PADRÕES DE DESMATAMENTO NOS BIOMAS AMAZÔNIA, CERRADO E PANTANAL NA BACIA HIDROGRÁFICA DO ALTO PARAGUAI, MATO GROSSO - BRASIL

The objective of this study is to analyze the spatial dynamics of vegetation cover and land use and the rate of deforestation in the Upper Paraguay River Basin, located in the Brazilian state of Mato Grosso, so that the information can contribute to the development of territorial planning strategies aimed at environmental conservation. Analyses of the dynamics of changes in vegetation cover and land use and deforestation rates were carried out through procedures carried out via geoprocessing (cutting, reclassification, resizing and quantification) of the annual mapping data (1985-2020) generated by the Annual Mapping Project of Land Cover and Use in Brazil (MapBiomas). In the investigated hydrographic unit, the Natural Vegetation Areas decreased by 19.82%, while the Agricultural Anthropogenic Areas increased by 76.74%. In the basin, the average deforestation rate was 1.57%/year, while in the Amazon, Cerrado and Pantanal biomes in the basin it was 4.09%/year, 1.58%/year and 0.75%/year, respectively. In the Pantanal, the average deforestation rate went from 0.77%/year to 0.88%/year from the initial five-year period (1986-1990) to the end (2016-2020), while in the same period there was a reduction in the Amazon (5.12%/year to 2.22%/year) and in the Cerrado (1.68%/year to 1.21%/year). It can be seen that deforestation occurs heterogeneously in the basin with greater intensity in the biomes located in the plateau region (Amazon and Cerrado), where anthropogenic areas have surpassed areas of natural vegetation. Although the average rate of deforestation is low in the Pantanal, compared to the other biomes, a recent upward trend (2016-2020) in the average was observed.El objetivo de este estudio es analizar la dinámica espacial de la cobertura vegetal y el uso del suelo y la tasa de deforestación en la Cuenca del Río Alto Paraguay, ubicada en el estado brasileño de Mato Grosso, de manera que la información pueda contribuir al desarrollo de estrategias de planificación territorial orientadas a la conservación ambiental. Los análisis de la dinámica de los cambios en la cobertura vegetal y en las tasas de uso y deforestación del suelo se realizaron a través de procedimientos realizados a través del geoprocesamiento (corte, reclasificación, redimensionamiento y cuantificación) de los datos de mapeo anual (1985-2020) generados por el Proyecto Anual de Mapeo de Cobertura y Uso del Suelo en Brasil (MapBiomas). En la unidad hidrográfica investigada, las Áreas de Vegetación Natural disminuyeron en 19.82%, mientras que las Áreas Antropogénicas Agrícolas aumentaron en 76.74%. En la cuenca, la tasa promedio de deforestación fue de 1,57%/año, mientras que en los biomas Amazonia, Cerrado y Pantanal de la cuenca fue de 4,09%/año, 1,58%/año y 0,75%/año, respectivamente. En el Pantanal, la tasa promedio de deforestación pasó de 0,77%/año a 0,88%/año desde el quinquenio inicial (1986-1990) hasta el final (2016-2020), mientras que en el mismo período hubo una reducción en la Amazonia (5,12%/año a 2,22%/año) y en el Cerrado (1,68%/año a 1,21%/año). Se puede observar que la deforestación ocurre de manera heterogénea en la cuenca, con mayor intensidad en los biomas ubicados en la región de la meseta (Amazonas y Cerrado), donde las áreas antropogénicas han superado las áreas de vegetación natural. Aunque la tasa promedio de deforestación es baja en el Pantanal, en comparación con los otros biomas, se observó una tendencia al alza reciente (2016-2020) en el promedio.O objetivo deste estudo é analisar a dinâmica espacial da cobertura vegetal e uso da terra e a taxa de desmatamento na Bacia Hidrográfica do Alto Paraguai, localizada no estado brasileiro de Mato Grosso, visando que as informações possam contribuir no desenvolvimento de estratégias de planejamento territorial voltadas à conservação ambiental. Foram realizadas análises da dinâmica de mudanças da cobertura vegetal e uso da terra e das taxas de desmatamento por meio de procedimentos efetuados via geoprocessamento (recorte, reclassificação, redimensionamento e quantificação) dos dados anuais de mapeamentos (1985-2020) gerados pelo Projeto de Mapeamento Anual da Cobertura e Uso do Solo no Brasil (MapBiomas). Na unidade hidrográfica investigada as Áreas de Vegetação Natural sofreram redução de 19,82%, ao passo que as Áreas Antrópicas Agrícolas aumentaram 76,74%. Na bacia a taxa média de desmatamento foi de 1,57%/ano, enquanto que nos biomas Amazônia, Cerrado e Pantanal na bacia foi de 4,09%/ano, 1,58%/ano e 0,75%/ano, respectivamente. No Pantanal a taxa média de desmatamento foi de 0,77%/ano para 0,88%/ano do quinquênio inicial (1986-1990) para o final (2016-2020), enquanto no mesmo período houve redução na Amazônia (5,12%/ano para 2,22%/ano) e no Cerrado (1,68%/ano para 1,21%/ano). Constata-se que na bacia o desmatamento ocorre de forma heterogênea, com maior intensidade nos biomas localizados na região de planalto (Amazônia e Cerrado), onde as áreas antrópicas superaram as áreas de vegetação natural. Embora a taxa média de desmatamento seja baixa no Pantanal, comparado aos demais biomas, foi observada uma tendência de aumento recente (2016-2020) na médi

Epidemiologic and clinical characteristics of pregnant women living with HIV/AIDS in a region of Southern Brazil where the subtype C of HIV-1 infection predominates

AbstractSouthern Brazil has the highest prevalence rate of AIDS in the country and is the only region in the Americas where HIV-1 subtype C prevails.ObjectiveWe evaluated the epidemiologic and clinical characteristics of pregnant women living with HIV/AIDS in the South region of Santa Catarina, Brazil.MethodsAll pregnant women with HIV infection attending the obstetric outpatient clinic of Criciúma, State of Santa Catarina, in 2007 (n=46) were invited to participate. Data of 36 eligible participants were obtained through a standardized questionnaire.ResultsThe great majority were young, with a steady partner, low family income, low education level and referring early first sexual intercourse. Many reported use of illicit non-injecting drugs (55.5%) and unprotected sex with partners that were HIV-positive (57.7%), injecting drug user (22.2%), male inmate (19.4%), truck driver (13.8%), with history of sexually transmitted disease (11.1%) or men who have sex with men (MSM) (2.8%). Most (66.7%) of the participants had their HIV diagnosis done during the pregnancy, 7 (19.4%) had a previous history of HIV mother-to-child transmission. Therapy based on highly active antiretroviral therapy (94%) was initiated at 19.3 weeks on average and 33% showed irregular antiretroviral adherence.ConclusionThese results confirm previous data on HIV epidemiology in Brazil and suggest that the women partners’ sexual behavior and unprotected sexual intercourse are important aspects of HIV epidemic. Additional efforts in education, prophylaxis and medication adherence are needed

Correlação entre rendimento e geração de resíduos sólidos na Região Metropolitana de São Paulo

INTRODUÇÃO: Considerando a discussão da gestão de resíduos sólidos urbanos (RSU) ao longo dos anos faz-se necessário um aprofundamento dos fatores que interferem no volume de lixo gerado pelos municípios, possibilitando um planejamento de seu descarte. OBJETIVO: avaliar a relação entre o volume de resíduos gerados e a renda dos moradores da região metropolitana de São Paulo. MÉTODOS: Foram obtidos dados de quantidade de RSU/habitante/dia e a renda per capita de 05 municípios do ABC Paulista, para o ano de 2009. A relação entre estas variáveis foi avaliada pelo teste de correlação de Pearson. RESULTADOS: Foi observada uma correlação positiva (r=0,67) e estatisticamente significante (p=0,003) entre o aumento do nível socioeconômico com a geração de massa RSU coletada. DISCUSSÃO: A correlação entre o volume de RSU e renda per capita reforça a necessidade de direcionar estudos sobre consumo e a geração de resíduos sólidos

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Associação do teste sorológico ML Flow com a baciloscopia

Realizou-se estudo descritivo e exploratório relacionando as covariáveis aos resultados do teste sorológico ML Flow e baciloscopia. Foram estudados 60 casos novos de hanseníase diagnosticados no Centro de Referência em Dermatologia Sanitária. Para a baciloscopia, foi utilizada a coleta de esfregaço dérmico em quatro sítios, sendo o resultado expresso pelo índice bacilocópico. O ML Flow foi registrado de modo qualitativo e semi-quantitativo. Para o estudo da concordância, foi utilizado o índice de Kappa e, para sua interpretação, os critérios de Landis e Koch. Para análise estatística foram realizados a regressão logística e o teste de Kruskal-Wallis. O ML Flow mostrou forte associação com a baciloscopia, observou-se que o aumento gradativo do índice baciloscópico foi acompanhado pelo aumento semi-quantitativo dos níveis de anticorpos medidos pelo ML Flow, tendo sido positivo em 100% dos casos com baciloscopia positiva. Os resultados deste estudo evidenciaram que o ML Flow, por estar fortemente correlacionado à bacilocopia, poderá tornar-se um valioso instrumento auxiliar na classificação e alocação dos pacientes para fins de tratamento

Secondary myeloid neoplasms: bone marrow cytogenetic and histological features may be relevant to prognosis

Abstract Background: Secondary myeloid neoplasms comprise a group of diseases arising after chemotherapy, radiation, immunosuppressive therapy or from aplastic anemia. Few studies have addressed prognostic factors in these neoplasms. Method: Forty-two patients diagnosed from 1987 to 2008 with secondary myeloid neoplasms were retrospectively evaluated concerning clinical, biochemical, peripheral blood, bone marrow aspirate, biopsy, and immunohistochemistry and cytogenetic features at diagnosis as prognostic factors. The International Prognostic Scoring System was applied. Statistical analysis employed the Kaplan–Meier method, log-rank and Fisher's exact test. Results: Twenty-three patients (54.8%) were male and the median age was 53.5 years (range: 4–88 years) at diagnosis of secondary myeloid neoplasms. Previous diseases included hematologic malignancies, solid tumors, aplastic anemia, autoimmune diseases and conditions requiring solid organ transplantations. One third of patients (33%) were submitted to chemotherapy alone, 2% to radiotherapy, 26% to both modalities and 28% to immunosuppressive agents. Five patients (11.9%) had undergone autologous hematopoietic stem cell transplantation. The median latency between the primary disease and secondary myeloid neoplasms was 85 months (range: 23–221 months). Eight patients were submitted to allogeneic hematopoietic stem cell transplantation to treat secondary myeloid neoplasms. Important changes in bone marrow were detected mainly by biopsy, immunohistochemistry and cytogenetics. The presence of clusters of CD117+ cells and p53+ cells were associated with low survival. p53 was associated to a higher risk according to the International Prognostic Scoring System. High prevalence of clonal abnormalities (84.3%) and thrombocytopenia (78.6%) were independent factors for poor survival. Conclusion: This study demonstrated that cytogenetics, bone marrow biopsy and immunohistochemistry are very important prognostic tools in secondary myeloid neoplasms

Pregnancy complications and perinatal outcomes of women with hemoglobinopathies

Objective: To estimate the prevalence of gestational complications and perinatal outcomes in women with and without hemoglobinopathies. Method: This is a cross-sectional study with a quantitative approach, performed from 110 medical records of pregnant women who underwent prenatal, childbirth, postpartum and perinatal care in a gynecology and obstetrics service of the University Hospital at the Federal University of Mato Grosso do Sul, Brazil, between 2010 and 2011. Results: Gestational complications in women with and without hemoglobinopathies in the variables: obstetric (preterm labor, pre-eclampsia, ruptured membranes for more than six hours (17.06 times; 12.19 times; 4.27 times respectively); clinical: urinary tract infection, heart failure, severe anemia (2.97 times; 12.6 times;  9.75 times, respectively), and perinatal: cesarean delivery, neonatal infection; the newborn in the neonatal intensive care unit; fetal death, stillbirth (1.57 times; 39.00 times; 12.19 times; 12.9 times; 9.75 times; respectively) were higher in the presence of hemoglobinopathies. Conclusion: The pregnancy outcomes of women with hemoglobinopathies, perinatal and their newborns showed a higher prevalence of complications than women without this change. Keywords: Hemoglobinopathies; Pregnancy Complications, Hematologic; Perinatal Care