O IMPACTO DO USO DA TERRA NAS CARACTERÍSTICAS DOS SOLOS NA APA DO TIMBURI, PRESIDENTE PRUDENTE-SP

La apropiación del relieve, con el fin de dominar la naturaleza en favor del modelo de producción capitalista, causa daños ambientales, especialmente a los suelos y la vegetación. La erosión del suelo es causada por la desagregación, eliminación y transporte de partículas que se producen naturalmente a través de la acción de la gravedad, el agua y el viento. Sin embargo, la acción humana ha ido intensificando y acelerando estos procesos, superando los niveles naturales de pérdida de suelo, promoviendo su constante transformación y provocando cambios en sus características originales, junto con la pérdida de fertilidad y nutrientes.Este trabajo tiene como objetivo analizar el impacto del uso de la tierra en la formación de procesos erosivos y sus consecuencias sobre las características del suelo en  unapropiedad rural ubicada en el Área de Protección Ambiental de Timburi, municipio de Presidente Prudente-SP. La experiencia empírica reveló un perfil de suelo extremadamente alterado, con un gran número de capas segmentadas que no entran en ninguna clase del Sistema Brasileño de Clasificación de Suelos, lo que permite el debate sobre el uso de la tierra y el manejo inadecuado de los recursos naturales.The appropriation of the land, to dominate nature for the benefit of the capitalist production model, causes environmental damage, especially to the soil and vegetation. Soil erosion is caused by the disintegration, removal and transport of particles that occur naturally through the action of gravity, water and wind. However, human action has intensified and accelerated these processes, exceeding the natural levels of soil loss, promoting its constant transformation, and causing changes in its originals characteristics, along with the loss of fertility and nutrients. This work aims to analyze the impact of land use on the formation of erosive processes and their consequences on soil characteristics n arural property located in the Environmental Protection Area of Timburi, municipality of Presidente Prudente-SP. The empirical experience revealed an extremely altered soil profile, with a large number of segmented layers that do not fall into any class of the Brazilian Soil Classification System, which allows the debate about land use and inadequate management of natural resources.A apropriação do relevo, com o intuito de dominar a natureza em prol do modelo de produção capitalista, acarreta danos ambientais, sobretudo aos solos e à vegetação. A erosão dos solos é propiciada pela desagregação, remoção e transporte de partículas que ocorrem de forma natural por meio da ação da gravidade, da água e do vento. No entanto, a ação humana vem intensificando e acelerando esses processos, ultrapassando os níveis naturais de perda dos solos, promovendo sua transformação constante e provocando alterações em suas características originais, juntamente com a perda de fertilidade e de nutrientes. Este trabalho tem como objetivo analisar o impacto do uso da terra na formação de processos erosivos e suas consequências nas características do solo numa propriedade rural localizada na Área de Proteção Ambiental do Timburi, município de Presidente Prudente-SP. A experiência empírica revelou um perfil de solo extremamente alterado, com grande quantidade de camadas segmentadas que não se enquadram em nenhuma classe do Sistema Brasileiro de Classificação de Solos, o que possibilita o debate acerca do uso da terra e do manejo inadequado dos recursos naturais

Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups

Background: Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovascular disease (primary prevention). Methods: In CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation), 4401 participants with type 2 diabetes mellitus and chronic kidney disease were randomly assigned to canagliflozin or placebo on a background of optimized standard of care. Results: Primary prevention participants (n=2181, 49.6%) were younger (61 versus 65 years), were more often female (37% versus 31%), and had shorter duration of diabetes mellitus (15 years versus 16 years) compared with secondary prevention participants (n=2220, 50.4%). Canagliflozin reduced the risk of major cardiovascular events overall (hazard ratio [HR], 0.80 [95% CI, 0.67-0.95]; P=0.01), with consistent reductions in both the primary (HR, 0.68 [95% CI, 0.49-0.94]) and secondary (HR, 0.85 [95% CI, 0.69-1.06]) prevention groups (P for interaction=0.25). Effects were also similar for the components of the composite including cardiovascular death (HR, 0.78 [95% CI, 0.61-1.00]), nonfatal myocardial infarction (HR, 0.81 [95% CI, 0.59-1.10]), and nonfatal stroke (HR, 0.80 [95% CI, 0.56-1.15]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome). Conclusions: Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

La explotación agrícola y ganadera y la degradación de los suelos en el interior del estado de São Paulo, Brasil

El territorio brasileño ha sufrido grandes cambios en el paisaje debido a la explotación de sus recursos naturales, hídricos, minerales y vegetales. Actualmente, uno de los recursos más explotados es el suelo, que está siendo erosionado intensamente como consecuencia de la producción agropecuaria a gran escala, con el fin de satisfacer la demanda del mercado internacional. El oeste del estado de São Paulo está dedicado casi en su totalidad a la cría de ganado bovino y al cultivo de la caña de azúcar sin un manejo adecuado del suelo. La práctica de estas actividades ha ocasionado un elevado número de focos erosivos lineales y también la sedimentación de los cauces de los ríos, como sucede en el Área de Protección Ambiental (APA) del Timburi, ámbito de estudio de este trabajo. Ante este panorama, es necesario actuar con medidas de conservación o recuperación de áreas degradadas, con el objeto de reducir los cambios causados por la influencia humana en los suelos. De esta manera, la investigación propone el análisis del agotamiento del suelo como recurso natural, además de la discusión de posibles técnicas de recuperación de las áreas degradadas y el manejo de los recursos naturales, que han sido utilizados con el fin de reducir y contener los daños causados por la intensa explotación.The Brazilian territory has undergone profound changes in the landscape due to the exploitation of its natural, water, mineral and vegetable resources. At present, one of the most exploited resources is soil, which is being intensively sucked up because of agricultural production and is being exploited on a large scale, to meet the demand of the international market. The west of the state of São Paulo is dedicated, entirely, to the breeding of cattle and the cultivation of sugar cane in proper soil management. The practice of this activity has generated a high number of linear erosive foci and the sedimentation of the riverbeds, as in the Environmental Protection Area of Timburi, territorial cut of this work. Given this panorama, it is necessary to act with conservation measures or recovery of degraded areas, to reduce the changes caused by human interference in the soils. In this way, the work proposes the analysis of the depletion of the soil as a natural resource, in addition to the discussion of techniques of recovery of degraded areas and the management of natural resources, which have been used to reduce and contain the damage caused by intense exploitation.“Fundação de Amparo à Pesquisa do Estado de São Paulo” (FAPESP), beca “Bolsa Estágio de Pesquisa no Exterior” (BEPE), proceso 2022/00293-7

Land use by agricultural activities and its impact on watersheds

A apropriação do relevo pelos seres humanos, conforme os fins econômicos, tem alterado a dinâmica dos processos da natureza, acarretando a degradação ambiental desenfreada e o uso exacerbado dos recursos naturais, ocasionando o desequilíbrio dos ecossistemas. O presente estudo propõe compreender esses aspectos na prática, analisando os casos da Bacia Hidrográfica do Ribeirão das Três Barras, Capinópolis (Minas Gerais) e um recorte da Bacia Hidrográfica do Córrego da Onça, localizado na Área de Proteção Ambiental do Timburi, Presidente Prudente (São Paulo), Brasil. Ambas são utilizadas para atividades agropecuárias, predominando o manejo inadequado, gerando focos erosivos laminares e lineares, tendo como consequência perda de solos, assoreamento de cursos d’água e diminuição do número de nascentes fluviais. Para impedir processos como estes é necessário preservar os ecossistemas, implementando técnicas de conservação e manejo adequado dos recursos naturais em conjunto com os proprietários rurais.La apropiación del relieve por parte de los seres humanos, en función de los fines económicos, ha alterado la dinámica de los procesos de la naturaleza, provocando una degradación ambiental desenfrenada y un uso exacerbado de los recursos naturales, causando el desequilibrio de los ecosistemas, analizando los casos de la Cuenca Hidrográfica de Ribeirão das Três Barras, Capinópolis (Minas Gerais) y una sección de la Cuenca Hidrográfica del Arroyo de Onça, ubicada en el Área de Protección Ambiental de Timburi, Presidente Prudente (São Paulo), Brasil. En ambas se realizan actividades agrícolas, predominando la gestión inadecuada, generando focos erosivos laminares y lineales, lo que provoca la pérdida de suelo, el aterramiento de los cauces y la reducción del número de cabeceras de los ríos. Para prevenir estos procesos es necesario preservar los ecosistemas mediante la aplicación de técnicas de conservación y una gestión adecuada de los recursos naturales en colaboración con los propietarios rurales.The appropriation of the relief by human beings, according to economic purposes, has altered the dynamics of nature's processes, leading to unbridled environmental degradation and the exacerbated use of natural resources, causing the unbalance of ecosystems, analyzing the cases of the Watershed of Ribeirão das Três Barras, Capinópolis (Minas Gerais) and a section of the Watershed of the Stream of Onça, located in the Environmental Protection Area of Timburi, Presidente Prudente (São Paulo), Brazil. Both are used for agricultural activities, predominantly the inadequate management, generating laminar and linear erosive foci, resulting in soil loss, silting up of waterways and reduction of the number of riverheads. To prevent processes such as these, it is necessary to preserve ecosystems by implementing conservation techniques and proper management of natural resources in conjunction with rural landowners

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale & Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting & Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (<60, 60-69, and >_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 & PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages <60, 60-69, and >_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791