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Objective: to identify spatial clusters corresponding to abandonment of routine vaccines in children., Method: an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator., Results: the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively., Conclusion: in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.

Objective: To analyze the temporal trend of vaccination coverage for hepatitis A, measles, mumps and rubella, and varicella in a Brazilian state from 2014 to 2020., Methods: An ecological, time-series study that considered data from 853 municipalities in the state of Minas Gerais that compose the 14 regions of the state, these being the territorial units of analysis. Records of applied doses of hepatitis A, measles, mumps and rubella, and varicella vaccines registered in the Brazilian Immunization Information System were analyzed. Trends were estimated by Prais-Winsten regression and 95% confidence intervals of measures of variation were calculated., Results: Low vaccine coverage of hepatitis A, measles, mumps and rubella, and varicella was identified. Coverages above 95% were observed only in 2015 for the vaccine against hepatitis A (98.8%) and, in 2016, for varicella (98.4%). The measles, mumps and rubella vaccine showed coverage of less than 95% in all analyzed years. Decreases of 13.6 and 4.3% between the years 2019 and 2020 were identified for the measles, mumps and rubella, and hepatitis A vaccines, respectively. There was a decreasing trend in hepatitis A vaccination coverage in the South (p=0.041), East (p=0.030), and North (p=0.045) regions; and for the measles, mumps and rubella in Jequitinhonha Valley (p=0.002), East (p=0.004), and North (p=0.024) regions. Increasing coverage was observed only for varicella in eight regions of the state., Conclusions: The data point to heterogeneity in the temporal behavior of vaccination coverage in Minas Gerais. The downward trend in some regions causes concern about the possibility of resurgence of diseases, such as measles, which until then had been controlled.

Objectives: to identify high-risk areas of leprosy in Brazil from 2001 to 2015., Methods: this is an ecological study of spatial analysis based on Brazilian municipalities. Spatial scan statistics were used to identify spatial clustering and measure the relative risk from the annual detection rate of new cases of leprosy. By criterion based on the Gini index, only secondary clusters were considered., Results: spatial scan statistics detected 26 clusters, in which the detection rate was 59.19 cases per 100 thousand inhabitants, while in the remainder of the country it was 11.76. Large part of the cluster area is located in the Legal Amazon. These groups included only 21.34% of the total population, but 60.40% of the new cases of the disease., Conclusions: Leprosy remains concentrated in some areas, showing the need for control programs to intensify actions in these municipalities.

Background: Hyperthyroidism (Hy) exerts a broad range of influences on a variety of physiological parameters. Its disruptive effect on cardiovascular system is one of its most remarkable impacts. Moreover, Hy has been clinically associated with stress - induced hyperactivation of the hypothalamic-pituitary-adrenal axis., Objective: Evaluate the impact of short-term Hy on cardiac performance and adrenal activity of rats., Methods: Induction of Hy in Wistar rats through injections of T3 (150 µg/kg) for 10 days (hyperthyroid group - HG) or vehicle (control group). The cardiovascular performance was evaluated by: echocardiography (ECHO); heart weight/body weight (mg/gr) ratio; contractility of isolated papillary muscles (IPM) and direct measurement of blood pressures. Adrenal activity was evaluated by adrenal weight/body weight (mg/gr) ratio and 24-hour fecal corticosterone (FC) levels on the, 5th and 10th days of T3 treatment., Results: In HG, the ECHO showed reduction of the End Systolic and End Diastolic Volumes, Ejection, Total Diastolic and Isovolumic Relaxation Times, Diastolic and Systolic Areas and E/A ratio. Heart Rate, Ejection Fraction and Cardiac Output increased. The heart weight/body weight ratio was higher. Similarly, in IPM, the maximum rate of force decay during relaxation was higher in all extracellular calcium concentrations. Systolic blood pressure (SBP) levels were higher. (p ≤ 0.05). On the other hand, there was no difference in the adrenal weight/body weight ratio or in the 24-hour FC levels., Conclusions: Hy induces positive inotropic, chronotropic and lusitropic effects on the heart by direct effects of T3 and increases SBP. Those alterations are not correlated with changes in the adrenal activity.

Purpose: To verify cervical length using transvaginal ultrasonography in pregnant women between 28 and 34 weeks of gestation, correlating it with the latent period and the risk of maternal and neonatal infections., Methods: 39 pregnant women were evaluated and divided into groups based on their cervical length, using 15, 20 and 25 mm as cut-off points. The latency periods evaluated were three and seven days. Included were pregnant women with live fetuses and gestational age between 28 and 34 weeks, with a confirmed diagnosis on admission of premature rupture of membranes. Patients with chorioamnionitis, multiple gestation, fetal abnormalities, uterine malformations (bicornus septate and didelphic uterus), history of previous surgery on the cervix (conization and cerclage) and cervical dilation greater than 2 cm in nulliparous women and 3 cm in multiparae were excluded from the study., Results: A <15 mm cervical length was found to be highly related to a latency period of up to 72 hours (p=0.008). A <20 mm cervical length was also associated with a less than 72 hour latency period (p=0.04). A <25 mm cervical length was not found to be statistically associated with a 72 hour latency period (p=0,12). There was also no significant correlation between cervical length and latency period and maternal and neonatal infection., Conclusion: The presence of a short cervix (<15 mm) was found to be related to a latency period of less than 72 hours, but not to maternal or neonatal infections.