Light means power: harnessing light spectrum and UV-B to enhance photosynthesis and rutin levels in microtomato plants.

Urban vertical agriculture with lighting system can be an alternative green infrastructure to increase local food production irrespective of environmental and soil conditions. In this system, light quality control can improve the plant physiological performance, well as induce metabolic pathways that contribute to producing phenolic compounds important to human health. Therefore, this study aimed to evaluate the influence of RBW (red, blue and white) and monochromatic (red and blue; R and B, respectively) light associated or not with UV-B on photosynthetic performance and phenolic compound production in microtomato fruits cultivated via vertical agriculture. The experimental design adopted was completely randomized, with six replicates illuminated with 300 µmol·m-2·s-1 light intensities (RBW, RBW + UV, B, B + UV, R, and R + UV), 12 h photoperiod, and 3.7 W·m-2 UV-B irradiation for 1 h daily for the physiological evaluations. Twenty-six days after the installation, gas exchange, chlorophyll a fluorescence and nocturnal breathing were evaluated. Fruits in different ripening stages (green, orange, and red) were collected from microtomato plants grown under with different light qualities, to evaluate the physiological performance. The identification and quantification of the phenolic compound rutin was also performed to investigate their metabolic response. This study identified that plants grown under B + UV had high photosynthetic rates (A=11.57 µmol·m-2·s-1) and the fruits at all maturation stages from plants grown under B and B + UV had high rutin content. Meanwhile, the activation of suppressive mechanisms was necessary in plants grown under R because of the high nocturnal respiration and unregulated quantum yield of the non-photochemical dissipation of the photosystem II. These results highlight the importance of selecting light wavelength for vegetable cultivation to produce fruits with a high content of specialized metabolites that influence color, flavor, and health promotion, which is of special interest to farmers using sustainable cropping systems.

Alterações osteometabólicas em pacientes em tratamento antineoplásico: revisão de escopo / Osteometabolic changes in patients under antineoplastic treatment: scoping review

Objetivo: sintetizar as principais evidências acerca das alterações osteometabólicas presentes nos pacientes em tratamento antineoplásico. Métodos: trata-se de uma revisão de escopo, seguindo a metodologia do Instituto Joanna Briggs, nas bases de dados PubMed/MedLine, Cochrane Library, LILACS, The British Library e Google Scholar. A revisão está protocolada no Open Science Framework. Resultados: muitos antineoplásicos possuem efeito na arquitetura óssea, reduzindo sua densidade, tais como moduladores seletivos de receptores de estrogênio, inibidores da aromatase, terapia de privação androgênica, e glicocorticoides. Para evitar tais desfechos, o tratamento e prevenção podem ser realizados pela suplementação de cálcio e vitamina D, exercícios físicos, uso de bifosfonatos, denosumab, e moduladores seletivos do receptor de estrogênio. Conclusão: pessoas com maior risco de desenvolver câncer também possuem maior risco de osteopenia e osteoporose, quando processo já estabelecido e em tratamento antineoplásico, devido ao compartilhamento de fatores de risco. Torna-se evidente a necessidade da densitometria óssea nos pacientes em tratamento contra o câncer para de prevenção e promoção de saúde óssea nesses pacientes, além de mais pesquisas com alto nivel de evidência para subsidiar tal uso.

Objective: To summarize the main evidence regarding osteometabolic changes in patients undergoing antineoplastic treatment. Methods: This is a scoping review, following the methodology of the Joanna Briggs Institute, using PubMed/MedLine, Cochrane Library, LILACS, The British Library, and Google Scholar. This review is registered in the Open Science Framework. Results: Many antineoplastics affect bone architecture by reducing its density, such as selective estrogen receptor modulators, aromatase inhibitors, androgen deprivation therapy, and glucocorticoids. To avoid such outcomes, treatment and prevention can be achieved by calcium and vitamin D supplementation, physical exercise, use of bisphosphonates, denosumab, and selective estrogen receptor modulators. Conclusion: people at a higher risk of developing cancer also have a higher risk of osteopenia and osteoporosis when the process is already established and undergoing antineoplastic treatment because of the grouping of risk factors. The need for bone densitometry in patients undergoing cancer treatment to prevent and promote bone health in these patients is evident, in addition to more research with a high level of evidence to support such use.

Organizational intervention to improve access to retinopathy screening for patients with diabetes mellitus: health care service improvement project in a tertiary public hospital.

INTRODUCTION: The aim of this study was to improve the access to diabetic retinopathy (DR) screening with retinographies in a tertiary care center through a process conducted by an interdisciplinary group driven by a nurse. MATERIALS AND METHODS: This is a quality improvement study that evaluated the flow for DR screening conducted by an interdisciplinary group using the Plan-Do-Study-Act methodology. As a result measure, we assessed the quantity of retinographies performed after the project implementation, the proportion of patients who presented abnormal retinographies, and the proportion of patients referred to a specialist. RESULTS: The new patient screening flow and the reinforcement of available human resources led to an increase in the number of retinographies performed and screened patients. A total of 1184 retinographies were conducted, and it was possible to observe DR alterations in 37.8 % patients, of which only 6 % needed to be referred to the DR reference center. CONCLUSIONS: This study showed a significant increase in the number of retinographies performed. The Plan-Do-Study-Act methodology was an important tool to improve the flow of patient access to fundus images, helping to consistently and continuously improve these processes.

EVALUATION OF THE SATISFACTION OF REMOTE TEACHING IN POSTGRADUATE COURSES IN HEALTH: SYSTEMATIC REVIEW / EVALUACIÓN DE LA SATISFACCIÓN CON LA ENSEÑANZA A DISTANCIA EN CURSOS DE POSTGRADO EN SALUD: REVISIÓN SISTEMÁTICA / AVALIAÇÃO DA SATISFAÇÃO DO ENSINO REMOTO EM CURSOS DE PÓS-GRADUAÇÃO EM SAÚDE: REVISÃO SISTEMÁTICA

Objective: To analyze and identify in the scientific literature how remote teaching is being used and how it was evaluated in postgraduate health courses. Methods: Systematic review with a search in the Virtual Health Library (VHL), with the descriptors distance education, remote learning, residency, graduate studies and health in Portuguese and English, between 2017 and 2021, in Portuguese, English and Spanish. Results: From 750 initial results, 19 articles were included. The United States leads with the largest number of publications on the subject. The evaluation of students who studied through remote teaching is positive. Conclusion: Remote teaching was introduced very quickly for a large number of specialties in the world, with this, even showing positive aspects in this type of teaching, some negative points were evident and that future improvements must be made

Objetivo: Analizar e identificar en la literatura científica el uso de la enseñanza a distancia y su evaluación en los cursos de posgrado en salud. Métodos: Revisión sistemática en las bases de datos Medline, Lilacs, BDEnf, IBECS, BBO y BDENF con los descriptores educación a distancia, aprendizaje a distancia, residencia, estudios de posgrado y salud entre 2017 y 2021, en portugués, inglés y español. Resultados: La búsqueda inicial identificó 750 resultados. En la fase de análisis de títulos y resúmenes quedaron 66 estudios. Finalmente, se incluyeron 19 artículos. Estados Unidos lidera con el mayor número de publicaciones sobre el tema. La valoración de los alumnos que estudiaron a través de la docencia a distancia es positiva. Conclusión: La enseñanza a distancia se implementó muy rápidamente para una gran cantidad de especialidades en el mundo, con lo que, aun mostrando aspectos positivos en este tipo de enseñanza, se evidenciaron algunos puntos negativos y que se deben realizar mejoras futuras

Objetivo: Analisar e identificar na literatura científica a utilização do ensino remoto e sua avaliação em cursos de pós-graduação em saúde. Métodos: Revisão sistemática nas bases de dados Medline, Lilacs, BDEnf, IBECS, BBO e BDENF com os descritores educação a distância, ensino remoto, residência, pós-graduação e saúde entre 2017 a 2021, nos idiomas português, inglês e espanhol. Resultados: A busca inicial identificou 750 resultados. Na fase de análise dos títulos e resumos sobraram 66 estudos. Por fim foram incluídos 19 artigos. Os Estados Unidos lideram com o maior número de publicações acerca do tema. A avaliação dos discentes que estudaram através do ensino remoto é positiva. Conclusão: O ensino remoto foi colocado de forma muito rápida para uma grande quantidade de especialidades no mundo, com isso, mesmo evidenciando-se aspectos positivos nesse tipo de ensino, ficou evidente alguns pontos negativos e que se deve fazer melhorias futuras.

Prevalence of diabetic retinopathy in Brazil: a systematic review with meta-analysis.

AIMS: To evaluate the prevalence of diabetic retinopathy (DR) in Brazilian adults with diabetes mellitus via a systematic review with meta-analysis. METHODS: A systematic review using PubMed, EMBASE, and Lilacs was conducted, searching for studies published up to February 2022. Random effect meta-analysis was performed to estimate the DR prevalence. RESULTS: We included 72 studies (n = 29,527 individuals). Among individuals with diabetes in Brazil, DR prevalence was 36.28% (95% CI 32.66-39.97, I2 98%). Diabetic retinopathy prevalence was highest in patients with longer duration of diabetes and in patients from Southern Brazil. CONCLUSION: This review shows a similar prevalence of DR as compared to other low- and middle-income countries. However, the high heterogeneity observed-expected in systematic reviews of prevalence-raises concerns about the interpretation of these results, suggesting the need for multicenter studies with representative samples and standardized methodology.

Microbial Inoculation Improves Growth, Nutritional and Physiological Aspects of Glycine max (L.) Merr.

Considering a scenario where there is a low availability and increasing costs of fertilizers in the global agricultural market, as well as a finitude of important natural resources, such as phosphorus (P), this study tested the effect of the inoculation of rhizospheric or endophytic microorganisms isolated from Hymenaea courbaril and Butia purpurascens on the growth promotion of Glycine max (L.) Merr. The tests were conducted in a controlled greenhouse system, and the effects of biofertilization were evaluated using the following parameters: dry biomass, nutritional content, and photochemical and photosynthetic performance of plants. Seed biopriming was performed with four bacterial and four fungal isolates, and the results were compared to those of seeds treated with the commercial product Biomaphos®. Overall, microbial inoculation had a positive effect on biomass accumulation in G. max, especially in strains PA12 (Paenibacillus alvei), SC5 (Bacillus cereus), and SC15 (Penicillium sheari). The non-inoculated control plants accumulated less nutrients, both in the whole plant and aerial part, and had reduced chlorophyll index and low photosynthetic rate (A) and photochemical efficiency. Strains PA12 (P. alvei), SC5 (B. cereus), and 328EF (Codinaeopsis sp.) stood out in the optimization of nutrient concentration, transpiration rate, and stomatal conductance. Plants inoculated with the bacterial strains PA12 (P. alvei) and SC5 (B. cereus) and with the fungal strains 328EF (Codinaeopsis sp.) and SC15 (P. sheari) showed the closest pattern to that observed in plants treated with Biomaphos®, with the same trend of direction of the means associated with chlorophyll index, (A), dry mass, and concentration of important nutrients such as N, P, and Mg. We recommend the use of these isolates in field tests to validate these strains for the production of biological inoculants as part of the portfolio of bioinputs available for G. max.

A Study on the Anti-NF-κB, Anti-Candida, and Antioxidant Activities of Two Natural Plant Hormones: Gibberellin A4 and A7.

INTRODUCTION: Gibberellins (GA) are terpenoids that serve as important plant hormones by acting as growth and response modulators against injuries and parasitism. In this study, we investigated the in vitro anti-NF-κB, anti-Candida, and antioxidant activity of gibberellin A4 (GA4) and A7 (GA7) compounds, and further determined their toxicity in vivo. METHODS: GA4 and GA7 in vitro toxicity was determined by MTT method, and nontoxic concentrations were then tested to evaluate the GA4 and GA7 anti-NF-κB activity in LPS-activated RAW-luc macrophage cell culture (luminescence assay). GA4 in silico anti-NF-κB activity was evaluated by molecular docking with the software "AutoDock Vina", "MGLTools", "Pymol", and "LigPlot+", based on data obtained from "The Uniprot database", "Protein Data Bank", and "PubChem database". The GA4 and GA7 in vitro anti-Candida effects against Candida albicans (MYA 2876) were determined (MIC and MFC). GA7 was also evaluated regarding the viability of C. albicans preformed biofilm (microplate assay). In vitro antioxidant activity of GA4 and GA7 was evaluated against peroxyl radicals, superoxide anions, hypochlorous acid, and reactive nitrogen species. GA4 and GA7 in vivo toxicity was determined on the invertebrate Galleria mellonella larvae model. RESULTS: Our data show that GA4 at 30 µM is nontoxic and capable of reducing 32% of the NF-κB activation on RAW-luc macrophages in vitro. In vitro results were confirmed via molecular docking assay (in silico), since GA4 presented binding affinity to NF-κB p65 and p50 subunits. GA7 did not present anti-NF-κB effects, but exhibited anti-Candida activity with low MIC (94 mM) and MFC (188 mM) values. GA7 also presented antibiofilm properties at 940 mM concentration. GA4 did not present anti-Candida effects. Moreover, GA4 and GA7 showed antioxidant activity against peroxyl radicals, but did not show scavenging activity against the other tested radicals. Both compounds did not affect the survival of G. mellonella larvae, even at extremely high doses (10 g/Kg). CONCLUSION: Our study provides preclinical evidence indicating that GA4 and GA7 have a favorable low toxicity profile. The study also points to GA4 and GA7 interference with the NF-κB via, anti-Candida activity, and a peroxyl radical scavenger, which we argue are relevant biological effects.

The impact of COVID-19 on the indigenous peoples related to air and road networks and habitat loss.

The vegetation loss in the Brazil's Legal Amazon (BLA) in 2020 corresponds to the highest loss observed in a decade, caused by the intensification of fires, mineral extraction activities, and other pressures. The possibility of earning from illegal activities such as deforestation and mining attracts the population to indigenous territories, while fires aggravate respiratory problems and enhance the current COVID-19 crisis. Furthermore, the BLA's road network is usually related to increased deforestation and fires in its areas of influence, and airports are known to contribute to spreading COVID-19 infections worldwide. Therefore, we decided to evaluate the effect of characteristics of Special Indigenous Health Districts (DSEIs) (including population, number of airports, and extent of the road network) and vegetation loss rates (deforestation, and area of vegetation lost by fires and mining) on the number of COVID-19 cases and deaths among the indigenous population in DSEIs in the BLA. We observed a positive correlation between the number of cases and deaths and the number of Indigenous Primary Healthcare Units, suggesting that many of these units did not increase appropriate activities for prevention and protection from COVID-19 in the DSEIs. The DSEIs with larger air transport and road networks were more affected by COVID-19. These networks constituted critical mechanisms for facilitating the spread of SARS-CoV-2 in the BLA. Additionally, we noted that changes that impact the landscape of DSEIs, such as fires and mining, also impact legal indigenous areas (IAs). Thus, IAs are not spared from exploratory processes in the district's landscape. Models that associate the air transport and road networks with the transformation of the landscape in IAs from burning or mining can explain the number of indigenous people who died due to COVID-19. These results are particularly important given the current disruptive scenario imposed by the Brazilian government on critical institutions that detect and fight fires in indigenous lands and the policies enacted to combat COVID-19 in Brazil, which are based on denying isolation measures and delaying vaccinations.

Early neurovascular retinal changes detected by swept-source OCT in type 2 diabetes and association with diabetic kidney disease.

PURPOSE: To evaluate retinal thickness and capillary density in patients with type 2 diabetes (T2D) and their association with diabetic kidney disease (DKD) using swept-source optical coherence tomography (SS-OCT). METHODS: A cross-sectional study was conducted with T2D patients with mild or no diabetic retinopathy (DR) and nondiabetic controls. Inner retinal layer thickness was measured with SS-OCT. Retinal capillary density and the foveal avascular zone (FAZ) were measured with SS-OCT angiography (OCTA). SS-OCT parameters were compared in patients with and without diabetic kidney disease (DKD) and nondiabetic controls. RESULTS: 131 DKD eyes showed decreased ganglion cell layer plus (GCL+) (p = 0.005 TI; p = 0.022 I), retinal nerve fiber layer (RNFL) (p = 0.003), and central retinal thickness (CRT) (p = 0.032), as well as foveal avascular zone (FAZ) enlargement (p = 0.003) and lower capillary density in the superficial vascular plexus (p = 0.016, central quadrant), compared to controls. No statistically significant changes were found between diabetic patients without significant DKD and controls. CONCLUSION: Our findings suggest early neurovascular damage in patients with T2D; these changes were more significant in patients with DKD. Larger longitudinal studies are warranted to determine the role of early neurovascular damage in the pathophysiology of severe DR.

Efficiency of the Hydroponic System as an Approach to Confirm the Solubilization of CaHPO4 by Microbial Strains Using Glycine max as a Model.

The sustainable development of agriculture can be stimulated by the great market availability of bio-inputs, including phosphate-solubilizing microbial strains. However, these strains are currently selected using imprecise and questionable solubilization methodologies in solid or liquid media. We hypothesized that the hydroponic system could be a more efficient methodology for selecting phosphate-solubilizing strains as plant growth promoters. This methodology was tested using the plant Glycine max as a model. The growth-promoting potential of the strains was compared with that of the Biomaphos® commercial microbial mixture. The obtained calcium phosphate (CaHPO4) solubilization results using the hydroponic system were inconsistent with those observed in solid and liquid media. However, the tests in liquid medium demonstrated poor performances of Codinaeopsis sp. (328EF) and Hamigera insecticola (33EF) in reducing pH and solubilizing CaHPO4, which corroborates with the effects of biotic stress observed in G. max plants inoculated with these strains. Nevertheless, the hydroponic system allowed the characterization of Paenibacillus alvei (PA12), which is also efficient in solubilization in a liquid medium. The bacterium Lysinibacillus fusiformis (PA26) was the most effective in CaHPO4 solubilization owing to the higher phosphorus (P) absorption, growth promotion, and physiological performance observed in plants inoculated with this bacterium. The hydroponic method proved to be superior in selecting solubilizing strains, allowing the assessment of multiple patterns, such as nutritional level, growth, photosynthetic performance, and anatomical variation in plants, and even the detection of biotic stress responses to inoculation, obtaining strains with higher growth promotion potential than Biomaphos®. This study proposed a new approach to confirm the solubilizing activity of microorganisms previously selected in vitro and potentially intended for the bio-input market that are useful in P availability for important crops, such as soybeans.

The association between cardiovascular risk factors and major cardiovascular diseases decreases with increasing frailty levels in geriatric outpatients.

BACKGROUND: Frailty marks a process of increasing dysregulation of physiological systems which increases the risk of adverse health outcomes. This study examines the hypothesis that the association between multiple cardiovascular risk factors (CVRF) and cardiovascular diseases (CVD) becomes stronger with increasing frailty severity. METHODS: Cross-sectional analysis of 339 older adults (55.2% women; aged 75.2 ±â€¯9.1 years) from an outpatient geriatric clinic from a middle-income country. The frailty index (FI) was calculated as the proportion of 30 possible health deficits. We assessed hypertension, diabetes, obesity, dyslipidemia, sedentarism and smoking as CVRF (determinants) and myocardial infarction, stroke, heart failure as CVD. Poisson regression models adjusted for age, sex, and education was applied to estimate the association between frailty as well as CVRF (independent variables) with CVD (dependent variable). RESULTS: Of the 339 patients, 18,3% were frail (FI ≥ 0.25) and 32.7% had at least one CVD. Both frailty and CVRF were significantly associated with CVD (PR = 1.03, 95% CI 1.01 to 1.05; p = 0.001, and PR = 1.46, 95% 1.24 to 1.71; p < 0.001, respectively) adjusted for covariates. The strength of the association between CVRF and CVD decreased with increasing frailty levels, as indicated by a significant interaction term of frailty and CVRF (p < 0.001). CONCLUSION: Frailty and CVRF are both associated with CVD, but the impact of CVRF decreases in the presence of frailty. When confirmed in longitudinal studies, randomized controlled trials or causal inference methods like Mendelian randomization should be applied to assess whether a shift from traditional CVRF to frailty would improve cardiovascular outcome in the oldest old.

Forest fires and deforestation in the central Amazon: Effects of landscape and climate on spatial and temporal dynamics.

Forest fires and deforestation are the main threats to the Amazon forest. Extreme drought events exacerbate the impact of forest fire in the Amazon, and these drought events are predicted to become more frequent due to climate change. Fire escapes into the forest from agriculture and pasture areas. We assessed the potential drivers of deforestation and forest fires in the central Brazilian Amazon and show that over a period of 31 years (1985-2015) forest fires occurred only in years of extreme drought induced by El Niño (1997, 2009 and 2015). The association of forest fires with strong El Niños shows the vulnerability of forest to climate change. The areas deforested were closely associated with navigable rivers: 62% of the total deforestation from 2000 to 2018 was located within the 2 km of rivers. There was a notable increase in deforestation and forest fire during the 2015 El Niño in comparison to previous years. Only a small part of the forest that burned was deforested in the years following the wildfires: 7% (1997), 3% (2009) and 1.5% (2015). Forest close to roads, rivers and established deforestation is susceptible to deforestation and fire since these areas are attractive for agriculture and pasture. Indigenous land was shown to be important in protecting the forest, while rural settlement projects attracted both forest fire and deforestation. Of the total area in settlement projects, 40% was affected by forest fires and 17% was deforested. Rivers are particularly important for deforestation in this part of Amazonia, and efforts to protect forest along the rivers are therefore necessary. The ability to predict where deforestation and fires are most likely to occur is important for designing policies for preventative actions.

Man vs. machine: Predicting hospital bed demand from an emergency department.

BACKGROUND: The recent literature reports promising results from using intelligent systems to support decision making in healthcare operations. Using these systems may lead to improved diagnostic and treatment protocols and to predict hospital bed demand. Predicting hospital bed demand in emergency department (ED) attendances could help resource allocation and reduce pressure on busy hospitals. However, there is still limited knowledge on whether intelligent systems can operate as fully autonomous, user-independent systems. OBJECTIVE: Compare the performance of a computer-based algorithm and humans in predicting hospital bed demand (admissions and discharges) based on the initial SOAP (Subjective, Objective, Assessment, Plan) records of the ED. METHODS: This was a retrospective cohort study that compared the performance of humans and machines in predicting hospital bed demand from an ED. It considered electronic medical records (EMR) of 9030 patients (230 used as a testing set, and hence evaluated both by humans and by an algorithm, and 8800 used as a training set exclusively by the algorithm) who visited the ED of a tertiary care and teaching public hospital located in Porto Alegre, Brazil between January and December 2014. The machine role was played by Support Vector Machine Classifier and the human prediction was performed by four ED physicians. Predictions were compared in terms of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUROC). RESULTS: All graders achieved similar accuracies. The accuracy by AUROC for the testing set was 0.82 [95% confidence interval (CI) of 0.77-0.87], 0.80 (95% CI: 0.75-0.85), 0.76 (95% CI: 0.71-0.81) for novice physicians, machine, experienced physicians, respectively. Processing time per test EMR was 0.00812±0.0009 seconds. In contrast, novice physicians took on average 156.80 seconds per test EMR, while experienced physicians took on average 56.40 seconds per test EMR. CONCLUSIONS: Our data indicated that the system could predict patient admission or discharge states with 80% accuracy, which was similar the performance of novice and experienced physicians. These results suggested that the algorithm could operate as an autonomous and independent system to complete this task.

Wildfires as a major challenge for natural regeneration in Atlantic Forest.

The natural regeneration management is a good strategy of ecological restoration of the Atlantic Forest, one of the most devastated biomes on the planet. However, the frequent occurrence of wildfires is one of the challenges to the success of this method. The objective of this study was to evaluate the effects of wildfires on forest dynamics in Atlantic Forest. The studied area was explored during the coffee cycle when plantations replaced primary forests. We used remote sensing data to analyze the forest dynamics over a period of 50 years (1966-2016). We used the INPE burn database to find the occurrence of hot spots from 1998 to 2016. During this period, we selected the years most affected by the fires for the identification of fire scars using the Normalized Burn Ratio spectral index. From this set of information, we used the methodology of weights of evidence to relate forest dynamics and wildfire events with biophysical and anthropic variables. The results showed that in 1966 the forest area accounted for 8.01% of the land cover, and in 2016 this number rose to 18.55% due to the spontaneous natural regeneration process. The regenerating areas were mainly related to the proximity of the remaining fragments and the portions of the landscape receiving the least amount of global solar radiation. The proximity to urban areas, roads and highways, damaged regeneration and favored both deforestation and wildfire events. Fire scars preferentially occur where there is greater sun exposure. It is possible to observe a negative correlation between the natural regeneration process and the fire scars. We concluded that fire severity is one of the factors that shape the landscape of the region while slowing the regeneration process in preferential areas.

A história obstétrica de gestantes com trombofilias hereditárias / Obstetric history of pregnant women with hereditary thrombophilias

Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x2 =4,2) e de pré-eclâmpsia (p=0,03; X2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica. (AU)

Introduction: Venous thromboembolic disease and obstetric complications resulting from placental thromboembolism are the main causes of maternal and fetal morbidity and mortality. Pregnancy is considered an independent factor for the development of thrombosis, as its risk is 5 to 6 times greater in pregnant women when compared to non-pregnant women, being even higher after childbirth. Methods: This historical cohort included patients seen at the Obstetrics Service of Federal University of Juiz de Fora (exposed patients, n = 70) and at the School of Medicine of Barbacena (unexposed patients, n = 74). The patients were divided into two groups: Group 1 consisted of patients with some thrombophilia identified through measurement of protein S, protein C, homocysteine, antithrombin III, MTHFR mutation, prothrombin and factor V Leiden mutations; and Group 2 consisted of patients from the low obstetric risk service. Results: There was an association between thrombophilia and previous abortion, as well as thrombophilia and previous fetal death (p < 0.05). MTHFR mutation was associated with history of HELLP syndrome (p = 0.03; x2 = 4.2) and preeclampsia (p = 0.03; x2 = 4.5) when in homozygous mutation. Homozygous MTHFR was also associated with mean homocysteine levels, so that homozygotes were those with highest homocysteine levels (p = 0.01; x2 = 5.8; x = 27.2 ± 41.2 vs. 12.62 ± 19.0). Conclusions: Hereditary thrombophilias may be associated with poor obstetric outcome and should be valued at clinical obstetrics. (AU)

Landowner perceptions of the value of natural forest and natural grassland in a mosaic ecosystem in southern Brazil.

The forest-grassland mosaics of southern Brazil have been subject to many land use and policy changes over the decades. Like many grasslands around the world, the Campos grasslands are declining with few conservation efforts underway. In contrast, forests receive much attention and many incentives. It is hypothesized that perception of land cover has the potential to shape ecosystems. Here we conduct a questionnaire to further our understanding of decision-making practices that alter landscapes (Campos grassland, Araucaria forest, agriculture and plantation) and direct land policies in the region. Our analysis reveals that plantations are significantly less desirable than the other landscape types. However, plantation land use has increased by 87 % over the past few decades, as a result of industry and government incentives. The proportions of other landscape types have remained consistent over the past two decades. Restoration of native vegetation is not a priority of landowners and restoration would require a financial incentive.