IMPACTO DE ALTERAÇÕES AMBIENTAIS NA TRANSMISSÃO DA MALÁRIA E PERSPECTIVAS PARA O CONTROLE DA DOENÇA EM ÁREAS DE ASSENTAMENTO RURAL DA AMAZÔNIA BRASILEIRA

ENVIRONMENTAL CHANGES IMPACT IN MALARIA TRANSMITION AND PROSPECTS FOR THE DISEASE CONTROL IN BRAZILIAN AMAZON RURAL SETTLEMENTS. Malaria is one of the most important parasitic diseases of the world, and Brazil is the country that contributes with the largest number of malaria cases in the American continent. Although 99% of notified cases occur in the Legal Amazon, there is great heterogeneity of malaria transmission within the Amazon region, which can be explained by different factors, such as environmental and entomological issues, host and parasite biology. In this article, a literature review of possible interactions between the environment and malaria is presented, focusing malaria in  rural agricultural settlements. Issues such as environmental changes and their impact in plasmodial transmission, spatial malaria heterogeneity, land use and deforestation alternatives, and perspectives for disease control within rural settlements are discussed.  Keywords: Malaria; deforestation; Amazon; rural settlements.IMPACTO DE LOS CAMBIOS AMBIENTALES EN LA TRANSMISIÓN DE LA MALARIA Y PERSPECTIVAS PARA EL CONTROL DE LA ENfERMEDAD EN LAS ZONAS RURALES DE ASENTAMIENTOS DE LA AMAZONIA BRASILEÑA. La malaria es una enfermedad parasitaria importante de hoy, y Brasil es un país que aporta el mayor número de registros de malaria en las Américas. Aunque 99% de los casos reportados en el país ocurren en el Amazonas, existe una gran heterogeneidad en la transmisión de la malaria dentro de la región amazónica, que puede explicarse por varios factores diferentes, incluyendo las variables ambientales, los factores entomológicos inherentes a la biología de los humanos y de lo parásito. En este artículo se presenta una revisión bibliográfica sobre las posibles interacciones entre el medio ambiente y la transmisión de la malaria, con especial atención a la malaria en el contexto de los asentamientos rurales. Se discuten los cambios ambientales y su impacto en la transmisión de Plasmodium, la heterogeneidad espacial de la malaria, los problemas de uso de la tierra y las alternativas a la tala de árboles, y las perspectivas para el control de la enfermedad en el marco de los asentamientos rurales. Palabras clave: Malaria; deforestación; Amazônia; asentamientos rurales  A malária é uma das principais doenças parasitárias da atualidade, e o Brasil é o país que contribui com o maior número de casos de malária no continente americano. Embora 99% dos casos notificados no país ocorram na Amazônia Legal, há grande heterogeneidade na transmissão da malária dentro da própria região amazônica, que pode ser explicada por vários fatores diferentes, como variáveis ambientais, entomológicas, fatores inerentes à biologia do hospedeiro e do próprio parasita. Neste artigo, apresenta-se uma revisão da literatura sobre as possíveis interações entre o meio-ambiente e a transmissão de malária, com enfoque na malária dentro do contexto dos assentamentos rurais. São discutidas as alterações ambientais e seus impactos na transmissão do Plasmódio, a heterogeneidade espacial da malária, as questões ligadas ao uso da terra e alternativas ao desmatamento, e as perspectivas para o controle da doença dentro do âmbito dos assentamentos rurais

Epidemiology of Cutaneous Leishmaniasis and description of phlebotomine sandfly populations in the city of Acrelandia, Acre, Brazil

São apresentadas neste artigo a distribuição da leishmaniose tegumentar (LT) e descrição das populações de flebotomíneos em Acrelândia, Acre. Os dados epidemiológicos foram obtidos a partir de fichas de notificação de casos ocorridos entre 2001 e 2004, e os dados entomológicos são provenientes de capturas com armadilhas luminosas efetuadas entre 2004 e 2005 na zona rural de Acrelândia. Ocorreram 82 novos casos de LT, com idade entre 2 e 69 anos, sendo 75,6% em homens e 83,9% na zona rural. Predominou a LT com lesões únicas (78%). A microscopia direta da lesão, intradermorreação de Montenegro e biópsia apresentaram positividade de 100%, 98% e 79,5%, respectivamente. A resposta ao tratamento farmacológico foi bem sucedida em 71,6% dos casos; a falência terapêutica foi maior em pacientes com diagnóstico exclusivamente clínico (41,2%) e nos que receberam dose diária inadequada de antimonial pentavalente (64,3%). Foram coletados 40 espécimes de flebotomíneos em propriedades rurais com casos de LT (3 gêneros, 14 espécies), sendo 3 espécies conhecidas como vetoras ou possíveis vetoras de Leishmania: Nyssomyia antunesi predominou no peridomicílio (59,1%) e em margens de matas; Nyssomyia whitmani foi freqüente no peridomicílio (15%) e a única espécie encontrada no intradomicílio, e Trichophoromyia ubiquitalis foi capturada no peridomicílio. O uso de dados epidemiológicos existentes no serviço de saúde de Acrelândia, embora com várias limitações, permitiu avaliar a eficácia do diagnóstico e o tratamento empregados no município, enquanto os dados entomológicos coletados podem orientar estudos mais amplos visando identificar os vetores e espécies circulantes na região.This paper describes the distribution of cutaneous leishmaniasis (CL) in the city of Acrelandia, state of Acre, and its phlebotomine sandfly population. Epidemiological data were obtained from case reporting forms in 2001-2004, and entomological data resulted from catches performed between 2004 and 2005 using light traps. A total of 82 new cases of CL, aged between 2 and 62 years, 75.6% males, and 83.9% in the rural area, were identified. The prevailing clinical form was cutaneous (92.7%) with a single lesion (78%). Direct microscopic exams of lesions, Montenegro skin reaction tests, and biopsies resulted in 100%, 98% and 79.5% positivity rates, respectively. The therapeutic response was successful in 81.7% of subjects; treatment refractoriness was higher among CL patients with clinical diagnosis only (41.2%) and among those who received inadequate daily doses of antimonial drug (64.3%). Forty specimens of phlebotomine sandfly were collected around houses with CL cases (3 genera, 14 species); three of those species are known as vectors or possible vectors of Leishmania: Nyssomyia antunesi prevailed in the peri-domiciliary environment (59.1%) and forest borders; Nyssomyia whitmani was frequent in peri-domiciliary areas (15%) and was the only female captured in the intra-domiciliary environment; and Trichophoromyia ubiquitalis was found in the peri-domiciliary environment. The information derived from pre-existing epidemiological data, despite limitations, provided an evaluation of diagnosis and treatment efficacy, while the entomological data can be used as a guideline to develop a larger study aimed to identify both vectors and circulating Leishmania species.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Assistência Técnica e Extensão Rural (ATER) no Território rural Sertão Central Cabugi e Litoral Norte (RN): o desafio da adequação sócio-técnica

O objetivo é analisar as ações de Assistência Técnica e Extensão Rural (ATER) no Território Rural Sertão Central Cabugi e Litoral Norte (RN), demonstrando as limitações de integração com o crédito e a organização coletiva, e evidenciando a necessidade da adequação sócio-técnica para o desenvolvimento rural. A metodologia utilizada foi a do “Diagrama de Venn”, e a técnica utilizada foi a realização de visitas aos dez municípios que compõem o Território. Os resultados se basearam nos levantamentos e no roteiro de entrevistas com prestadores de ATER, associações e atores dos dez municípios do Território, que, de forma participativa, avaliaram as ações de ATER. Concluindo, percebe-se a necessidade de um modelo de ATER capaz de promover maior integração com o crédito e à organização coletiva e que incorpore mais as questões relacionadas com a adequação sócio-técnica.

A experiência estética no consumo de coleções

O colecionar é uma forma especializada de comportamento do consumidor. O presente artigo tem por objetivo demonstrar como o colecionismo de estátuas e figuras de ação proporciona a seus colecionadores uma experiência estética e contribui para uma vida estetizada. Por meio de um levantamento bibliográfico e revisão da literatura, revela-se que esse tipo de coleção corresponde a um processo ativo, seletivo e apaixonado de adquirir e possuir coisas percebidas como parte de um conjunto de objetos de memória, comprometido com o sentir. A partir da interação de componentes cognitivos e emocionais do colecionador com os objetos de coleção, desencadeia-se sentimentos, impressões e imagens carregadas de sentido simbólico. Conclui-se que o poder de evocação sentimental dos objetos de coleção proporciona uma imersão estetizada do consumo, surgindo como uma forma de expressão e cultura hedônica individualista

La experiencia estética en el consumo de colecciones: un estudio sobre coleccionistas de estatuas y figuras de acción

O colecionar é uma forma especializada de comportamento do consumidor. O presente artigo tem por objetivo demonstrar como o colecionismo de estátuas e figuras de ação proporciona a seus colecionadores uma experiência estética e contribui para uma vida estetizada. Por meio de um levantamento bibliográfico e revisão da literatura, revela-se que esse tipo de coleção corresponde a um processo ativo, seletivo e apaixonado de adquirir e possuir coisas percebidas como parte de um conjunto de objetos de memória, comprometido com o sentir. A partir da interação de componentes cognitivos e emocionais do colecionador com os objetos de coleção, desencadeia-se sentimentos, impressões e imagens carregadas de sentido simbólico. Conclui-se que o poder de evocação sentimental dos objetos de coleção proporciona uma imersão estetizada do consumo, surgindo como uma forma de expressão e cultura hedônica individualista.El coleccionar es una forma especializada de comportamiento del consumidor. El presente artículo tiene por objetivo demostrar cómo el coleccionismo de estatuas y figuras de acción proporciona a sus coleccionistas una experiencia estética y contribuye a una vida estetizada. Por medio de un levantamiento bibliográfico y revisión de la literatura, se revela que ese tipo de colección corresponde a un proceso activo, selectivo y apasionado de adquirir y poseer cosas percibidas como parte de un conjunto de objetos de memoria, comprometido con el sentir. A partir de la interacción de componentes cognitivos y emocionales del coleccionista con los objetos de colección, se desencadenan sentimientos, impresiones e imágenes cargadas de sentido simbólico. Se concluye que el poder de evocación sentimental de los objetos de colección proporciona una inmersión estetizada del consumo, surgiendo como una forma de expresión y cultura hedónica individualista.The collecting is a specialized form of consumer behavior. The aim of this article is to demonstrate how the collecting of statues and figures of action gives their collectors an aesthetic experience and contributes to an aesthetic life. Through a literature review reveals that this type of collection corresponds to an active, selective and passionate process of acquiring and possessing things perceived as part of a set of memory objects, committed to feel. From the interaction of cognitive and emotional components of the collector with the collection of objects, it triggers feelings, impressions and images loaded with symbolic meaning. It is concluded that the power of sentimental evocation of collection objects provides an aesthetic immersion of consumption, appearing as a form of expression and hedonic individualistic culture

USE OF SINGLE- AND DOUBLE-LUMEN PERIPHERALLY INSERTED CENTRAL CATHETERS IN EXTREMELY PREMATURE NEWBORNS: A RANDOMIZED CLINICAL TRIAL

Objetivo: comparar as taxas de complicações, infecção e obstrução do cateter central de inserção periférica mono lúmen com o duplo lúmen em prematuros extremos.Método: ensaio clínico randomizado, com 30 recém-nascidos de idade gestacional entre 24 e 32 semanas. As variáveis coletadas foram tempo de duração, complicações, manipulação dos cateteres e obtenção de acessos venosos periféricos. A análise foi realizada por estatística descritiva.Resultados: houve diferença nas taxas de manipulação do cateter (p=0,001) e obtenção de acessos venosos concomitantes (p=0,01). Contudo, não houve diferença nas taxas de complicações (p=0,14), obstrução (p=0,55) e infecção (p=0,47). O cateter duplo lúmen não eleva os riscos de complicações, porém é mais manipulado. Entretanto, reduz a obtenção de novos acessos periféricos, e consequentemente a dor dos prematuros.Conclusão: a utilização do cateter central de inserção periférica duplo lúmen é benéfica para os recém-nascidos que necessitam de terapia infusional múltipla.Objective: compare the rates of complications, infections and obstruction of single-lumenperipherally-inserted central catheters to those of double-lumen catheters in extremelypremature infants.Method: randomized clinical trial with 30 newborns with gestational age between 24 and 32weeks. The variables collected were period of use, complications, handling of catheters andobtaining peripheral venous accesses. Analysis was performed using descriptive statistics.Results: there were differences in rates regarding handling catheters (p=0.001) and obtainingconcomitant venous accesses (p=0.01). However, there was no difference in complication(p=0.14), obstruction (p=0.55) and infection rates (p=0.47). Despite being more frequentlyhandled, double-lumen catheters do not increase the risk of complications. They reduce theneed for obtaining new peripheral accesses and, consequently, the pain of premature infants.Conclusion: the use of double-lumen peripherally-inserted central catheters is beneficial fornewborns that need multi-infusion therapy.Objetivo: comparar las tasas de complicaciones, infección y obstrucción del catéter centralde inserción periférica mono lumen con las del doble lumen en bebés prematuros extremos.Método: ensayo clínico aleatorizado con 30 recién nacidos en edad gestacional entre 24 y 32semanas. Las variables recogidas fueron la duración, las complicaciones, la manipulación delcatéter y la obtención del acceso venoso periférico. El análisis fue realizado por estadísticasdescriptivas.Resultados: una diferencia fue observada en las tasas de manipulación del catéter (p=0,001) yobtención de accesos venosos concomitantes (p=0,01). Sin embargo, no se observó diferenciaen las tasas de complicaciones (p=0,14), obstrucción (p=0,55) e infección (p=0,47). El catéterdoble lumen no aumenta el riesgo de complicaciones, pero es más manipulado. Tambiénreduce la obtención de nuevos accesos periféricos y, en consecuencia, el dolor de los bebésprematuros.Conclusión: el uso del catéter central de inserción periférica doble lumen es beneficioso paralos recién nacidos que requieren terapia de infusión múltiple

Determination of the Minimum Alveolar Concentration (MAC) of Isoflurane and Sevoflurane in Callithrix penicillata

Background: The minimum alveolar concentration (MAC) is a measure of quantitative anesthetic potency and has become the standard index for the evaluation and comparison of volatile anesthetics, in addition to guiding dose administration. Black-tufted marmosets (Callithrix penicillata) are primates present in the clinical and surgical routine of veterinary hospitals, as well as experimental models, especially in neuroscience. Few studies have evaluated the potency of the main volatile anesthetics in this species. This study aimed to determine the MAC of isoflurane and sevoflurane in C. penicillata using the up-and-down method and to evaluate the effects of these drugs on the quality of anesthetic induction, maintenance, and recovery. Materials, Methods & Results: Twenty-four animals of undetermined age were used. All marmosets were healthy according to hematological and physical evaluation. The animals were randomly divided into 2 groups: ISOMAC and SEVOMAC. Each animal was induced to general anesthesia in an anesthetic box with oxygen (5 L/min) and sevoflurane at 7% in the SEVOMAC group or isoflurane at 5% in the ISOMAC. Upon reaching lateral decubitus, orotracheal intubation was performed. General anesthesia was maintained with isoflurane or sevoflurane diluted in oxygen (0.8 L/min) using a non-rebreathing delivery system under spontaneous ventilation. As defined in the pilot study, the first animal from ISOMAC started the maintenance of anesthesia with 2.6% isoflurane, while the first animal in SEVOMAC received 4% sevoflurane. After finishing the instrumentation to assess heart rate, respiratory rate, systolic blood pressure, pulse oximeter oxygen saturation, end-tidal carbon dioxide concentration, and rectal temperature, a 15-min wait to reach anesthetic equilibrium was allowed, and then an electrical noxious stimulation (50 mA and 50 Hz) was performed on the lateral aspect of the thigh (a faradic current of 3 consecutive single stimuli, followed by 2 continuous stimuli). The animals' responses to the electrical stimulus were observed. The presence of a positive response (gross movement of the limbs, head, or vocalization) or a negative response (absence of gross movements) determined the increase or reduction, respectively, of the inhalation anesthetic concentration by 10% in the subsequent marmoset. The quality of anesthetic induction and recovery from anesthesia was evaluated using a scale that measured the intensity of agitation, coughing, nausea, and vomiting. Physiological variables were recorded before (M0) and after (M1) applying the nociceptive stimulus. Isoflurane and sevoflurane MAC values in C. penicillata were 2.29 ± 0.10% and 3.93 ± 0.61 % respectively. Physiological parameters, quality of anesthetic induction and recovery did not differ significantly between groups. However, isoflurane caused irritation of the airway and ocular mucous membranes, more coughing episodes, and tearing at induction. There was no difference between groups for time to extubation and recovery time to regain sternal position. Discussion: Previous studies in primates found lower MAC values for both anesthetics, except for Lemur catta. Those findings may be explained by the use of different nociceptive stimuli and the MAC determination method employed, although no differences in MAC values have been described between bracketing or up-and-down methods in human primates and dogs. It is unlikely that the stimulus and technique alone are the determining factors for the high concentration of isoflurane and sevoflurane observed in the present study since MAC was high with both halogenates, indicating that dose extrapolation from other species can lead to the wrong anesthetic dosage. Keywords: Callithrix penicillata, marmoset, isoflurane, sevoflurane, minimum alveolar concentration (MAC).Background: The minimum alveolar concentration (MAC) is a measure of quantitative anesthetic potency and has become the standard index for the evaluation and comparison of volatile anesthetics, in addition to guiding dose administration. Black-tufted marmosets (Callithrix penicillata) are primates present in the clinical and surgical routine of veterinary hospitals, as well as experimental models, especially in neuroscience. Few studies have evaluated the potency of the main volatile anesthetics in this species. This study aimed to determine the MAC of isoflurane and sevoflurane in C. penicillata using the up-and-down method and to evaluate the effects of these drugs on the quality of anesthetic induction, maintenance, and recovery. Materials, Methods & Results: Twenty-four animals of undetermined age were used. All marmosets were healthy according to hematological and physical evaluation. The animals were randomly divided into two groups: ISOMAC and SEVOMAC. Each animal was induced to general anesthesia in an anesthetic box with oxygen (5 L/min) and sevoflurane at 7% in the SEVOMAC group or isoflurane at 5% in the ISOMAC. Upon reaching lateral decubitus, orotracheal intubation was performed. General anesthesia was maintained with isoflurane or sevoflurane diluted in oxygen (0.8 L/min) using a non-rebreathing delivery system under spontaneous ventilation. As defined in the pilot study, the first animal from ISOMAC started the maintenance of anesthesia with 2.6% isoflurane, while the first animal in SEVOMAC received 4% sevoflurane. After finishing the instrumentation to assess heart rate, respiratory rate, systolic blood pressure, pulse oximeter oxygen saturation, end-tidal carbon dioxide concentration, and rectal temperature, a 15-minute wait to reach anesthetic equilibrium was allowed, and then an electrical noxious stimulation (50 mA and 50 Hz) was performed on the lateral aspect of the thigh (a faradic current of 3 consecutive single stimuli, followed by 2 continuous stimuli). The animals' responses to the electrical stimulus were observed. The presence of a positive response (gross movement of the limbs, head, or vocalization) or a negative response (absence of gross movements) determined the increase or reduction, respectively, of the inhalation anesthetic concentration by 10% in the subsequent marmoset. The quality of anesthetic induction and recovery from anesthesia was evaluated using a scale that measured the intensity of agitation, coughing, nausea, and vomiting. Physiological variables were recorded before (M0) and after (M1) applying the nociceptive stimulus. Isoflurane and sevoflurane MAC values in C. penicillata were 2.29 ± 0.10% and 3.93 ± 0.61% respectively. Physiological parameters, quality of anesthetic induction and recovery did not differ significantly between groups. However, isoflurane caused irritation of the airway and ocular mucous membranes, more coughing episodes, and tearing at induction. There was no difference between groups for time to extubation and recovery time to regain sternal position. Discussion: Previous studies in primates found lower MAC values for both anesthetics, except for Lemur catta. Those findings may be explained by the use of different nociceptive stimuli and the MAC determination method employed, although no differences in MAC values have been described between bracketing or up-and-down methods in human primates and dogs. It is unlikely that the stimulus and technique alone are the determining factors for the high concentration of isoflurane and sevoflurane observed in the present study since MAC was high with both halogenates, indicating that dose extrapolation from other species can lead to the wrong anesthetic dosage