Proteinose alveolar: manifestação paraneoplásica?

Pulmonary alveolar proteinosis (PAP) is a rare condition of unknown etiology. It hasbeen described as the presence of periodic acid-Schiff-positive proteinaceous material(rich in lipids) in the alveoli. Its pathogenesis is believed to consist of an overproductionor surfactant removal defect at the lung. The association of PAP with respiratorydiseases, silicosis, exposure to aluminium or titanium, and hematological neoplasiashas been reported. Here we report two cases of pulmonary alveolar proteinosis andneoplasm diagnosed at the PulmonaryDepartment at Hospital de Clínicas de PortoAlegre.A proteinose alveolar (PA) é uma doença rara, de etiologia desconhecida, caracterizadapelo acúmulo alveolar de material proteináceo PAS + (ácido-periódico de Schiff), ricoem fosfolipídios. Acredita-se que a patogênese consiste na superprodução ou defeitona remoção do surfactante ao nível do epitélio pulmonar (10). A PA pode estar associadaa infecções respiratórias (1,2), silicose (3), exposição ao alumínio (4), titânio (5) e aneoplasias hematológicas (6-8). Neste presente artigo, serão apresentados dois relatosde casos de proteinose alveolar e carcinomas diagnosticados no Serviço de Pneumologiado Hospital de Clínicas de Porto Alegre

(Im)possibilities of Autonomy:? Social Movements In and Beyond Capital, the State and Development

In this paper we interrogate the demand and practice of autonomy in social movements. We begin by identifying three main conceptions of autonomy: (1) autonomous practices vis-à-vis capital; (2) self-determination and independence from the state; and (3) alternatives to hegemonic discourses of development. We then point to limits associated with autonomy and discuss how demands for autonomy are tied up with contemporary re-organizations of: (1) the capitalist workplace, characterized by discourses of autonomy, creativity and self-management; (2) the state, which increasingly outsources public services to independent, autonomous providers, which often have a more radical, social movement history; and (3) regimes of development, which today often emphasize local practices, participation and self-determination. This capturing of autonomy reminds us that autonomy can never be fixed. Instead, social movements' demands for autonomy are embedded in specific social, economic, political and cultural contexts, giving rise to possibilities as well as impossibilities of autonomous practices

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030