortalidade por IC entre as UF e regiões brasileiras foi decrescente ao longo de 21 anos. Houve tendência crescente da mortalidade por IC na região Norte e na categoria outros estabelecimentos de saúde.