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1.
Sci Rep ; 14(1): 5131, 2024 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-38429332

RESUMEN

Land use change and atmospheric composition, two drivers of climate change, can interact to affect both local and remote climate regimes. Previous works have considered the effects of greenhouse gas buildup in the atmosphere and the effects of Amazon deforestation in atmospheric general circulation models. In this study, we investigate the impacts of the Brazilian Amazon savannization and global warming in a fully coupled ocean-land-sea ice-atmosphere model simulation. We find that both savannization and global warming individually lengthen the dry season and reduce annual rainfall over large tracts of South America. The combined effects of land use change and global warming resulted in a mean annual rainfall reduction of 44% and a dry season length increase of 69%, when averaged over the Amazon basin, relative to the control run. Modulation of inland moisture transport due to savannization shows the largest signal to explain the rainfall reduction and increase in dry season length over the Amazon and Central-West. The combined effects of savannization and global warming resulted in maximum daily temperature anomalies, reaching values of up to 14 °C above the current climatic conditions over the Amazon. Also, as a consequence of both climate drivers, both soil moisture and surface runoff decrease over most of the country, suggesting cascading negative future impacts on both agriculture production and hydroelectricity generation.

2.
Nature ; 626(7999): 555-564, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38356065

RESUMEN

The possibility that the Amazon forest system could soon reach a tipping point, inducing large-scale collapse, has raised global concern1-3. For 65 million years, Amazonian forests remained relatively resilient to climatic variability. Now, the region is increasingly exposed to unprecedented stress from warming temperatures, extreme droughts, deforestation and fires, even in central and remote parts of the system1. Long existing feedbacks between the forest and environmental conditions are being replaced by novel feedbacks that modify ecosystem resilience, increasing the risk of critical transition. Here we analyse existing evidence for five major drivers of water stress on Amazonian forests, as well as potential critical thresholds of those drivers that, if crossed, could trigger local, regional or even biome-wide forest collapse. By combining spatial information on various disturbances, we estimate that by 2050, 10% to 47% of Amazonian forests will be exposed to compounding disturbances that may trigger unexpected ecosystem transitions and potentially exacerbate regional climate change. Using examples of disturbed forests across the Amazon, we identify the three most plausible ecosystem trajectories, involving different feedbacks and environmental conditions. We discuss how the inherent complexity of the Amazon adds uncertainty about future dynamics, but also reveals opportunities for action. Keeping the Amazon forest resilient in the Anthropocene will depend on a combination of local efforts to end deforestation and degradation and to expand restoration, with global efforts to stop greenhouse gas emissions.


Asunto(s)
Bosques , Calentamiento Global , Árboles , Sequías/estadística & datos numéricos , Retroalimentación , Calentamiento Global/prevención & control , Calentamiento Global/estadística & datos numéricos , Árboles/crecimiento & desarrollo , Incendios Forestales/estadística & datos numéricos , Incertidumbre , Restauración y Remediación Ambiental/tendencias
3.
Science ; 381(6664): 1261, 2023 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-37733850

RESUMEN

Early in August this year, a high-profile summit was held in Belém, Brazil, where the eight Amazonian countries discussed the future of the Amazon. The nations recognized that the Amazon is very close to reaching a tipping point for turning into a degraded ecosystem. The result of their discussions was the Belém Declaration, an ambitious plan to protect and conserve the Amazon forests and to support Indigenous Peoples and local communities. Concern arose, however, because they failed to agree on attaining zero deforestation by 2030 and on avoiding new explorations in the Amazon for fossil fuel. The Declaration also lacks specific and measurable indicators. The ministers of Foreign Affairs therefore have a very important role in further refining the agenda and deadlines so that the Belém Declaration can be implemented.


Asunto(s)
Conservación de los Recursos Naturales , Bosques , Humanos , Brasil , Combustibles Fósiles , Pueblos Indígenas
4.
Sci Rep ; 13(1): 15928, 2023 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-37741891

RESUMEN

This study presents novel insight into the mechanisms of Atlantic Meridional Overturning Circulation (AMOC) reduction and its recovery under a warmer climate scenario. An one-thousand-year-long numerical simulation of a global coupled ocean-ice-atmosphere climate model, subjected to a stationary atmospheric radiative forcing, depict a coherent picture of the Arctic sea ice melting as a trigger for the initial AMOC reduction, along with decreases in the northward fluxes of salt and heat. Further atmospheric-driven ocean processes contribute to an erosion of the stable stratification of the fresher, yet colder waters in the surface layers of the North Atlantic, contributing to the recovery of a permanently altered AMOC.

5.
Nature ; 621(7978): 318-323, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37612502

RESUMEN

The Amazon forest carbon sink is declining, mainly as a result of land-use and climate change1-4. Here we investigate how changes in law enforcement of environmental protection policies may have affected the Amazonian carbon balance between 2010 and 2018 compared with 2019 and 2020, based on atmospheric CO2 vertical profiles5,6, deforestation7 and fire data8, as well as infraction notices related to illegal deforestation9. We estimate that Amazonia carbon emissions increased from a mean of 0.24 ± 0.08 PgC year-1 in 2010-2018 to 0.44 ± 0.10 PgC year-1 in 2019 and 0.52 ± 0.10 PgC year-1 in 2020 (± uncertainty). The observed increases in deforestation were 82% and 77% (94% accuracy) and burned area were 14% and 42% in 2019 and 2020 compared with the 2010-2018 mean, respectively. We find that the numbers of notifications of infractions against flora decreased by 30% and 54% and fines paid by 74% and 89% in 2019 and 2020, respectively. Carbon losses during 2019-2020 were comparable with those of the record warm El Niño (2015-2016) without an extreme drought event. Statistical tests show that the observed differences between the 2010-2018 mean and 2019-2020 are unlikely to have arisen by chance. The changes in the carbon budget of Amazonia during 2019-2020 were mainly because of western Amazonia becoming a carbon source. Our results indicate that a decline in law enforcement led to increases in deforestation, biomass burning and forest degradation, which increased carbon emissions and enhanced drying and warming of the Amazon forests.


Asunto(s)
Dióxido de Carbono , Secuestro de Carbono , Conservación de los Recursos Naturales , Política Ambiental , Aplicación de la Ley , Bosque Lluvioso , Biomasa , Brasil , Dióxido de Carbono/análisis , Dióxido de Carbono/metabolismo , Política Ambiental/legislación & jurisprudencia , Atmósfera/química , Incendios Forestales/estadística & datos numéricos , Conservación de los Recursos Naturales/estadística & datos numéricos , El Niño Oscilación del Sur , Sequías/estadística & datos numéricos
6.
An Acad Bras Cienc ; 95(1): e20211629, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37162084

RESUMEN

This article performs an analysis of female participation in science, in the Brazilian system of graduate studies and scientific research as a case study. This is relevant because science is a central supporting structure for modern societies and, therefore, a detailed analysis of the scientific power structure behind academic policy creation can reveal aspects of androcentrism in scientific activity. The main goal of this work is to identify the process of misogyny in science by describing its reproductive pattern. Our results show that women are around 50% of the undergraduate and graduate students when all fields are taken into consideration, but only 37% of the researchers in the CNPq system. We also observe a significant increase in female percentage within scientific activities at the initial and intermediary levels, except for the most prestigious areas as hard science. However, a scissor effect is identified between the initial level and the more prominent positions. This unbalanced participation reveals that female occupations in science are mostly as lower workforce since women are quite far from the social decision-making circles in this career.


Asunto(s)
Educación de Postgrado , Tecnología , Humanos , Femenino , Brasil , Reproducción , Investigadores
7.
Funct Integr Genomics ; 23(2): 101, 2023 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-36964864

RESUMEN

Biodiversity is proposed as a sustainable alternative for the economic development of high-biodiversity regions. Especially in the field of biodiversity genomics, the development of low-cost DNA sequencing opens an opportunity for new actors beyond academia to engage in genomic sequencing. However, it is challenging to adequately compensate non-academic actors such as local populations for their contribution to the innovation process, preventing better bioeconomy development. Although many repositories register genomic data to support biodiversity research, they do not facilitate the fair sharing of economic benefits. In this work, we propose the creation of the Amazon Biobank, a community-based genetic database. We employed blockchain to build a transparent and verifiable log of transactions involving genomic data, and we used smart contracts to implement an internal monetary system for all participants who collect, insert, process, store, and validate genomic data. We also used peer-to-peer solutions to allow users with commodity computers to collaborate with the storage and distribution of DNA files. By combining emerging technologies, Amazon Biobank provides adequate benefit-sharing among all participants that collaborate with data, knowledge, and computational resources. It also provides traceability and auditability, allowing easy association between biotechnological research and DNA data. In addition, the solution is highly scalable and less dependent on the trust deposited in any system player. Therefore, Amazon Biobank can become an important stepping stone to unlock the potential of bioeconomy in rich ecosystems such as the Amazon Rainforest.


Asunto(s)
Bancos de Muestras Biológicas , Ecosistema , Humanos , Genómica , Bases de Datos Genéticas , ADN
8.
Science ; 379(6630): eabo5003, 2023 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-36701466

RESUMEN

Amazonian environments are being degraded by modern industrial and agricultural activities at a pace far above anything previously known, imperiling its vast biodiversity reserves and globally important ecosystem services. The most substantial threats come from regional deforestation, because of export market demands, and global climate change. The Amazon is currently perched to transition rapidly from a largely forested to a nonforested landscape. These changes are happening much too rapidly for Amazonian species, peoples, and ecosystems to respond adaptively. Policies to prevent the worst outcomes are known and must be enacted immediately. We now need political will and leadership to act on this information. To fail the Amazon is to fail the biosphere, and we fail to act at our peril.


Asunto(s)
Efectos Antropogénicos , Ecosistema , Bosques , Humanos , Biodiversidad , Conservación de los Recursos Naturales , Brasil
9.
Sci Adv ; 8(24): eabj3309, 2022 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-35704589

RESUMEN

In recent years, the area affected by forest degradation in the Brazilian Amazon has frequently been higher than deforestation. From August 2006 to July 2019, the degraded area totaled 194,058 km2, representing almost two times the 99,630 km2 deforested in the same period. The impacts of degradation include biodiversity loss and changes in the carbon stocks, affecting the CO2 balance and future climate changes. This paper aims to explore socioeconomic and environmental factors that influence forest degradation, project future scenarios, and assess the impact on the regional carbon balance, combining forest degradation and deforestation-related processes (clear-cut deforestation and secondary vegetation dynamics). We show that, while net CO2 emissions from 2020 to 2050 are 0.74 Gt CO2 in the Sustainable scenario, this value reached 22.63 Gt CO2 in the Fragmentation scenario, an increasingly plausible scenario given the recent trends in the region.

10.
Nature ; 595(7867): 388-393, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34262208

RESUMEN

Amazonia hosts the Earth's largest tropical forests and has been shown to be an important carbon sink over recent decades1-3. This carbon sink seems to be in decline, however, as a result of factors such as deforestation and climate change1-3. Here we investigate Amazonia's carbon budget and the main drivers responsible for its change into a carbon source. We performed 590 aircraft vertical profiling measurements of lower-tropospheric concentrations of carbon dioxide and carbon monoxide at four sites in Amazonia from 2010 to 20184. We find that total carbon emissions are greater in eastern Amazonia than in the western part, mostly as a result of spatial differences in carbon-monoxide-derived fire emissions. Southeastern Amazonia, in particular, acts as a net carbon source (total carbon flux minus fire emissions) to the atmosphere. Over the past 40 years, eastern Amazonia has been subjected to more deforestation, warming and moisture stress than the western part, especially during the dry season, with the southeast experiencing the strongest trends5-9. We explore the effect of climate change and deforestation trends on carbon emissions at our study sites, and find that the intensification of the dry season and an increase in deforestation seem to promote ecosystem stress, increase in fire occurrence, and higher carbon emissions in the eastern Amazon. This is in line with recent studies that indicate an increase in tree mortality and a reduction in photosynthesis as a result of climatic changes across Amazonia1,10.


Asunto(s)
Ciclo del Carbono , Secuestro de Carbono , Cambio Climático/estadística & datos numéricos , Conservación de los Recursos Naturales/estadística & datos numéricos , Bosques , Atmósfera/química , Dióxido de Carbono/análisis , Monóxido de Carbono/análisis , Actividades Humanas , Fotosíntesis , Lluvia , Estaciones del Año , Temperatura
12.
Sci Adv ; 5(12): eaba2949, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32064324
13.
Proc Natl Acad Sci U S A ; 115(46): 11671-11679, 2018 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-30397144

RESUMEN

Large uncertainties still dominate the hypothesis of an abrupt large-scale shift of the Amazon forest caused by climate change [Amazonian forest dieback (AFD)] even though observational evidence shows the forest and regional climate changing. Here, we assess whether mitigation or adaptation action should be taken now, later, or not at all in light of such uncertainties. No action/later action would result in major social impacts that may influence migration to large Amazonian cities through a causal chain of climate change and forest degradation leading to lower river-water levels that affect transportation, food security, and health. Net-present value socioeconomic damage over a 30-year period after AFD is estimated between US dollar (USD) $957 billion (×109) and $3,589 billion (compared with Gross Brazilian Amazon Product of USD $150 billion per year), arising primarily from changes in the provision of ecosystem services. Costs of acting now would be one to two orders of magnitude lower than economic damages. However, while AFD mitigation alternatives-e.g., curbing deforestation-are attainable (USD $64 billion), their efficacy in achieving a forest resilience that prevents AFD is uncertain. Concurrently, a proposed set of 20 adaptation measures is also attainable (USD $122 billion) and could bring benefits even if AFD never occurs. An interdisciplinary research agenda to fill lingering knowledge gaps and constrain the risk of AFD should focus on developing sound experimental and modeling evidence regarding its likelihood, integrated with socioeconomic assessments to anticipate its impacts and evaluate the feasibility and efficacy of mitigation/adaptation options.


Asunto(s)
Conservación de los Recursos Naturales/economía , Agricultura Forestal/economía , Agricultura Forestal/métodos , Brasil , Cambio Climático , Simulación por Computador , Ecosistema , Bosques , Políticas , Medición de Riesgo/métodos , Árboles
14.
Sci Adv ; 4(2): eaat2340, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29492460
15.
An Acad Bras Cienc ; 89(1 Suppl 0): 773-786, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28492731

RESUMEN

The Brazilian Scientific Mobility Program - Science without Borders (SwB) - saw the concession of over 101 thousand scholarships for Brazilian STEM students and education professionals to attend universities worldwide. As the first phase of this program ends, it is time to take a first look at its impacts, mainly on the undergraduate student body (79% of total scholarships implemented). Benefits included a 6-month language course (optional), a one year undergraduate course and optional 2 month internship in a university, government laboratory or technology company. Positive impacts have been seen on entrance into post-graduate programs (>20% of SwB students compared to <5% of the overall student body of similar fields), as well as high representation of lower income families (>50% from families with less than 6 minimum wages per month). The impact of the program will need to be evaluated over the next years, but innovation on the part of the students is already apparent. Any new SwB program needs to take into account the lessons learned from this first experience and therefore recommendations are presented.


Asunto(s)
Educación de Postgrado/estadística & datos numéricos , Cooperación Internacional , Ciencia/educación , Brasil , Humanos , Evaluación de Programas y Proyectos de Salud
16.
An. acad. bras. ciênc ; 89(1,supl): 773-786, May. 2017. tab, graf
Artículo en Inglés | LILACS | ID: biblio-886654

RESUMEN

ABSTRACT The Brazilian Scientific Mobility Program - Science without Borders (SwB) - saw the concession of over 101 thousand scholarships for Brazilian STEM students and education professionals to attend universities worldwide. As the first phase of this program ends, it is time to take a first look at its impacts, mainly on the undergraduate student body (79% of total scholarships implemented). Benefits included a 6-month language course (optional), a one year undergraduate course and optional 2 month internship in a university, government laboratory or technology company. Positive impacts have been seen on entrance into post-graduate programs (>20% of SwB students compared to <5% of the overall student body of similar fields), as well as high representation of lower income families (>50% from families with less than 6 minimum wages per month). The impact of the program will need to be evaluated over the next years, but innovation on the part of the students is already apparent. Any new SwB program needs to take into account the lessons learned from this first experience and therefore recommendations are presented.


Asunto(s)
Humanos , Ciencia/educación , Educación de Postgrado/estadística & datos numéricos , Cooperación Internacional , Brasil , Evaluación de Programas y Proyectos de Salud
17.
PLoS One ; 12(2): e0172330, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28222159

RESUMEN

BACKGROUND: This study aims to describe the role of mobility in malaria transmission by discussing recent changes in population movements in the Brazilian Amazon and developing a flow map of disease transmission in this region. METHODOLOGY/PRINCIPAL FINDINGS: This study presents a descriptive analysis using an ecological approach on regional and local scales. The study location was the municipality of Porto Velho, which is the capital of Rondônia state, Brazil. Our dataset was obtained from the official health database, the population census and an environmental database. During 2000-2007 and 2007-2010, the Porto Velho municipality had an annual population growth of 1.42% and 5.07%, respectively. This population growth can be attributed to migration, which was driven by the construction of the Madeira River hydroelectric complex. From 2010 to 2012, 63,899 malaria-positive slides were reported for residents of Porto Velho municipality; 92% of the identified samples were autochthonous, and 8% were allochthonous. The flow map of patients' movements between residential areas and areas of suspected infection showed two patterns of malaria transmission: 1) commuting between residential areas and the Jirau hydropower dam reservoir, and 2) movements between urban areas and farms and resorts in rural areas. It was also observed that areas with greater occurrences of malaria were characterized by a low rate of deforestation. CONCLUSIONS: The Porto Velho municipality exhibits high malaria endemicity and plays an important role in disseminating the parasite to other municipalities in the Amazon and even to non-endemic areas of the country. Migration remains an important factor for the occurrence of malaria. However, due to recent changes in human occupation of the Brazilian Amazon, characterized by intense expansion of transportation networks, commuting has also become an important factor in malaria transmission. The magnitude of this change necessitates a new model to explain malaria transmission in the Brazilian Amazon.


Asunto(s)
Enfermedades Endémicas , Malaria/transmisión , Dinámica Poblacional , Animales , Brasil/epidemiología , Ciudades , Conservación de los Recursos Naturales , Geografía Médica , Humanos , Malaria/epidemiología , Ocupaciones , Centrales Eléctricas , Población Rural , Migrantes , Transportes , Población Urbana
18.
Rev Bras Ginecol Obstet ; 38(9): 456-464, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27788530

RESUMEN

Purpose To evaluate the anatomic and functional results of a laparoscopic modified Vecchietti technique for the creation of a neovagina in patients with congenital vaginal aplasia. Methods Retrospective study of nine patients with congenital vaginal aplasia submitted to the laparoscopic Vecchietti procedure, in our department, between 2006 and 2013. The anatomical results were evaluated by assessing the length, width and epithelialization of the neovagina at the postoperative visits. The functional outcome was evaluated using the Rosen Female Sexual Function Index (FSFI) questionnaire and comparing the patients' results to those of a control group of 20 healthy women. The statistical analysis was performed using SPSS Statistics version 19.0 (IBM, Armonk, NY, USA), Student t-test, Mann-Whitney U test and Fisher exact test. Results The condition underlying the vaginal aplasia was Mayer-Rokitansky-Küster-Hauser syndrome in eight cases, and androgen insensitivity syndrome in one case. The average preoperative vaginal length was 2.9 cm. At surgery, the mean age of the patients was 22.2 years. The surgery was performed successfully in all patients and no intra or postoperative complications were recorded. At the first postoperative visit (6 to 8 weeks after surgery), the mean vaginal length was 8.1 cm. In all cases, the neovagina was epithelialized and had an appropriate width. The mean FSFI total and single domain scores did not differ significantly from those of the control group: 27.5 vs. 30.6 (total); 4.0 vs. 4.2 (desire); 4.4 vs. 5.2 (arousal); 5.2 vs. 5.3 (lubrication); 4.2 vs. 5.0 (orgasm); 5.3 vs. 5.5 (satisfaction) and 4.4 vs. 5.4 (comfort). Conclusions This modified laparoscopic Vecchietti technique is a simple, safe and effective procedure, which allows patients with congenital vaginal aplasia to have a satisfactory sexual activity, comparable to that of normal controls.


Asunto(s)
Laparoscopía , Vagina/anomalías , Vagina/cirugía , Adolescente , Adulto , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Recuperación de la Función , Estudios Retrospectivos , Autoinforme , Sexualidad , Resultado del Tratamiento , Vagina/fisiología , Adulto Joven
19.
Proc Natl Acad Sci U S A ; 113(39): 10759-68, 2016 09 27.
Artículo en Inglés | MEDLINE | ID: mdl-27638214

RESUMEN

For half a century, the process of economic integration of the Amazon has been based on intensive use of renewable and nonrenewable natural resources, which has brought significant basin-wide environmental alterations. The rural development in the Amazonia pushed the agricultural frontier swiftly, resulting in widespread land-cover change, but agriculture in the Amazon has been of low productivity and unsustainable. The loss of biodiversity and continued deforestation will lead to high risks of irreversible change of its tropical forests. It has been established by modeling studies that the Amazon may have two "tipping points," namely, temperature increase of 4 °C or deforestation exceeding 40% of the forest area. If transgressed, large-scale "savannization" of mostly southern and eastern Amazon may take place. The region has warmed about 1 °C over the last 60 y, and total deforestation is reaching 20% of the forested area. The recent significant reductions in deforestation-80% reduction in the Brazilian Amazon in the last decade-opens up opportunities for a novel sustainable development paradigm for the future of the Amazon. We argue for a new development paradigm-away from only attempting to reconcile maximizing conservation versus intensification of traditional agriculture and expansion of hydropower capacity-in which we research, develop, and scale a high-tech innovation approach that sees the Amazon as a global public good of biological assets that can enable the creation of innovative high-value products, services, and platforms through combining advanced digital, biological, and material technologies of the Fourth Industrial Revolution in progress.


Asunto(s)
Agricultura , Cambio Climático , Conservación de los Recursos Naturales , Brasil , Bosques , Geografía , Producto Interno Bruto , Actividades Humanas , Humanos , Internacionalidad , Transpiración de Plantas/fisiología , Factores de Riesgo , Estaciones del Año
20.
Rev. bras. ginecol. obstet ; 38(9): 456-464, Sept. 2016. tab, graf
Artículo en Inglés | LILACS | ID: biblio-843898

RESUMEN

Abstract Purpose To evaluate the anatomic and functional results of a laparoscopic modified Vecchietti technique for the creation of a neovagina in patients with congenital vaginal aplasia. Methods Retrospective study of nine patients with congenital vaginal aplasia submitted to the laparoscopic Vecchietti procedure, in our department, between 2006 and 2013. The anatomical results were evaluated by assessing the length, width and epithelialization of the neovagina at the postoperative visits. The functional outcome was evaluated using the Rosen Female Sexual Function Index (FSFI) questionnaire and comparing the patients' results to those of a control group of 20 healthy women. The statistical analysis was performed using SPSS Statistics version 19.0 (IBM, Armonk, NY, USA), Student t-test, Mann-Whitney U test and Fisher exact test. Results The condition underlying the vaginal aplasia was Mayer-Rokitansky-KüsterHauser syndrome in eight cases, and androgen insensitivity syndrome in one case. The average preoperative vaginal length was 2.9 cm. At surgery, the mean age of the patients was 22.2 years. The surgery was performed successfully in all patients and no intra or postoperative complications were recorded. At the first postoperative visit (6 to 8 weeks after surgery), the mean vaginal length was 8.1 cm. In all cases, the neovagina was epithelialized and had an appropriate width. The mean FSFI total and single domain scores did not differ significantly from those of the control group: 27.5 vs. 30.6 ( total); 4.0 vs. 4.2 (desire); 4.4 vs. 5.2 (arousal); 5.2 vs. 5.3 (lubrication); 4.2 vs. 5.0 ( orgasm); 5.3 vs. 5.5 (satisfaction) and 4.4 vs. 5.4 ( comfort ). Conclusions This modified laparoscopic Vecchietti technique is a simple, safe and effective procedure, which allows patients with congenital vaginal aplasia to have a satisfactory sexual activity, comparable to that of normal controls.


Resumo Objetivo Avaliar os resultados anatômicos e funcionais da técnica laparoscópica modificada de Vecchietti para a criação de uma neovagina em pacientes com aplasia vaginal congênita. Métodos Estudo retrospectivo de nove pacientes com aplasia vaginal congênita submetidas à técnica laparoscópica modificada de Vecchietti, no nosso departamento, entre 2006 e 2013. Os resultados anatômicos foram aferidos através da avaliação do comprimento, largura e reepitelização da neovagina nas consultas pós-operatórias. Os resultados funcionais foram avaliados com recurso à versão em português do questionário Female Sexual Function Index de Rosen, comparando os resultados das pacientes aos de um grupo de controle de 20 mulheres saudáveis. A análise estatística foi realizada utilizando o programa SPSS Statistics versão 19.0), o teste t de Student, teste U de Mann-Whitney e teste exato de Fisher. Resultados A etiologia subjacente à aplasia vaginal foi a síndrome de Mayer-Roki-tansky-Küster-Hauser em oito casos, e a síndrome de insensibilidade aos andrógenos em um caso. O comprimento vaginal médio pré-operatório era de 2,9 cm. À data da cirurgia, a média de idade das pacientes era de 22,2 anos. A cirurgia foi realizada com sucesso em todos os casos, sem registo de complicações intra ou pós-operatórias. Na primeira avaliação pós-operatória (6 a 8 semanas após a cirurgia), o comprimento vaginal médio foi de 8,1 cm. Em todos os casos, a neovagina estava reepitelizada e com amplitude adequada. As pontuações médias, total e de cada domínio, obtidas no questionário de avaliação da função sexual não diferiram significativamente das do grupo controle: 27,5 vs 30,6 (total); 4.0 vs 4.2 (desejo); 4,4 vs 5,2 (excitação); 5,2 vs 5 , 3 (lubrificação); 4,2 vs 5,0 (orgasmo); 5,3 vs 5,5 (satisfação) e 4,4 vs 5,4 ( conforto ). Conclusões A técnica laparoscópica modificada de Vecchietti é um procedimento simples, seguro e eficaz, permitindo às pacientes com aplasia vaginal congênita uma atividade sexual satisfatória, comparável à dos controles normais.


Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Adulto Joven , Procedimientos Quirúrgicos Ginecológicos/métodos , Laparoscopía , Vagina/anomalías , Vagina/cirugía , Recuperación de la Función , Estudios Retrospectivos , Autoinforme , Sexualidad , Resultado del Tratamiento , Vagina/fisiología
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