Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon

BACKGROUND: Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS: In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. CONCLUSIONS: Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Patrimônio e desenvolvimento: as políticas de patrimônio cultural nos anos 1960

This article aims at analyzing aspects of 1960s Brazilian cultural heritage policies, highlighting changes related to the articulation of concepts such as development, culture and heritage within the Directory of National Historical and Artistic Heritage - DPHAN, today Institute of National Historical and Artistic Heritage (IPHAN). It discusses the effects of industrialization, urban growth and development improvement measures on heritage concepts and policies, analyzing initiatives that focus on preserving cultural assets acknowledged as national historical and artistic heritage and enhancing their economical potential. The discussion emphasizes notions and understandings on heritage and preservation that had substantial bearing on preservation measures carried on by DPHAN from the 1960s on regarding the identification, valorization and protection of cultural heritage, as well as the disciplinary and institutional debates this Directory proposed.O objetivo deste artigo é analisar especificidades dos anos 1960 no que diz respeito às políticas de patrimônio, destacando algumas mudanças de entendimentos, noções e propostas, notadamente referentes às relações entre desenvolvimento, cultura e patrimônio trabalhadas pelo Instituto do Patrimônio Histórico e Artístico Nacional, então Diretoria do Patrimônio Histórico e Artístico Nacional (DPHAN). Para tanto, vai-se partir das discussões e debates desse momento acerca dos efeitos da industrialização, do crescimento urbano e das políticas desenvolvimentistas sobre as políticas de patrimônio a partir dessa década, analisando as iniciativas voltadas à patrimonialização de bens culturais, à preservação do acervo que compunha o patrimônio histórico e artístico nacional e ao fomento de suas potencialidades econômicas. Na discussão proposta neste artigo, priorizar-se-ão os entendimentos e ações de preservação da DPHAN relacionados a identificação, valoração e proteção dos bens culturais, assim como os diálogos disciplinares e institucionais que a diretoria procurou estabelecer

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Efficacy of vitamin D supplementation in gestational diabetes mellitus: Systematic review and meta-analysis of randomized trials.

BackgroundTrials have examined on the benefits of vitamin D supplementation in pregnant women.ObjectiveThis review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo.MethodWe performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).ResultsThe total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality.ConclusionWe did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women

SARS-CoV-2 in children with cancer in Brazil : results of a multicenter national registry

Background: Strategies to mitigate the impact of COVID-19 in special populations are complex and challenging. Few studies have addressed the impact of COVID-19 on pediatric patients with cancer in low- and middle-income countries. Methods: Multicenter observational cohort study with prospective records and retrospective analyses starting in April 2020 in 21 pediatric oncology centers distributed throughout Brazil. Participants: Patients under 18 years of age who are infected by the SARS-CoV-2 virus (confirmed diagnosis through reverse transcriptase-polymerase chain reaction [RT-PCR]) while under treatment at pediatric oncology centers. The variables of interest included clinical symptoms, diagnostic and therapeutic measures. The repercussions of SARS-CoV-2 infection on cancer treatment and general prognosis were monitored. Results: One hundred seventy-nine patients were included (median age 6 [4–13] years, 58% male). Of these, 55.9% had acute leukemia and 34.1% had solid tumors. The presence of SARS-CoV-2 was diagnosed by RT-PCR. Various laboratory markers were analyzed, but showed no correlation with outcome. Children with low or high BMI for age had lower overall survival (71.4% and 82.6%, respectively) than those with ageappropriate BMI (92.7%) (p = .007). The severity of presentation at diagnosis was significantly associated with outcome (p < .001). Overall mortality in the presence of infection was 12.3% (n = 22). Conclusion: In children with cancer and COVID-19, lower BMI was associated with worse prognosis. The mortality in this group of patients (12.3%) was significantly higher than that described in the pediatric population overall (~1%)

Patrimônio Cultural e escrita da história:a hipótese do documento na prática do Iphan nos anos 1980

In the 1980s, technicians from the Institute for National Artistic and Historical Heritage (Iphan) began to look to the academic discipline of History for arguments to support the selection of heritage assets that went beyond the grandiose. Engaging actors and concepts from France’s historiography they justified listing buildings and urban ensembles with characteristics that did not fit into the colonial-based national identity narratives used by the institution in its early decades. During this time, sites such as Laguna (in Santa Catarina State), Cuiabá (in Mato Grosso State), Morro da Conceição and XV de Novembro Square (in the City of Rio de Janeiro), among others, were preserved not only for the historical value of their buildings, but also for their potential as a source of history. New preservation rationales for immovable assets were developed; these sought to circumvent the concepts set out in the provisions of Decree-Law No. 25/37, striving instead to protect sites and places according to their documental value. This article aims to discuss the city as a document, retrieving the concepts of document from Social History and Brazilian historiographical practices in their relationship with the preservation of built heritage. We will seek to examine how cities and their architecture were treated as sources by the field of preservation in Brazil, as well as to understand the theoretical discourse and the authors mentioned herein, such as Marc Bloch and Jacques Le Goff, and the studies of the urban centers where such rationale was put to practice, most notably Laguna, in Santa Catarina.Na década de 1980, técnicos do Instituto do Patrimônio Histórico e Artístico Nacional (Iphan) passaram a utilizar argumentos do campo disciplinar da história para justificar a seleção do patrimônio para além dos cânones da excepcionalidade. Mobilizando autores e conceitos da Escola dos Annales, justificavam tombamentos de conjuntos urbanos cujas características não se enquadravam nas narrativas de identidade nacional via colonial praticadas nas primeiras décadas da Instituição. Laguna/SC, Cuiabá/MS, Morro da Conceição e Praça XV de Novembro no Rio de Janeiro, por exemplo, serão preservados não somente pelo valor histórico das suas edificações, mas também pela sua potencialidade como fonte histórica. Elaboram-se, então, argumentos de preservação de bens imóveis que buscavam driblar os conceitos do aporte legal do Decreto-lei no 25/37, buscando proteger sítios e lugares por seu valor documental. O artigo discute as relações entre escrita da história e preservação do patrimônio cultural, tendo como foco o caso de Laguna/SC. Pretende-se compreender de que maneira a proteção legal foi justificada a partir do inédito entendimento da cidade como documento por meio do estudo do processo de tombamento, seus estudos técnicos e as mobilizações teóricas do campo da história social e de autores como Marc Bloch e Jacques Le Goff

Interaction between Work and Metabolic Syndrome: A Population-Based Cross-Sectional Study

Metabolic syndrome (MS) is a clinical condition and a relevant risk factor in the development of cardiovascular diseases; it occurs as a result of lifestyle factors, e.g., work. The aim of this research was to estimate the interaction between work and MS among primary health care (PHC) nursing professionals in the state of Bahia, Brazil. A sectional multicentered study carried out in 43 municipalities in Bahia, whose study population consisted of nursing professionals. The exposure variables were occupation, professional exhaustion, and working time, and the outcome variable was MS. Interaction measures based on the additivity criteria were verified by calculating the excess risks due to the interactions and according to the proportion of cases attributed to the interactions and the synergy index. The global MS prevalence is 24.4%. There was a greater magnitude in the exposure group regarding the three investigated factors (average level occupation, professional exhaustion, and working time in PHC for more than 5 years), reaching an occurrence of 44.9% when compared to the prevalence of 13.1% in the non-exposure group (academic education, without professional burnout, and working time in PHC for up to 5 years). The study’s findings showed a synergistic interaction of work aspects for MS occurrence among PHC nursing professionals