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Since its first identification in Brazil, the variant of concern (VOC) Gamma has been associated with increased infection and transmission rates, hospitalizations, and deaths. Minas Gerais (MG), the second-largest populated Brazilian state with more than 20 million inhabitants, observed a peak of cases and deaths in March-April 2021. We conducted a surveillance study in 1240 COVID-19-positive samples from 305 municipalities distributed across MG's 28 Regional Health Units (RHU) between 1 March to 27 April 2021. The most common variant was the VOC Gamma (71.2%), followed by the variant of interest (VOI) zeta (12.4%) and VOC alpha (9.6%). Although the predominance of Gamma was found in most of the RHUs, clusters of Zeta and Alpha variants were observed. One Alpha-clustered RHU has a history of high human mobility from countries with Alpha predominance. Other less frequent lineages, such as P.4, P.5, and P.7, were also identified. With our genomic characterization approach, we estimated the introduction of Gamma on 7 January 2021, at RHU Belo Horizonte. Differences in mortality between the Zeta, Gamma and Alpha variants were not observed. We reinforce the importance of vaccination programs to prevent severe cases and deaths during transmission peaks.

Introduction: The aim of the study was to identify factors associated with the causes of in-hospital morbidity and mortality in an elderly Brazilian population due to osteoporotic hip fractures., Method: Retrospective cohort study involving a population over 60 years of age admitted to hospital due to osteoporotic hip fractures and followed up from hospitalization to outcome (discharge or mortality) from 2010 to 2018, in a public hospital in Brasília, the capital of Brazil. Multivariate analysis was performed using the Poisson regression model with a robust variance, observing the hierarchical model proposed and the receiver operating characteristic (ROC) curve to obtain the cutoff point for mortality incidence in relation the total length of hospital stay. Significance level was set as p < 0.05. The analyses were conducted using the SAS 9.4 software., Result: The mean hospital mortality rate among the 402 patients involved was 18.4%, and the associations made with the outcome mortality were per relevance: respiratory infection, age over 90 years, high preoperative cardiovascular risk, chronic obstructive pulmonary disease (COPD) as comorbidity, serum hemoglobin level ≤ 10 and other infections. Mortality also showed association with longer total length of hospital stay, as well as with prolonged postoperative period., Conclusion: Hip fractures in the elderly due to osteoporosis indicate a relationship between the sicker profile of the aging elderly population and the prevalence of chronic diseases strongly associated with in-hospital infections, contributing to increased mortality. There were fewer early interventions, and mortality was also associated with prolonged postoperative period. The aim of this study was not to compare independent variables with each other, but suggests the relationship between the presence of comorbidities, which predisposes to the development of infections, directly linked to mortality., Competing Interests: The authors have declared that no competing interests exist.

Background: Brazil is a signatory to the World Health Organization End TB Strategy and the United Nations Sustainable Development Goals. This study aims to characterize tuberculosis (TB) deaths and TB mortality rates in Brazil for the period 1997-2017., Methods: We performed an ecological study based on information for TB deaths between 1997 and 2017 extracted from the Mortality Information System of the Brazilian Ministry of Health. Data included gender, age group and geographic regions. The trends in mortality rates were estimated using Joinpoint regression analysis, which identifies years in which there is a change in slope of the time series by the Monte Carlo permutation., Results: Between 1997 and 2017 there were 104 172 recorded TB deaths in Brazil and the mortality rates were higher for men and the elderly. The age-adjusted mortality rate decreased from 4.2 per 100 000 in 1997 to 3.0 per 100 000 in 2003 to 2.0 per 100 000 in 2017. The average percentage reduction from 1997 to 2003 was 6.2% (95% confidence interval [CI] -7.7 to -4.7) per year, while from 2003 to 2017 it was 3.0% (95% CI -3.4 to -2.5) per year, representing a slowdown in the rate of decline., Conclusion: The high number of deaths and the slowdown in the decline of mortality rates from TB in Brazil maintain the disease as an important public health concern and an obstacle to reaching goals set by international commitments., (© The Author(s) 2021. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The study aimed to investigate the association between social capital indicators and depressive symptoms among university students from Brazil. The study drew on a sample of 579 randomly selected university students, from a greater crossnational study conducted in 2018. Students completed a self-administered questionnaire assessing depressive symptoms, indicators of social capital and lifestyle behaviors. Data were analyzed using multivariate logistic regression models. Indicators of social capital included trust, group membership and frequency of meeting friends. Four social capital indicators were significantly associated with clinically relevant depressive symptoms. Students who agreed that people are likely to take advantage of one another were more likely to report depressive clinically relevant symptoms (OR: 1.80, 95%CI: 1.00 - 3.23) as well as students who agreed that people are not willing to help in case needed (OR: 2.11, 95%CI: 1.02 - 4.36). Perceived stress, smoking and hazardous alcohol consumption were not associated with clinically relevant depressive symptoms. Social capital plays an important role in explaining depressive symptoms among Brazilian university students. The study suggests that creating trust and enhancing participation in social networks can be an important strategy for promoting mental health among university students investigated in this study.

Perinatal mortality includes fetal mortality and early neonatal mortality (0 to 6 days of life). The study described perinatal deaths in Brazil in 2018 according to the modified Wigglesworth classification. The data sources were the Brazilian Mortality Information System and the Brazilian Information System on Live Births. Fetal mortality and perinatal mortality rates were calculated per 1,000 total births (live births plus stillbirths) and the early neonatal mortality rate per 1,000 live births, compared using their respective 95% confidence intervals (95%CI). Perinatal deaths were classified in groups of antepartum causes, congenital anomalies, prematurity, asphyxia, and specific causes. For each group of causes, the study calculated the number of deaths by weight group, in addition to mortality rates and respective 95%CI, besides the spatial distribution of mortality rates by state of Brazil. A total of 35,857 infant deaths were recorded, of which 18,866 (52.6%) were early neonatal deaths, while stillbirths totaled 27,009. Perinatal deaths totaled 45,875, for a mortality rate of 15.5‰ births. The highest mortality rate (7.6‰; 7.5‰-7.7‰) was observed in the antepartum group, followed by prematurity (3.6‰; 3.6‰-3.7‰). In the antepartum group, 14 of the 27 states (eight of which in the Northeast and four in the North) presented perinatal mortality rates above the national rate. Perinatal mortality in Brazil was high, and most deaths could have been prevented with investment in prenatal and childbirth care.

Objective: This study evaluates the association of serum retinol, hepcidin levels, and anemia in children., Methods: This cross-sectional study included 312 children, ages 6 to 59 mo, from Rio de Janeiro, Brazil. The association between hepcidin and retinol levels, hematologic parameters, and body mass index (BMI) was analyzed using a generalized linear model with and without adjustment for C-reactive protein (CRP) level. Logistic regression analysis was used to test anemia as an outcome and serum retinol level as a predictive variable using the odds ratio (OR) function., Results: Anemia was present in 14.6% of the children, 5.8% presented iron deficiency anemia, and 9.6% had vitamin A deficiency. The increase in serum retinol levels reduced the chances of anemia (OR = 0.13; confidence interval = 0.29-0.59). When CRP level was not adjusted for in the multiple regression analyses, retinol, ferritin levels, and BMI/age were predictors of serum hepcidin levels (β = -3.36, 0.14, 1.02, respectively; P = 0.032). Accordingly, serum retinol levels were inversely associated with CRP levels (β = -0.025 and P < 0.001)., Conclusions: The association between serum retinol and hepcidin levels in children ages 6 to 59 mo seems to be dependent on inflammation. Taken together, the results reinforce the need for the development of further studies to better understand the relationship between vitamin A and anemia of inflammation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objetive: To analyze the trends of COVID-19 in Brazil in 2020 by Federal Units (FU)., Method: Ecological time-series based on cumulative confirmed cases of COVID-19 from March 11 to May 12. Joinpoint regression models were applied to identify points of inflection in COVID-19 trends, considering the days since the 50 th confirmed case as time unit., Results: Brazil reached its 50 th confirmed case of COVID-19 in 11 March 2020 and, 63 days after that, on May 12, 177,589 cases had been confirmed. The trends for all regions and FU are upward. In the last segment, from the 31 st to the 63 rd day, Brazil presented a daily percentage change (DPC) of 7.3% (95%CI= 7.2;7.5). For the country the average daily percentage change (ADPC) was 14.2% (95%CI: 13.8;14.5). The highest ADPC values were found in the North, Northeast and Southeast regions., Conclusions: In summary, our results show that all FUs in Brazil present upward trends of COVID-19. In some FUs, the slowdown in DPC in the last segment must be considered with caution. Each FU is at a different stage of the pandemic and, therefore, non-pharmacological measures should be adopted accordingly., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective to describe the evolution of COVID-19 in Brazil up until epidemiological week 20 of 2020. Methods this is an ecological study based on data and official documents from the Brazilian Ministry of Health and international organizations; comparisons were made between Brazil and other countries and incidence and mortality rates were calculated. Results by the end of epidemiological week 20, 233,142 cases, and 15,633 deaths had been confirmed for Brazil as a whole and 3,240 (58.2%) of the country's municipalities had reported at least one case; Brazil was at an earlier phase of the pandemic when compared to other countries, except Russia and Turkey, regarding cumulative cases, and except Canada regarding cumulative deaths; the highest rates were found in Brazil's Northern Region states, where Amazonas state had the highest incidence rates(4,474.6/1,000,000) and mortality rates (331.8/1,000,000). Conclusion Brazil is one of the countries with the highest number of confirmed cases and deaths, with marked regional differences.

Background: Cervical cancer has high prevalence and mortality rates in worldwide female population. Persistent infection by high-risk Human Papillomavirus (hr-HPV) is the main cause of this cancer. However, many environmental, genetical, and epigenetical cofactors can modulate viral infection and cervical carcinogenesis. Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism is a genetic factor that has been associated with many pathologies, including cancer. Nevertheless, studies with cervical cancer presented controversial results, and varied according to ethnicity. Thus, the aim of this study was to determine association between MTHFR C677T polymorphism, Human Papillomavirus (HPV) infection and cervical cancer., Methods: A case-control study was performed with 150 histological cervical samples. Case group were divided in Cervical Intraepithelial Neoplasia (CIN) grade I (n = 30), CIN II (n = 30), CIN III (n = 30), and Squamous Cervical Carcinoma (SCC) (n = 30). Control group was composed by 30 samples without lesion, presenting cervicitis. HPV detection was performed by conventional Polymerase Chain Reaction (PCR) with SPF primers set, and by real-time PCR specific for HPV 16 and hr-HPV. MTHFR C677T polymorphism was analyzed by PCR followed by Restriction Fragment Length Polymorphism (RFLP)., Results: Frequency of MTHFR CC genotype was 72.7% (n = 109), CT 23.3% (n = 35) and TT 4.0% (n = 6). Polymorphic T allele frequency was 15.7%. No statistically significant association was observed between MTHFR C677T polymorphism and presence of pre-neoplastic or neoplastic cervical lesions. Similar frequencies of T allele was observed in control (23.3%) and cases (13.3%) groups (p = 0.174). In addition, there was no statistically significant association between MTHFR C677T polymorphism and viral infection, even considering hr-HPV or HPV 16 positivity., Conclusion: MTHFR C677T polymorphism was not associated with cervical cancer and HPV infection.

Aim: Our aim was to evaluate the correlation and concordance measures between clinical, endoscopic and histologic remission in Crohn's disease (CD) under treatment. Method: Twenty-four patients with CD under treatment were included in a prospective consecutive cross-sectional study from January to September 2018. Clinical activity was assessed by Crohn's Disease Activity Index (CDAI). All of the patients were submitted an ileocolonoscopy with biopsy and classified by Simple Endoscopic Score (SES-CD). Histologic activity was assessed by Global Histologic Activity Score (GHAS) modified. Remission was considered with CDAI <150; SES-CD ≤2 and GHAS ≤4. Results: Clinical remission was established in 53%, however, only 50% had mucosal healing (MH) and 70% had inflammatory histologic activity. Correlation between endoscopic and histological measures was strong and positive (σ = 0.73, p  < .0003). The concordance remission agreement between SES-CD and GHAS was weak with (κ) = 0.3 (IC 95%: -0.09; 0.69). The greatest disparity arose when clinical activity (CDAI) was compared with histological measures (σ = 0.20, p  = .45), (κ) = 0.26 (IC = -0.03; 0.56). Conclusion: The score SES-CD correlates well with histological score GHAS in CD under treatment, however, there is low concordance between both mainly in patients with anti-TNFs treatment. CDAI score had low correlation and concordance with histological score GHAS. In this sample, patients under treatment and without symptoms had low MH and histologic healing.

As the world's population ages, chronic and degenerative diseases are rising. This scenario demands the development of new treatment techniques with lower costs, which are as efficient as the existing ones. Hypodermoclysis is the infusion of fluids into the subcutaneous tissue with a butterfly needle. This technique may be used for isotonic fluid replacement and to administer cytosine arabinoside, clodronate, antibiotics and narcotic analgesics. This review evaluates the evidence supporting the use of hypodermoclysis to treat elderly patients with dehydration and patients with terminal cancer, and discusses its indications, adverse effects and perspectives. A MEDLINE search of the last 30 years was done to recover all available literature. Hypodermoclysis therapy is a safe and effective method to provide fluids and narcotic analgesic therapy in elderly patients that are mild and moderate dehydrated and in patients with cancer. It seems a good option to provide antibiotics, but there is a need for more studies to evaluate this indication.

The objective of this study was to identify and describe the actions of Brazilian senators in the field of public health in 1995 and 1996. We also sought to determine if profession, regional background, or political party influenced the senators' actions. The actions were divided into three types: legislative (proposal and review of bills and petitions); supervisory (information requests to the executive branch and the establishment of inquiry committees and other special committees); and parliamentary (speeches). The data were collected from two databases maintained by the Senate, namely MATE and DISC. Of the 89 senators who were in office during the study period, 76 were involved with public health issues. Of the total of 667 actions studied, there was a predominance of speeches (43% of all actions), most of them responding to news reported by regional or national media. Supervisory activities were limited (5% of all actions were information requests). The subjects dealt with most frequently were health policies (30%), drugs (9%), regulation of health professions (8%), disease control (7%), and worker health (6%). Concerning the professions of the senators, the most frequent categories were physicians, teachers, and journalists. The senators representing the North and Northeast regions performed 62% of the actions and were involved with almost all the health subjects. Although 43% of the actions were carried out by liberal and right-wing senators, the senators from socialist and labor parties had a stronger proportional participation (both in terms of senators involved and actions performed). It is interesting to note that socialist and labor senators showed minimal involvement in the issue of worker health. The predominance of speeches as a prevalent type of action, the limited and disjointed scope of legislative actions, and, especially, the poor monitoring and control show the need for deep changes in the work process of the Senate's technical committees and, therefore, of the Senate's technical support unit.