RESUMO
The scenario of deforestation in the Amazon may change with the reconstruction of Highway BR-319, a long-distance road that will expand the region's agricultural frontier towards the north and west of the Western Amazon, stretches that until then have extensive areas of primary forest due to the hard access. We simulate the deforestation that would be caused by the reconstruction and paving of Highway BR-319 in Brazil's state of Amazonas for the period from 2021 to 2100. The scenarios were based on the historical dynamics of deforestation in the state of Amazonas (business as usual, or BAU). Two deforestation scenarios were developed: (a) BAU_1, where Highway BR-319 is not reconstructed, maintaining its current status, and (b) BAU_2, where the reconstruction and paving of the highway will take place in 2025, favoring the advance of the deforestation frontier to the northern and western portion of the state of Amazonas. In the scenario where the highway reconstruction is foreseen (BAU_2), the results show that deforestation increased by 60% by 2100 compared to the scenario without reconstruction (BAU_1), demonstrating that paving would increase deforestation beyond the limits of the highway's official buffer area (40 km). The study showed that protected areas (conservation units and indigenous lands) help to maintain forest cover in the Amazon region. At the same time, it shows how studies like this one can help in decision-making.
Assuntos
Conservação dos Recursos Naturais , Monitoramento Ambiental , Brasil , Agricultura , ComércioRESUMO
PURPOSE: To describe outcomes of customized peripheral anterior lamellar keratoplasty (PALK) for late ectasia of the donor-recipient junction after penetrating keratoplasty (PK) for keratoconus. METHODS: This was a single-center, retrospective review of 33 eyes (28 patients) that developed ectasia restricted to the graft-host junction; 17 eyes underwent PALK using lamellar resections of 8- to 11-mm width starting at the external margin of the previous PK and suturing a same-size donor graft (annular or segmental). Five eyes were excluded from analysis because of postoperative complications unrelated to the technique. RESULTS: The average time between PK and diagnosis of secondary ectasia was 28 years (range 9-49 years). Slit-lamp examination showed localized thinning and elongation of the scar at the graft-host junction with well-defined biomicroscopic limits. Preoperatively, the mean keratometric measures were K1: 44.8 ± 4.8 D and K2: 54.1 ± 4.8 D and postoperatively K1: 47.5 ± 3.5 D and K2: 50.8 ± 2.6 D. The mean improvement in corrected visual acuity was 10 lines, and mean cylinder improved from 9.3 ± 2.1 D to 3.3 ± 1.4 D. All cases showed anatomical and refractive improvement. CONCLUSIONS: With long-term follow-up, late post-PK ectasia becomes an increasing problem. PALK can be a successful surgical option to reinforce the ectatic area while preserving a functional clear PK. By adding donor corneal tissue, PALK restores the ectatic area, improves visual acuity, keratometric values, and astigmatism, and preserves the functional graft while avoiding the higher risks of a larger diameter PK.
Assuntos
Córnea/patologia , Ceratocone/cirurgia , Ceratoplastia Penetrante/métodos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Acuidade Visual , Adolescente , Adulto , Criança , Córnea/cirurgia , Topografia da Córnea , Dilatação Patológica/diagnóstico , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Ceratocone/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Adulto JovemRESUMO
A patient tracing programme was implemented at an HIV clinic in Trinidad and Tobago to address the problem of defaulters from HIV care and non-adherence to antiretroviral treatment (ART). The study objective was to evaluate the implementation and outcomes of this programme conducted between April and September 2017. Using patient tracing contact methods, trained social workers attempted to contact 1058 patients lost to follow up (LTFU) between July 2016 and March 2017. Of the 1058 LTFU, 192 were ineligible: 27 (2.5%) were transferred to another clinic, 64 (6%) deceased, 35 (3.3%) hospitalised, 50 (4.7%) migrated and 16 (1.5%) incarcerated. Of the 866 eligible patients for patient tracing, 277 (32%) remained permanently LTFU and 589 (68%) were successfully contacted, re-engaged in care and received adherence counselling. Of the 589 who returned to care, 507 (86%) restarted ART. The three most common barriers reported among the 589 who were reengaged were 'forgetting their appointments' (20%), 'being too busy/work' (16%), and 'not wanting to be seen attending the HIV clinic' (12%). The study findings demonstrated the tracing programme as feasible for re-engaging those who are LTFU and highlighted barriers that can be addressed to further improve retention in HIV care among people living with HIV.
Assuntos
Antirretrovirais/administração & dosagem , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Sistemas de Identificação de Pacientes , Adolescente , Adulto , Feminino , Humanos , Perda de Seguimento , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Estudos Retrospectivos , Trinidad e Tobago , Adulto JovemRESUMO
Population-based testing for BRCA1/2 mutations detects a high proportion of carriers not identified by cancer family history-based testing. We sought to determine whether population-based testing is an effective approach to genetic testing in the Bahamas, where 23% of women with breast cancer carry one of seven founder mutations in the BRCA1 or BRCA2 gene. We determined the prevalence of founder BRCA mutations in 1847 Bahamian women without a personal history of breast or ovarian cancer, unselected for age or family history. We found that 2.8% (20/705) of unaffected women with a family history of breast/ovarian cancer and 0.09% (1/1089) of unaffected women without a family history carry a BRCA mutation. A total of 38% of unaffected women with a known mutation in the family were found to carry the familial mutation. We previously suggested that all Bahamian women with breast or ovarian cancer be offered genetic testing. These current data suggest that additionally all unaffected Bahamian women with a family history of breast/ovarian cancer should be offered genetic testing for the founder BRCA mutations.
Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Efeito Fundador , Frequência do Gene , Mutação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bahamas , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Feminino , Predisposição Genética para Doença , Testes Genéticos , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/metabolismo , Adulto JovemRESUMO
Purpose: To compare the ability to detect preoperative ectasia risk among LASIK candidates using classic ERSS (Ectasia Risk Score System) and Pentacam Belin-Ambrósio deviation index (BAD-D), and to test the benefit of a combined approach including BAD-D and clinical data. Methods: A retrospective nonrandomized study involved preoperative LASIK data from 23 post-LASIK ectasia cases and 266 stable-LASIK (follow up > 12 months). Preoperative clinical and Pentacam (Oculus; Wetzlar, Germany) data were obtained from all cases. Mann-Whitney's test was performed to assess differences between groups. Stepwise logistic regression was used for combining parameters.The areas under the Receiver Operating Characteristic (ROC) curves (AUC) were calculated for all parameters and combinations, with pairwise comparisons of AUC (DeLong's method). Results: Statistically significant differences were found for age, residual stromal bed (RSB), central corneal thickness and BAD-D (p<0.001), but not for sphere, cylinder or spherical equivalent (p>0.05). ERSS was 3 or more on 12/23 eyes from the ectasia group (sensitivity = 52.17%) and 48/266 eyes from the stable LASIK group (18% false positive). BAD-D had AUC of 0.931 (95% CI: 0.895 to 0.957), with cut-off of 1.29 (sensitivity = 87%; specificity = 92.1%). Formula combining BAD-D, age and RSB provided 100% sensitivity and 94% specificity, with better AUC (0.989; 95% CI: 0.969 to 0.998) than all individual parameters (p>0.001). Conclusion: BAD-D is more accurate than ERSS. Combining clinical data and BAD-D improved ectasia susceptibility screening. Further validation is necessary. Novel combined functions using other topometric and tomographic parameters should be tested to further enhance accuracy. .
Objetivo: Comparar a capacidade de detectar risco de ectasia no pré-operatório de LASIK usando o clássico ERSS (Ectasia Risk Score System) e índice Belin- Ambrósio (BAD- D) do Pentacam; e para testar o benefício de uma abordagem combinada, incluindo BAD-D e dados clínicos. Métodos: Estudo não randomizado retrospectivo envolveu dados pré-operatórios de LASIK de 23 casos que evoluíram para ectasia pós-LASIK e 266 casos estáveis após LASIK com acompanhamento mínimo de 12 meses. Dados préoperatórios clínicos e do Pentacam (Oculus, Wetzlar, Alemanha) foram obtidos para todos os casos. O teste de Mann-Whitney foi realizado para avaliar as diferenças entre grupos. Regressão logística foi utilizada para combinar parâmetros. As áreas sob as curvas Receiver Operating Characteristic (ROC; AUC) foram calculadas para todos os parâmetros e as combinações. Comparações de pares das AUC foram realizadas com método de DeLong. Resultados: Foram encontradas diferenças estatisticamente significativas para a idade, residual leito estromal (RSB), espessura corneana central e BAD- D (p <0,001), mas não para a grau esférico, cilindro ou equivalente esférico (p > 0,05). ERSS foi de três ou mais em 12/23 olhos do grupo ectasia (sensibilidade = 52,17 %) e 48/ 266 olhos do grupo LASIK estável (18% falso positivo). BAD- D teve AUC de 0,931 (IC 95%: 0,895-0,957), com corte de 1,29 (sensibilidade=87%, especificidade=92,1%). A fórmula que combinou BAD-D, idade e RSB, gerou 100% de sensibilidade e especificidade de 94%, com melhor AUC (0,989, IC 95%: 0,969-0,998) do que todos os parâmetros individuais (p>0,001). Conclusão: BAD-D é mais preciso do que ERSS. Combinações de dados clínicos e os BAD-D melhorou a capacidade de identificação ...
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Técnicas de Diagnóstico Oftalmológico/normas , Dilatação Patológica/diagnóstico , Dilatação Patológica/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Curva ROC , Medição de Risco , Córnea/cirurgia , Córnea/patologia , Topografia da CórneaRESUMO
PURPOSE: To assess the efficacy and safety of the anti-VEGF receptor-2 (VEGFR-2) antibody ramucirumab as first-line therapy in patients with advanced hepatocellular carcinoma and explore potential circulating biomarkers. EXPERIMENTAL DESIGN: Adults with advanced hepatocellular carcinoma and no prior systemic treatment received ramucirumab 8 mg/kg every two weeks until disease progression or limiting toxicity. The primary endpoint was progression-free survival (PFS); secondary endpoints included objective response rate (ORR) and overall survival (OS). Circulating biomarkers were evaluated before and after ramucirumab treatment in a subset of patients. RESULTS: Forty-two patients received ramucirumab. Median PFS was 4.0 months [95% confidence interval (CI), 2.6-5.7], ORR was 9.5% (95% CI, 2.7-22.6; 4/42 patients had a partial response), and median OS was 12.0 months (95% CI, 6.1-19.7). For patients with Barcelona Clinic Liver Cancer (BCLC) stage C disease, median OS was 4.4 months (95% CI, 0.5-9.0) for patients with Child-Pugh B cirrhosis versus 18.0 months (95% CI, 6.1-23.5) for patients with Child-Pugh A cirrhosis. Treatment-related grade ≥ 3 toxicities included hypertension (14%), gastrointestinal hemorrhage and infusion-related reactions (7% each), and fatigue (5%). There was one treatment-related death (gastrointestinal hemorrhage). After treatment with ramucirumab, there was an increase in serum VEGF and placental growth factor (PlGF) and a transient decrease in soluble VEGFR-2. CONCLUSION: Ramucirumab monotherapy may confer anticancer activity in advanced hepatocellular carcinoma with an acceptable safety profile. Exploratory biomarker studies showed changes in circulating VEGF, PlGF, and sVEGFR-2 that are consistent with those seen with other anti-VEGF agents.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/sangue , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais Humanizados , Antineoplásicos/farmacologia , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Placentário , Proteínas da Gravidez/sangue , Modelos de Riscos Proporcionais , Fator A de Crescimento do Endotélio Vascular/sangue , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/antagonistas & inibidores , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/sangue , RamucirumabRESUMO
Nossa regiäo de atuaçao foi o bairro Maria Cecília, regiäo norte de Londrina - PR, área de abrangência da Unidade Básica de Saúde Maria Cecília. Nesse estudo da cárie dentária fizemos uma revisäo bibliográfica sobre o que é, como se forma e suas consequências, para que pudéssemos através de métodos verificar a conscientizaçäo da populaçäo quanto à higiene bucal, dificuldades na prevençäo da cárie e os trabalhos realizados para a prevençäo. Os métodos empregados foram: entrevistas com profissionais da área, pessoas ligadas à área de estudo, questionário, análise de dados, etc. Com os resultados em mäos concluímos que a populaçäo pode ter acesso aos conhecimentos de prevençäo à cárie, já que tem a escova dental, porém podem näo estar seguindo certas regras de higiene bucal, podendo haver aí falta de conscientizaçäo da importância destas normas
Assuntos
Higiene Bucal , Cárie DentáriaRESUMO
The morphological features of M. leprae, M. leprae murium, M.tuberculosis, M. smegmatis, M.phlei, and of the vole bacillus were compared by electron microscopy. A cell wall and nuclear structures were observed in the different species, and their characteristics were defined. Changes in the morphology of M.leprae murium as a result of exposure in vitro to saponified fractions of moogrol, to oleic acid, as well as to boiling in 0.85 per cent salinesolution, to strong bases and to formaldehyde, are described. Te morphologic pattern of M. leprae and of M. leprae murium, as revealed by electron micrographs, is in general respects different from that of the cultivable mycobacteria. On the other hand, these two leprosy strains slosely resemble each other.