ABSTRACT Background: Ocular toxoplasmosis is the leading cause of infectious posterior uveitis worldwide, accounting for 30-50% of all cases in immunocompetent patients. Conventional treatment is associated with adverse effects and does not prevent recurrence. Intravitreal drug administration can improve disease outcomes and reduce side effects. Herein, we conducted a systematic review and meta-analysis on the efficacy of intravitreal injections for treating ocular toxoplasmosis. Methods: The systematic search was conducted using PubMed, SciELO, and Google Scholar with the descriptors “ocular toxoplasmosis” AND “intravitreal”. We analyzed studies that met the inclusion criteria, i.e., experimental cases in patients treated intravitreally for ocular toxoplasmosis. Considering the systematic review, we focused on the number of intravitreal injections, the therapeutic drug class, and the presence of preexisting conditions. To assess the efficacy of intravitreal injections, a meta-analysis was performed using visual acuity, side effects, disease recurrence, and inflammatory responses as variables. Results: Intravitreal injection-induced side effects were rarely observed (0.49% [0.00, 1.51%] ). The use of antiparasitic and anti-inflammatory drugs afforded improved visual acuity (99.81% [98.60, 100.00%]) and marked effectiveness in treating ocular toxoplasmosis. Conclusions: Intravitreal injections may facilitate the successful treatment of ocular toxoplasmosis. However, clinicians should carefully evaluate the presence of preexisting conditions for ocular toxoplasmosis or previous diseases, as these can impact the decision to administer intravitreal injections.

ABSTRACT Background: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. Methods: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. Results: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. Conclusions: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.

ABSTRACT OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: “hepatitis B” AND (“informal recycling” OR “waste picker” OR “recyclable waste collectors” OR “solid waste segregator”) AND (“recyclable waste” OR “solid waste”) AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%–22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

ABSTRACT OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: “hepatitis B” AND (“informal recycling” OR “waste picker” OR “recyclable waste collectors” OR “solid waste segregator”) AND (“recyclable waste” OR “solid waste”) AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%–22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

RESUMO Objetivo. Verificar a existência de associação de indicadores de gestão de resíduos sólidos e socioeconômicos municipais com índices de incidência de dengue, Zika e Chikungunya nos municípios do estado brasileiro de Minas Gerais. Métodos. Este estudo de caráter exploratório, quantitativo e transversal abrangeu os 853 municípios do estado de Minas Gerais. Todos os dados utilizados foram secundários, coletados e agrupados por regionais de planejamento. Como variáveis independentes, foram consideradas a cobertura de coleta de resíduos sólidos urbanos, cobertura de coleta seletiva e massa de resíduos sólidos urbanos, além de um indicador da qualidade da destinação final de resídulos, índices de desenvolvimento humano municipal e de Gini, renda mensal per capita e porcentagem de vulneráveis à pobreza. Os fatores potencialmente associados aos desfechos – incidências municipais de dengue, Chikungunya e Zika – foram selecionados inicialmente através de análises univariadas. Posteriormente, os modelos de regressão linear para as incidências de dengue, Chikungunya ou Zika foram gerados considerando os preditores selecionados pela análise univariada. Resultados. Não foi observada associação entre gestão de resíduos sólidos e incidência de Chikungunya e Zika. Por sua vez, a incidência de dengue associou-se à gestão de resíduos sólidos e apresentou relação inversa significativa com o percentual de vulneráveis à pobreza. Houve também associação direta o índice de Gini, sugerindo que quanto maiores os registros de incidência de dengue de 2007 a 2016, maiores os valores de Gini dos municípios – ou seja, maior a desigualdade social. A cobertura da coleta seletiva apresentou relação inversa e significativa com os casos de dengue, sugerindo que quanto menor a cobertura da coleta de seletiva, maiores foram os casos registrados de dengue. Conclusões. A gestão de resíduos sólidos pode influenciar os casos de dengue e, por isso, deve ser considerada nas ações de saúde pública.

ABSTRACT Objective. To investigate whether solid waste management and municipal socioeconomic indicators are associated with incidence rates of dengue, Zika, and Chikungunya in municipalities located in the state of Minas Gerais, Brazil. Methods. This exploratory, quantitative, cross-sectional study included all the 853 municipalities of Minas Gerais. Only secondary data were used, collected and grouped according to planning regions. Independent variables included regular urban solid waste collection, separated waste collection, and urban solid waste mass, in addition to a quality indicator of final waste disposal, municipal human development and Gini indices, monthly per capita income, and percentage of population vulnerable to poverty. The factors potentially associated with outcomes – municipal incidence of dengue, Chikungunya, and Zika – were initially selected by univariate analysis, followed by linear regression analysis for the incidence of dengue, Chikungunya, or Zika using the predictors selected through univariate analysis. Results. Solid waste management was not associated with incidence of Zika or Chikungunya. In turn, the incidence of dengue was associated with solid waste management and had a significant inverse association with percent population vulnerable to poverty. A direct association was also observed with Gini index, suggesting that the higher the incidence of dengue from 2007 to 2016, the higher the municipal Gini coefficient and thus social inequality. Selective waste collection was inversely and significantly correlated with dengue cases, suggesting that the lower the coverage by regular separated waste collection, the higher the number of dengue cases. Conclusions. Solid waste management may influence the occurrence of dengue cases, and therefore should be considered in the planning of public health actions.

RESUMEN Objetivo. Investigar si el manejo de los residuos sólidos y los indicadores socioeconómicos municipales están asociados con las tasas de incidencia de dengue, zika y chikunguña en los municipios del estado de Minas Gerais, Brasil. Métodos. Estudio exploratorio, cuantitativo y transversal que incluyó los 853 municipios de Minas Gerais. Sólo se utilizaron datos secundarios, recopilados y agrupados según las regiones de planificación. Las variables independientes incluyeron la recolección urbana regular de residuos sólidos, la recolección separada de residuos y la masa de residuos sólidos urbanos, además de un indicador de calidad de la eliminación final de desechos, el desarrollo humano municipal y los índices de Gini, el ingreso mensual per cápita y el porcentaje de población vulnerable a la pobreza. Los factores potencialmente asociados con los resultados –incidencia municipal de dengue, zika y chikunguña– se seleccionaron inicialmente mediante un análisis univariado, seguido de un análisis de regresión lineal para la incidencia del dengue, zika o chikunguña utilizando los predictores seleccionados mediante el análisis univariado. Resultados. El manejo de residuos sólidos no se asoció con la incidencia de zika o chikungunya. A su vez, la incidencia del dengue se asoció con un manejo sólido y tuvo una asociación inversa significativa con el porcentaje de población vulnerable a la pobreza. También se observó una asociación directa con el índice de Gini, lo que sugiere que cuanto mayor sea la incidencia del dengue entre 2007 y 2016, mayor será el coeficiente de Gini municipal y, por lo tanto, la desigualdad social. La recolección selectiva de residuos se correlacionó de manera significativa e inversa con los casos de dengue, lo que sugiere que cuanto menor sea la cobertura de la recolección regular selectiva de residuos, mayor será el número de casos de dengue. Conclusiones. La gestión de los residuos sólidos puede influir en la aparición de casos de dengue y, por lo tanto, debe considerarse en la planificación de las medidas de salud pública.

Abstract Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

Abstract This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.

RESUMO A destinação dos resíduos de serviços de saúde (RSS) representa uma discussão ampla e polêmica, e o momento de revisão da resolução da diretoria colegiada n.º 306/2004, da Agência Nacional de Vigilância Sanitária (ANVISA), é oportuno para ampliar esse debate. Nesse contexto, este artigo buscou, por meio da revisão de publicações científicas, subsidiar escolhas que favoreçam a sustentabilidade ambiental e a proteção da saúde humana na destinação dos RSS. Foram realizadas pesquisa bibliográfica, em âmbitos nacional e internacional, e a revisão de instrumentos legais que regulam a destinação dos RSS no Brasil. As resoluções da ANVISA (n.º 306/2004) e do Conselho Nacional do Meio Ambiente (n.º 358/2005) mostram que a disposição final dos RSS do subgrupo A4 pode ser feita em local licenciado para receber RSS, sem tratamento prévio. Diversas publicações científicas apontam para a falta de evidências quanto à existência de riscos aumentados para o ambiente e à saúde humana dos RSS se comparados aos resíduos sólidos domiciliares e explicam que ambos poderiam ter destinação final com base nos mesmos requisitos. A segregação dos RSS de acordo com os riscos reais de cada grupo e no momento da geração, assim como o acondicionamento como barreira de proteção, é o procedimento mais seguro de gerenciamento de risco contra contaminações e acidentes, sobrepondo-se aos requisitos para a destinação final. A exigência de tratar previamente os resíduos do subgrupo A4 antes de serem aterrados, conforme defendem alguns, poderia resultar em desnecessária elevação dos custos do processo sem evidência de redução dos riscos envolvidos.

ABSTRACT The disposal of healthcare waste (HCW) is a controversial and wide discussion, and the review of the Collegiate Directorate Resolution no. 306/2004, from the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA), a Brazilian regulation, is appropriate to increase this debate. In this context, through the review of scientific publications, this paper supports choices that promote environmental sustainability and the protection of human health during the HCW disposal process. A bibliographical research including national and international levels and a review of legal instruments about HCW management in Brazil were done. The rules of ANVISA (no. 306/2004) and National Environment Council (no. 358/2005) point out that the final disposal of HCW, specially the subgroup A4, could be done in certified place to disposal HCW, without prior treatment. Several scientific papers mention the lack of evidences about increased risks of some kinds of HCW when compared to domestic waste, and these wastes may have final disposal based on the same criteria. Segregation of the HCW according to the real risks of each group at the moment of the generation of waste, as well as the packaging as a protective barrier, configures a safer risk management procedures against contamination and accidents. The requirement to treat the A4 subgroup before landfill disposal, as argue by some researchers, could represent an increase of unnecessary economical costs without evidences of risk reduction.

Resumo O contato humano com os resíduos implica riscos biológicos, químicos e físicos à saúde dos trabalhadores envolvidos com a coleta, o transporte e o armazenamento. O potencial de risco para a saúde humana decorrente do contato com os resíduos de saúde ou domiciliares ainda gera muita polêmica. Sendo assim, a proposta deste trabalho foi de identificar o contexto das discussões científicas sobre risco/infecção pelos vírus das hepatites B e C em trabalhadores que coletam resíduos de serviço de saúde ou domiciliares. As buscas abrangeram publicações até 2013 em bancos de dados nacionais e internacionais, sendo selecionados 11 artigos através de uma revisão da literatura, dos quais seis concluem que há maior risco de infecção nos trabalhadores que coletam resíduos domiciliares se comparados com os não expostos aos resíduos, três estudos apontam haver maiores riscos entre os profissionais que coletam os resíduos de saúde se comparados com aqueles que coletam os resíduos comuns, e outros dois concluem não haver diferenças entre expostos e não expostos.

Abstract Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.

Resumen El contacto humano con los residuos implica riesgos biológicos, químicos y físicos para la salud de los trabajadores que participan en su recogida, transporte y almacenamiento. El riesgo potencial para la salud humana, como resultado del contacto con los desechos médicos o del hogar, sigue generando mucha controversia. Por lo tanto, el propósito de este estudio fue identificar el contexto de las discusiones científicas sobre el riesgo/infección por el virus de la hepatitis B y C en los trabajadores de recolección de residuos de servicios de salud o del hogar. Fueron recogidos artículos publicados hasta 2013 en bancos de datos nacionales e internacionales; se seleccionaron 11 artículos a través de una revisión de la literatura, seis de los cuales concluyen que hay un mayor riesgo de infección entre los trabajadores que recogen la basura doméstica, en comparación con los no expuestos a los residuos, tres estudios sugieren que existe un mayor riesgo entre los profesionales que recogen los residuos médicos, en comparación con los que la recogida de residuos ordinarios, y otras dos concluyen que no había diferencias entre expuestos y no expuestos.

Resumo O contato humano com os resíduos implica riscos biológicos, químicos e físicos à saúde dos trabalhadores envolvidos com a coleta, o transporte e o armazenamento. O potencial de risco para a saúde humana decorrente do contato com os resíduos de saúde ou domiciliares ainda gera muita polêmica. Sendo assim, a proposta deste trabalho foi de identificar o contexto das discussões científicas sobre risco/infecção pelos vírus das hepatites B e C em trabalhadores que coletam resíduos de serviço de saúde ou domiciliares. As buscas abrangeram publicações até 2013 em bancos de dados nacionais e internacionais, sendo selecionados 11 artigos através de uma revisão da literatura, dos quais seis concluem que há maior risco de infecção nos trabalhadores que coletam resíduos domiciliares se comparados com os não expostos aos resíduos, três estudos apontam haver maiores riscos entre os profissionais que coletam os resíduos de saúde se comparados com aqueles que coletam os resíduos comuns, e outros dois concluem não haver diferenças entre expostos e não expostos.

Abstract Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.

Resumen El contacto humano con los residuos implica riesgos biológicos, químicos y físicos para la salud de los trabajadores que participan en su recogida, transporte y almacenamiento. El riesgo potencial para la salud humana, como resultado del contacto con los desechos médicos o del hogar, sigue generando mucha controversia. Por lo tanto, el propósito de este estudio fue identificar el contexto de las discusiones científicas sobre el riesgo/infección por el virus de la hepatitis B y C en los trabajadores de recolección de residuos de servicios de salud o del hogar. Fueron recogidos artículos publicados hasta 2013 en bancos de datos nacionales e internacionales; se seleccionaron 11 artículos a través de una revisión de la literatura, seis de los cuales concluyen que hay un mayor riesgo de infección entre los trabajadores que recogen la basura doméstica, en comparación con los no expuestos a los residuos, tres estudios sugieren que existe un mayor riesgo entre los profesionales que recogen los residuos médicos, en comparación con los que la recogida de residuos ordinarios, y otras dos concluyen que no había diferencias entre expuestos y no expuestos.

A necessidade de aplicarmos as diretrizes ambientais no contexto produtivo de qualquer empresa é hoje uma realidade no cenário mundial. O beneficiamento e a comercialização de resíduos, em diversos seguimentos industriais, têm levado as organizações a uma nova ideologia sobre a questão do gerenciamento desses materiais, sendo que a geração de receita, através da reciclagem, tem contribuído para a expansão dessa prática. Carepa é um co-produto oriundo da oxidação da superfície do aço, quando submetido ao gradiente térmico ou à simples ação do tempo. No ramo siderúrgico, provém, basicamente, das operações de lingotamento contínuo e laminação. Carepas são óxidos de ferro, cuja disposição, em pátios de resíduos deve ser realizada, seguindo-se as normas ambientais pertinentes, visto que podem ser classificados como resíduos perigosos (Classe I, NBR 10004:2004). Entretanto há poucos estudos no sentido de se viabilizar sua reciclagem, agregando valor ao co-produto em questão. Nesse sentido, operações unitárias de secagem, peneiramento e briquetagem foram adotadas no processamento desse material. Caracterizações físicas e químicas permitiram investigar suas propriedades e potencialidades industriais, de forma a adequar os parâmetros ambientais, econômicos e produtivos às necessidades das empresas.

The concern to apply environmental rules within the productive context of any company is actually a reality in the worldwide scene. Waste improvement and commercialization in many industrial deals have led organizations to a new ideology about the managing of this material, where the increase of income generated by its recycling has much contributed to the expansion of this practice. Scale is a by-product, which arises from oxidation of the steel surface when it is submitted to a thermal gradient or simply to the action of time. In the metallurgical field, it basically derives from the operations of continuous casting and rolling. Scale are iron oxides whose disposal at wastes yards must be carried out following the pertinent environmental laws, since they can be classified as dangerous wastes (Class I, NBR 10004:2004). However, there are few studies towards its improvement so as to enhance the worth of the by-product in reference. In this context, drying, sieving and briquetting unit operations were employed on the material processing. Physical and chemical characterizations enabled investigation of their properties and prospective industrial applications, aiming to adapt the environmental, economical and processing parameters to the companies' requirements.